← Culture Apothecary with Alex Clark
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- [00:00]
Alex Clark
Is it possible for a couple to do IVF in a 100% ethical, moral way?
- [00:06]
Dr. Aaron Kotti
In my opinion, no.
- [00:08]
Alex Clark
Are only non viable embryos what are being destroyed in the IVF process?
- [00:14]
Dr. Aaron Kotti
No, no, no. Many healthy viable embryos are being destroyed in the IVF process. A petri dish is not a perfectly conducive environment for human life and no one ever asked their permission to do this.
- [00:25]
Alex Clark
You are one of the most credentialed doctors I've ever had on the show. You are also probably the most controversial.
- [00:31]
Dr. Aaron Kotti
Bad happen when good people fail to speak out.
- [00:59]
Alex Clark
Dr. Aaron Kotti is a physician specializing in psychiatry with a focus on bioethics surrounding reproductive technology. In this interview he will present scientific and evidence based arguments against fertility treatments like ivf, perspectives you may have not heard before. The goal is to gently encourage you to consider another viewpoint on the ethical issues surrounding these practices. While every baby is a blessing regardless of how they were conceived, Dr. Cariotti invites you to consider that not all methods of conception are ethically sound or free from consequences. The desire for a child is natural, but it's important to recognize that some fertility treatments such as IVF can bring with them ethical dilemmas that are often overlooked. Dr. Cariotti does not seek to condemn those who pursue these treatments at all, and neither do I, but rather to foster a conversation about the moral implications of these practices. This interview aims to provide a thought provoking perspective urging you to reflect deeply on the decisions surrounding reproductive technologies and their broader societal impact. We also get into some new reproductive technologies that may become available to us in as little as 10 years which should gravely concern you. Dr. Cariotti is the author of three books including most recently the New Abnormal the Rise of the Biomedical Security State. He is a fellow and Director of the Program in Bioethics and American Democracy at the Ethics and Public Policy Center. He's also a plaintiff in the landmark free speech case Missouri vs Biden challenging government censorship on social media. His work has been published in everything from the Wall Street Journal to the Washington Post and is frequently seen on NBC, cbs, cnn, Fox and npr. Culture Apothecary is a beautifully shot multi camera show available to view on YouTube if you subscribe to Real Alex Clark Watch on Spotify. Our goal is to heal a sick culture physically, emotionally and spiritually with expert guests twice a week on a myriad of countercultural issues on everything from parenting to ultr processed food. This show is free, but you can support us by leaving a five star review wherever you listen or take it a step further by making a tax deductible donation through the link in the description. I'm Alex Clark. Please welcome Dr. Aaron Kotti to Culture Apothecary. You are one of the most credentialed doctors I've ever had on the show. First of all, you are also probably the most controversial. And in this interview, what I really want to focus on are the ethical and moral question marks, if you will, surrounding reproductive technology and fertility treatments that we are familiar with and that we use. And then I want to get into kind of some upcoming technology that people likely haven't heard of yet in my audience and what should really be a cause for concern. So what I want to start with is this widely held belief that all technology is good, that new advancements in technology are always a good thing, because as humans, we're just evolving and learning new things.
- [03:58]
Dr. Aaron Kotti
Thank you for that. And I'll wear that as a badge of honor that I'm the most controversial doctor that you've had on the show. Yeah, this. This notion that technology is automatically good and that it's automatically going to take us in the direction of progress. I think anyone who's familiar with the history of, let's say, the last hundred years should be able to look at that notion and recognize that this is kind of actually the devil's doctrine, that if, if we can do something, we should do it. I mean, take nuclear technology, for example. It can be used for good purposes to generate energy. Even that is controversial. What do you do with the waste that's generated? Or it can be used to make a bomb that kills literally millions of people. So technology itself is not automatically going to lead us to progress toward health and human flourishing. And especially when it comes to medical technology and biomedical technologies, we have to think carefully about how they're being used. They can be used for the purpose of health and healing, and that's a good thing. They can also be used in ways that unfortunately can become dehumanizing. Many people these days, the so called transhumanists, for example, propose to use science and technology not just to take sick people and make them well, not just using technology for the traditional purpose of medicine, which is healing and health, but taking healthy people and making them, quote, unquote, better than, well, bigger, faster, stronger, smarter. Wouldn't it be a great thing if we could give you a pill or, you know, a drug that would improve your concentration and improve your attention, or make it so that you never needed to sleep? Or take a short person and make them tall, or take a slow person and make them fast. And based on our experience so far with these kinds of technologies, we recognize that actually when we start deviating from the purposes of medicine, always and only hopefully aimed toward health and healing, and try to use technology for these other purposes instead of actually making people healthier and happier, and instead of leading toward human flourishing, we end up having all kinds of negative downstream consequences that people didn't think about when they set off on these kind of utopian Promethean projects.
