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Speaker 1: On today's show, as we wrap up this season, we're

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Speaker 1: doing something a little different. We're going into the future

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Speaker 1: to learn about a technology that's in the works but

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Speaker 1: not yet available, a technology that even in its development stage,

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Speaker 1: has people asking all kinds of questions.

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Speaker 2: Imagine it became possible so that you could go to

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Speaker 2: a hotel where Brad Pitt had been, you could take

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Speaker 2: the dead skin, and you could use that genetic material

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Speaker 2: to produce children. Would that be something that was problematic.

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Speaker 1: We're talking about a type of reproductive technology called in

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Speaker 1: vitro gametogenesis or IVG, that has the potential to open

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Speaker 1: up a whole world of options for how humans procreate.

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Speaker 1: IVG is essentially a process where cells, including human skin cells,

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Speaker 1: could be used to make babies. Glen Cohen knows all

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Speaker 1: about IVG. He's a professor of bioethics and law at

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Speaker 1: Harvard Law School.

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Speaker 2: You could both produce sperm an egg yourself and have

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Speaker 2: a child that is your direct genetic descendant, but completely

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Speaker 2: taking your genetic material rather than someone else. Now, I

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Speaker 2: think for most people this strikes them as extremely strange

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Speaker 2: as a desire. Why would you possibly ever want this?

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Speaker 2: But just as there are people who want a single pair.

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Speaker 2: In terms of rearing a child, there might be people

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Speaker 2: who want to not have anybody else's genetic material involved.

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Speaker 1: This may sound like science fiction, but scientists and biotech

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Speaker 1: startups are already working or making it a reality. I'm

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Speaker 1: Laurena Rora Hutchinson. I'm the director of the Ideas Lab

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Speaker 1: at the Johns Hopkins Berman Institute of Bioethics. On today's episode,

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Speaker 1: there are a lot of ways IVG could be used.

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Speaker 1: People who for any reason aren't able to juice eggs

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Speaker 1: or sperm could still have biological children, like people who've

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Speaker 1: gone through menopause and people whose fertility has been impacted

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Speaker 1: by cancer treatment. And people in same sex relationships could

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Speaker 1: both be the genetic parent of the same child. But

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Speaker 1: given that we could be shaping the future of humanity

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Speaker 1: with this new technology, there are a lot of ethical

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Speaker 1: questions to unravel. Are there good or bad reasons to

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Speaker 1: do IVG? How much should regulators play a role? And

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Speaker 1: how long do we have before all this becomes a reality.

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Speaker 1: Some researchers predict that it may take decades, while commercial

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Speaker 1: startups promise proof of concept trials within one to two years.

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Speaker 1: From pushkin Industries and the Johns Hopkins Berman Institute of Bioethics.

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Speaker 1: This is playing God. We'll hear more from Glen Cohen

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Speaker 1: later on in this episode, but first I wanted to

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Speaker 1: understand more about this technology, like how it actually works

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Speaker 1: and where the research stands today. So I called up

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Speaker 1: Amanda Clark. She's a professor of molecular, cell and Developmental

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Speaker 1: biology at the University of California, Los Angeles, and she's

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Speaker 1: an internationally renowned researcher and expert on in vitro gamito genesis.

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Speaker 1: She's been working on developing it for decades.

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Speaker 3: I am a basic scientist, and I'm interested in questions

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Speaker 3: that are related to fertility and infertility and reproductive health.

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Speaker 3: And what I saw as I looked at the scientific

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Speaker 3: landscape for what's available to couples who are struggling with infertility,

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Speaker 3: is that there seems to be a limit to what

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Speaker 3: can currently be achieved with assisted reproductive technologies and medical technologies.

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Speaker 3: So for those individuals who, for example, they're ovary or

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Speaker 3: testis was destroyed as part of occupational health injury or

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Speaker 3: due to chemotherapy or radiation therapy following a cancer diagnosis,

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Speaker 3: and now they're cancer survivors. All of these types of

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Speaker 3: injuries destroy the cells in the overy in testice that

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Speaker 3: enable a person to have a biologically related child. And

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Speaker 3: so as a stem cell scientist, I became really interested

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Speaker 3: in what could we do as in a scientific community

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Speaker 3: to be able to help those individuals and couples who

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Speaker 3: want to have a family that don't have the cell

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Speaker 3: types necessary for it anymore. So could we regenerate these

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Speaker 3: cell types from stem cells? And that's the basis of

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Speaker 3: in vitrogemetogenesis.

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Speaker 1: Could you give me the broad strokes of what's going

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Speaker 1: on with IVG and how it works, So if you're

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Speaker 1: just explaining this to someone who had no idea what it.

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Speaker 3: Was, So let's begin with the G in IVG. So

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Speaker 3: IVG stands for in vitro gametagenesis. So most people understand

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Speaker 3: what in vitro is because in vitro fertilization is used

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Speaker 3: currently as a medical technology to help an individual or

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Speaker 3: a couple to have a baby. The G gametogenesis means

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Speaker 3: game meats eggs and sperm. So if we add it together,

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Speaker 3: in vitro gamita genesis means making eggs and sperm in

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Speaker 3: the lab for the purposes of reproduction. For those people

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Speaker 3: that their testes and their ovaries aren't working properly, they

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Speaker 3: may not make a functional egg cell or a sperm cell.

