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Response to A Brand New Life NST 18 March 2006

Response to A Brand New Life NST 18 March 2006
by Dr. Musa Mohd. Nordin

23rd March 2006
The Editor NST
Dear sir,

I read your headliner article with much interest (A Brand New Life; NST; 18th March 2006). It brings hope to many affected families. Christopher Reeves best known as Superman, a staunch supporter of embryonic stem cell research did not live long enough to witness any major breakthroughs in stem cell cures for his spinal paralysis.

Nonetheless, it is important that we do not lose perspective of the limitations of this new technology and thus send wrong messages and create false hopes to your readers. Private cord blood banks has hyped on similar anecdotes and isolated examples to go on an onslaught of emotional marketing of private collection and storage of umbilical cord blood.

As a member of the National Committee on Human Cloning and Stem Cell Research, we have deliberated these issues but have yet to make them public. For the former, draft laws are already in the Attorney-General’s chambers.

There is universal interest in discovering and developing a permanent source of cells which would be capable of generating any cell type and which would avoid the problem of transplant rejection. These cells called human stem cells have the unlimited capability to divide and the potential ability to develop into most of the specialized cells or tissues of the human body. Hence the potential to generate replacement cells and tissues to treat many conditions including Parkinson’s disease, Alzheimer’s disease, leukaemia, stroke, heart attack, diabetes, multiple sclerosis, rheumatoid arthritis and spinal cord injury.

The National Blood Bank has already been collecting and banking cord blood as part of their non-profitable National Cord Blood Bank. The National Cord Blood Bank would be available to doctors to search the public registry for possible unrelated but matched samples as an alternative source for stem cell transplantation.

The issue is clouded further by the sales pitching and often non-evidence based medicine claims of private cord banks. Undoubtedly, parents would be vulnerable to “emotional marketing” at the time of the birth of their child. Professor Nick Fisk, Chairman of the Royal College of Obstetrics & Gynaecology Scientific Advisory Committee said “We are concerned that commercial companies are targeting pregnant women with such emotive literature when the scientific evidence is not yet there to back up their claims”.

There are no accurate estimates on the likelihood of children requiring their own stored cord blood. The best guess of this ever happening ranges from 1 in 1,000 to 1 in 200,000. There is therefore only a tiny and remote chance of children ever requiring to utilize their own stored cells.

Scientific indications for collection and banking of cord blood are far and few in between. In families where there is a known genetic disease that can be treated by cord blood transplantation, cord blood collection and storage are recommended for siblings born into these families. Cord blood collection is also recommended in specific settings eg

1. A sibling who is suffering from leukemia, just in case he relapses and may require cord blood transplantation
2. A sibling in whom cord blood transplant is indicated but has no match related donor available.

The storing of cord blood privately by private cord banks is based on the premise that the sample is stored specifically for use within the family concerned and more specifically the child’s own future use (autologous transplant).

Autologous transplantation itself maybe problematic because the use of one’s own stem cells may not cure the underlying pathology. In the case of leukaemia and other congenital disorders eg thalassaemia and Fanconi’s anaemia; transplanting ones own stem cells with the defective genetic and immune structure (thus causing the disease) would only be returning the disease to oneself.

The 80-100ml of umbilical cord blood collected at birth may not be adequate when the baby grows into an adolescent or adult. The volume of cells is insufficient if he should ever require it later in life.

Thus, the concept of a ‘biological insurance’ which is much hyped by the private cord banks is therefore actuarially unsound given the very low estimates on the likelihood of use, or the need of using one’s own cord blood for transplantation. The emotional marketing is however burgeoning the bank balances of private cord banks.

In the final analysis, public cord blood banking should be expanded for the benefit of the wider population. Collection of altruistic donations of cord blood and directed donations for families at high risk should be encouraged. The National Cord Blood Bank was set up to achieve these objectives at no cost. Rather than just to keep the cord blood banked for one’s own use, it should be made available to others who may need the cord blood in the allogenic (genetically different) setting.

Dr. Musa Mohd. Nordin
Consultant Paediatrician & Neonatologist
musa@mpf.org.my
Damansara Specialist Hospital;
119 Jalan SS 20/10
Damansara Utama
Petaling Jaya 47400