- [06:18]
Alex Clark
Why were you intrigued as a doctor in the ethics surrounding reproductive technology? Like, were you, were you working in pediatrics? Like, why, why this topic?
- [06:29]
Dr. Aaron Kotti
So when I was at the University of California, I did chair the ethics committee. And so we got ethics consults from all the various departments in the hospital, including consults of complicated cases from obstetrics, maternal fetal medicine cases where you had a complicated pregnancy, difficult issues that were wrapped up in that. So, for example, I remember being consulted on a surrogacy case. There was a couple from abroad that had come and hired a gestational surrogate in California, someone basically to carry their baby for them during the nine months of pregnancy. And surrogacy is one of those issues at the beginning of life where there's all kinds of complicated ethical problems associated with it that many people don't think about when they set off on, on these projects. And what happened in this case basically, was the surrogate got pregnant with twins, which is very frequent because they use ivf. Oftentimes they will implant more than one embryo to try to increase their odds of achieving a viable pregnancy. And when you do that, your chances of getting twins or triplets goes up considerably. In this case, the surrogate conceived twins. And it turns out that one of the twins, based on prenatal genetic testing, likely had some kind of heart condition. Wasn't a fatal heart condition. It was a heart condition that required cardiac surgery immediately after birth that probably would have led to a normal, more or less healthy life. But the intentional parents who had hired the surrogate did not want a baby that had any sort of medical condition. So they tried to force the surrogate to have an abortion of the one member of the twin pair that had the heart condition. And the surrogate did not want to have an abortion. She was morally opposed to, to that. And so we had this conflict. We also had a difficult situation in that basically these intentional parents were going to abandon, I'll call him Baby B after he was born, the baby with the heart condition. And we had no disposition, we had no family for that baby. So we had to get involved in basically a complicated process of finding adoptive parents for this child who had been abandoned by the intentional parents.
- [08:43]
Alex Clark
The state ended up siding them with the surrogate, the woman.
- [08:46]
Dr. Aaron Kotti
The state didn't get involved because the parents were actually from abroad, which is common in California. California. Well, the United States in general, But California in particular is sort of the wild west of surrogacy. When the state of law gets involved, it becomes even more complicated because the law very often doesn't know what to do with these kinds of cases. So we did get the social services agency involved that helped basically to arrange an adoption. But it was kind of up to the ethics committee to navigate the. The issues of basically how do we first of all get someone to consent for this baby to have cardiac surgery after it was born? Because during the pregnancy, that surrogate mother, the woman carrying the twins, had the right to consent for interventions. But immediately after giving birth, based on the surrogacy contract, she had no more parental rights over the parents. Those were given over to these intentional parents. The intentional parents then abandoned baby B, and baby B essentially became temporarily a ward of the state. So, yeah, that was, I mean, that's one example among many that I could.
- [09:53]
Alex Clark
Cite that you were just working with at the University of California. Is that what you said?
- [09:58]
Dr. Aaron Kotti
Yeah, that you were.
- [09:59]
Alex Clark
That you would come across your desk and you would look at and you were like, this is interesting. Like this whole field of reproductive technology and fertility and all of that, like surrogacy, ivf, that was just. It piqued your interest.
- [10:10]
Dr. Aaron Kotti
Yeah, and it piqued my interest even earlier. I mean, I started studying bioethics and philosophy as an undergraduate. And already at that time, these, these ethical issues at the beginning of life, sort of life at the extremes at the very beginning of life and at the end of life piqued my curiosity because they, they raised so many profound issues about human life itself, about what does it mean to be human, what does it mean in. In these stages to be dependent on others and how do we care for those who are most vulnerable, especially those who can't speak for themselves. So I've had a long standing issue, interest in these issues.
- [10:47]
Alex Clark
What is wrong with having human beings grade certain types of embryos for problems? Why wouldn't we want to choose human embryos that are going to have the best grade outcome possible?
