To follow is an excerpt from the September 24, 2010 CQ Researcher report on "Impact of the Internet on Thinking" by Alan Greenblatt.
~~~~~~~~~~~~~~~~~~~~~~
The Pew Internet & American Life Project put a variation of Nicholas Carr's question 
— “Does Google make us stupid?” — to hundreds of technology experts. [Footnote 14] A majority disagreed with Carr's premise, but their ideas about how intelligence had been reshaped by the Internet ranged widely.
Some felt that people were freed up from rote tasks such as memorization of facts. That could end up meaning that we have to redefine what we mean by intelligence, as machines take up a greater share of the tasks once left to the human mind. Some stated their belief that the Internet had helped create a “hive brain” that allows people to share thoughts and come to collective solutions to complex problems together.
“There's a pretty broad feeling among lots of technology users that these tools can serve their needs in new ways,” says Lee Rainie, who directs the Pew project.
“You can gather up information quickly and easily, which might have taken you enormous amounts of time in an earlier age,” he says. “At the same time, people will moan and groan about the distractions that these devices bring into their lives.”
No one disputes that the Internet has made much more information readily available to just about anyone. “It's been a boon in that it gives access to all kinds of stuff that a crummy high-school library wouldn't have even come close to having,” says Robert Thompson, a professor of popular culture at Syracuse University.
But Thompson worries that the way Google filters information makes it potentially less useful, in certain respects. He jokes that good students will cite material from the third page of links that a Google search calls up, while bad students will not look past the first page.
“The problem is that so much of the stuff that would really be a boon is not used, because it's not on the first page of a Google search,” he says.
The narrowing of information — necessary given the glut that's now available — can cause problems even among serious researchers. Lehrer, the author of How We Decide, cites a study indicating that since scientific papers have been widely available online, fewer of them are being cited.
“Even though we have access to all sorts of information, we seem to be citing the same texts,” Lehrer says. “The Internet allows us to filter our world, to cherry-pick our facts. It's just human nature writ large.”
David Levy, a professor at the University of Washington's Information School, says that the rapid transmission and accumulation of knowledge made possible by technology is helpful, but he worries that information overload can have some ill effects.
Namely, he's concerned that the flood of information leaves people with no time to think. “There's another piece of the process of learning and growing and getting information further assimilated, and that's the time for contemplation,” he says. “We're just not allowing ourselves sufficiently the time to do deeper reflection.”
Paul Saffo, managing director for Discern Analytics, a Silicon Valley forecasting firm, says there's a case to be made that the Internet is helping to make individuals smarter. There have been studies showing that not just Web searches but also video games are good at stimulating and strengthening parts of the brain.
“Video games turn out to be amazing for the brain,” Lehrer says. “They're like doing pushups for the brain.”
But Saffo worries, too, that the Internet ethos of instant and ever-changing information can have its deleterious effects on society as a whole. “The collective impact of this technology causes more people to look at and concentrate on the immediate at the expense of the long-term,” he says.
This effect of everyone concentrating solely on the moment can lead to catastrophic mistakes and have an ill effect on democracy, Saffo suggests. “This is the dark side of the eternal present,” he says. “There's no capacity to step back and frame things in different ways. Anyone who dares think long-term will be taken down.”
In his Atlantic article and follow-up book The Shallows, Carr is careful to state that the Internet has been enormously beneficial in a number of ways. Critics of his book nevertheless contend that he has overstated the extent of the problems of concentration and deep thought created or exacerbated by technology.
Proportion of Recreational Computer Time Spent on Various Activities
To the extent that people skim, get distracted or fail to think deeply about the words and images flitting across their screens — well, people have always found ways to avoid thinking too deeply. Long before Twitter, there were television sitcoms, Lehrer points out. And long before people could waste time playing Minesweeper and Scrabble online, there were plenty of games made out of cardboard and plastic.
But Carr argues that the Internet is not simply a tool for distraction and time wasting. He says it affects how the brain processes information.
In his book, Carr cites studies showing that people reading short stories with hyperlinks embedded in them retain a good deal less of the content than people who read them on the printed page, because the need to make decisions about whether to click on the links keeps them from concentrating on the text at hand. [Footnote 15]
“Dozens of studies by psychologists, neurobiologists, educators and Web designers point to the same conclusion: When we go online, we enter an environment that promotes cursory reading, hurried and distracted thinking and superficial learning,” Carr writes in The Shallows.