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Speaker 3: And so if your egg cell or sperm cell's not

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Speaker 3: functional or you don't make them in your body, that

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Speaker 3: means you can't have a biologically related child.

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Speaker 1: And so with IVG eggs or sperm cells made.

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Speaker 3: So in future, agamtagenesis means instead of these egg and

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Speaker 3: sperm cells being made inside of the body, they are

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Speaker 3: made in the lab by researchers, starting with a different

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Speaker 3: cell type in the body, for example a skin cell.

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Speaker 3: So scientists now know how to take a biopsy of

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Speaker 3: the skin or perhaps a biopsy of the blood, and

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Speaker 3: to grow those cells in the lab and to use

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Speaker 3: molecular biology to convert those cells to a stem cell.

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Speaker 3: And this stem cell has the potential to become an

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Speaker 3: egg and sperm cell in the lab that could then

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Speaker 3: be used for fertilization through in vitro fertilization.

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Speaker 1: So, just to be clear on this, it means someone

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Speaker 1: would be able to create an egg or sperm which

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Speaker 1: was genetically matched to them because they'd be using their

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Speaker 1: own skin cells.

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Speaker 3: Yes, that's right. So in future, agametera genesis provides the

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Speaker 3: opportunity for having a genetically related child because the skin cell,

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Speaker 3: for example, comes from the person who's the intended parent. Wow.

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Speaker 1: So where exactly is this technology currently?

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Speaker 3: In future, gemtagenesis is being used for research because scientists

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Speaker 3: still can't make an egg or sperm cell in the

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Speaker 3: lab from human cells. So what scientists are able to

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Speaker 3: do is to make very immature egg or sperm cells

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Speaker 3: in the lab from human cells. And so this is

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Speaker 3: actually very helpful because we don't understand much about how

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Speaker 3: egg and sperm cells are made inside the body because

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Speaker 3: they're inside an organ and they're relatively rare cell type,

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Speaker 3: and so in future, cometagenesis is providing really important molecular

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Speaker 3: and genetic information about how gameat forms and that can

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Speaker 3: help us to understand the disease of infertility. But it's

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Speaker 3: not yet at the point of making a GA meat

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Speaker 3: that can be used for reproductive purposes. We are looking

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Speaker 3: at decades away from being able to make an egg

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Speaker 3: or sperm cell in the lab that could be used

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Speaker 3: for reproductive purposes, and that's where the field would like

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Speaker 3: to go.

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Speaker 1: When we do get to that point, what applications do

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Speaker 1: you think would be the best to try first for

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Speaker 1: clinical research?

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Speaker 3: Well, one of the options is to study in vitrogametogenesis

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Speaker 3: in a species that is closely related to humans, for example,

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Speaker 3: using non human primates as an alternate model to make

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Speaker 3: game meats in the lab, and to use those lab

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Speaker 3: made gameats the egg or the sperm cell in order

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Speaker 3: to cure a disease model of infertility. And once those

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Speaker 3: scientific models have shown that the game meat can successfully

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Speaker 3: lead to a healthy pregnancy and a healthy baby, and

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Speaker 3: that the resulting animal itself is fertile, only then will

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Speaker 3: this technology move into clinical trials inhuman.

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Speaker 1: And so, if it is shown to be safe and effective,

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Speaker 1: as you've just explained, and it becomes approved as a

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Speaker 1: reproductive technology, who do you think would be interested in

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Speaker 1: using it?

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Speaker 3: And why? I certainly get emails on a regular basis

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Speaker 3: from couples that have been going through in viture fertilization

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Speaker 3: for five years or more and successive rounds, and none

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Speaker 3: of them have been successful, and so this is the

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Speaker 3: sort of group who would be very interested in signing

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Speaker 3: up for in future commutagenesis. Of course, we had the

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Speaker 3: really important breakthrough study that was published using a mouse model,

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Speaker 3: which is a model that scientists use in the lab

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Speaker 3: where the sex of a gameat can be switched so

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Speaker 3: that an egg cell can be made from cells that

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Speaker 3: are taken from a man. And so this opens up

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Speaker 3: the possibility of same sex reproduction for those that are

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Speaker 3: socially infertile. And I think that this is a really

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Speaker 3: important aspect of the technology as well.

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Speaker 1: And what would it take to make sure that it

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Speaker 1: would be a safe process?

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Speaker 3: Yeah, in vitrogametogenesis would need to be proven safe. That

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Speaker 3: game meat would need to be proven to have the

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Speaker 3: equivalent quality competency of a gameat an eggorosperm that would

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Speaker 3: have been made inside of the body. And so what

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Speaker 3: this means is testing the quality of the gameat, the

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Speaker 3: competency of the gamat and developing scientific tools that don't

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Speaker 3: exist yet. And so a lot of that technology now

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Speaker 3: needs to be developed too.

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Speaker 1: Do you think that could be potential safety risks two

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Speaker 1: children born via IVG.

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Speaker 3: Well, human reproduction itself is actually not very successful and

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Speaker 3: that is why the use of in future fertilization is

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Speaker 3: increasing year over year of a year around the world.