- [10:59]
Dr. Aaron Kotti
So yeah, you were referring to pre implantation genetic testing, which is often done in conjunction with ivf, which is basically create new human life, a new embryo in the laboratory test it for various genetic conditions and then take only the ones that we deem to be genetically most fit and implant them in a uterus to try to bring them to birth. And with the others, we simply discard them. We, we kill them because they're deemed unfit or less than optimized. And I think there's many problems with this. One is that it revives old attitudes that were prominent in the early 20th century in the so called eugenics movement. When you say the word eugenics, most people think of the Nazis. The fact that the Nazis killed and euthanized people with disabilities, which is widely known now. People who were mentally ill or had physical disabilities were taken to hospitals and against their will, they were basically killed by Nazi doctors. But what many people don't realize is that the eugenics movement did not begin in the 20th century in Germany. It began in the United States and Great Britain, where people who were deemed genetically unfit were involuntarily sterilized. So 27 of the 50 states in the US had laws in the 20th century permitting men or women who were mentally ill or in many cases just impoverished at the margins of society. They didn't really have a diagnosable physical or mental condition, but they were deemed, you know, to have a propensity to criminality or promiscuity or whatever. So they were basically involuntarily sterilized.
- [12:35]
Alex Clark
Who was behind that movement in the United States?
- [12:38]
Dr. Aaron Kotti
Well, many key foundations in the United States. It was very mainstream. So the Carnegie foundation, the Rockefeller foundation were supportive of this. Margaret Sanger and the Planned Parent, the early Planned Parenthood movement was deeply involved in this. And many prominent politicians, from FDR to others, were basically supportive of eugenics. It was sort of seen as part of mainstream progressivism and it got a bad name after World War II. Rightly so. Eugenics sort of went underground. But what's happening now with pre implantation genetic testing is that those same discriminatory attitudes are basically kind of being revived in our attitude toward the creation of new human life. Right? And we, we take human life that should be received as a gift and as something of a surprise, if you will, when that baby is born, we don't know exactly what it's going to look like. And we're going to welcome it into the world, even if it's sick, even if it requires medical care, even if he or she is disabled in some way. But if you start trying to control that process at the beginning of life using the means that you just described, basically you Take the, the reception of new human life as a gift and you turn it into a project of our own creation. It becomes a kind of quality control manufacturing process where the person has to be made according to our exact specifications. And if they're, if they turn out to not meet those specifications, they're seen as less than right. So this can be used for sex discrimination. Basically, you know, people from certain cultures that value boys over girls will use it to basically ensure that they don't have a baby girl, which reinforces those sex stereotypes and those discriminatory attitudes towards one or another gender. This can be used to discriminate against people with disability and illness as well. But now there are companies actually offering services not just to try to eliminate genetic diseases. And actually you're not, it's worth noting that you're not using this to actually treat genetic diseases. You're simply eliminating those people who have genetic diseases.
- [14:55]
Alex Clark
That's a really good point.
- [14:56]
Dr. Aaron Kotti
It's sometimes framed as a treatment. No treatment is taking a sick or an afflicted individual and doing something to make them healthier. Right. To try to cure that illness. That's a good thing. We should be using these technologies for that kind of purpose. But what you're describing here with pre implantation, genetic testing and discarding of embryos is not actually treating anyone. It's simply killing those human beings in their earliest stage of development who are deemed not to meet our exact quality control specifications. The danger is, you know, the eugenics of the past was sort of state sponsored and top down and coercive. The new eugenics isn't necessarily coercive. But that's not the only problem that was associated with eugenics. The other problem that's associated with it is it basically takes our attitude toward other people and shifts it in ways that can disvalue certain classes of individuals. It actually changes our attitude toward those people who are living and walking among us, who are, who are afflicted with the conditions that we deemed basically unfit for, you know, the, for life and for the, for the opportunity to grow and develop and come into the world.
- [16:11]
Alex Clark
When you were talking about discarding embryos, you used the word killing. Now that might be controversial for some people or confusing for some people. Why would sex selection or discarding embryos be considered killing a human being?
- [16:26]
Dr. Aaron Kotti
Sure. Well, an embryo is simply a human being, a fully formed, genetically complete human organism in its earliest stage of development. It's not a different kind of entity than you and I. You and I were once embryos in the earliest moments of our life in the earliest moments of our existence. So the. The word embryo does not designate a different type of entity. It designates a stage of human development. The same thing with the word fetus. That's just a later stage of prenatal development. Just like newborn or infant, toddler or teenager or elderly designates another stage of development. So it is killing, because clearly this is a living human being that has the functions of a living human being at that early stage of development. It may not look to the naked eye like a human being, but that is simply what a human being looks like at that early stage of development. And we can know a lot about that human being. That's why we do prenatal genetic testing in some cases, because it can actually show us a lot about that human being. And. And those genes are the same through all stages of development. So I use that word because it's. It's. Even if it is ethically controversial, it's the most accurate description of what happens when you take a living organism, in this case a member of the species homo sapiens, a human being, and you throw it in the trash basket. Right. Which is essentially what happens in those cases.
