Genetic Future

The market for designer babies

Edited 2/2/09: The cited study discusses pre-natal genetic screening, not only embryo screening; I’ve updated some wording to reflect this, but it doesn’t have any major impact on the overall message.

Razib points to an article suggesting that Australian couples are “flocking” to a US fertility clinic that allows them to screen their potential IVF embryos for sex and even cosmetic traits like skin and eye colour, in addition to variants that predispose to severe disease risk. (“Flocking”, in this context, means about 14 couples a month.)

This follows on the heels of a fairly widely-publicised study published last week that surveyed around 1,000 genetic counselling patients about their attitudes towards pre-natal genetic testing. The study was sold to the media as indicating that “consumers desire more genetic testing, but not designer babies” – but the numbers actually suggest a substantial market for genetic screening.

The survey found that the majority of respondents would elect to screen for diseases like mental retardation, blindness, cancer and heart disease, and a hefty minority (20%) would screen for a disease that would result in death by the age of 50. More surprisingly, over 10% of respondents would screen for tall stature, athletic performance, or increased intelligence. Although this population is not a perfectly representative sample of the broader population, I’m still surprised to see that demand for such a socially unacceptable process is as high as this.

No doubt stories like this will result in increased hand-wringing and predictions of moral anarchy from social conservatives over the next few years. However, there are several good reasons to expect that embryo screening for late-onset diseases and non-disease traits (such as gender and eye colour) will not become widespread, at least in the near future: 


  1. Embryo screening is only possible for couples undergoing IVF. Given the substantial financial costs of IVF, its currently low success rate, and general unpleasantness, it’s unlikely that it will become the default mode of reproduction for fertile couples in the near future – particularly when the alternative strategy is free, simple, and vastly more enjoyable.
  2. Embryo screening is simply not feasible for most common diseases and complex traits. I’ve covered this before: basically, we now know that the majority of common diseases (e.g. type 2 diabetes and obesity) and complex trait (e.g. height and athletic performance) are affected by hundreds to thousands of different genetic variants, each with very small effect. That means that there is no “perfect” human being; all of us (and all of our potential embryos) have slightly increased risk of some diseases, and slightly decreased risk of others. So instead of being able to select a “disease-free” embryo, parents will face a difficult and unpalatable choice between embryos with a range of slightly different disease susceptibilities.
  3. Genetic screening for complex adult-onset diseases will become redundant as medicine improves. Why invest money in genetic screening for conditions like type 2 diabetes or coronary heart disease when it’s highly likely that almost all of these conditions will be completely treatable by the time your child reaches the age of susceptibility? Similarly, the value of selecting for intelligence-boosting alleles will likely be massively outweighed by other approaches to improving academic performance. This was one of the most unrealistic aspects of the movie Gattaca - what, a society with the technology to screen embryos can’t devise a treatment for a minor heart defect?

Note that the objections above only hold true for common, late-onset diseases and other complex traits; it’s clear from the survey that screening for severe early-onset disease (like muscular dystrophy or severe mental retardation) is already attractive to parents, and I’d expect this to soon become near-universal among couples using IVF.

If you’re already investing tens of thousands of dollars in the IVF procedure, and screening is available, it would require a very strong moral objection to refuse. After all, it’s not like you’re actually discarding any more embryos than you normally would be; you’re simply using additional information to decide which of the embryos to implant.

The same actually holds true for selecting on the basis of “cosmetic” traits: if a couple if already undergoing IVF, I can’t think of any convincing moral objection to them using whatever arbitrary criteria they like to decide which of their dozen or so embryos to implant. Indeed, I expect parental demand will drive the inclusion of complex disease genes and “cosmetic” traits in the standard genetic screen for IVF embryos, although this will make for some very difficult decisions. Most of the moral objections to this process seem to rest on the vague notion that it somehow “devalues” human life; call me idealistic, but I suspect that parents will love their IVF-conceived children just as much regardless of whether they were randomly plucked from a Petri dish or selected on the basis of genetic information.

This freedom won’t result in a generation of blue-eyed, blond-haired children, for two reasons. Firstly, this outcome would require a universality of preferences for certain traits that simply doesn’t exist. Such a dramatic outcome is no more likely than a generation of girls all called “Susannah”. Similarly, while its clear that the availability of pre-natal gender testing can result in a skew in male/female frequencies (see China, India), this will likely ultimately correct itself as a low frequency of one sex increases its attractiveness to parents. And secondly, it’s important to emphasise that this screening will only occur in parents undergoing IVF, who are likely to remain a substantial minority for the foreseeable future.

