Air Date: Week of September 1, 2006

We may not talk about where babies come from very often, but there's a booming, and largely unregulated, business making sure they get here. Host Bruce Gellerman talks with Debora Spar about her recent book, "Baby Business - How Money, Science and Politics Drive the Commerce of Conception."

Transcript

GELLERMAN: It’s Living on Earth. I’m Bruce Gellerman. On the world’s stock markets investors bid on shares in companies. On the world’s commodity markets you can buy and sell stakes in everything from gold bullion to pork bellies. Then there’s a largely unseen and unregulated global market that people don’t like to think of in terms of money: Kids as commerce.

It’s the baby biz: adoption, in vitro fertilization, sperm donation, surrogates and perhaps, one day, clones. Harvard business school professor Debora Spar has taken a look at the bottom line in the trade in children. Her new book is called "The Baby Business - How Money, Science and Politics Drive the Commerce of Conception." Thanks for coming in Debora, welcome to Living on Earth.

SPAR: It’s my pleasure, thank you.

GELLERMAN: How big is the baby business?

SPAR: Well, in the U.S. alone right now it’s about $3 billion a year, and that’s really only counting IVF treatments and some of the hormones.

GELLERMAN: IVF being?

SPAR: In vitro fertilization.

GELLERMAN: I was reading in your book that in, what, 2001 there were 41,000 IVF children born in the United States?

SPAR: That’s right. It’s a very large number.

GELLERMAN: Now, when they first started they were called test-tube babies, and it really was not accepted at all.

SPAR: That’s exactly right. First of all, it’s worth noting that test-tube is the wrong word here. Although these children are conceived outside the womb – they’re actually conceived in Petri dishes – but test tubes always seemed like a better image for people. But for sure when the first baby was conceived – Louise Brown, 1978 – people went wild, and there were protests in the streets, and picketing. And people said Louise Brown was a monster.

And yet what’s happened, as we’ve seen, is that there were so many parents who couldn’t conceive children the old-fashioned way, that they scrambled to the doctors who could produce IVF babies, and within a couple of years the demand was so high, and so many children had been born healthy, that really the opposition went away.

GELLERMAN: Has the demand gone up for children over the years? And if so, why?

SPAR: No. Actually, that’s one of the most interesting things that I found in this research. If you go back to the beginnings of time, or go back to the Bible, as I do in this book, we see that there has always been a demand for children. Because for whatever reasons, roughly 10 to 15 percent of all populations across all time have been infertile; and those people have always wanted to produce children. And it really wasn’t until the past several decades that technology gave them a way to produce.

GELLERMAN: But the notion here – that it’s become a business – is still unsavory.

SPAR: For sure it’s unsavory. It’s disconcerting. It upsets people. But what I try to do in this book is to say that we really have to fess up, if you will, and say it is a market, and people are spending money, and making money, and making babies.

GELLERMAN: You write that it’s largely unregulated.

SPAR: It is very unregulated.

GELLERMAN: I mean, if I were to want to adopt a child, say, there are regulations, there are rules, there are requirements.

SPAR: That’s right. And one of the things I’m arguing in this book is that I think we should look at the fertility market in some ways akin to the way we look at adoption. And we don’t want to set up a heavy-handed Regulatory Authority of Baby Creation, but I think we need some basic rules of the road.

GELLERMAN: Well what would those rules be?

SPAR: Well, I argue we need to start with the easy ones. First of all, we just need to look at the medical implications of what we’re doing here. Most of these technologies seem to be very safe for both the mothers and the children, but not all of them are. We need to look more closely. We need to look at the implications for women of shooting them up with massive amounts of hormones. We need to look at the implications for women who donate their eggs and also receive massive amounts of hormones. We need to look at the implications of multiple births; of doctors and clinics who are willing to implant four or five embryos at a time, giving rise to multiple pregnancies. We just need to look at these things and think about where we might want to draw some lines, purely for reasons of medical safety and the health of the mothers and babies concerned.

GELLERMAN: What other technologies are out there?