- [18:04]
Alex Clark
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- [20:30]
Dr. Aaron Kotti
IVF in the United States is very unregulated and the laws in different countries vary. But most countries have stricter laws, for example about how many embryos you can implant in a uterus at one time. You may not remember, might have been a little bit before your time, but there was a case not too long ago in California of a woman who gave birth to eight babies. The so called octomon.
- [20:58]
Alex Clark
Oh sure, yes, I know her.
- [21:00]
Dr. Aaron Kotti
This was not naturally conceived. This was. This was a rogue IVF physician who decided he was going to implant eight embryos and all eight of them, which is rather unusual if you were to do that, all eight of them actually achieved a viable pregnancy. There's no laws or regulations about the age of the mother with ivf, for example. So you have elderly women bringing children into the world, genetically related children into the world through ivf, intending to be their mothers, but not living long enough to see their children attain high school, which was entirely foreseeable, given their stage of life. I mean, there's a reason why the body naturally goes into menopause, for example, at a certain age, because in order to care for children that you might conceive using your gametes, using the eggs in your body, you should be hopefully at an age where the odds statistically are likely that you will be able to raise that child to adulthood. So, I mean, other examples could be multiplied. But essentially you have an industry that is very, very profitable, that does not want any regulation and oversight, that wants to operate basically on the principle of maximizing profitability.
- [22:18]
Alex Clark
And are there also rules in other countries about embryos being on ice?
- [22:23]
Dr. Aaron Kotti
There are some places that try to do a better job of basically putting fewer embryos or limiting the number of embryos that can be put in on ice, as you said, in cryopreservation. So essentially, if you don't quickly implant an embryo, it will die unless it's put into cold storage, which is essentially what happens in many IVF clinics. And one of the consequences of sort of Wild west, unregulated IVF industry in the United States is that no one knows the number for sure, but reasonable estimates are that there are anywhere between half a million and several million embryos right now in cold storage, on ice, in a suspended state of animation. And we now know that you can thaw out an embryo and implant it later, in some cases a decade or two after it has been frozen, which leads to all kinds of strange possibilities. You could have. You could have two twins, for example, that were created via IVF at the same time. One of them is implanted, one of them is frozen for 20 years and then implanted. You have two twins that essentially were conceived at the same time, but whose developmental age now is 20 years apart.
- [23:38]
Alex Clark
So why should. Does that matter to you?
- [23:42]
Dr. Aaron Kotti
First of all, no one knows what to do with these frozen embryos. And there's legal battles around these frozen embryos. The actress Sofia Vergara and her ex boyfriend, Nick Loeb, have been in a fight over what to do with the disposition of their embryos after the breakup of their relationship. That's been a legal battle that's been actually going on for many years. Do we treat these embryos as property which is what most states do. Well, in that case, in the case of a divorce or a breakup, how do you, you know, you can divide up material assets, you know, reasonably well in a situation like that. You cannot divide up embryos in a situation like that. And if there's a difference about what to do with those embryos, that creates legal conflicts. Many of the parents don't want those embryos to be destroyed. They feel morally conflicted or ambivalent about that because let's say they, they created half a dozen embryos with IVF and they brought three of those to birth, and they have three in cold storage. Well, they know what those embryos are. They know that if you put them in the conducive environment of the womb, this is what they become. They become, they are in fact, our children in their earliest stage of development. So they feel conflicted about simply destroying them. They feel conflicted about donating them to science for research or adopting them out to another couple that might bring them to birth because they don't want their own genetically related offspring being raised by another family. So they don't know what to do. The clinics don't know what to do with these frozen embryos. And we're stuck in this kind of limbo where there seems to be no just resolution to this conundrum. So it's a very serious problem that most people who are advocates of IVF would prefer not to think about and prefer simply to ignore. Most intentional parents that go into IVF do so with the best of intentions. Obviously, they want to have a child and they, whenever possible, they want to have a child that's genetically related to them, which is a good and beautiful thing. And they're often kind of advised that, you know, there may be this question about what to do with the spare embryos later. But they're, they're so focused on what they want, which is their child or their two or three children or whatever their, their plans are, that if and when they get that, it's only then that they start thinking deeply about, okay, what are the issues that were raised by creating these so called excess embryos that we now don't know what to do with.
- [26:03]
Alex Clark
Is it possible for a couple to do IVF in a 100% ethical, moral way?
