Oct 29, 2018

Silver Spoons and Golden Genes: Designing Inequality?

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A recent web series sparked controversy with the headline that “Designer babies aren’t futuristic. They’re already here.” The online articles make the case that disparate access to frozen embryo screening for debilitating diseases—sickle cell anemia, Tay-Sachs, or cystic fibrosis—is “designing inequality into our genes.”

The authors are right that reproductive technology isn’t open to everyone. A single cycle of in vitro fertilization (IVF)—the tool that combines sperm and egg in a lab—costs 57% of the average American’s annual income in 2018. The multiple cycles it usually takes to get a baby costs upwards of $100,000. Just fifteen states make insurers cover reproductive technology. Even these often limit coverage mandates to married couples unable to conceive, thereby denying equal benefits to non-traditional families.

People who use IVF (~2% of all U.S. births today) can pay an extra fee to diagnose embryos for certain medical conditions before deciding which to implant. In his 2016 book, The End of Sex, Professor Hank Greely predicted that within 20-40 years, advances in genomic science and stem cell research will make this technique—preimplantation genetic diagnosis (PGD)—the most common way of making babies in a developed country like the United States.

For now, just about 5% of IVF embryos are screened using PGD.

The “designer baby” authors argue that if PGD becomes routine, “we risk creating a society” in which “genetic disease— something that has always epitomized our shared humanity” comes to afflict only certainly groups, based on “culture or geography or poverty.” They worry that limited availability of these prenatal interventions will confer genetic advantages only on those offspring whose parents can afford or otherwise access them. This objection about genetic inequality is serious, but not new. And it could be addressed, at least in theory, if—as Greely thinks it will, once regulators appreciate its cost benefits—health insurance comes to cover PGD as a matter of medical entitlement.

Others have taken this anxiety farther.

Molecular biologist Lee Silver fears that disparate access to genetic technologies will drive a wedge between enhanced and un-enhanced classes of people, which will “live in segregated social worlds where there is little chance for contact between them.”

Biophysicist Gregory Stock worries that “cultural distinctions could become more embedded in our genetics and may increase the biological differences among human populations.”

Political scientist Francis Fukuyama predicts that the concentration of emerging reproductive genetic powers in the hands of the few will give rise to a new race of aristocrats whose “claim to better birth will be rooted in nature and not convention.”

These commentators don’t give any good reason, however, to think that this polarization threat is plausible.

I found evidence for a related concern about egalitarian attitudes in an essay on “Silver Spoons and Golden Genes.” My claim is that routine offspring selection would make it more difficult to convince the successful to adopt a charitable moral posture toward those less advantaged citizens.

I’m not saying that the abstract case for compassion will be harder to make, but rather that it will fall on less receptive ears. DNA is among the last life circumstances whose influence is widely understood to lie beyond the frontier of individual or parental control. The randomness involved in most reproduction today makes it less demanding for us to appreciate that another person’s fate just as easily could have been ours.

But if we believe that we’ve replaced the hand nature dealt us with the one our parents bought for us, our endowments may become just one more influence that people are perceived to deserve—for better or worse. The “Just World Hypothesis” from social psychology suggests that the successful, in order to preserve the plausibility of their own deservingness, will attribute their own achievements less to privilege than birthright, and cast the hardship of others as less bad luck than bad choices.

My point isn’t that sons bear the sins of their fathers, but that we should pause before dislocating our shared sense of genetic luck. I agree with the “designer baby” authors in celebrating greater access to embryo screening for devastating disorders. But they overlook how the fragility of egalitarian attitudes gives reason to rethink prenatal enhancements at least for healthy traits like strength, memory, and intelligence.

The post Silver Spoons and Golden Genes: Designing Inequality? appeared first on Bill of Health.

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