The Trouble with Biological Insurance

Jennie Haw questions the marketing of private cord blood banking as Biological InsuranceTM

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The Cord Blood Bank of Canada, one of 9 private, for-profit cord blood banks in the country, advertises cord blood stem cells as Biological InsuranceTM. The bank targets prospective parents and suggests to them that paying to collect cord blood at birth and bank cord blood stem cells is a way to ensure their child’s future health by having blood stem cells available for treatment should they be needed. This marketing strategy suggests that parents would be responsible and prudent to bank cord blood privately, that is, to purchase biological insurance.

The idea of privately banked cord blood stem cells as biological insurance is at best, limited and, at worst, misleading (here). It is nonetheless effective. Most Canadians are very familiar with insurance. From auto and home insurance to life and employment insurance, most have purchased and perhaps benefited from having insurance. In principle, these financial forms of insurance protect people from the economic burden resulting from unexpected and uncontrollable negative events, such as auto accidents or unemployment, by pooling or spreading individual risk across a population. For example, auto insurance protects a person from the costs resulting from a car accident. Each individual car owner is at some risk for being in an accident and these individual risks are pooled by the auto insurance company and shared across a group (i.e. other insurance holders) such that if a person is in an auto accident s/he is protected from the financial cost of the accident.

Taejo's Umbilical Cord Tomb

Taejo’s Umbilical Cord Tomb

Unlike financial types of insurance, biological insurance of the type promoted by private banks does not protect people by sharing individual risk across a population. Instead, women and couples are encouraged to keep their child’s umbilical cord blood for their child’s and family’s potential future use if they have a disease that can be treated with the stored blood stem cells. Instead of pooling risk, this type of biological insurance operates by placing greater responsibility on individuals to manage future harm.

Many clinical organizations, including the Society of Obstetricians and Gynecologists of Canada, do not recommend private cord blood stem cell banking unless there is clinical evidence that the newborn (or a sibling) is at risk of having a disease that can be treated with blood stem cells (here). Otherwise, the very low probability that one’s own cord blood stem cells will be used for one’s own treatment is reason to avoid banking cord blood stem cells in a private bank. Private banks, however, market to all prospective parents regardless of whether they have or are expecting a child with increased clinical risk for a disease that could be treated with blood stem cells.

An argument can be made, however, that, like other forms of insurance, not having to use one’s biological insurance is a good thing. Many people buy travel insurance in case they require medical care while traveling in a different country; however, if they do not use it because they remain healthy during their trip this is generally thought of as fortunate. Similar reasoning applies with car insurance, private health insurance, dental insurance, and trip cancellation insurance. Likewise, proponents of private cord blood stem cell banking might argue that if the banked cord blood is never used this is not to be seen as a problem. If the biological insurance is not used, presumably one’s child has not been diagnosed with any of the conditions treatable by cord blood stem cells. This may not be the case, however. In some instances, banked cord blood stem cells might not have been used because they were clinically useless.

Consider the case of a woman who privately banked cord blood stem cells because she feared for her child’s future health. When her child was diagnosed with leukemia she thought the moment had come for her to use her biological insurance. To her great dismay, the oncologist told her that the cord blood stem cells were of no potential therapeutic value because the banked stem cells would carry the genetic predisposition to leukemia. With childhood leukemia, a blood stem cell transplant from a different, unaffected person is needed. As such, the biological insurance purchased for the child was useless. This is a second key difference between biological insurance of the type marketed by private cord blood banks and financial types of insurance: there is no guarantee that this biological insurance will be usable when it is needed.

When privately banked cord blood stem cells are needed, they may be clinically useless for a number of reasons including the complexity of the medical condition, the size of the child, and the amount of the blood stem cells banked. For example, currently, the amount of blood stem cells banked is enough to treat someone approximately 110 lbs. or lighter. Expansion techniques aimed at increasing the number of blood stem cells banked are currently being studied, however, none of these techniques are beyond the experimental stage.

Marketing private cord blood stem cell banking as biological insurance, and suggesting to parents that they are purchasing insurance for their child’s future health, is misleading. There is no guarantee that this insurance will do what it promises when, or if, it is needed.

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Jennie Haw is a PhD Candidate in the Department of Sociology at York University, Toronto, Canada.

To read more about this issue, see Jennie Haw Canada’s National Public Cord Blood Bank Opens Its Doors

One comment

  1. Robyn MacQuarrie · · Reply

    In her piece “The Trouble with Biological Insurance”, Jennie Haw exposes several flaws of the marketing of private cord blood banking as a form of insurance. I applaud her effort to address this important issue, and would suggest that the many physicians, midwives and nurse practitioners who deliver care to pregnant women take a moment to familiarize themselves with this issue, and the ways in which they may influence the decisions their patients make.

    Many of these cord blood banks have created and distributed promotional materials which often populates the waiting rooms, clinic rooms and penholders in prenatal clinics. Few physicians give these promotional materials much thought, and see the provision of these materials as “informing their patients”. However, not all care providers are appropriately educated on the value of banked stem cells for autologous use, and often approach the issue as likely to do no harm if the patient can afford it. What is worrisome about this practice is the potential effect of simply having this promotional material available. Patients may perceive their care provider to be in support or recommending this practice simply by having the pamphlets available. While care providers are becoming increasingly cognizant of the ethical quandary promotional materials from pharmaceutical companies create, they often do not recognize these ancillary services as equally problematic. This creates a conflict of interest, as the SOGC does not recommend private cord blood banking with the exception of a few clinical scenarios. Additionally, often these private cord banks compensate physicians for collecting the cord blood (fifty dollars or more for thirty seconds of “work”), which further complicates the conflict of interest.

    While the SOGC only supports private cord banking in very select scenarios, it does recommend that altruistic donation of cord blood for public banking be encouraged when cord blood banking is being considered. Until recently, this was a challenge as there was no national program available to donate to. With the opening of the National Public Cord Blood Bank, this option now becomes available to a greater number of Canadians.

    I would strongly encourage Canadian maternity service providers to educate themselves around this issue, recognize the power of the presence of promotional materials from for profit private banks, and educate their patients on the value of public banking.

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