There was an interesting op-ed in the NYT yesterday. It’s about the commercialization of infertility treatment, but I think it makes points that can be understood more broadly. And, somewhat like the adoption story I blogged about yesterday, it makes me think about the importance of trying to put a bigger frame around the problem.
The authors–Miram Zoll and Pamela Tsigdinos–are women who pursued/endured “increasingly invasive and often experimental interventions, many of whose long-term health risks are still largely unknown.” The treatments were unsuccessful and eventually Zoll and Tsigndinos decided to stop. This is a decision the women are (now) happy with:
Ending our treatments was one of the bravest decisions we ever made, and we did it to preserve what little remained of our shattered selves, our strained relationships and our depleted bank accounts.
Having been through the treatments, the women now turn a critical eye on the fertility industry. “[W]e study its marketing tactics with eagle eyes, and understand how, like McDonald’s, the fertility industry works to keep people coming back for more.”
I think it’s quite right to examine these tactics closely. There’s no doubt in my mind that a lot of advertising preys on the pain and vulnerability associated with infertility. There’s nothing like offering a cure–giving people hope–to get customers to beat down your door.
But of course, this isn’t just true of the fertility industry. Pick up a newspaper and scan the ads for medical treatment centers/drugs/experimental surgeries and so on. Go look at the ads aimed at those with male pattern baldness, say. Or wrinkles and age spots. Or even those with cancer or heart disease.
You can say it’s all about free information and consumer choice or you can say it’s horrifying. And both are partly true, I guess. Perhaps it is in the nature of the free-market approach to medical care and free speech being extended to medical/pharmaceutical advertising and all that. It’s not that I don’t think there’s a legitimate complaint here, it’s that the complaint can really be writ much more broadly.
Does the fertility industry in particular behave badly in this commercial environment? I don’t see that it does. It does what all sectors do–it advertises, it tries to convince people they need the services it provides and that it can provide them better than anyone else. It’s not that I think this is a defense of the industry, but it’s a way of placing the criticism in a larger frame.
Zoll and Tsigdinos also identify another facet of the problem, though, one that I’d like to highlight. Perhaps this points the way towards a solution. (And I’ve talked about this before, though I don’t have a link to quite where at the moment.) It’s their last paragraph:
Being unable to bear children is a painful enough burden to carry, without society’s shaming and condemning those who recognize that their fertility fantasy is over. It is time to rein in the hype and take a more realistic look at the taboos and myths surrounding infertility and science’s ability to “cure” it.
Infertility (and I’m realizing that the meaning of that term may be somewhat ambiguous) won’t kill you. It isn’t like cancer. I don’t mean that the pain of infertility isn’t real–it is for many quite real and substantial. But in a way it is rather like male pattern baldness. (I’m sorry if this gives offense to folks–please bear with me a moment.) It’s a problem because we (as a culture) believe it is a problem. It’s stigmatized. It makes one an object of sympathy. And I’m not convinced it has to be that way.
After all, people who are infertile can raise children and become parents, whether via adoption or via third-party reproduction avenues. So it’s not that you miss your chance to be a parent. You miss your chance to be a genetic parent or maybe your chance (if you are a woman) to be pregnant. And we (as a culture) tell you that’s a huge loss and that you should do a great deal–invest your time and money, subject yourself to painful and perhaps risky treatments–to avoid it. I take the call at the end of the essay to be one for rethinking this, for de-emphasizing the importance of the genetically-related child or perhaps for having children at all. (Which reminds me of the recent Time magazine article on child-free living.) It’s a call I would like to join.
One final side point: Zoll and Tsigdinos quote some statistics on the success rate of ART. For instance: “In the United States, the Centers for Disease Control and Prevention puts the overall failure rate at almost 70 percent.” It’s important to put statistics like this in context. Susan Crockin (a lawyer expert in ART matters who also teaches at Georgetown Law School) did that this way:
“there is a 1 in 3 chance in nature of conceiving. This argument. . . spins the “almost 70%” failure rate w/o acknowledging an overall success rate that parallels or slightly exceeds nature and in specific
patient populations exceeds them significantly.” (emphasis added).
Statistics are always open to interpretation and restatement, of course. There’s just lots of ways to think about these things.