There’s little doubt that there will be a gradual shift towards widespread testing for seriously nasty variants even in couples conceiving naturally, either through carrier screening (a la Counsyl) or non-invasive testing of embryos using foetal DNA present in the mother’s blood (like the tests for Down syndrome and other diseases developed by Sequenom). However, neither of these technologies makes widespread screening for complex traits or common diseases feasible, unless you seriously believe that couples would terminate a pregnancy on the basis of a 0.7% increase in rheumatoid arthritis risk.

In summary: we are moving into a world in which genetic screening for severe, early-onset diseases will likely become commonplace, and where testing for non-disease traits among IVF participants will also occur. However, don’t believe the hype: it’s highly unlikely that the world of “designer babies” routinely selected on the basis of height and IQ, as predicted by social conservatives and scare-mongering media, will ever become a pervasive reality.
 

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Feighanne Hathaway, Esther Burns, Harry Ostrer (2009). Consumers’ Desire towards Current and Prospective Reproductive Genetic Testing Journal of Genetic Counseling DOI: 10.1007/s10897-008-9199-3


Comments

  1. #1 Doug Alder
    February 1, 2009

    Leaving aside the totally invalid argument about “playing god” – invoking a non-existent supernatural entity as a moral reason is never a valid argument – what is wrong, at the individual parental, rather than societal, level with a

    world of “designer babies” routinely selected on the basis of height and IQ

    (assuming the technology to do so) Granted if everyone’s ideal was the same, and the monetary cost was affordable, we would be looking at an increased risk of losing genetic event diversity in our species and that is never a good idea. However, from the parental perspective, it is your moral duty as a parent to provide the best possible chances for survival for your children. In the modern world that unfortunately means intelligence, physical strength, height and looks are a great advantage towards success and survival. A good case could be made that as a parent, in a situation where screening is available AND accurate, you would be morally remiss if you did not screen embryos for traits that could positively or adversely affect your potential child. Although potentially a stickier moral problem (dependent on how advanced gestation is and where you believe intelligence and life begins) if it were possible to do such screening in utero then the same moral obligation exists.

  2. #2 sederhana
    February 1, 2009

    “This was one of the most unrealistic aspects of the movie Gattaca – what, a society with the technology to screen embryos can’t devise a treatment for a minor heart defect?”

    I don’t think you should imply that such a society wouldn’t be able to deal with those defects but rather would avoid treating them so that they’ll disappear from the population,

    isn’t that what the whole movie was about, ill individuals (I’m of course speaking of genetic related illness) fading from population?

    so, the more these kind of people would have got treatment so that they could reach age to reproduce the more people like that there would be – I’ts actually heppening right now in the real world – so I don’t think it’s about the Gattaca society lacking the tools to do so but rather avoiding it becuase it would seem illogical to the kind of society depicted in the movie to promote those traits in the population,

    therefore I think it would be quite a ‘realistic aspect’ of such a society and consequently of the movie.

  3. #3 Fargo
    February 1, 2009

    I have to say that I’m all for screening. Preserve genes for study, but if, as a species, we could eliminate handicaps then I’m all for it. It’d be slow, and never complete, but as a goal it’s a very good thing. As for master race babies, well, sure, there’s going to be people striving for that sort of thing, and I think that’s fine. Their successes and failures should provide insight if nothing else. Morally speaking I just don’t care, so long as it isn’t imposed on people.

    Which, in my current view, was the point of Gattaca. The creation of a permanent underclass because society bought into the hype. Exactly the same way some people have felt, and feel, that blacks aren’t as intellectually capable as whites. The issue wasn’t that they couldn’t have been taught, it was simply that the culture didn’t feel there was any reason to expend the resources on it. You know, the sort of abominations of ignorance that we frequently get locked into.

    My final thought- Chimera Kids. Someone should trademark that now, eventually it’ll be the new OshKosh.

  4. #4 Carl Shulman
    February 1, 2009

    “The creation of a permanent underclass because society bought into the hype.”

    Isn’t it an important part of the story that that underclass WON’T be permanent, as an ever-greater fraction of parents choose to use reproductive technologies? The protagonist’s parents reacted to their first child’s strong genetic predisposition to heart disease (and he actually does suffer heart problems) by using PGD for the second. Eventually almost everyone will be enhanced, and there will be less genetically-based inequality and discrimination than there was before.

  5. #5 c23
    February 1, 2009

    So what would it take to go beyond embryo screening and just design them from scratch? That is, pick which genes you want, possibly including genes that neither parent has, and then make the embryo, rather than just rejecting an “inferior” embryo and “rerolling?” That, along with identification of more “good” alleles, would make designer babies a more attractive proposition – which might stimulate more research into ways to make IVF cheaper and less unpleasant.