“It's possible to think deeply while surfing the Net, just as it's possible to think shallowly while reading a book,” Carr continues, “but that's not the type of thinking that technology encourages and rewards.” [Footnote 16]
Getting used to technological distraction can cause problems in social settings, suggests Small, the UCLA psychiatrist.
“We have a generation of digital natives with very strong techno-skills and very strong neuro pathways for multitasking and experiencing partial continuous attention and other wonderful adaptive skills,” Small says. “But they're not developing the face-to-face human contact skills.”
There isn't strong data about this, Small says, but the idea that young people, especially, have more difficulty interacting with people in person when they are texting other people with near-constancy is evident all around us, he suggests.
“The Internet's not making us stupid or smarter — it's changing the way we're processing information,” Small says.
“You cannot stop the technology train,” he adds. “It's way out of the station, coming down the tracks. You have to adapt.”
The Issues:
*Is the Web changing the way we think?
*Does the Web shorten attention spans?
*Are people addicted to the Internet?
For more information see the CQ Researcher report on "Impact of the Internet on Thinking" [subscription required] or purchase the PDF
~~~~~~~~~~~~~~~~~~
Footnotes
[14] Janna Quitney Anderson and Lee Rainie, “Does Google Make Us Stupid?” Pew Internet & American Life Project, Feb. 19, 2010.
[15] Carr, op. cit., p. 127.
[16] Ibid., p. 115.
Does the Internet make us smarter?
Teen Birth Rates Dropped in 2008
By Marcia Clemmitt
A decade-and-a-half steep drop in the U.S. teen birth rate may have essentially hit bottom in 2005, with upticks in 2006 and 2007 representing only a statistical “bouncing around” of the rates rather than harbingers of a longer-term rise.
University of Pennsylvania Graduate School of Education professor Rebecca A. Maynard advanced that theory in our March 26 Researcher report on teen pregnancy, and new data from the Centers for Disease Control and Prevention (CDC) suggests she may be right. In 2008, teen births declined by 2 percent, the CDC reports. (http://www.cdc.gov/media/pressrel/2010/r100406.htm)
The 2008 drop doesn’t necessarily mean that the 2006-2007 birth-rate increase was a fluke, but it does suggest that it might be. Several more years of data will be needed before analysts really understand the current trends. The 2008 drop itself is undeniable good news, however.
Despite news on teen birth rates that’s been almost uniformly encouraging for two decades, Americans remain bitterly divided over what schools should teach students about sex, however.
For example, a law passed in Wisconsin in February with strong support from both Democratic and Republican state legislators directs school districts that have sex education programs to tell students how to use condoms and other contraceptives.
But one district attorney opposes contraceptive education and has put five school districts on notice that they must either disobey the new law or see their schools’ sex-ed teachers charged with criminal activity.
"Forcing our schools to instruct children on how to utilize contraceptives encourages our children to engage in sexual behavior, whether as a victim or an offender," Juneau County District Attorney Scott Southworth wrote to the schools last month. The law “promotes the sexualization – and sexual assault – of our children.” "If a teacher instructs any student aged 16 or younger how to utilize contraceptives under circumstances where the teacher knows the child is engaging in sexual activity with another child -- or even where the 'natural and probable consequences' of the teacher's instruction is to cause that child to engage in sexual intercourse with a child -- that teacher can be charged" with contributing to the delinquency of a minor, wrote Southworth.
Others accuse the DA of overreaching.
“Using condoms isn’t a crime for anyone,” said Rep. Kelda Helen Roys, D, who helped develop the new law.
State legislators generally agree that educating students about both the value of abstaining from sex and the proper usage of condoms and other contraceptives is the most effective means of encouraging responsible behavior and preventing teen pregnancies and sexually transmitted diseases, Roy said. (http://www.jsonline.com/news/statepolitics/90020507.html)
Are abstinence-only sex-education programs ineffective?
To follow is an excerpt from the CQ Researcher on "Teen Pregnancy" by Marcia Clemmitt, March 26, 2010
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Over the past few years, the first large-scale,
federally funded analyses of abstinence-only sex-ed programs have emerged, and by and large the news has been complex and not terribly encouraging.
