Superbabies?

0:01Sigal Samuel:Oh, hey. Sorry, love to chat, but I'm busy shopping all the rollbacks and more at Walmart. Grab a what? Cancel that. I gotta grab these big savings on the Walmart app online and in-store like right now. See who? Nope, unavail. The only thing I want to see are the prices just lowered on Tech Home and all my must-haves. Wait, you want to shop Walmart with me? Alrighty, I think I can fit you in. It's tax season, and at LifeLock, we know you're tired of numbers. But here's a big one you need to hear. Billions. That's the amount of money and refunds the IRS has flagged for possible identity fraud. Now here's another big number.

0:43100 million. That's how many data points LifeLock monitors every second. If your identity is stolen, we'll fix it guaranteed. One last big number. Save up to 40 % your first year. Visit LifeLock.com slash podcast for the threats you can't control. Terms apply. I am someone who is a little bit obsessed with always trying to do the right thing. That's Vox reporter Seagal Samuel.

1:10Sigal 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. Seagal needed a way out. So she decided to start an advice column, something she thought could help her with her own ethical dilemmas. Seagal'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.

1:52Sigal Samuel: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.

2:29She 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.

2:45Sigal Samuel: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.

3:26Sigal Samuel:I don't know how to feel about any of this. On the one hand, it feels weirdly eugenics-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?

3:53What does a parent owe their child?

3:55Sigal Samuel:Yeah. It's such a weighty question. 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, oh, I don't want to over-medicalize everything. But on the other hand, like, maybe I'm supposed to be over-medicalizing this.

4:32Sigal Samuel: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 expectant mothers, are 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.

4:59How 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?

5:09Sigal Samuel: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 one, two, three, four, 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. And what do we know about the tests?

5:45Like, how do they actually work?

5:47Sigal Samuel: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. The 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.

6:25Sigal Samuel: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 XYZ 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.

7:08Sigal Samuel: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 going to 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.

7:48Right.

7:49Sigal Samuel: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 going to develop diabetes, but just a few years later than they otherwise would have.

8:33Sigal Samuel: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. 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, nevermind lay people. So I think it's like really important to understand it doesn't mean the embryo is not going to get this thing, right?

9:08Sigal Samuel:It 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 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.

9:55Sigal Samuel:Yes, I think that's such an important point. No one is like sitting there pining, oh, I wish I 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.

10:33Sigal Samuel: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 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 deemphasizing 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.

11:10Sigal Samuel: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.

11:33coming up in a minute what should the parent do yeah i mean that's where it gets

11:38Sigal Samuel:really complicated and hard and this is where a lot of people are going to start fighting

11:47Sigal Samuel:eczema is unpredictable but you can flare less with epglis a once monthly treatment for moderate to severe eczema. After an initial four-month or longer dosing phase, about four in ten people taking EBCLIS achieved itch relief and clear or almost clear skin at 16 weeks. And most of those people maintained skin that's still more clear at one year with monthly dosing. EBCLIS, LibriKizumab LBKZ, a 250 milligram per two milliliter injection, is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema.

12:18Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection.

12:40Sigal Samuel:Ask your doctor about EBCLIS and visit EBCLIS.lily.com or call 1-800-LILY-RX or 1-800-545-5979. K-pop Demon Hunter's Saja Boys Breakfast Meal and Huntrix Meal have just dropped at McDonald's. They're calling this a battle for the fans. What do you say to that, Rumi? It's not a battle. So glad the Saja Boys could take breakfast and give our meal the rest of the day. It is an honor to share. No, it's our honor. It is our larger honor. No, really. Stop. You can really feel the respect in this battle. Pick a meal to pick a side. Ba-da-ba-ba-ba. And participate in McDonald's while supplies last. For the last 10 years, everything in American politics has basically revolved around one man.

13:24And as a political journalist who came of age during Donald Trump's rise in 2016, I've had a front row seat. I am officially running for president of the United States. It's going to be only America first. America first.

13:42Sigal Samuel:Thousands of supporters of President Trump stormed the U.S. Capitol building. But is it possible to talk about politics without talking about Donald Trump? That's the question I'm going to ask in our new show from Vox. The idea of like a post-Trump or not exactly Trump-focused show can exist because he's not really driving any agenda items. It really does feel like so reactive. You know, I think this Iran thing is also going to cause a big split in the GOP. So far it doesn't among like people who say they're MAGA voters are still with Trump. But like, for the first time, you see on a major issue, open opposition from the start of this war.

14:17I'm Estet Herndon, and welcome to America Actually.

14:32So 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?

14:42Sigal Samuel:Yeah, so I think the first thing is a scientific issue. It has a bit of a funny name. It's called pleiotropy. 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.

15:22Sigal Samuel: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 going to run you$25 ,000. 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.

16:00And there might just be kind of pressure on people with less money to spend their life savings onto things like this.

16:07Sigal Samuel: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.

16:48Sigal Samuel:So that creates a risk of implicit coercion, which I do think 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 going to 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 going to be a girl. 10 years later, 20 years later, the kid says, actually, I'm trans.

17:26Sigal Samuel:And I, you know, I don't identify as a girl. And then they're going to 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 might feel like, oh, 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, right. I worry, like, this is going to create a lot of therapy sessions on, like, topics we haven't had to deal with before.

17:56Okay, 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...

18:10Sigal Samuel: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 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 more people start using this technology.