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Speaker 3: And one thing we have learned about studying embryos in

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Speaker 3: the IVF lab is there's a lot of genetic abnormalities

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Speaker 3: during early embryo development in humans, much more so than

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Speaker 3: in any other species. And actually we understand very little

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Speaker 3: about why there is so much genetic instability in the

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Speaker 3: early human embryo. And of course, genetic instability in the

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Speaker 3: early human embryo leads to early pregnancy loss. And so

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Speaker 3: when we turn now to in vitrogamy genesis, the expectation

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Speaker 3: is that the game meat made a research in the

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Speaker 3: lab and used in fertilization studies is also going to

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Speaker 3: have these same issues that a game meat made in

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Speaker 3: the body has. And so the question is how do

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Speaker 3: we measure the quality of an embryo made from an

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Speaker 3: in vitrogametogenesis gameat eggosperm versus an eggosperm cell that's made

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Speaker 3: inside the body. And so that's the beginning of understanding

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Speaker 3: how these ga meats would be safe. But in the

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Speaker 3: end not even natural conception has always successful, and so

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Speaker 3: we know that there are children that are born who

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Speaker 3: do suffer from genetic abnormalities, and so it's safeguarding against

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Speaker 3: all of those potential eventualities with a game meat made

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Speaker 3: inside the lab.

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Speaker 1: And are there concerns in the academic research community about

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Speaker 1: this technology being used in a way that's risky or problematic.

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Speaker 3: So I think it's really important that the academic community

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Speaker 3: talks about the promise but also the realistic challenges of

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Speaker 3: in viuturogemeta genesis. What makes me very nervous is that

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Speaker 3: it's potentially possible to get ahead of the science and

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Speaker 3: talk about in viuture gemeta genesis as being a technology

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Speaker 3: that's right around the corner for use in reproduction. But

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Speaker 3: what we're talking about is a reproductive technology that has

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Speaker 3: the potential to be transformative. But there's a lot of

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Speaker 3: scientific hurdles that need to be overcome in order for

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Speaker 3: this technology to become a reality, and it's really important

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Speaker 3: that as scientists we communicate that effectively so that we're

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Speaker 3: not giving false hope to people who think this technology

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Speaker 3: is going to be right around the corner and could

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Speaker 3: help them within the next five to ten years, when

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Speaker 3: the technology is just not there yet, and the most

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Speaker 3: important thing will be ensuring the safety of the technology,

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Speaker 3: and that in the end comes down to the quality

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Speaker 3: of the erg or sperm cell made in the lab

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Speaker 3: and ensuring that that quality is equivalent to the quality

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Speaker 3: of an erg or sperm cell that would have been

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Speaker 3: made in the body.

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Speaker 1: Thank you, Amando. It's been amazing to hear about this

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Speaker 1: new technology and all the important work that you're doing.

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Speaker 3: So happy for the opportunity to talk about the science.

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Speaker 1: After the break, we'll go back to Glen Cohen. The

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Speaker 1: ethicis we heard from earlier. We'll find out how he

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Speaker 1: thinks as a society we should approach IBG. Let's go

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Speaker 1: back to Glen Cohen. Glenn is a professor and deputy

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Speaker 1: dean at Harvard Law School. There, he's also the director

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Speaker 1: of the Peak Flom Center for Health Law, Policy, Biotechnology,

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Speaker 1: and Bioethics. Glenn thinks reproductive technologies like IVG have the

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Speaker 1: potential to really change our society and spark new ethical challenges. So, Glenn,

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Speaker 1: could you tell us about some of the ethical issues

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Speaker 1: surrounding IVG.

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Speaker 2: So when talking about IVG, I think it's really important

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Speaker 2: to distinguish different use cases, because different use cases raise

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Speaker 2: different ethical questions. Start with the easiest use case, I think,

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Speaker 2: ethically speaking, which is the use of IVG to help

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Speaker 2: individuals who cannot produce scam meat, So, for example, people

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Speaker 2: who cannot produce eggs during their regular, normal, healthy fertility period.

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Speaker 2: For that group, some of the issues are, what do

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Speaker 2: we have to do to perfect this technology? Does it

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Speaker 2: involve a lot of embryo destruction along the way and

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Speaker 2: is that a problem? How do we know when this

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Speaker 2: is safe and effective and ready for human use? And

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Speaker 2: when do we move to first in human How will

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Speaker 2: we know what the inter generational effects might be and

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Speaker 2: how do we track that? And can we actually demand

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Speaker 2: to have data from successive generations people who never consented,

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Speaker 2: for example, to this because they were born this way.

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Speaker 2: And then I think we have some kind of interesting

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Speaker 2: questions about policing inappropriate use, So whether, for example, we're

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Speaker 2: worried that people might derive eggs from adult cells from

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Speaker 2: someone who didn't consent, so taking leftover skin cells for example.

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Speaker 2: And then maybe finally is just a broader question about

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Speaker 2: whether this is a worthwhile goal for humanity, especially when

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Speaker 2: we have so many people with other kinds of medical needs.

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Speaker 2: Is this really where we should be spending our time,

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Speaker 2: spending our money, and spending our research effort.

