Unmanaged Care: The Need to Regulate New Reproductive Technologies in the United States

In the aftermath of allegations of the misuse of human eggs in the United States, questions are being raised about whether profitable reproductive services should continue to function in a free market under the aegis of physicians or should be regulated. Other countries in which reproductive technologies are employed to a significant degree have developed regulations governing their use, many as a result of recommendations made by inter-disciplinary commissions that solicited public input. Policy makers in the United States have been reluctant to regulate reproductive technologies, however, because their use is politically controversial, they want to whittle down government, some do not consider infertility an illness, and some believe regulation would interfere with the right to reproduce. Yet the unfettered use of reproductive technologies can create such harms as lack of informed consent, providing procedures not medically indicated for financial gain, practice by unqualified personnel, injury to patients and donors, failure to screen donated gametes, and inadequate medical record keeping. Americans place special value on the welfare of children and those who bring them into the world. Such values can outweigh individual procreative liberty when new reproductive technologies are at issue. Although the optimal course would be to establish a regulatory body to govern reproductive technologies, this is not politically feasible now. The newly established National Bioethics Advisory Commission provides a forum in which issues surrounding reproductive technologies should be addressed at this time in the United States.     

The evolution of female sexuality and mate selection in humans

Understanding female sexuality and mate choice is central to evolutionary scenarios of human social systems. Studies of female sexuality conducted by sex researchers in the United States since 1938 indicate that human females in general are concerned with their sexual well-being and are capable of sexual response parallel to that of males. Across cultures in general and in western societies in particular, females engage in extramarital affairs regularly, regardless of punishment by males or social disapproval. Families are usually concerned with marriage arrangements only insofar as those arrangements are economically or politically advantageous, but females most often have a voice in arranged marriages. Extended families also concentrate on a couple’s future reproduction rather than on sexual exclusivity. Although marriage for females is often compromised by male or family reproductive interests (which may not in fact differ from female interests), females appear to exercise their sexuality with more freedom than has previously been suggested. Notions of human females as pawns in the male reproductive game, or as traders of sex for male services, should be dispelled.     

Birds Do It. Bees Do It. So Why Not Single Women and Lesbians?

Infertile couples have come to take assisted reproductive technologies (ART) for granted. An increasing number of single women and lesbian couples also desire to have children and turn to ART, especially donor insemination, to fulfill this desire. While most married couples find that access to ART is limited primarily by the ability to pay, for single women and lesbian couples, the story may be much different. In the United States, they may find that doctors and infertility clinics view their desires as immoral and refuse to accept them as patients, although other doctors and clinics readily accept them. In most other countries, however, it is against the law for single women and lesbian couples to make use of ART, including donor insemination.
In this paper I will argue that marital status and sexual orientation should not serve as a barrier to accessing the world of reproductive medicine. I will base this conclusion on two arguments. First, that justice requires that we treat like cases alike. Just as we would not accept or reject patients for cardiac rehabilitation programs based on factors such as a history of poor eating habits, so too we should not look at nonmedical factors such as marital status when deciding whether to treat infertility. For the second justification for the conclusion of equal access to ART, I will examine the concept of the family. I will argue that it is morally acceptable for single women and lesbian couples to have children and to head families.     

Birds do it. Bees do it. So why not single women and lesbians?

Infertile couples have come to take assisted reproductive technologies (ART) for granted. An increasing number of single women and lesbian couples also desire to have children and turn to ART, especially donor insemination, to fulfill this desire. While most married couples find that access to ART is limited primarily by the ability to pay, for single women and lesbian couples, the story may be much different. In the United States, they may find that doctors and infertility clinics view their desires as immoral and refuse to accept them as patients, although other doctors and clinics readily accept them. In most other countries, however, it is against the law for single women and lesbian couples to make use of ART, including donor insemination.
In this paper I will argue that marital status and sexual orientation should not serve as a barrier to accessing the world of reproductive medicine. I will base this conclusion on two arguments. First, that justice requires that we treat like cases alike. Just as we would not accept or reject patients for cardiac rehabilitation programs based on factors such as a history of poor eating habits, so too we should not look at nonmedical factors such as marital status when deciding whether to treat infertility. For the second justification for the conclusion of equal access to ART, I will examine the concept of the family. I will argue that it is morally acceptable for single women and lesbian couples to have children and to head families.     