- [26:09]
Dr. Aaron Kotti
In my opinion, no. And I understand that that's going to be a controversial opinion among many people in our audience, But I think essentially when you start creating human life in the laboratory, when you start involving a third party in a process that should be essentially the human life Coming into being as the result of the union of the mother and the father and hopefully a loving, stable union that's able to provide a familial context for that child. When you start separating those things out and you start bringing in a third party who engages in a kind of manufacturing process, you have already in subtle ways, instrumentalized that new human life. You've begun to, begun to treat a someone as a something. Even if you don't create excess embryos, even if you implant and attempt to give the opportunity for continued life to all the embryos you create, that is a more ethically acceptable way to approach ivf. Even then, there are all kinds of unforeseen consequences to this process that I think undermine, you know, the possibility that basically that this is ethical. I mean, one of the things that we're discovering now is that no one ever IVF was essentially an unconsented experiment on the child. Right. We didn't really know would this cause more medical problems for children? We now know that it does. Right. There's really. There is evidence that children born of IVF have higher rates of certain chronic medical conditions than the general population.
- [27:44]
Alex Clark
Like what?
- [27:45]
Dr. Aaron Kotti
There's evidence, for example, for metabolic syndrome. There's evidence. There is some evidence. Although this is controversial and we need more research. There's some evidence of higher rates of autism and other developmental disorders among children who are conceived via ivf. Probably because the laboratory is not a perfectly conducive environment. A petri dish is not a perfectly conducive environment for human life. We also don't know the effects of long term cold storage cryopreservation on new human life. So we're essentially engaged. When we embarked on the whole project of ivf, the unknown number of embryos that were killed before the first successful case of an IVF birth in 1978 were essentially engaged in an unconsented experiment on individuals who we now know probably are adversely impacted in terms of their health. And no one ever asked their permission to, to do this or to bring them into the world in this way.
- [28:44]
Alex Clark
What is your opinion on the ethics of a couple who has an excess amount of embryos? They decide to implant several, they have several kids, but with the extras, they put them up for adoption to be raised by other families.
- [28:56]
Dr. Aaron Kotti
I'm of two minds on this issue. I'm sort of divided and I'm still actually wrestling with this notion of embryo adoption. On the one hand, it seems like the humane thing to do for an embryo in cold storage to give it the opportunity of life. On the other hand, there are some complicated ethical issues associated with embryo adoption as well. And so I don't think it is the solution to make IVF ethical. I mean, first of all, there are not enough interested adoptive parents that are willing to go through this process in order to handle the millions of embryos that are awaiting life in cold storage. Can we save some of them through embryo adoption? Perhaps. Would that be a good thing? Perhaps. Although it's not without its own set of kind of ethical difficulties. So on the one hand, I'm sympathetic to people that want to do that. It does show some respect and regard for the value of human life. But on the other hand, I don't think that is the solution to sort of take the problems associated with IVF and, you know, propose this is the way to fix them.
- [30:09]
Alex Clark
I guess for me, what kind of stands out in that type of scenario is that those children who are adopted out as embryos to another family, they're obviously going to grow up and find out about how they were conceived, and they're going to know that they have siblings out there that got to stay with mom and dad and that they didn't. And then what would that create for that child as far as their sense of identity and sense of belonging and worthiness and love? I just. That is what scares me about that scenario personally.
- [30:38]
Dr. Aaron Kotti
Yeah, there was. There's a notion of psychology that was coined a couple of decades ago, but it is really applicable to these situations with assistive reproductive technologies. And it's this idea of what's called genealogical bewilderment that as these kids grow up, especially as they get into adolescence and young adulthood, what we're discovering is this desire to know not just my adoptive parents, if you will, my intentional parents who raised me, but to know my genetic lineage as an intrinsic, constitutive part of my identity. And in obvious ways, you could see how well people would want to know, do I have a family history of heart disease or cancer or something like that that I should be worried about? So it's. It's often framed in those terms. But actually, if you dig into what's happening psychologically with these children, it goes much deeper than just wanting to know my family medical history or wanting to know my family mental health history or something like that. It's really wanting to know my origins. And like you said, you framed it very well with your question. I probably have genetically related siblings out there that I don't know, that I've never met. My parents sort of chose those ones to bring into their family and to raise, and they let me go, or did they reject me, or was it a loving thing to actually adopt me? So these issues are granted, also found in cases of adoption, but the difference between adoption and assisted reproductive technologies is adoption is, I think, a morally praiseworthy and ethically good thing because it takes a bad scenario, a suboptimal scenario, and tries to make the best out of it. Right? You have, you have biological parents that are, for whatever reason, incapable, unable to raise their own children. And so yes, the loving thing in that case is to try to find another family for them and to make the best of it. And even then, we know that adoptive children deal with some of these identity issues very commonly and this desire to know their biological parents who but what happens in assisted reproductive technologies is not there's a kind of a tragic situation that developed unintentionally that we're trying to make the best out of, as with adoption, but we're actually setting out in advance to create this scenario as though it's an acceptable way of going about making children. And I think that's the key distinction between encountering these issues in the context of adoption, where no one set out to kind of create this scenario on purpose, and assisted reproductive technologies, where we know in advance we're going to create these kinds of scenarios and create these kinds of problems for children.
