Baby Business

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WANT A BETTER BABY?

YOU CAN BUY ONE FROM A FERTILITY CLINIC

NICHOLAS NEWMAN BOOK REVIEW BY OF:

The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception. Harvard Business School 2006

By Debora L. Spar, Price: £15.99 Tuesday, 09 January 2007

Deborah Spar’s latest book, ‘The Baby Business’ introduces a new and distasteful (?) subject of IVF (In Vitro Fertilisation), commonly known as “test tube babies”. This medico-scientific advances in human fertilisation has raised a storm of controversy involving, ethical, moral and commercial issues. Want a child, but don’t or can’t do it the traditional way, well you can go to your neighbourhood fertility clinic, with luck and sufficient funds for the baby of your preferred gender and optimal genetic mix using IVF. There are several different IVF techniques available, but the usual process involves; interalia, the women taking fertility drugs to help her produce more eggs. The eggs are then harvested and fertilized in the laboratory. The woman is given hormone drugs to prepare her womb to receive the fertilized eggs. The fertilized eggs are placed inside the womb and a normal pregnancy follows. As a result of IVF a child growing up today could have two fathers and three mothers. The sperm donor that produced the sperm, the woman that sold her eggs to the clinic, the surrogate mother who rented out her womb, and the infertile parents, that are bringing up the child.

This book is certainly thought provoking about this $3 billion infertility industry. In America alone where in 2001 ‘nearly 41,000 children were born via IVF’ Spar observes. This book makes clear the golden opportunities available to investors in this untrammelled free market. One keeps getting the thought, that this book is not really discussing the meeting the desperate needs of a childless family, but is revealing a modern version of the slave trade, where, couples are prepared to shop abroad to satisfy their desires, if the home market fails them.

In India, IVF’s gender selection technology is having unforeseen consequences, with such know-how resulting in an imbalance between the sexes. In the United States, this technology has realised the dreams of science fiction, enabling mothers past their prime, single parents and gay couples to have children.

Though such opportunities may satisfy the customers, who take advantage of such opportunities, the question that needs to be answered, is what harm the long term results, such IVF technology can have on the resultant children.

One such question, still to be resolved, should mothers in their sixties, be able to have children. Who will bring the kids up if the mothers die soon afterwards? Will the state have to bear the cost?

Similar questions need to be determined by policy makers for gay couples, where one partner dies and also for single parents. Strangely, the advocates of such child bearing/raising rights seem oddly hesitant about such responsibilities in the long term.

For the investor, the business Spar describes is an American market that sounds ideal for a knowledgeable entrepreneur. There is little or no regulation and for the ‘snake oil salesman’, there are plenty of opportunities to bamboozle the customer with complex jargon of the technology, using also interpretations of the Hippocratic Oath, as an added marketing tool to exploit the often desperate customer. This free enterprise market paradise, with its lack of real competition and transparency, would make even the crooked railroad barons of yesteryear, feel at home. The system ensures that service providers can maximise their profits, scalp their customers, while still being respected by the community.

For the client, it can be a very costly business as Spar points out. Given that at least 15% of couples have some sort of fertility problem, it is estimated there are 8 million infertile women in the United States alone; this could result in the spending every year of at least $3 billion per annum.

Though there is not officially a ‘market’ in the USA, it is not unknown for desperate couples to import babies from Eastern Europe and South America though what Deborah Spar euphemistically terms ‘beyond the market’ for the worldwide black market in the purchase of babies . For those prepared to follow the technological route, prices range from $275 for a vial of sperm, eggs (up to $25,000 each, nine months rent of a womb ($20,000) and the creation of an embryo ($12,000 per cycle). Desperate couples can spend $100,000 for round upon round of unsuccessful IVF treatments. Certainly, only the rich can be involved, while the desperate poor are ruthlessly exploited for the use of their wombs, eggs or sperm.

Spar argues that some form of regulation is needed; the law of the jungle must end. The author argues that public policy makers must make the vital decisions on public regulation of the market, if society is to ameliorate the potential harmful implications, which the market may generate. She has observed that in regulated Europe where there is greater transparency about costs, the customer seems to benefit. Prices for treatment can be considerably cheaper than in the USA, with one cycle of IVF costing £2,400, egg donation £4,500 and surrogacy £4,500.

