Superbabies?

Parents are supposed to provide the best life possible for their kids, right? But what does that mean when genetic testing for the baby enters the picture? And how far should they go? Vox senior reporter Sigal Samuel received that ethically ambiguous question for her advice column Your Mileage May Vary from a parent-to-be, and in this episode walks Noam through her thinking using a philosophical framework. For show transcripts, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unxtranscripts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unexplainable⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ And please email us! ⁠⁠⁠[email protected]⁠⁠⁠ We read every email. Support Unexplainable (and get ad-free episodes) by becoming a Vox Member today: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/members⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Thank you! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Noam Hassenfeld?

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• 0:37Speaker 01

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• 1:23Speaker 02

  I am someone who is a little bit obsessed with always trying to do the right thing.

• 1:29Noam Hassenfeld?

  That's Vox reporter Sigal Samuel.

• 1:32Speaker 02

  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.

• 1:52Noam Hassenfeld?

  Sigal 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.

• 2:13Speaker 02

  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 honesty versus kindness. Those are all good values, but what do you do when they conflict?

• 2:38Noam Hassenfeld?

  I wanted to talk to Sigal 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.

• 3:07Speaker 02

  So this is the question from a reader.

• 3:11Speaker 02

  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's 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 eugenicy to do so much tinkering with embryos, and

• 3:56Speaker 02

  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?

• 4:15Noam Hassenfeld?

  What does a parent owe their child?

• 4:17Speaker 02

  Yeah.

• 4:18Noam Hassenfeld?

  It's such a weighty question. What did you first think when you read this?

• 4:22Speaker 02

  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?"

• 4:30Noam Hassenfeld?

  Yeah.

• 4:30Speaker 02

  Really, that's the moral optimization thing that I've struggled with for years. 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, oh, 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

• 5:14Speaker 02

  even out in the world yet, but already you're a bad parent somehow.

• 5:21Noam Hassenfeld?

  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?

• 5:30Speaker 02

  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. Mazel tov. Great. They are going to create a profile for each of your embryos. They're going to give you, like, a little chart and it's going to say, like, embryo 1, 2, 3, 4, blah, blah, blah. And for each embryo, they're going to 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 going to give you that profile for each of the embryos.

• 6:04Noam Hassenfeld?

  And what do we know about the tests? Like, how do they actually work?

• 6:08Speaker 02

  Okay, so we should differentiate between a couple of different kinds of tests, right?

• 6:12Noam Hassenfeld?

  Okay.

• 6:13Speaker 02

  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. The more new and controversial testing is called polygenic testing.

• 6:32Noam Hassenfeld?

  Okay.

• 6:32Speaker 02

  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.

• 6:48Noam Hassenfeld?

  And stuff like IQ and depression, are these based on genetic markers?

• 6:54Speaker 02

  So there is, for depression, a strong genetic component. IQ also has a strong genetic component.

• 7:03Speaker 02

  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.

• 7:37Noam Hassenfeld?

  And how accurate are they?

• 7:39Speaker 02

  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 going to be more accurate than psychiatric conditions, which these polygenic tests tend to not perform as well on. These are conditions that are influenced by multiple genes. So it's not like you turn on this one gene, boom, we know it has X effect.

• 8:09Noam Hassenfeld?

  Right.

• 8:10Speaker 02

  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 2 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%.

• 8:32Noam Hassenfeld?

  Yeah.

• 8:33Speaker 02

  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 prediabetes, or they're going to 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 going to develop it. But it's not like a bill of perfect health that the customer might be imagining when they hear these claims.

• 9:05Noam Hassenfeld?

  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.

• 9:18Speaker 02

  Yeah, I think the statistical claims here are very confusing, even for experts, never mind laypeople. 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 prediabetic, 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.

• 9:51Noam Hassenfeld?

  Yeah, it feels like diabetes or, you know, a BRCA 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 diffuse and maybe more socially culturally related.

• 10:16Speaker 02

  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?

• 10:24Noam Hassenfeld?

  It's bad.

• 10:25Speaker 02

  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.

• 10:59Noam Hassenfeld?

  Yeah, I feel the same. I mean, I have OCD 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.