- [33:28]
Alex Clark
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- [35:41]
Dr. Aaron Kotti
So, I mean, I think it's important to talk about, like, what's politically feasible and you know, a total ban on IVF in the United States I don't see as something politically feasible. So I don't think that's worth talking about from a policy perspective because, you know, even if it would resolve these issues, I think it's not politically realistic just given the current political climate. So as, as a provisional measure, what I would like to see is better regulation of the industry, more data on what is going on with this industry, because IVF clinics are basically not required to report any, virtually any data to the CDC or to public health agencies other than basically their, their success rates in achieving pregnancy. And even then, the enforcement mechanism for data reporting is very, very, very weak in federal and state laws. So like, is a good provisional first step that I think people on both sides of these debates and both sides of these issues could hopefully get on board with and therefore would be potentially politically feasible, is let's get some sensible reporting requirements in place so that, for example, we could track the health of these children across the lifespan. Like, that would be a good place to start, right? So that we can track and try to minimize at least some of the worst abuses that are happening in ivf. Clinics taking advantage of parents who are very often in a vulnerable scenario because they're desperate to have children. I mean, one thing that, when we're talking about this issue that I think is very important to acknowledge, especially, you know, people who are on the other side of this debate, I mean, many, many of our listeners were probably conceived by ivf. Many of our listeners probably have undergone IVF themselves in order to achieve pregnancy and have children. Their children are of course, a beautiful thing. It's just acknowledging the pain of infertility, right? The reason this industry is so successful and powerful and financially lucrative is because one in six couples is struggling with infertility. And many of my colleagues at the Ethics and Public Policy center and elsewhere are trying to refocus our attention on what they call restorative reproductive medicine, which is, let's not look at IVF as the only solution, right? So, okay, maybe we're not going to do away with ivf, but maybe we could take a, both and approach and say rather than just jumping straight to IVF as kind of the first thing that's offered to couples having difficulty conceiving who are obviously in a very painful and anguishing circumstance if they want to have a child, why don't we put more resources in science and medicine toward trying to understand, diagnose and correct the underlying causes of infertility. I think that's something your audience can readily grasp. 100 because, you know, you, you've, you've drilled down on your show on many of the problems associated with our contemporary healthcare practices and you know, sort of patching up problems with band aids in a sense. IVF doesn't treat infertility. It simply doesn't end run around infertility. A treatment for infertility would be whether the man or the woman is having is the source of the problem with difficulty conceiving. What can we do to correct that underlying problem so that they can, they can conceive a child the natural way, the old fashioned way, the much more fun, less invasive and intrusive way. So I would be an advocate. I think a realistic program that people on both sides of this debate could get behind is let's get some sensible regulation around IVF and let's put more resources into restorative reproductive medicine and help people understand that maybe IVF isn't your only option. Maybe there's some other ways that medicine and that good, you know, healthcare practices can help you achieve what you want to achieve, which would obviously be a good, a good and beautiful thing to have children.
- [39:37]
Alex Clark
Is there a class injustice in how we approach infertility?
- [39:41]
Dr. Aaron Kotti
Absolutely. I mean, ivf, you know, one of the dirty little secrets of the industry is that it caters to people who can pay for it. Right. Very often not covered by insurance. People are paying minimum $15,000 per cycle, sometimes having to go through multiple cycles.
- [39:57]
Alex Clark
So when I hear you say that, we talked about the eugenics in gender selection and disabilities and all those types of things, but there could be almost a sneaky underlying form of eugenics in that really only certain classes of families who can afford this technology can reproduce. And that people who are in poverty cannot afford this technology. They're not reproducing.
