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Bioethicist and industry spokesman on the baby business

Posted by Jesse Reynolds on March 3rd, 2009

Following on stories from the Associated Press on the absence of regulation in the fertility industry and from the Wall Street Journal on genetic selection for skin, hair, and eye color, a news article today raises further questions about America's "wild west" field of assisted reproduction. My colleague Marcy Darnovsky was cited in Suzanne Bohan's piece, which was published both in a group of thirty Northern California newspapers and as a shorter version delivered by the UPI wire.

Two other cited individuals are worth noting, as well. The prominent bioethicist Art Caplan drew the connection from the assisted reproduction industry to both eugenics and the profit motive:

But the nature of the business calls for tighter oversight, said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania and a regular MSNBC commentator....

Caplan has long favored an oversight system for fertility clinics modeled on those governing blood- and organ donation services. Caplan helped establish the latter, the United Network for Organ Sharing, in the 1980s. It consists of an advisory board, and works on contract with a federal health agency. The United States is also one of only a handful of developed countries without laws regulating specific treatment protocols in fertility clinics, such as the number of embryo transfers or screening embryos for sex selection.

And the high rate of multiple births isn't the most vexing concern for Caplan. What alarms him is the prospect of fertility clinics offering services to endow offspring with extra intelligence, athletic ability, or physical attributes. A procedure called preimplantation genetic diagnosis, or PGD, already is used to screen for sex selection at many clinics in the United States, as well as for genetic abnormalities.

''PGD is the single most controversial subject to ever face this field because you get right back to the eugenics issue,'' he said, referring to a movement that arose in the early 20th century that called for the promotion of certain traits among humans, and the reduction of others....

''The industry sees this not just as inevitable, but incredibly lucrative,'' Caplan said.

He took a similar line on Fox News this morning:

Sean Tipton, the spokesperson for the American Society for Reproductive Medicine, was in a more awkward position. The ASRM issues guidelines, whose flexibility it defends as necessary for doctors to adapt to particular cases. However, the guidelines appear to be violated by 80% of fertility clinics.

Regarding whether it's likely that four out of five cases could merit exceeding the guidelines due to unusual challenges in conceiving, he said the society couldn't second-guess doctors' decisions.

''We don't like to assume,'' Tipton said.
And when asked about the potential for PGD to select for nonmedical characteristics - a practice contrary to his organization's guidelines - Tipton only deferred to the mantra of parental choice:
Tipton, with the reproductive society, said it wouldn't comment on a technology not yet in use, other than to say, ''We are generally in favor of physicians providing good, understandable information, so patients can make the best decision for their families.''

California Senator on fertility industry regulation

Posted by Jesse Reynolds on March 3rd, 2009

Sen. Negrete McLeod

A California state senator has taken action toward providing oversight for the state's unregulated fertility industry. Gloria Negrete McLeod (D-Chino) introduced SB 674, which would define fertility clinics and egg extraction sites as "outpatient settings," bringing them under the jurisdiction of the Medical Board of California and establishing accreditation standards and guidelines for their operation. In a press statement, Sen. Negrete McLeod said, "It is alarming that the State of California has no one watching out for patients who go to these fertility clinics or surgical centers.  There should be a greater level of scrutiny over these clinics because of their increasing popularity."

The district of Sen. Negrete McLeod is just a few miles from the home of the mother of the recent octuplets. The senator is also the former chair of the California Legislative Women's Caucus. A few years ago, she introduced a bill which would have brought conflict-of-interest provisions to the state's stem cell research agency.

National Academies of Science Takes on Forensics

Posted by Osagie Obasogie on March 2nd, 2009

The National Academies of Science (NAS) has released a report on the tragic state of criminal forensics. Strengthening Forensic Science in the United States has been received by many as a scathing critique of pretty much every modern forensic technique used in criminal investigations, including ballistics, blood splatter analyses, and fingerprint techniques. The NAS committee rightly calls for establishing a new agency independent of the Justice Department to oversee law enforcement’s use of forensic techniques. Attorney General Eric Holder is currently reviewing the report.

This has been a long time coming; many experts in the field of forensic science have been calling into question the techniques used to put thousands of people behind bars without any independent verification of their validity. Unfortunately, however, the report does not give as much scrutiny to the emerging issues surrounding DNA forensics despite several unresolved questions and growing ethical concerns. For a more detailed description, check out Chapter Three of the new CGS report Playing the Gene Card? A Report on Race and Human Biotechnology

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Even before the octuplets, there was one-at-a-time-dot-org

Posted by Marcy Darnovsky on February 27th, 2009

A silver lining of the octuplets-induced media storm is the attention it's rained on efforts to reduce the numbers of twins, triplets and beyond that IVF creates. This is a goal driven by the startlingly high risks of IVF multiples for mothers and babies. It's shared by nearly all reputable fertility doctors, and endorsed by the voluntary guidelines [PDF] issued (but not enforced) by the American Society for Reproductive Medicine.

Thankfully, the trend is in the right direction. But the US still lags very far behind the countries that take a less laissez-faire approach.

Of course, in most of those countries health insurance covers the basic cost of IVF treatment, so patients feel a lot less desperate about getting pregnant on the first try. (In fact, it turns out that transferring multiple embryos barely boosts success rates, but misconceptions - so to speak - are widespread.)

The latest available US figures, for 2006, show that "single embryo transfer" - which is recommended for most women younger than 35, and which does not significantly reduce the rate of successful pregnancies - was used in only 3.3% of cycles. By contrast, single embryos are transferred in 60% of cases in Finland, and in 70% of cycles in Sweden. Unsurprisingly, that pushes twin rates way down and makes triplets very rare.

In the UK, the government agency that regulates assisted reproduction (the Human Fertilisation and Embryology Authority) recently issued rules requiring fertility clinics to reduce their multiple birth rates from the current average of 24% to 10% by 2012. And a group of British assisted reproduction experts, professional organizations, and patient groups has launched an attractive and persuasive campaign called "One at a Time." Its website about the IVF-multiples situation compiles current numbers and trends, documents the risks, and calls clearly for the remedy - the eponymous "one at a time."

Previously on Biopolitical Times:

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