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Speaker 1: Yeah, a lot of different ethical issues there. So you've

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Speaker 1: begun with talking about keeping it within a person's period

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Speaker 1: of life where they would, in theory be able to

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Speaker 1: produce eggs. Could you talk about some of the ethical

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Speaker 1: issues around using IVG for a person who's gone through menopause,

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Speaker 1: for example.

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Speaker 2: So I often like to distinguish what I call mimicking

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Speaker 2: uses versus extending uses of new reproductive technologies. Mimicking is

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Speaker 2: attempting to give people who by virtue of medical issues

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Speaker 2: would ordinarily be able to do the kind of reproduction

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Speaker 2: that everybody else does, enabling them to do that. So

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Speaker 2: a way of thinking about this is there's a person

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Speaker 2: with a disability and we're trying to correct for that disability.

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Speaker 2: Extension uses are attempts to extend and give people fertility

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Speaker 2: options that would not be available to other people similarly situated.

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Speaker 2: And the post meant apausal example is a good example

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Speaker 2: of an extension use. Women have as a species a

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Speaker 2: set reproductive period where they are producing eggs that comes

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Speaker 2: to an end, and the question is should we extend

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Speaker 2: beyond that end. So, in terms of the ethical issues

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Speaker 2: that are raised here, one set of issues has to

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Speaker 2: do with whether enabling reproduction later in life is a

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Speaker 2: worthwhile goal. There are some individuals who are worried that

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Speaker 2: when you produce children whose parents are quite old, that's

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Speaker 2: an unfortunate circumstance for the child. And that's a relevant

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Speaker 2: thing to think about. So that's one issue. Another is

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Speaker 2: that there are some individuals who just think the human

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Speaker 2: species is a particular kind of thing and living a

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Speaker 2: uniquely good human life is to be a particular kind

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Speaker 2: of entity. And that's an entity that has a period

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Speaker 2: for everything, right, a time for all things in life,

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Speaker 2: and it's just wrong to go beyond that.

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Speaker 3: Yeah.

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Speaker 1: So it's really interesting hearing your distinction of extension versus mimicking.

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Speaker 1: And I'm just really curious when people are in the

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Speaker 1: same sex relationship and they want to reproduce genetically, would

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Speaker 1: you also put them in the extension category.

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Speaker 2: Yeah, so I think this is a really interesting question,

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Speaker 2: especially if we're talking, for example, about two women. Right,

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Speaker 2: you may have two women who are actually completely healthy

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Speaker 2: in terms of their reproductive life. Right, if we were

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Speaker 2: to provide sperm, each of them would be able to reproduce.

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Speaker 2: And yet they're making an ask to say that's it's

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Speaker 2: not what we want. We want to both be genetic parents,

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Speaker 2: And they're saying It's not that I want to kind

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Speaker 2: of have parody with somebody who's healthy when I'm unhealthy. Instead,

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Speaker 2: they're saying, I want to have parity with everybody else

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Speaker 2: who's heterosexual, infertile, who's able to basically use sperm and

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Speaker 2: egg from both parts of their couple. I do think

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Speaker 2: that this is an extension use. Now calling it an

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Speaker 2: extension use does not itself determine whether it's right or wrong,

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Speaker 2: good or bad, But I think it does acknowledge that

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Speaker 2: the ask here is a little bit different, and that

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Speaker 2: the political theory and the questions we're going to ask

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Speaker 2: about whether this is the kind of ask that's appropriate

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Speaker 2: or one society should support, are a little bit different

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Speaker 2: than the case of somebody who's facing medical infertility. Some

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Speaker 2: of my colleagues, they prefer the term disfertility for this situation.

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Speaker 2: Single individuals, same sex individuals. So it's not that they are,

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Speaker 2: in terms of their healthcare or their medical state, infertile.

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Speaker 2: It's that there's a social reason why they can't reproduce,

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Speaker 2: and they are making an ask of society to help

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Speaker 2: them overcome this social reason.

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Speaker 1: Yeah, so interesting the different ways that things become framed,

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Speaker 1: even in the development of the science has big impacts

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Speaker 1: on how it's then perceived by wider society.

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Speaker 2: And that's exactly right. And it's worth emphasizing that one

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Speaker 2: of the leading IVG commercial players, there's not that many

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Speaker 2: on the scene, but have been public about it in

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Speaker 2: the press about them and the New Yorker story that

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Speaker 2: was done about them, there's a lot of emphasis that

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Speaker 2: the leading kind of scientists and the leading kind of

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Speaker 2: business person in it are gay men, right, and this

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Speaker 2: idea of kind of personalizing it. So a big part

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Speaker 2: of their story and their pitch is that as gay men,

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Speaker 2: we wanted to have children with our partners that are

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Speaker 2: also genetically both of ours. All of this puts pressure

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Speaker 2: on the question about whether genetic parentage is the end

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Speaker 2: all and be all right, because you might say, there's

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Speaker 2: a way in which all of this discussion of IVG

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Speaker 2: might strike adoptive parents, for example, as quite untoward. Is

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Speaker 2: to say, it's so important that I know adopt that

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Speaker 2: actually that I want to invent this entire new technology

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Speaker 2: and do this. So there's a way in which how

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Speaker 2: you frame this is also how you frame questions about

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Speaker 2: the value of genetic connection versus other kinds of connections,

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Speaker 2: and I think it's worthwhile for us to have that conversation.

