10.6092/issn.2038-3460/17170
In the current biomedical literature Umbilical Cord Blood (UCB) is considered a valid source of hematopoietic stem cells for hemopoiesis reconstitution. The acknowledgment of the potential of UCB for transplants prompted the transformation of this human tissue from a discarded human residuum to a valuable life-saving tissue. Drawing on the notion of bio-objectification (Webster 2012), this paper critically investigates the socio-technical process by which this transformation occurred, and explores the two-way interaction between basic biological research and clinical settings in which the therapeutic use of UCB was developed. Secondly, drawing on the notion of biobanks as forms of governing life, this paper analyzes how different institutional arrangements in UCB biobanking produce different routes in UCB bio-objectifications and different economic regimes of UCB exploitation. UCB biobanking thus entails diverging articulations of the relationship between biomedicine and society, and the co-construction of medical technologies, therapeutic applications, subjectivities and social rationalities.
application/pdf
2038-3460
17170
1
en
Lorenzo Beltrame
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
bioeconomy
The Bio-Objectification of Umbilical Cord Blood: Socio-Economic and Epistemic Implications of Biobanking
Text.Serial.Journal
https://tecnoscienza.unibo.it/
5
Essays
2014-07-14
2023-06-12
2014-07-14
2023-07-24
67-90
TS
Lorenzo Beltrame
2014/07/14
10.6092/issn.2038-3460/17170
67
Institute for Advanced Studies on Science, Technology and Society (IAS-STS)
2038-3460
1
bioeconomy
en
90
The Bio-Objectification of Umbilical Cord Blood: Socio-Economic and Epistemic Implications of Biobanking
https://tecnoscienza.unibo.it/article/download/17170/16071
5
                                                                                Essay
The Bio-Objectification of Umbilical
Cord Blood: Socio-Economic and
Epistemic Implications of Biobanking
	
  
Lorenzo Beltrame
Institute for Advanced Studies on Science, Technology and Society (IAS-STS)
	
  
	
  
       Abstract: In the current biomedical literature Umbilical Cord Blood
       (UCB) is considered a valid source of hematopoietic stem cells for hemo-
       poiesis reconstitution. The acknowledgment of the potential of UCB for
       transplants prompted the transformation of this human tissue from a dis-
       carded human residuum to a valuable life-saving tissue. Drawing on the no-
       tion of bio-objectification (Webster 2012), this paper critically investigates
       the socio-technical process by which this transformation occurred, and ex-
       plores the two-way interaction between basic biological research and clini-
       cal settings in which the therapeutic use of UCB was developed. Secondly,
       drawing on the notion of biobanks as forms of governing life, this paper an-
       alyzes how different institutional arrangements in UCB biobanking produce
       different routes in UCB bio-objectifications and different economic regimes
       of UCB exploitation. UCB biobanking thus entails diverging articulations of
       the relationship between biomedicine and society, and the co-construction
       of medical technologies, therapeutic applications, subjectivities and social
       rationalities.

       Keywords: umbilical cord blood; biobank; bio-objectification; bioeconomy.

       Corresponding author: Lorenzo Beltrame, Institute for Advanced
       Studies on Science, Technology and Society (IAS-STS), Kopernikusgasse 9,
       8010 Graz, Austria – Email: beltramelorenzo@fastwebnet.it




1. Introduction

   Umbilical Cord Blood (UCB) contains stem and progenitor cells ca-
pable of restoring haematopoiesis, i.e. the physiological process by which
the organism produces blood cells. It is therefore currently used for
	
  
TECNOSCIENZA
Italian Journal of Science & Technology Studies
5(1) pp. 67-90 – ISSN 2038-3460
www.tecnoscienza.net                              2014
68                                                          Tecnoscienza - 5 (1)

