The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception Hardcover – Feb 1 2006
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From Publishers Weekly
Among the troubling aspects of new reproductive technologies is the takeover of reproduction by the marketplace. This probing study accepts the free market process while casting a discerning and skeptical eye at its pitfalls. Harvard business prof Spar (The Cooperative Edge: The Internal Politics of International Cartels) explores many aspects of the high-tech commodification of procreation: the fabulous revenues commercial fertility clinics earn from couples' desperate desire for children and the ensuing conflicts between medical ethics and the profit motive; the premiums paid for sperm and eggs from genetically desirable donors; the possible exploitation of poor, nonwhite and Third World surrogate mothers paid to gestate the spawn of wealthy Westerners; the fine line between modern adoption practices and outright baby selling; and the new entrepreneurial paradigm of maternity, in which the official "mother" simply finances the assemblage of sperm, purchased egg and hired womb and lays contractual claim to the finished infant. Spar considers most of these developments inevitable and not undesirable (they provide kids to parents who want them), but calls for government regulation to curb excesses and protect the interests of all involved. Her sanguinity will not satisfy all critics, but she offers a lucid, nuanced guide to this brave new world. (Feb. 14)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
"Spar builds a case for some regulation to ensure that it "manufacture[s] embryos that turn into babies," accessible to all who want them." -- The Globe and Mail, May 27, 2006See all Product Description
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Spar quickly dismisses ethical concerns, arguing that they are messy, controversial, and incapable of any resolution. Thus her focus is single: to see how the desire for babies fits in with the world of trade and commerce. And her premises are not easily gainsaid: people desire to have babies (and/or baby parts, or services, or technologies) and there are many who are happy to provide these things, especially for a price. It is as simple as that: supply and demand.
Economically speaking, as Spar keeps noting, it is a match made in heaven. This trade in babies is therefore inevitable and here to stay, she argues. The horse has bolted, and there is no going back to the stable now. We must live with the new reproductive technologies, and their inevitable commercialization. The only question is whether the baby market should be open slather, or whether some sort of regulatory scheme should be put in place.
The bulk of this book examines the various areas of the baby trade - be it IVF, surrogacy, sperm and egg selling, cloning and the like - and how money has been invariably linked to the fertility industry.
Of course this book describes the situation in the US, where there is very little government regulation at all over the fertility business. Other nations do have regulatory schemes in place, which the author refers to now and then. But it is the wild west of the American fertility trade that is in focus here.
Spar believes that the market will always be part of this industry, and that it is not a bad thing at all. But she recognizes that as the "product" in discussion is a human baby, many are reluctant to speak of it all in purely financial terms. She occasionally acknowledges the critics, like Leon Kass, who see much of the reproductive industry as involved in the commodification of children and the manufacture of life, but seems little impressed by their concerns.
Indeed, she says early on that the market will always triumph, while issues of morality will remain unresolved, and by implication, be of secondary importance. Thus she simply accepts the reproductive revolution and Big Biotech as necessary, inevitable forces that will not go away. Don't worry about the ethical concerns, she seems to suggest. Instead, given the inevitability of the market in this area, the only real issue is what kind of regulation, if any, do we want applied. The topic of regulation she only addresses briefly, and in her final chapter.
She in fact claims not to have any clear answers here. She does state her preference, a "light-handed regulatory regime" in which choice, information and costs are considered. She recognizes that there may be a dark side to an unchecked market, especially in some of the `yuk' areas like human cloning, but she seems to think the market as a whole, with a little help from the government, will largely get things right.
Thus she is optimistic about both the science and economics of the reproductive revolution. Many others, of course, are worried about the brave new world implications of where all this is headed. Spar here and there acknowledges these concerns, but generally sees them as irrelevant or of no great consequence. Of course such considerations are too controversial for many to even raise. Indeed, free marketers will be squeamish about such discussions. But they are nonetheless part of the equation.
Indeed, the traditional philosophical, spiritual and social implications are as much a part of this discussion as mere market concerns. So for a more inclusive and well-rounded discussion of these issues, the reader needs to go elsewhere.
But if the reader wants a simple overview and history of the new reproductive technologies, and their economic implications, this book is undoubtedly a good place to begin.
In her fascinating book The Baby Business, Debora Spar lays out all the choices available to present day Rachels and Jacobs. Approximately 15% of women and 10-15% of men in the U.S. have fertility problems. In 2002 about 17% of married women in the U.S. were either infertile or had impaired fecundity. In 1995 there were 6.1 million infertile women in the U.S. and approximately a third of them sought some type of treatment and only 1% sought assisted reproductive treatment. The baby business is big business - excluding adoption and PGD, it was a $3 billion market in the US in 2004 with a third being accounted for by IVF and another third by fertility drugs.
Spar argues that step one is to call a spade a spade. Eggs may be `donated' but donors get compensated in the form of gifts, which include massages and diamond necklaces. Spar writes of an attorney by the name of Noel Keane who started a brokerage business in the surrogacy market in the mid 1970's. At one point Keane tried to eliminate payment for surrogacy and found that the "supple dried up". Clearly, the main motivation for adoption brokers and medical doctors alike is money. It is a business. Once we acknowledge this we have to deal with property rights - something that even children understand - it's my toy! It's mine because I paid for it and in the market economy transactions involve not just the exchange of goods for money but also the rights to do whatever we please with those goods. If those rights are violated - we can call the police and seek redress from the judicial system. But the baby business is different - it's my car and I can sell it - sure. It's my sperm and I can sell it - OK. It's my blood - it's my kidney - it's my baby - I can sell them. Back off! You can donate your blood and maybe even your kidney - but forget about selling babies - that's not on. Really?
The baby business is indeed a funny business. All the consumer is interested in is the end product - they want a baby but nobody is selling them. Instead people are selling inputs such as sperm or eggs and services. The birth mother in an adoption situation is merely carrying the baby, the agent is facilitating, in the case of IVF the medical doctor is providing an alternative process rather than infertility treatment - everyone is selling services and no one is selling the end product. The laws of demand and supply do not work in this business - willingness to pay continues to be incredibly high. People will do anything to get baby, or the willingness to pay is very high. The story of Rachel and Jacob is telling enough, but Spar writes about a lady who went through 9 cycles of IVF, produced 198 eggs and failed to get pregnant. Prices continue to be high in this market even though scale has increased, so for example the real price of IVF has not fallen in the last 20 years even though the practice has become more prevalent.
All markets need rules - the baby business is no different. Compared to other developed countries the market in the U.S. is relatively unregulated. Rules differ across countries, which leads to arbitrage. People travel across borders to avoid restrictive national rules. Further, regulators need to recognize that all the different avenues from adoption to IVF are substitutes, albeit imperfect, so how you regulate one market has an impact on another. Spar does not deal with the moral issues of the baby business and neither does she judge the market. Instead she suggests alternative regulatory options. These include for example, banning the business altogether, treating it like a luxury good which implies inequitable access and using the donation model as in the case of kidneys, which will lead to shortages and queuing. In addition she calls for a political debate in the U.S., which should address issues relating to access to information, equity, direct and indirect costs and the limits to parental choice.
This is an important an intriguing book, unfortunately it is unlikely to attract the broad readership it deserves. This is because infertility is not a mainstream issue. Having said that however, it will not take much for politicians and the public at large to pay serious attention to the message of this book. What is likely to set off the debate is the link between cloning embryonic stem cells and the market for high tech reproduction no matter how tenuous- all it will take is an eager customer with a very high willingness to pay, an ambitious scientist and a botched experiment.
This review first appeared on a now defunct blog on June 16, 2006
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