Cloning and adoption: a reply to Levy and Lotz

In previous articles I discussed the ethics of human reproductive cloning, focusing on a possible future scenario in which reproductive cloning can be accomplished without an elevated risk of anomalies to the children who are created. I argued that in such a scenario it would be ethically permissible for infertile couples to use cloning as a way to have genetically related children and that such use should not be prohibited. In 'Reproductive Cloning and a (Kind of) Genetic Fallacy', Neil Levy and Mianna Lotz raise objections to my conclusions. They disagree with the view, for which I argued, that some couples can have defensible reasons for desiring genetically related children. They also offer several new arguments against reproductive cloning, including an argument that it would diminish the number of adoptions, thereby adversely affecting the welfare of children who need to be adopted. In this paper I point out that Levy and Lotz's criticisms misconstrue my arguments and that there are serious problems with their arguments for prohibiting infertile couples from using cloning, including their argument from adoption.     

Factors affecting commercial application of embryo technologies in New Zealand: a modelling approach

New reproductive technologies include sexed sperm and embryo-based technologies. The technology of sperm sexing, for various reasons, is not available in New Zealand and its use has not been modelled. Embryo technologies are however already in use on a limited scale and various scenarios for their use in both the dairy and beef industries in New Zealand have been modelled. This review briefly discusses the various technologies available and some of their potential strengths and weaknesses. In the dairy industry, modelling has been used to simulate the production of breeding bulls for large breeding companies and the production of replacement heifers in dairy herds. For the beef industry, similar modelling has been carried out to determine the opportunities for more efficient beef production.All the models confirmed that at current levels of performance, embryo-based reproductive technologies are usually not profitable in New Zealand except in niche market situations where the returns from the resulting offspring are significantly greater than can be obtained from natural mating or artificial insemination (AI) reproduction systems. This is confirmed by the low uptake of these technologies in this country to date. Even if performance lifts to levels similar to AI, profitability is likely to occur only if the costs of pregnancies to embryo-based reproductive technologies can occur at prices less than two to four times greater than AI or natural mating. This break-even requirement depends on the returns that can be achieved and the advantages that can be captured by the technology over and above those available from AI or natural mating. Two new uses for reproductive technologies in dairy cattle could be the proliferation of novel or rare genotypes from gene discovery programs and improving the female reproductive rate for optimal marker assisted selection. In both these uses the technology is not at present competing with AI or natural mating. The challenge exists therefore for the biological scientists to satisfy these requirements, coupled with the ethical and human factors involved in the introduction of any new technology.Potential end users of the technologies have been surveyed. They are quite positive about the technologies provided they can use them profitably and are keen to obtain more information about them.     

Videotaped Patient Stories: Impact on Medical Students' Attitudes Regarding Healthcare for the Uninsured and Underinsured

The attitudes of medical students toward the current United States healthcare system are not well described in the literature. A graded survey was developed to assess awareness and motivation toward the care of the uninsured and underinsured as well as the impact of a video intervention on these attitudes. The survey, which showed good internal consistency (Cronbach’s alpha = 0.85), was administered before and after viewing a collection of videotaped patient stories. Although a spectrum of beliefs emerged from the analysis of survey responses, some common attitudes were identified. Eighty-five percent of respondents either agreed or strongly agreed that medical care should be provided to everyone, regardless of their ability to pay. In addition, 66% indicated they would be willing to forgo a portion of their income to provide care to those who do not have access to healthcare services. These values were strongly correlated with increasing respondent age and primary care specialty choice (p<0.01). The video intervention did not heavily influence student responses, perhaps due to a ceiling effect created by the large number of students who were already sympathetic toward the underserved. Overall, this data reflects that United States medical students recognize a need to provide care to the underserved and are willing to make personal sacrifices to meet that need.     

Transgenerational epigenetic information through the sperm: Sperm cells not just merely supply half of the genome for new life; they also seem to transmit additional information via epigenetic modifications

The biological cause for the increase in Autism Spectrum Disorder may be fathers’ older age and the epigenetic marks it leaves on sperm cells. Subject Categories: Chromatin, Epigenetics, Genomics & Functional Genomics, Development & Differentiation, Ecology

