Judicature: The Clone Age --book review

Judicature Genes and Justice
The Growing Impact of the New Genetics on the Courts

November-December 1999 Vol 83(3)

No defined boundaries
book review by Dena S. Davis
The Clone Age: Adventures in the New World of Reproductive Technology, by Lori B. Andrews. Henry Holt and Co. 1999. 264 pages. $25.00
If reproductive technology is the Wild West of medicine, as Lori Andrews claims, then Andrews herself is surely Paladin, the hero of "Have Gun, Will Travel." Whether she is jetting off to Dubai to advise the government on cloning; litigating a challenge to an Illinois law passed to deter in vitro fertilization; or brazening her way past the customs agent in Miami, straight off a flight from Columbia with a container of blood samples and sperm that "absolutely cannot" be opened, Andrews is in the thick of the action. This account of her adventures is a quick read and an enthralling story that should engage and reward the neophyte and sophisticate alike.
Any reader who begins this book with a dewy-eyed view of selfless doctors helping infertile women and men to have "miracle children" will soon be disabused. Andrews presents us with few heroes, and most of her characters are downright money-grubbing, if not nefarious. Men come off much worse than women, but few people come off well. Her tale is largely one of carelessness, cynicism, and a focus on profit and scientific success for its own sake; the interests of the would-be parent or the baby itself are often so far in the background they hardly seem to surface at all. Andrews reminds us that it is harder to regulate reproductive technology than nuclear technology, and presents one "truism" learned from her career: "If it worked in just one animal, it will be tried in a woman."
Government employees appear no better than private researchers. Chapter 12, "Genetic Politics," is a particularly unflattering portrait of Francis Collins, head of the National Human Genome Research Institute—the folks who are spearheading the Human Genome Project together with the U.S. Department of Energy. According to Andrews, who took over from Nancy Wexler as chair of the working group set up to address difficult social issues such as genetic discrimination, the working group was deliberately torpedoed by Collins. After Andrews quit, she was told by James Watson, the famous geneticist and previous head of the Institute, that he had "wanted a group that would talk and talk and never get anything done."
As Andrews says, this book is primarily a memoir, and thus rather loosely organized. But simply by describing her own "adventures," Andrews touches on virtually all the interesting topics in reproductive technology. She describes the precipitous rise of multiple births engendered by infertility treatment, looks critically at the lack of concern for the grave risks this poses to mothers and babies alike, and remarks that, "Like the proverbial traveling salesman who impregnates the farmer's daughter, the infertility doctors who use technology to create superpregnancies seem untroubled by their results." She takes us on a rather nauseating tour of websites and other venues created to sell upmarket sperm and eggs to wealthy buyers, and introduces us to a purveyor of sperm from Nobel prize-winners and other geniuses (only Mensa women need apply).
Abused and maltreated
Andrews reminds us of all the ways—from negligence to deliberate malfeasance—that couples who use reproductive technology can be misused, abused, and maltreated. Sperm donation, for example, began in 1884 with a medical doctor inseminating a woman while she was anesthetized, without her knowledge or consent. A century later, Dr. Cecil Jacobson became mildly famous in Virginia for siring somewhere between 15 and 75 children with his own sperm, when he had told couples that he would be choosing sperm from anonymous donors matched to the husbands' characteristics. Worse yet, Jacobson gave some women hormones to convince them that they were pregnant, stringing then along for as much as 23 weeks with fake sonograms, only to tell them that they had "miscarried" and "absorbed" the babies into their bodies. Andrews points out that Jacobson was a respected clinician with a fine medical pedigree, and that, during his trial, many prominent people supported him and wrote letters on his behalf, including Senator Orrin Hatch.
Andrews' discussion of surrogacy is also filled with scary stories in which the children created through this process are in danger of being pulled apart by warring parents, or falling through the cracks with no parents at all. (Lawyers, it should be noted, are rarely more attractive than doctors in Andrews' universe.) Her chapter on posthumous reproduction, entitled "The Sperminator," is equally chilling in its portrait of reckless, self-serving doctors and grieving, impulsive families, rushing to "harvest" sperm from dead and comatose men without a firm notion of what those men would have wanted.
The most positive chapters in the book focus on genetic researchers doing fieldwork in Venezuela and Sardinia, two places with high concentrations of potentially lethal genes, in the first case for Huntington Disease and in the second for thalassemia. Andrews sketches some of the ethical ambiguities in this work, especially in Venezuela, where the research subjects lack the means even to obtain the basic medical care that we do know how to provide. She touches on some of the double standards that obtain between research in our own country and research with poor and uneducated people abroad. Nonetheless, the final portrait is of doctors and researchers honestly trying to help people faced with terrible tragedy, and of some actual good being done. In contrast, she is very wary of eugenic uses of genetic testing, and of increasingly more demanding "admissions standards" before children are welcomed into the world.
The book begins with the trip to Dubai, and the strangeness of that environment is Andrews' metaphor for her own work: no defined boundaries. And yet, Andrews does attempt to draw some lines. She begins and ends with the subject of human cloning, of which she disapproves. She worries that her largely successful legal efforts in the name of procreative liberty, on the part of women who wanted to use reproductive technology to conquer infertility, made her an unwitting champion of cloning as well. Perhaps she has done her work too well?
Roller-coaster of a read
This book is a great roller-coaster of a read, and one I will recommend to my law school library (and probably send to a couple of friends for Christmas). Andrews didn't write it as a sober treatise in ethics or law, and it would be wrong to compare it to her other work, which constitutes a large and impressive scholarly oevre. Nonetheless, precisely because this is the kind of work that will appeal to readers with little prior knowledge, I wish she had been a bit more careful to distinguish fact from opinion. For example, I disagree with Andrews' assertion that most (American?) scientists have now embraced the notion of human cloning, a shift that she said took "a matter of months." She may turn out to be right about this, but she doesn't present the evidence. I am more troubled by the way in which she sometimes presents hypothetical questions as if they were based on fact rather than speculation, a practice misleading to the unwary reader. (This habit may come from constructing too many law school exams.) It would be easy to believe, from one paragraph in her "Genetic Politics" chapter, that a gene had been discovered and pinpointed that definitively predicted sexual orientation, and that the Armed Services was seriously contemplating using that gene to decide who to kick out of the army.
Although Andrews' galloping style makes the book so much fun, I wish she had spent a little more time drawing connections between the facts she presents and the inferences she draws. A particularly irritating example: "There is speculation that Dolly's cells most likely are set to the genetic clock of the nucleus donor and therefore are comparable to those of her six-year-old progenitor, which could psychologically lead people to view cloned animals and humans as short-lived, disposable copies." Well, I know that the first part of that statement is true, i.e., that the speculation about Dolly's "genetic age" exists. But who has been wondering if that early aging problem would lead people to think of cloned humans as disposable copies, and what are their grounds for their concern? That seems like an enormous and unwarranted leap, and I'd like to see some of the steps filled in.

Dena S. Davis is an associate professor at Cleveland-Marshall College of Law.

The online presentation of this publication is a special feature of the Human Genome Project Information Web site.