美國人奶售賣產業方興未艾

When Gretty Amaya took an unpaid maternity leave five months ago, she started what she calls a part-time job to help pay the bills. Ms. Amaya, who lives in Miami, has made more than $2,000 so far by pumping breast milk and selling what is left over after feeding her baby daughter.

格萊迪·艾梅亞(Gretty Amaya)在五個月前開始休無薪產假時，爲了增加收入，開始從事一項她所謂的“副業”。住在邁阿密的艾梅亞女士，靠賣襁褓中的女兒喝不了的母乳，已經賺到了兩千多美元。

Frozen milk from Ms. Amaya — and from hundreds of other women throughout the country — is flown here to what resembles a pharmaceutical factory. Inside, it is concentrated into a high-protein product fed to extremely premature babies in neonatal intensive care units, at a cost of thousands of dollars a baby.

艾梅亞擠出的人乳經冷凍後，被空運到一個類似藥廠的地方，全國其他幾百名女人提供的人乳也都送到這裏。這裏把母乳濃縮爲一種高蛋白製品，專門提供給新生兒特護病房中的早產兒使用，每個早產兒要爲此花費數千美元。

Breast milk, that most ancient and fundamental of nourishments, is becoming an industrial commodity, and one of the newest frontiers of the biotechnology industry — even as concerns abound over this fast-growing business. The company that owns the factory, Prolacta Bioscience, has received $46 million in investments from life science venture capitalists.

母乳是最古老、最基本的營養品，如今已經成爲一種工業品，成爲生物科技工業最新的前沿產品——儘管這項快速增長的生意存在着不少爭議。這家工廠是由普羅拉科塔生物科學公司(Plolacta Bioscience)公司開設的，該公司從生命科學領域的風險投資人那裏獲得了4600萬美元投資。

“This is white plasma,” said Scott A. Elster, the company’s chief executive. He was comparing milk to blood plasma, which has long been collected from donors and made into valuable medical products like immune globulin, which helps fight infections, and clotting factors for hemophiliacs.

“這就相當於白色的血漿，”公司首席執行人斯科特·A·埃爾斯塔(Scott A. Elster)將母乳比作血漿，長期以來，醫藥業從捐贈者那裏收集血漿，製成昂貴的藥品，諸如抗感染的免疫球蛋白，以及給血友病人用的凝血因子。

Concentrated milk could be just the start. Researchers say that breast milk, which evolved over eons to provide optimal nutrition and protect babies from infection, is brimming with potential therapeutics, not only for babies but possibly for adults, to treat intestinal or infectious diseases, like the bowel ailment known as Crohn’s disease, for example.

濃縮人乳可能只是個開始。研究人員稱，經歷了長期的進化後，母乳可以提供最優的營養，保護嬰兒不受感染，其中充滿各種療法的可能性，不僅僅可以用於嬰兒，或許也可以用於成人的腸道或感染性疾病治療，比如名爲克羅恩病(Crohn’s disease)的腸疾。

“We are at the tip of the iceberg for milk,” said Bruce German, director of the Foods for Health Institute at the University of California, Davis, and chairman of Evolve Biosystems. Evolve and some other small companies like Glycosyn, Jennewein Biotechnologie and Glycom are trying to develop products based on complex sugars that are abundant in breast milk and that appear to nourish bacteria in the digestive tract that are important to health.

“關於母乳的功用，我們還只是看到了冰山一角，”加州大學戴維斯分校健康食品研究院院長、進化生物系統公司（Evolve Biosystems）董事會主席布魯斯·日耳曼(Bruce German)說道。“進化”以及格里康辛(Glycosyn)、詹內懷恩生物科技(Jennewein Biotechnologie)、格里康姆(Glycom)等小公司都在研發基於復糖的產品，復糖大量存在於母乳之中，可以在消化道內培養菌羣，對健康非常有益。

But the commercialization of breast milk makes many people uneasy. They worry that companies might capture most of the excess breast milk and make products that would be too costly for many babies, while leaving less milk available for nonprofit milk banks.

