Superbabies?

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I am someone who is a little bit obsessed with always trying to do the right thing. That's Vox reporter, Cigal Samuel. Not just like the good thing, but the most good thing. And I just found in the past few years that that was really making me kind of pretty unhappy. It was torturing me somewhat because often it's just impossible to optimize more life and it's exhausting and misery inducing to try. Cigal needed a way out. So she decided to start an advice column, something she thought could help her with her own ethical dilemmas. Cigal's column is called Your Myelage May Vary. And it's pretty untraditional for an advice column. Because it's oriented around this particular philosophical idea called value pluralism. The premise there is that each of us contains multiple values, multiple things we hold dear. And awkwardly, those values are often in tension with each other. It's not like one of them is dumb and one of them is the right one. You might have conflicting values in a situation like honesty versus loyalty or honesty versus kindness. Those are all good values, but what do you do when they conflict? I wanted to talk to Cigal because her column kind of feels like a kindred spirit to unexplainable. She's way more interested in how to think about a question than she is about figuring out the exact answer. She tackles huge questions and she brings in wisdom from everywhere, ancient Greece, early Islam, enlightenment philosophy, bloggers. But for this episode, I wanted to focus on a particularly fascinating question about having kids. So this is the question from a reader. My partner and I did IVF recently and luckily we ended up with several embryos. One of those will be implanted in me so I hopefully get pregnant. But which one? My fertility clinic is encouraging me to do PGA testing, which would screen for things like Down syndrome and would also let me see the sex of each embryo so I could potentially choose whichever I want. And to be honest, I really want a girl. I'm also hearing about these new companies that contest embryos for all kinds of things. Like how smart the kid might be, how tall they'll get, whether they'll have a lower chance of getting breast cancer, diabetes, mental illness. I don't know how to feel about any of this. On the one hand, it feels weirdly eugenic to do so much tinkering with embryos and I can't help feeling a little pressured into over-medicalizing everything with these expensive tests. But then again, if I could do something to make my baby healthier and happier, don't I kind of have to do everything in my power? What is a parent-oh their child? What is a parent-oh their child? Yeah. It's such a wavy question. What did you first think when you read this? I mean, to be honest, my first thought was like, oh man, that sentence, like, don't I have to do everything in my power? Yeah. Really, that's the moral optimization thing that I've struggled with for years. Like, don't I have to do the best thing, not just a good thing. It's my child we're talking about. Don't I need to do the best I possibly can for them? So I really, right away, felt for this person. On the one hand, feeling pressured and feeling like, oh, I don't want to over-medicalize everything. But on the other hand, maybe I'm supposed to be over-medicalizing this. It's my child's future. But the tacit thing that I hear behind this question is guilt and shame. I think new parents, and especially, like, expectant mothers, are subjected to a lot of social scrutiny and shaming. So I think the context here that's unspoken in this question is like, your kid isn't even out in the world yet, but already you're a bad parent somehow. How exactly do these screenings lower risk? Do they do sort of a profile of various embryos and then you kind of get to pick your favorite? Yes. Basically, what these companies will do is let's say you've done IVF and you've managed to get, I don't know, 10 embryos. Amazing. Mazeltov. Great. They are going to create a profile for each of your embryos. They're going to give you like a little chart and it's going to say like embryo 1, 2, 3, 4, blah, blah, blah. And for each embryo, they're going to say this one 12% more risk of diabetes, but minus 13 risk of schizophrenia increased IQ potentially on the horizon, but oh, higher risk of diabetes, right? So they're going to give you that profile for each of the embryos. And what do we know about the tests? Like, how do they actually work? Okay. So we should differentiate between a couple different kinds of tests, right? Okay. So the test that this person mentions, PGTA, is a pretty simple test. It's been around since the 90s. It can screen for conditions like Down syndrome. It can let you see the sex of each embryo. It's pretty common. The more new and controversial testing is called polygenic testing. And that is something that tests for very complex conditions that are influenced by thousands of genes. And we're talking about depression, breast cancer, but also selecting for a toler kit or a kid with a higher IQ. So it's a lot more complex. And stuff like IQ and depression are these based on genetic markers? So there is for depression a strong genetic component. IQ also has a strong genetic component. There's a lot of unknowns. A lot of what we have is sort of correlational evidence. Causal is harder, particularly with something like intelligence. A lot of people have overemphasized how much we know genetically about this. And they've tried to say like, if you know XYZ about the genes, you can pretty well