An Economist Looks at the Fertility Industry

Debora Spar, a professor of business administration and an associate dean at the Harvard business school, has recently published Baby Business: How Money, Science and Politics Drive the Commerce of Conception. She is interested in trends in economies and rules of exchange that come in the wake of new technologies, like satellite television, the Internet, and now, IVF. At first, she says, “people get all excited, where there are no rules, and which creates new markets. Over time, these technologies become regulated because people want and need rules.” And the infertility business is interesting to her because in the US is a 3-billion-dollar-a-year sector. According to the author, in this interview anyway, there is nothing more to this business but supply and demand: 15% of the population is infertile, and this represents a high constant demand, and the price of ova, especially those of Harvard grads, has remained high because there is short supply. The average cost of a baby is well over $50,000.

More messy questions include that of whether the therapies ought to be considered enhancements because most infertility is not a disease of the woman who undergoes the treatment. For example, a couple’s infertility may be attributed to male factor infertility, in a heterosexual couple; and, a single woman or a woman in a same sex partnership desiring to be pregnant requires assisted reproduction, IVF being the most common, in order to conceive . Thus a woman who undergoes IVF treatment may herself be reproductively healthy. One could also hold the view that most female infertility may be a social construct; a position that gains support in light of the billion dollar IVF industry in the US, that most women in heterosexual infertile couples would be willing to adopt a child, and the message that having a biological child is considered necessary in order for a woman to realize her "true" potential as a woman.

In the end, even if one considers women’s infertility a disease of the woman who undergoes the treatment, therapy for IVF is time consuming, invasive, and potentially harmful, costly, and most likely is will not be successful. Maybe economists haven't been looking at what supports the billion dollar infertility industry and IVF, but ethicists have.

Global governance needed for species-changing and species-endangering procedures

A summary of Governing Biotechnology
by George Annas

Professor George Annas of Boston University believes that the test for the 21st century is to create a way to govern biotechnology that will lead to the improvement of human life as opposed to destroying it. He explains that biotechnology has had a bumpy back-and-forth road, with issues such as bioterrorism pushing it back and practices like somatic cell nuclear transfer pushing it forward. Annas feels that the first necessary reform is to make clear to lay persons the difference between reproductive cloning and somatic cell nuclear transfer. Somatic cell nuclear transfer is not harmful and therefore cannot be categorized as destructive to humans; rather, it improves the lives of humans. Annas also argues that we need to create a global rules system that includes various governments, industries, NGOs and the public.

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Got Calcium?

The Women's Health Initiative (WHI), a 15-year federally funded study involving more than 36,000 women ages 50 to 79, found that taking calcium (1,000 milligrams daily) and vitamin D (400 international units daily) improved hip bone density, but didn't decrease the risk of hip fractures.

But experts are saying don't stop taking those calcium supplements yet -- in other bone studies involving frail older women, calcium supplementation appeared beneficial. Researchers say additional study is needed to provide more conclusive results.

Got Health Care?: Privatization of Canada's health care

aCanada's publicly financed health insurance system — frequently described as the third rail of its political system and a core value of its national identity — is going to have to move over to make room for private care as well. Critics are complaining that it will lead to disparities in health care, but what's not being said in this article that in the US we also have disparities in health care and a two-tier system -- either you have insurance or you don't.

States' Tug of War on Plan B

Nearly every state is or soon will be wrestling with legislation that would expand or restrict access of the "morning-after" pill.

The makers of the morning-after pill, known commercially as Plan B, asked the FDA for the right to sell the drug over the counter in April 2003, four years after it was first approved for use. The agency's staff and an advisory panel strongly favored the application, saying that unprotected sex often occurs when it is difficult to get a doctor's prescription. They said that easier and faster access to the drug would reduce the number of abortions.

More than 60 bills have been filed in state legislatures already this year; the resulting tug of war is creating an availability map for the pill that looks increasingly similar to the map of "red states" and "blue states" in the past two presidential elections -- with increased access in the blue states and greater restrictions in the red ones.