COVID‐19 is not the only pandemic that is affecting an increasing number of people; autism spectrum disorder (ASD) is another ongoing pandemic that has attracted much less attention despite the fact that its prevalence is rapidly increasing. Between 1975 and 2009, the frequency of ASD in the United States increased from 1/5,000 to 1/110, and the US Centers for Disease Control and Prevention recently reported an incidence as high as 1/54 (see “Further reading”). This is not confined to the United States of course but the same trend can be observed in other countries as well. One possible explanation for this dramatic increase in ASD is the change of diagnostic criteria. These were established in the 1980s and have since been expanded to include milder forms of autism. Along with more public awareness of ASD and more cases being recognized as such, this would explain, at least in part, the increasing number of affected children, but social and diagnostic factors are not sufficient to explain the rise of ASD: there must also be biological factors at play. Indeed, various epidemiological studies suggest that the age of the parents, in particular the father’s age, is an important risk factor.The age at childbirth is related to socioeconomic issues: longer education or higher costs for raising and educating children correlate with older parental age. In addition, assisted reproductive technologies are further increasing the age of birth as this helps women to delay motherhood until into their late 30s or even 40s. However, as both reproductive capacity and the quality of germline cells decline with age, older age at childbirth is associated with lower pregnancy rates, increased risk of miscarriage, and higher risk of various diseases and disorders for the children.     

Making Sense of Child Welfare When Regulating Human Reproductive Technologies

Policy-makers have attempted to frame the ethical requirements that are relevant to the creation of human beings via reproductive technologies. Various reports and laws enacted in New Zealand, Canada, Australia, and Britain have introduced tests for how we should weigh child welfare when using these technologies. A number of bioethicists have argued that child welfare should be interpreted as a “best interests” test. Others have argued that there are ethical reasons why we should abandon this kind of test. I will argue that at least some of the relevant policy can be interpreted as requiring those wishing to exercise their procreative liberty to have a reasonable plan to care and nurture any resulting child, thereby respecting the internal preconditions of that liberty. This interpretation of child welfare requirements answers some of the ethical worries about a child welfare test.     

Of totemism and ethnicity: Consciousness,practice and the signs of inequality*

In 1997, it was reported that a sheep had been successfully ‘cloned'at the Roslin Institute in Scotland. The sheep, named Dolly, attracted a great deal of attention and the idea of ‘cloning’ appeared to generate, in much of the western world at least, both anxiety and anticipation in equal measure. Discussion generated in the media immediately turned to the advantages and disadvantages of cloning people. I focus here on some of the responses to Dolly in the United States and in Britain. Drawing on fieldwork, pre‐Dolly, in the north of England, largue that the image of ‘the clone’ acts as a conceptual brake, as a marker of limits, to possibilities presented through new reproductive and genetic technologies. ‘Cloning’ provides an ethnographic window through which specific cultural understandings of kinship can be discerned.     

Assessing and managing methylmercury risks associated with power plant mercury emissions in the United States

Until the Clean Air Mercury Rule was signed in March 2005, coal-fired electric utilities were the only remaining, unregulated major source of industrial mercury emissions in the United States. Proponents of coal-burning power plants assert that methylmercury is not a hazard at the current environmental levels, that current technologies for limiting emissions are unreliable, and that reducing mercury emissions from power plants in the United States will have little impact on environmental levels. Opponents of coal-burning plants assert that current methylmercury exposures from fish are damaging to the developing nervous system of infants, children, and the fetus; that current technology can significantly limit emissions; and that reducing emissions will reduce exposure and risk. One concern is that local mercury emissions from power plants may contribute to higher local exposure levels, or "hot spots." The impact of the Mercury Rule on potential hot spots is uncertain due to the highly site-specific nature of the relationship between plant emissions and local fish methylmercury levels. The impact on the primary source of exposure in the United States, ocean fish, is likely to be negligible due to the contribution of natural sources and industrial sources outside the United States. Another debate centers on the toxic potency of methylmercury, with the scientific basis of the US Environmental Protection Agency's (EPA's) recommended exposure limit questioned by some and defended by others. It is likely that the EPA's exposure limit may be appropriate for combined exposure to methylmercury and polychlorinated biphenyls (PCBs), but may be lower than the available data suggest is necessary to protect children from methylmercury alone. Mercury emissions from power plants are a global problem. Without a global approach to developing and implementing clean coal technologies, limiting US power plant emissions alone will have little impact.     

Images and Image: Technology and the Social Politics of Revealing Disorder in a North American Hospital

In the United States and elsewhere diagnostic activities are now prominently centered on images derived from technologies such as magnetic resonance, computed tomography, and angiography. In this article I examine language, actions, and interactions in a multidisciplinary team of biomedical specialists whose members meet routinely to visually interpret and assess such images. Convened behind the scenes, in a conference room from which patients are excluded, these meetings are examined as privileged performances in which team members exercise their visual faculties and interpretive skills to address issues that include their statuses and reputations, and to politically position themselves and their specialties. Ethnographic data derived from close observation of 23 such diagnostic meetings are presented. I suggest that problems posed by the attempt to synthesize information from diagnostic images serve as vehicles for evaluating or "diagnosing" the professional capabilities and "image" of the participating physicians. Team-based divisions and attempts to reassert challenged autonomies also characterize this socially oriented diagnostic process.     