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Speaker 2: That conversation requires us to take a hard look at

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Speaker 2: ourselves and say, why is genetic parentage so important for us?

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Speaker 2: Why is it so important that both of us be

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Speaker 2: genetic parents? And it's true, fertile heterosexual individuals are able

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Speaker 2: to do this, no problem. But you know, is this

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Speaker 2: the kind of thing that we think it's a really

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Speaker 2: strong moral imperative to have technology to solve, or instead

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Speaker 2: should our goal be to try to de emphasize genetic parentage.

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Speaker 2: And there's a certain irony here because chosen family and

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Speaker 2: I'm gay, so I can say this chosen family is

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Speaker 2: a big adage within the gay community. And yet it

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Speaker 2: seems to be there's a way in which this is

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Speaker 2: a chosen family, but also a way in which this

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Speaker 2: is a very genetically related family that in some ways

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Speaker 2: reproduces very typical, very heterosexual conceptions of what family is.

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Speaker 1: I think that some of the questions that are raising here,

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Speaker 1: we really have to think about this as we are

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Speaker 1: moving into this new unknown territory and the directions we're

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Speaker 1: going in, the implications that can have so would IVG

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Speaker 1: resolve any of the ethical concerns around existing alternatives to

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Speaker 1: biological procreation, so for example, using an egg donor surrogacy

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Speaker 1: or adoption.

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Speaker 2: So one thing that's nice about IVG that helps kind

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Speaker 2: of resolve some of the ethical considerations about other technologies

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Speaker 2: is for egg retrieval. There's many people who say egg

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Speaker 2: retrieval imposes risks on women, and in particular, if you

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Speaker 2: think about egg freezing, where we're talking about young women

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Speaker 2: who are kind of proactively trying to retrieve eggs and

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Speaker 2: freeze them for a potential future use, there's a way

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Speaker 2: in which they are imposing hardship on themselves, costs upon themselves,

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Speaker 2: and also the potential low risk levels but potential for

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Speaker 2: things like ovarian hyperstimulation syndrome for a potential future use.

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Speaker 2: And if you could tell people, if you ever find

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Speaker 2: yourself in that situation, we'll have a solution then and

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Speaker 2: there you don't have to proactively do that, that might

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Speaker 2: be quite attractive. So that's one thing that might be

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Speaker 2: ethically good about this or solve another ethical problem. The

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Speaker 2: other is the question of markets for eggs more generally

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Speaker 2: and sperm to a lesser extent. But there are some

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Speaker 2: people who find it objectionable that we have widespread markets

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Speaker 2: in the United States where people buy and sell eggs.

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Speaker 2: If you think those kinds of markets are problematic, there's

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Speaker 2: a way in which IVG solves the problem because you

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Speaker 2: now are able to do it to yourself. So it

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Speaker 2: ends a certain market that at least some people find problematic.

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Speaker 2: Those are two kind of advantageous parts about IVG. One

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Speaker 2: disadvantage is, at least in the case of gay men

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Speaker 2: or single men or women who have a medical issue

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Speaker 2: that stops them from carrying to term, it might increase

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Speaker 2: the use of surrogacy. And for people who think markets

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Speaker 2: and surrogacy or surrogacy as a whole is problematic, it

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Speaker 2: may be that by stimulating surrogacy use in the United

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Speaker 2: States or across the world is a problem.

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Speaker 1: So how will we know when it's ready to do

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Speaker 1: a trial with human participants?

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Speaker 2: So this is a very very complicated process. You know,

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Speaker 2: we have an agency FDA, which is very good at

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Speaker 2: looking at drugs, for example, to say we're ready to

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Speaker 2: do a clinical trial in human beings. It does not

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Speaker 2: have particular experience with reproductive technologies. And in the US

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Speaker 2: at least that's partially a political reality that it doesn't.

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Speaker 2: But I think that essentially what you're going to do

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Speaker 2: is you're going to get increasingly close to human kinds

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Speaker 2: of processes in animals and animals whose biology and reproduction

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Speaker 2: is closer and closer to humans. You're going to get

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Speaker 2: more and more evidence, and then at some point we're

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Speaker 2: going to have to just make a decision, and it's

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Speaker 2: probably going to be a regulator who's going to make

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Speaker 2: the decision that we are close enough and we have

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Speaker 2: enough evidence that with people who are fully informed of

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Speaker 2: the risk, who are well selected for a clinical trial

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Speaker 2: to minimize the risk, that it's time to begin a

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Speaker 2: clinical trial in human beings.

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Speaker 1: And some of the groups that are furthest along in

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Speaker 1: getting IVG technology ready for human reproduction are for profit companies.

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Speaker 1: Where are they coming from?

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Speaker 2: These our companies that I think have a lot in

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Speaker 2: common with some of the tech companies we've seen in

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Speaker 2: Silicon Valley. And this is not uncommon when people are

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Speaker 2: pushing an envelope that there is kind of a philosophy

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Speaker 2: in Silicon Valley that there's a great idea, there's an

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Speaker 2: unmet need and we should solve it with technology, and

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Speaker 2: there's a way in which that's exactly what's being done here.

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Speaker 2: But in the biospace as opposed to the technological.

