Ad now appearing in campus newspapers including UC Berkeley and Columbia
Press releases issued this week by two fertility companies bespeak changing - and troubling - dynamics in the growing commerce surrounding women's eggs.
In a February 11 statement, a Charlotte, NC fertility company called REACH announced an "urgent call for egg donors" and said that it is "eyeing far more aggressive means to recruit young women for egg donations in 2008." The press release is suffused with a tone of emergency about the "alarmingly widening gap between supply and demand" and the "spiraling" wait times "for older couples wanting to start families."
But there is no similar sense of urgency on the company's "What to Expect" web page for prospective egg donors. There, not a single risk or side effect is mentioned, though the known short-term risks are significant (and include, rarely, death) and the lack of data about long-term risks is notorious.
While the Charlotte fertility company seeks to grow its business via the now-traditional model of recruiting young women to provide eggs for people who are undergoing in vitro fertilization, emerging ventures are targeting a new demographic: fertile women who choose - or can be persuaded - to postpone childbearing until their 40s or beyond. Offers to freeze women's eggs for later use - after advancing a career, or meeting the partner of one's dreams - now litter the Internet, despite the experimental nature of egg-freezing technology.
One new egg-freezing venture is a partnership between a company called Extend Fertility and a Seattle fertility clinic. According to their joint press release, they will be offering "the first elective egg freezing service" in the Pacific Northwest. Unsurprisingly, Extend Fertility plays up the "freedom" and "empowerment" that putting eggs on ice offers to women, and plays down the risks of extracting them in the first place. "Egg harvesting is a proven, safe procedure," its website states.
Extend Fertility also minimizes the experimental status and highly uncertain outcomes of egg freezing, referring repeatedly to "breakthroughs" and offering "client testimonials" from women who have frozen their eggs (though not from any who have thawed and used them to make babies).
Extend Fertility's website declares that it "adher[es] to the strictest medical and ethical standards," and implies that its service is approved by the American Society for Reproductive Medicine, the fertility industry's trade and lobbying group. But it doesn't mention that ASRM recently concluded that while egg freezing may be appropriate for women undergoing chemotherapy that is likely to damage their eggs, it is an experimental technique and "should not be offered or marketed as a means to defer reproductive aging."
Is anyone out there looking for a case study in the need for regulation and oversight?
Your faithful bloggers here at Biopolitical Times are not the only ones with an eye towards the intersection of biotechnology and politics. The cover of a recent issue of New Scientist caught my eye, featuring a crowd of individuals colored red or blue (representing American Republicans and Democrats) with the large caption, "Two tribes: Are your genes left-wing or right-wing?" This conveniently captures almost all that is wrong with media coverage of genetic discoveries. It implies that that genes code, directly and in one of only two ways, for variations in modern social behaviors.
The article itself, though, is more balanced. It offers a summary of research indicating that political preferences may have a significant genetic component. The underlying thinking is that genetic differences can influence general behavioral characteristics such as openness to new experiences, conscientiousness, and extroversion, which in turn impact political orientation and engagement. While there is some evidence of such a relationship, investigation into behavioral genetics contain fundamental shortcomings. The article brought up some:
But some studies linking biology to political attitudes need to be taken with a pinch of salt. One recent brain-scan study, published in The New York Times as an opinion piece, was pilloried in the press for being marketing, not science. The study was criticised in part because the researchers involved had links to FKF Applied Research, a firm which employs brain scanning in its market research work. And there is no shortage of critics who question the whole idea of linking politics with biology. Personality studies in particular have been singled out as sloppy science, in part because qualitative traits like openness cannot be measured in the way that height or eye colour can. To gauge personality, psychologists generate a series of questions designed to measure the trait of interest. Asking a subject whether they "jump into things without thinking" is one way to measure openness. But some of the questions on the tests assess issues that are political in nature, such as a subject's views about foreigners. If this is the case, "the correlation is completely circular", says Evan Charney, a political scientist at Duke University in Durham, North Carolina.
Even with these caveats, such research has disturbing social implications - and the New Scientist article only makes this potential worse. My greatest concerns is that accepting that genes determine political orientation could cause deepening political apathy. The article opens and closes with this:
The race to become the most powerful politician on earth is well under way, and the US is gripped by election fever. In newsrooms and bars across the land, liberals and conservatives are slugging it out, trying to convince each other that their way of thinking is right. They may be wasting their breath....
So the guy at the bar may never agree with you, but perhaps realising that can be liberating. "We spend a lot of energy getting upset with the other side," says [Rice University political scientist John] Alford. We often think our opponents are misinformed or stubborn. Accepting that people are born with some of their views changes that, Alford points out. Come to terms with these differences, and you can spend the energy now wasted on persuasion on figuring out ways of accommodating both points of view.
Heck, why bother voting when you could just have your cheek swabbed?
The fact is, some contrasting points of view can't be "accommodated" or reconciled. Society works through some of these differences through politics. It's not always pretty, but it is necessary to a functioning democracy. And while some individual tendencies may have genetic components, history unambiguously indicates that ideas which are more persuasive and backed by better organizing become not only policy, but also widespread social norms - at least until the next ones supersede them.
Not only have less than two in five US medical schools implemented recommended policies governing institutional conflicts of interest, but those recommendations - from the US Department of Health and Human Services - don't address conflicts on the Institutional Review Boards that offer ethical approval for research involving human subjects. And the IRBs are often not informed of conflicts of interest by the researchers seeking approvals of their protocols. That's the take-home message of a blog post by Merrill Goozner, who cites results from a survey released in the new issue of the Journal of the American Medical Association.
Does disclosure of conflicts of interest to members of an IRB -- whether they exist within the institution, the management of the institution, or within the IRB itself -- ensure that the trial under review adheres to the highest ethical standards? Isn't it possible that those conflicts will influence the review? And doesn't the mere presence on the IRB of someone with a stake in the outcome of that trial create the appearance that the conflict of interest may have influenced a decision?...
There is a solution, of course. Forget about "guidance." Congress could step in and pass a law that prohibits investigators or university officials with conflicts of interest from sitting on IRBs and requires NIH to collect conflict-of-interest disclosure data from grant recipients and post it on its grants database (it's known as the CRISP database). To enforce the law, NIH could cut off all federal grants to that institution if those policies aren't adopted by a date specified in the legislation.
New Zealand and the U.S. are the only countries in the developed world that allow drug companies to peddle their prescription wares directly to the public. According to the Government Accountability Office, Big Pharma spent $4.2 billion on direct-to-consumer advertising in the U.S. during 2005 - and that already staggering sum is expanding at about 20% per year, which would put it at $7.25 billion in 2008. Lawmakers in several states have attempted to regulate or restrict the practice, mostly unsuccessfully.
Pharma is also eyeing other markets, and has mounted a major lobbying campaign to allow direct-to-consumer ads in Europe and Canada. Last week, the European Commission, which drafts legislation for the European Parliament, announced a public consultation [PDF] about a proposal to allow drug companies to put "non-promotional information" about prescription drugs on radio and television.
By opening the debate on drug company information provision, the EC is kowtowing to pharma industry's demands to advertise directly to consumers. This is the first step towards US-style drug advertising and concepts such as 'Pharma TV'. Prescription drugs are not washing powders and should not be sold as such. The EC must protect the right of European consumers to independent, impartial information about healthcare.
Want a more scholarly assessment? A 2007 study in the Annals of Family Medicine concluded:
Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.
The Marketing Overdose campaign has produced several short videos - some serious, some spoofs. The drug ads - clearly a tempting target - are also satirized by the U.S. Consumers Union, in the clip embedded here.