It is clear that the policy makers have not caught up with the consequences that developments in technology and the impact of globalisation has had on the fertilization market. In the United States, there is not one single nationwide market in existence, instead as in the European Union, each state determines its own fertilization polices and regulations. Unlike in Europe, the American culture appears at first glance, less willing to let state agencies to interfere with personal matters. Nevertheless, in some states, due to the lobbying of the anti-abortion religious right, such interference in such personal matters is on a par with Europe, though for different reasons. For consumers, this crazy patchwork of differing fertility policies and regulations on what is permissible has led to the phenomena of ‘fertility tourism’ where shoppers shop for the regulatory regime that suits them best. For many this means ducking and diving through the loopholes, while for others it means going abroad to a fertility clinic, for a spot of IVF and sun in says a clinic by the beach in the Dominican Republic.

Spar has found that both service providers and clients question the need for regulation, seeing it as just another bit of costly red tape. As one mother in her fifties of newly born twins observered to the author, “I had my babies. I paid for my babies. I could afford my babies. Why is it more complicated than that?” As for the fertility pioneers, they worry that regulation would add to costs, inhibit progress and informed Deborah Spar “If we had been under scrutiny, many steps would have been forbidden.”

As in America, it looks like many Europeans share similar attitudes on the topic. Fertility tourism is just as prevalent on this side of the Atlantic, as state side. Britain is a good example of how harmful, heavy handed public regulation in the market place, can work against the needs of customers by causing market distortions and unforeseen problems. One example was the UK Government’s Human Fertilisation and Embryology Authority (HFEA) decision to remove sperm, egg and embryo donor anonymity, which has resulted in a disastrous collapse in supplies from UK donors. This was done to satisfy the so called need’s of children born by this method to know who their respective father or mother was. Despite warnings that this measure would have disastrous impact on donor supplies, the measure was passed. This has led to artificial insemination clinics reporting being forced to import from abroad, or couples are becoming "fertility tourists", and heading to other countries like Denmark, which have retained anonymity for treatment.

HFEA reports, as a result of the current regulatory regime, that couples are being driven abroad. Clinics in Spain are treating twice as many British patients as they were before the legislation regarding sperm, egg and embryo donor’s lack of anonymity was introduced last April 2006 and are recruiting English-speaking staff, to cope with the demand. Some experts estimate that the number runs into the thousands. Demand is growing for fertility treatment in Britain but the shortage of sperm, egg and embryo donors, has become so acute that many clinics are advising women who cannot afford to wait to go abroad for treatment. Some overseas clinics have been reported offering couples treatment, which is so dangerous that it has been banned in the UK - for example implanting five embryos, which significantly raises the chance of multiple pregnancies - the biggest risk in IVF for both mothers and babies.

As a result of Britain’s current heavy handed regulatory system has, a HFEA spokesman said. "It is very sad when we receive complaints from patients about their treatment abroad and we are not able to help or reassure them.” Already, there are calls for this law to be reversed, in the interests of public health. Further examples of Britain’s heavy handed approach to regulations, which have forced desperate couples abroad, include imposing of maximum age limits for couples to be treated, and the banning by the HFEA in July 2007 for the payment of sperm, eggs and embryos, which has resulted in drastic cuts in supplies.

Another argument is over the degree of regulation concerned with the balancing of demand with supply. As British regulators have learnt to their cost, restricting supply at home, has forced this insatiable demand to seek suppliers abroad outside the UK’s regulatory framework. Such action has had not only a negative impact on research, but has meant that bodies like the HFEA have not been able to protect the interests of couples who pay for overseas services. The situation in Europe, as in America, with every member state having its own individual regulatory framework is no longer sustainable. The business of conception has matured sufficiently, points out Spar, that competing sets of regulations between states are damaging the future of the industry. It is time, according to the author, in the interests of all concerned, that Brussels created a single European fertility market.

Spar makes it clear that there are no easy answers, but expresses a preference for, a "light-handed regulatory regime" in which choice, information and costs are considered. To assist in the necessary deliberations, she suggests a series of policy options that decision makers should take into account.

