9
Freakonomics: Fetal genetic testing raises big questions
A two-week-old boy finds his feet in his new world.
To view this content, Javascript must be enabled and Adobe Flash Player must be installed.
BOB MOON: It's Freakonomics time. It's that time every couple of weeks here on Marketplace where we explore the hidden side of everything. Today: When a new technology is unveiled, sometimes, the unexpected comes along too.
Here's Stephen Dubner.
STEPHEN DUBNER: One day, during a reporting trip to Anhui Province in China, the journalist Mara Hvistendahl visited a family planning office. She saw something strange.
Mara Hvistendahl: They showed me to a room in their office where an ultrasound machine was kept. And there actually was two locks on the door.
It was kept under lock and key, because --
Hvistendahl: In some countries where sex selection has taken off, people see this machine as really a way to ensure them a boy.
Since the introduction of the ultrasound in Asia, in the early 1980s, it's often been used to determine the gender of a fetus -- and, if it's female -- have an abortion. In a part of the world with big populations, these sex selection abortions have had a big, unintended consequence.
Hvistendahl: I mean there are over 160 million females missing from the population in Asia, and to put that in perspective, it's more than the entire female population of the United States.
So, what happens in a world with too many men? For starters, there's more sex-trafficking, more AIDS, and a higher crime rate. In fact, if you want to know the crime rate in a given part of India, one surefire indicator is the gender ratio. The more men, the more crime. Now, the ultrasound machine didn't create these problems, but it did enable them. So, you have to wonder. What's next?
STEPHEN QUAKE: With a blood test where blood is drawn from the arm it's zero risk for the baby, and essentially zero risk for the mom.
That's Dr. Stephen Quake, he's a biophysicist at Stanford. He's developed a new blood test that will screen for genetic abnormalities, like Down syndrome, in a fetus. That's typically done now with amniocentesis, which requires sticking a big needle through a woman's abdomen -- through the uterus, and into the amniotic sack. A blood test would do away with a lot of that risk, the invasiveness and the cause, and it would give parents information earlier in a pregnancy.
QUAKE: The overall goal here I think is to lower stress. Impending parenthood is a very stressful time.
If more people opt for Quake's blood test, then more people would find out earlier on that they have a fetus with a genetic abnormality. So, would we see the end of Down syndrome births? Here's my Freakonomics co-author, economist Steve Levitt.
STEVEN LEVITT: There are many people now who are willing to put in God's hands whether or not they have a Down syndrome child and I think those are the kind of parents who if they have a Down syndrome child will give loving and supportive households. And then there's the set of parents who desperately want to avoid having a Down syndrome child, who cannot handle financially or psychologically the cost that would come with it.
In other words, just because there's an easier test -- doesn't mean everyone will want to use it. Levitt, being an economist, doesn't see this situation as simply a moral decision; he sees it as a "sorting mechanism."
LEVITT: In a world in which there are two different kinds of people, some who welcome Down syndrome children and some who don't, it seems to me that if you have a cheap, easy, safe, reliable test, that that's a perfect sorting mechanism to ensure that in some sense the "right" Down syndrome children get born.
Dr. Quake's blood test is in clinical trials now, and may be on the market this year. So, we'll start to see the outcome sooner, rather than later. What'll it be? That's hard to say. The future is the future.
But don't be surprised if we turn out to be -- surprised. There are a lot of powerful laws in the universe, but the law of unintended consequences may be one of the most powerful.
I'm Stephen Dubner for Marketplace.
I agree with some of the other comments here: we went from how ultra sound was being used for a bad result to getting rid of a downs syndrome child if you can't handle it, which was spun as a good result? How about extending the argument: now we can potentially start "sorting" out other undesirable diseases, like asthma, sickle cell anemia, dwarfism, heart problems, cystic fibrosis, MS. Oh, wait, why don't we take that a step further and just do away with traits we just don't like: aggression, brown hair, short height, bow legs, lazy eyes? Now it's an interesting story. GATACCA anyone?