但母乳的商品化令許多人感到不安。他們擔心這些公司可能會獲取絕大部分可用的剩餘母乳，用以爲其他嬰兒製造昂貴的物品，剝奪非盈利的“母乳銀行”的母乳來源。

“The competition comes in the form of how much surplus breast milk is there in the country and who’s getting it,” said Kim Updegrove, executive director of the nonprofit Mothers’ Milk Bank at Austin. “The nonprofit milk banks have a long history of providing milk to the sickest babies, and provide it based on medical need and not on insurance reimbursement or financial resources.”

“競爭源自這個國家的母乳剩餘量，以及由誰來得到它們，” 非盈利機構、奧斯汀“母乳銀行”的執行會長基姆·厄普德格洛夫(Kim Updegrove) 說道。“非盈利的母乳銀行會將母乳提供給最弱小的嬰兒，這是一種悠久的傳統，它們提供母乳是基於醫學上的需要，而不是基於保險賠償或經濟狀況。”

Debate is also intense over whether women should be paid for their milk or donate it altruistically. Opponents of payments, worried about breast milk “farming,” say women might try to increase their milk output unsafely, hide health problems that could make the milk unsafe, mix in cow milk to increase volume or deprive their own babies so they can sell more.

對於女人是否應當出售人乳，抑或應當無私地捐贈出去，也存在激烈的爭論。反對出售母乳的人擔心母乳的“農場化”，他們說女人可能會用不安全的方式增加母乳產量；隱瞞自己的健康問題，從而令母乳來源變得不安全；在母乳內摻加牛奶；抑或剋扣親生子女的食量，以便多賣一點母乳。

When Medolac Laboratories, a competitor of Prolacta, said last year that it wanted to buy milk from women in Detroit, it was accused of profiting at the expense of black women.

普羅拉特卡的競爭對手美多拉克實驗室(Medolac Laboratories)去年稱，公司希望從底特律的母親們那裏購買人乳，結果被控告爲損害黑人婦女利益而牟利。

“We are deeply concerned that women will be coerced into diverting milk that they would otherwise feed their own babies,” the Black Mothers’ Breastfeeding Association wrote in an open letter in January. Medolac, which said it was working with the Clinton Foundation and wanted to encourage breast-feeding by making it financially attractive, abandoned its plan.

“我們深切擔心女人會被脅迫進入提供母乳的行業，從而無法餵養自己的嬰兒，”1月，黑人母親母乳餵養協會(the Black Mothers’ Breastfeeding Association )在公開信中稱。當時正在與克林頓基金會(Clinton Foundation)合作，通過提供經濟援助來鼓勵母乳餵養的美多拉克公司表示，公司只得放棄原計劃。

Defenders of payments say that if companies are going to profit, it is only fair for them to pay the suppliers for their raw material, especially since pumping takes considerable time and effort. (Prolacta, which started paying only last year, was accused previously of not making clear to women that their milk donations were going to a for-profit company). Moreover, they say, the commercialization of breast milk could increase the supply available.

母乳交易的辯護者們認爲，如果公司要用母乳盈利，那麼只有向原材料的提供者付酬纔是公平的，特別是吸取母乳十分費時費力（普羅拉科塔公司只是在去年纔開始付費的，之前它曾被控告沒有對女人們澄清，她們所捐贈的母乳將會被盈利公司使用）。此外，他們說，母乳的商品化有助於增加母乳供應。

The American Academy of Pediatrics says that because of the “potent benefits of human milk,” all premature babies should receive breast milk, preferably from their mothers, but if not, then from donors. But there is not enough donor milk for that, experts say, partly because many women do not know that they can donate or sell excess milk.

