Human Nature: Science, Technology, and Life.

Sex Selection: Nobody's Business?

Last week, when Ross Douthat made a case for "regulating abortion," I asked him and other pro-lifers how far we should go. The Partial Birth Abortion Ban Act has a maximum jail sentence of two years for doctors who perform the forbidden procedure. Is that the kind of regulation we should apply to abortions? Would the country stand for it?

Today, let's turn the tables on those of us who oppose abortion regulation. How far should we go? Would you oppose regulation even of abortions aimed at preventing the births of girls? Because there's increasing evidence that such abortions, which take place by the millions in Asia, are now being done by the thousands in the United States as well.

Let's start with the data noted here last year, when

economists Douglas Almond and Lena Edlund published an article in Proceedings of the National Academy of Sciences examining the ratio of male to female births in "U.S.-born children of Chinese, Korean, and Asian Indian parents." Among whites, the boy-girl ratio was essentially constant, regardless of the number of kids in a family or how many of them were girls. In the Asian-American sample, the boy-girl ratio started out at the same norm: 1.05 to 1. But among families whose first child was a girl, the boy-girl ratio among second kids went up to 1.17 to 1. And if the first two kids were girls, the boy-girl ratio among third kids went up to 1.5 to 1. This 50 percent increase in male probability is directly contrary to the trend among whites, who tend to produce a child of the same sex as the previous child.

A recent paper by economist Jason Abrevaya adds:

The evidence from the California natality data is particularly striking for Indian births between 1991 and 2005: second-born children are 0.9 percentage points more likely to be boys, third-born children 6.6 percentage points more likely, and fourth-born children 8.1 percentage points more likely. Moreover, Indian parents are significantly more likely to have a boy (and a terminated pregnancy since last birth) if they have had only daughters previously. The simple framework of Section 4.5 suggests that the unusually high boy percentages among third- and fourth-born Indian children in California would be consistent with gender-selective abortion rates of around 10%. ...

Using census data, Abreveya estimates that from 1991 to 2004, U.S. families of Chinese or Indian descent aborted more than 2,200 fetuses just for being girls. (For the data, see Table 13 of his paper; he explains his calculations on Pages 23-24.)

Researchers had expected sex selection among Asians to decline as they became Americans. But in today's New York Times, Sam Roberts reports:

Demographers say the statistical deviation among Asian-American families is significant, and they believe it reflects not only a preference for male children, but a growing tendency for these families to embrace sex-selection techniques, like in vitro fertilization and sperm sorting, or abortion. ... [A] number of experts expressed surprise to see evidence that the preference for sons among Asian-Americans has been so significantly carried over to this country.

Roberts quotes one woman who got pregnant with a boy after having two girls. The woman says flatly: "If the third one was going to be a girl, then I would say probably I would have terminated."

Should that abortion be allowed? And if legal intervention in such cases is unwise, should we do something short of that? Should schools teach that aborting girls is wrong? Should doctors counsel couples not to do it? Should community leaders speak out against it? The last president called for a culture of life. Should this president call for a culture of respect for women?

What about purveyors of sex selection? Roberts notes that at least one assisted reproduction provider, the Fertility Institutes, offers sex selection and "has unabashedly advertised its services in Indian- and Chinese-language newspapers in the United States." (The company has also promoted and withdrawn an offer to select embryos for "eye color, hair color and complexion.") This form of sex selection takes place when the offspring are tiny, dish-bound embryos, not fetuses. The clinic's medical director, Dr. Jeffrey Steinberg, says the practice is "not harming anyone." Is he right? Should he be allowed to continue peddling sex selection (as he does in this video) to Asian-Americans? And if it's fine to advertise this service at the embryonic stage, why not at the fetal stage?

Absolutists on both sides need to think carefully. If you're pro-life, how far are you willing to go in regulating abortion? If you're pro-choice, how far are you willing to go in leaving it unregulated?

Lady Parts

Yesterday I wrote about an awful story in California. A number of couples hired gestational surrogates through a fertility brokerage. They were directed to put money in trust accounts to pay the surrogates throughout their pregnancies. Now the money is gone. Andy Vorzimer, an attorney involved in the case, told the New York Times, "We've got couples in the midst of pregnancies with no ability to pay the surrogate." I ended the piece this way:

I hope the women carrying these pregnancies will see them through, even if the company that hired them doesn't. But that financial burden shouldn't fall on them alone. Here's the contact page for an attorney working the case. If you'd like to prevent abortions, help pregnant women, and facilitate reproductive choice at the same time, now's your chance.

