Is self-storage of umbilical cord blood an "IQ tax" or a new path? [Sales staff are promoting storage at their own expense, and there are chaos such as exaggerated publicity and crowding out donation channels; experts say that it should be advocated to store umbilical cord blood in public banks]
Regarding the storage of umbilical cord blood out of her own pocket, Ye Qiu, a pregnant woman, still feels that she has paid an "intelligence quotient tax".
On July 7, while Ye Qiu was waiting for a maternity checkup at a hospital in Guangzhou, a woman in a "white coat" advertised to pregnant women the necessity of self-storing cord blood: it can treat more than 80 kinds of intractable diseases such as leukemia. It is a once-in-a-lifetime opportunity. The contained hematopoietic stem cells can be used by three generations of the family. After storage, they will receive medical insurance worth 1.025 million yuan every year.
Ye Qiu was persuaded and paid on the spot to purchase an 18-year cord blood storage service.
Umbilical cord blood refers to the blood collected from the umbilical vein after the fetus is delivered and the umbilical cord is cut off.
Cord blood storage at own expense has become a hot "business".
A number of pregnant women told the Beijing News reporter that when they were doing maternity examinations in the hospital, they would encounter salesmen in white coats who would sell cord blood storage services through various channels.
In fact, although umbilical cord blood hematopoietic stem cells have certain application value, there are considerable standards for collection and storage.
At present, most of the various institutions on the market have the problem of exaggerated propaganda.
In addition, due to the strict restrictions imposed by the state, many institutions that claim to be able to store umbilical cord blood do not have relevant qualifications themselves.
Due to performance orientation, sales staff crowd the donation channel, leaving pregnant women who really want to donate cord blood "no way to go".
Mao Qun'an, director of the Department of Planning, Development and Informatization of the National Health Commission, once said in an interview with the media that the organizer of the cord blood bank should objectively introduce the clinical role of cord blood, and under the premise of fully guaranteeing the right to know and the right to choose, pregnant women should be independent. Choose to store or donate cord blood.
It is also understood that the National Cord Blood Bank is under active preparation.
As a national-level public welfare cord blood bank, it is conducive to giving full play to the role of existing resources and providing corresponding support for clinical and scientific research.
Salespeople put on "white coats"
This was the first time Ye Qiu knew about umbilical cord blood.
When the woman in the "white coat" in front of her handed out the brochure, Ye Qiu thought she was a nurse in the hospital.
The "white coat" told Ye Qiu that the umbilical cord blood was the blood left in the umbilical cord after the child was born, "it can give the child a second life at a critical moment".
The other party repeatedly mentioned that leukemia, aplastic anemia, mucopolysaccharidosis, neuroblastoma and other sudden diseases commonly seen in children can be cured by umbilical cord blood.
In the words of the "white coat", as long as you spend 10,000 yuan to buy a service for self-storage of umbilical cord blood, you can enjoy the treatment of three generations, and even treat Alzheimer's disease in the elderly.
Although he was a little worried, Ye Qiu paid 19,800 yuan on the spot and received a cord blood collection kit with the attitude of "seeking peace of mind".
Only wait until the day of delivery to collect and store cord blood.
Ye Qiu's experience is not an isolated case.
Mao Yu, a pregnant woman, is a medical staff member with ten years of work experience. Since her husband was a leukemia patient, Mao Yu took the attitude of "insurance" when purchasing cord blood storage services.
Experts say otherwise about the many "functions" of cord blood claimed by the above salespeople.
Zhang Yongqing, deputy director of the Hematology Department of the 309th Hospital of the People's Liberation Army, once analyzed in an interview with the media that umbilical cord blood is not a cure for all diseases, and most of it is useful to others.
The functions of the cord blood bank and the bone marrow bank complement each other. When the patient cannot find the matching bone marrow stem cells, they can find the matching cord blood stem cells.
After returning home, Ye Qiu searched and found that the "white coat" was not a medical staff, but a salesperson of the cord blood self-storage service.
