Robert L. Klitzman is the author of the new book Designing Babies: How Technology is Changing the Way We Create Children. A medical doctor, he is a professor of psychiatry at Columbia University. His other books include Am I My Genes? and When Doctors Become Patients, and his work has appeared in a variety of publications, including JAMA and The New York Times.
Q: Why did you decide to focus on reproductive technology in
your new book?
A: I wrote a previous book, Am I My Genes?, seven years ago.
I interviewed people about why they were getting genetic testing—people who
were at risk of different diseases, including Huntington’s disease. If you have
the gene, you will die of it. There’s a 50 percent chance that each of your
children will have it.
People said, Should I have kids? Should I abort the fetus?
If I screen my genes, what will that mean about my own life—I would have been
screened out as an embryo.
And also, a friend asked me to be a sperm donor, that I
wouldn’t have to be involved in raising the kid. I thought, That’s interesting.
There are friends undergoing IVF, gay couples having kids. Ten percent of all
people in the world are infertile, and people are using IVF, and there are a
lot of questions.
The U.S. is one of three countries where you can buy or sell
human eggs. It’s the only country where you can rent a womb. It’s become a
multi-billion-dollar industry, and with the technology, you can change the
genes of your descendants.
Q: How did you research the book, and did you learn anything
that particularly surprised you?
A: I started to interview doctors, patients, people at IVF
clinics. I thought I’d focus on screening, but I realized there was a whole
range of issues: how much it costs, how much is a child worth, how people
struggle with that.
I was struck with the fact that in this country, most egg or
sperm donors are anonymous. In many countries, that’s illegal. A man’s sperm
can produce 130 kids. In Europe, there are no anonymous donors. In Ireland, you
get a birth certificate that says, created by donor sperm.
Only three countries buy or sell human eggs. I was
surprised. This is eugenics—the price of eggs go up with SAT scores. You want
your son to look like Brad Pitt, they will give you a donor. We’ve turned
reproduction into a multi-billion-dollar business, and it is unregulated in the
U.S.
And also what struck me is for a woman who want a kid and is
infertile, how hard that is. There are lot of emotional issues.
Q: What do you see looking ahead when it comes to the future
of reproductive technology and the ethical issues associated with it?
A: I think one big issue is going to be gene editing. We
have a technology, CRISPR, that’s like genetic scissors. It’s been done in
China. Increasingly, this will be done—put in genes related to socially
desirable traits. You can make children taller. There are genes associated with
IQ. There may be risks involved. These are one set of concerns I have.
The other is that IVF clinics report data to the CDC [Centers
for Disease Control and Prevention] but it’s voluntary. We need more
understanding of what’s going on. Seven percent of all births in Denmark use
IVF. The prediction is that there will be 10 percent in the U.S. born this way,
and with the ability to select genes.
This will enable us to get rid of certain genes, but it will
be expensive. Breast cancer will be a disease of poor people, as the wealthy
will be able to screen for it. Will there be a need for more insurance
coverage?
Q: How was the book's title chosen, and what does it signify
for you?
A: The term is sometimes used in the narrow sense, to alter
the genes of a child, but I use it metaphorically, for a range of issues. What
egg and sperm donor we choose, the embryos we reject—we are now in the business
of designing babies. We are affecting, and have altered, reproduction. Making
it technological gives us a wide range of choices.
Q: What are you working on now?
A: I’m working on a different project. The working title is,
Doctor, Will You Pray for Me?. It’s about what patients can teach us about
religion and spirituality today. Religion and spirituality issues come up, but
we don’t teach doctors to deal with it.
Q: Anything else we should know?
A: I wrote the book with several audiences in mind. One is a
general educated audience. Everyone has someone they know, even if they’re not
aware of it, who have used artificial reproductive technology. But there’s a
taboo about it. It’s a huge multi-billion-dollar business—you can get rid of
diseases, but there are ethical issues. For people trying to have a child, it’s
important, but for a general audience, there are meaningful stories.
--Interview with Deborah Kalb
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