predict the intelligence. I think there's a lot of researchers now who will tell you like, no, actually, we really don't know like the interplay with environments and other things. So it's a lot more complicated of a story than some genetics based companies might have you believe. And how accurate are they? So it depends what you're testing for. So sometimes people want to know the risk of each embryo for diabetes, maybe a Brake mutation that someone might end up getting breast cancer. That broadly speaking is going to be more accurate than psychiatric conditions, which these polygenic tests tend to not perform as well on. These are conditions that are, you know, influenced by multiple genes. So it's not like you turn on this one gene, boom, we know it has X effect. Right. I also think it's like very important to understand the statistical claims are like a little tricky here. So they can claim that if you choose a certain embryo, it'll have a 12% lower risk than others of developing type tube diabetes. Am I here that and you might think, oh my God, that's amazing. The chance of my kid ever developing diabetes just went down by 12%. Yeah. But it's not like a on off switch that's so just like black or white you have it or you don't, right? Things are often on a continuum. So if you hear that, really what it means is like a kid that might have developed diabetes is likely now at the high end of pre-diabetes or they're going to develop diabetes, but just a few years later than they otherwise would have. The same thing for breast cancer, right? Yes, you'd rather the kid develop it later if they're going to develop it, but it's not like a bill of perfect health that the customer might be imagining when they hear these claims. So they're kind of framing it in a sense of the kid won't get diabetes or they'll be less likely to get it. And what you're saying is that they just might spend less of their life with diabetes. Yeah. I think the statistical claims here are very confusing even for experts never mind lay people. I think it's like really important to understand. It doesn't mean the embryo is not going to get this thing, right? It means conditions are on a continuum. Not like one day you wake up out of nothing. Suddenly you have like full-blown diabetes. There's pre-diabetic, right? Like there's a whole continuum and it's also worth noting like mental health conditions are on a continuum, right? You can have let's say depression. It could be mild, moderate, severe. So that's also something to think about. Yeah, it feels like diabetes or a brach-emutation for breast cancer or some of these more concrete things. They feel very different from an IQ score or depression or other psychiatric disorders which are both maybe more diffuse and maybe more socially, culturally related. Yes. I think that's such an important point. No one is like sitting there pining. Oh, I wish I had cancer. It's like, no, you don't want it, right? It's bad. You don't want cancer. But mental health conditions are a little trickier. Like I'm someone who has anxiety and some obsessive tendencies. Sometimes that's incredibly annoying for my life. But in my experience, I also feel like it's correlated with my creativity because I feel like the same kind of thing in my brain that leads me into like rabbit holes of worry. Also leads me into rabbit holes of, I've just found out this cool scientific fact. Now I want to go into the wee hours of the morning researching it and then write a children's book about it. Yeah, I feel the same. I mean, I have OCD and I hate it. And then there are oftentimes when it definitely feels like a superpower that I can hyper-focus or I can hear details or I can like obsess over something to a point that I can make it perfect. And you can work on improving a mental health condition. You can work on emphasizing the pros and de-emphasizing the negatives. But if someone came to me and gave me a magic wand to just eliminate all of it, that seems harder. That seems like a harder decision. Yeah, same. Like, if someone gave me the magic wand and told me I could eliminate my stuff, like I would say no thanks. Yeah. I don't want to romanticize these conditions. You know, sometimes stuff can be really hard, but on balance, like no, I wouldn't just be like, let's wave a magic wand and get rid of it. So I don't think I would want to do that for a baby, either. Coming up in a minute, what should the parent do? Yeah, I mean, that's where it gets really complicated and hard. And this is where a lot of people are going to start fighting. The support for the show comes from ShipStation. If you would like a good tongue twister, try saying ShipStation sure supports our show three times fast. Close your eyes. Pretend you are the CEO of a company that produces tongue twisters. All day, every day, you are generating turns of the tongue. 