transplantations in patients suffering from haematological malignancies,
and immunological and metabolic disorders (Navarrete and Contreras
2009). The discovery that UCB contains haematopoietic stem cells
(HSCs) dates back to 1974 (Knudtzon 1974). However, the first success-
ful UCB transplant was performed in 1988 on a paediatric patient with
Fanconi anaemia, using UCB from a sibling (Gluckman et al. 1989).
    Nowadays, UCB is considered a valid alternative to bone marrow
(BM) transplantation for reconstituting haematopoiesis in both children
and adults also in the case of partial histocompatibility (Kurtzberg et al.
1996). The graft/host tissue compatibility in human allotransplant is regu-
lated by the human leukocyte antigen (HLA) complex – i.e. the loci of
genes encoding the proteins (antigens) responsible for immune reactions
and thus also for organ transplant rejections – so that the more the HLA
complex of the donor and recipient match, the less the immune system of
the recipient will reject the engrafted tissue. Common in BM transplant is
graft-versus-host-disease: the lymphocytes (a particular kind of leukocytes
or white blood cells) in the engrafted tissue attack the host’s body cells
because they recognize them as antigenically foreign. Consequently, there
must be histocompatibility between the HLA systems of the BM donor
and recipient – which makes the search for a compatible donor a difficult
and long procedure. Instead, since UCB lymphocytes have a naive im-
munophenotype (Han et al. 1995), there is a low rate of graft-versus-host
disease in UCB transplants (Broxmeyer 1995; Wagner et al. 1996) permit-
ting transplantation also between partially mismatched donors and recipi-
ents (Kurtzberg et al. 1996; Wagner et al. 1996; Rubinstein et al. 1998).
    Moreover, the biomedical literature stresses that, while BM registries
are databases of potential donors and BM donation requires hospitaliza-
tion and general or spinal anaesthesia (a painful and risky procedure),
UCB repositories store tissues directly available on-demand, collected
with little or no risk for the donors, and with a lower incidence of micro-
bial, fungal and virus infections. Thanks to these features, the use of UCB
in transplantation has increased over the years. According to Bone Mar-
row Donor Worldwide (the organization managing the registries of all
HSC sources – BM, UCB and peripheral blood), more than 20,000 UCB
transplants were reported worldwide from 1989 to 2009, and more than
560,000 UCB units were stored in more than 100 UCB banks (Bone Mar-
row Donor Worldwide 2013). Therefore, what “was generally regarded,
along with the whole placenta and the attached portion of umbilical cord
containing it, as a discarded human residuum” (Fernandez 1998, S84), is
now considered a valuable life-saving tissue. The term ‘valuable’ is of key
importance, because it refers not only to UCB’s clinical utility in trans-
plants – or as an epistemic thing (Rheinberger 1997) in oncology, haema-
tology and stem cell research – but also to its economic exploitation and
the related societal and ethical issues. UCB used in the clinical setting is
not what was once discarded; rather, it is a bio-object (Webster 2012)
fabricated in a complex, multilayered network of practices, procedures
Beltrame                                                                  69
and institutions that (non-linearly) links the social world of basic biomed-
ical research with that of clinics and, furthermore, with society at large.
The key node of this network is the UCB bank: it is the institutional site
in which the bio-objectification of UCB takes place. It therefore makes
this tissue available for its “mobility across different socio-technical do-
mains…[and] between different sectors or network of society” (Webster
2012, 3), as well as for economic exploitation. Indeed, there are two main
institutional arrangements of UCB biobanking: the worldwide network of
national public biobanks – which manage the storage and distribution of
this tissue for the public healthcare system – and the private sector, where
private companies sell to new and prospective parents the opportunity to
store the UCB of a newborn child for future familial use by paying a fee.
This entails two different forms of (economic) evaluation of UCB: in the
public sector UCB is considered a public resource, which is collected
through an act of donation and supplied in a redistributive economy; in
the private sector, instead, UCB is regarded as a private biological asset,
and UCB banking is advertised and sold to parents as a biological insur-
ance against possible future illnesses in a market economy framework,
where individuals negotiate with the emerging biomedical industry on ex-
clusive possession of a corporeal commodity.
    By drawing on the notion of bio-objectification (Webster 2012), this
paper will first explore how UCB was transformed from a waste material
to a valuable life-saving tissue. I shall show how the bio-objectification of
UCB took place through a two-way interaction between the bench and
the bedside. Secondly, by using the analytical framework developed by
Gottweis (2008), which considers biobanking as a form of governing life,
I shall analyze how the institutional arrangements of UCB biobanks imply
different routes to UCB bio-objectification and are thus connected to di-
verging articulations of the relation between biomedicine and society. Ac-
cording to Martin et al. (2008b, 142), UCB biobanking is a crucial site in
which there occurs a co-construction of “new promissory technologies,
novel therapeutic applications, and new types of consumers motivated by
changing moral imperatives”. This paper analyzes this co-construction in
the two opposing institutional arrangements of UCB biobanking, and
thus considers the related social implications.
    Finally, I shall show how the focus on institutional arrangements al-
lows the notion of bioeconomy to be rethought in more critical terms.


2. Bio-Objectification, Biobanks and the Bioeconomy

   Webster (2012) has developed the concept of bio-objectification as a
heuristic device to refer to the technoscientific creation of life forms and
“technologically enacted vital materiality” (p. 2) in order to take into ac-
70                                                            Tecnoscienza - 5 (1)

count the biotechnological transformation of life and its biological
boundaries.
    Developments in biotechnologies and the life sciences have moved the
control and manipulation of vital processes to the level of their cellular
and molecular mechanisms (Waldby 2002): cells, tissues and biological
information (such as gene sequences) are disentangled from their corpo-
real embodiments and transformed into technologies deployed in bio-
medicine and, in general, in the biotech industry. Webster (2012, 2), in-
deed, exemplifies bio-objectification, and the biotechnological reformula-
tion of the living, by showing how aborted foetal tissues, previously re-
garded as waste matter, “can be re-vitalised as source material for stem
cell lines”.
    This biotechnological reformulation and transformation of biological
entities has resulted in new types of “separable, exchangeable and rein-
corporable body parts” (Rabinow 1999, 95) which flow in international
circuits and are exploited for the creation of “biovalue” – i.e. “the yield of
vitality produced by the biotechnical reformulation of living processes”
(Waldby 2002, 310). A growing body of social science literature has
drawn attention to the ways in which the body and its component parts
have become a preeminent site of capitalization. Scholars have noted that
the biotech field is increasingly “organised as a market” (Birch 2006, 3),
and that “the object of bioscience, the practice of bioscience, and the lo-
cations of bioscience have all been changing […] toward more corporate
forms and context of research” (Sunder Rajan 2006, 4). In other words,
biosciences are not only committed to the production of truth, but are
increasingly intertwined with the creation and mobilization of venture
capital through the “patenting of cell lines, genes and transgenic organ-
isms” and their transformation into “intellectual property and possible
sources of profit” (Waldby 2002, 310).
    This literature has explored the growing commercialization of life it-
self and its socio-cultural implications by extending the work of Michel
Foucault. Firstly, it draws on his notion of biopolitics (Foucault 1976), i.e.
the practice of governance that brought life itself and its mechanisms into
the realm of political calculations and rationalities addressing the biologi-
cal existence of individuals and populations. Secondly, it explores the in-
tertwining between modern biology and political economy – whereby the
“organic becomes the living and the living is that which produces, grows
and reproduces” (Foucault 1973, 232) – at the molecular and cellular lev-
el. In this sense, terms such as bioeconomy or biocapital have been intro-
duced to highlight how biological entities (organs, tissues, cells, and gene
sequences) “are increasingly inserted into projects of product-making and
profit-seeking” (Helmreich 2008, 464). Consequently, life has become
“productive of economic value…[and] the manipulation of life generates
a value accorded to the enhancement of health” (Rose and Novas 2005,
455). This “relocation of wealth in the creative forces of human biological
Beltrame                                                                   71
life” (Cooper 2008, 6) means that “life becomes, literally, annexed within
capitalist process of accumulation” (Cooper 2008, 19).
    Moving from ‘molar’ level of populations and bodies to cellular and
molecular components (Rose 2007) means that the capitalization of life
itself and the exploitation of biovalue in the current bioeconomy pass
through the bio-objectification of biological entities. UCB represents a
paradigmatic example of a bio-object, both because it was transformed
from waste to a clinical and epistemic valuable thing, and because it cir-
culates internationally among countries and different social environments
(laboratories, hospitals, biotech companies) by virtue of a new medium of
technical innovation, namely “biobanks or cord blood banks” (Webster
2012, 3). However, the case of UCB tends to complicate the picture
drawn by the literature on bioeconomy. Several scholars define the cur-
rent bioeconomy as a form of market economy, and they link its birth
with the neoliberal turn in national economic policies (Cooper 2008;
Birch 2006). The biotech sector organized in a post-Fordist corporate
way (Sunder Rajan 2006) is seen as consubstantial with the core neo-
liberal idea that the human well-being and the social good “will be max-
imized by maximizing the reach and frequency of market transactions”
and by individual entrepreneurial freedoms (Harvey 2005, 3). In this
sense, Sunder Rajan (2003, 92) pointed out that, in any institutional ar-
rangement of biomedical research: “it is the very definition of what con-
stitutes market logic that is often most at stake in the strategic articula-
tions of biocapitalism”; and also the relocation of biomedical knowledge
and information in the public domain (e.g. in the case of the Human Ge-
nome Project) represents “less an attempt to negate market logic as much
as it is to redefine the terrain in such a way that ‘market logic’ is dictated
by the strategic interests” of corporate actors (Sunder Rajan 2003, 105).
    However, the bio-objectification of UCB does not automatically mean
its commodification in a market (bio)economy framework, since the sys-
tem of public UCB biobanks organizes and supports a global redistribu-
tive tissue economy in which UCB is considered a public resource. I shall
show in what follows that the bio-objectification of UCB takes place with-
in a particular socio-technical infrastructure, namely a biobank, which
connects different areas of biomedical research with society. I shall
demonstrate that it is the institutional arrangement of biobanking that
determines the route of bio-objectification of UCB and thus both its sta-
tus as a (bio)economic good and the related implications for the articula-
tion between biomedicine and society. In other words, I shall explore
how the co-construction of biomedical technologies, therapeutic applica-
tions and subjectivities, rationalities and social solidarities varies accord-
ing to the institutional arrangements of UCB biobanking. The two main
arrangements of UCB biobanking (the public system vs. the private
commercial sector) entail:
    • two opposing main regimes of UCB biovalue exploitation (i.e. a re-
       distributive tissue economy vs. a market bioeconomy);
72                                                                  Tecnoscienza - 5 (1)

