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In Cord Blood

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And because Cryo-Cell isn't a drug company, rules governing its relationships with physicians are even more porous.

"It's not illegal," says Arthur Caplan, a professor of bioethics at the University of Pennsylvania. Unlike a drug, banked cord blood isn't immediately used. "This is something you're storing for future use, so it's held to a laxer standard."

At the same time that Maass insists that Zafran's arrangement is common in the industry and aboveboard, he hints that his competitors don't have the same scruples, with some even offering doctors blatant kickbacks. Zafran and Cryo-Cell point out that Zafran is merely paid for his participation as a member of the company's Medical and Scientific Advisory Board, never for individual referrals.

And Zafran points out that when he does act as spokesman, he doesn't necessarily promote Cryo-Cell but cord blood banking in general. That was the case in 2001, when Cryo-Cell paid Zafran, along with Minnesota Viking Cris Carter, to co-chair the company's "Save the Stem Cells Campaign." Cryo-Cell flew Zafran to Minnesota to "increase public awareness about umbilical cord blood as a non-controversial, readily available source of stem cells," according to a press release. Zafran and Maass, however, seem reluctant to discuss the Save the Stem Cells campaign, saying that it wasn't successful.

New Times spoke to several doctors and ethicists who say that even indirect financial involvement in a private cord blood bank constitutes a conflict of interest. But even if these conflicts are unethical, they aren't illegal, so most doctors in private practice are policed only by themselves.

"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. '"

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Julia Reischel