Yesterday evening, Vorzimer sent me an e-mail to clarify the situation:

The article has obviously resonated with your readers as my inbox has been flooded with concerned people offering to donate funds so as to avoid possible abortions. I am happy to inform you that there are no situations in which a surrogate has elected to abort because of this financial scandal. While many of the surrogates will not be reimbursed for their out-of-pocket expenses lost wages or even have their medical bills paid, every single one of them has committed to moving forward.

That's great news. I'm impressed with the surrogates. I'm also impressed with all of you who contacted Vorzimer and offered your support so they wouldn't have to end their pregnancies. Pro-lifers are often accused of moralizing and interfering but not helping. You disproved the caricature. And I hope you'll stand by your offers even if no abortions are at stake.

In recent days, I've had a few curious exchanges with friends, readers, and bloggers who wonder why I keep writing about this stuff: abortions, pregnancies, IVF, surrogates—what some of my critics jokingly call "lady parts." What's my agenda? Do I have a problem with women controlling their bodies? Am I a frontman for the religious right, a useful idiot who pretends that compromise on these issues is possible when, in fact, it isn't? Even Vorzimer, in a tweet posted on his blog, initially responded to my article by remarking, "The lengths (or depths) abortion foes will go to make a point."

Vorzimer and I have had some back and forth since then, so we've come to understand each other better. But the misunderstanding was my fault, not his. I need to do a better job of explaining myself.

This may sound strange, but I don't consider myself a real abortion foe. I have friends and sparring partners who think abortions should be illegal or at least heavily restricted. To me, that's the chief dividing line in the debate. I don't feel comfortable crossing that line. I don't think a regime of abortion restrictions enacted in the name of life would make this world a better place. I think it would cause a mess—hypocrisy, deceit, interrogations, amateur home surgery, moral crudity backed by the force of law—as ugly as any war fought in the name of peace.

I don't equate abortion with murder. I don't even think it's the worst option available to a woman facing unintended pregnancy. Every abortion dilemma is different, because every situation is different. The person best situated to make the right decision is the pregnant woman. A few years ago, I wrote a whole book on this point.

So why do I keep bringing up abortion as a moral problem? Because it is a moral problem. It's the destruction of a developing human being. For that reason, the less we do it, the better. When I say abortion is bad, I'm not saying it's necessarily worse than bringing a child into the world in lousy circumstances. I'm saying it's worse than avoiding unintended pregnancy in the first place. That's why I keep pushing contraception. If you cause an unintended pregnancy and an abortion because you didn't want to wear a condom, you should be ashamed.

But that's the conventional life/choice debate. The reason I keep you posted on developments in IVF, surrogates, and embryo screening is that they're transforming the debate. They're changing the conditions on which our moral positions rely. Were you pro-choice because the embryo was in a woman? Now we have embryos in dishes. Did you support embryo screening for fatal diseases? Now we're talking about screening embryos for eye color. Does the value of an embryo depend on what its mother thinks? Now we have embryos with two mothers: a genetic one and a gestational one. Should they at least consult each other?

I got into this field because the moral questions are enduring but the facts are always changing. Technology is transforming culture. And I write about the value of unborn life because that's the problem my fellow pro-choicers don't like to talk about. I want to challenge you. Keeping the government out of these sticky moral questions doesn't make them go away. It just puts the burden on you to face them responsibly.

The Crackdown on Embryo Screening

Remember that bill in Georgia to restrict in vitro fertilization? The Associated Press thought it was dead. Surprise! The Georgia Senate revised it and passed it a week ago.

The bill is part of a nationwide project to regulate the emerging industry of embryo production. In one state or another—and then another and another—legislation will be filed to restrict IVF. The battles will be fought over which uses of preimplantation genetic diagnosis are acceptable. And these fights will be every bit as ugly as the preceding fights over abortion.

More here.