Studies overwhelmingly have found little or no evidence that abstinence-only courses change teen sexual behavior in ways that would avert pregnancies or the spread of STDs. But abstinence-education supporters say most studies take a too-narrow view of what constitutes reliable evidence. Some research, they say, has found good effects from abstinence-only programs.
Weed said his analyses found that abstinence programs used in several states substantially decrease the number of students who began having sex within a year after completing the course. In one Virginia district, nine percent of students began having intercourse a year after they finished the abstinence program that Weed studied, compared to an average of 16.4 percent of students in that district who would have been expected to initiate sex by that age, for example. [Footnote 19]
Of the many analysts who commented on their research to the CDC task force, two found “serious limitations” in the panel's conclusions about abstinence-only programs. Notably, the panel unfairly ignored findings that abstinence programs reduce teens' sexual activity because the results didn't come from randomized control trials, wrote Irene Ericksen, a researcher at the Institute for Research and Evaluation, and Danielle Ruedt, a public-health programs coordinator in the Governor's Office for Children and Families in Georgia. And the panel's report also implied that sex ed focusing on contraceptive information “is a superior approach,” a conclusion they said was “not supported by the evidence” examined by the task force. [Footnote 20] Earlier this year, a randomized control study for the first time showed significant positive results for an abstinence-focused program, according to research led by the University of Pennsylvania's Jemmott. He found that a specific abstinence-only program helped delay the first sexual experience for a group of mostly 12-year-old African-American students in urban schools. Only about a third of the program participants began having sex within the next two years, compared to 42 percent of those who attended a safe-sex program. [Footnote 21]
“This is a rigorous study that means we can now say that it's possible for an abstinence-only intervention to be effective,” said Jemmott. [Footnote 22]“We now have, for the first time, news that an abstinence intervention can help,” says Albert, of the National Campaign to Prevent Teen and Unplanned Pregnancy. “This course did take an approach that is different” from more traditional abstinence-only programs, he explains. “It did honestly answer questions about contraception, and it did not say ‘delay until marriage.’” Perhaps because of that difference, it “did not reduce condom use.”
Rebecca A. Maynard, a professor of education and social policy at the University of Pennsylvania Graduate School of Education, says the main takeaway from all the recent studies should be that, generally speaking, “abstinence education does no better and no worse than comprehensive” sex education. In fact, neither has been shown to strongly affect teens' behavior, she concludes.
The Mathematica study, for example, showed that “abstinence-only education didn't hurt kids,” she says, while comprehensive sex-ed proponents had long argued that it would, by decreasing condom use. But abstinence-only sex ed also wasn't “the solution to the problem.” In essence, she says, the body of research now available shows “no significant difference” between abstinence-only and abstinence-plus (comprehensive sex education) programs.
That's not surprising, she explains. The content of most abstinence-only programs “overlaps greatly with abstinence-plus” programs. The best courses of both varieties “all have a core of things about values, peer pressure and good decision-making,” while they “diverge only in saying ‘you may not ever’ [in the case of abstinence-only courses] or ‘you may not want to’ [in abstinence-plus].”
Critics' complaints about both kinds of courses are largely caricatures. “Very, very few curricula say, ‘God will strike you dead if you have sex,’ or, on the abstinence-plus side, “‘Just go have fun, and don't think about the consequences,’” Maynard says.
*Comprehensive sex-education — the alternative to abstinence-only curricula and sometimes called abstinence-plus or comprehensive risk reduction — recommends delaying sex but focuses strongly on informing students about condom use and contraception.
The Issues:*Are abstinence-only sex-education programs ineffective?
*Will Obama's plan to fund only evidence-based sex-ed programs work?
*Does teen parenthood lead to a lifetime of hardship?
For more information see the CQ Researcher report on "Teen Pregnancy" [subscription required] or purchase the CQ Researcher PDF.
Footnotes:
[15] Christopher Trenholm, et al., “Impacts of Four Title V, Section 510 Abstinence Education Programs,” Mathematica Policy Research Inc., April 2007, .
[16] Quoted in Daniel J. DeNoon, “Expert Panel Rejects Abstinence-Only Sex Ed,” WebMD Health News online, Nov. 6, 2009. The Task Force report has not yet been formally released by the Centers for Disease Control and Prevention.
[17] Quoted in ibid.
