Preventive Medicine Column

Dr. David L. Katz

Last week, I argued the need to put a face on public health.  This week, I make the reciprocal argument: at times, we need to face the fact that what’s best for one of us may diverge from what’s best for all of us.

A college student, contemplating medical school, recently sent me a note expressing his concern about this, noting that an ever-growing human population seemed a threat to the health and perhaps viability of our species.  So, he wondered if he might better ‘take care of people’ by doing something to protect the planet from our collective abuses, than by tending to patients one at a time.

His note reached me about the time the Nobel Committee announced its selection of Dr. Robert G. Edwards, the father of in vitro fertilization (IVF), and thus figurative father to all of the “test tube babies” it has produced- as this year’s winner of the Nobel Prize in medicine.

The selection of Dr. Edwards for this singular distinction was immediately controversial.  The Vatican promptly objected, because IVF leads to the production of those controversial ’embryos’ that are destined to be discarded- or could be directed into stem cell research.

While embryos that DON’T lead to babies being born are the concern for the Church  (I note, in passing, that baby-making the old-fashioned way also produces many ‘wasted’ embryos, but these go undetected as “late periods”) my own ambivalence with Dr. Edwards’ prize is more about the babies that are born.

To be sure, as a doctor who has confronted infertility both among my patients, and in my extended family, I have deep sympathy for the couple that wants a baby and can’t have one.  I fully appreciate the compelling, life-changing power of Dr. Edwards’ work for these families.  I also recognize that someone who got their start with IVF could be reading this post right now.  I mean no personal offense.

But…the student’s ambivalence is legitimate.  Haven’t we gone forth and multiplied more than enough already?  If we look at a picture just a bit larger than the individual, or couple- our collective problem is too many people, not too few.  Indeed, the case could be made that much of what most threatens the future for us all- including all of the offspring of Dr. Edwards’ test tubes- is the ever-burgeoning human population.

Now, of course, the contribution of “test tube” babies to the global human population is -and likely always will be- a rounding error, and a small rounding error at that.  And when one such baby is born, the benefit to the family otherwise bereft of children will certainly be vastly more intense and immeasurably more palpable than the incremental harm to the planet, and our collective future plans for living here.

But I am nonetheless left with a certain ambivalence based on principle.  In an over-populated world, is the application of cutting-edge science to ensure that everyone can have babies worthy of the greatest recognition we know how to bestow?  As we reflect on this, let’s recall that this technology is not just the difference between child and childlessness for a young and desperate couple- it has also morphed into related fertility treatments that have given us sextuplets, octuplets, and babies born to post-menopausal women.  And reality TV spin-offs.

I greatly respect the good that Dr. Edwards has done for couples wishing fervently for family-hood.  I certainly appreciate the good he intended.  But, of course, among the world’s excessive population are many orphans needing parents.  And I can’t help but wonder if the Nobel committee adequately considered the cultural context of this advance.

That context might be informed by The Three Musketeers, who famously gave us:  “all for one, and one for all.”  The reality is, we may need to choose.   Do we count among the crowning achievements of our age any ground-breaking biomedical advance that serves some one, or only those that align the needs of one and all?

As a doctor, I’m used to “all for one;” that’s what we try to give our patients.  But a Nobel Prize Committee is not taking care of a patient; they are rendering a judgment on behalf of our culture.  And if our culture moves too far toward all for one, and away from one for all, it leads irrevocably to the tragedy of the commons, as described by Garrett Hardin.  That’s bad for all.

How we reconcile “all for one” with “one for all,” and prioritize between them when we must, will say much about the character of our culture.  And perhaps help predict its future.




Dr. David L. Katz;