These problems were all resolved with SPDRs Gold Trust (ticker symbol GLD). Greg Mulhauser is probably the most authoritative contributor here on the topic of exchange-traded products, and I recommend reviewing this thread:
https://bitcointalksearch.org/topic/winkelvoss-etp-could-become-the-pricing-mechanism-for-btc-252330
Yes, the market value of Realcoin may deviate from its net-asset value (NAV), but this is the mechanism that is used to either grow or shrink the trust (assuming it's modelled after GLD). Any deviation from NAV is a risk-free arbitrage opportunity for the authorized participants, and so will be closed very quickly.
Here's how it works in the case of the Winklevoss ETF:
Now imagine bitcoin is trading at $500 on BitStamp, but the ETF shares are trading at $550 on NASDAQ. Since 1 share = 1 bitcoin (in our example), there is an arbitrage opportunity. Someone can short-sell 10 ETF shares for $5500 and take $5000 from the proceeds and buy 10 bitcoins from BitStamp. So now this person has $500 cash, a debt of 10 ETF shares and 10 extra bitcoins. He then calls up the bitcoin ETF and says "as an authorized participant, I want to execute my right to swap these 10 bitcoins for 10 newly-issued ETF shares." The ETF is obliged to take the bitcoins and issue him new shares in return. The arbitrager then uses these 10 new shares to close his short position, profiting by $500.
The net result was that the ETF's bitcoin holdings increased by 10 BTC and the arbitrager earned a risk-free $500 profit.
The same thing can also happen in reverse: if the ETF price is lower than the BitStamp price, arbitragers will do the opposite thing and coins will flow out of the ETF.
A bitcoin ETF trading on the NASDAQ would have a significant effect on the bitcoin market.
http://thismatter.com/money/mutual-funds/etf.htm