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Speaker 1: Space, it seems like IVG could end up being pretty expensive.

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Speaker 1: So how do f this think about the problem of

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Speaker 1: unequal access to these new reproductive technologies.

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Speaker 2: You know the writer William Gibson, I think he said

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Speaker 2: this on NPR once. It was quoted as saying, the

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Speaker 2: future is already here, it's just not very evenly distributed.

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Speaker 2: And I think that's like an interesting perspective on this

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Speaker 2: or ethicists like me. It is a concern when we

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Speaker 2: have something that's good, that we think is going to

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Speaker 2: make people's lives go better, that it only be available

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Speaker 2: to a small subset of the population. So I do

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Speaker 2: think that this is something to keep one's eye on.

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Speaker 2: But that said, if we look at in vitro fertilization

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Speaker 2: as kind of a predecessor of technology, it's still extremely expensive.

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Speaker 2: It's still not available to most people, and although I

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Speaker 2: think it's somewhere between fifteen or nineteen US states have

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Speaker 2: some requirement that insures cover IVF, it's a relatively weak

439
00:26:32,800 --> 00:26:35,440
Speaker 2: form of coverage. So in some ways, I would say,

440
00:26:35,440 --> 00:26:38,240
Speaker 2: if you ask me the cynical hat on. My guess

441
00:26:38,280 --> 00:26:41,040
Speaker 2: is if IVG ever becomes available, it'll take a while

442
00:26:41,119 --> 00:26:43,840
Speaker 2: to have any requirement of insurance coverage, and I doubt

443
00:26:43,880 --> 00:26:46,439
Speaker 2: that the insurance coverage requirement will be more robust than

444
00:26:46,480 --> 00:26:48,840
Speaker 2: the one we have for IVF at the moment, which

445
00:26:48,880 --> 00:26:51,800
Speaker 2: is not all that robust. So with IVF and all

446
00:26:51,840 --> 00:26:54,439
Speaker 2: reproductive technologies, it's become a game of the haves and

447
00:26:54,480 --> 00:26:54,920
Speaker 2: have not.

448
00:26:55,960 --> 00:26:59,480
Speaker 1: And what is the best case scenario in your mind

449
00:26:59,560 --> 00:27:02,320
Speaker 1: regarding the laws and regulations surrounding IVG.

450
00:27:03,960 --> 00:27:07,840
Speaker 2: For me, the best possible story of regulation, We'll start

451
00:27:07,840 --> 00:27:09,720
Speaker 2: with a particular use case, and I would say start

452
00:27:09,720 --> 00:27:12,479
Speaker 2: with one of the less objectionable, easier to get behind

453
00:27:12,600 --> 00:27:16,080
Speaker 2: use cases, So, for example, the use of IVG to

454
00:27:16,119 --> 00:27:19,560
Speaker 2: allow individuals who are still within their typical reproductive years

455
00:27:20,000 --> 00:27:22,560
Speaker 2: to reproduce because they are not able to produce eggs

456
00:27:22,640 --> 00:27:25,280
Speaker 2: or sperms. Supply them the thing that they are missing,

457
00:27:25,880 --> 00:27:29,720
Speaker 2: And basically we would start there. We'd have significant public engagement,

458
00:27:29,760 --> 00:27:33,560
Speaker 2: maybe we'd have citizen juries, deliberative democracy experiments, we'd have

459
00:27:33,600 --> 00:27:37,480
Speaker 2: widespread discussion as a country, we'd have debates in Congress

460
00:27:37,640 --> 00:27:40,000
Speaker 2: or in parliament, and we would settle on what I

461
00:27:40,000 --> 00:27:42,960
Speaker 2: would hope would be a heavily regulated system where we

462
00:27:43,040 --> 00:27:49,080
Speaker 2: have a government agency supervising learning, licensing, getting data, and

463
00:27:49,119 --> 00:27:51,960
Speaker 2: then evaluating after a set period of time whether to

464
00:27:52,000 --> 00:27:54,359
Speaker 2: expand to one of the other use cases, and again

465
00:27:54,680 --> 00:27:57,120
Speaker 2: providing an opportunity to engage on those questions.

466
00:27:58,400 --> 00:28:00,639
Speaker 1: And so that's the best case. Could you tell us

467
00:28:00,640 --> 00:28:01,399
Speaker 1: the worst case?

468
00:28:02,520 --> 00:28:05,159
Speaker 2: Well, I think there are two worst cases. One worst

469
00:28:05,160 --> 00:28:08,480
Speaker 2: case is straight out prohibition. That we have people who

470
00:28:08,480 --> 00:28:11,359
Speaker 2: could benefit from this technology, and we decide without any

471
00:28:11,440 --> 00:28:14,800
Speaker 2: real deep reflection it's just too weird, it's too icky,

472
00:28:14,840 --> 00:28:16,320
Speaker 2: We're just going to prohibit it. And for me, that's

473
00:28:16,359 --> 00:28:18,800
Speaker 2: a bad case scenario because if there's value to this

474
00:28:18,920 --> 00:28:20,879
Speaker 2: for some people, I'd like to at least us have

475
00:28:20,880 --> 00:28:24,080
Speaker 2: an adult conversation about it. The other worst case scenario,

476
00:28:24,119 --> 00:28:27,880
Speaker 2: I think would be a totally unregulated system where anybody

477
00:28:27,960 --> 00:28:30,840
Speaker 2: could do this tomorrow, just at you find it too

478
00:28:30,880 --> 00:28:32,800
Speaker 2: a physician or a lab that's willing to do and

479
00:28:32,880 --> 00:28:36,439
Speaker 2: the technology is available and nobody's monitoring it, nobody is concerned,

480
00:28:36,480 --> 00:28:38,400
Speaker 2: nobody's considering the ethical objections.

