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Reactions to the octuplets

Posted by Jesse Reynolds on February 4th, 2009

It's not difficult to have an opinion about last week's birth of octuplets near Los Angeles.

The 33-year-old mother already has six children, aged seven and younger, one of whom is autistic. She is an unemployed student (ironically, with a degree in child and adolescent development) and lives with her parents (who recently filed bankruptcy) in a 1500 square foot three-bedroom house. All her children were conceived by IVF. She has hired a publicity agent, and seeks $2 million for an interview. Her mother, the grandmother of the babies, reports that her daughter is "obsessed with children" and was "just hoping for one more daughter." A friend mysteriously reported that the woman could afford the fertility treatments because she was paid for them.

Will the octuplets be the tipping point toward serious consideration of regulation for the assisted reproduction industry? Might the U.S. baby business be ready to leave its Wild West days behind?

Here are some comments reported in the media:

David Magnus, Stanford Center for Biomedical Ethics:

[I]f the octuplets were produced through in vitro fertilization, it would spotlight the poorly regulated infertility and reproduction field. "This is a huge problem," Magnus said. "You've got a virtually unregulated marketplace with tort law serving as regulation in the U.S."….The professional organizations should take a stricter line with doctors and clinics, he said. "They've been very loath to take that action." But "if you leave it up to the marketplace," he added, "there will be abuses."

Art Caplan, Center for Bioethics at the University of Pennsylvania (1, 2):

"She has a right to be left alone to decide for herself whether to have a baby. But that doesn't entitle you to the technology involved here."

"Anyone who transfers eight embryos should be arrested for malpractice."

Linda MacDonald Glenn, Women's Bioethics Project Scholar:

"Hopefully, this case will call attention to the need for regulation and oversight of Assisted Reproductive Technologies. Currently, we have a laissez-faire attitude towards ARTs and fertility clinics; we have trusted the doctors and clinics to regulate themselves, via the American Society for Reproductive Medicine - and this case demonstrates that we can no longer simply turn a blind eye."

M. Sara Rosenthal, bioethicist at the University of Kentucky's College of Medicine:

"[T]here's wide consensus from every single ethicist and fertility specialist that this was irresponsible and unethical to implant that many embryos. This is an outrageous situation that should not happen."

Dr. Geeta Swamy, assistant professor of obstetrics and gynecology at Duke University:

"But it really is still up to the individual physician. There aren't any laws or legal ramifications to it."

R. Dale McClure, MD, President, American Society for Reproductive Medicine:

"[T]ransferring eight embryos in an IVF cycle is well beyond our guidelines."

Sean Tipton, American Society for Reproductive Medicine spokesman (1, 2):

"While the early press coverage touted the successful delivery of the octuplets as a happy, joyful thing, high-order multiple births should never be considered a medical success story. A number of commentators are saying a woman with six kids should not be allowed medical treatment to have additional ones, and I think, at a common sense level, that makes good sense. However, to make that work, that means someone is going to start deciding for other people how, when and why they can have children. That's a very big step and one that we might not be prepared to take."

"We have no legal authority to stop someone from practicing."

Suleena Kansal Kalra, reproductive endocrinologist, University of Pennsylvania:

"It's a complete failure when something like this happens, a poor reflection of what we do...To put this many embryos back in a woman who is so young and had proven fertility is completely irresponsible."

Lynn Paltrow, Executive Director, National Advocates for Pregnant Women (via an email to Salon):

What I would check if I had the time is the extent to which coverage of this story - whether negative or positive - is framed as a question of ethics. When the pregnant woman is not brown or black and the drugs/technologies are provided by big pharma, the discussion focuses on questions of ethics. But if the issue is childbearing by low-income women of color, and the drug is homegrown/ illegal then the debate is a question of punishment through the criminal justice or civil child welfare system.... [W]omen who take fertility drugs and choose to carry three or more embryos to term often experience pregnancy loss and risk severe, lifelong harm to the children who survive."

Lisa Factora-Borchers at the blog of Bitch magazine:

"[I]f the feminist movements want to analyze her decision and talk about the ramifications of choosing this path of motherhood, I understand the need to pick the situation apart. What I don't understand is how her ability to choose is deemed wrong because she made a decision that most people would not have chosen. It's important to remember what women who came before us fought for and I'm pretty sure it was the right to choose not WHAT to choose. While we don't know all the circumstances, we know that she exercised a right that generations before us have fought so long for: accessible healthcare, reproductive health with knowledge, and, ultimately, the choice to make decisions about our own lives.
There's something to celebrate there."

Ann at the Feministing blog:

"That this was [the mother's] choice and she seems very happy, so that's that."

Richard Paulson, director of the fertility program at the University of Southern California, who helped write the American Society for Reproductive Medicine guidelines:

"We're picking out this incredibly rare event, and all of a sudden, we want to pass laws," says Paulson. "Would we write laws limiting the size of someone's family to six? Would we write laws mandating selective reduction?" he asks, referring to the option of aborting some embryos if a high number successfully implant in the uterus. "Restricting reproductive rights would be a minefield."

Brendan O'Neill, editor of Spiked:

"However, the implication behind the widespread denouncement of Suleman's doctors as 'irresponsible', 'negligent' and even 'criminal' is ominous indeed. Are we saying that doctors should decide which women are desirable for IVF treatment and which are not? That they should limit the choices of those women who are 'unmarried, unemployed' and who already have kids at home? And those who have 'no money, no job', too?"

