Speaker 1: On today's show, as we wrap up this season, we're
Speaker 1: doing something a little different. We're going into the future
Speaker 1: to learn about a technology that's in the works but
Speaker 1: not yet available, a technology that even in its development stage,
Speaker 1: has people asking all kinds of questions.
Speaker 2: Imagine it became possible so that you could go to
Speaker 2: a hotel where Brad Pitt had been, you could take
Speaker 2: the dead skin, and you could use that genetic material
Speaker 2: to produce children. Would that be something that was problematic.
Speaker 1: We're talking about a type of reproductive technology called in
Speaker 1: vitro gametogenesis or IVG, that has the potential to open
Speaker 1: up a whole world of options for how humans procreate.
Speaker 1: IVG is essentially a process where cells, including human skin cells,
Speaker 1: could be used to make babies. Glen Cohen knows all
Speaker 1: about IVG. He's a professor of bioethics and law at
Speaker 1: Harvard Law School.
Speaker 2: You could both produce sperm an egg yourself and have
Speaker 2: a child that is your direct genetic descendant, but completely
Speaker 2: taking your genetic material rather than someone else. Now, I
Speaker 2: think for most people this strikes them as extremely strange
Speaker 2: as a desire. Why would you possibly ever want this?
Speaker 2: But just as there are people who want a single pair.
Speaker 2: In terms of rearing a child, there might be people
Speaker 2: who want to not have anybody else's genetic material involved.
Speaker 1: This may sound like science fiction, but scientists and biotech
Speaker 1: startups are already working or making it a reality. I'm
Speaker 1: Laurena Rora Hutchinson. I'm the director of the Ideas Lab
Speaker 1: at the Johns Hopkins Berman Institute of Bioethics. On today's episode,
Speaker 1: there are a lot of ways IVG could be used.
Speaker 1: People who for any reason aren't able to juice eggs
Speaker 1: or sperm could still have biological children, like people who've
Speaker 1: gone through menopause and people whose fertility has been impacted
Speaker 1: by cancer treatment. And people in same sex relationships could
Speaker 1: both be the genetic parent of the same child. But
Speaker 1: given that we could be shaping the future of humanity
Speaker 1: with this new technology, there are a lot of ethical
Speaker 1: questions to unravel. Are there good or bad reasons to
Speaker 1: do IVG? How much should regulators play a role? And
Speaker 1: how long do we have before all this becomes a reality.
Speaker 1: Some researchers predict that it may take decades, while commercial
Speaker 1: startups promise proof of concept trials within one to two years.
Speaker 1: From pushkin Industries and the Johns Hopkins Berman Institute of Bioethics.
Speaker 1: This is playing God. We'll hear more from Glen Cohen
Speaker 1: later on in this episode, but first I wanted to
Speaker 1: understand more about this technology, like how it actually works
Speaker 1: and where the research stands today. So I called up
Speaker 1: Amanda Clark. She's a professor of molecular, cell and Developmental
Speaker 1: biology at the University of California, Los Angeles, and she's
Speaker 1: an internationally renowned researcher and expert on in vitro gamito genesis.
Speaker 1: She's been working on developing it for decades.
Speaker 3: I am a basic scientist, and I'm interested in questions
Speaker 3: that are related to fertility and infertility and reproductive health.
Speaker 3: And what I saw as I looked at the scientific
Speaker 3: landscape for what's available to couples who are struggling with infertility,
Speaker 3: is that there seems to be a limit to what
Speaker 3: can currently be achieved with assisted reproductive technologies and medical technologies.
Speaker 3: So for those individuals who, for example, they're ovary or
Speaker 3: testis was destroyed as part of occupational health injury or
Speaker 3: due to chemotherapy or radiation therapy following a cancer diagnosis,
Speaker 3: and now they're cancer survivors. All of these types of
Speaker 3: injuries destroy the cells in the overy in testice that
Speaker 3: enable a person to have a biologically related child. And
Speaker 3: so as a stem cell scientist, I became really interested
Speaker 3: in what could we do as in a scientific community
Speaker 3: to be able to help those individuals and couples who
Speaker 3: want to have a family that don't have the cell
Speaker 3: types necessary for it anymore. So could we regenerate these
Speaker 3: cell types from stem cells? And that's the basis of
Speaker 3: in vitrogemetogenesis.