Some bills expand access -- in Maryland, New York, Kentucky and Illinois specially trained pharmacists would have the right to dispense emergency contraception without a prescription. Other bills require pharmacies to stock and distribute the drug, and to ensure that the pill is made available to women who come into emergency rooms after a sexual assault.

But some bills would make it more difficult for many women to get emergency contraception, which is effective for only 72 hours after a woman experiences a contraceptive failure or unprotected sex. Legislation in New Hampshire, for instance, would require parental notification before the drug is dispensed, and more than 20 other states will consider bills that give pharmacies the right not to stock the drug and pharmacists the right not to dispense it, even to women with valid prescriptions.

Bad to the Bone: Body Snatchers

The owner of a biomedical supply house and three others were charged with selling body parts for use in transplants in a scheme a district attorney called "something out of a cheap horror movie."

The indictment was the first set of charges to come out of a widening scandal involving scores of funeral homes and hundreds of bodies, including that of "Masterpiece Theatre" host Alistair Cooke, who died in 2004.

The investigation has raised fears that some of the body parts could spread disease to transplant recipients.

Rose Gill Hearn, commissioner of the NY City's Department of Investigation, said "It was shockingly callous in its disregard for the sanctity of human remains."

Prosecutors said the defendants took organs from people who had not given consent or were too old or too sick to donate and forged consent forms and altered the death certificates to indicate the victims had been younger and healthier.

X-rays and photos of recently exhumed cadavers show that where leg bones should have been, someone had inserted white plastic pipes -- the kind used for home plumbing projects, available at any hardware store. The pipes were crudely reconnected to hip and ankle bones with screws before the legs were sewn back up. (Watch how X-rays provided clues -- 1:18)

Designer Microbes, the Human Genome Project and Alternative Fuels

J. Craig Venter, the man who is known for mapping the human genome, is proposing to create a new form of life that can help create alternative fuels. He hopes to create designer microbes -- the heart of a biological engine -- from scratch, then adding genes culled from the sea to turn crops such as switch grass and cornstalks into ethanol.

While he's at it, he'd like to modify or devise microorganisms to produce a steady stream of hydrogen.

Venter also now sports an extensive collection of genetic material scooped from the sea from a three year Darwinesque journey around the world -- and that's the raw material for his alternative fuel project. With $15 million from Mexican venture capitalist Alfonso Romo Garza, he has launched a new company in Rockville called Synthetic Genomics Inc.

This is pretty exciting -- a chance to conserve the earth's limited resources and create alternative fuels -- on the other hand, what sort of risks might be associated with creating such new life form?

Separating Fact From Spin in the Abortion debate

NPR does a excellent job of explaining the facts behind late-term or 'partial birth' abortion, explaining why it is so controversial, why is the procedure was developed in the first place, and how it relates to the entire abortion debate:

"Activists on both sides of the issues see the constitutionality of the Partial-Birth Abortion Ban Act as pivotal to the larger debate. Abortion-rights backers say the ban is a first step toward trying to outlaw all abortions. Even some supporters of the ban say that if it is upheld, they could then move on to try to outlaw the far more common D&E procedure, whose description is nearly as unpleasant as that of the D&X.

The court could also use the law to address the 'health' exception currently required for all abortion restrictions. Abortion foes say the current health exception upheld by the court is so broad -- encompassing mental health problems as well as physical ones -- that just about any abortion-procedure ban would have to be invalidated. But abortion-rights supporters say that without a health exception, women could be forced to carry to term fetuses with no chance at life, but whose birth could leave the pregnant women unable to carry a later pregnancy, or could exacerbate serious ailments such as diabetes."