    I doubt this will happen anytime soon, but “ever” is a long time.

  6. #6 Carl Shulman
    February 1, 2009

    The ultimate technology along these lines would be direct synthesis of desired chromosomes, similar to Craig Venter’s effort to synthesize bacterial genomes de novo. However, in addition to continued exponential advance in the effectiveness of DNA synthesis, this would require control over epigenetic factors as well.

  7. #7 Paul Murray
    February 1, 2009

    Beats me why people don’t like the idea. The notion that people “ought” to bear and raise congenitally ill children if that what God chooses to give ‘em is not very far removed from the idea that people ought to bear and raise the child should they fall pregnant.

    If anyone can clealy ennunciate the difference between objections to genetic screening and objections to abortion on demmand – especially when those objections are on “moral” grounds – I’d like to hear ‘em.

  8. #8 Cannonball Jones
    February 2, 2009

    I think the objection that we won’t see widespread screening because it’s complex and expensive is very short-sighted. We’re going to be able to do it a lot quicker and a lot cheaper very soon so the availability will spread from IVF couples to anyone who can afford it. The idea that we won’t see true designer babies due to the complex factors that determine how we’ll end up will be the main bottleneck. I can’t see anyone untangling that mess for some time and it’s probably a good thing too.

    That said I have no problem with screening for things like Down syndrome, fatal childhood diseases, etc. Just seems like common sense to me, avoiding lots of potential pain and hardship for the the child as well as the parents. I know this runs into the ‘where do you draw the line’ problem, but just because the problem exists doesn’t mean we should avoid the issue altogether.

  9. #9 Daniel MacArthur
    February 2, 2009

    Good points from everyone. A couple of quick responses:

    c23: genetic engineering is a different story (note that I specified “designer babies routinely selected on the basis of height and IQ” – admittedly it’s not very clear, but I was talking about embryo selection rather than targeted engineering).

    Genetic editing on the scale of going in and correcting every possible defect is still a long way off, but it’s theoretically possible. Still, I suspect that for a long time to come it will be far easier to just treat the conditions medically than to try to eradicate all of the susceptibility genes in the population.

    Cannonball Jones: I completely agree that the objection involving the difficulties of IVF will only apply for the next few years, until techniques improve (that’s why I specify “near future” for that paragraph). However, even with those improvements it will take a lot longer before IVF appeals sufficiently to make it the default mode of reproduction.

    As you say, the major long-term limitation of screening for most of these traits is their genetic complexity.

  10. #10 Jesse
    February 2, 2009

    I think one issue that nobody brings u here — we’re assuming people behave rationally when given access to certain technologies. Well, news flash, they don’t.

    I mean look at it this way: rationally, sensibly, I should use my time on the Internet to do something productive, but the biggest draw on the internet is porn.

    Mathematically, I know that buying a house is often a terrible investment, but there is huge, huge societal pressure to buy one because it’s a common measure of having “arrived” as it were — have you ever known anyone to be unhappy at buying their first home? Even though we are all paying the price now for it.

    Rationally, nobody who lives in a city has any reason to buy an SUV. If you have loads of kids use a minivan, right? But people bought them anyway.

    So, when genetic screening technologies are available, I could definitely see people flocking to a generation of blond, blue-eyed babies. Especially in western countries, where the “value” of such is subliminally enhanced day after day after day. Just look at which girls grace the cover of the magazines. (And to a lesser extent, which men). Rational? No. Sensible? no. But it’s very real. After all, an entire generation of girls (mine) did end up with “Jennifer” as a staggeringly common first name.

    I could see a thousand ways that — logically or not — it could be used, or rather misused, terribly. Not because parents shouldn’t try to give their kids the best opportunities available, but because of the perceptions and mores of the surrounding society, and the way it is structured.

    Now, a lot of these concerns are less pressing when discussing IVF treatments. But still, there is an issue here when the technologies become available. Also, lets remember that what a parent thinks is a good thing to select for — take athletic ability — may not necessarily be what’s best for the child involved.

  11. #11 D
    February 2, 2009

    “No doubt stories like this will result in increased hand-wringing and predictions of moral anarchy from social conservatives over the next few years.”