SPAR: Well, what we’re beginning to be able to do more and more, is to manipulate the embryo itself. So IVF creates the embryo artificially, if you will, or outside the womb. We now have technologies led by something called pre-implantation genetic diagnosis, which allows researchers to take the tiny embryo, when it’s really only eight cells large, remove a single cell from that embryo, and test it for a range of genetic diseases; then, once you do the tests, of course, the parents can choose which embryos they want to implant.

GELLERMAN: What about at the edges of the technology and where this might be going? I’m thinking of cloning.

SPAR: This pre-implantation genetic diagnosis is really quite intriguing because right now it’s being done largely for medical reasons to allow parents to select against some horrible genetic disease; it’s also being done for gender selection. But take that one step further and it’s not that hard to begin to screen for things like hair color and eye color. And I think we need to think about that, and make sure that that’s something we want to allow.

If you then go further down the spectrum – or the slippery slope, depending on your perspective – one can imagine parents trying cloning. The cases that we know of are not the crazy ones that people always think about. It’s not the mad scientist who wants 50 copies of himself to rule the world. It’s overwhelmingly parents who have lost a child. A four-year-old gets killed suddenly by a bus; the desperate parents don’t just want another child, they want that child back. And the doctors or the researchers who have begun to push to the edges of this technique have all told me that the calls they get are from these kinds of parents.

GELLERMAN: What about a parent who has a child with a genetic disease, and they want to create a child that can help cure their first child?

SPAR: Right. That’s something that we’re already doing right now. So it’s for a handful of genetic diseases where a child is dying and the only way to save that child is by having a perfectly matched blood or bone marrow donor.

GELLERMAN: And you can do that now?

SPAR: Yeah. Yeah. A number of those cases have occurred already using pre-implantation genetic diagnosis. What they do, the parents go through IVF, they produce a number of embryos, and then the doctors, using very, very sophisticated screens, they screen the embryos for healthy embryos, and also embryos that are a genetic match for the sick child.

GELLERMAN: Is the United States the center of this global marketplace?

SPAR: California seems to be the center of the global marketplace. California has a very permissive environment, as you’d imagine, it has a large market for many of these technologies. And there has been not legislation in California, but court cases, which have put some kind of basic rules of the road out there, mostly having to do with making sure the intended parents can in fact get access to the child in cases of contestation.

GELLERMAN: But you’d think that with the intersection of science and ethics that there would be a tremendous amount of regulation of this commerce.

SPAR: You would think so, but, in fact, in this country we get precisely the opposite. And I think that has to do very deeply with the divisive nature of the abortion debate in this country. It’s very, very hard to deal legally with these technologies until you determine what the moment of conception is.

GELLERMAN: So instead of dealing with this they just let it go and out of mind, out of sight?

SPAR: Exactly.

GELLERMAN: Unspoken.

SPAR: There’s virtually no political incentive for someone in Washington to tackle this issue, and so it really has just been pushed to the sidelines.

GELLERMAN: Well they’ve gotten very good at making these embryos and implanting them and having children as a result of that kind of conception. But there are then excess embryos.

SPAR: That’s right. At the moment, the estimates say that there’s 400,000 excess embryos in the United States alone.

GELLERMAN: Four hundred thousand?

SPAR: Four hundred thousand.

GELLERMAN: And what’s the law say about the buying and selling of those?

SPAR: The law says nothing. There is no law. The one thing we do know legally now is you can’t use those embryos for stem cell research. So the only legislation we have, or prohibitions we have, say you cannot use those for research. Other than that, it’s kind of fair game. What’s happening at the moment is that there’s more of a friends and family market in these embryos; so clinics will make them available to couples or individuals if they’re not having luck with other means.

And there’s been a really interesting development, out of California again, where a gentleman who runs an adoption agency there has begun a program of what he calls embryo adoption, which is mostly among Christian conservatives, that if a Christian couple has created an embryo – they don’t want that embryo destroyed, they certainly don’t want it used for research – they will legally allow that embryo to be adopted by another couple. And clearly there’s a lot of implications here because if you can adopt an embryo, you presumably can’t do other things with an embryo.

GELLERMAN: And you can buy and sell it?

SPAR: That’s right. And again, that has not quite happened yet, but if you look at other elements of this market I see no reason not to expect that we’re not going to get a market in embryos as well.