Stem cell colloquy: conclusion

The stem cell data presented and discussed during the symposium raise the hope that important medical progress can be made in several fields: neuro-degenerative diseases, those linked to cellular deficit, some aspects of aging linked to cellular degeneration, and the treatment of cancers that may harm normal tissues at risk of being infiltrated by malignant cells. Three main types of stem cells are available. (i) Those present in normal adult tissue: contrary to what was believed, some data suggest that certain adult stem cells have a great plasticity (they can differentiate into cells different from those in tissues from which they were taken) and can proliferate in vitro without losing their properties. Nevertheless, their use faces several obstacles: in ill or elderly subjects, then these cells can be limited in number or not multiply well in vitro. In this case, auto-grafting of the cells cannot be used. They must be sought in another subject, and allo-grafting causes difficult and sometimes insoluble problems of immunological tolerance. (ii) Embryonic stem cells from surplus human embryos, obtained by in vitro fertilisation, which the parents decide not to use: these cells have a great potential for proliferation and differentiation, but can also encounter problems of immunological intolerance. (iii) Cells obtained from cell nuclear transfer in oocytes: these cells are well tolerated, since they are genetically and immunologically identical to those of the host. All types of stem cells can be obtained with them. However, they do present problems. For obtaining them, female oocytes are needed, which could lead to their commercialization. Moreover, the first steps for obtaining these cells are identical to those used in reproductive cloning. It therefore appears that each type of cell raises difficult scientific and practical problems. More research is needed to overcome these obstacles and to determine which type of stem cell constitutes the best solution for each type of disease and each patient. There are three main ethical problems: (a) to avoid the commercialization of stem cells and oocytes (this can be managed through strict regulations and the supervision of authorized laboratories); (b) to avoid that human embryos be considered as a mere means to an end (they should only be used after obtaining the informed consent of the parents; the conditions of their use must be well defined and research programs must be authorized); (c) to avoid that research on stem cell therapy using cell nuclear replacement opens the way to reproductive cloning (not only should reproductive cloning be firmly forbidden but authorization for cell nuclear transfer should be limited to a small number of laboratories). Overall, it appears that solutions can be found for administrative and ethical problems. Harmonisation of international regulations would be desirable in this respect, in allowing at the same time each country to be responsible for its regulations. A last ethical rule should be implemented, not to give patients and their families false hopes. The scientific and medical problems are many, and the solutions will be long and difficult to find. Regenerative medicine opens important avenues for research, but medical progress will be slow.     

Abandonment and accumulation: embryonic futures in the United States and Ecuador

When frozen embryos are publically debated in the United States, they are most often positioned as having two possible future trajectories: (1) as individual humans and (2) as contributors to stem cell research. Long-term embryo accumulation threatens both of these futures. An accumulated embryo is stuck in a clinic, held back from having an individual future or from contributing to science. There are other kinds of futures, though. For some patients in the United States and Ecuador, where I conducted ethnographic research, future reckoning involves a vision of responsibility toward embryos embedded within a specific family. For these patients, frozen embryo donation to another family or to science constitutes abandonment. The future at stake is not that of an individual embryo's life, but a group's future who would abandon one of its own. These patients would rather destroy embryos than freeze them for a future away from their relations. [Ecuador, United States, in     

Consequences of Future Data Center Deployment in Canada on Electricity Generation and Environmental Impacts: A 2015–2030 Prospective Study

The environmental impacts of data centers that provide information and communication technologies (ICTs) services are strongly related to electricity generation. With the increasing use of ICT, many data centers are expected to be built, causing more absolute impacts on the environment. Given that electricity distribution networks are very complex and dynamic systems, an environmental evaluation of future data centers is uncertain. This study proposes a new approach to investigate the consequences of future data center deployment in Canada and optimize this deployment based on the Energy 2020 technoeconomic model in combination with life cycle assessment methodology. The method determines specific electricity sources that will power the future Canadian data centers and computes related environmental impacts based on several indicators. In case‐study scenarios, the largest deployment of data centers leads to the smallest impact per megawatt of data centers for all of the environmental indicators. It is found that an increase in power demand by data centers would lead to a reduction in electricity exports to the United States, driving the United States to generate more electricity to meet its energy demand. Given that electricity generation in the United States is more polluting than in Canada, the deployment of data centers in Canada is indirectly linked to an increase in overall environmental impacts. However, though an optimal solution should be found to mitigate global greenhouse gas emissions, it is not clear whether the environmental burden related to U.S. electricity generation should be attributed to the Canadian data centers.     