Speaker 1: Could you give me the broad strokes of what's going
Speaker 1: on with IVG and how it works, So if you're
Speaker 1: just explaining this to someone who had no idea what it.
Speaker 3: Was, So let's begin with the G in IVG. So
Speaker 3: IVG stands for in vitro gametagenesis. So most people understand
Speaker 3: what in vitro is because in vitro fertilization is used
Speaker 3: currently as a medical technology to help an individual or
Speaker 3: a couple to have a baby. The G gametogenesis means
Speaker 3: game meats eggs and sperm. So if we add it together,
Speaker 3: in vitro gamita genesis means making eggs and sperm in
Speaker 3: the lab for the purposes of reproduction. For those people
Speaker 3: that their testes and their ovaries aren't working properly, they
Speaker 3: may not make a functional egg cell or a sperm cell.
Speaker 3: And so if your egg cell or sperm cell's not
Speaker 3: functional or you don't make them in your body, that
Speaker 3: means you can't have a biologically related child.
Speaker 1: And so with IVG eggs or sperm cells made.
Speaker 3: So in future, agamtagenesis means instead of these egg and
Speaker 3: sperm cells being made inside of the body, they are
Speaker 3: made in the lab by researchers, starting with a different
Speaker 3: cell type in the body, for example a skin cell.
Speaker 3: So scientists now know how to take a biopsy of
Speaker 3: the skin or perhaps a biopsy of the blood, and
Speaker 3: to grow those cells in the lab and to use
Speaker 3: molecular biology to convert those cells to a stem cell.
Speaker 3: And this stem cell has the potential to become an
Speaker 3: egg and sperm cell in the lab that could then
Speaker 3: be used for fertilization through in vitro fertilization.
Speaker 1: So, just to be clear on this, it means someone
Speaker 1: would be able to create an egg or sperm which
Speaker 1: was genetically matched to them because they'd be using their
Speaker 1: own skin cells.
Speaker 3: Yes, that's right. So in future, agametera genesis provides the
Speaker 3: opportunity for having a genetically related child because the skin cell,
Speaker 3: for example, comes from the person who's the intended parent. Wow.
Speaker 1: So where exactly is this technology currently?
Speaker 3: In future, gemtagenesis is being used for research because scientists
Speaker 3: still can't make an egg or sperm cell in the
Speaker 3: lab from human cells. So what scientists are able to
Speaker 3: do is to make very immature egg or sperm cells
Speaker 3: in the lab from human cells. And so this is
Speaker 3: actually very helpful because we don't understand much about how
Speaker 3: egg and sperm cells are made inside the body because
Speaker 3: they're inside an organ and they're relatively rare cell type,
Speaker 3: and so in future, cometagenesis is providing really important molecular
Speaker 3: and genetic information about how gameat forms and that can
Speaker 3: help us to understand the disease of infertility. But it's
Speaker 3: not yet at the point of making a GA meat
Speaker 3: that can be used for reproductive purposes. We are looking
Speaker 3: at decades away from being able to make an egg
Speaker 3: or sperm cell in the lab that could be used
Speaker 3: for reproductive purposes, and that's where the field would like
Speaker 3: to go.
Speaker 1: When we do get to that point, what applications do
Speaker 1: you think would be the best to try first for
Speaker 1: clinical research?
Speaker 3: Well, one of the options is to study in vitrogametogenesis
Speaker 3: in a species that is closely related to humans, for example,
Speaker 3: using non human primates as an alternate model to make
Speaker 3: game meats in the lab, and to use those lab
Speaker 3: made gameats the egg or the sperm cell in order
Speaker 3: to cure a disease model of infertility. And once those
Speaker 3: scientific models have shown that the game meat can successfully
Speaker 3: lead to a healthy pregnancy and a healthy baby, and
Speaker 3: that the resulting animal itself is fertile, only then will
Speaker 3: this technology move into clinical trials inhuman.
Speaker 1: And so, if it is shown to be safe and effective,
Speaker 1: as you've just explained, and it becomes approved as a
Speaker 1: reproductive technology, who do you think would be interested in
Speaker 1: using it?