美國兒科學會(The American Academy of Pediatrics )稱，由於“人乳的潛在好處”，早產嬰兒都應當食用母乳，最理想的來源是生母，但如果無法做到這一點，則應食用來自捐贈者的人乳。專家稱，但目前沒有足夠的母乳捐贈來源，部分原因是因爲很多女人不知道她們可以捐贈或販賣多餘的母乳。

Mr. Elster said Prolacta processed 2.4 million ounces, or 18,750 gallons, of milk last year and aimed to do 3.4 million this year. That compares to the 3.1 million ounces dispensed in 2013 by all 18 nonprofit milk banks that belong to the Human Milk Banking Association of North America. Those milk banks do not pay women for milk but do charge hospitals a few dollars an ounce to cover the costs of screening donors and pasteurizing the milk.

埃爾斯塔說，普羅拉科塔去年生產了240萬盎司，或18750加侖母乳（約合7萬升——譯註），今年計劃提供340萬盎司母乳。相比之下，2013年，18家屬於北美人乳銀行協會的非盈利母乳銀行分發了310萬盎司母乳。這些母乳銀行不向提供母乳的母親們付酬，但向使用母乳的醫院收取費用，主要是篩選捐贈者和對母乳進行消毒的成本費，大約每盎司幾美元。

Some women give milk directly to other mothers who need it, using milk-sharing sites like Eats on Feets. Some sell their milk to other mothers (or in some cases to male body builde rs who believe it builds muscle), through websites like Only the Breast, hoping to receive more than the $1 an ounce that Prolacta and Medolac pay. Some health authorities say direct sales or sharing pose risks because the milk is usually unpasteurized.

有些女人通過“Eats on Feets”等母乳分享網站直接向其他有需要的母親提供母乳。有些女人通過“Only the Breast”等網站把自己出產的母乳直接賣給其他母親（有時也賣給相信母乳能促進肌肉生長的男性健身者），普羅拉科塔和美多拉克等公司收購母乳的價格是每盎司一美元，在這些網站上出售母乳的價格要高一些。但是有些健康專家稱，直接販賣或分享母乳存在風險，因爲這些母乳通常並未經過高溫消毒。

Prolacta’s products are intended for extremely premature infants who weigh less than 1,250 grams, or 2.76 pounds, at birth, babies who can fit in the palm of a hand. Those babies need more nutrition than they can receive from breast milk alone.

普羅拉科塔的母乳製品是提供給體重在1250克（2.76磅）以下的極早產兒的，這樣的嬰兒出生後可以用一隻手掌捧起來。除了母乳，他們還需要更多營養。

Prolacta makes a fortifier containing high levels of protein, fats and minerals, which is used to supplement breast milk. It costs about $180 an ounce, and a baby would typically consume $10,000 worth over several weeks. Generally, the cost is paid by the hospital or insurers, not the parents.

普羅拉科塔公司的產品提供了加強營養，包括高蛋白、脂肪和礦物質，作爲母乳的補充。這種產品每盎司售價180美元，一個早產嬰兒通常在數週時間裏要吃價值一萬美元的該種製品。一般而言，這筆錢並不由父母支付，而是由醫院或保險公司承擔。

Although the fortifier is vastly more expensive than formulas or fortifiers made from cow milk, Prolacta argues that it saves money in the long run. Clinical trials it has sponsored suggest that by allowing tiny babies to avoid cow proteins, its product reduces the incidence of necrotizing enterocolitis, a devastating and costly infection that can require the surgical removal of part of the intestine.

儘管這種加強營養品比由牛奶製成的配方奶或者加強營養品昂貴，但據普羅拉科塔公司稱，從長期而言，使用它其實是更省錢的。公司贊助的臨牀試驗表明，這種製品因爲沒有讓小嬰兒食用牛乳蛋白，從而減少了壞死性小腸結腸炎的發病率，這種疾病後果嚴重，治療費用不菲，可能需要動手術切除部分腸道。

Mr. Elster said Prolacta, which is privately held and does not disclose its revenue, is growing 40 percent a year. He said its product was used by about 150 of the 900 neonatal intensive care units that care for these extreme preemies.

普羅拉科塔公司現爲私人所有，並未公開自己的收入，但埃爾斯塔表示，公司在一年內收入增長了40%。他還說，在900個早產兒特護病房中，有150個都使用該公司的產品。

But not all doctors are persuaded, and others say that while they would like to use the product, it is too expensive.