[18] Quoted in “Hearing on Domestic Abstinence-only Programs: Assessing the Evidence,” transcript, House Committee on Oversight and Government Reform, April 23, 2008.
[19] Quoted in ibid.
[20] Irene Ericksen and Danielle Ruedt, “A Minority Report: Fundamental Concerns About the CDC Meta-Analysis of Group-based Interventions to Prevent Adolescent Pregnancy, HIV, and Other STIs,” Nov. 18, 2009.
[21] For background, see Lewin, “Quick Response to Study of Abstinence Education,” op. cit.
[22] Quoted in ibid.
Is youth violence on the upswing?
To follow is an excerpt from the CQ Researcher issue on "Youth Violence" by Thomas J. Billitteri, March 5, 2010:
To read the news in recent months it would be easy to think the nation is in the grip of a new youth crime wave. In Patchogue, on Long Island, seven teens were charged in a fatal assault on an 
Ecuadorian immigrant, and prosecutors alleged a pattern of teen violence against Hispanics in the area. [Footnote 15] In Texas, two young men, 19 and 21, were charged with a church fire, and authorities said they may face charges in nine others. [Footnote 16]
But Barry Krisberg, former president of the National Council on Crime and Delinquency and now a distinguished senior fellow at the University of California, Berkeley, law school, says youth crime “is way down from the peak in the middle 1990s.” Since then, he adds, “it leveled off a little bit, and the latest numbers suggest it's down again. There's hardly a surge of it at any level.”
In testimony last year to a congressional hearing, Krisberg said much of the public's perception of rising youth crime is based on the way news outlets report on crime.
A study conducted in Dallas, Washington, D.C., and San Mateo County, Calif., found that the media consistently reported increases in juvenile crime — if they were short-term increases — but not crime decreases, he said. In addition, Krisberg said, the media consistently attributed most of the violence problems to youth whereas most violence was committed by young adults. And, he said, the media often failed to offer context: “They don't do a good job of answering the ‘why’ questions.” [Footnote 17]
The relentless airing of incidents over the Internet has only heightened the public's view that youth crime is surging.
Still, in some cities, and in some neighborhoods, perception and reality can be one.
“These [aggregate crime] data are numbers from all over the country put into a blender, and in some communities the levels are very low, and in other communities they are crazy high,” says Melissa Sickmund, chief of systems research at the National Center for Juvenile Justice. “You can't go into a community that's experiencing a real problem in their world, on their streets, with their kids ending up dead or their kids ending up behind bars because they committed these crimes, and tell them nationally stuff is down, it's not a problem.”
In Pittsburgh, an informal survey of students ages 9 to 18 in urban neighborhoods found that almost 80 percent have had family members or friends wounded or killed by gun violence. [Footnote 18] In South Philadelphia, parents, teachers and activists testified recently at a public hearing on school violence in the wake of several highly publicized incidents, including the fatal shooting of a high school football star.[Footnote 19]
Jeffrey Butts, a criminologist who this spring will become executive director of the Criminal Justice Research and Evaluation Center at the John Jay College of Criminal Justice, points out that while aggregate youth crime has not been going up nationally, it can seem that way. Crime, he says, is “very local,” meaning crime rates may vary among neighborhoods a few blocks from each other.
“If you're living in a poor, disadvantaged neighborhood with no infrastructure and lots of gang activity, it can seem that [crime] has gotten lots worse in the last couple of years,” he says. Criminologists are only now developing reliable techniques to measure crime trends at the neighborhood level, he says.
Butts says violent youth crime generally has been fluctuating in a narrow range near what may turn out to be the bottom of a trough formed over the last dozen or so years. While youth crime is “not going up” he says, “I can't imagine it will go down a whole lot more, especially given what's going on in the economy.”
Whatever the direction of overall trends, youth violence continues to plague pockets of many big cities, with minorities often the heaviest victims. “There remains an extraordinary and unconscionable persistent problem of extremely high violent criminal victimization,” says Kennedy of John Jay College. “This is peer-on-peer stuff…. It's extremely densely concentrated among young black men in particular neighborhoods.”
The crime is typically perpetrated by what Kennedy calls “a very small population of high-rate offenders involved in high-rate-offending groups like gangs, drug crews, neighborhood sets, and so on…. Most of the serious violent crime in these communities is perpetrated by members of these standout groups.”