- [40:23]
Dr. Aaron Kotti
Yeah, I think there's a lot to that. You know, basically IVF is offered to people that can pay for it. And the genetic testing that often goes hand in hand with ivf, which is used not just for sex selection and not just to try to eliminate genetic diseases, but many companies are. Are pitching it now to try to. You know, we can't do this perfectly, given the complexities of genetics, but to try to increase your odds of getting the kind of desirable traits that you want. These are services that are offered to the wealthy. So I think there is. There is a form of class discrimination when it comes to these assisted reproductive technologies. I mean, the other example of this is that the women who are being used as surrogates, right, the woman who carries a child inside of her for nine months and then goes through labor and gives birth to that child and is, according to the surrogacy contract, never even allowed to touch that child after she gives birth to it. I mean, can you imagine going through labor and hearing that baby crying and then never seeing or touching that baby again? We know that there's a lot of bonding that happens during pregnancy. We know that the child turns preferentially to the pregnant mother's voice because it learns the voice as an unborn child learns that voice, begins to bond to that. To that mother in very, very profound ways that were. That we barely understand. We're severing that bond with a surrogate and putting her through the risks of pregnancy and in some cases, exploiting her in other ways. And the women who do that, do it usually for money, right? So again, they're gonna come. They're gonna come from a class of women who are economically more vulnerable and therefore would sell their. Their body in this way to be used in this way, typically to a wealthy couple that does it, you know, maybe for medical reasons, but sometimes just simply for reasons of convenience because, you know, I don't want to go through the ordeal of pregnancy myself, so I'm going to hire someone else to do it. So you see all kinds of interesting class based issues around justice and equality when it comes to something like surrogacy as well. That again, is one of those kind of issues that's swept under the, the carpet when people focus only on the outcome of people getting what they want.
- [42:44]
Alex Clark
Sure. And I also think, you know, a lot of people hear that like, okay, yes, that's sad. A baby, you know, in the womb is bonding with that surrogate mother and their voice and all that. But they're a newborn baby, they're going to forget that in a couple of weeks and then they're going to be in a loving home. And so why does that really matter?
- [42:59]
Dr. Aaron Kotti
Well, it's, it's disruptive to their development, actually. And so this kind of attitude, one of the things that troubles me about the kind of casual way that people think about these technologies and think about these issues is the kind of easy, casual, dismissive way in which any harms or potential harms to the child sort of get waved away in exactly that fashion that you just illustrated with your question. And I actually find that very troubling because when you talk about a situation where children are involved, actually prioritizing the needs of the grownups is exactly the opposite of what a sane and humane and healthy society does.
- [43:44]
Alex Clark
Yes, right.
- [43:45]
Dr. Aaron Kotti
A sane society does not instrumentalize children to gratify the needs of parents.
- [43:50]
Alex Clark
Yes, right.
- [43:50]
Dr. Aaron Kotti
Parents act in a self sacrificing way, inconveniencing themselves, doing everything they can to minimize harms to children. But somehow with assisted reproductive technologies, and I think again, going back to what I said earlier about the way in which the process itself and the technologies themselves subtly instrumentalize the child, turn it into a product to be manufactured. Right. Rather than a gift to be welcomed that then leads, I think, and encourages this kind of casual, dismissive attitude. Well, yeah, I mean, what, what if it turns out. So what if it turns out that these kids have higher rates of health problems or they have attachment difficulties because they were ripped away from their gestational mother at birth. Right. At least they exist. Right. At least they're here. You know, the alternative is they wouldn't exist in the first place. Well, I find that attitude actually troublingly callous and a kind of reversal of roles where the job of the, the grownups in the room is to put the needs of the children first. And somehow with these Technologies, we've decided it's okay not to do that.
- [45:01]
Alex Clark
Is there a fertility technology that is both more successful and more ethical than ivf?
- [45:09]
Dr. Aaron Kotti
I think we don't know the answer to that question because most of the, most of the methods used for alternative means of dealing with infertility are not as well studied with ivf. But there is some early evidence that certain things with restorative reproductive medicine interventions at the level of hormones and correcting endocrine problems, there are sometimes surgical interventions that can be done, have success rates that are as good or better than ivf. So for example, a common cause of infertility is polycystic ovarian disease. And another common cause of infertility is uterine fibroids. And there are surgical interventions that can be done very often to correct these things without removing the ovaries, without removing the uterus, to try to actually restore reproductive functioning. In those cases, it's not always possible to do those surgeries. And there are not necessarily a lot of specialists that do those surgeries, but the ones who do are reporting actually very good outcomes. So I think again, this is an understudied, underappreciated, under resourced area within medicine. But the pioneers that are out there and the data that I've seen recently from some of their clinics suggest that larger scale studies and more intervention, more research on these interventions would suggest you could probably get outcomes that are as good, if not better than ivf. The, the, the actual pregnancy rates with IVF are not very good. About one third, or even in some cases less than a third of the IVF cycles that a woman has to go through will end up achieving pregnancies. And even after multiple cycles, some women spend tens of thousands or even hundreds of thousands of dollars on IVF and still don't manage to achieve pregnancy. So it's not the perfect solution.