Before signing the contract, the sales staff never mentioned the probability, storage conditions and location of the use of self-saved umbilical cord blood.
Shi Xiaodong, chief physician of the Department of Hematology and Oncology of the Capital Institute of Pediatrics, believes that "the probability of using umbilical cord blood stem cells for autologous transplantation is very low." Taking the most frequent leukemia mentioned by sales staff as an example, the umbilical cord blood may already have mutated genes. , so it's actually hard to use.
A report released by the American Society for Blood and Marrow Transplantation (ASBMT) in 2008 also showed that the probability of using cord blood stored in an autologous bank at one’s own expense was about 0.04% to 0.0005%.
The issue of the "shelf life" of cord blood is also worthy of attention.
The preservation of umbilical cord blood has strict conditions. It needs to be stored in liquid nitrogen at minus 196 ℃, and the liquid nitrogen needs to be replaced every two weeks.
Zhang Yongqing explained that umbilical cord blood is rich in hematopoietic stem cells and can be stored in liquid nitrogen at minus 196°C for 50 years in theory.
But over time, the number of stem cells also decays.
And whether the umbilical cord blood stored at his own expense can be well stored is the most worrying issue for Mao Yu.
In the electronic contract signed by Ye Qiu, the cell activity is stipulated as follows: "The umbilical cord blood hematopoietic stem cells can theoretically be stored for a long time within the validity period of the agreement stipulated in this agreement, or even for a long period of time after the validity period of the agreement expires. At the same time, due to There is not enough time in medicine to confirm the shelf life of umbilical cord blood hematopoietic stem cells that do not lose activity, so no professional organization can guarantee that umbilical cord blood hematopoietic stem cells will not lose activity permanently after cryopreservation."
A reporter from the Beijing News found that most pregnant women who choose to store their umbilical cord blood do not know the conditions and probability of using umbilical cord blood.
When the sales staff explained, in addition to publicizing the scope of treatment and the effect of treatment, they also used the anxiety of pregnant women to use a lot of words such as "responsible for the child" and "not sorry for the child".
The qualification of the cord blood bank is "beautiful and charming"
The Beijing News reporter learned that at present, the only legal cord blood banks approved in China are seven cord blood hematopoietic stem cell banks in Beijing, Tianjin, Shanghai, Zhejiang, Shandong, Guangdong and Sichuan.
In addition, each province and city can only establish one cord blood bank, and cord blood cannot be collected in other places.
Therefore, for pregnant women, it is not only necessary to "break through" in the words of sales staff, but also to have the ability to distinguish the qualifications of storage institutions.
In June of this year, when Huihui, a mother in Henan, tried to store umbilical cord blood, she found that the "cord blood bank" mentioned by the salesperson was actually the "blood bank" of a biotechnology company in Zhengzhou.
A reporter from the Beijing News consulted the above-mentioned biotechnology company as a pregnant woman. A sales consultant sent the "Blood Station License" of Shandong Cord Blood Bank, claiming that the company "is one with Shandong Cord Blood Bank".
According to public information, Shandong Cord Blood Bank was jointly established by Qilu Hospital of Shandong University and Shandong Qilu Stem Cell Engineering Co., Ltd. (referred to as Qilu Stem Cell Company). Construction began in 1993 and was approved by the former Ministry of Health in 2001. In 2008, it was approved by Shandong Province. Practice acceptance by the competent health administrative department.
The management and operator of Shandong Cord Blood Bank is Qilu Stem Cell Company.
According to industrial and commercial information, the major shareholder of Qilu Stem Cell Company is Nanjing Xinjiekou Department Store Co., Ltd.
And Nanjing Xinjiekou Department Store Co., Ltd., the biological company that signed the contract with Hehuihui, has the same shareholder.
Does this mean that the "license" of the cord blood bank can be loaned out?
A reporter from the Beijing News consulted Shandong Cord Blood Bank on this basis. A technical person in charge said, "Shandong Cord Blood Bank is operated strictly in accordance with the requirements of the Shandong Provincial Health and Health Commission. We don't know much about this company, but we will never put " The Blood Bank Practice License is authorized to other companies, and the collection of umbilical cord blood from Shandong Cord Blood Bank can only be carried out in Shandong Province.”