Color ID Suspended

Thanks to the eagle-eyed Center for Genetics and Society, I just learned that the fertility company that was advertising eye-, hair-, and skin-color selection in human embryos (which I've provisionally nicknamed Color ID) has dropped the plan, at least for now. Here's the full text of the statement released Monday by the Fertility Institutes:

In response to feedback received related to our plans to introduce preimplantation genetic prediction of eye pigmentation, an internal, self regulatory decision has been made to proceed no further with this project. Though well intended, we remain sensitive to public perception and feel that any benefit the diagnostic studies may offer are far outweighed by the apparent negative societal impacts involved. For those patients with albinism or other ocular pigmentation disorders, we continue to offer preimplantation genetic diagnosis in general but will not be investigating the genetics of pigmentation of any body structures.

It's not clear how long the company's decision "to proceed no further" will last. The statement is titled "Eye and Hair Color Program Suspension."

CGS calls this a mere "postponement" and urges Congress to step in. "Like the financial industry, the fertility industry has shown that it is incapable of regulating itself," the group argues. The Fertility Institutes' announcement of a "self-regulatory decision" to suspend Color ID seems to have been crafted to head off such regulation.

What's really interesting about the statement is the reference to being "sensitive to public perception." I wonder whether that evolving factor—public opinion about aesthetic embryo selection—will determine when the suspension ends.

Brainchild Abuse

An idea passes from one person to another to another, changing shape with every transaction. No one controls the outcome. Everyone in the chain knows what the idea means to him, but no one knows how the idea will turn out.

That's the story of PGD so far. I wonder how it ends.

More here.

Incest and Eugenics

Does science support our laws against incest and cousin marriage? If so, does it also support other laws that would restrict sexual or procreative freedom in the name of genetic health?

To longtime readers of Human Nature, this question should be, if you'll pardon the term, familiar. A few years ago, we looked at the science and ethics of "The Love That Dare Not Speak Its Surname." Then we examined the prevalence of inbreeding in nature. Then we considered the awkward question of why, if incest is too genetically risky to permit, maternity in your 40s isn't.

Now biologist Hamish Spencer and political scientist Diane Paul, writing in PLOS Biology, have reviewed the history of U.S. laws against cousin marriage, along with their scientific basis. And again, the evidence raises unsettling implications.

They start with the statistical case against restricting cousin marriages:

[T]he National Society of Genetic Counselors (NSGC) convened a group of experts to review existing studies on risks to offspring and issue recommendations for clinical practice. Their report concluded that the risks of a first-cousin union were generally much smaller than assumed—about 1.7%-2% above the background risk for congenital defects and 4.4% for pre-reproductive mortality—and did not warrant any special preconception testing. In the authors' view, neither the stigma that attaches to such unions in North America nor the laws that bar them were scientifically well-grounded.

But Paul and Spencer point out that the data aren't clear-cut. First, "statistics on the risks associated with cousin marriage are necessarily averages across many traits, and they are likely to be different for different populations." And second, it's

inappropriate to extrapolate findings from largely outbred populations with occasional first-cousin marriages to populations with high coefficients of inbreeding and vice-versa. Standard calculations, such as the commonly cited 3% additional risk, examine a pedigree in which the ancestors (usually grandparents) are assumed to be unrelated. In North America, marriages between consanguineal kin are strongly discouraged. But such an assumption is unwarranted in the case of UK Pakistanis, who have emigrated from a country where such marriage is traditional and for whom it is estimated that roughly 55%-59% of marriages continue to be between first cousins. Thus, the usual risk estimates are misleading: data from the English West Midlands suggest that British Pakistanis account for only ~4.1% of births, but about 33% of the autosomal recessive metabolic errors recorded at birth.

In other words, the American calculations understate the risk for an already inbred population such as British Pakistanis. And calculations based on British Pakistanis overstate the risk for most American cousin couples. You can't draw a uniform line against cousin marriages based on science. Arguably, for the same reasons, you can't draw a uniform line against sibling incest.

The same case can be made against a uniform age of sexual consent. The authors point out,

Beginning in the 1860s, many states passed anti-miscegenation laws, increased the statutory age of marriage, and adopted or expanded medical and mental-capacity restrictions in marriage law. Thus, laws prohibiting cousin marriage were but one aspect of a more general trend to broaden state authority in areas previously considered private.

As Human Nature has noted before, the age of actual maturity varies considerably depending on the person and the type of maturity (sexual, cognitive, emotional) involved. Granted, lawmakers have to draw lines somewhere. But let's not pretend such consistent lines are consistently apt.

