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 Seagal 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. Like it was torturing me somewhat. Because often it's just impossible to optimize moral life and it's exhausting and misery inducing to try. Seagull needed a way out.

So she decided to start an advice column, something she thought could help her with her own ethical dilemmas. Sigal's column is called Your Mileage 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 you know honesty versus kindness. Those are all good values, but what do you do when they conflict? I wanted to talk to Seagal 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 PGTA 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 can test 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-y 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 does a parent owe their child? What does a parent owe their child? Yeah. It's such a weighty question. What 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 like felt for this person. On the one hand, feeling pressured and feeling like, ugh, I don't want to over-medicalize everything. But on the other hand, like maybe I'm supposed to be over-medicalizing this. Like 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 like 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. Mazletov. Great. They are gonna create a profile for each of your embryos. They're gonna give you like a little chart and it's gonna say like embryo one, two, three, four, blah, blah, blah.

And for each embryo they're gonna say This one, 12% more risk of diabetes, but minus 13 risk of schizophrenia. Increased IQ potentially on the horizon, but ooh, higher risk of diabetes, right? So they're gonna 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 first 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. more new and controversial testing is called polygenic testing. Okay. And

That is something that tests for very complex conditions that are influenced by thousands of genes. So we're talking about like depression, breast cancer, but also Selecting for a taller kid 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 X, Y, Z 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 BRCA mutation that, you know, someone might end up getting breast cancer. That broadly speaking is gonna 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 two diabetes. You might hear 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 gonna 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 gonna 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. So I think it's like really important to understand it doesn't mean the embryo is not gonna get this thing, right? It means conditions are on a continuum. It's 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, you know, a BRAC a mutation 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. uh 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, you know, had cancer. It's like no, it just you don't want it, right? It's bad. 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 f I feel the same. I mean, I I have O C D and

I hate it. And then there are often times 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 I if someone gave me the magic wand and told me I could eliminate my stuff, like I would say no thanks. I don't wanna romanticize these conditions. Like, 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 gonna start fighting. Nu har vi med oss, Sandra. Du och familjen fick punkka på bilen innan egens hn fram till djurparken. Ja, det blev häng på erfirans rastplats istället. Ja. Vi fick ju se några äckorrar i alla fall. Ho i dess naturliga habitat och allt. Dagens hjälper lite, presenteras av Iff, som hjälper det mycket.

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Superbabies, baby geniuses 2. 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 the scientific issue. It has a bit of a funny name. It's called pleotropy. Okay. 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 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. One company, for example, Orchid, it charges$2,500 per screened embryo.

So if you test 10 embryos, that's gonna run you 25k. Right. So in the short term at least, that does raise the specter of entrenching some kind of caste system 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 savings onto 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 a pop.

That still raises what I would call the specter of implicit coercion. So I actually get more worried about this when it becomes cheaper. If it's cheap enough that, you know, Joe Schmo 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 at a massive professional and educational disadvantage. So that creates a a risk of implicit coercion, which I do think is is worrisome. Yeah. And from the perspective of the child, I don't know, unless your parent lies to you later on. You know, you're gonna 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 gonna be a girl. Ten years later, twenty years later, the kid says, Actually I'm trans and I you know, I don't identify as a girl.

And then they're gonna 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, ooh, 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 it is. Right. I worry like this is gonna create um 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. Yep. 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 gonna 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 and 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 a happy life, that are just like, you know, okay, someone has anxiety, someone has this, someone has that, there's there's pros and cons to it. That that is much more of an open question, I would say. So clearly there are arguments against this.

At the same time, I I don't want to make it seem like this is an obvious decision. Yeah, 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, Nora Sidiki, who heads up the company Orchid, 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. She'll say, What if you could have stopped it, but chose not to? I do find myself compelled by some of this. Yes. As someone who's about to be a parent. Yep. 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 Tay Sachs, which is this, you know, debilitating fatal disease. And 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 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 satisficing. 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 any one axis 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, satisficing in the context of like,

Thinking about the genetic lottery for your child means, yeah, let's prevent them from having debilitating things like Tay SACs. Cause 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 Adonist, right? Like that doesn't feel like satisfacing anymore. So so what did you tell the person who wrote in? I told them, look, I'm I am not gonna tell you like

You shouldn't do this kind of screening ever, right? I think it 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 preying on your worst fears and insecurities as a prospective 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 prospective 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.

Hm. What 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 into polygenic 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 societally come to think are like, oh, just screen out and nix 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. Yeah. 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 wanna say, Let's give my child the best chance at the best life. Yep.

Maybe being humble about what we think of as the best life. Yeah. And if we're overconfident in 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. Confused about it?

I don't wanna necessarily presume to know for my kid what's gonna be the most beautiful kind of life. If you want more advice on the Your mileage may vary advice column comes out twice a month and you can find a Or get it in your email info. Perfect newsletter.

This episode was produced and hosted by Noam Hassenfeld, 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 Salotarov. from Meredith Hotnot. Sound design from Christian Ayala, fact checking from Melissa Hirsch. Amy Padula is a very important thing. I'm Sally Helm and I jump in to record the credits when necessary. Bird Pinker told me was confused.

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