Amy Tuteur, "The Skeptical OB":

"The "choice" is the decision to have an abortion, and it does not extend to any possible choice in reproductive ethics. That's why Nadya Suleman had a right to get pregnant, a right to terminate the pregnancy and a right to carry it to term. She had no right to deliberately conceive octuplets, however, and it is a misunderstanding of reproductive rights to claim that she did....
In the rush to protect abortion rights, people should not ignore the rest of medical ethics. The right to end a pregnancy does not confer the right to begin one using artificial means. The right to selectively reduce a multiple pregnancy does not confer the right to create a multiple pregnancy of any number of embryos. In fact, the right to control one's body does not confer the right to demand medical treatment of any kind if it is not medically indicated.
The "right to choose" is the right to choose to terminate a pregnancy; it does not confer a right to choose anything, even if it is a reproductive choice."

George Dvorsky, transhumanist:

Now, I'm a huge advocate of reproductive freedoms and equal access to repro-tech, but something clearly failed to happen here. In this case, the fertility clinic that performed the procedure failed to exercise both restraint and common sense. They also showed a complete disregard for guidelines - a strong indication that, while regulation exists for repro-tech procedures, it's not being enforced strongly enough. This needs to change...A lassez-faire approach to repro-tech won't work to protect the interests of those hoping to use these technologies and to protect those lives that are created as a result.

Update: See more recent quotes (Feb. 10)

Potential payment for eggs in New York: An update

Posted by Jesse Reynolds on January 30th, 2009

On Monday, the ethics committee of New York state's stem cell research program met, and among its the agenda items was consideration of payments for women to provide eggs for stem cell research. CGS and the Pro-Choice Alliance for Responsible Research sent a letter to the committee urging them to reject payments, and Newsday published an op-ed which I authored with the same message.

However, the committee spent most of its time on developing proper informed consent procedures, and deferred consideration to its next meeting. A video of the meeting is available online.

An industry-funded "awareness" campaign

Posted by Jesse Reynolds on January 30th, 2009

An intriguing variety of marketing involves promotion through public awareness campaigns. Sometimes these campaigns are undertaken by sectors with numerous small producers, none large enough to advertise on its own - think Garrison Keillor's imaginary "Ketchup Advisory Council." Other times the motivation is that consumers may not feel comfortable receiving overt advertising for a particular product or service. Pharmaceutical companies, for example, "help make people aware" that they may unknowingly suffer from a condition or carry a potentially dangerous gene.

Newsweek's Claudia Kalb reports on a new campaign to educate women about their so-called "biological clocks." While her story focuses on the campaign's informal, Web 2.0, and viral nature, her final paragraph touches on the self-interest of its organizer, the American Fertility Association, and its primary funder, a pharmaceutical company that makes drugs used in assisted reproduction:

Like other informational events, the AFA's program isn't purely altruistic. It was launched with $25,000 from drug maker Schering-Plough, which makes the fertility drug Follistim. Other sponsors include a New York-based pharmacy that provides fertility prescriptions and several fertility clinics. Doctors who lead the discussions are asked to make a donation to the AFA, and gift bags that will be given to attendees will contain handouts from the sponsors as well as educational information. [AFA's director of development Corey] Whelan is matter-of-fact about the AFA's need for financial support for their infertility prevention program, which is free to the women who attend. But, she insists, "We're trying to decrease the patient population, not increase it."
While the AFA engages in a number of broad fertility-related activities, such as adoption referrals, it is primarily an industry organization, as its list of sponsors indicates.  I am skeptical that the AFA and its new fertility "awareness campaign" are meant to "decrease the patient population." This has the appearance of an attempt to drum up business for profitable high-tech solutions.

This has been tried before. In 2001, the American Society for Reproductive Medicine launched a similar campaign. (In fact, its website is still online.) Although the ASRM is more focused on assisted reproduction than the AFA, its campaign emphasized that behaviors such as smoking and unsafe sex can affect one's fertility later. Yet then, some  feminists were uncomfortable with the ASRM’s message. Kim Gandy, president of the National Organization for Women (NOW), said:
Certainly women are well aware of the so-called biological clock. And I don't think that we need any more pressure to have kids.
She wrote in an op-ed:
NOW commends the good doctors for attempting to educate women about their health, but we think they are going about it in the wrong way - by blaming individual women and their behavior for a problem that is caused by many factors, some behavioral, but most not. The ASRM gets free publicity, and women are, once again, made to feel anxious about their bodies and guilty about their choices.
Greater understanding among prospective parents about the inevitable decline of their fertility would be a good thing. Too often, a mistaken image of perpetual fecundity is promoted by assisted reproduction technologies and by media coverage of celebrities producing children well into their forties with no apparent problems. Unfortunately, an industry endeavor such as the AFA's will likely continue the trend.

From cellular reprogramming to human genetic modification

Posted by Jesse Reynolds on January 30th, 2009

Amander Clark, whose lab performed the research

A team of stem cell researchers has produced precursors to gametes from induced pluripotent stem (or iPS) cells, which in turn are reprogrammed from normal body cells. The health blog of the Los Angeles Times reports on an upcoming scientific paper from a lab at the University of California, Los Angeles.

My colleague Marcy Darnovsky has previously expressed concerns (1 [PDF], 2) about artificial gametes, particularly around safety issues and the promotion to gays and lesbians of extreme - and risky - methods of assisted reproduction. This latest development raises another: While iPS cells may resolve quandaries about embryo destruction and egg acquisition, they could also be a path towards human genetic modification. Under the present technology, in fact, iPS cells are produced via genetic modification. Of course, any proposals to create babies through artificial gametes, especially with the current genetic modification and viral vector methods, are a long way off. But when, and if, they come, let's hope that policies to prevent potential abuses are in place.

[HT to AJOB Blog.]

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