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Web Letter

Rebecca Tuhus-Dubrow presents a reasonably balanced view of human-assisted reproductive technology (ART). I honestly congratulate her on what I recognize was a good effort in dealing with a difficult and controversial subject. However, as a lifetime Nation reader and someone with twenty years experience in ART, I feel compelled to comment on some common misconceptions that have crept into her commentary and unfortunately seem endemic to this discussion.

In an offhand comment, Tuhus-Dubrow refers to the infamous "Wild West" of supposedly unregulated ART practice in the US. If memory serves, this nonsense can actually be credited back to the "ethicist" Dr. Leon Kass, whom she later quotes in the article. Unfortunately, this is a piece of out-of-date sloppy journalistic shorthand with seemingly vampiric powers to survive, despite being diametrically at odds with the basic facts. It would seem a simple matter for journalists to take a quick look at how ART clinics and practitioners are actually regulated in the US, but they never seem to and "Wild West" sounds so much more interesting.

ART in the US is in fact arguably one of the most highly regulated forms of medical practice on the planet. Of course, physicians involved in ART are regulated, licensed and scrutinized in the usual fashion and, as they are often the top specialists in their field, they are probably subject to even more scrutiny, board certification etc. Individuals in every other position in the ART laboratory--dealing with patient material--are required to maintain specific and strict competency certifications, up to ART laboratory directors who must hold and maintain a highly demanding Laboratory Director certification. ART clinics are routinely inspected by the College of American Pathologists, a certification agency mandated to perform this task, which involves a physical inspection as well as detailed critical review of all clinic protocols and case records. And finally, every ART lab is registered annually with the FDA for compliance with human tissue banking protocols. Beyond all of this direct oversight, ART is the only form of medical practice in my experience where the specific details and results of every single patient must--by federal law--be submitted in a timely, highly regulated fashion to a national database. This data is not only available to the regulatory community but is public resource that any patient, journalist or interested party can easily access. So much for the "Wild West."

My second issue involves the general tone--perhaps somewhat derived from the books being reviewed--that infertility patients are somehow uniquely vulnerable and hysterical and are being at least subtly taken advantage of by a profit-hungry "fertility industry" pushing unregulated snake-oil procedures. This is another bit of foundationless nonsense that seems to be boilerplate commentary when ART is discussed. One would hope that feminists at least would see the first part of this for the sexist, misogynistic garbage that it is. The "profit-hungry fertility industry" component is simply another "ethicist"/journalist-derived piece of sensationalist, derogatory character assassination. It is repeated again and again despite having no connection with the boring reality.

ART infertility medicine is precisely like every other type of medical practice. The treatment modalities employed have been developed in the same fashion as every other form of current medical practice (review board approved clinical trials etc.). These treatments are applied by physicians and scientists (under the uniquely strict regulatory environment described above) in successfully treating a plethora of very real and mostly well-defined physical/physiological deficits in ART patients. As for the supposed hysterical, needy individuals being taken advantage of: in my experience, ART patients are if anything exceptionally well informed, highly rational and very pro-active in their own care.

Rather than an unscrupulous "industry" (sounds bad doesn't it?), I think it is entirely arguable that ART represents not only one of the greatest success stories in the history of modern medicine but a powerfully ethical liberating force in human society in providing valid reproductive options where none existed before. With great effort, skill and courage on the part of ART practitioners, adverse situations that were 100 percent medically hopeless a few decades ago are now routinely addressed. In fact, the "multiple birth" problem that Tuhus-Dubrow and the reviewed authors correctly bring up is an unfortunate concrete example of this success.

The increase in multiple births has arisen not from "profit-hungry" medical practice but from the spectacular advancements in improved embryonic development and implantation achieved by the ART practice community over the past two decades. Furthermore, this is without any question currently recognized by ART practitioners as a major treatment issue (perhaps the major treatment issue) that must now be solved in our goal to facilitate healthy singleton births for all patients. This issue has been a primary discussion topic at every recent professional ART-related meeting that I have attended and much current clinical work is being devoted to solving it. In fact, this problem is already being solved with many clinics currently achieving very high singleton/very low multiple birth rates.

I will close by referring to the supposed "yuck" factor that ethicists claim as a guide in weighing ethically challenging issues. My personal "yuck" factor becomes highly activated when considering the actions of the self-proclaimed ethicists themselves. Ethicists like Kass have been making ill-informed, reactionary pronouncements about assisted reproduction for decades--pronouncements that without the slightest foundation have questioned the basic rights of free individuals to simply seek medical assistance with their eminently rational and real desire to have children. Apparently Kass is now happy with normal "married couples" using ART--how nice. I suppose the thousands of single parent and same sex couples who currently use ART in unethically building their own families are out of luck. One would hope that progressives at least see this kind of "ethics" for what it is. Fortunately, the reality is that hardly anyone apart from perhaps other ethicists have paid much attention to their dire, truly hysterical warnings. Unfortunately, one particularly “yucky” situation that can be partly blamed on “ethical" critics and the reactionary politicians who have made use of them over the years is the shameful and irrational continued moratorium on normal funding and support for basic research in human embryology.

Certainly, as Tuhus-Dubrow discusses, ART brings with it some very serious choices and decisions--choices and decisions that affect not only the patients themselves but their future children. I would strongly argue that these are choices and decisions that clearly reside with the patients/parents involved. ART practitioners have an absolute and solemn duty to provide correct information, valid treatment options, proper counsel and the best possible performance in helping these patients to achieve the goals inherent in these choices and decisions. I feel we have lived up to these requirements and that ART constitutes a tremendously positive and highly ethical advancement in human medicine.

Henry Malter

Maplewood, NJ

Dec 5 2007 - 1:50pm

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