Speaker 3: And why? I certainly get emails on a regular basis
Speaker 3: from couples that have been going through in viture fertilization
Speaker 3: for five years or more and successive rounds, and none
Speaker 3: of them have been successful, and so this is the
Speaker 3: sort of group who would be very interested in signing
Speaker 3: up for in future commutagenesis. Of course, we had the
Speaker 3: really important breakthrough study that was published using a mouse model,
Speaker 3: which is a model that scientists use in the lab
Speaker 3: where the sex of a gameat can be switched so
Speaker 3: that an egg cell can be made from cells that
Speaker 3: are taken from a man. And so this opens up
Speaker 3: the possibility of same sex reproduction for those that are
Speaker 3: socially infertile. And I think that this is a really
Speaker 3: important aspect of the technology as well.
Speaker 1: And what would it take to make sure that it
Speaker 1: would be a safe process?
Speaker 3: Yeah, in vitrogametogenesis would need to be proven safe. That
Speaker 3: game meat would need to be proven to have the
Speaker 3: equivalent quality competency of a gameat an eggorosperm that would
Speaker 3: have been made inside of the body. And so what
Speaker 3: this means is testing the quality of the gameat, the
Speaker 3: competency of the gamat and developing scientific tools that don't
Speaker 3: exist yet. And so a lot of that technology now
Speaker 3: needs to be developed too.
Speaker 1: Do you think that could be potential safety risks two
Speaker 1: children born via IVG.
Speaker 3: Well, human reproduction itself is actually not very successful and
Speaker 3: that is why the use of in future fertilization is
Speaker 3: increasing year over year of a year around the world.
Speaker 3: And one thing we have learned about studying embryos in
Speaker 3: the IVF lab is there's a lot of genetic abnormalities
Speaker 3: during early embryo development in humans, much more so than
Speaker 3: in any other species. And actually we understand very little
Speaker 3: about why there is so much genetic instability in the
Speaker 3: early human embryo. And of course, genetic instability in the
Speaker 3: early human embryo leads to early pregnancy loss. And so
Speaker 3: when we turn now to in vitrogamy genesis, the expectation
Speaker 3: is that the game meat made a research in the
Speaker 3: lab and used in fertilization studies is also going to
Speaker 3: have these same issues that a game meat made in
Speaker 3: the body has. And so the question is how do
Speaker 3: we measure the quality of an embryo made from an
Speaker 3: in vitrogametogenesis gameat eggosperm versus an eggosperm cell that's made
Speaker 3: inside the body. And so that's the beginning of understanding
Speaker 3: how these ga meats would be safe. But in the
Speaker 3: end not even natural conception has always successful, and so
Speaker 3: we know that there are children that are born who
Speaker 3: do suffer from genetic abnormalities, and so it's safeguarding against
Speaker 3: all of those potential eventualities with a game meat made
Speaker 3: inside the lab.
Speaker 1: And are there concerns in the academic research community about
Speaker 1: this technology being used in a way that's risky or problematic.
Speaker 3: So I think it's really important that the academic community
Speaker 3: talks about the promise but also the realistic challenges of
Speaker 3: in viuturogemeta genesis. What makes me very nervous is that
Speaker 3: it's potentially possible to get ahead of the science and
Speaker 3: talk about in viuture gemeta genesis as being a technology
Speaker 3: that's right around the corner for use in reproduction. But
Speaker 3: what we're talking about is a reproductive technology that has
Speaker 3: the potential to be transformative. But there's a lot of
Speaker 3: scientific hurdles that need to be overcome in order for
Speaker 3: this technology to become a reality, and it's really important
Speaker 3: that as scientists we communicate that effectively so that we're
Speaker 3: not giving false hope to people who think this technology
Speaker 3: is going to be right around the corner and could
Speaker 3: help them within the next five to ten years, when
Speaker 3: the technology is just not there yet, and the most
Speaker 3: important thing will be ensuring the safety of the technology,
Speaker 3: and that in the end comes down to the quality
Speaker 3: of the erg or sperm cell made in the lab
Speaker 3: and ensuring that that quality is equivalent to the quality
Speaker 3: of an erg or sperm cell that would have been
Speaker 3: made in the body.
Speaker 1: Thank you, Amando. It's been amazing to hear about this
Speaker 1: new technology and all the important work that you're doing.
Speaker 3: So happy for the opportunity to talk about the science.