Let me get this straight. When you don't know what the sex is and have an abortion it is choice but when you do know and have one it is deplorable? When holding a baby count backwards by 1 minute intervals and tell me when this human being is no longer human eligible for disposal? My stance on abortion is obvious but my demographic is not - agnostic gay man. If we don't respect life at its most vulnerable when should we?
I often enjoy “Freakonomics†but yesterday’s story on genetic testing was disjointed and its concluding comments startling and deeply offensive.
On the one hand it was acknowledged that the consequences of sex selective abortions -- increased crime, sexually transmitted diseases and sex trafficking -- have been unintended and tragic. On the other hand, the testing and abortion of fetuses due to genetic abnormalities is casually described by Dr. Drake as the acceptable result of the quest to “lower stress†facing expectant parents.
I found myself physically shaking as Mr. Levitt blithely labeled genetic testing as “a perfect sorting mechanism†to reduce the number of children born with Down syndrome. It is extremely troubling to think that he wasn’t the least bit uncomfortable with his statement that such testing can help ensure that only the “right†children with Down syndrome would be born!
Ah yes, wouldn’t the world be a better place without all those people deemed less than perfect, or annoying, or maybe just different from us? Isn’t that view what motivated Hitler in exterminating Jews, Gypsies, the handicapped, etc.? Isn’t the true measure of a free society how we treat the weak and vulnerable?
It is not the ultrasound machine or the blood test that is causing undesirable, even evil consequences, but our society’s insatiable desire for control and the widespread belief that we have the right to judge whether some human lives are less valuable than others.
Thank you for this thought-provoking article. As an abortion moderate, I really appreciated a balanced discussion of the unintended consequences of abortion on demand. Perhaps that can move the debate forward to a time when is Bill Clinton said, abortions can be legal and rare.
I was engaged with this story right from the start but then it took a detour and never got back on track. Talk about unintended consequences!
Anyway, I don't think it's only the "introduction of the ultrasound machine" that has resulted in the abortion of 160,000 female fetuses; it's also legislation limiting the number of children a family may have combined with a tradition of disrespect for women. The resulting population imbalance and the behavior of men in male-dominated societies is the story I wanted to hear more of. Indeed, there's so much more to investigate even in cultures where the population is relatively balanced but all the social and political power remains in the purview of males.
Regardless of genetic testing methods (and new ones will continue to be developed), as long as it's available people will make choices based on multiple factors beyond sex, beyond Down's syndrome, and who knows what others. The real question raised in my mind is this: Will human nature ever rise to a level of mutual compassion, respect and understanding for all people irrespective of gender, age, ability, skin color, and so many more conditions that divide us that is equal to the sophistication of our technology?
This is one of the most poorly constructed stories I have ever heard. It begins about ultrasound imaging being used for sex-selection and then jumps to detection of Down's Syndrome with a new blood test. One assumes there is a connection between the two ideas, but it was never stated in your story. What will be the effect of the new blood test be on the practice of identifying and aborting female fetuses? Probably exactly the same because any test that can detect genetic abnormalities can also determine sex. So what then? Will the sex of the fetus be kept from the parents? Authorities could do that with ultrasound if they wanted to. Imagine the ultrasound photo that the expectant parents proudly show to their families - with a little black bar over the private parts. This story was pathetic.
I just heard Steven Levitt's remarks about a new blood test for Down Syndrome in which he says it will be a "sorting mechanism" for the "right" parents for a Down Syndrome child. As someone who was uninformed about this genetic condition, and whose first child was born with this Trisomy 21, I found his statement naive and lacking insight into the way people respond to the unexpected. What my husband and I discovered was that we had a capacity to love her unconditionally and evolve into more compassionate people. Over time we began to understand and to appreciate the special qualities our daughter could bring to both us and all the people whose lives she has touched. While her arrival was a surprise, we are thankful for the gift she has been to us. I'd like to think that we have been the "right" parents for such a job. Also, contrary to what Mr. Levitt states, this test most assuredly has moral implications, because if the medical world assumes Down Syndrome will be a thing of the past because there is a safe easy test, a consequence will be that supportive services and research into finding ways to develop the potential of people with Down syndrome will wither away. This would be tragic for them and their families.
Sincerely,
Ann-Marie Gillett