     • different routes in UCB bio-objectification;
     • contrasting meanings of UCB as a clinical object and an epistemic
       thing (Rheinberger 1997);
      • opposing forms of social solidarity and obligation.

    This analytical framework is thus based on the notion of biobanks as
forms of governing life. Put simply, biobanks are collections of human
biological materials combined with information (personal, medical, gene-
alogical, etc.) and are thus crucial sites within contemporary biomedical
research, since they provide samples and bio-information for genomics
(Gottweis and Lauss 2011) and stem cell research (Waldby and Mitchell
2006).
    According to Gottweis and Lauss (2011, 62-65): “Biobanks consist of
highly complex and multiconnected networks […] stretching to a variety
of nodes such as medical schools, hospitals, and health care provision”.
Biobanks are not only techno-epistemic technologies linking several sec-
tors of scientific research and healthcare provision, they are also a sort of
socio-technical interface between biomedicine and society. As Gottweis
and Petersen pointed out, biobanks:

             …constitute a complex process of representing science, bodies,
        medicine and technology. They are a form of governing life and in-
        volve a multitude of actors such as scientists, patients, or industry
        who actively engage in building, describing and operating bi-
        obanks and who contribute to translating particular scientific-
        technological visions into material practices. They involve the de-
        ployment of physical infrastructures, artefacts, machines, tools, in-
        struments and buildings. […] Biobanks always connect with socie-
        ty, culture, the economy and politics. Biobanks incorporate visions
        for the future of medicine and healthcare, offer resources to medi-
        cal research and the pharmaceutical industry and embed images of
        the patient, the citizen, collective identity and society.
                                               (Gottweis and Petersen 2008, 9)

    As a form of governing life, the way in which a biobank restructures
“the boundaries between the scientific/technological, the social, the cul-
tural, and the political” (Gottweis 2008, 22) depends on the institutional
arrangements in which it operates. Gottweis and Lauss identified three
different types of biobanks:

            (a) the entrepreneurial biobank model that is often carried out
        in a public private partnership between a commercially oriented
        entity and different state institutions; (b) the biosocial model in
        which patient activist groups promote, fund, and facilitate the cre-
        ation and operation of a biobank; and (c) the public biobank mod-
        el in which biobank networks are supported mostly through tax-
        payers money and nonprofit research funding organizations.
                                              (Gottweis and Lauss 2011, 66)
Beltrame                                                                73


    Each of these types implies a different form of governance: a top-
down model in the public biobanks, a bottom-up one in the biosocial and
“horizontal exchanges between sellers and buyers, producers and con-
sumers” (Gottweis and Petersen 2008, 8) in the entrepreneurial model
based on market logic. This distinction is particularly suitable because
UCB biobanking is organized into two main models: the network of pub-
lic UCB biobanks for allogeneic donation, and the commercial sector of
private banks for the autologous or family storage. And, as I shall show in
the following sections, the institutional arrangement of UCB biobanking
implies different routes to UCB bio-objectification and different ways to
articulate the relationship among scientific research, the healthcare sys-
tem and the market, but also because it exerts effects on the articulations
between biomedicine and society.
    Therefore, in what follows, first I shall analyze the process of UCB’s
transformation from a waste material into a valuable tissue. Using the no-
tion of bio-objectification, I shall show how this transformation occurred
through a two-way interaction between the social world of basic biologi-
cal research and that of clinical applications. Second, by drawing on the
notion of biobanks as a form of governing life, I shall show how bio-
objectification takes place in a particular socio-technical infrastructure
whose institutional arrangement defines the articulation of the relation
among biomedicine, economy and society. The aim of this paper is to call
into question the idea that the modern bioeconomy coincides with the
market economy framework and thus means the commodification of life
and its cellular and molecular components. On the contrary, I shall show
that the economic regime of biovalue exploitation is the outcome of insti-
tutional arrangements created by the actors involved, and that these ar-
rangements have implications for the way in which a society is organized.
    The paper is based on discourse analysis carried out on articles pub-
lished in scientific journals – retrieved in PubMed by searching for ‘Pla-
cental and Cord Blood banking’ – and on documents produced by bio-
ethics and medical professional bodies (American Academy of Pediatrics
1999; Royal College of Obstetricians and Gynaecologists 2006; European
Group on Ethics in Science and New Technologies 2004; Committee on
Obstetric Practice 2008), as well as corporate communications available
on the websites of private UCB banking companies. Scientific papers re-
trieved in PubMed were subsequently selected according to various crite-
ria. The historical analysis of the development of UCB bio-objectification
was carried out on the basis of review articles (e.g. Gluckman 2009; Na-
varrete and Contreras 2009) and therefore considered milestone papers in
the evolution of UCB clinical application and UCB-derived stem cell sci-
ence – retrieved by analyzing bibliographic references. Another set of ar-
ticles included in the analysis dealt with the establishment of UCB banks
and the development of techniques for storing and processing UCB.
74                                                          Tecnoscienza - 5 (1)