Speaker 1: After the break, we'll go back to Glen Cohen. The
Speaker 1: ethicis we heard from earlier. We'll find out how he
Speaker 1: thinks as a society we should approach IBG. Let's go
Speaker 1: back to Glen Cohen. Glenn is a professor and deputy
Speaker 1: dean at Harvard Law School. There, he's also the director
Speaker 1: of the Peak Flom Center for Health Law, Policy, Biotechnology,
Speaker 1: and Bioethics. Glenn thinks reproductive technologies like IVG have the
Speaker 1: potential to really change our society and spark new ethical challenges. So, Glenn,
Speaker 1: could you tell us about some of the ethical issues
Speaker 1: surrounding IVG.
Speaker 2: So when talking about IVG, I think it's really important
Speaker 2: to distinguish different use cases, because different use cases raise
Speaker 2: different ethical questions. Start with the easiest use case, I think,
Speaker 2: ethically speaking, which is the use of IVG to help
Speaker 2: individuals who cannot produce scam meat, So, for example, people
Speaker 2: who cannot produce eggs during their regular, normal, healthy fertility period.
Speaker 2: For that group, some of the issues are, what do
Speaker 2: we have to do to perfect this technology? Does it
Speaker 2: involve a lot of embryo destruction along the way and
Speaker 2: is that a problem? How do we know when this
Speaker 2: is safe and effective and ready for human use? And
Speaker 2: when do we move to first in human How will
Speaker 2: we know what the inter generational effects might be and
Speaker 2: how do we track that? And can we actually demand
Speaker 2: to have data from successive generations people who never consented,
Speaker 2: for example, to this because they were born this way.
Speaker 2: And then I think we have some kind of interesting
Speaker 2: questions about policing inappropriate use, So whether, for example, we're
Speaker 2: worried that people might derive eggs from adult cells from
Speaker 2: someone who didn't consent, so taking leftover skin cells for example.
Speaker 2: And then maybe finally is just a broader question about
Speaker 2: whether this is a worthwhile goal for humanity, especially when
Speaker 2: we have so many people with other kinds of medical needs.
Speaker 2: Is this really where we should be spending our time,
Speaker 2: spending our money, and spending our research effort.
Speaker 1: Yeah, a lot of different ethical issues there. So you've
Speaker 1: begun with talking about keeping it within a person's period
Speaker 1: of life where they would, in theory be able to
Speaker 1: produce eggs. Could you talk about some of the ethical
Speaker 1: issues around using IVG for a person who's gone through menopause,
Speaker 1: for example.
Speaker 2: So I often like to distinguish what I call mimicking
Speaker 2: uses versus extending uses of new reproductive technologies. Mimicking is
Speaker 2: attempting to give people who by virtue of medical issues
Speaker 2: would ordinarily be able to do the kind of reproduction
Speaker 2: that everybody else does, enabling them to do that. So
Speaker 2: a way of thinking about this is there's a person
Speaker 2: with a disability and we're trying to correct for that disability.
Speaker 2: Extension uses are attempts to extend and give people fertility
Speaker 2: options that would not be available to other people similarly situated.
Speaker 2: And the post meant apausal example is a good example
Speaker 2: of an extension use. Women have as a species a
Speaker 2: set reproductive period where they are producing eggs that comes
Speaker 2: to an end, and the question is should we extend
Speaker 2: beyond that end. So, in terms of the ethical issues
Speaker 2: that are raised here, one set of issues has to
Speaker 2: do with whether enabling reproduction later in life is a
Speaker 2: worthwhile goal. There are some individuals who are worried that
Speaker 2: when you produce children whose parents are quite old, that's
Speaker 2: an unfortunate circumstance for the child. And that's a relevant
Speaker 2: thing to think about. So that's one issue. Another is
Speaker 2: that there are some individuals who just think the human
Speaker 2: species is a particular kind of thing and living a
Speaker 2: uniquely good human life is to be a particular kind
Speaker 2: of entity. And that's an entity that has a period
Speaker 2: for everything, right, a time for all things in life,
Speaker 2: and it's just wrong to go beyond that.
Speaker 3: Yeah.
Speaker 1: So it's really interesting hearing your distinction of extension versus mimicking.
Speaker 1: And I'm just really curious when people are in the
Speaker 1: same sex relationship and they want to reproduce genetically, would
Speaker 1: you also put them in the extension category.
