What exactly did those Swedes have in mind when they awarded the 2010 Nobel Prize in Medicine to the inventor of the test-tube baby, the British biologist Robert G. Edwards?
The prize is given for a "discovery" which has "conferred the greatest benefit on mankind." In vitro fertilization, or IVF, though, is more a clinical application than a theoretical advance. The father of French IVF, Jacques Testart, expressed his disdain for the Nobel committee's choice in the journal Quotidien du médecin. "That deserves a Nobel? I thought that the prize was meant for discoveries, not for inventions." On the other hand, the birth of nearly 4 million IVF babies to infertile couples worldwide since the arrival of Louise Brown in 1978 seems to be an indisputable good.
What tipped the balance in Edwards's favor was his particular "vision," not just of infertility, but of science. For decades, Edwards fought to wrest control of reproductive mores from the "establishment."
Scientists in Charge
In "a visionary key paper" published in Nature in 1971 and highlighted by the Nobel Committee, he insisted that it was up to scientists to set ethical standards, not politicians or religious figures. "When scientists clearly foresee potential conflicts with existing rules of society arising from their work, paradoxically both human progress and scientific freedom may hang on their activism generally regarded as social or political," he wrote.
Christer Höög, a Nobel official from the Karolinska Institute, framed Edwards as a visionary maverick whose dogged work brought joy to childless couples by defying religious, political, and scientific conservatism. Perhaps he and his colleagues were taking a leaf from the Nobel Peace Prize committee. For the last three years, this prize has been used to rebuke climate-change sceptics (Al Gore and the IPCC), George Bush (Barack Obama) and China (Liu Xiaobo). And this year, the Medicine prize was used to twit bioethical conservatives.
Edwards was a forerunner of the scientific activism which has become such a familiar feature of the passionate debate over climate change. "[Scientists] may have to stir up public opinion," he wrote, "even lobby for laws before legislatures, in the hope that the attitudes of society as evidenced in its laws will mature at a rate not too far behind the transition of scientific discovery into technological achievement."
Bizarrely, Professor Höög told the media that the ethical controversies over IVF had all been resolved. This is a bit like claiming that the ethics of nuclear weapons have been resolved. Perhaps in the tearooms of the Karolinska Institute, but not elsewhere.
Edwards always saw IVF as a deeply ethical issue. In 2003 he told the London Times: "It was a fantastic achievement, but it was about more than infertility. It was also about issues like stem cells and the ethics of human conception. I wanted to find out exactly who was in charge, whether it was God himself or whether it was scientists in the laboratory."
And, he told the Times, "It was us."
An Ethical Desert
The Catholic Church is widely seen as the main critic of IVF. The church argues that each human embryo, from the moment of conception, is a human person who has a right to be treated with dignity and to be born into a family with a mother and a father. It points out that hundreds of thousands, if not millions, of embryos have been destroyed in the course of IVF treatment. Although this goes to the heart of the controversy, few people outside Christian circles feel compelled by this stark logic. A churchman defending the right to life of a human being who is no bigger than the dot over an i is much less persuasive than Bob Edwards cuddling a baby at his IVF clinic.
But regardless of one's views on the personhood of the embryo, this is far from being the only ethical problem with IVF. Back in 2004, the US President's Council on Bioethics published an extensive report outlining a number of issues that still vex IVF: the well-being of the participants in assisted reproduction, the possibility of human enhancement, and the disposition of "spare" human embryos left over after treating patients.
Every week brings news of new ethical conundrums, ranging from OctoMom, the fertile California woman who had IVF octuplets plus six other IVF children, to using the wrong sperm in clinics, to villages in India where the main industry is surrogate motherhood for rich Westerners.
None of this is really surprising. IVF was born in an ethical desert. Edwards and other pioneers brushed aside elementary principles of clinical ethics in their eagerness to defeat infertility. Women were effectively being used as guinea pigs. The President's Council report noted, for example, that IVF was carried out on 1,200 women before any studies were reported on primates. ICSI, an IVF technique for injecting a single sperm into an egg, is extensively used today. Yet, as the report also noted, ICSI was only tried on animals years after it was declared an ordinary clinical procedure by the IVF profession. And there has been an appalling dearth of long-term health studies of IVF children.
A Flickering Beacon
From the standpoint of traditional medical practice, IVF is puzzling because it is a technique for bypassing the misery of infertility rather than a therapy for curing it. This means that the focus of the IVF specialist is making a mother happy with a "miracle baby." The child itself is a deliverable for a client. This is why there has been so little interest in the long-term health of IVF children.
Or even in their health at birth. The Nobel committee dismissed studies showing that the risk of birth defects is twice as great in IVF-conceived children.
From a utilitarian point of view, IVF may not be achieving the greatest good for the greatest number, either. While individual couples get their bouncing bundle of joy, IVF may actually depress birthrates instead of increasing them. Many women balance the cost of having a child against extra income. They defer children, with IVF as their safety net. But leaving it too late, they then find themselves unable to conceive. The availability of IVF acts as a will o' the wisp, a flickering beacon of hope, allowing women to invest so heavily in their careers that they are unprepared for the inexorable fading of their fertility.
Far from Neutral
IVF has helped to engineer massive social change as well. The creation of thousands of genetic orphans who are cut off from their sperm-donor fathers, a rise in single mothers and gay parenting, and the growth of surrogacy as an industry in the developing world are all a result of the ready availability of IVF.
The day of designer babies has not yet arrived, but it is coming. And Edwards was a cheerleader. Long before the birth of Louise Brown, he foresaw that his work would eventually lead to embryonic stem-cell research, sex selection, and genetic engineering. His 1999 remarks backing eugenics are widely quoted: "Soon it will be a sin for parents to have a child that carries the heavy burden of genetic disease. We are entering a world where we have to consider the quality of our children." He was actually in favour of human reproductive cloning, provided that the procedure was safe.
Given Edwards's very public record as a campaigner for moral change, the Nobel committee's selection was far from neutral. By garlanding the man who made cloning and eugenics possible and by overlooking IVF's numerous moral complications, the Nobel committee has canonized Edwards's radical view that scientists are the ultimate arbiters of ethics. It's not a good way to begin the biotech century. •
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