    Finally, articles concerning ethical issues in UCB biobanking and the
debate between public and private UCB banks were collected. In this
way, a corpus of 108 papers published in the period 1974-2009 (i.e. from
the discovery of the presence of HSC in UCB to the 20th anniversary of
the first UCB transplant) was analysed through qualitative discourse anal-
ysis aimed at detecting both the construction of UCB-derived stem cells
as clinical and epistemic objects and economic goods, and the production
of social entities and relations. This approach recovers the constitutive
function of discourse – as practice that forms the objects of which it
speaks (Foucault 1972, 64) – and is thus constitutive of social identities,
social relations and systems of knowledge and belief (Fairclough 1992).
But it is less focused on the (re)production of power relations, domi-
nance, ideology and hegemony within discursive practices as in critical
discourse analysis (Fairclough 1995; van Dijk 1993), and more on the
construction of the image and the role of individuals as citizens and/or
consumers in the regimes of economic relations and biopolitics models
embedded in the various institutional arrangements of UCB biobanking.
This analytical approach was also applied to the analysis of documents
produced by bioethics and medical professional bodies, and to the corpo-
rate communications of private UCB banking companies retrieved on the
Internet by searching for umbilical cord blood banking companies. Ana-
lyzing corporate communications and websites was necessary because sci-
entific papers and the documents of medical professional bodies tend to
be biased against private biobanking. Following social science analysis of
UCB biobanking (Martin et al. 2008b; Brown and Kraft 2006) and arti-
cles dealing with the controversy between public and private UCB bio-
banks, I selected the most cited and largest private companies and then
analysed their advertising and communications.


3. The Bio-Objectification of UCB from Bedside to Bench

    The umbilical cord as a site of haemopoiesis was discovered in the
1970s by Knudtzon (1974), who detected colony-forming cells in human
UCB. Unclear at that time was both the nature of these cells and their
function, to the point that Knudtzon wrote that “they might merely rep-
resent an escape from the bone marrow into the circulation” (Knudtzon
1974, 360). Reported in 1982 was the “identification of a unique class of
human hemopoietic colony-forming cells with extensive ability to gener-
ate progenitors for secondary colonies” (Nakahata and Ogawa 1982,
1324). However, confirmation that UCB is an effective provider of HSC
for haematopoietic reconstitution came only in 1988, when a team led by
Eliane Gluckman transplanted UCB into a child in order to cure Fanconi
anaemia (Gluckman et al. 1989). Interestingly, the laboratory-based con-
firmation that UCB contains HSCs well within the range of BM stem cells
Beltrame                                                                          75
“that have been associated with successful autologous and major histo-
compatibility complex-matched allogeneic bone marrow transplantation”
(Broxmeyer et al. 1989, 3830) was forthcoming only one year later. In-
deed, Smith and Thomson recounted the story of UCB science and clini-
cal application in these terms:

               The study of umbilical cord blood began in 1982, when discus-
           sions between Broxmeyer and Boyse led to laboratory experiments
           that suggested that umbilical cord blood contained hematopoietic
           stem cells that might be suitable for transplantation [...] This la-
           boratory-based research led to the collection and banking at Indi-
           ana University in Indianapolis of cord blood from the siblings of
           children who were in need of transplantation. Gluckman et al in
           Paris were the first to use a sibling cord blood unit that had been
           banked by Broxmeyer at Indiana University to transplant a child
           with Fanconi anemia.
                                              (Smith and Thomson 2000, 127-8)

    Similarly, Gluckman (2009) described the clinical application of UCB
as the outcome of the collaboration between the laboratory researches of
Broxmeyer and her clinical work. The interesting features of this narrative
are: (a) the intertwining between laboratory-based research and the clini-
cal setting, and (b) the central role played by the banking of UCB.
    The first point testifies to how the clinical application of UCB did not
follow the linear model of translational medicine – which postulates a
one-way flow from the bench to the bedside – but a two-way interaction
between basic biological research and medicine, as described by Keating
and Cambrosio (2001) in their study on cytogenetics. In several respects,
the history of UCB science and clinical application resembles that of BM,
where the first clinical trial was carried out in 1957 before the develop-
ment of the biological knowledge of HSC (i.e. prior to developing
knowledge on the identity of HSC, techniques for its enumeration, and its
functioning mechanism). Both BM and UCB clinical applications were
developed in a “regime of hope” which proceeded “on the basis of specu-
lative potential therapeutic efficacy, even in the absence of a clear demon-
stration of underlying principles” (Martin et al. 2008a, 32). Authors
pointed out that the development of BM transplantation was “character-
ized by a clinically driven shift from the imagined possibilities of the clin-
ic back into exploratory fundamental research” (Martin et al. 2008a, 33).
Similarly, in the case of UCB, it was successes in transplantation that
prompted the basic research on the features of stem cells contained in it.
The clinical application of UCB transplant ran in parallel with laboratory-
based research on UCB-derived stem cells. During the 1990s, in fact, clin-
ical applications of UCB transplants were carried out notwithstanding the
scant reliability of quantitative assays for HSCs in humans (Gluckman
1996). For example, Broxmeyer et al. (1992, 4112) maintained that “the
numbers of human repopulating cells cannot yet be calculated”. Still to-
76                                                           Tecnoscienza - 5 (1)