Speaker 2: Yeah, so I think this is a really interesting question,
Speaker 2: especially if we're talking, for example, about two women. Right,
Speaker 2: you may have two women who are actually completely healthy
Speaker 2: in terms of their reproductive life. Right, if we were
Speaker 2: to provide sperm, each of them would be able to reproduce.
Speaker 2: And yet they're making an ask to say that's it's
Speaker 2: not what we want. We want to both be genetic parents,
Speaker 2: And they're saying It's not that I want to kind
Speaker 2: of have parody with somebody who's healthy when I'm unhealthy. Instead,
Speaker 2: they're saying, I want to have parity with everybody else
Speaker 2: who's heterosexual, infertile, who's able to basically use sperm and
Speaker 2: egg from both parts of their couple. I do think
Speaker 2: that this is an extension use. Now calling it an
Speaker 2: extension use does not itself determine whether it's right or wrong,
Speaker 2: good or bad, But I think it does acknowledge that
Speaker 2: the ask here is a little bit different, and that
Speaker 2: the political theory and the questions we're going to ask
Speaker 2: about whether this is the kind of ask that's appropriate
Speaker 2: or one society should support, are a little bit different
Speaker 2: than the case of somebody who's facing medical infertility. Some
Speaker 2: of my colleagues, they prefer the term disfertility for this situation.
Speaker 2: Single individuals, same sex individuals. So it's not that they are,
Speaker 2: in terms of their healthcare or their medical state, infertile.
Speaker 2: It's that there's a social reason why they can't reproduce,
Speaker 2: and they are making an ask of society to help
Speaker 2: them overcome this social reason.
Speaker 1: Yeah, so interesting the different ways that things become framed,
Speaker 1: even in the development of the science has big impacts
Speaker 1: on how it's then perceived by wider society.
Speaker 2: And that's exactly right. And it's worth emphasizing that one
Speaker 2: of the leading IVG commercial players, there's not that many
Speaker 2: on the scene, but have been public about it in
Speaker 2: the press about them and the New Yorker story that
Speaker 2: was done about them, there's a lot of emphasis that
Speaker 2: the leading kind of scientists and the leading kind of
Speaker 2: business person in it are gay men, right, and this
Speaker 2: idea of kind of personalizing it. So a big part
Speaker 2: of their story and their pitch is that as gay men,
Speaker 2: we wanted to have children with our partners that are
Speaker 2: also genetically both of ours. All of this puts pressure
Speaker 2: on the question about whether genetic parentage is the end
Speaker 2: all and be all right, because you might say, there's
Speaker 2: a way in which all of this discussion of IVG
Speaker 2: might strike adoptive parents, for example, as quite untoward. Is
Speaker 2: to say, it's so important that I know adopt that
Speaker 2: actually that I want to invent this entire new technology
Speaker 2: and do this. So there's a way in which how
Speaker 2: you frame this is also how you frame questions about
Speaker 2: the value of genetic connection versus other kinds of connections,
Speaker 2: and I think it's worthwhile for us to have that conversation.
Speaker 2: That conversation requires us to take a hard look at
Speaker 2: ourselves and say, why is genetic parentage so important for us?
Speaker 2: Why is it so important that both of us be
Speaker 2: genetic parents? And it's true, fertile heterosexual individuals are able
Speaker 2: to do this, no problem. But you know, is this
Speaker 2: the kind of thing that we think it's a really
Speaker 2: strong moral imperative to have technology to solve, or instead
Speaker 2: should our goal be to try to de emphasize genetic parentage.
Speaker 2: And there's a certain irony here because chosen family and
Speaker 2: I'm gay, so I can say this chosen family is
Speaker 2: a big adage within the gay community. And yet it
Speaker 2: seems to be there's a way in which this is
Speaker 2: a chosen family, but also a way in which this
Speaker 2: is a very genetically related family that in some ways
Speaker 2: reproduces very typical, very heterosexual conceptions of what family is.
Speaker 1: I think that some of the questions that are raising here,
Speaker 1: we really have to think about this as we are
Speaker 1: moving into this new unknown territory and the directions we're
Speaker 1: going in, the implications that can have so would IVG
Speaker 1: resolve any of the ethical concerns around existing alternatives to
Speaker 1: biological procreation, so for example, using an egg donor surrogacy
Speaker 1: or adoption.