South Dakota: Gunning for Roe

South Dakota lawmakers passed the most restrictive ban on abortion, in the hopes of getting Roe vs. Wade overturned. The measure, which passed the state Senate 23 to 12, makes it a felony for doctors to perform any abortion, except to save the life of a pregnant woman. Proposed amendments to include exceptions for rape and incest were defeated. Assuming the Governor signs the bill, it is scheduled to become law July 1st.

The law is so restrictive that even many pro-life advocates don't think that it will pass constitutional muster.

Ethical Entertainment

“Oscar has developed a social conscience this year, with weighty real-life themes ranging from ethics in big business and media to racial tensions, dominating the movies vying for the big prizes” writes Los-Angeles-based Marc Lavine in the Mail & Guardian this week.

The Oscars are just around the corner. And people here in South Africa are paying special attention – not only because our Charlize is once again up for an award, this time for her role in North Country, but because a local film, Tsotsi, has also been nominated for an Academy Award.

Ethical, moral and social issues seem to be the order of the day if one considers those films that have scooped the nominations this year. Which, according to Hollywood Reporter columnist Marty Grove, is unusual, given that, a few years ago, the serious film would have been the odd-man out. But this year, many of the films that are up for various awards – Capote, Good Night, and Good Luck, Crash, Munich, The Constant Gardener, Syriana, Brokeback Mountain - deal with issues that Hollywood once thought too serious and too dark for mainstream movie-goers, including homophobia, freedom of expression, journalistic ethics and media censorship, terror in the Middle East and the morality of avenging terrorism.

In a rather more cynical view, Brian Johnson of Canada’s Maclean’s magazine claims that these movies collectively represent a landscape of (white) liberal guilt, populated by tortured male protagonists. Never in the history of the academy have issue-oriented films so thoroughly dominated, he writes.

Which got me thinking: South Africa may be a relative new-comer to the Oscar’s list of nominees, but it has a long(er) history of producing films that have highlighted ethically-weighty and socially-conscious issues. In Tsotsi’s “raw and compassionate depiction of Johannesburg’s criminal underworld, where poverty and AIDS are mainstays of existence,” there is an “almost mythic sense of reclamation and redemption…an insightful glimpse of post-apartheid life, from its most violently severe to its most culturally vibrant.”

Tsotsi follows in the film reel of other powerful depictions of apartheid’s legacies of racial inequality, injustice, bitterness, outrage, hope, and forgiveness: Cry, the Beloved Country is one; Country of My Skull another. Cry, the Beloved Country’s portrayal of the “path of tolerance and compassion” and Country of My Skull’s portrayal of “how a country goes about resolving its pain” run parallel to the themes of redemption and reconciliation that have punctuated South Africa’s reality.

And then there are those that have placed women on centre stage. Zulu Love Letter shows the “desperate and emotional journey of two mothers searching for their daughters” while the main character grapples with the “haunting images and unrelenting grief of the past”, and aims her “barely suppressed rage…not directly at White South Africans so much as those around her for not dwelling on what she and millions of others endured during the apartheid era.” Yesterday, South Africa’s first ever Oscar-nominated film in 2005, deals with AIDS as other movies have dealt with apartheid, depicting “what AIDS does to people, families, and communities without being overly dramatic or too emotional about it.” It is a film about one woman’s survival, courage and determination, with the lead character, Yesterday, fighting against AIDS, and refusing to die before she completes her mission: seeing her daughter go to school.

Like the gritty roles that have seen a transformed beauty, Charlize Theron, nominated for Oscars – Monster and North Country - these films convey some of the harsh messages that emanate from what, to so many of us who live here, is a very beautiful country, with an extraordinary people.

Sex as entitlement, sex as power?

“A man…stabbed his wife in the neck because she would not have sex with him and then proceeded to have sex with the bloodied woman…”

In a previous blog post earlier this month (see below, The Politics of Violence Against Women: A South African Perspective, posted Thursday 2nd February), I wrote about how the daily experience of inequality by women and the violence perpetrated against women by men continue unabated in South Africa. “Because of our patriarchal system, power is in the hands of men. Women do not have much say in decision-making, societal issues, and even more sadly, in their intimate relationships. Men control their sexual rights. Women cannot choose when, how and with whom they can have sex” (Memela, 2005, p.98).

