• Pioneer Days
Pioneer Days
In contrast with most science, reproductive medicine is a statistical black hole. It’s been 25 years since the first test-tube baby was born, yet basic questions remain unanswered – the data uncollected and unanalyzed.
Doctors have not systematically studied the impact of reproductive technologies on children born with their aid or mothers impregnated through their use. We don’t know which experimental techniques are being used, who is using them and what type of adverse health effects have occurred – though we do know that one technique inadvertently passed along genetic male infertility and that another produced a child with DNA from three “parents.”
In a landmark report released last month, the President’s Council on Bioethics wrote that new reproductive technologies “move from the experimental context to clinical practice with relatively little oversight or deliberation.”
As if to prove the point, Dr. Sherman Silber of the Infertility Center of St. Louis at St. Luke’s Hospital last week announced that he had transplanted ovarian tissue from a healthy woman into her identical twin, who is infertile.
At universities and hospitals, an independent review board must first evaluate and approve the use of experimental procedures on human subjects. But at assisted reproduction clinics, there is no such oversight. Guidelines and the reporting of results are entirely voluntary. There is something of a Wild West atmosphere to the field.
Dr. Silber is, to be sure, a brilliant physician. For many couples coping with infertility – a condition that affects about one in six- he is a miracle worker. Those who have met Dr. Silber are astounded by the range of his intellectual curiosity and his willingness to challenge conventional wisdom.
Still, it’s hard not to feel just a bit uneasy about the speed with which he has taken a procedure that previously had been successfully tried only in a rhesus monkey and used it on humans. “I’m nervous that this really is an experiment that has gone too fast,” bioethicist Arthur Caplan told reporter Tina Hesman for a story in Sunday’s Post-Dispatch. “It’s good to be a pioneer, but pioneers sometimes get lost.”
Reproductive medicine is a field like no other. Here, ethical questions are sometimes raised only after the fact, when new technologies have already pushed back the frontiers of science. The interests of couples desperate to become parents are clear, as are the interests of doctors. But who represents the interests of the child or of society as a whole? For that matter, what are the interests of the child and society as a whole?
Those questions can’t be answered until the data are collected and the studies undertaken as the President’s Council has recommended. In the meanwhile, someone has to clean up Dodge City. It would be best if that were doctors and professional societies. But sometimes when they fail to act, government must step in.
St. Louis Post-Dispatch