Speaker 2: So one thing that's nice about IVG that helps kind
Speaker 2: of resolve some of the ethical considerations about other technologies
Speaker 2: is for egg retrieval. There's many people who say egg
Speaker 2: retrieval imposes risks on women, and in particular, if you
Speaker 2: think about egg freezing, where we're talking about young women
Speaker 2: who are kind of proactively trying to retrieve eggs and
Speaker 2: freeze them for a potential future use, there's a way
Speaker 2: in which they are imposing hardship on themselves, costs upon themselves,
Speaker 2: and also the potential low risk levels but potential for
Speaker 2: things like ovarian hyperstimulation syndrome for a potential future use.
Speaker 2: And if you could tell people, if you ever find
Speaker 2: yourself in that situation, we'll have a solution then and
Speaker 2: there you don't have to proactively do that, that might
Speaker 2: be quite attractive. So that's one thing that might be
Speaker 2: ethically good about this or solve another ethical problem. The
Speaker 2: other is the question of markets for eggs more generally
Speaker 2: and sperm to a lesser extent. But there are some
Speaker 2: people who find it objectionable that we have widespread markets
Speaker 2: in the United States where people buy and sell eggs.
Speaker 2: If you think those kinds of markets are problematic, there's
Speaker 2: a way in which IVG solves the problem because you
Speaker 2: now are able to do it to yourself. So it
Speaker 2: ends a certain market that at least some people find problematic.
Speaker 2: Those are two kind of advantageous parts about IVG. One
Speaker 2: disadvantage is, at least in the case of gay men
Speaker 2: or single men or women who have a medical issue
Speaker 2: that stops them from carrying to term, it might increase
Speaker 2: the use of surrogacy. And for people who think markets
Speaker 2: and surrogacy or surrogacy as a whole is problematic, it
Speaker 2: may be that by stimulating surrogacy use in the United
Speaker 2: States or across the world is a problem.
Speaker 1: So how will we know when it's ready to do
Speaker 1: a trial with human participants?
Speaker 2: So this is a very very complicated process. You know,
Speaker 2: we have an agency FDA, which is very good at
Speaker 2: looking at drugs, for example, to say we're ready to
Speaker 2: do a clinical trial in human beings. It does not
Speaker 2: have particular experience with reproductive technologies. And in the US
Speaker 2: at least that's partially a political reality that it doesn't.
Speaker 2: But I think that essentially what you're going to do
Speaker 2: is you're going to get increasingly close to human kinds
Speaker 2: of processes in animals and animals whose biology and reproduction
Speaker 2: is closer and closer to humans. You're going to get
Speaker 2: more and more evidence, and then at some point we're
Speaker 2: going to have to just make a decision, and it's
Speaker 2: probably going to be a regulator who's going to make
Speaker 2: the decision that we are close enough and we have
Speaker 2: enough evidence that with people who are fully informed of
Speaker 2: the risk, who are well selected for a clinical trial
Speaker 2: to minimize the risk, that it's time to begin a
Speaker 2: clinical trial in human beings.
Speaker 1: And some of the groups that are furthest along in
Speaker 1: getting IVG technology ready for human reproduction are for profit companies.
Speaker 1: Where are they coming from?
Speaker 2: These our companies that I think have a lot in
Speaker 2: common with some of the tech companies we've seen in
Speaker 2: Silicon Valley. And this is not uncommon when people are
Speaker 2: pushing an envelope that there is kind of a philosophy
Speaker 2: in Silicon Valley that there's a great idea, there's an
Speaker 2: unmet need and we should solve it with technology, and
Speaker 2: there's a way in which that's exactly what's being done here.
Speaker 2: But in the biospace as opposed to the technological.
Speaker 1: Space, it seems like IVG could end up being pretty expensive.
Speaker 1: So how do f this think about the problem of
Speaker 1: unequal access to these new reproductive technologies.
Speaker 2: You know the writer William Gibson, I think he said
Speaker 2: this on NPR once. It was quoted as saying, the
Speaker 2: future is already here, it's just not very evenly distributed.
Speaker 2: And I think that's like an interesting perspective on this
Speaker 2: or ethicists like me. It is a concern when we
Speaker 2: have something that's good, that we think is going to
Speaker 2: make people's lives go better, that it only be available
Speaker 2: to a small subset of the population. So I do
Speaker 2: think that this is something to keep one's eye on.