As if drawing a line under the issues highlighted in that post, an article in one of our local papers today offers an all-too real and tragic example of the cultural belief that sex is a man’s right and a woman’s obligation – and of the violent consequences of women’s refusal to submit: “…the couple had quarreled that evening because the accused wanted to have sex and his wife did not. The two eventually went to bed and the argument continued. The husband then went to the kitchen, fetched a knife and stabbed his wife.”

Abortion and US Supreme Court again

The US Supreme Court Supreme Court agreed yesterday to decide whether a 2003 federal ban on the procedure that critics call "partial birth" abortion is constitutional, setting the stage for its most significant ruling on abortion rights in almost 15 years. The issue: whether the constitutional right to have an abortion means that any law regulating this procedure must contain an exception to protect a woman's health.

In 2000, in the case of Stenberg vs Carhart, the Supremes struck down a Nebraska ban on this procedure, in a 5 to 4 ruling that it was so vaguely written that it could also criminalize other procedures, and that it lacked an exception for the woman's health.

The federal Partial-Birth Abortion Ban Act of 2003 banned the procedure except when necessary to save the life of the woman, deliberately omitting an exception to protect the woman's health. The law formally declared that such an abortion could never be necessary to preserve health.

Food for thought: Is this 2003 Act by Congress an attempt to practice medicine like they did in the Terri Schiavo case?

Promote stem cell research ... donate your baby's umbilical cord

For those who object to the use of leftover IVF embryos and therapeutic cloning for embryonic stem cell research, there is another alternative: Donate your soon-to-be born baby's umbilical cord for public storage so that it can be used for research or to treat or save the life of an unrelated person.

The Institute of Medicine of the National Academy of Sciences issued a report last year calling for the establishment of a National Cord Blood Stem Cell Bank Program; what the National Marrow Donor Program is doing is the first step.

[thanks, Karama Neal!]

Ethical Concerns Halts Death Penalty Execution

Prison officials in California postponed indefinitely the execution of a condemned killer, saying they could not comply with a judge’s order that a medical professional administer the lethal injection.

The ethical showdown came to a head when two anesthesiologists refused to participate in the execution after learning they would be expected to tell prison officials whether or not the prisoner needed more sedation or possibly even give him more medication, thereby allowing the execution to proceed. Prison officials couldn't find a doctor, nurse, or other person licensed to inject medications to give a fatal dose of barbiturate.

The AMA and many other medical groups have long opposed doctors having any role in executions, including monitoring a prisoner’s vital signs or giving technical advice.

Women on Board(s)

Chris MacDonald, author of partner blog, Business Ethics, has commented on and pointed out some interesting studies on women and corporate boards.

WBP Announces East Coast Advisory Board

SEATTLE – The Women’s Bioethics Project (WBP) today announced that it has established an East Coast Advisory Board, which has attracted some of the most prestigious and respected leaders in the fields of bioethics, medicine and reproductive rights. The advisory board will provide guidance and strategic direction to the WBP as it continues in its mission to serve as a bridge between scholarship and policy-making, ensuring that women’s voices, health concerns and unique life experiences are brought to bear on ethical issues related to health care and biotechnology.