481
00:28:38,600 --> 00:28:42,360
Speaker 1: So I guess it's with developments like these, the science

482
00:28:42,400 --> 00:28:45,880
Speaker 1: needs to happen but also the infrastructure around the regulations

483
00:28:46,000 --> 00:28:47,880
Speaker 1: also needs to happen too.

484
00:28:48,720 --> 00:28:51,160
Speaker 2: I think that's right. And also I'll just say the

485
00:28:51,240 --> 00:28:53,959
Speaker 2: human face of what we're talking about, right, Yeah. One

486
00:28:54,040 --> 00:28:55,760
Speaker 2: of the reasons why we're seeing enforce in the United

487
00:28:55,800 --> 00:28:59,720
Speaker 2: States a raft of personhood bills and restrictions on abortion.

488
00:29:00,000 --> 00:29:02,480
Speaker 2: Any of the same arguments might apply to embryo destruction,

489
00:29:02,600 --> 00:29:06,120
Speaker 2: but we don't see huge attempts to politically restrict in

490
00:29:06,200 --> 00:29:08,720
Speaker 2: vitro fertilization in the United States. And if you ask why,

491
00:29:09,320 --> 00:29:12,920
Speaker 2: one of the answers is even very conservative legislatures they

492
00:29:13,040 --> 00:29:16,120
Speaker 2: know or they themselves have used in viuture fertilization. There's

493
00:29:16,160 --> 00:29:18,600
Speaker 2: somebody who they picture when they picture the technology, and

494
00:29:18,640 --> 00:29:21,200
Speaker 2: they picture the happy family that is the result. The

495
00:29:21,320 --> 00:29:23,760
Speaker 2: more those kinds of stories can be, the stories of

496
00:29:23,880 --> 00:29:26,760
Speaker 2: things like in vitro commutagenesis, the more likely it is

497
00:29:26,840 --> 00:29:28,960
Speaker 2: that you will find a political majority in favor of

498
00:29:29,000 --> 00:29:31,160
Speaker 2: permitting it. The less you are able to tell that

499
00:29:31,320 --> 00:29:32,600
Speaker 2: kind of story, the harder it will be.

500
00:29:33,840 --> 00:29:36,680
Speaker 1: It was so fascinating for me to talk with Amanda

501
00:29:36,800 --> 00:29:39,080
Speaker 1: and Glenn and hear about where we are at with

502
00:29:39,200 --> 00:29:43,240
Speaker 1: this new technology. I can see how something like IVG

503
00:29:43,640 --> 00:29:46,400
Speaker 1: would bring so much to so many people who long

504
00:29:46,760 --> 00:29:50,320
Speaker 1: for having a genetically related baby. But I can also

505
00:29:50,480 --> 00:29:54,480
Speaker 1: see the importance of thinking really intentionally about this how

506
00:29:54,640 --> 00:29:58,760
Speaker 1: if IVG becomes widely available, we'll need to be careful

507
00:29:58,840 --> 00:30:02,280
Speaker 1: about how it's used for what purpose. Even though it

508
00:30:02,400 --> 00:30:05,600
Speaker 1: remains to be seen how this technology develops and how

509
00:30:05,680 --> 00:30:08,960
Speaker 1: we can use it responsibly, I think it's important that

510
00:30:09,080 --> 00:30:13,479
Speaker 1: we all start having these conversations now. Throughout the series,

511
00:30:13,760 --> 00:30:17,160
Speaker 1: we've been talking about the decisions we make about technology,

512
00:30:17,680 --> 00:30:21,880
Speaker 1: and specifically what the ethical implications are of how new

513
00:30:22,000 --> 00:30:25,920
Speaker 1: medical technologies are used. I'm thinking about the strong in

514
00:30:25,960 --> 00:30:30,040
Speaker 1: Goldberg's losing their son, Sally Settel's search for a kidney,

515
00:30:30,600 --> 00:30:34,760
Speaker 1: Andrew Cameron fighting for his patients, and so many other

516
00:30:34,920 --> 00:30:40,400
Speaker 1: moving stories of patients, families, scientists, and caregivers. I'm also

517
00:30:40,520 --> 00:30:43,360
Speaker 1: thinking about all the people whose stories we haven't heard

518
00:30:43,600 --> 00:30:46,320
Speaker 1: because they weren't able to access the care they needed.

519
00:30:47,520 --> 00:30:52,520
Speaker 1: Sometimes these medical dilemmas involve difficult decisions, often with no

520
00:30:52,840 --> 00:30:57,720
Speaker 1: perfect answer. Whatever we choose, we must live or die

521
00:30:58,040 --> 00:31:07,680
Speaker 1: with the consequences. We hope you've enjoyed playing God and

522
00:31:07,800 --> 00:31:10,240
Speaker 1: we have something extra lined up for you. Next week.