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Where should we begin with Esther Perel and the special live taping of today explained hosted by yours truly. The Vox Media podcast stage will also feature sessions from Brunei Brown and Adam Grant, Marcus Brownlee, Keith Lee, Vivian II, Robin Arzone and more. Visit voxmedia.com slash South by Southwest to pre-register. Get a special discount on your South by Southwest Innovation badge. That's voxmedia.com slash South by Southwest. Hope to see you there. Super, baby. Baby geniuses too. So let's talk about the should part of this question. Like should this person select for the best possible baby? I wonder if you can start with the argument for it. Where would you start there? Yeah, so I think the first thing is a scientific issue. It has a bit of a funny name. It's called playotropy. It's basically a fancy way of saying that we know not that much about which genes cause what. You might have a gene that's correlated with, let's say, depression, but it might also be correlated with a bunch of other things. So if everyone were to suddenly start selecting embryos to try to prevent their kids from getting depression, we don't actually know what would happen on a project. But it's a population level. It's possible other traits might be impacted. There does seem to be a general trend that, you know, decreasing the risk for like one disease also goes along with decreasing risk for other diseases, but it still worries me somewhat because there's a lot we don't know. I also wonder how much this stuff costs. Like would this only be available to rich people? So right now polygenic testing is not cheap. In company, for example, orchid, it charges $2,500 per screened embryo. So if you test 10 embryos, that's going to run you 25k. So in the short term, at least that does raise the specter of entrenching some kind of castus stem where you get this growing gap between rich and poor people because the rich people get to have the babies that are smarter, stronger, healthier, and the poorer people don't. And there might just be kind of pressure on people with less money to spend their life saving some to things like this. Yeah, absolutely. And that's actually my concern about the longer term, especially. So technologies do tend to get cheaper as they mature. So it is conceivable that in 10, 20 years, you know, we'll have a way to do this kind of polygenic screening that is not $2,500 bucks a pop. But that still raises what I would call the specter of implicit coercion. So actually get more worried about this when it becomes cheaper. And if it's cheap enough that, you know, Joe Schmok can do it, then you start to have this cross society trend of lots and lots and lots of people are doing it. And now if you don't do that for your kid, you kind of start to feel like you're putting them out of massive professional and educational disadvantage. So that creates a risk of implicit coercion, which I do think is worrisome. And from the perspective of the child, I don't know unless your parent lies to you later on, you know, you're going to know like this kind of testing was done to arrive at the you that you became. Yeah. And you might feel some type of way about it. So for example, you can find out the sex of the baby. The question asker in the column said, to be honest, I really want a girl. So I'm really tempted. But like, what if you, you really want a girl? Oh, you select for the one that says it's going to be a girl 10 years later, 20 years later, the kid says, actually, I'm trans. And I, you know, I don't identify as a girl. And then they're going to know unless you lie to them that you went out of your way to choose a girl. And it was so important to you to have a girl. They have this sense of my parents spent tens of thousands of dollars trying to achieve this consumer good. And they're, they might feel like, oh, I extra feel like a disappointment to you now. Yeah. I mean, kids have to deal with enough disappointing their parents all the time as they are. Right. I worry like this is going to create a lot of therapy sessions on like topics we haven't had to deal with before. Okay. And then I think kind of like hovering over this whole conversation is the idea of eugenics. Is there a concern about removing certain types of like just real human experience? Yeah. Removing human experience from the equation. I think absolutely. I think, you know, this is sort of like the extension of a problem that already exists, you know, in terms of let's say conditions like Down syndrome, which are screened for so commonly now. And, you know, that's really ethically questionable because even if we come to a place where we feel confident that for you as an individual, polygenic screening is going to lead to a better outcome for your individual kid, we still have to look at on the population level, what does this mean for society if more people start using this technology? You start to get questions about removing entire swaths of human experience from the world. And I don't know. I think that when you have conditions that are very compatible with happy life that are just like, you know, okay, someone has anxiety, someone has this, someone has that. There's pros and cons to it. That is much more of an open question, I would say. So clearly there are arguments against this. At the same time, I don't want to make it seem like this is an obvious decision. You clearly don't think this is an obvious decision. What are the arguments in favor of selecting for babies? I think the argument in favor pulls a lot from this intuition that probably a lot of us have, which is like, look, it's your kid. Like, surely you want to do the best you can for your kid, right? Like of course, you want them to have the best possible life they can possibly have. And you have some philosophers like Julian Sevalescu, for example, who argue that parents have a moral obligation to create children with the best chance of the best life. And you see this argument echoed in the founders of some of these polygenic testing companies. So for example, Norse Dickey, who heads up the company Orkid, one of the polygenic testing companies, she talks a lot about like protecting your kids from various health conditions, talking about some kind of health problem down the line. And she'll say, what