GELLERMAN: So it’s astonishing, actually, that you have this incredibly large global business taking place unregulated and basically unobserved.

SPAR: That’s right. Because it gets back to the basic nature of this; because it’s so personal and intimate, people don’t want to subject it to the light of day. And again, what I’m trying to argue here is that everyone’s better off if we get over our disgust here, if you will, or level of discomfort, and say we’ve got to look at what’s going on and then figure out if there’s pieces of this that needs to be restrained in some way.

GELLERMAN: Of course, science really is pushing the ethical issue here. You have a couple, they have fertilized embryos, and the husband says, no, you can’t use it, I’m no longer your husband. The wife says, I want to have a baby and I can’t do it any other way.

SPAR: That’s right. And there was a case of that here in Boston last year where the embryos were implanted in the wife, who was now divorced from the husband, and the husband sued the fertility clinic for having forced him to become a father against his will.

GELLERMAN: So what did the court say?

SPAR: The courts forced the clinic to cover his child support payments.

GELLERMAN: Where does this go in 50 years? Technology’s driving this; what’s the edge of this known universe?

SPAR: The edge of this known universe, I suspect, is that we’re gonna have more and more children created through non-traditional means. I don’t suspect that technology will ever replace the old-fashioned means, because as one of the doctors said to me, people would still rather have sex. So we’re certainly never going to see full replacement, but we will see more and more people having more and more children through these alternative means. Having children later in lives; having children with same-sex partners.

I think the part that I find most worrisome is the potential for genetic manipulation, and I think we need to watch this. And I think we need to understand – which we don’t understand yet – what is it that people choose when they choose their children? Do they choose characteristics that are as much like themselves as possible – in other words, are they trying to replicate the children they would have had through natural means, or are they trying to create something different? Something better. If it’s the latter, I get worried. And I don’t know that it is, but I think that’s the part of the market we really need to watch.

GELLERMAN: What about the kids as commodities for people that, you know, are 60 years old? Women that are 60 years old and want to have a child because they want to have a child?

SPAR: Yeah, I think this is another very important piece of this. And this is very very hard to do politically. But as the technology gets better and better, I think we need to think as a society whether we are willing to let all people under all circumstances produce children. And this will be a horrible decision to make, but we do this already in adoption. We do say that a 65-year-old woman can’t adopt an infant. I think we’d want to be obviously looser when people are using their own genetic material. But I think we need to think about it. I heard recently of a case where a couple was using high tech means to produce children, because their existing children had been taken from them by the department of social services for child abuse. This couple was allowed to procreate again, and that makes me very worried.

GELLERMAN: You’re getting right up to the edge of eugenics.

SPAR: Absolutely. But I would much rather that we realize that we’re getting up to that edge and figure out where we draw the line, rather than just finding ourselves having already fallen over the edge, and have it be too late.

GELLERMAN: You have three children.

SPAR: Yes.

GELLERMAN: All natural?

SPAR: No. Two were created the old-fashioned way and the third was adopted.

GELLERMAN: Why did you adopt a child?

SPAR: I always wanted to adopt, for no strong reasons. There’s never been any adoption in my family that I’m aware of. I felt very blessed that I was able to conceive easily, and healthy children. And I did know there were an awful lot of children out there and it seemed like an intriguing thing to do.

GELLERMAN: Did you purchase your child?

SPAR: Yeah, I think I did.

GELLERMAN: You had trouble answering that.

SPAR: Of course, because nobody wants to acknowledge, no parent wants to put those words together, "I purchased my child." But I’m okay with saying that, because I think it was a transaction, if you will, that was a very good transaction. And I purchase health care; I will hopefully be spending lots of money to send my oldest child to a good college next year, I will be purchasing an education. We purchase lots of things that also have value, have personal value, to us.

GELLERMAN: With me has been Debora Spar, Spangler Family Professor of Business Administration at the Harvard Business School, and author of the new book, "The Baby Business - How Money, Science and Politics Drive the Commerce of Conception." Professor Spar, thank you very much.

SPAR: Thank you, it’s been a pleasure.

[MUSIC: Liz Miller "Babies" from ‘Baby Fantasy: Projections of a New Mother’ (Busy Lizzy Music - 2002)]