day, the suggested minimum quantity of UCB stored is empirically estab-
lished – it is recommended to store only the largest units of more than
70ml in order to have at least ≥2x105 CD34+ cells/kg – even if the opti-
mal cell count and the relation between CD34+ cells and successful en-
graftment is still not known (Gluckman 2009, 623). CD34+ cells are cells
expressing CD34 cell surface protein, which mediates the attachment of
stem cells to stromal cells and thus permits haematopoiesis. The CD34
surface marker is thus considered a marker for HSCs, and the assay of
CD34+ cells is used to estimate the number of HSCs in a given sample.
    However, as Martin et al. (2008a, 33) have shown, the identity of
HSCs in terms of CD34 surface makers is contested within the bench
community, but it is stabilized in practice in clinical protocols (see also
Brown et al. 2006, 338). In other words, this is another example of the
non-linearity between the bench and the bedside in the clinical applica-
tion of UCB-derived stem cells.
    In general, the history of UCB application shows a two-way flow from
the bedside to the bench. Indeed, while clinical haematologists trans-
planted UCB – and demonstrated the therapeutic efficacy of UCB trans-
plant also in HLA mismatching settings (Kurtzberg et al. 1996; Rubin-
stein et al. 1998; Wagner et al. 1996) – experimental hematologists were
showing that compared with BM, UCB contains a more primitive cell
population that has more in vitro and in vivo proliferative potential (Hao
et al. 1995). Similarly, while clinicians successfully used UCB stored in
biobanks, laboratory scientists were developing techniques to reduce the
volume of stored UCB units while avoiding the loss of viable HSCs and
the use of toxic cryo-preservants (Rubinstein et al. 1995; Denning-
Kendall et al. 1996). More interestingly, the shift of UCB transplant from
a “investigational” procedure (American Academy of Pediatrics 1999,
117) to a routine clinical practice (Gluckman 2009) was prompted prin-
cipally by the publication of statistical analyses on the outcomes of trans-
plant (Rubinstein et al. 1998; Eapen et al. 2007) and by reviews of follow-
up studies (Navarrete and Contreras 2009). This two-way relationship be-
tween the bench and the bedside was made possible by a peculiar institu-
tional setting: the university hospital or the close association and proximi-
ty between clinical and research institutions. As in the case of BM trans-
plant (Martin et al. 2008a), such proximity fostered collaboration be-
tween clinicians and scientists and created an international epistemic
community of both UCB practitioners and UCB stem cell scientists.
    The second point of the narrative quoted above refers to the role of
biobanks. In fact, the development of both UCB transplant and UCB
stem cell science would not have been possible without the establishment
of UCB biobanks. Indeed, in order to be available for both transplanta-
tion and experimentation, UCB should be collected, tested, processed,
preserved and distributed. The first UCB biobanks were set up in univer-
sities and public hospitals (Armitage et al. 1999; Lazzari et al. 1996; Ru-
binstein et al. 1994), and it was in these infrastructures that knowledge on
Beltrame                                                                 77
UCB stem cells and technologies to improve its clinical use and preserva-
tion were developed. Therefore, UCB biobanks are both crucial nodes in
the network linking institutions (laboratories, universities, research cen-
tres, hospitals and health care providers) and the sites in which the com-
plex and heterogeneous web of knowledge, expertise, devices, technolo-
gies and biochemical substances coalesces in the process of UCB bio-
objectification. The bio-objectification of UCB takes place mainly in UCB
biobanks through a process termed UCB biobanking, that is, the set of
“processing, testing, cryopreservation, storage, listing, search, selection,
reservation, release, and distribution of cord blood units” (NetCord-
FACT 2013, 8), since a UCB unit “is the end-product of a series of pro-
cesses” (NetCord-FACT 2013, 58).
    The bio-objectification of UCB starts with the process of collection at
the moment of delivery, thanks to an articulation with changes in birthing
practices. As Brown (2013) has illustrated, from the late 1960s onwards,
obstetric and midwifery manuals and guidelines recommended umbilical
cord clamping immediately after the delivery in order to reduce maternal
post-partum haemorrhages. This means that the blood in the umbilical
cord and placenta is not transferred to the newborn, and thus becomes
available to collection, since it has been demonstrated that minimizing the
time between infant delivery and cord clamping increases the volume of
UCB, and thus of HSCs (Donaldson et al. 1999). Moreover, obstetricians
or gynaecologists must obtain informed consent from the prospective
mothers, and they must also generate a medical record regarding the
pregnancy and the medical history of the mother and her family. This is a
first step in the process of “informationization” (Gottweis 2008, 27) by
which the biological is transformed into information inserted in a com-
puterized database. Similarly, after the umbilical cord has been clamped,
the blood contained in it should be drained by gravity (and exploiting
placenta pulsation), using a sterilized needle and a catheter, and then
gathered in a blood collection bag containing an anticoagulant (NetCord-
FACT 2013). Therefore, collecting UCB entails both an articulation of
biomedical practices and a network of technologies, devices and sub-
stances. In other words, what is sent to a UCB biobank is a tissue partially
informationalized and already processed.
    The second step of UCB bio-objectification is carried out at a UCB
biobank – or a set of UCB processing facilities linked to the biobank –
and entails analysis of the UCB units (tests for genetic diseases and mi-
crobial contamination, cell count and cell viability assays, and HLA typ-
ing), and other UCB processing procedures: volume reduction and cryo-
preservation. Both procedures involve the use of devices and biochemical
substances: centrifuges, Hydroxyethyl Starch to separate HSCs from red
cells and plasma, Dimethyl Sulfoxide as cryo-protectant, freezing bags,
metal canisters and freezers with a monitoring system (NetCord-FACT
2013). When processed UCB units are stored in a cryopreservation de-
78                                                          Tecnoscienza - 5 (1)