Moreover, Paul and Spencer raise a far more troubling problem: The increase in genetic risk caused by cousin marriages among British Pakistanis may actually be overstated, for a curious reason.

[F]or a variety of reasons (including fear that a cousin marriage would result in their being blamed for any birth defects), UK Pakistanis are less likely to use prenatal testing and to terminate pregnancies. Thus the population attributable risk of genetic diseases at birth due to inbreeding may be skewed by prenatal elimination of affected fetuses in non-inbred populations.

In other words, many of the birth defects cited by British politicians as grounds for restricting cousin marriages may actually be the result not of cousin marriage, but of failure to screen and abort defective fetuses. So, in addition to maternity in your 40s, we now have a second logical target for genetic regulation: If inbreeding is too dangerous, what about "inflicting" maladies on your children by failing to screen the embryos? If you know you carry bad genes—and particularly if you're at higher risk of passing down a serious disease than most sibling couples would be—shouldn't we police your procreation just as carefully?

Faith and Healing

Should parents go to jail for believing so devoutly in faith healing that they don't seek lifesaving medical treatment for their children?

Leilani and Dale Neumann of Wausau, Wis., will soon find out. Their 11-year-old daughter died of diabetic complications after they relied on prayer rather than doctors to heal her. Now they face trial for reckless endangerment and a potential prison sentence of 25 years. They're the third couple slapped with criminal charges in the last year for failing to seek treatment for a child. In today's New York Times, Dirk Johnson reports:

About 300 children have died in the United States in the last 25 years after medical care was withheld on religious grounds, said Rita Swan, executive director of Children's Health Care Is a Legal Duty ... Criminal codes in 30 states, including Wisconsin, provide some form of protection for practitioners of faith healing in cases of child neglect and other matters ...

Swan lost her own son after failing to seek prompt medical attention. She says she waited, catastrophically, because she thought "once we went to the doctor, we'd be cut off from God." The Neumanns seem to have been under the same impression. Johnson reports that they're "followers of an online faith outreach group" (on the Web here) that includes, among other things, an essay preaching that "Jesus never sent anyone to a doctor or a hospital. Jesus offered healing by one means only! Healing was by faith."

I don't know how the case will turn out. But the more important thing to communicate to parents is that this is bad religion. Science is a way of grappling with what we can know empirically. Religion is a way of grappling with what we can't. Each of these disciplines must recognize its limits and defer, beyond that, to its counterpart. Properly understood, there's nothing unscientific about religion, and there's nothing irreligious about science.

I'm not saying the distinction is perfectly clean. It isn't. Sometimes religion and science have to work together. But it's crucial to ask which kind of question you're facing. Healing is a physical phenomenon. Can faith influence it? Yes. Look at the latest study on acupuncture: It sometimes works, apparently because patients believe in it. But what happens when people pray for your recovery without you knowing about it? Answer: Nothing. Belief, not God, is the medically salient factor.

That's how science, at its best, works with religion. It doesn't claim to disprove God's existence. It can't. It addresses only empirically testable ideas, including faith healing. And it reports whatever its methods find. Instead of laughing at acupuncture, it looks at the evidence, admits that acupuncture sometimes works, and tries to figure out why.

Religion, at its best, needs the same humility. God isn't stupid. He doesn't give you a hammer and insist that you bang nails with your head. If this is his world, then so are the tools he has given you: doctors, medicine, and your brain. In the time of Jesus, most people died in childhood. Do you want to go back to that? Do you think that those deaths were God's will—but that today's long lives, made possible by modern medicine, aren't?

As medicine advances, difficult moral questions will arise. If failure to seek available treatment is reckless endangerment, what happens when the available treatment comes, for example, from destroying embryos to get stem cells? Can you be jailed for refusing to give your daughter treatment that's based on what you regard as killing? Or take embryo screening: Already, it has advanced to the point where parents who make babies the old-fashioned way, with all its risks, are seen as "inflicting" genetic maladies on their kids.

But taking your gravely ill child to the doctor isn't one of those tough calls. God doesn't hate doctors. He made them. Want to show your faith? Use what he gave you.