但他們並沒有說服所有的醫生，有些醫生稱，他們倒是願意使用這種產品，但它實在太貴了。

“I’ve been stymied by the cost equation,” said Dr. Jae H. Kim of the University of California, San Diego. He said his hospital spends no more than $25,000 a year for donor milk for all babies. Adding Prolacta’s fortifier for just the 50 to 70 extremely premature infants each year would cost more than $500,000.

加州大學聖迭戈分校的基伊·H·基姆(Jae H. Kim)醫生說，“成本平衡令我困擾。”他還表示，自己的醫院每年花費不到2.5萬美元，用來處理捐贈而來的母乳，提供給所有嬰兒。然而如果僅僅是對50到70名極早產兒使用普羅拉科塔的加強營養品，每年就要多花50萬美元。

Each batch of milk arriving at the $18 million factory here, outside Los Angeles, is tested for viral infections, nicotine, drugs of abuse, dilution and adulteration by cow’s milk. The women who supply the milk take blood tests for infectious diseases, must provide notes from doctors saying they and their baby are healthy and must furnish DNA samples to verify that their milk came from them.

每一批母乳都來到洛杉磯城外那座價值1800萬美元的工廠進行檢驗：是否有病毒感染、是否含尼古丁、過量藥品、是否經過稀釋、是否摻加牛奶。提供人乳的女人要經過血檢，以便排查傳染病，還必須提供醫生證明，證實她們和她們的嬰兒身體健康，並需提供DNA樣本，以便驗證人乳的來源確實爲她們本人。

“Even the vitamins you take you have to report to them,” said Ms. Amaya.

“連你吃的維生素都得申報，”艾梅亞說。

Prolacta now faces competition from its own founder, Elena Medo, who left in 2009 and started Medolac, which is based in Lake Oswego, Ore. Prolacta sued Ms. Medo in January, accusing her of “absconding” with its customer list. Ms. Medo called the suit “extremely anticompetitive and certainly unjustified.”

普羅拉科塔如今面對競爭，對手正是該公司的創始人伊莉諾·美多(Elena Medo)，2009年，她離開普羅拉科塔，在俄勒岡州的奧斯威戈湖創立了美多拉克。1月，普羅拉科塔控告美多攜帶公司客戶名單“潛逃”。美多說這起案子“完全是反競爭的，根本不公平”。

Medolac’s first product, which it sells to hospitals, is donor milk that is sterilized rather than pasteurized, so it does not have to be frozen or refrigerated.

美多拉克的第一件產品是賣給醫院的，它使用經滅菌處理的捐贈母乳，而非使用巴氏消毒法，因此無需冷凍或冷藏。

A third competitor could be Glenn Snow, who founded the milk-selling website Only the Breast. He has started a company, International Milk Bank, to buy the milk offered on that website and turn it into products for hospitals.

第三個競爭者可能是母乳交易網站“Only the Breast”的創始人格倫·斯諾(Glenn Snow)，他已經開了一家名爲“國際母乳銀行”的公司，通過網絡購買母乳，並將它製成產品，賣給醫院。

“It’s a fascinating industry, and it’s brand-new,” he said.

“這是很棒的產業，而且是嶄新的，”他說。

The next frontier could be the complex sugars in milk. Glycosyn, Jennewein and Glycom, which has worked with Nestlé, are trying to synthesize them to make products that would nurture a healthy gut “microbiome.” Prolacta and Medolac say their ability to collect milk nationally will allow them to extract those sugars from the milk.

下一項研究前沿是人乳中的復糖。格里康辛、詹內懷恩與格里康姆與雀巢公司合作，試圖人工合成這些復糖，令產品中含有有益健康的“微生物菌羣”。普羅拉科塔和美多拉克稱，在未來，他們在全國收集人乳的能力可以令他們足以將這些糖類從人乳中提取出來。

Until now, “there’s never been enough milk in one place to be able to do it,” Ms. Medo said.

迄今爲止，“在單一地點收集的母乳數量都足以進行這項研究，”美多說。