The first option is to let market forces determine demand and supply in the baby business. Under this option, the market will flourish but the rich will be the only ones to benefit, until someone like Henry Ford turns up and develops much cheaper techniques.

The second is to ban the technology behind the baby business altogether, deciding that permitting it is against the public good. Germany, which has had very good reason to be sceptical about these new technologies, has led the way in many respects by simply banning or heavily regulating some of them. The trouble with this option is the demand for babies is simply too high, and like with ‘prohibition’ in America in the 1920’s. All it will do is drive it underground or people will look elsewhere.

The third option is to treat reproduction technology, just like that used for organ transplants, and remove the exchange, completely from the market.

Though the third option is seen as more feasible Deborah Spar notes that options one and two, are to some extent is in use with adoption already. Application is seen by Spar as a problem, especially where the market in such matters as the supply of sperm, eggs and embryos, is already established. Instead, Spar sees the only option left is for the state to regulate the market, so that society may maximize the benefits of this technology for the public good.

Instead of proposing a program of reforms for our legislators to follow, which one would typically expect from such an in depth investigation into this distasteful subject, Spar argues that the pace of change in both public opinion and technology is so great that policy suggestions made in 2005, can soon become irrelevant a year or so later. The recent victory of the Democrats, that has given them control of both Houses of Congress, means they plan to overturn many of the existing restrictions, that the Republican’s had placed on the research and technology of the baby business.

Spar argues that the baby business is not just a commercial matter, but also a political one. This means that any top down prescriptive strategy is likely to fail. Spar contends that what the market needs, ‘is a politically determined strategy, one that emerges from a dedicated and explicit political debate. ‘Such a debate in the United States is likely to be no ‘tea party’, depending on the state of local politics. Without such a debate, the baby business industry, Deborah Spar suggests could fall into chaos or fall prey to vested interests.

Such a debate should be guided by the following principles for which a political debate should be based. The process should acknowledge the reality of the baby trade, rather than as we would wish it to be. It should also grope towards some sort of regulatory framework. Spar admits the process looks very daunting, but if we break the debate into manageable pieces it is achievable. She suggests in order to reach greater consensus breaking the debate down into principles rather than problems or technologies. This should lead to the production of more effective policies.

Regarding the principles that should be applied to such a debate, these should be based on access to information, equity, limits of legality, costs of reproductive technology and extent of parental choice.

In terms of access to information, already such a tradition is already well developed in the medical world, with warning notices on drugs for instance. Spar suggests implementing such a tradition in the field of reproductive technology should be straightforward.

As for the second principle equity; already such notions as they apply to prenatal care, has been extended by law and regulation to all American women, she notes.

Regarding the question of where to set the limits of legality, already the baby business is full of prospects that are reaching the boundaries of legality. The real question is what should be made permissible and what to outlaw, that is workable in its implementation. After all, a too strict regime can drive the technology underground or couples abroad.

Then there is the money question, i.e. the cost of reproductive technology. There are not only the direct costs that the customers have to pay, but there are the additional societal costs that we all have to pay

Lastly, there is the extent of parental choice, for conceiving a child is one of the most important decisions a couple can make. But, it is in society’s interests to play its part in the decision making. There is not only the question of the age, fitness, health and suitability of parents to be, there are also broader questions that society must ask. Should the state encourage couples to have more children in order to reverse the plunging population’s levels in many developed countries?

Spar, observes, such a debate based on the principles already outlined, will entail ‘intense political debate across an intimate and often tragic landscape. But we must have this debate, and we must make these choices.’ Spar argues it is in our interests to acknowledge the market realities and developments in reproductive technologies have created. Then we need to determine how best to manage this market for our own best interests.

Perhaps what best sums up the present situation we are experiencing with the baby business industry, is the following observation made about contraception. In 1938, the public view of contraception was held to be notorious and repugnant subjects as surrogate motherhood, fetal research, or genetic engineering are held by too many critics today. Birth control in the 1930’s was seen as wrong, against nature and the will of God. Ultimately, however this opposition was overcome, demand for contraception was too strong to resist. The technology was available, it worked, and the lure for the market was huge. A similar fate predicts Deborah Spar awaits the next round of the baby trade.

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