vice, the entire documentation, comprising both biological and technical
information, is inserted into a database through a validated system.
    The UCB as the end-product of this socio-technical network of pro-
cesses is something very different from what was once discarded; it is now
a biotechnologically manipulated thing available both for clinical applica-
tion and for biomedical research. In a biobank, UCB has two different
ontological statuses: 1) as a processed tissue which is stored in a specific
place (a freezer); 2) as a record of medical information inserted in a data-
base which makes it accessible to international electronic search systems
(like the international Bone Marrow registry). It thus flows worldwide in
a transnational network of computer databases; and when it is identified
as suitable for a transplant, also the tissue can flow transnationally in a
network of UCB banks, hospitals and transplant centres.
    It is worth noting that after the transplantation, the informational on-
tological status of UCB does not cease existing; not only because the doc-
umentation must be conserved, but also because now generated is a new
medical record regarding the process of engraftment and the follow-up
on the transplant procedure. Again, the UCB unit continues to exist with
a double status: as an engrafted tissue in the recipient (in which regener-
ates haematopoiesis), and as a medical record regarding the transplant
and the process of engraftment registered in the biobank’s database and
thus available to the scientific literature on the outcomes of cord blood
transplantations. The bio-objectified UCB is thus an immortal entity.


4. Constructing Communities in the Public UCB Biobank-
    ing System

    The general process of UCB bio-objectification transforms what was
once a discarded material into an usable object, but it does not define the
form of its exploitation and valuation. This depends on the institutional
arrangement in which the UCB biobanking takes place. The UCB bi-
obank is thus the key node in a network connecting hospitals (where
UCB is collected) and universities and transplant centres (where UCB is
used as an epistemic and clinical object), and it is also the main site of
UCB bio-objectification. However, the institutional arrangement of UCB
biobanking determines the specific route to UCB bio-objectification and
thus the form of the co-construction of this medical technology and sub-
jectivities and social rationalities.
    After the first successful UCB transplantation, researchers and clini-
cians started to establish biobanks to store UCB units. The first public
UCB biobank was set up in New York in 1991 (Rubinstein et al. 1994),
and at the beginning of the 1990s others were established in Paris
(Gluckman et al. 1993), London (Armitage et al. 1999), Milan (Lazzari et
al. 1996) and in other Western countries. From the outset, UCB practi-
Beltrame                                                                79
tioners highlighted the need for forms of international cooperation and
coordination among biobanks and clinicians and researchers in the field
of UCB transplantation and HSC science. The Eurocord group, an organ-
ization aimed at promoting cooperation and developing standards in the
field of UCB science, banking and clinical application (Gluckman 1996)
established the International NetCord Foundation, a non-profit associa-
tion of UCB banks which has nearly 35 member banks and registries rep-
resenting about 51% of the global supply of publicly banked cord blood
(NetCord 2013). NetCord manages an integrated database that connects
multiple UCB banks registries worldwide. But it operates also for the cre-
ation of standards and accreditation criteria for UCB biobanks: together
with the US Foundation for the Accreditation of Cellular Therapy
(FACT) it publishes a manual defining standards for UCB collection,
processing, testing and banking (NetCord-FACT 2013). In this way,
along with national and international biobanks’ regulations, NetCord and
FACT have created an international accreditation system, and thus a set
of standards, which applies to UCB biobanks (both public and private)
participating in this network. In general, the public UCB biobanking sys-
tem is organized as an international network (Brown et al. 2011), and it is
sustained by an institutional architecture consisting of medical profes-
sional and governmental organizations.
    Within this institutional arrangement, UCB is bio-objectified in such a
way that UCB “has gained new status as a natural resource” (Annas 1999,
1521); UCB practitioners, indeed, consider UCB to be a human tissue, so
that they apply the rule that “no part of the human body should be com-
mercialized and that donation of organs or cells should be free and anon-
ymous” (Gluckman et al. 1996, 108). Defining UCB as a public resource
supplied and managed in a redistributive economy framework, means
that UCB donation is regarded “as a rare and praiseworthy example of
altruism” (Annas 1999, 1522) “for the benefit of society” (Pinch 2001,
59). In this sense, UCB donation is framed “as a gift rather than a com-
modity” and society can claim ownership “to promote the common
good” (Sugarman et al. 1995, 1784).
    The public UCB biobanking system operates according to the logic of
Foucauldian bio-politics of the population: it is a form of governing life
that disciplines bodies (and their parts), regulates populations (Gottweis
2008) and creates an identification between “the supply of blood, organs
and other bodily fragments and the body politic as contained within the
limits of the nation-state [which generates] a relationship between the
anonymous solidarity that links donor and recipient and the constitution
of a subjecthood that is, simultaneously, biological and national” (Santoro
2009, 18). As Brown (2013, 98) has summarized, public UCB biobanking
“is promoted with reference to a solidaristic moral economy of gift and
altruistic participation in imagined community and nationhood”. For ex-
ample, when the European Commission asked for an opinion on UCB
biobanking from the European Group on Ethics in Science and New
80                                                          Tecnoscienza - 5 (1)