• 11:31Speaker 02

  Yeah, same. Like, if someone gave me the magic wand and told me I could eliminate my stuff, like, I would say no thanks. I don't want to 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.

• 11:54Noam Hassenfeld?

  Coming up in a minute, what should the parent do?

• 11:57Speaker 02

  Yeah, I mean, that's where it gets really complicated and hard. And this is where a lot of people are gonna start fighting.

• 12:08Noam Hassenfeld?

  Support for the show comes from Sonos. Hey, Sonos, give me some music.

• 12:15Noam Hassenfeld?

  All right, one of life's great mysteries. You're listening to music in the living room, but you gotta grab something from the kitchen. You don't want to take the speaker with you, but you also don't want to miss that beat drop. And this is where I introduce you to the magic of Sonos. Sonos sent me a couple speakers to try out, so I've got to move two here in the living room. And then I walk down the hall.

• 12:40Noam Hassenfeld?

  I get in here to the kitchen, and I got a brand-new Sonos Play right here on the counter. I can open the fridge, grab a seltzer.

• 12:57Noam Hassenfeld?

  And yeah, I didn't miss a second. And I can make each speaker louder or softer in the Sonos app, or if I'm using AirPlay, so I can make it louder in the kitchen without blasting whoever is still in the living room. It's all just easy, and it sounds amazing. These speakers are crisp, they've got great bass, and I'm especially impressed with the new Sonos Play. It packs this, like, truly awesome sound in a much smaller size. So, I don't know, if I want to

• 13:30Noam Hassenfeld?

  head outside for a minute.

• 13:33Noam Hassenfeld?

  It's super easy, and yeah, pretty nice out. Visit sonos.com and build your system. Sonos, love the sound, feel the system.

• 13:48Speaker 03

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• 15:13Speaker 01

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• 16:07Noam Hassenfeld?

  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?

• 16:17Speaker 02

  Yeah, so I think the first thing is a scientific issue. It has a bit of a funny name. It's called pleiotropy.

• 16:22Noam Hassenfeld?

  Okay.

• 16:23Speaker 02

  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.

• 17:01Noam Hassenfeld?

  I also wonder how much this stuff costs. Like, would this only be available to rich people?

• 17:07Speaker 02

  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 going to run you 25K.

• 17:19Noam Hassenfeld?

  Right.

• 17:20Speaker 02

  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.

• 17:35Noam Hassenfeld?

  And there might just be kind of pressure on people with less money to spend their life savings onto things like this.

• 17:42Speaker 02

  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 bucks a pop. But 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 risk of implicit coercion, which I do think is worrisome.

• 18:27Noam Hassenfeld?

  Yeah.

• 18:28Speaker 02

  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.

• 18:38Noam Hassenfeld?

  Yeah.

• 18:39Speaker 02

  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? 10 years later, 20 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."

• 19:16Noam Hassenfeld?

  Yeah.

• 19:16Speaker 02

  And they're, they might feel like, "Ooh, I extra feel like a disappointment to you now."

• 19:21Noam Hassenfeld?

  Yeah, I mean, kids have to deal with enough disappointing their parents all the time, as it is.

• 19:24Speaker 02

  Right, right. I worry, like, this is gonna create a lot of therapy sessions on, like,

• 19:29Noam Hassenfeld?

  Yeah.

• 19:29Speaker 02

  topics we haven't had to deal with before.

• 19:31Noam Hassenfeld?

  Okay, and then I think, kind of like hovering over this whole conversation is the idea of eugenics.

• 19:37Speaker 02

  Yep.

• 19:38Noam Hassenfeld?

  Is there a concern about removing certain types of, like, just real?

• 19:45Speaker 02

  Human experience?

• 19:46Noam Hassenfeld?

  Yeah, removing human experience from the equation.

• 19:50Speaker 02

  I think absolutely. I think, you know, this is sort of like the...

• 19:55Speaker 02

  Extension of a problem that already exists, you know, in terms of, let's say, conditions like Down's 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 going to 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.

• 20:40Speaker 02

  That, that is much more of an open question, I would say.

• 20:44Noam Hassenfeld?

  So clearly there are arguments against this. At the same time, I don't want to make it seem like this is an obvious decision.

• 20:50Speaker 02

  Yeah.

