Back to the Future

Today, Louise Joy Brown is 30. Few people now know who she is, or that she was at the center of one of the great scientific controversies of the second half of the 20th century. At the time, Louise Brown was variously seen as a blessing, an oddity, or an aberration. She was a miracle child, the first baby born as a result of in vitro fertilization (IVF), or a “test-tube baby.” In 1978, after she was born in secret in an English hospital, the announcement of her birth made worldwide headlines.

Today, some reports show that as many as one out of every 100 babies is conceived in vitro.  Over 115,000 people in the United States owe their births to this process. San Diego alone has nearly ten clinics that offer IVF. It is no longer exceptional. Many of us know a family member, a friend, or a colleague who has used IVF. And, although there is no universal agreement, most of us count it among our blessings that IVF has helped open the doors of parenthood and family for so many who were previously unable to conceive. We celebrate the technology that has enabled so many couples that want children to be able to create a warm and productive place for them. We are sympathetic to the pain and emotional trauma of infertility, and we are pleased that science has offered a solution. But the truth is that, today, we rarely give in vitro fertilization much thought. It has become just one more thing that some people do. It seems . . . natural.

But we did not always think this way. In the years preceding Louise’s conception, during the frenzied build up to her birth, many were skeptical and afraid. There seemed to be so much potential for harm. Some felt that procreation should be a direct result of sexual intercourse. To break this connection, as IVF did, was to chip away at intimacy and threaten the sanctity of marriage. Others were concerned about the potential for physical and psychological damage to both mother and child. This was new and uncharted territory, and no one could say for sure that IVF would be safe, or that children born of this process would be “normal.”

There were several other troubling questions. Was it ethical to subject a baby to such risk without it having the ability to consent? Were women becoming experimental pawns for overeager, male, doctors and scientists? Were we further exacerbating the world’s overpopulation? To what extent did we really want women’s reproductive systems to be wrested from their wombs and put into the hands (and test tubes) of scientists? And finally, what about the wasted eggs and the fetuses lost to experimentation and failed implantation? Didn’t they have rights?

From the beginning, San Diego universities and institutions were instrumental in raising national awareness about the potential benefits and dangers of this new technology. As early as 1984, after only 100 IVF babies had been born in the U.S., a coalition of scientists, doctors and lawyers at the cutting edge of the young science (including U.C. San Diego biologist Dr. Clifford Grobstein), were reporting to Congress, helping to inform the general public and shape the national discussion.

Now, many of these same questions, about rights, about responsibilities, about family values and scientific ethics, have resurfaced with stem cell research. We, in San Diego, must once again take a leading role in the complex ethical debates ahead of us. There is deep concern, once again, over the moral status of human embryos.  This time the focus is not on creating new lives, but on the potential benefits of stem cell research for those who are already born.  We are concerned about the science fiction-like potential of human cloning, but these anxieties are also about our experience of powerlessness and vulnerability.  We are faced with science we do not understand and scientists who seem to have the power to shape our futures in fundamental ways.  We worry that this new technology, even as it saves lives, may contribute to social inequalities by making genetic improvements available only to the rich today, just as IVF seemed to offer a reproductive advantage only to those who could afford the process.

These are real concerns and difficult questions. Americans faced similar dilemmas with in vitro fertilization. Thirty years ago, as scientific leaders, San Diego helped the country to imagine our future with IVF. As a nation, we saw some futures we liked and others we did not. We imagined how we might weave this new science into the fabric of our society. That is how we began. This is always how we should begin. The time for vigorous, broad-based discussion has come again, and we may learn from both the successes and failures of IVF. While there are important lingering concerns about discarded embryos and industry oversight, we have incorporated in vitro fertilization into our society in ways that are in large part consistent with our values of parenting and family.

Now, as leaders in the young science of stem cells, San Diego scientists must once again look up from their test tubes and help the nation imagine our futures with stem cell research, so we may consider which of those futures are consistent with the values we hold dearest, and then become advocates for that future. This vital work is already beginning.  Our major universities, most noticeably San Diego State University, the University of San Diego, and UC San Diego have come together in a partnership to create the Center for Ethics in Science and Technology, which is helping to explore the ethical dimensions of new areas of science and technology, like stem cell research.  And our leading stem cell research institutions, including the Burnham Institute for Medical Research, the Salk Institute for Biological Studies, The Scripps Research Institute, and UC San Diego have created a collective approach to help scientists address the ethical dimensions of research, and particularly stem cell research, through the San Diego Research Ethics Consortium.  As we begin again, the history of in vitro fertilization should offer us confidence in the constructive power of these conversations, and provide valuable lessons about the responsibilities that come with our scientific leadership.

Tate Hurvitz is a professor of English at Grossmont College. You can contact him directly at tate.hurvitz@gcccd/edi. Or set the tone of the debate with a letter to the editor.