The members of the newly formed WBP East Coast Advisory Board include:

R. Alta Charo, J.D., visiting professor of law, University of California, Berkeley; Knowles Professor of Law & Bioethics, University of Wisconsin Law and Medical Schools

Nancy Chilton, public relations consultant; Council of Advocates, Planned Parenthood of New York City

Katie Danziger, chair, board development, Planned Parenthood of New York City

Robin N. Fiore, Ph.D., Adelaide R. Snyder Professor of Ethics, Florida Atlantic University

Maureen Jerome, corporate manager, art historian; principal ARTLIFEdesign. LLC

Frances Kissling, president, Catholics for a Free Choice

Hilde Lindemann Nelson, Ph.D., associate professor of philosophy,

Michigan State University

Linda MacDonald Glenn, J.D., LLM, associate adjunct professor, University of Vermont, lawyer, and consultant

Mary Mahowald, Ph.D., professor emerita, Department of Obstetrics and Gynecology, University of Chicago; MacLean Center for Clinical Medical Ethics

Jonathan Moreno, Ph.D., senior fellow, Center for American Progress; Emily Davie and Joseph S. Kornfeld Professor of Biomedical Ethics; director, Center for Biomedical Ethics, University of Virginia

Laura Philips, Ph.D., MBA, chief operating officer, NexGenix

Pharmaceuticals

Rosemarie Tong, Ph.D., distinguished professor of Health Care Ethics in the Department of Philosophy; director, Center for Professional and Applied Ethics, University of North Carolina, Charlotte.

Leslie R. Wolfe, Ph.D., president, Center for Women Policy Studies

“The addition of so many recognized and thoughtful individuals to our East Coast Advisory Board will significantly strengthen our position as an authentic and important voice within current and emerging bioethics debates,” said Kathryn M. Hinsch, founder of the WBP. “We are so pleased that they have agreed to join us in our efforts. The newly established East Coast board will work closely with our West Coast advisory board, which was established in 2004 and has guided the organization from its inception.”

Denmark in the News for Something Else

Denmark is the only country in the world with an established National ART reporting system that counts all ART treatments, including in vitro techniques and intrauterine inseminations. Recently a “Summary The European Society for Human Reproduction and Embryology (ESHRE)” has been published. This report contains data on Assisted Reproduction in Europe since 1997. In Denmark in 2002, a total of 20, 837 treatment cycles were performed. The result was that 6.2% of all infants were born after assisted reproduction.

More on Marriage and Financial (Dis)Incentives...

And in a similar vein to our previous post, Slate has an interesting article that provides an argument that polygamy can benefit women economically. (Although Tim Harford kinda misses the whole demeaning aspect of the men-buy-women-sell dowry thing).

Still, Harford does rightfully point out: "When men are taken out of the marriage market by war or by prison, women suffer. The reverse is probably true, too: When women are taken from the marriage market, men suffer. In China, the policy of one-child families coupled with selective abortion of girls has produced "surplus" males. Such men are called "bare branches," and China could have 30 million of them by 2020. Perhaps polyandry—women with multiple husbands—would be the logical response to the situation in China."

[thanks again, Sean Philpott!]

The Show-Me-The-Money Approach to Prostitution and Marriage

Wife or whore? It's as simple as that according to an economic analysis in Forbes online. : Two well-respected economists created a minor stir in academic circles a few years back when they published "A Theory of Prostitution" in the Journal of Political Economy. The paper was remarkable not only for being accepted by a major journal but also because it considered wives and whores as economic "goods" that can be substituted for each other. Men buy, women sell.

To be fair, economists Edlund and Korn admit that spouses and streetwalkers aren't exactly alike: a key differentiator in Edlund and Korn's model is reproductive sex. Wives can offer it, whores can not.

Just gives you sort of a warm, fuzzy feeling, doesn't it? Reminds me of J. G. Raymond's essay on women as reproductive conduits and incidental incubators.

[thanks Sean Philpott for bringing this article to our attention]

Gazzaniga on Cloning

Michael Gazzaniga, author of The Ethical Brain, and member of the President's Commission on Bioethics, make an argument for the therapeutic cloning in the NY Times today, saying that "The president's view is consistent with the reductive idea that there is an equivalence between a bunch of molecules in a lab and a beautifully nurtured and loved human who has been shaped by a lifetime of experiences and discovery. His view is a form of the 'DNA is destiny' story."