The "Measures for the Administration of Blood Stations" stipulates that blood stations are divided into general blood stations and special blood stations.
Special blood banks include umbilical cord blood hematopoietic stem cell banks and other types of blood banks approved and established by the National Health Commission according to the needs of medical development. Without the "Blood Bank Practice License", they shall not carry out the business of collecting and supplying umbilical cord blood hematopoietic stem cells.
In other words, the above-mentioned biotechnology company located in Henan is unlikely to obtain the qualifications for the storage and supply of cord blood.
Regarding the qualification of umbilical cord blood storage, many places have also issued documents to regulate it.
In 2009, the Shandong provincial health administrative department issued a notice requiring "resolutely investigating and punishing medical institutions that collect and provide umbilical cord blood for non-scientific research purposes for institutions in other provinces and in this province that have not obtained a "Blood Station Practice License"."
In July 2013, the Shandong provincial health administrative department once again issued Document No. 89 on the specification of umbilical cord blood collection work. The cord blood hematopoietic stem cell bank collects and provides cord blood.
In 2011, the Jiangsu provincial health administrative department made it clear that no institution in the province was allowed to open a cord blood hematopoietic stem cell bank, and required medical institutions not to collect cord blood.
The Beijing News reporter's investigation found that in addition to the provinces where the seven cord blood banks approved by the former Ministry of Health and the provincial health administrative departments are located, there are also institutions that claim to be able to collect and store cord blood in other provinces.
A 2021 judgment from the Shenyang Heping District People's Court on China Judgment Documents Online showed that a pregnant woman had already signed a contract with a biotech company for cord blood storage services at her own expense.
The staff of another biotechnology company took the pregnant woman's umbilical cord blood without permission in the delivery room.
There are still many risks when pregnant women want to use umbilical cord blood after spending money.
In April 2022, the National Health Commission's Medical Reform and Hospital Administration issued the "National Restricted Technology Catalog and Clinical Application Management Specifications (2022 Edition)", in which the "Allogeneic Hematopoietic Stem Cell Transplantation Technology Clinical Application Management Specification" The source of hematopoietic stem cells must be legal, the unrelated bone marrow hematopoietic stem cells should be provided by the China Marrow Bank, and the cord blood hematopoietic stem cells should be provided by the cord blood hematopoietic stem cell bank approved by the National Health Commission.
Shi Xiaodong told the Beijing News reporter that doctors will not use umbilical cord blood sources other than the national public bank in clinical treatment, and to perform hematopoietic stem cell transplants, both hospitals and doctors need corresponding qualifications.
That is to say, any type of stem cells stored in any other informal stem cell bank will not be able to obtain legal use in clinical hospitals in case it is needed.
Behind the "hot" self-sustaining and "cold" donations
Some pregnant women told the Beijing News reporter that sales staff spared no effort in promoting self-storage cord blood, and seldom took the initiative to inform that cord blood can still be donated.
When some pregnant women want to donate their umbilical cord blood, they find that "it's not that easy".
In 1999, the "Administrative Measures for Umbilical Cord Blood Hematopoietic Stem Cells (Trial)", in addition to stipulating the establishment of examination and approval, practice licenses, etc., also clarified that applicants for the establishment of umbilical cord blood hematopoietic stem cell banks need to have "multiple channels to raise construction funds to operate funds". Ability".
Therefore, from the very beginning of its establishment, the domestic cord blood hematopoietic stem cell bank has implemented the policy of "coexisting with the public and self-supporting the public", that is, it has the dual functions of "public bank" and "autologous bank".
To put it simply, the public bank accepts umbilical cord blood donated by puerperae for free, for matching use by patients in need in the whole society; the autologous bank provides paid cord blood storage services.
On the whole, it is to use the income from the operation of the own library to undertake the public welfare construction and social services of the public library.