In Cincinnati, where an Operation Ceasefire program is under way, “there are about 60 of these identifiable offending groups, and they have a totality of about 1,500 people in them,” Kennedy says. “They are associated — as victims, offenders or both — with 75 percent of all the killings in Cincinnati. Those identified by name — and therefore open to criminal-history background checks — average 35 prior charges apiece.” Still, Kennedy points out, those 1,500 and all the groups associated with the killings represent a tiny fraction of the metro area's overall population.
Fox, the Northeastern University criminologist, says that in updating his study on homicides and gun killings among black youth, he found an improvement in the latest data, for 2008. Still, he says, “I don't think it changes the overall argument and overall findings that this plummeting crime rate we've been seeing in this country is not across the board and that we still have rates among certain segments, particularly young black males, that remain elevated.
“These things can vacillate from year to year. Unless we see these numbers go down for several more years, I'm still very concerned about what's happening among some Americans in some cities. And I'm concerned that there's very little attention paid toward it because overall things are better.”
The Issues
- Is youth violence on the upswing?
- Are minority youths singled out for arrest and detention?
- Are “get tough” policies the best approach for fighting youth crime?
For more information see the CQ Researcher report on "Youth Violence" [subscription required] or purchase the CQ Researcher PDF.
Footnotes:
[15] Anne Barnard, “Youth Charged With More Attacks on Latinos,” The New York Times, Jan. 29, 2009, www.nytimes.com/2009/01/29/nyregion/29patchogue.html.
[16] Derrick Henry, “2 Men Charged in Texas Church Fire,” The New York Times, Feb. 21, 2010, www.nytimes.com/2010/02/22/us/22webchurch.html?ref=us.
[17] Testimony before House Judiciary Subcommittee on Crime, Terrorism and Homeland Security, Feb. 11, 2009, http://judiciary.house.gov/hearings/hear_090211.html.
[18] Sally Kalson, “Survey finds gun violence affects youth,” Pittsburgh Post-Gazette, Jan. 20, 2010, www.post-gazette.com/pg/10020/1029497-53.stm. The written survey of 455 students was a project of the Metro-Urban Institute of the Pittsburgh Theological Seminary and several other organizations.
[19] Dafney Tales, “Violence has students attending in fear,” Philadelphia Daily News, Jan. 29, 2010.
Excerpt from the "Gays in the Military" report
Below is an excerpt from the "Current Situation" section of this week's CQ Researcher report on "Gays in the Military" by Peter Katel, September 18, 2009
~~~~~~~~~~~~~~~~
Current Situation
Advocates of allowing gays to serve in the military may agree on the ultimate goal — but not on how to reach it. President Obama, for instance, wants Congress to repeal the 1993 law banning homosexuality in the armed forces. Congress passed the law, so Congress must undo it, he reasons.
But gay-ban opponents at the University of California's Palm Center say the congressional route is a dead end, at least for now.
“We don't think there is any chance of getting legislation through Congress any time soon,” says Aaron Belkin, the center's director. “The issue in Congress is completely stalled.”
Instead, he and five colleagues argued in a paper last May, the president should use authority granted him by the so-called “stop loss” law to halt sexuality-based discharges of military personnel. As the Palm Center team analyzes the law and related statutes, the president is authorized to prevent discharges during periods of national emergency if it is found that keeping personnel from leaving is essential to national security. [Footnote 59] The liberal Center for American Progress advocates the same strategy.
Such a move, Belkin says, would show opponents that allowing gays and lesbians to remain in the ranks does no harm. With that result established, he says, “Politically and operationally, it would be extremely difficult to get this toothpaste back in the tube.”
Remaking military policy by executive fiat would eventually make congressional action easier, not harder, he argues, although repealing the law would be necessary eventually. “It doesn't take any political capital to sign an order because the issue is polling at 75 percent in favor,” he says, citing recent surveys. [Footnote 60]
Ban supporter Donnelly at the Center on Military Readiness says bypassing the political process would be “outrageous,” and an admission of desperation. “I don't think the president is politically unwise enough to do something like that.”