Speaker 2: But that said, if we look at in vitro fertilization
Speaker 2: as kind of a predecessor of technology, it's still extremely expensive.
Speaker 2: It's still not available to most people, and although I
Speaker 2: think it's somewhere between fifteen or nineteen US states have
Speaker 2: some requirement that insures cover IVF, it's a relatively weak
Speaker 2: form of coverage. So in some ways, I would say,
Speaker 2: if you ask me the cynical hat on. My guess
Speaker 2: is if IVG ever becomes available, it'll take a while
Speaker 2: to have any requirement of insurance coverage, and I doubt
Speaker 2: that the insurance coverage requirement will be more robust than
Speaker 2: the one we have for IVF at the moment, which
Speaker 2: is not all that robust. So with IVF and all
Speaker 2: reproductive technologies, it's become a game of the haves and
Speaker 2: have not.
Speaker 1: And what is the best case scenario in your mind
Speaker 1: regarding the laws and regulations surrounding IVG.
Speaker 2: For me, the best possible story of regulation, We'll start
Speaker 2: with a particular use case, and I would say start
Speaker 2: with one of the less objectionable, easier to get behind
Speaker 2: use cases, So, for example, the use of IVG to
Speaker 2: allow individuals who are still within their typical reproductive years
Speaker 2: to reproduce because they are not able to produce eggs
Speaker 2: or sperms. Supply them the thing that they are missing,
Speaker 2: And basically we would start there. We'd have significant public engagement,
Speaker 2: maybe we'd have citizen juries, deliberative democracy experiments, we'd have
Speaker 2: widespread discussion as a country, we'd have debates in Congress
Speaker 2: or in parliament, and we would settle on what I
Speaker 2: would hope would be a heavily regulated system where we
Speaker 2: have a government agency supervising learning, licensing, getting data, and
Speaker 2: then evaluating after a set period of time whether to
Speaker 2: expand to one of the other use cases, and again
Speaker 2: providing an opportunity to engage on those questions.
Speaker 1: And so that's the best case. Could you tell us
Speaker 1: the worst case?
Speaker 2: Well, I think there are two worst cases. One worst
Speaker 2: case is straight out prohibition. That we have people who
Speaker 2: could benefit from this technology, and we decide without any
Speaker 2: real deep reflection it's just too weird, it's too icky,
Speaker 2: We're just going to prohibit it. And for me, that's
Speaker 2: a bad case scenario because if there's value to this
Speaker 2: for some people, I'd like to at least us have
Speaker 2: an adult conversation about it. The other worst case scenario,
Speaker 2: I think would be a totally unregulated system where anybody
Speaker 2: could do this tomorrow, just at you find it too
Speaker 2: a physician or a lab that's willing to do and
Speaker 2: the technology is available and nobody's monitoring it, nobody is concerned,
Speaker 2: nobody's considering the ethical objections.
Speaker 1: So I guess it's with developments like these, the science
Speaker 1: needs to happen but also the infrastructure around the regulations
Speaker 1: also needs to happen too.
Speaker 2: I think that's right. And also I'll just say the
Speaker 2: human face of what we're talking about, right, Yeah. One
Speaker 2: of the reasons why we're seeing enforce in the United
Speaker 2: States a raft of personhood bills and restrictions on abortion.
Speaker 2: Any of the same arguments might apply to embryo destruction,
Speaker 2: but we don't see huge attempts to politically restrict in
Speaker 2: vitro fertilization in the United States. And if you ask why,
Speaker 2: one of the answers is even very conservative legislatures they
Speaker 2: know or they themselves have used in viuture fertilization. There's
Speaker 2: somebody who they picture when they picture the technology, and
Speaker 2: they picture the happy family that is the result. The
Speaker 2: more those kinds of stories can be, the stories of
Speaker 2: things like in vitro commutagenesis, the more likely it is
Speaker 2: that you will find a political majority in favor of
Speaker 2: permitting it. The less you are able to tell that
Speaker 2: kind of story, the harder it will be.