Eugenic Euphemisms

First, we said IVF embryos weren't pregnancies. That's technically correct: Pregnancy begins when the embryo implants in the womb. Then we called early embryos "pre-embryos" so we could dismantle them to get stem cells. That was technically incorrect, but we did it because it made us feel better. Now we're adjusting the word conception. Henceforth, testing of IVF embryos to decide which will live or die is "preconception." Don't fret about the six eggs we fertilized, rejected, and flushed in selecting this baby. They were never really conceived. In fact, they weren't embryos. According to Serhal, each was just "an affected cluster of cells."

More here.

The DNA Age

My colleague Jack Shafer says the Pulitzers are a fraud. "There's no real science or even fairness behind the picking of winners and losers," he wrote in a piece published four years ago and reprinted last week, after this year's winners were announced. In particular, he noted, "I doubt that one newspaper reader in 10,000 could tell you a day after the Pulitzers are awarded who got the prize for explanatory reporting."

Well, never argue with Shafer. Except this once. The winner of this year's prize for explanatory reporting deserved every bit of it, not just for her terrific writing, but because, for the past two years, she's been pioneering the journalism of the next century.

The prize announcement salutes Amy Harmon of the New York Times for her "examination of the dilemmas and ethical issues that accompany DNA testing." Harmon's series, "The DNA Age," has actually covered far more than that. It began two years ago and has weaved its way through a thicket of emerging controversies. Her opening topic was people who used DNA tests to establish unexpected ancestry—such as whites claiming to be black, or Christians claiming to be Jewish—in order to gain the ensuing advantages in areas such as minority admissions, Israeli citizenship, or Native American entitlements. Then she turned to the psychological and social effects of studies that tell us much of our behavior is genetically influenced.

Harmon wrote about the moral deliberations of couples who used preimplantation genetic diagnosis to weed out embryos that might carry or pass on diseases. She talked to parents of Down syndrome kids, who worried that the eradication of Down fetuses by prenatal tests would turn their children, in the public's mind, from disabled people into freakish burdens that should never have been brought to term. She detailed our increasingly methodical genetic engineering of dogs as a potential preview of genetic engineering of human beings. She introduced us to women who had healthy breasts surgically removed based on genetic predictions of cancer. She explored fears that analyses of average genetic and trait differences among populations might foment a "new era of racism." She chronicled the emerging ability to Google your own DNA. She wrote about families who use the Internet to find and bond with other families over shared genetic disorders.

Last month, Harmon looked at "genomic elitism," the practice among rich people of paying hundreds of thousands of dollars for a full DNA analysis normal people couldn't afford. And a week ago, she scrutinized "surreptitious sampling," the law-enforcement technique of obtaining incriminating DNA samples by testing cells and fluids you inadvertently leave in public places every day.

Half of what's amazing about this body of work is that nobody else has done anything quite like it. In retrospect, the trends Harmon has covered will be recognized as the story of our age. We're living in an era of science and technology. Discoveries about ourselves and the world, coupled with our increasing power to transform both, are changing how we live, what we think, and who we are. This is happening at a pace unheard of in previous generations. In Sunday's Washington Post, another of my favorite science writers, Joel Achenbach, points out:

The most important things happening in the world today won't make tomorrow's front page. They won't get mentioned by presidential candidates or Chris Matthews or Bill O'Reilly or any of the other folks yammering and snorting on cable television. They'll be happening in laboratories—out of sight, inscrutable and unhyped until the very moment when they change life as we know it. Science and technology form a two-headed, unstoppable change agent.

The fact that such developments are now being recognized by the Pulitzer board and are blanketing the Post's Sunday opinion section is, in itself, good news.

But that's only half the reason to applaud Harmon's award. The other half is the way she has covered—or, in her case, invented—the beat. Lots of writers, including me, have opined about the abstract virtues or evils of biotechnology. We think we're being visionary or "morally serious." But real moral seriousness isn't about abstractions. It's about flesh and blood: the real people in whom, and in whose lives, the abstractions take shape. You can't really understand or explain abortion, war, or economic globalization until you've talked to people who have been through it. The same is true of biotechnology. If you go in with moral assumptions, the experiences you see or hear about may change your mind, or at least complicate it. That's part of the point of reporting, not to mention reading.

I can't do justice to "The DNA Age" in a blog post. Read it for yourself. It's as provocative as any sci-fi collection and as nuanced as any novel. Except it's real.