The Palm Center also sees the proposed move as a way of short-circuiting Pentagon opposition, she notes. Indeed, a follow-up paper by the center said: “The legislative process would open a can of worms by allowing military leaders to testify at hearings and forge alliances with opponents on the Hill. A swift executive order would eliminate opportunities for them to resist.”[Footnote 61]
The Washington-based Servicemembers Legal Defense Network, however, views congressional action as the only practical approach — and one with excellent prospects. “We're looking at the next 12 months for repeal,” says Kevin Nix, the network's communications director. That time frame would put the matter before the Democratic-controlled 111th Congress, which runs through 2010.
Congressional-strategy advocates say hearings expected later this year will create new legislative momentum by providing a national forum for evidence of the practical and moral benefits of opening the armed forces to gays.
By early September, however, no dates had been set for the hearings. On the House side, an aide to Armed Services Committee Chairman Ike Skelton, D-Mo., said the panel is unlikely to take up the issue until a new under secretary for personnel and readiness has been allowed to settle into the position. The Senate Armed Services Committee hasn't set a date either. Chairman Carl Levin, D-Mich., has said he would hold a hearing in the fall.
“We firmly believe that repeal can get done in this Congress,” Nix says.
Footnotes
[59] Aaron Belkin, et al., “How to End ‘Don't Ask, Don't Tell’: A Roadmap of Political, Legal, Regulatory, and Organizational Steps to Equal Treatment,” Palm Center, May, 2009, www.palmcenter.org/files/active/0/Executive-Order-on-Gay-Troops-final.pdf. For background on stop-loss, see Pamela M. Prah, “Draft Debates,” CQ Researcher, Aug. 19, 2005, pp. 661–684. Lawrence J. Korb, et al., “Ending ‘Don't Ask, Don't Tell’: Practical Steps to Repeal the Ban on Openly Gay Men and Women in the U.S. Military,” Center for American Progress, June 2009, .
[60] Morales, op. cit.
[61] Aaron Belkin, “Self-Inflicted Wound: How and Why Gays Give the White House a Free Pass on ‘Don't Ask, Don't Tell,’” Palm Center, July 27, 2009.
~~~~~~~~~~~
To view the entire report, login to CQ Researcher Online [subscription required], or purchase the CQ Researcher PDF
Gays in the Military
Should the ban on homosexuals be lifted?
By Peter Katel, September 18, 2009
Political passions over the ban on open homosexuality in the U.S. military are stirring again. A new legislative fight on the issue may be headed for House and Senate hearings as early as this fall. 
Iraq War veteran Rep. Patrick J. Murphy, D-Pa., is proposing legislation to end sexuality-based discrimination in the armed forces. Under the “don't ask, don't tell” policy, gays and lesbians are barred from military service unless their orientation stays hidden. The policy was designed as a compromise to a 1993 call to lift the ban. Supporters of the policy say dropping it would degrade the “unit cohesion” that is critical to battlefield effectiveness. But Murphy and some other recent vets argue that most of today's warriors don't care about their comrades' sexuality. In another element of political drama, some gay political activists are questioning President Barack Obama's level of commitment to pushing for repeal, as he has promised to do.
The Issues
- Can military units function effectively with openly homosexual members?
- Is the “don't ask, don't tell” approach to differentiating sexual “orientation” from conduct a viable compromise?
- Should the United States follow other countries' examples and allow gays to serve openly in the military?
Overview of the report on "Reproductive Ethics"
By Marcia Clemmitt, May 15, 2009
After 33-year-old Nadya Suleman, a mother of six, gave birth to octuplets on Jan. 26, the California fertility specialist who treated her was summoned to appear before the Medical Board of California. The board — which can revoke physicians' licenses for egregious misconduct — is investigating whether Michael Kamrava, head of the West Coast IVF Clinic in Beverly Hills, violated accepted standards of medical practice when he implanted at least six embryos in Suleman during in vitro fertilization (IVF) treatment in 2008, leading to the multiple birth.
Suleman has told reporters that all 14 of her children were conceived using IVF — a high-tech treatment in which eggs are fertilized in the laboratory, then implanted into a woman's uterus for gestation — and that six embryos were implanted in each of her six pregnancies, although she's had only two multiple births: the octuplets and a set of twins.
But professional guidelines from the American Society for Reproductive Medicine recommend implanting only one or two embryos in younger women, such as Suleman, because of the high risk multiple births pose to children and mothers.