• 20:50Noam Hassenfeld?

  You clearly don't think this is an obvious decision. What are the arguments in favor of selecting for babies?

• 20:56Speaker 02

  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 Savalescu, 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 Siddiqui, who heads up the company Orchid, one of the polygenic testing companies, she talks a lot about like protecting your kids

• 21:37Speaker 02

  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?

• 21:48Noam Hassenfeld?

  I do find myself compelled by some of this.

• 21:51Speaker 02

  Yes.

• 21:52Noam Hassenfeld?

  As someone who's about to be a parent.

• 21:53Speaker 02

  Yep.

• 21:53Noam Hassenfeld?

  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 TESAC, 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?

• 22:32Speaker 02

  I go back to Herbert Simon, who is a Nobel laureate in economics and in a way, the granddaddy of a lot of our 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.

• 22:57Noam Hassenfeld?

  Okay.

• 22:57Speaker 02

  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 suffice. 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-Sachs, because 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 Adonis, right? Like, that doesn't feel like satisficing anymore.

• 23:40Noam Hassenfeld?

  So what did you tell the person who wrote in?

• 23:43Speaker 02

  I told them, look, I'm, I am not going to tell you, like, you shouldn't do this kind of screening ever, right? I think 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?

• 24:11Noam Hassenfeld?

  Give us money.

• 24:12Speaker 02

  Yeah, 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.

• 24:45Noam Hassenfeld?

  What did people think about the advice you gave? Did you hear from any readers?

• 24:49Speaker 02

  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.

• 25:34Speaker 02

  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.

• 25:53Noam Hassenfeld?

  Yeah.

• 25:53Speaker 02

  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.

• 26:02Noam Hassenfeld?

  I mean, it just makes me think of...

• 26:06Noam Hassenfeld?

  Trying to have a goal of humility when you want to say, "Let's give my child the best chance at the best life."

• 26:12Speaker 02

  Yep.

• 26:13Noam Hassenfeld?

  Maybe being humble about what we think of as the best life.

• 26:18Speaker 02

  Yeah.

• 26:18Noam Hassenfeld?

  And if we're overconfident in what we think of as best, I don't know, life surprises you in a lot of ways.

• 26:24Speaker 02

  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 were like deeply confused about it. So I don't want to necessarily presume to know for my kid what's going to be the most beautiful kind of life.

• 26:52Speaker 04

  If you want more advice from Sigal, the "Your Mileage May Vary" advice column comes out twice a month, and you can find it on vox.com or get it in your email inbox by signing up for the Future 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 Salataroff with help from Meredith Hoddinott. Mixing and sound design from Christian Ayala. Fact checking from Melissa Hirsch. Julia Longoria and Jorge Just are our editorial directors. Amy Padula gives great advice. I'm Sally Helm, and I jump in to record the credits when necessary.

• 27:35Speaker 04

  Bird Pinkerton was confused. Can't you just get any guitar? Platty shook her head.

• 27:42Speaker 05

  You think it's easy to be a platypus playing a guitar? You think I can just buy a platypus guitar at Guitar Center? If you are ever going to put this guitar back together, you'll need to find the man who made it.

• 27:57Speaker 04

  Thanks to Brian Resnick for co-creating the show with Bird and Noam. And if any of you out there have thoughts about the show, send us an email. We are at [email protected]. You can also leave us a review or a rating wherever you listen, which really helps us out. And if you are into supporting the show and all of Vox in general, join our membership program. You can go to vox.com/members to sign up. Unexplainable is part of the Vox Media Podcast Network, and we'll see you next time.

• 28:37Noam Hassenfeld?

  Support for the show comes from Sonos. No matter how much you know about frequency response or harmonic distortion, the thing that's going to make you fall in love with a speaker is how it makes you feel. And Sonos has that it factor, you know? It's this seamless system that makes things sound good in every room. That obviously takes some serious engineering, but it also takes a big-picture understanding of how and why we actually listen to things. The birthday playlist, the new TV show, the exciting new game you just got. And for the nerds out there, Sonos does have amazing frequency response and extremely low harmonic distortion. Visit sonos.com and build your system. Sonos: Love the sound, feel the system.

• 29:26Speaker 01

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