Speaker 1: It was so fascinating for me to talk with Amanda
Speaker 1: and Glenn and hear about where we are at with
Speaker 1: this new technology. I can see how something like IVG
Speaker 1: would bring so much to so many people who long
Speaker 1: for having a genetically related baby. But I can also
Speaker 1: see the importance of thinking really intentionally about this how
Speaker 1: if IVG becomes widely available, we'll need to be careful
Speaker 1: about how it's used for what purpose. Even though it
Speaker 1: remains to be seen how this technology develops and how
Speaker 1: we can use it responsibly, I think it's important that
Speaker 1: we all start having these conversations now. Throughout the series,
Speaker 1: we've been talking about the decisions we make about technology,
Speaker 1: and specifically what the ethical implications are of how new
Speaker 1: medical technologies are used. I'm thinking about the strong in
Speaker 1: Goldberg's losing their son, Sally Settel's search for a kidney,
Speaker 1: Andrew Cameron fighting for his patients, and so many other
Speaker 1: moving stories of patients, families, scientists, and caregivers. I'm also
Speaker 1: thinking about all the people whose stories we haven't heard
Speaker 1: because they weren't able to access the care they needed.
Speaker 1: Sometimes these medical dilemmas involve difficult decisions, often with no
Speaker 1: perfect answer. Whatever we choose, we must live or die
Speaker 1: with the consequences. We hope you've enjoyed playing God and
Speaker 1: we have something extra lined up for you. Next week.
Speaker 1: It's a prequel episode about a troubling chapter in medical
Speaker 1: history that helped give birth to the field of bioethics.
Speaker 1: In the nineteen sixties in Seattle, a committee of everyday
Speaker 1: people sort of like a jury of peers, was tasked
Speaker 1: with deciding which critically ill patients in their community deserved
Speaker 1: to live and who should be left to die. So
Speaker 1: watch out for that in your podcast feed next week.
Speaker 1: Thanks to our guests in this episode, Amanda Clark and
Speaker 1: Glen Cohen. Playing God is a co production of Pushkin
Speaker 1: Industries and the Johns Hopkins Berman Institute of Bioethics. Emily
Speaker 1: Vaughn is our lead producer. Production support from Sophie Crane
Speaker 1: and Lucy Sullivan. Our editors are Karen Shakergie and Kate
Speaker 1: Parkinson Morgan. Mixing by Samir Sengupta, the music by Echo Mountain,
Speaker 1: Engineering support from Sarah Bruguerre and Amanda Kaiwang. Show art
Speaker 1: by Sean Karney, fact checking by David jar and Arthur Gompertz.
Speaker 1: Our executive producer is Justine Lang at the Johns Hopkins
Speaker 1: Berman Institute of Bioethics. Our executive producers are Jeffrey Kahan
Speaker 1: and Anna Mastriani, working with Amelia Hood and with support
Speaker 1: from Susan Snead, Aaron Henkin, Abigail Brickler, Kim bikermer Anna Oakes,
Speaker 1: and Jamie Smith. Special thanks to Ari Cohen. Funding provided
Speaker 1: by the green Wall Foundation. Special thanks to voice coach
Speaker 1: Vicky Merrick. This is our last episode, so we'd like
Speaker 1: to thank some of the many people at Pushkin who've
Speaker 1: supported this show throughout the season, including Jacob Weisberg, Heather Fane,
Speaker 1: John Snarz, Letal Malad Greta Cohne, Carl Mcliori, Jasmine Perez,
Speaker 1: Eric Sandler, Jordan mcmill, Isabella Navarez, Nicole op Den Bosch,
Speaker 1: Maya Kanig, Jake Flanagan, Owen Miller, David Glover, Nina Lawrence,
Speaker 1: Mia LaBelle, and Ian Petzer. To learn more about bioethics
Speaker 1: and the issues presented in this series, please visit Bioethics
Speaker 1: dot jhu dot Edu Forward slash Playing God. I'm Lauren
Speaker 1: Aroora Hutchinson. Thanks for listening to Playing God. As you've
Speaker 1: heard through the series. I'm the director of the Ideas
Speaker 1: Lab at the Johns Hopkins Berman Institute of Bioethics at
Speaker 1: the Ideas Lab. We are exploring new innovative ways of
Speaker 1: telling stories about the intersection of ethics, science, medicine, and
Speaker 1: public health. As well as podcasts, we do screenwriting, films,
Speaker 1: and immersive experiences. To get involved, visit Bioethics dot Jhu
Speaker 1: dot edu, Forward Slash Ideas Lab