    I don’t think there’ll be much of a left-right divide on this. There isn’t, for example, a big difference between number of abortions procured by conservative and liberal women. Also, consider gay or gender-atypical babies…

  12. #12 jay
    February 2, 2009

    have you ever known anyone to be unhappy at buying their first home? Even though we are all paying the price now for it.

    my monthly mortgage/tax payments are less than rent now on a comparable house… and I have equity… and they are not going to change drastically in the future (unlike rent)

    But more on the point, you seem to get very upset about trivia. Is it really a problem if lots of people choose blond blue-eyed children? Not really. And even so, if they become common, others are going to go for the more exotic looks… so what? In virtually all cases parents will be trying to have intelligent, healthy children and using technology for that purpose. That’s a good thing. What’s the problem?

    (Comment on your other example: I always wondered about why in some circles there was hostility to SUVs and not minivans, when they are essentially the same size vehicle, often with the same engines, I can only suspect that the difference in reaction is emotional: SUVs are ‘aggressive’ looking, minivans are ‘domesticated’)

  13. #13 Hayat Dersi
    February 2, 2009

    I think one issue that nobody brings u here — we’re assuming people behave rationally when given access to certain technologies. Well, news flash, they don’t.

  14. #14 Jesse
    February 2, 2009

    @jay– many minivans actually get better mileage than their SUV counterparts, the point I was making is that there isn’t any really good, logical reason to buy an SUV except that it is ‘manly’ or ‘aggressive’ or whatever– I mean look at it this way, very few people bought the things in 1990, loads of people were buying them years later. It wasn’t because there was some innate demand for SUVs deep in the human psyche. It was because of a massive ad campaign.

    That wasn’t rational, tho, was it?

    And remember that your house, to be an investment, has to gain value at higher than both the rate of inflation and the rate of your loan. At current rates that’s about 7%+ per year. That doesn’t happen very often for very long (if you are going to live in it that’s another matter, but the Wall Street Journal did a really interesting analysis a couple of years back and showed that most people lose money on their houses once you figure in taxes and maintenance, and improvements).

    So while your monthly payment is less, once you factor in the total amount, you are usually in the red unless you trade way down when you move.

    Anyhow, the whole point of the comment was to say that people just don’t behave rationally, and there are ways many technologies get misused because of it for that reason, and sometimes it isn’t a bad idea to ask what those possible mis-uses are, and how to mitigate them before they are a problem.

    I mean, why do we have licenses to drive? If we were all rational nobody would ever drve without knowing how. But we sort of acknowledge that people do dumb things and try to mitigate it. Or why we don’t allow parents to ask for just any old plastic surgery on a child (my 9-year old needs a nose job!) without heavy consultation with a physician, if at all. Why we are careful about parents who withhold medical treatment from kids for religious reasons.

    Make sense now?

  15. #15 Julie Stahlhut
    February 2, 2009

    The first thought that always occurs to me when this subject arises: If people could choose their children’s body types, there are going to be a lot of disappointed parents whose kids have the perfect build for football or basketball or gymnastics but turn out to hate sports. (Insert similar discrepancy between “designer” physical or intellectual trait and offspring’s actual interests here.)

    Not even identical twins have identical personalities. There’s a lot more going on in the environment than we understand yet.

  16. #16 jay
    February 2, 2009

    And remember that your house, to be an investment, has to gain value at higher than both the rate of inflation and the rate of your loan. At current rates that’s about 7%+ per year.

    No, it just has to return more than renting (100% loss) and greater loss renting as rents go up and my mortgage does not.

    Regarding reproduction, people will likely want to get their offspring the optimum combination of brains and beauty for genetic success. I don’t think that is an irrational behavior.

    and your other point regarding the success of the SUV “It was because of a massive ad campaign.” Actually it had very litte to do with ad campaigns (ad campaings are actually very limited in their ability to change human behavior.) During the 80s people started buying trucks, plain ordinary trucks, till, quite to the surprise of everyone including the auto industry, by the late 80s the Ford pickup was the single best selling vehicle in the US. This was no Detroit mind control, this was a consumer revolt against the downsized, CAFE emasculated cars of the 80s. they realized that trucks still had the substance that they missed from the old days. All Detroit did was dress them up a bit, after they saw where the trend was heading.

    But even in ‘consumer choices’, researchers often have a myopically narrow view of rational choice, usually trying to boil it down to cost in dollars (as if that is really rational). Beyond ‘repair ratings’ and ‘gas mileage’ are a number of other, rational factors, comfort, safety, capacity, and other things. People place different values on these things, but that does not make their choice irrational, anymore than driving the cheapest econobox available is a rational choice.

    When it comes down to it, even status is not necessarily an irrational criterion. Status can be parlayed (with skill) into influence, power and resources, and mating opportunities (the gold standard of evolutionary success)

  17. #17 Donna B.
    February 3, 2009

    The problem I have with designer babies is that the end result is selecting for ‘average’ qualities that will ultimately lessen the chance for ‘advancement’ of the species, so to speak.

