To the Editor: Samuel and colleagues’ article on the ethics of umbilical cord blood (UCB) banking1 reflects much of the misinformation and bias that bedevil this debate. They argue against storage of autologous stem cells from UCB for a variety of contradictory, paternalistic or ideologically driven reasons.

The indication for autologous UCB storage is in anticipation of developments in regenerative medicine, an exciting field that holds great promise; it is not in anticipation of transplantation for malignancy, which is unlikely to occur. Samuel et al acknowledge these points, yet base their criticism of autologous storage on the latter indication.

Next, they state that autologous stem cells can be easily harvested at any time in life. Perhaps, for use in transplantation; but cells obtained later in life are likely to be of little use in regenerative medicine. Capacity for in-vitro manipulation declines with age.

Third, they argue that the two alternatives of public and private UCB storage are mutually incompatible — “public good or private benefit” (my emphasis). Australia’s three public banks are close to achieving the desired number of cords (about 20 000) needed for transplantation medicine in the non-Indigenous population.2 There is no shortage, and certainly no shortage of potential donors. Why argue against autologous storage as if there is?

Fourth, the authors disapprove of the for-profit motive in private-sector medicine. That may be their ideological position, but it is paternalistic to impose that view on the rest of us. Can parents not make up their own minds on the value of autologous storage? At $2000 upfront and $150 a year, storage is not so expensive that “only a small proportion of the population are able to afford [it]”. I remind readers of media reports that the Australian Government’s Baby Bonus (now $5000) was often used to purchase luxury items such as flat-screen televisions rather than being spent on the baby’s needs.3

The authors are correct in one respect: some (but not all) private UCB banks have been deliberately deceptive and misleading in their marketing, and, in so doing, have been predatory and exploitative. However, it does not then follow that parents cannot access sound and sober health advice in the marketplace.

The public versus private UCB storage debate does have an ethical dimension, but not this one. This debate is really just a turf war.

In reply: Roberts asserts that we are biased, paternalistic and driven by an ideological objection to private umbilical cord blood (UCB) storage. While this is impressive rhetoric, it bears little resemblance to the points made in our article.1

Contrary to Roberts’ assertion, we do not object to private UCB storage. Our primary concern is that marketing campaigns make misleading or grandiose claims about the possible application of privately stored UCB in cancer care and regenerative medicine. For, although stem cell research does have great promise, it remains clinically unproven in the management of degenerative conditions. Offering hope of cure or amelioration of illness based on scientific speculation is enormously problematic, especially when directed at vulnerable parents concerned about their unborn child. While some private UCB banks take great care to avoid deliberate deception, many do not.2,3 We agree that parents should be able to decide for themselves how and if to store their child’s UCB, but they need accurate information to do so.

Finally, Roberts asserts that there is no shortage of public UCB units or donors. In reality, there is a vast shortage of UCB units available to ethnic minority and Indigenous patients.4 North Caucasian donation also needs to be maintained, particularly as the impact of double-cord transplantation becomes apparent.4