Technologies (2004, 18), the latter stated that public UCB banking “im-
plies an act of solidarity or generosity” and “contributes to the social co-
hesion”, while private companies represent “a more general shift […]
from a health system based on solidarity” which has characterized the Eu-
ropean social welfare model. In this way, public UCB biobanking also
constructs subjectivities and social rationalities: citizens as part of the
body politic are requested to contribute actively to the public good by
donating UCB, and a redistributive tissue economy operates to sustain
this social solidarity and bond.
    The subjectivity of citizens is also constructed in the biomedical and
bioethical literature on UCB donation. For example, the American Acad-
emy of Pediatrics has criticized the advertising of private UCB biobanks,
which promise a biological insurance against possible future illness, be-
cause “families may be vulnerable to emotional marketing at the time of
birth of a child” (American Academy of Pediatrics 1999, 116). Citizens
are defined as vulnerable to the mass media advertising and direct-
marketing approach of private companies which, through “dramatic, im-
passioned language” (Pinch 2001, 56), sell a service based on a unrealistic
prospects and on a misleading use of the expression ‘biological insurance’
since the probability that autologously stored UCB will be of use “ap-
proaches to zero” (Annas 1999, 1523; Committee on Obstetric Practice
2008). Thus, public UCB practitioners have criticized private biobanking
not only because it results in a wastage of resources and damage to public
health (Royal College of Obstetricians and Gynaecologists 2006; Perlow
2005), but also because it exploits the vulnerability of prospective par-
ents.
    To summarize, in public UCB biobanking, citizens are constructed
both as members of the body politic who must participate in the biopoli-
tics of the (national) population for the common good, and as subjects
vulnerable to misleading advertising regarding the range of uses of UCB
in biomedicine – subjects who must be protected by the state. This
framework entails not only the definition of UCB as a public resource for
the good of the body politic – and thus a redistributive economy support-
ing social solidarity – but it more radically affects the ontological and
technical status of the bio-objectified UCB.
    Martin et al. (2008b, 137) have pointed out that public UCB biobanks
operate in what they call a “regime of truth”: UCB is stored for use in its
current applications, and research on UCB is carried out “on the basis of
current present-oriented ‘evidence-based’ support for existing applica-
tions” of UCB stem cells. By contrast, private UCB biobanks work in a
regime of hope, where the autologous collection is not only aimed at ex-
isting applications in oncology and haematology but at the future pro-
spect of regenerative medicine (Brown and Kraft 2006; Martin et al.
2008b). It is worth noting that the possible use of UCB-derived stem cells
for regenerative medicine is also explored in public research settings –
e.g. the study and characterization of mesenchymal stem cells contained
Beltrame                                                                 81
in placenta and umbilical cord tissue, or the possibility to differentiate
UCB cells into non-haematopoietic cells for use in organ repair. Howev-
er, some scholars (Brown and Kraft 2006; Martin et al. 2008b) have
stressed that public UCB biobanks deal more with the improvement of
current UCB applications (e.g. the expansion of HSCs for treating adults
as well), while private banks highlight more their possible future use in
regenerative medicine. For example, literature reviews of UCB transplan-
tation mention only the current application of UCB-derived stem cells in
haematology (e.g. Navarrete and Contreras 2009) while the advertising of
private UCB banks or articles explaining the work of research centres
linked to private biobanks (e.g. Bardelli 2010) report experiments and
clinical trials using UCB-derived stem cells in regenerative medicine.
    Hence it seems that there are different expectations in the two institu-
tional settings about the clinical use of UCB-derived stem cells and, ac-
cordingly, they are transformed into different epistemic things. Finally,
according to Santoro (2009), UCB processing procedures vary between
the public and the private sector, and private companies do not perform
the quality controls and transformation procedures adopted by public
UCB biobanks. Santoro (2009, 16) points out that we find two different
bio-objects in the public and private sector.


5. Constructing Citizens as Consumers in the Private UCB
   Biobanking Sector

    Contemporaneously with the establishment of the first public UCB
biobanks, also private biobanks were set up in several Western countries
(e.g. the Cord Blood Registry in San Bruno, California and ViaCord, Bos-
ton). Martin et al. (2008b) have counted 112 private UCB banks operat-
ing worldwide and which store some 881,000 UCB samples. These bi-
obanks are commercial enterprises which sell the possibility to store UCB
for future use by the autologous donor (i.e. the child) or family members.
UCB thus acquires a biovalue as a biological asset: it takes the form of
economic capital for the private biobank, and of a speculative investment
for parents. Accordingly, UCB biobanking is defined by private compa-
nies as a “biological insurance” (Wolf 1998, 5) or “a form of property
whose value is oriented toward the biological future” (Waldby and
Mitchell 2006, 125). By using expressions such as “peace of mind” (Cryo-
Save 2013), “store your child’s future” (Smart Cells 2013a) or “put a little
something away for a rainy day”, private companies try to induce new and
prospective parents to invest in a technology that may, in the future,
prove to save the life of family members (Brown and Kraft 2006, 314;
Brown et al. 2006). As Brown and Kraft have pointed out, the language
and metaphors of banking, investment and insurance refer not only to
commercialization, but also to aspirational emotions, affectivity, expecta-
82                                                          Tecnoscienza - 5 (1)

