As promised, a quick review today of some fairly current facts and opinions about bioethics. The main focus of this post is medicine and infertility (and its sister-issue stem cell research). However, it is clear that further discussion is needed in other areas as well — including but not limited to:
the role of government in the conduct of medicine and research as industries,
the role of pharmaceutical companies in all medical fields,
the ethics and hard choices in end-of-life issues,
the regulation of genetic engineering in plants and animals,
scientific method and safety, especially in relation to our food supply.
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First off, nothing like a few juicy statistics to get the ball rolling:
Amgen, a for-profit biotechnology corporation founded in 1980, generated over $13 billion in revenues during 2006.
In 2002, 10% of all U.S. women of child-bearing age had made at least one infertility-related doctor visit in the past; 2-3% had visited in the past year.
Americans spend $4 billion a year on Assisted Reproductive Technology (ART), or an average of $12,400 per infertile couple, yet still the field offers just a one-in-three chance of success. [So the question is: what are the other 2/3 actually buying, and should it be it legal to sell such a thing as “hope”?]
In 1989, just 30,000 assisted births were recorded worldwide. By 2002, the number had climbed to 200,00 —a sevenfold increase. If that growth rate continues (and if reported infertility continues to rise, as it has steadily since the mid-1960s), then by 2009 the number of ART births each year could top out at around 375,000 per year, or almost 9% of all births in the U.S.
That’s a lot of people, and alot of money. Now that we’ve seen the numbers, though, let’s back off and calm down a bit. It should be noted that not all assistance can be defined as using “test tube baby” methodology, or other expensive, invasive processes. In vitro fertilization, embryo placement in surrogate mothers, and other more expensive, invasive, and ethically thorny procedures are still less common, and only used when less extreme methods are ineffective. Though fertility drugs are not cheap, they are still the preferred method of treatment for infertile couples.
Furthermore, scientific advances, and better success rates (using more ethical, embryo-friendly methods) are making ART less of an ethical or philosophical issue, and more of an economic one. That would not end the debate, just shift it toward the purview of insurance companies, politicians, and the medical/business community, moreso than churches or the general population.
But we should still prepare ourselves for the debate to continue for several generations, as well it should. For example: according to a study published in the journal Nature in August 2006, stem cells can now potentially be harvested without destroying viable embryos (fertilized eggs… which in most monotheistic worldviews are already human beings, as the division and growth of cells begins within hours of fertilization). But much of this work is in its early stages and the long-term implications for both the cell beneficiaries and the embryos are not yet known.
Or how about this little tidbit: one of the young women at the seminar I attended on this subject last Thursday said that infertile couples have frequently been placing classified ads in the college newspaper. The ads offer tens of thousands of dollars to a woman willing to donate a genetically “smart”, healthy, and most importantly young egg to the couple for in-vitro fertilization. So our nation’s best and brightest are already being impacted by these issues, whether or not they are infertile themselves. So clearly, it’s not a challenge that is going to go away.
Not to mention there’s that whole bugaboo about disagreements between insurance companies, infertile couples and doctors, or between medical/economic interests and “irrationality”, as one genetic researcher put it in that 2006 National Geographic article:
Robert Lanza, medical director of the biotechnology firm Advanced Cell Technology in Worcester, Massachusetts, reported in the August 24 issue of the journal Nature…
“We’re showing for the first time that it’s possible to create stem cells without destroying the embryo and … without destroying its potential for life,” Lanza said.
“Hopefully, this removes the last rational reason for people to oppose stem cell research.”
In other words, people who do not support the destruction of viable embryos are just being irrational. Or put another way, one cannot make scientific advances and be constrained by ethical concerns AT THE SAME TIME. He also uses the sticky phrase “potential for life” in referring to an embryo, which some would say is already alive. It’s this kind of thinking that makes medical ethics a major political and social issue for the 21st century.
And with people like physicians Bill Frist (former Republican senator from Tennessee), Howard Dean (now head of the Democratic National Committee), and the current presidential candidates at the forefront of policy-making and influence in the United States, it behooves us to know what our leaders in medicine and politics are up to, lest they all get too cozy and sell us a load of crap. (Again! …)
The terms and civility of the debate should change, too, so that it can become less adversarial and more cooperative. It’s really not an “abortionists vs. Christians” thing. It’s moms, dads, friends, politicians, physicians and business interests all coming together — to make decisions about what is best for the most people, and what should be absolutely avoided, for our physical, economic and moral health as a nation.
My wife and I went though some early treatment methods. I’m sure most readers of this post know people who have been affected. So as a nation — in churches, schools, community forums, on the news, on Oprah (as long as she gets it right and stays unbiased… as if that could ever happen…) — we should be talking a little bit about this stuff every day. It’s that big, that important.
We need not talk aobut it all day, just enough to stay on top of the rapidly changing landscape. Because if history is any indication, the wave of technological change can get ahead of the ethical curve really quickly, and if that happens, we’ll all be left to let the thieves and profiteers have the run of the store.