523
00:31:10,640 --> 00:31:14,200
Speaker 1: It's a prequel episode about a troubling chapter in medical

524
00:31:14,360 --> 00:31:18,200
Speaker 1: history that helped give birth to the field of bioethics.

525
00:31:18,960 --> 00:31:22,720
Speaker 1: In the nineteen sixties in Seattle, a committee of everyday

526
00:31:22,800 --> 00:31:26,400
Speaker 1: people sort of like a jury of peers, was tasked

527
00:31:26,480 --> 00:31:31,320
Speaker 1: with deciding which critically ill patients in their community deserved

528
00:31:31,400 --> 00:31:35,280
Speaker 1: to live and who should be left to die. So

529
00:31:35,440 --> 00:31:37,880
Speaker 1: watch out for that in your podcast feed next week.

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00:31:39,720 --> 00:31:43,000
Speaker 1: Thanks to our guests in this episode, Amanda Clark and

531
00:31:43,120 --> 00:31:48,240
Speaker 1: Glen Cohen. Playing God is a co production of Pushkin

532
00:31:48,320 --> 00:31:53,000
Speaker 1: Industries and the Johns Hopkins Berman Institute of Bioethics. Emily

533
00:31:53,120 --> 00:31:57,959
Speaker 1: Vaughn is our lead producer. Production support from Sophie Crane

534
00:31:58,080 --> 00:32:02,840
Speaker 1: and Lucy Sullivan. Our editors are Karen Shakergie and Kate

535
00:32:02,960 --> 00:32:09,000
Speaker 1: Parkinson Morgan. Mixing by Samir Sengupta, the music by Echo Mountain,

536
00:32:09,760 --> 00:32:14,760
Speaker 1: Engineering support from Sarah Bruguerre and Amanda Kaiwang. Show art

537
00:32:15,000 --> 00:32:20,240
Speaker 1: by Sean Karney, fact checking by David jar and Arthur Gompertz.

538
00:32:22,320 --> 00:32:27,120
Speaker 1: Our executive producer is Justine Lang at the Johns Hopkins

539
00:32:27,240 --> 00:32:31,440
Speaker 1: Berman Institute of Bioethics. Our executive producers are Jeffrey Kahan

540
00:32:31,560 --> 00:32:36,120
Speaker 1: and Anna Mastriani, working with Amelia Hood and with support

541
00:32:36,280 --> 00:32:42,360
Speaker 1: from Susan Snead, Aaron Henkin, Abigail Brickler, Kim bikermer Anna Oakes,

542
00:32:42,480 --> 00:32:47,480
Speaker 1: and Jamie Smith. Special thanks to Ari Cohen. Funding provided

543
00:32:47,600 --> 00:32:51,880
Speaker 1: by the green Wall Foundation. Special thanks to voice coach

544
00:32:52,320 --> 00:32:56,880
Speaker 1: Vicky Merrick. This is our last episode, so we'd like

545
00:32:57,000 --> 00:32:59,480
Speaker 1: to thank some of the many people at Pushkin who've

546
00:32:59,480 --> 00:33:06,360
Speaker 1: supported this show throughout the season, including Jacob Weisberg, Heather Fane,

547
00:33:07,280 --> 00:33:15,600
Speaker 1: John Snarz, Letal Malad Greta Cohne, Carl Mcliori, Jasmine Perez,

548
00:33:16,480 --> 00:33:24,080
Speaker 1: Eric Sandler, Jordan mcmill, Isabella Navarez, Nicole op Den Bosch,

549
00:33:24,960 --> 00:33:34,400
Speaker 1: Maya Kanig, Jake Flanagan, Owen Miller, David Glover, Nina Lawrence,

550
00:33:34,880 --> 00:33:40,600
Speaker 1: Mia LaBelle, and Ian Petzer. To learn more about bioethics

551
00:33:40,760 --> 00:33:44,920
Speaker 1: and the issues presented in this series, please visit Bioethics

552
00:33:45,000 --> 00:33:53,960
Speaker 1: dot jhu dot Edu Forward slash Playing God. I'm Lauren

553
00:33:54,000 --> 00:33:59,800
Speaker 1: Aroora Hutchinson. Thanks for listening to Playing God. As you've

554
00:33:59,840 --> 00:34:02,960
Speaker 1: heard through the series. I'm the director of the Ideas

555
00:34:03,040 --> 00:34:06,800
Speaker 1: Lab at the Johns Hopkins Berman Institute of Bioethics at

556
00:34:06,840 --> 00:34:09,880
Speaker 1: the Ideas Lab. We are exploring new innovative ways of

557
00:34:10,000 --> 00:34:14,000
Speaker 1: telling stories about the intersection of ethics, science, medicine, and

558
00:34:14,080 --> 00:34:18,160
Speaker 1: public health. As well as podcasts, we do screenwriting, films,

559
00:34:18,239 --> 00:34:22,880
Speaker 1: and immersive experiences. To get involved, visit Bioethics dot Jhu

560
00:34:23,160 --> 00:34:25,799
Speaker 1: dot edu, Forward Slash Ideas Lab