'Peddling promise? An analysis of private umbilical cord blood banking company websites in Canada' by Alessandro R. Marcon, Blake Murdoch & Timothy Caulfield in (2021) Cell and Tissue Banking comments
Private umbilical cord blood banking is growing around the world. A family’s decision to bank cord blood publicly or privately can be influenced by numerous sources including healthcare practitioners, personal networks, the popular press, social media and marketing discourse from private entities. Issues have been raised concerning how private banks market their services, particularly with regards to the likelihood of use and for what purposes cord blood can be used. The objective of this study was to analyze the marketing on the seven company websites offering private cord blood storage in Canada. We performed a mix of content and general qualitative analysis on the seven websites. Our analysis shows substantial hype around cord blood uses, amplifying the promise of speculative uses and distorting the likelihood of use. Findings show that this promotional messaging often deploys communication strategies which draw on testimonials and emotionally-charged narratives. Questions should be asked about whether the promissory aspects of these websites constitute breaches of Canadian law or regulation. Careful monitoring of the private cord blood space is important for ensuring that the Canadian public is adequately and accurately informed of the services being offered.
The authors argue
Umbilical cord blood banking has grown significantly over the past two decades. The option was first made available in the 1990s following the discovery that cord blood is a rich source of stem cells (Kurtzberg 2017). These stem cells can now be used to treat blood and immune system disorders, and also in research on novel therapies not yet ready for clinical application (Allan 2020; W. T. Shearer et al. 2017). Unlike the United Kingdom, which has had an operational public banking program since 1996 (Haw 2016), and even though Quebec established a functioning provincial system in 2004, it was not until 2013 that Canada developed a national public banking program (Haw 2016; Héma-Québec 2012; NHS, access 2020). Private cord blood banks began offering storage in Canada as early as 1996 (Haw 2016) and have expanded significantly since. The current global market is projected to be worth $23 billion by 2025 (Global News Wire 2019).
Public banking is overseen by government agencies, free of cost for the donor, and the collected materials are used to treat other patients or for research. Collecting as much cord blood as possible from a wide variety of ethnic groups is important to ensure opportunities for Canada’s ethnically diverse population. Private banking is for-profit, and stores cord blood for clients until retrieval is requested. Individuals generally pay an initial fee (approximately $1000 CAD), which covers registration and collection, followed by a yearly storage fee (approximately $125). There are currently seven private banking companies marketing in Canada (Parent’s Guide to Cord Blood 2020). Since both public and private institutions are interested in obtaining cord blood, Canadian parents are tasked with obtaining accurate, up-to-date information about whether and where to donate or store the cord blood following childbirth.
Decisions to bank publicly or privately can be influenced by numerous sources including healthcare practitioners, personal networks, the popular press, social media and marketing discourse (Graham et al. 2016; Morgan et al. 2005; Peberdy et al. 2018; Soroka et al. 2013). Popular health websites such as www.babycenter.ca or www.webmd.com have pages dedicated to explaining the differences between public versus private banking (Private cord blood banking in Canada access 2020; Umbilical cord blood banking access 2020). Research has shown, however, the public’s awareness and knowledge of cord blood uses is lacking, and that information sources accessed by the public can be “varied, fragmented and inconsistent” (Peberdy et al. 2018). The differing and often opposing discourses produced by public and private institutions likely contribute to this confusion.
Tensions exist in Canada between private and public cord blood banking. In Canada, as well as abroad, policy statements and government discourse recommend public banking over private, except in cases where a family might benefit from cord blood use based on an established prior condition like, for example, a sibling with leukemia, sickle cell disease, Hodgkin’s lymphoma or thalassemia (MyHealth Alberta access 2020; Health Link BC access 2020; Health Canada 2019; Shearer et al. 2017). These recommendations have been made because the potential for autologous (for donor) or allogeneic (for others) use offered by private banking is extremely low–a point confirmed by usage data (Shearer et al. 2017). Private banking is also costly and can elude regulatory oversight, in turn impacting overall blood quality (Shearer et al. 2017). In contrast, public banks provide public health benefits and regulatory oversight, which helps to ensure effectiveness while minimizing risk (Mohammed and EL Sayed 2015; MyHealth Alberta access 2020; HealthLink BC, access 2020; Health Canada 2019). Provincial and federal governments have also stressed how private banks commonly oversell the potential for cord blood use, especially with regards to more speculative therapies where evidence to support clinical application is lacking (Mohammed and EL Sayed 2015; MyHealth Alberta access 2020; HealthLink BC, access 2020; Health Canada 2019).
Academic research investigating the public–private divide has described how public banks typically operate on a “regime of truth,” in contrast to private banks which typically operate on a “regime of promise” (Brown 2013; Martin et al. 2008). Here, private banks often apply the element of hope to their marketing discourse, upselling potential benefits, and thus playing into the “promissory” (Petersen and Krisjansen 2015) and “hyping” (T. Caulfield and Condit 2012; Master and Resnik 2013; Montague 2019) elements of the health sciences. Private banking has also been marketed as type of “biological insurance” for parents wanting to do whatever is possible for their children’s and family’s benefit (Brown 2013; Marcon et al. 2020; Martin et al. 2008; Weeks 2018). Indeed, a labeling shift has been observed with private banks now typically describing their services as “family banks” (Brown 2013; Martin et al. 2008; Weeks 2018). Further research documenting the procedures undertaken by women who stored blood privately in Canada found the process to be more complex and arduous than the women had expected (Haw 2016). Notably, a range of critical commentary also exists around public banking processes (Allan et al. 2016; Brown 2013; Isasi et al. 2013, 2018). In some contexts, critiques of drawing absolute distinctions between public and private banks have been raised, noting that similar marketing efforts are present in both (Beltrame 2020).
The banking of cord blood will likely continue to increase both publicly and privately. Indeed, recent research on the portrayal of cord blood in the North American popular press has found that the topics of public and private banking feature significantly (Marcon et al. 2020). This research also shows that while private banking was more commonly portrayed as problematic than beneficial, strong and potentially persuasive narrative messaging around private banking benefits was also present, which might impact a family’s decision (Caulfield et al. 2019; Marcon et al. 2020). The public is increasingly going online to access health information (Shearer and Gottfried 2017), and because both the public’s knowledge and awareness of cord blood uses is lacking and because private cord blood banks typically oversell the potential for cord blood use, it is vital to observe and analyze the information influencing cord blood banking decisions. This includes analyzing the online marketing of the private cord blood banks as these companies’ practices may elude regulatory oversight, particularly with regards to misleading the public around the probability of usefulness and the practical benefits of private cord blood banking. Indeed, these companies require accreditation to operate in Canada, and it is their responsibility to adhere to government mandated truth-in-advertising standards (Murdoch et al. 2020).
... The objective of this research was to analyze the marketing on the seven cord blood companies’ websites offering services in Canada. While research on the marketing of cord blood exists for other contexts or periods (i.e., Beltrame 2020; Brown 2013), there is no research for the current Canadian context. Given the concerns raised around private-banking marketing, we considered it valuable to analyze the manner in which the companies are marketing their services to the public. We sought to analyze specific characteristics and themes evident on the websites, and the degree to which websites promoted the growing future potential of stem cell use as a reason to store cord blood in a private bank.