History

Techno Baby Steps

Fears of revolutionary scientific changes are greatly exaggerated

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In the past month, a coterie of prominent naysayers have strongly condemned a new biomedical advance as going dangerously beyond what they regard as the ethical pale. While shrouded in the usual mystifying and hyperbolic rhetoric–we're creating Aldous Huxley's Brave New World! say critics–such attacks on what most people view as progress are instructive. The critics argue that science and medicine are advancing at a rate that far outstrips our ability to make wise and informed decisions. The only proper course of action, they say, is to stop what we're doing immediately.

This point of view packs a certain emotional wallop, but it is based on a completely mistaken understanding of how societies actually develop and adopt new technologies. History has repeatedly demonstrated that, far from promiscuously embracing every new scientific and medical procedure that comes along, societies incorporate them gradually and incrementally–and while working out important practical and ethical concerns.

The latest advance to prompt criticism took place earlier this year at St. Barnabas Medical Center in New Jersey. Researchers there helped several couples to have children using a technique called cytoplasmic transfer. The women were infertile due to a defect in the cytoplasm of their eggs (cytoplasm is the cellular material outside of the nuclei of cells). A doctor introduced cytoplasm from donor eggs into the women's eggs. Revitalized by the cytoplasm transfer, the eggs were fertilized, inserted into their mothers' wombs, and brought to term. Couples made happy by the advance of scientific knowledge, right?

Absolutely not, according to bioethicists Erik Parens of the Hastings Center and Eric Juengst of Case-Western Reserve University. In an editorial published in the April 20 Science, they objected because when cytoplasm is transferred, the minute energy-producing organelles called mitochondria are also transferred. While the vast majority of a cell's genes are confined to its nucleus, mitochondria do have their own tiny set of genes which pass down through generations. So cytoplasmic transfer is, say the bioethicists, "the first case of human germline genetic modification resulting in normal healthy children." While Parens and Juengst wrote that they "admire the therapeutic result of oplasmic transfer," they added that "we hope that before any other inadvertent steps are taken toward making IGMs [inheritable genetic modifications], those interventions will receive the public discussion they deserve."

Parens and Juengst's piece was followed a month later by another editorial in Science. This one was an explicit call for a federal ban on any germline research, including cytoplasmic transfer. The authors were Audrey Chapman, who heads the American Association for the Advancement of Science's Dialogue on Science, Ethics, and Religion program, and Mark Frankel, who heads the AAAS' Scientific Freedom, Responsibility, and Law program. They justified their proposed ban by pointing to the allegedly "rapid pace of biomedical research [that] has seriously challenged society's ability to make informed and reasoned choices about whether and how to proceed with its development and use."

There's simply no evidence for that view. Technological leaps and scientific revolutions generally take place one technical baby step and one modest lab result at a time. This relatively slow process gives scientists and the public time to think about and understand the ramifications of what is being discovered. Hence, it took nearly 50 years to get from transistors to supercomputers, and from the structure of the DNA double helix to decoding the human genome.

Or consider the incremental nature of biomedical progress in relation to human reproductive technologies. The first step toward in vitro fertilization arguably took place in 1779, when Italian scientist Lazzaro Spallanzani, experimenting with frogs and dogs, proved that sperm was necessary for fertilization. Shortly thereafter, Scottish surgeon John Hunter performed the first human artificial insemination, using a syringe filled with the husband's sperm. The first artificial insemination using donor sperm was attempted in France in the mid-19th century (and not without controversy—children born using artificial insemination with donor sperm were considered illegitimate).

In the U.S., a scandal erupted in 1908 when Dr. Addison Hard revealed that he had been used a quarter of a century earlier as a sperm donor to fertilize a woman whose husband was infertile. The husband knew, but the wife, who was under anesthesia when the procedure was performed, had not been told (thus the scandal). In 1974, the American Bar Association devised a widely adopted statute which held that if a wife uses donor semen to become pregnant with her husband's consent, then the husband is the natural father of the child. Today, thousands of American women, both single and married, use artificial insemination to become pregnant each year.

Louise Joy Brown was the first human baby born by means of in vitro fertilization, in which human eggs are fertilized outside of a woman's body. That happened in Britain on July 25, 1979. Animal geneticist Robert Edwards had developed in vitro techniques in mice in the 1960s. In the 1970s, he joined with gynecologist Patrick Steptoe to adapt the mouse protocol as a way to help infertile people. Today, some 300,000 children worldwide are born each year through the use of in vitro fertilization techniques. Once controversial, recent polls show that 75 percent of Americans approve of in vitro fertilization as a way for couples to overcome infertility. In 1992, researchers in Belgium developed intracytoplasmic sperm injection (ICSI) as a method for overcoming infertility in men with poor sperm function. ICSI differs from standard in vitro fertilization because doctors inject a single sperm into an egg to fertilize it, as opposed to simply allowing sperm to compete for fertilization in a petri dish.

Then there's surrogate motherhood, which is arguably as ancient as the Old Testament story of Sarah and Hagar, in which Hagar served as the surrogate mother for Sarah and Abraham's child, Ishmael. Twenty-one years ago in Kentucky, the first baby was born to a surrogate mother who had legally contracted to bear one for a couple. The wife was unable to have children, so the surrogate was artificially inseminated with the husband's sperm. The first successful gestational surrogacy, in which an embryo was transferred to the womb of a second woman who had no genetic relationship to it, occurred in 1985.

The point of the above potted history of reproductive medicine is that each technological step was incremental and was generally only taken when the methods have been shown to be safe and effective through animal research. As important, individuals and social and legal institutions responded to and guided the changes. The results, most would have to agree, have been overwhelmingly positive, with more people able to pursue more options.

However, where many see steady incremental progress toward healing more and more human ills, others see a slippery slope down which a hapless humanity is uncontrollably sliding. At nearly every step in the history of reproductive medicine, critics stood firm against the new techniques. They argued that "society" disapproved, that the new ways were contrary to the will of God, and that using them would cause grave ethical difficulties.

This was not only true for new reproductive techniques but also for contraceptive technologies. The rubber condom, introduced by Goodyear in 1844, was eventually outlawed in 1873 by the Comstock Law, which made contraceptive advertising illegal and permitted the Post Office to confiscate condoms sent through the mail. Of course, the birth-control pill, arguably the most significant reproductive technology ever invented, was outlawed in many states when it was introduced in 1960.

But despite the worries of the naysayers, we have shown ourselves to be quite capable of resolving the issues raised by the advent of these technologies. We've done a good job of determining parental responsibility for in vitro children, crafting enforceable surrogacy contracts, and so on.

Which brings us back to our starting point: the calls for a ban on cytoplasmic transfer because the process has, according to the AAAS's Audrey Chapman and Mark Frankel, "seriously challenged society's ability to make informed and reasoned choices."

Such calls are wholly ahistorical; there is simply no evidence that the pace of biomedical research is outstripping our ability to resolve issues surrounding the new techniques. As important, why is "society" the right level at which to decide whether or not to use new therapies?

Surely patients and their physicians are the proper people to make "informed and reasoned choices" about their health and the health of their children. In the case of cytoplasm transfers, the result so far has been healthy children born to parents who would otherwise have been infertile. Why should the parents, much less "society," pay any attention to naysaying busybodies like Parens, Juengst, Chapman and Frankel?

Progress surely consists of fulfilling human hopes for health, flourishing, and happiness. That's what the new reproductive technologies can help do, if only the naysayers will let them.