The Inconvenient History of IVF
Let’s Not Distort Debates about Human Cloning and Heritable Gene Editing
By Pete Shanks
Cloning is back in the headlines. Researchers managed to create two macaque monkeys by cloning, and immediately there was talk about using the Dolly-the-sheep technique to create human clones. Which leads straightaway to the claim that public concerns about human reproductive cloning “echo many of the earlier objections to IVF.”
That is historically inaccurate. It’s also a notion that promotes, either deliberately or inadvertently, an extreme technological agenda that would lead to the production of not just human clones but also genetically engineered people.
The specter of human cloning was raised in the widely syndicated Associated Press article about the cloned monkeys entitled: “Scientists Successfully Clone Monkeys: Are Humans Up Next?” It was also featured in Reuters, (picked up by NBC and many others), The Guardian, National Review, and the London Daily Telegraph, for instance; most of them had “human” in the headline as well as the body text. Almost all the coverage opposed human reproductive cloning, but only on safety grounds: 77 other implanted embryos had failed. My colleague Marcy Darnovsky made the most detailed and compelling ethical case against it in New Scientist.
However, some academics and journalists saw no ethical objection at all. John Harris, a broadly libertarian British bioethicist, recycled the hoary old claim that twins are clones, so why worry? That’s definitional wordplay at its worst: Plants (the most commonly cloned organisms) are not people, their clones are not embryos, and twins are individuals as any parent knows. By no coincidence, Harris is also strongly in favor of human heritable gene editing.
Multiple surveys over the past 30 years, including one by Pew Research Center in 2016 and another by AARP Research in 2018, confirm that the American public is “largely wary about gene editing for babies” and “worried the technology would negatively affect society.” Cloning fares even worse: Public opinion opposes human reproductive cloning by margins of 6–1 or even more.
By contrast, numerous studies show that Americans generally accept in vitro fertilization (IVF), and that it probably would be even more widely used if it were less expensive.
These data points are now regularly used by some advocates of human cloning and heritable gene editing as part of a revisionist historical narrative about IVF that supports their agenda. According to this story, people are queasy now about cloning and germline modification, but their benighted fears won’t last. It was “the same with IVF when it first happened,” Werner Neuhausser of Harvard’s Stem Cell Institute told MIT Technology Review in 2015. Smithsonian magazine headlined an article in September 2017, “In Vitro Fertilization Was Once As Controversial As Gene Editing is Today.”
However, this historical account isn’t really true. It would indeed be a shame if this false narrative were to distort the public debates now.
Reaction to the Birth of Louise Brown
In terms of both elite and public opinion, there are some similarities between the debates about IVF in the 1970s and about gene editing in this decade — but there are also notable differences. For one thing, the first “test-tube baby” was not, as the narrative described above suggests, viewed with suspicion. In fact, Louise Brown was both famous and popular as soon as she was born, in England on July 25, 1978. In the first week of August 1978, Gallup surveyed 2684 American adults, who favored the use of IVF for infertility by 60–28. Indeed 53% of respondents said they might use the procedure themselves.
This was less than two weeks after the announcement of the very first IVF birth. It is simply incorrect to say, as Robin Marantz Henig did in a 2002 New York Times article (and many others have since), that “our collective attitude about in-vitro fertilization took a 180-degree turn after the first few test-tube babies turned out to be normal.” There may have been a change over the previous decade, as speculation about “artificial reproduction” was building, but it was complete by the time of the birth.
The public was by then well primed. Louise Brown’s birth was the front page lead in the New York Times, which ran multiple stories, and in most U.S. newspapers. It was also on the cover of both Time and Newsweek. The London Daily Mail paid $570,000 for an exclusive. In order to include a picture of the baby, the New York Times actually ran, on page A16, a photo of someone reading the Daily Mail.
Steptoe and Edwards
The instant publicity derived partly from the public-relations instincts of Dr. Patrick Steptoe and especially Dr. Robert Edwards, who had frequently been accused of a “tendency to seek publicity in the press, television and so on.” Edwards justified this as early as 1971, on the grounds that “scientists may have to stir up public opinion, even lobby for laws before legislatures.” Martin Johnson, now an emeritus professor of Reproductive Sciences at Cambridge and a Fellow of the Royal Society noted in 2011 that:
“It is difficult nowadays, when the public communication of science is embedded institutionally, to understand how damaging to them this was.”
These unconventional attitudes almost certainly contributed to the fact that Edwards and Steptoe did have a hard time getting funding for their work. That is one of the data points that is now being misleadingly cited to promote the narrative of heroic struggle before ultimate triumph, and to support the idea that modern technologies will soon be as popular as IVF (and modern rule-benders will become celebrated).