A program for the study of long-term adaptation to a weightless environment providing three-dimensional freedom of movement

The mechanical details of a working model of a proposed small-animal space station which is currently undergoing bench tests are briefly described together with supporting evidence pointing to the feasibility of the program. The one-third cubic meter canister weighs less than 250 kg when loaded for a 9-month period. It would transmit by slow-scan television data concerning mice which it is proposed would be born in the weightless state. Observation of their silhouettes would indicate their growth rates and study of the picture sequence their activity patterns. For example, their use and defense of the feeding and nesting areas and their care of their young.The device would also be used to determine whether the weightless state affected the development of a circadian rhythm or the periodicity of any rhythm that was observed. Recovery of the animals' special living compartment by rendezvous in orbit would permit testing of those born in the device in the earth's gravity field by familiar methods such as those that have been used for the assessment of negative geotactic responses and for the evaluation of rodents living in vertical, as opposed to horizontal mazes.This work was jointly supported by the National Aeronautics and Space Administration, Office of Advanced Research and Technology, and the United States Air Force's Aerospace Medical Division through United States Air Force Contract F29600-67-C-0010.     

IVF and women's interests: an analysis of feminist concerns

Feminist objections to the new reproductive technologies are examined. The author argues that although these technologies entail significant risks and costs to women, help only a small minority, and do not address the underlying social causes of infertility, women's interests do not demand the rejection of research on and use of reproductive technologies. Their potential threat to female reproductive autonomy can be counteracted by protecting individual civil rights. Warren urges that women, as well as members of various racial, ethnic, and socioeconomic groups, be represented in decisions on reproductive technologies, participate in their development and funding, and supervise their provision.     

Mass Producing Food Traditions for West Africans Abroad

In this article, I examine West African foods sold mainly in specialty grocery stores, focusing on how technologies used in food production in West Africa are referenced in the brand names and packaging of processed African foods sold in the United States. Through their association with "timeless" West African food-processing techniques, such foods evoke memories of childhood and home. Yet the transformation of West African foods through new technologies of processing, packaging, and branding reflects different time and health concerns of West African immigrants living in the United States. Through their purchase of time-saving, mass-produced, and hygienically packaged foodstuffs, which are ideologically similar to but technologically very different from the production processes and cooking in Africa, West Africans in the United States use food to maintain social relations with their particular families, hometown associations, and religious groups, while also constituting national, regional, and global connections through the reinvention of food traditions.     

The greening of biotechnology: the growth of the US biotechnology industry

The growth and advancement of biotechnology worldwide has been the focus of many studies, and at the heart of this advancement has been a new industry of small biotechnology firms in the United States. Since the early 1970s more than 300 small companies have been founded in the United States to work with the new technologies of genetic engineering, monoclonal antibody production, and in related areas. In addition, many major corporations in the United States have sought entry into biotechnology. Hundreds of new companies have been founded to interact with the biotechnology firms and large corporations, supplying reagents, equipment, fermentation expertise and serving a variety of other ancillary functions. Nowhere else in the world has a biotechnology industry been initiated to such a large degree. Today, the average US biotechnology firm is six to seven years old. The current state of the US biotechnology industry, historical perspectives, major trends and some future outlooks will be described below.     

Irrigated agriculture and freshwater wetlands: A struggle for coexistence in the western United States

This paper is a review of the major environmental problems associated with irrigated agriculture in the western United States. Freshwater wetlands are being contaminated by subsurface agricultural irrigation drainage in many locations. Historic freshwater inflows have been diverted for agricultural use, and remaining freshwater supplies are not sufficient to maintain these important natural areas once they are degraded by irrigation drainage. Migratory birds have been poisoned by drainwater contaminants on at least six national wildlife refuges; waterfowl populations are threatened in the Pacific and Central flyways. Revised water allocation policies and regulatory actions are probably necessary to correct existing damage and prevent future problems. The benefits of maintaining healthy wetlands should be used as a rationale for negotiating increases in freshwater supplies. Cost analyses that show the importance of wetlands in dollar values are critical to the success of these negotiations. The next few years will provide unique opportunities for wetland managers to use cost analyses to make changes in water allocation policies. Federally subsidized water has supported and expanded agriculture at the expense of native wetlands for over 100 years in the western United States. This trend must be reversed if these wetlands and their fish and wildlife populations are to survive.