Harvard Business School Publishing, 2006.
The fact that this book is published by the Harvard Business School and the author is a professor there tells us much about how this topic is broached. The main focus of the book is on how the infertility industry (the baby business) and the market interact. Other vital elements in the discussion about fertility, such as moral considerations, are barely mentioned. And this is where the book breaks down. Yes, the market side to the question is very important, and rightly needs to be explored, but taken out of a bigger social and ethical context, the approach comes across barren and empty (no pun intended).
But Spar quickly dismisses ethical concerns, arguing that they are messy, controversial, and incapable of any resolution. Thus her focus is single: to see how the desire for babies fits in with the world of trade and commerce. And her premises are not easily gainsaid: people desire to have babies (and/or baby parts, or services, or technologies) and there are many who are happy to provide these things, especially for a price. It is as simple as that: supply and demand. People will always want babies, and new technologies will keep arising to make this possible. Thus the market makes itself right at home in this area.
Indeed, economically speaking, as Spar keeps noting, it is a match made in heaven. This trade in babies is therefore inevitable and here to stay, she argues. The horse has bolted, and there is no going back to the stable now. We must live with the new reproductive technologies, and their inevitable commercialization. The only question is whether the baby market should be open slather, or whether some sort of regulatory scheme should be put in place.
That there is a thriving baby business with lots of money exchanging hands is certainly not in question. This book largely examines the various areas of the baby trade – be it IVF, surrogacy, sperm and egg selling, cloning and the like – and how money has been invariably linked to the fertility industry.
Of course this book describes the situation in the US, where there is very little government regulation at all over the fertility business. Other nations do have regulatory schemes in place, which the author refers to now and then. But it is the wild west of the American fertility trade that is in focus here.
Spar believes that the market will always be part of this industry, and that it is not a bad thing at all. But she recognizes that as the “product” in discussion is a human baby, many are reluctant to speak of it all in purely financial terms. She occasionally acknowledges the critics, like Leon Kass, who see much of the reproductive industry as involved in the commodification of children and the manufacture of life, but seems little impressed by their concerns.
Indeed, she says early on that the market will always triumph, while issues of morality will remain unresolved, and by implication, be of secondary importance. Thus she simply accepts the reproductive revolution and Big Biotech as necessary, inevitable forces that will not go away. Don’t worry about the ethical concerns, she seems to suggest. Instead, given the inevitability of the market in this area, the only real issue is what kind of regulation, if any, do we want applied. The topic of regulation she only addresses briefly, and in her final chapter.
She in fact claims not to have any clear answers here. She does state her preference, a “light-handed regulatory regime” in which choice, information and costs are considered. She recognizes that there may be a dark side to an unchecked market, especially in some of the ‘yuk’ areas like human cloning, but she seems to think the market as a whole, with a little help from the government, will largely get things right.
Thus she is optimistic about both the science and economics of the reproductive revolution. Many others, of course, are worried about the brave new world implications of where all this is headed. Spar here and there acknowledges these concerns, but generally sees them as irrelevant or of no great consequence.
Thus this book achieves some useful ends, but not enough. It makes a good case for the financial interests involved in the fertility business, and shows how the various technologies have been interwoven with market concerns from early on. But the implications of this, and the bigger picture questions are just not dealt with here.
Again, it is the fait accompli approach she takes throughout that may bother readers. These technologies are here to stay, and there is nothing we can – or should – do about them, she insists. Yet many think we can and should do something. Germany, which has had very good reason to be skeptical about these new technologies, has led the way in many respects by simply banning or heavily regulating some of them.
Such an approach may not be the only one, nor the best, but it is an option that can be more seriously considered. Moreover, much of the dilemma of infertility is based on bad choices. For example, while natural or biological infertility will always affect a small percentage of men and women, much infertility can be prevented. Simply listening to our biological clocks is a good starting point. Putting off children in order to pursue a career is a lifestyle choice which has very real repercussions.
And many sexually transmitted diseases, often occasioned by promiscuity, lead to infertility. Abortion may as well. These are all preventable activities. Yet the book barely mentions them. But prevention is always better than cure, and instead of having tax-payers bail out the socially infertile, maybe we should stress, instead, ways to minimize infertility.
Of course such considerations are too controversial for many to even raise. Indeed, free marketers will be squirming at such remarks. But they are nonetheless part of the equation. Instead of just lamenting the fact that infertility will always be a problem (it is for some) and that it must always be treated (a questionable proposition), maybe a wider debate about what it means to be human, why life does not always give us what we want, and how the quest for perfection is often bound to disappoint, could be raised as well.
The traditional philosophical, spiritual and social issues are as much a part of this discussion as mere market concerns. So for a more inclusive and well-rounded discussion of these issues, the reader needs to go elsewhere. And even though his critiques are dismissed by Spar, the writings of Leon Kass would be an excellent place to begin.
But if the reader wants a simple overview and history of the new reproductive technologies, and their economic implications, this book is undoubtedly a good place to begin.