Although the notion of a sudden turnaround in public views of IVF following Louise Brown’s birth is incorrect, in the years preceding her birth there was a protracted, inconclusive and largely academic debate about the ethics of what Edward and Steptoe were attempting. In a later review, Martin Johnson et al. discussed the concerns about safety and ethics that apparently caused Edwards and Steptoe’s funding problem: the British Medical Research Council refused to fund the research unless primate studies were performed first; they also considered over-population a higher priority than infertility.
Unlike later controversies, the moral status of the embryo was not a major focus at the time, at least in the UK, though the treatment of research subjects undergoing experimental treatment was. The Johnson overview also stressed “the strong public interest” in the IVF project, and quoted one of the referees of an early funding application:
“When the first reports of this possible method of treating infertility appeared in the press, I had letters from a large number of women in Wales asking if there was any possibility if they could have ‘test tube’ babies.”
Anecdotal evidence of course does not prove anything, and American attitudes may have been different than British, but this does indicate that there was at least some early support for the concept we now know as IVF. That stands in contrast to a frequently cited 1969 Harris poll that reportedly shows that more than half of Americans thought emerging reproductive technologies were “against God’s will” and would “encourage promiscuity.” Unfortunately, the wording of the questions and the detailed results are no longer readily accessible. This, we should note, was almost a decade before Brown’s birth.
Scientists, bioethicists, politicians and others discussed these developing technologies throughout the 1970s, often focusing on reproductive cloning. For examples, see James Watson’s prescient 1971 Atlantic essay “Moving Toward the Clonal Man”; and the 1974 New York Times Magazine piece by David Rorvick, titled “The Embryo Sweepstakes: The winner will be a brave new baby conceived in a test‐tube and then planted in a womb.”
Many scientists and ethicists did remain critical even after the first birth. With no primate studies, it’s easy to see why. Some worried that Steptoe and Edwards (not to mention Lesley and John Brown, the parents) had got lucky — which was not an absurd idea at the time, though they had been working on the procedure for nearly a decade. Since then, of course, millions of babies have been born using IVF, and almost everyone accepts it.
Public Debates
The public, overall, comes out of the history of IVF very well. They were skeptical at first, then convinced, and immediately happy for the parents and baby. In September 1978, less than two months after Louise Brown entered the world, a Harris poll of American women showed that 85% “believe the ‘test-tube’ method of conceiving children should be made available to married couples that are unable to have children.”
Only a small minority now support the idea of reproductive human cloning, and even some of them think it’s not safe and possibly never will be. A few people have uninformed fantasies of cloning themselves (or Elvis or someone); we need not worry about them. President Obama summed up the prevailing sentiment when he said (while endorsing embryonic stem-cell research): “We will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.”
Reproductive cloning is, in practical terms, off the table. On the issue of human heritable gene editing, however, we urgently need a wide-ranging, public debate.
At the elite level, this has been underway for several years. The discussion increased sharply in intensity in 2015 when Chinese scientists reported the first use of gene editing on human embryos. In 2017 (see this summary by my colleagues Leah Lowthorp and Katie Hasson), Shoukrat Mitalipov of Oregon Health and Sciences University said his team hoped to bring germline editing into fertility clinics as soon as possible. In the UK, Kathy Niakan’s group at the Francis Crick Institute in London were using gene editing for basic research on embryonic development, which could have practical implications in a less scrupulous lab.
With the publication last year of Human Genome Editing: Science, Ethics, and Governance, a Report of the National Academies of Sciences (NAS), the supposed scientific consensus evolved in less than two years from a red light to a flashing yellow. The December, 2005 public conference NAS held recommended a moratorium, until there was “broad societal consensus about the appropriateness” of moving forward.
Less than two years later, with little completed new science and certainly no societal consensus, one of the authors explained, “We say proceed with all due caution, but we don’t prohibit germline.” It is hard to avoid the conclusion that elites are trying to pre-empt public debate by assuming what they hope to prove, and couching their approval in disingenuously moderate language.
IVF quickly overcame any biases against it on the part of the public. It did not take a major educational effort, it happened quite effortlessly. No marketing was required.
This is where we can see the dangers of the trope that “it was the same with IVF.” It’s a way of telling people that they need not be concerned about cloning or heritable gene editing, because they themselves are bound to change their minds.
That’s not public debate, it’s an attempt to close debate. We need to open it up.
- For much more, see the Center for Genetics and Society (for whom I consult), specifically their Human Genetic Modification and Human Cloning sections.