Multiple-birth babies, including twins, have a significantly higher risk for developing severe, debilitating disabilities such as chronic lung diseases or cerebral palsy, which occurs six times more often among twins and 20 times more often in triplets than it does in single babies.
The cost to the health-care system of multiple births is enormous. “The cost of caring for the octuplets would probably cover more than a year of providing IVF for everyone in L.A. County who needed it,” says David L. Keefe, professor of obstetrics and gynecology at the University of South Florida, in Tampa. “The likelihood that some of those kids will get cerebral palsy means they'll need a lifetime of care.”
The high-profile Suleman case has spurred calls for government regulation of fertility medicine — sometimes called assisted reproductive technologies, or ART. Like U.S. medicine generally, ART is not regulated by the federal government and only lightly supervised by state agencies. Since 1978 — when the world's first IVF baby, Louise Brown, was born in England — more than 3 million ART babies have been born worldwide, and some experts and ethicists fear the field's rapid expansion leaves too much room for abuses.
Others argue that lack of insurance coverage for IVF is the biggest problem with ART in the United States. Fertility treatments can cost more than $12,000 per cycle, pushing cash-strapped would-be parents to opt for the higher-risk, multiple-embryo implantation to increase their chances of a pregnancy.
By contrast, in most European countries — where IVF procedures are paid for through universal health-care systems — doctors generally implant only one fertilized embryo at a time. In Sweden and Finland, for instance, where the procedure is covered by insurance, doctors perform single-embryo implantations 70 percent and 60 percent of the time, respectively, compared to only 3.3 percent of the time in the United States.
In fact, some European governments prohibit multiple-embryo transfers for women under 36 and limit older women to no more than two embryos per cycle. As a result, “Triplets have virtually disappeared in Europe,” a Danish doctor told European colleagues at a 2006 fertility conference.
Self-regulation of ART in the United States clearly isn't working, said Marcy Darnovsky, associate executive director of the Oakland, Calif.-based Center for Genetics and Society, which advocates for responsible use of genetic technologies. According to the federal Centers for Disease Control and Prevention (CDC), to which ART clinics must report data, 80 percent of programs do not strictly follow American Society for Reproductive Medicine guidelines, making government regulation “long overdue,” she said.
“In reproductive matters, individuals are making decisions [that affect] not just themselves, but . . . others as well,” which makes regulation appropriate, said Johns Hopkins University scholars Franco Furger and Francis Fukuyama. Reproductive medicine is headed toward giving prospective parents “a range of . . . techniques to make specific choices about a baby's health and sex and eventually about other attributes,” said Furger, a research professor, and Fukuyama, a professor of international political economy, both at the Paul H. Nitze School of Advanced International Studies in Washington, D.C. “It would be misguided to take a wait-and-see attitude.”
Industrialized countries that pay for IVF through their universal health-care systems strictly regulate which services may be provided, says Susannah Baruch, director for law and policy at the Genetics & Public Policy Center, a think tank at John Hopkins funded by the Pew Charitable Trusts. The services typically include pre-implantation genetic diagnosis (PGD) — genetic testing of embryos. While PGD to detect serious genetic illnesses is conducted routinely, many countries strictly limit other PGD uses, such as selecting a child's gender, because they aren't considered in the public interest, she says.
However, in the United States — even though U.S. reproductive-medicine experts roundly criticize Kamrava's implantation of multiple embryos in the Suleman case — many ART experts also argue that government regulation of the industry is not necessarily a solution.
Suleman's case is much more of an outlier today than it would have been 15 years ago, when it wasn't unusual to have six embryos transferred, says Josephine Johnston, a research scholar at the Hastings Center for bioethics research in Garrison, N.Y. “I would have bet money that it was not IVF” that led to the octuplet birth, she says, but the use of ovary-stimulating drugs — a much cheaper, far less controllable method of assisted reproductive technology.
Multiple-embryo implantation is being phased out as ART technologies improve, Johnston says, and six-embryo implantation is “so far outside the guidelines it's amazing that a physician would do it.”
Such hair-raising cases are virtually always outliers and shouldn't be used to hastily enact laws, some analysts say.
