Features & Columns
BYOB: Stanford Professor's New Book Predicts the 'End of Sex'
world where babies are made to order
Unconditional love. A rekindling of purpose. A true understanding of what it means to be patient. These are the kinds of stale and embarrassing tropes trotted out in every self-help book and daytime TV segment ever produced on "The Joys of Parenting."
Please. Spare us the cheesy listicles enumerating the priceless lessons kids can teach us. Parents don't get into the game of childrearing to reconnect with a lost sense of child-like wonder—that's what LSD is for.
In the real world, mothers and fathers spend thousands of dollars on soon-to-be-outgrown athletic equipment, burning through paychecks and free time to ferry their precious little princes and princesses to expensive rehearsals and far-flung recitals. In this way, parents foist their own dreams upon the children they have sired, in the desperate, frenzied hope their progeny will achieve the greatness they did not.
And soon—within a generation or two, if we are to believe the predictions of Henry T. Greely, professor of law and genetics at Stanford University—advancements in the fields of genetics and fertility medicine will give these Apache-helicopter parents the power to begin molding their youngsters before they've even drawn their first breath.
Greely outlines his vision for the not-so-distant future in his new book, The End of Sex and the Future of Human Reproduction.
Oh, yeah... Greely also envisions a world where the physical act of baby-making no longer figures into making babies—at least not nearly as much as it does now. In The End of Sex, Greely predicts that by the middle of the 21st century, most individuals who are actively planning a family will forego the "old-fashioned" method of getting pregnant—atop a mattress or in the backseat of a car—and opt instead to effectively build their babies surrounded by the pale blues, sterile whites and brushed stainless steel silvers of the nearest fertility clinic.
Sounds awful, right?
The upshot to all of this, according to Greely, is that parents will have far more control over their child's prenatal health, and will navigate their pregnancies with greater peace of mind knowing that the little human they are about to fling into the world will have the best chance—genetically speaking—to live a healthy, meaningful and productive life.
A former lawyer, Greely joined the Stanford Law School faculty in 1985. His emphasis on the "ethical, legal, and social implications of new biomedical technologies" helped him earn a "courtesy" professorship in genetics from the Stanford School of Medicine. He currently serves as director of the university's Center for Law and the Biosciences, and as chair of the steering committee for the Stanford Center for Biomedical Ethics.
Over the course of his career, Greely has kept a close eye on the developments of the biotech sector—watching as state and federal courts grapple with the thorny, moral quandaries that inevitably arise when science and sex intersect.
He anticipates a not-so-distant future in which parents will not only be able to choose the sex of their baby, they'll take an active role in designing their children from top to bottom. With the help of less invasive in vitro fertilization techniques, geneticists' ever-increasing ability to precisely manipulate stem cells and the declining cost of mapping individual genomes, he believes scientists will create hundreds of viable embryos in the lab, run a full analysis of each embryonic genome and give couples a menu of potential children.
You might call it "building your own baby"—"BYOB," for short.
In the late 1970s, a pair of obstructed fallopian tubes led Lesley and John Brown to turn to fertility scientists to help them start a family. Their daughter, Louise, who turns 38 on July 25, was the world's first "test tube baby."
Back then, in vitro fertilization was a bleeding-edge technology. These days, IVF procedures are far more common and are used to treat couples experiencing a multitude of fertility issues. However, as Greely observes: "It's not cheap. It's unpleasant. And it's risky." But it doesn't have to be that way.
Currently, the IVF process necessarily involves extracting eggs from a woman's ovaries. The procedure is painful and can lead to complications—including swelling of the ovaries and infection. Worse, harvesting female gametes tends to only yield between three and 15 viable embryos, and sometimes produces none.
Greely forecasts that this highly invasive process will soon give way to a procedure in which geneticists use "induced pluripotent stem cells"—a type of stem cell that has the potential to become just about any kind of cell—to create female gametes out of a woman's skin cells. The technique has already been performed by Japanese and Chinese scientists using the skin cells of laboratory mice. This biological alchemy will remove the risk of complications for women and allow for the creation of an unlimited number of viable embryos, Greely says.
Next comes genetic mapping. Launched in 1990, the Human Genome Project was slow going at first. The work was expensive and time consuming. It took close to $1 billion and 13 years to sequence the very first human genome. Nowadays, it costs between $3,000 and $5,000 and takes somewhere between 24 and 48 hours.
All that remains is putting it all together. In the baby-building fertility clinics of the future, Greely predicts scientists will first use the aforementioned induced pluripotent stem cells to create around 100 viable embryos, then run what he calls "preimplantation genetic diagnosis" on each embryo. These PGDs will produce a wealth of information about how each potential individual will look and act. Everything from the sex and physical attributes to the likelihood of genetic disorders will be calculated and made available to parents.