    There is also the “this child” aspect of natural conception and a somewhat blind selection of IVF embryos. I know quite a few women who have had miscarriages that wonder, even years later, what that child would have been like (myself among them).

    I know two women who gave children up for adoption that had the same curiosity. I only know one woman who had an abortion, and frankly, the abortion is just not talked about.

    There’s a lot more involved than genetics.

    As for owning a house, it is perhaps not appreciated until it is paid for. Our insurance, taxes, and maintenance amount to less than $200/month. Rent on a similar abode would run $700/$800, which is still higher than our monthly payment on a 15 year mortgage was.

    We only wish we could move this house to California where it would rent for $2500/month or more :-)

  18. #18 Jesse
    February 3, 2009

    way OT, but here’s the math:

    I rent for 30 years, $1,000/month. My rent rises at the rate of inflation, let’s say 7%/year.

    By the end of 30 years I have paid 968K.

    I buy a 500K house. I get the world’s most fantastic fixed rate loan, and pay 6% on it.

    I pay $2997 per month. So I end up having spent about $1 million.

    That assumes no taxes, and that my house gains enough value over that period that I can sell it for enough to beat inflation. That works out to 1.6 million, if we use the last 30 years worth as a guide.

    But realistically, you aren’t going to get 6% on a loan. Go up to 8%, (more real averages) and that amount spent jumps really fast to 1.3M.

    ANd you probably put in a sizeable amount to improve it.

    Yeah, you get the house, but I could just as well move to a crappy rental and put the extra money in a combination T-bill funds and the stock market and I’d have done better. (If you bought those NYC muni bills in 1977 you’d be one happy camper, and tripled your money in 10 years).

    If you trade down some, then you can do well– like if you move to a cheaper area, but it isn’t easy to make that work for most people. You can’t just instantly up and move somewhere at a moment’s notice, if you have a family.

    Anyhow, yes, what a rational choice is will differ depending on what you value. I’m trying to get across that what is valuable to people may not be good for people, and that the assumption that technology use will take care of itself is just wrong — it almost never works out that way.

    You say people revolted against ‘emasculated’ (interesting choice of words) cars, but that massive marketing money had nothing to do with it? Then all those ad agencies must be bilking people and nobody ever knew! I wasn’t saying it was mind control, but if a few more people buy a truck, then I will be less likely to put money into promoting non-trucks, and then a feedback loop can result that has nothing whatsoever to do with the relative ‘rational’ merits of what you are buying. A lot of ads are designed to get the image of a product out there, so that when you buy stuff you’ll remember it.

    Realistically, such marketing campaigns do have an effect (or nobody would pay for them). Look at Apple iPods– you’re saying then there was some innate need for iPods? Or do you think that maybe, a clever marketing campaign had something to do with it? Plenty of devices (zune, f’r instance) function as well as ipods do in a number of ways. (From a purely technical standpoint).

    Now translate such a campaign to messing with kids’ genes and ask yourself if that isn’t a train wreck waiting to happen?

    Market choices don’t appear out of nowhere, you know. There’s a history behind them, and they interact with a lot of other social forces, for good and for ill. You have to acknowledge that at some point, if you don’t want to run into serious problems. It isn’t as easy as saying ‘what’s best for my kid’ because parents don’t always make the best decisions that way (if they did there would be no such thing as child abuse and therapists would be out of business).

  19. #19 Fargo
    February 4, 2009

    @Carl
    Maybe, it’s been a while since I saw the film. What I recall seemed to, at least vaguely, indicate that the procedures weren’t all that cheap, and that there was a reasonably large portion of the population not doing it for one reason or another, such as religion.

  20. #20 Andro Hsu
    February 5, 2009

    The problem with choosing what seem to be beneficial traits is that it presupposes that a certain set of environmental conditions will continue to exist in which those traits are beneficial. Traits are not in and of themselves good or bad; whether they are beneficial depends highly on the environment with which they interact. This is the primary reason that loss of genetic diversity is a bad thing for a population (and especially for the individuals who belong to the monoculture).

    So a mutation that can cause sickle cell anemia is actually beneficial to a population living in a malaria-ridden locale. And more fantastically, gills that look like female genitals on one’s neck might be freakish in today’s human society, but in a world covered with water…

  21. #21 Fargo
    February 5, 2009

    I’m not sure I want to know what other conditions, in a water world, would make me want to have vagina neck. Gills sure, but vagina neck? Not so much.

    Besides, if we truly mastered genetic manipulation we’d just give every baby vagina neck, or a better defense against malaria.