For example, ever since artificial insemination was introduced sperm banks have promised would-be parents a genetic lineage of intelligence, athleticism and good looks for babies born from donor sperm, says R. Alta Charo, a professor of law and bioethics at the University of Wisconsin Law School. But “it hasn't undermined Western culture as we know it,” she says. “So why do we think that people are very likely to go through much more onerous PGD to choose traits?” Very few will try to use it to enhance their baby's intelligence or appearance, so there would be little point in prohibiting such behavior, she says.
A recent study by New York University's Langone Medical Center supports Charo's view somewhat. Of 999 patients who completed a survey on traits they thought warranted use of PGD screening, solid majorities named potential conditions such as mental retardation, blindness, deafness, heart disease and cancer. Only 10 percent said they might use PGD to choose a child with exceptional athletic ability and 12.6 percent, high intelligence.
“People are after different things” in calling for ART regulation, making legislation difficult, Charo says. Some may want limits on the number of embryos implanted per cycle, but most are calling for rules to enforce “personal morality,” such as whether gay couples should become parents or whether lower-income mothers should be allowed to have very large families, Charo says. “We must then ask why we would regulate these [reproductive] personal choices differently from other personal choices.”
ART-related law would likely be based on the unusual cases that make headlines, “and bad cases make bad policy,” she says.
Opposition to regulation might drop considerably if insurance covered IVF and other artificial reproduction procedures, but today only 12 states require such coverage.
For instance, limitations on multiple-embryo implantations might be acceptable if insurance covered several single-embryo implantations for all patients who have experienced six months of proven infertility, suggests Ronald M. Green, a professor of ethics and human values at Dartmouth College.
Because of the high cost of IVF treatments, the lack of insurance coverage has deprived “the vast majority of the middle class” in America, as well as the poor, from the modern ART “revolution,” says Keefe at the University of South Florida. “Once you have the middle class covered, then I have no trouble saying, 'We're not going to pay' ” for multiple-embryo implantation.
Furthermore, the procedure doesn't have to cost $12,000 per cycle, as evidenced by the lower amounts accepted by IVF clinics when insurance companies that are required to cover the procedure negotiate lower fees, he says. “It's a lot cheaper [for society] to pay for IVF at $3,000 or $4,000 per procedure and deliver only singletons,” thus avoiding the harrowing medical problems and high costs associated with multiple births, he says.
Mandating coverage not only reduces the number of multiple births but also increases access for the middle class. “I practiced in Massachusetts and Rhode Island [which require coverage], where sheet-metal workers and heiresses from Newport” mingled at IVF clinics because insurance picked up the tab, Keefe says.
However, not all fertility doctors would opt into a fully insured system, says Dawn Gannon, director of professional outreach for RESOLVE, the National Infertility Association, which advocates that insurance companies treat infertility like any other medical condition. For example, when New Jersey mandated coverage, in 2001, “some clinics didn't take insurance at all, and some started taking it and then stopped,” she says, because “they got less money per procedure.”
If the United States enacts universal health-care coverage, advocates for the infertile hope ART will be covered as it is in other industrialized countries.
But universal coverage would still leave thorny issues unsettled, such as whether taxpayer subsidies should support ART for unmarried women or women over 40. For older women, the debate centers on whether it is appropriate for health insurance to subsidize an infertility problem that is the result of natural aging and not the result of a medical condition. Also, pregnancy is riskier for both the older mother and the child.
Earlier in IVF's history, many clinicians routinely refused ART to single women, older women, lesbians and, in some cases, poor people. A 1993 survey of Finnish ART clinics found that many doctors “preferred not to treat either lesbian or single women,” arguing that they “wanted to protect children from having inappropriate parents, primarily 'bad mothers,' ” according to Maili Malin, a medical sociologist at Finland's National Institute of Public Health. A single woman's marital status and “wish to have a child” were both “considered indications of . . . questionable mental health.”
Whatever the outcome, the coverage debate will generate intense emotion. “So much of your life feels out of control when you want a child but find that you can't have one,” says Jan Elman Stout, a clinical psychologist in Chicago. “This is often the very first challenge that people encounter in their lives that, no matter how hard they work at it, it may not work out for them.”
The Issues:
- Should fertility medicine be regulated more vigorously?
- Should parents be allowed to choose their babies' characteristics, such as gender?
- Should doctors be able to refuse assisted reproductive technologies (ART) services to gay, older or single people?
To view the entire report, login to CQ Researcher Online [subscription required], or purchase the CQ Researcher PDF.