Stranger Than Fiction
Greely is aware that all of this can sound like the plot to some dystopian sci-fi novel, especially when assuming that the service will only be available to the rich and that those who choose to use it will actively select for tall, athletic boys and blonde, waif-like girls.
Name-checking Mary Shelly's Frankenstein and Aldous Huxley's Brave New World, Greely acknowledges that the Western canon is brimming with cautionary tales warning of the consequences awaiting those who would play god. He understands the trepidation many have when it comes to bioengineering. Still, he is confident that the system he has outlined in his book will soon be commonplace.
Public health advocates will support the technology in the name of saving children from debilitating diseases; the insurance industry will see an opportunity to save money; and fertility clinics will jump at the chance to bring more patients in the door. Greely even sees the right-to-life movement playing a role.
Greely believes "the opening wedge" in the widespread adoption of this technology will come as a fertility treatment for "articulate, middle class, white, straight couples" who are unable to conceive naturally.
"Although the right-to-to life movement intellectually doesn't like the idea of embryos being made and not used," Greely says, "it does like the idea of people who want to have babies having babies."
Once the Food and Drug Administration approves a new drug, medical technology or procedure, doctors are free to use it for any purpose they deem suitable. That's when the healthcare and insurance industries will jump in—along with fertility clinics.
"There are already roughly 600 fertility clinics in the country," Greely observes. "They are very profitable. They have a good trade organization. And I think they will push very hard with advertising and lobbying to make this possible."
The amount of human suffering that arises from serious genetic disorders—such as Tay-Sachs, which usually kills children before they reach 5 years of age—is incalculable. However, according to Greely, the savings that would result from widespread adoption of this technology can be calculated.
Setting aside the potential savings that BYOBs might bring to the health system as fitter adults, Greely estimates that the amount of money saved in the treatment of babies with serious genetic disorders alone will make this technology so cost effective that governments and insurance companies will ensure that the service is free to everyone.
Greely estimates that producing a sexless baby will cost about $10,000 from start to finish. That means that 100 babies will run a cool million. One to 2 percent of all naturally born children enter the world with serious genetic disorders, according to Greely. Individuals with these types of conditions require such intensive care, that a single baby can easily rack up $1 million in medical bills in the first few months of their life.
Beyond the promise of avoiding genetic disease and reducing other gene-linked maladies, there is another reason Greely believes the technology he outlines will be adopted.
In theory, the aforementioned process of manipulating induced pluripotent stem cells—which will give scientists the power to turn skin cells into male and female gametes—will not only aid heterosexual couples battling fertility issues; it will also allow gay and lesbian couples to produce their own genetic children.
"I think that's a very politically attractive story," Greely says.
Of course, gay men will still have to find a surrogate to carry the baby to term, he notes. And lesbian couples will be unable to produce a male child without the addition of a Y chromosome. However, he thinks the technology to add a Y chromosome to a pair of gametes is not far off.
The Court of Public Opinion
Greely insists he is not making an argument in favor or against the system he is outlining. He is merely predicting what will come in the near future. "The book, to me, is kind of like a memo to a client," he says, slipping into the role of legal counselor. "Here are the pluses, here are the minuses. You make the decision."
There are plenty of individuals who have made strong arguments for and against genetically modified humans. In 2007, Michael J. Sandel, a professor of philosophy at Harvard, published a book, The Case Against Perfection: Ethics in the Age of Genetic Engineering. In an excerpt from the book, which ran in The Atlantic, Sandel writes:
"To appreciate children as gifts is to accept them as they come, not as objects of our design or products of our will or instruments of our ambition. ... The problem is not that parents usurp the autonomy of a child they design. The problem lies in the hubris of the designing parents, in their drive to master the mystery of birth."
There are also those who will stand against designer babies for religious reasons, such as the individual who left the following comment on the Amazon.com page for The End of Sex:
"This is NOT what God intended and NOT what God wants. This is what Satan wants. God created one man and one woman to be together and have families. He created sex to be pleasurable between a man and a woman. We need to turn back to Jesus."
Greely understands there will always be ethical, moral and religious arguments made against the future he is predicting. "This might not be popular in Mississippi or North Dakota, but in the city and county of San Francisco..." he trails off, letting the thought linger. A true litigator, he is trained to present evidence and allow jurors and judges to come to their own conclusions.
And, he is quite sure that once "more people see that the kids born this way don't have three heads," more folks will come to embrace this brave new world.