if you could have stopped it, but chose not to? I do find myself compelled by some of this as someone who's about to be a parent. Yeah. You know, I'm an Ashkenazi Jew. When Ashkenazi Jews have kids with other Ashkenazi Jews, it's kind of like default to go get tested for tasas, which is this, you know, debilitating fatal disease. It just makes me think that, okay, there is a universe where it feels very simple. But how do you weigh the potential benefits of protecting your child, of trying to give them the best life against the potential downsides, of commodifying our relationship to our kids, of causing an unknown reaction that we're not aware of? I go back to Herbert Simon, who is a Nobel laureate in economics, and in a way the granddaddy of a lot of our kind of maximizing, optimizing talk. And he came up with this term that I absolutely love, which is satisfying. That's a portmanteau of satisfying and sufficing. And that is meant to describe opting for the good enough choice. Okay. He said that, look, like many problems in life just contain way more variables and way too much uncertainty for maximizing along anyone access to be a feasible or even desirable thing. So often it just makes sense to go with an option that is good enough, you know, to satisfy. And to me, satisfying in the context of like thinking about the genetic lottery for your child, means, yeah, let's prevent them from having debilitating things like tasas, because that doesn't feel good enough for your child. But like maybe we don't need to try to make them like the tall, blue eyed adonis, right? Like that doesn't feel like satisfying anymore. So what did you tell the person who wrote in? I told them, look, I'm not going to tell you like, you shouldn't do this kind of screening ever, right? I think it depends on the situation. It depends like what you're screening for, what's your story. But what I would say is do not let yourself be bullied or shamed by others, especially if they have a profit incentive to push you to do a certain test, right? I think that when someone who runs a company says, what if you could have stopped it, but you chose not to give us money. Yeah, that's that's praying on your worst fears and insecurities as a perspective parent and it's kind of holding parents hostage to a moral logic that pretends to be giving them more autonomy. But actually, it's robbing you of autonomy because it's saying you must do this kind of testing on your child. And I just want perspective parents to feel like, look, you are nobody's hostage. You can look at the many different relevant factors in your family's life, weigh all of them in the balance and then make the choice that works good enough for your family. What did people think about the advice you gave? Did you hear from any readers? So there are a lot of people in my Twitter orbit who are very like interpolygenic testing, so they have argued with me a bunch. But I also got a really touching email from a mother of a child with Down syndrome. And she said, look, like I made the choice years ago to go ahead and have this child a lot of other people are just not going forward with pregnancies when they found out the kid will have Down syndrome. I went ahead and had this kid and like, I'm so happy. I love my kid. We have a great life. Like yeah, not everything is peaches and roses all the time. But I think it's totally compatible with a happy life. And I see that in my child's life and in my life as a parent. And so thank you for pointing out that these conditions that we've decidedly come to think are like, oh, just screen out and nicks them from the get go. Thank you for being willing to consider that actually. A lot of conditions are like in this zone where, yeah, there's some hard stuff about it, but there can also be some beautiful stuff about it. Maybe we don't need to be so quick to get rid of all possible swaths of human experience that look a little bit different. I mean, it just makes me think of trying to have a goal of humility when you want to say, let's give my child the best chance at the best life. We being humble about what we think of as the best life. Yeah. And if we're overconfident on what we think of as best, I don't know, life surprises you in a lot of ways. I think that's really, really true. I think like we are deeply confused as a species about what is the good? Like the whole history of philosophy is like one long lesson in like, we don't know what the good is and we're like, do you like to use about it? So I don't want it necessarily presumed to know for my kid. It's going to be the most beautiful kind of life. If you want more advice from Cicol, the your mileage may vary. Advice column comes out twice a month and you can find it on box.com or get it in your email inbox by signing up for the future perfect newsletter. This episode was produced and hosted by Noam Hassanfeld, who also wrote the music. He is out for now because in the time since we taped this episode, he has become a parent, congrats to Noam and the whole family. This episode was edited by Joanna Salatarov with help from Meredith Hottonot, mixing and sound design from Christianailla, fact checking from Melissa Hirsch. Julia Longoria and Jorge Just are our editorial directors. Amy Padula gives great advice. I'm Sally Helm and I jump in to record the credits when necessary. Bird Pinkerton was confused. Okay, you just get any guitar. Platy shook her head. You think it's easy to be a platypus playing a guitar? You think I can just buy a platypus guitar at guitar center? 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