Shi Xiaodong told the Beijing News reporter that the larger the amount of data in the public database, the greater the possibility of finding a suitable match for the patient.
As a source of hematopoietic stem cells, compared with bone marrow and peripheral blood, umbilical cord blood is more convenient to collect, less risk to donors, and easier to match.
The low risk and severity of graft-versus-host disease is an important measure of the success of the transplant.
At the same time, cord blood is stored in kind, and after collection, it will be sent to the cord blood bank.
As long as the matching is successful, it can be used quickly, and there is no temporary "donation regret" like in the bone marrow matching.
Since becoming pregnant, Mingya has decided to donate cord blood.
In July this year, on the day Mingya filled out the donation application on the official website of the Beijing Cord Blood Bank, a staff member who claimed to be the Beijing Cord Blood Bank added to WeChat.
The staff member sent a series of small videos and screenshots of the benefits of storing cord blood at their own expense.
"The picture is not high resolution and there is no complete PDF file."
After Mingya made clear her donation intention to the other party again, the above-mentioned "staff" asked him to meet and chat after the obstetric examination.
But in the 20-minute communication, the other party never mentioned the donation details.
Relevant personnel of Beijing Cord Blood Bank told Mingya in the follow-up return visit that this staff member was actually a salesperson and had fixed sales tasks every month, so there might be a situation where communication was not in place.
A reporter from the Beijing News consulted the Beijing Cord Blood Bank as a pregnant woman. A customer service staff said that the storage and donation are handled by the sales consultants dispatched by the cord blood bank in various hospitals.
The conditions for donation are that the pregnant woman is more than 34 weeks old, the fetus is single, the indicators of the obstetric examination are normal, and the giant cell test needs to be done at their own expense, and the partner of the pregnant woman needs to have five liver function tests.
Many pregnant women from Sichuan, Tianjin and other places told reporters from the Beijing News that they originally wanted to donate umbilical cord blood, but in the end most of them gave up because they could not find a clear donation channel.
A reporter from the Beijing News contacted umbilical cord blood sales consultants in several provinces as a pregnant woman and found that sales representatives generally do not mention donations unless they take the initiative to mention it.
Even if you ask for donation, the other party will still persuade you to save your cord blood.
Why do salespeople go so far as to recommend self-saved cord blood?
A cord blood salesperson in Liaoning told the Beijing News reporter that he has to complete at least 3 sales tasks every month, and the commission for each order is 800 yuan.
As for the relevant knowledge of umbilical cord blood, the salesperson said that the company does not have relevant training and relies on self-study.
As for whether the deal can be concluded in the end, "it depends on your ability to persuade pregnant women."
Professor Sui Suli from the School of Humanities and Social Sciences of Peking Union Medical College pointed out in a study in 2014 that the autologous libraries in Beijing, Guangdong and other places are much larger than the public libraries in terms of storage, but far less than the number of applications. public library.
The self-owned bank has economic benefits, but the social benefit is lower than that of the public bank.
The involvement of social and private capital has made the domestic cord blood bank develop rapidly, but at the same time it has also brought the hidden worry of shrinking public cord blood bank.
The "public retreat and private entry" of cord blood banks does not only appear in China.
According to the public information of the global bone marrow donor registry, as of December 2016, nearly 710,000 cord blood were stored in more than 160 public cord blood banks around the world, about 4 million in private banks, and 35,000 cord blood hematopoietic stem cell transplants worldwide. For example; although private banks store more cord blood, the number of clinical hematopoietic stem cell transplants provided by public banks is more than 30 times that of private banks.
Although the "Administrative Measures for Umbilical Cord Blood Hematopoietic Stem Cell Banks" implemented in 1999 stipulates: "No unit or individual shall conduct umbilical cord blood collection and supply activities for profit." However, a person in charge of the Medical Affairs Office of the Shanghai Municipal Health Bureau once interviewed As for the definition of non-profit, there is no set of systematic supervision measures, so it is difficult to define whether the cord blood bank is operating for profit or not.