tions and future health risks: UCB banking promises to offer “a simulta-
neously metaphorical and material indemnity against some unspecified,
though feared, future disease disaster” (Brown and Kraft 2006, 316).
    On the one hand, this future and risk-oriented discourse is clearly
linked to the neoliberal form of government that produces individuals
who “will govern themselves, master themselves, care for themselves”
(Rose 1993, 291-296) by acting through “a kind of privatization of risk
management […] in which the citizen adds to his or her obligations the
need to adopt a calculative and prudent personal relations to risk and
danger”. In this way, the subject is constructed as a calculative agent who
negotiates his/her own health in a market of biological services. This im-
age is mirrored in novel forms of interaction with the field of biomedicine
and biomedical research that some authors term ‘biological citizenship’, a
new form of activism related to biological and health conditions which
denotes the active engagement in biomedicine by formulating life strate-
gies, developing techniques for the everyday management of physiological
conditions, or by actively participating in biomedical research (Rose and
Novas 2005).
    On the other hand, this discourse is built on notions of kinship re-
sponsibilities. Parents are encouraged to do something against some po-
tential future loss or the uncertainties of future disease (Brown 2013); in
other words, to take care of the future of their family members. Brown
and Kraft (2006, 325) thus define autologous UCB preservation as a
“techno-moral entry point into an increasingly private linkage between
parenting and biomedicine” with a “set of ‘blood ties’, reproductive du-
ties and responsibilities connecting private consumers with biological ser-
vices”.
    The private UCB banking sector is thus organized according to what
Gottweis and Lauss (2011) term the ‘entrepreneurial model’, which is
based on market logic and operates through exchanges between sellers
and consumers. It represents a particular articulation of the relationship
between biomedicine and society and a form of governing life based on a
neoliberal notion of biopolitics. Accordingly, the private UCB banking
sector is characterized as “a neoliberal privatised market where individu-
als or families make an exclusive claim on a […] biological asset that re-
mains private property” (Brown et al. 2011, 1115; Santoro 2009). As we
have seen, in fact, this arrangement of UCB biobanking is built on, and in
turn creates, an ideal of a self-governing citizen who manages his/her own
health. Moreover, by using a rhetoric of indemnity, insurance and in-
vestment, it also creates a particular subjectivity: the individual is no
longer a vulnerable member of the body politic (who has to participate in
the common good), but a calculative and prudent consumer under an
ethical duty to take care of his/her relatives, who maximizes health and
well being by negotiating in a free market of biological services. There-
fore, private biobanking creates a different articulation of the co-
construction of medical technologies and subjectivities and social ration-
Beltrame                                                                    83
ality.
    Moreover, it entails, and in turn enables, a different route to UCB bio-
objectification.
Firstly, UCB in private biobanking is not a public resource but a private
good, even if it is not properly a commodity. As Brown (2013, 99) has
highlighted, parents pay a fee to retain proprietary control over an asset
diverted away from the globally distributed public UCB exchange sys-
tems (see also Brown et al. 2011). For what is sold and bought is not the
UCB units, but the storage service. As Waldby and Mitchell (2006, 124)
have noted, the private UCB account creates a form of possession which
excludes the commodity form, since the value of UCB resides in its not
being alienated, in its not having an exchange value.
    Secondly, this private good or biological asset has a value which re-
sides in the biological future, and more precisely in “the future-oriented
promissory value of regenerative medicine […] embedded largely in fu-
ture potential rather than present utility” (Martin et al. 2008b, 132;
Brown 2013; Waldby and Mitchell 2006). Indeed, in their advertising,
private UCB biobanks report both the current clinical application of
UCB and the experimental setting and clinical trials using UCB for heart,
lung and liver diseases (Smart Cells 2013b). Some private biobanks,
moreover, operate directly in the field of stem cell research and regenera-
tive medicine (Martin et al. 2008b) by promoting and carrying out re-
search on non-hematopoietic stem cells – such as the mesenchymal stem
cells – harvested from umbilical cord tissue to repair organs (Bardelli
2010). As mentioned above, UCB in the private sector is thus a different
epistemic thing and it is bio-objectified more according to a regime of
hope – i.e. the expectations surrounding the future of regenerative medi-
cine – and less according to the regime of truth of established clinical set-
tings in oncology and hematology – in which the public UCB biobanking
system operates (Martin et al. 2008b). Therefore, in contrast to the public
system, the institutional arrangement of the private sector implies a spe-
cific route to UCB bio-objectification that defines a different status of
UCB, as both a good and an epistemic thing for biomedical research, but
also entails a different co-construction of subjectivities and social rational-
ities.


6. Conclusion
    This paper has explored the bio-objectification of UCB as it was trans-
formed from waste material to a valuable life-saving tissue in clinics, and
to an epistemic thing in stem cell research. The bio-objectification of
UCB has taken place through a two-way interaction between basic bio-
logical research and medicine by virtue of a particular institutional ar-
rangement – that of university hospitals – in which different biomedical
expertises could cooperate. In this network of institutions and expertises,
84                                                             Tecnoscienza - 5 (1)

a key role is played by biobanks, which are the strategic nodes of inter-
connection and the material places in which the bio-objectification takes
place. Therefore, I have analyzed two opposing articulations of the insti-
tutional arrangement of UCB biobanking which give rise to different
routes to UCB bio-objectification. These routes are, furthermore, con-
nected to different framings of UCB’s status as both a good and an epis-
temic thing, and therefore to different economic regimes of biovalue ex-
ploitation, subjectivities and social rationalities. Indeed, biobanking is a
form of governing life. Hence different arrangements in UCB biobanking
entail different models of biopolitics.
    In the case of the public UCB biobanking system, UCB is bio-
objectified as a tissue for its application in established clinical settings (a
regime of truth), and it is defined as a public resource managed and ex-
changed in a redistributive bioeconomy according to a state-led biopoli-
tics of the population, in which the individual body and its component
parts are identified with the body politic. Accordingly, citizens are con-
structed as individuals having responsibilities for the community’s good.
In this sense, donation is an altruistic act which creates social solidarity
and cohesion, and reinforces social bonds. In the case of the private UCB
biobanking sector, instead, UCB is bio-objectified as a form of biological
insurance, a private corporeal asset, oriented toward the future of regen-
erative medicine development. It is both a private good and an epistemic
thing for the regime of hope of stem cell research. This asset does not
have exchange value as a commodity; rather, what is sold and bought is
the possibility to store it as an indemnity against possible future risks. In
fact, what is exchanged in the market is a biological service, not a material
good. In this sense, private biobanking operates according to a neoliberal
biopolitics in which the citizen is constructed as a responsible, calculative
and prudent consumer under an ethical duty to take care of his/her rela-
tives, and who negotiates the health of his/her relatives in a market of bi-
omedical services.
    The case of UCB bio-objectification opens an interesting window on
the contemporary bioeconomy because it sheds light on diverging articu-
lations of the process of exploiting biovalue. It shows how different insti-
tutional arrangements can give rise to different forms of bioeconomy (a
market vs. a redistributive economy) and, thus, how different routes to
bio-objectification entail opposing models of governing life, which, in
their turn, imply the construction of diverging subjectivities and social
solidarities and bonds. The case of UCB invites us to explore how the
market logic in the political economy of life itself is not an inevitability,
but rather the outcome of strategic articulations of the actors involved
and of the institutional arrangements in which both bio-objectification
and biovalue exploitation take place. In this sense, an economic regime of
biovalue exploitation is not only socially and politically shaping, but it is
also socially and politically shaped. Instead of considering bioeconomy in
its neoliberal market framework as a given, we should investigate the in-
Beltrame                                                                        85
stitutional arrangements, power relations, and agency of the collective
and institutional actors shaping the emerging economic regimes of
biovalue exploitation.




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