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"There's always conflict of interest in things like that," says Dr. Gary Kleiner, assistant professor of clinical pediatrics at the University of Miami's Miller School of Medicine, who conducts research with umbilical cord blood. "For me, it would be against university policy. You can't be the investigator and have a financial interest."
Conflicts of interest, experts say, can make it difficult for a practitioner to provide unbiased advice about private cord blood banking to young parents.
"In this case, people need to be told that it hasn't really worked yet," says Arthur Caplan, the bioethics expert. "You need someone without a dog in the fight to recommend a problematic procedure."
When payment is involved, Caplan says, disclosure is paramount. "One is absolutely obligated to disclose the relationship with the company how much one is paid," Caplan says. "In general, it's better not to recommend procedures you have a direct financial interest in to your patients. It's kind of coercive. Anything that might create coercion, pressure, or feelings of obligation should be avoided."
Zafran's hospital, Northwest Medical Center, is required to investigate such conflicts of interest to keep its accreditation.
Also, the American Medical Association explicitly characterizes "fee splitting," when a doctor is directly paid for referring a patient to a particular product or service, as unethical.
Maass says that what Zafran does can't be considered fee splitting. "It's not like we pay him to sell our service," he says. "We pay him to be our consultant in the capacity of the medical and scientific advisory board."
But in his office at Royal Palm OB/GYN, Zafran mentions that for the recent hospital-room webcast, he was paid more than his usual consulting fee. The extra compensation, he says, was for a lot of extra work.
"We put many, many hours into this adventure," he says. "We worked long and hard."
Some of that extra work involved using his influence on the hospital board to smooth the way for Cryo-Cell's advertisement to be shot at Northwest Medical Center.
"As chairman of the board of trustees at the hospital," he says, "it allowed us to move through administrative circles, to say that this was something we wanted to get involved in."
In addition, the Simmonses say that Zafran, their boss, recruited them for the commercial.
"We didn't talk to Cryo-Cell at all we worked entirely through Zafran," Rosa says. "He was really big into it. I had heard about it, but once I started seeing Dr. Zafran, then he gave us the brochure, so we read up on it."
The couple also heard about Cryo-Cell's webcast opportunity at the Royal Palm OB/GYN child birthing class, where a nurse told them that in exchange for participation in the webcast, a family would have its cord blood stored for free.
It seemed like a good deal, Rosa says. "I was going to have a C-section anyways, so I was like, 'Well, you know, why not? I'm going to have a C-section either way, so let's just do it this way. '"
The Sunshine State has always been fertile ground for medical get-rich-quick schemes, and cord blood stem cell businesses that operate in much more questionable ways than Cryo-Cell have blossomed here for years. In 2002, a former model named Laura Brown and a slick South African named Steve van Rooyen started a cord blood company called Biomark in a condo in Miami Beach. The couple advertised that their supply of cord blood would cure a range of diseases and soon were filling orders from all over the country. Today, Biomark faces a 52-count indictment in Georgia for fraud, but the pair have fled to Europe, where they've started a company called Advanced Cell Therapeutics that treats patients with neurological conditions using cord blood, a practice that is illegal in the United States.
I learned to be wary of Florida's cord blood businesses the hard way. About the same time that Brown and van Rooyen were advertising cord blood as a cure-all, a different doctor was setting up a cord blood clinic in Atlanta stocked with blood from a private cord blood bank in Orlando. During the brief time it operated, the Institute of Cellular Medicine showed my family firsthand how easy it is to latch on to a cord blood dream.
In the spring of 2002, my father seemed to have a cold he couldn't shake. His rich voice had become rough and scratchy, but his normal workaholic schedule as a government lawyer had kept him too busy to worry much about a persistent sore throat.
Then he was diagnosed with ALS Lou Gehrig's disease. His failing voice, we were told, was the first sign of the full-body paralysis that would overtake him, whittling his limbs down to twigs and eventually freezing his lungs. Because the nerve cells controlling his throat muscles were the first to die, doctors told us he had a variation of the disease that would progress quickly.
There is no cure for ALS, a disease that causes the body's motor nerve cells to die inexplicably. As we frantically searched for information and hope, however, it became clear that stem cells would one day be the answer.