Explore "Deposit and Donation Mutual Benefit"
As an expert in preparing to build China's first cord blood bank, Tong Chunrong, vice president of Beijing Lu Daopei Hospital, also emphasized in an interview that cord blood is useful, but it cannot be exaggerated.
For cord blood to be widely available, the premise should be public.
Shi Xiaodong also said that capital is profit-seeking, emphasizing that self-storage of umbilical cord blood itself has a commercial purpose.
Cord blood information stored in autologous banks is not available to public banks.
What should really be advocated is the deposit of cord blood in public banks.
Professor Qiu Lugui, the former head of the Tianjin Public Cord Blood Bank, pointed out that although the umbilical cord blood in the public bank is donated by mothers for free, it is very expensive to process.
Since the state did not allocate special funds to the public cord blood bank at the beginning of its establishment, it is basically invested by enterprises or local governments, so the cord blood bank needs continuous investment in order to develop.
It is estimated that building a cord blood bank with 10,000 specimens will require an investment of hundreds of millions of yuan.
And even if the inventory is no longer added, it needs to continue to invest in capital maintenance.
In this regard, Shanghai Cord Blood Bank has pioneered the storage plan of "mutual benefit of deposit and donation".
According to the plan, pregnant women can choose to voluntarily include the testing information of self-storage umbilical blood samples into the public database when they sign a contract for self-storage cord blood to provide the public with matching search services. Once the matching is successful and consent is obtained, ready for clinical transplantation.
For those who choose to donate umbilical cord blood hematopoietic stem cells to other patients, the cord blood bank will refund all the fees paid by the depositor in the early stage, and will enjoy the right to query the matching data for free in the bank for life.
If you or your immediate family members need to use umbilical cord blood for clinical treatment, if objective conditions permit, they will be provided with one piece of umbilical cord blood that meets clinical requirements for free. If objective conditions do not allow, the blood bank will also provide some humanitarian Rescue.
Shi Xiaodong believes that the innovative model of Shanghai Cord Blood Bank can not only ensure supervision, but also operate reasonably, and can carry out benign development. "Without investment, who will be the public bank? If the storage volume is too small, clinical application cannot be guaranteed. ."
Professor Sui Suli believes that, first of all, we can adjust the storage ratio of autologous and public libraries to encourage the development of public libraries.
The state can invest a certain amount of funds in the public bank to maintain its basic operations, and at the same time, it can also make appropriate incentives for the public bank to store donated cord blood, and encourage more people to join donations, so that the utilization rate of cord blood and the success rate of matching Higher, improving the social significance of cord blood banking.
Regarding the future development of the cord blood bank, in 2016, the former National Health and Family Planning Commission mentioned in its reply to the suggestion of the Fourth Session of the Twelfth National People's Congress that in order to give better play to the public welfare of the cord blood bank, it is actively preparing for the establishment of a national cord blood bank. As a national public welfare cord blood bank, the bank is conducive to giving full play to the role of existing resources and providing corresponding support for clinical and scientific research.
In addition, the former National Health and Family Planning Commission mentioned that it will further improve the management norms and technical standard system of cord blood banks, and guide all localities to strengthen the supervision and management of cord blood banks, cord blood stem cell collection and clinical application; Improve the operating mechanism, improve the efficiency of public services, strictly implement the charging items and standards approved by the price department, and shall not charge illegally; shall not collect cord blood stem cells across regions and ranges, and shall not publish advertisements in violation of regulations and exaggerate the effects of cord blood stem cell therapy.
At present, Mao Yu's husband's leukemia has been cured through chemotherapy, and there is no need to consider transplantation.
Regarding the storage of umbilical cord blood, Mao Yu also hopes to have a national-level cord blood bank, which is more secure than those operated by the company, and should expand the popularization of umbilical cord blood donation, "This is a good thing for patients who need transplants. "
(Ye Qiu, Mao Yu, Hui Hui, and Ming Ya are all pseudonyms)
Beijing News reporter Li Cong