- [47:03]
Alex Clark
I feel like what I keep seeing on social media are these women who are green lit to go through multiple rounds of ivf and then, you know, after so many times it comes out, oh, you have breast cancer or something like that. And I'm just confused. You would know more about this than me. But I just assumed that these fertility clinics, the IVF clinics, are doing all this testing to see, like, hey, is the reason you're not getting pregnant is because your body is going through some sort of other thing. How was she able to go through all these rounds of IVF and the whole time she had breast cancer and that's why it wasn't working?
- [47:34]
Dr. Aaron Kotti
Well, sad to Say many reproductive endocrinologists, many of these specialists in infertility have become a kind of one trick pony where IVF is simply their go to, that is the, that is the foundation for the economic model for their practice.
- [47:49]
Alex Clark
But that just seems unethical. Like shouldn't they be going through different testing to see if there's something else preventing pregnancy before telling someone to spend 15, 20, 30 grand?
- [47:57]
Dr. Aaron Kotti
You would think so. And that, that would be an ethical, much more ethical way to practice medicine. But unfortunately in many cases it's not. IVF becomes a kind of just knee jerk. Let's, let's run a few basic lab tests, right, to see if there's some sort of obvious problem that would have an easy solution. And if we don't find something in that regard, we're just going to sort of run run straight to IVF and the, the fertility industry, and I think it's fair to call it that the fertility industry, because it is an industry, it is a profit driven industry, has in many cases abandoned good. What I call Hippocratic medicine, which is, you know, let's do a thorough assessment. Let's you know, beginning with diet and exercise and self directed natural interventions, correct all the problems that we can correct, then go to other interventions like drugs and surgery as necessary, when necessary, used judiciously to try to correct the underlying problem before we jump straight to something like this, which again doesn't actually correct or treat the underlying infertility. It simply doesn't end run around it by conceiving the child through other means.
- [49:11]
Alex Clark
What is rrm?
- [49:13]
Dr. Aaron Kotti
So restorative reproductive medicine is sort of a, an umbrella term to designate not one particular intervention like IVF designates one particular intervention, but it's an umbrella term for, for basically a sort of disposition or philosophy of treating infertility that says we're going to dig into correcting the underlying cause.
- [49:37]
Alex Clark
Okay, so what we were just talking.
- [49:38]
Dr. Aaron Kotti
About, what we were just talking about.
- [49:40]
Alex Clark
So then my question is talking about the ally, like a lot of these IVF clinics, they should really be looking into this first and that there's ethical questions. Do you think that couples who have suffered through failed IVF cycles multiple times be able to sue IVF clinics who did not offer rrm?
- [49:58]
Dr. Aaron Kotti
You're gonna get, you're gonna get me in trouble for this. Yeah. I mean you could, you know, anyone in this, this country can sue anyone else at any time. So certainly, you know, I don't know if there are states whose malpractice lawsuits would capture that sort of scenario, most states rely on a rather vague concept called the standard of care to define what would count as malpractice. And one of the problems right now is that in their defense, the IVF clinics would just come back and say, well, the standard of care in this situation is ivf. And by that they mean what most other doctors around me are doing. Right? So very often the standard of care is not defined by the best available evidence or actually the most effective medical intervention, but it's defined by a kind of consensus of what institutional medicine happens to be doing. And, you know, without going too far down that rabbit hole, I think that's a problem with our legal definition. But if we could get the research and if there were a sufficient number of clinics that were doing restorative reproductive medicine and showing that it was less invasive, as successful, if not more successful than ivf, and didn't come with the whole host of complicated ethical issues, some of which we've talked about, some of which we haven't covered, if that could be sort of demonstrated, then you would have a basis for going back to some of these clinics who are not offering that and saying, basically, this is a form of malpractice. But I think until we have that, you would have an uphill battle in the courts. But, you know, I mean, there may be folks out there that want to road test some of those lawsuits and see how the court responds. But I think we're going to start seeing the growth of restorative reproductive medicine. There's. There's a demand for it.
- [51:43]
Alex Clark
Well, and that's also, I mean, I know personally that that is one of the focuses of the MAHA movement or coalition, that there are amazing people like midwife Lindsay Milis and some others who are really. They've kind of been put in charge by Bobby Kennedy to really, let's look into infertility in this country. Let's look into what is causing pcos, what is causing endometriosis, doing some studies and some testing and really putting the science to that so that hopefully there is more information so that people don't feel like their only option is, you know, big fertility industry, as I like to say. So if somebody were to go to you and say, doctor, you know, I'm. I'm desperate. I want a child more than anything. I don't want to do ivf, but I don't know what my other options are. I mean, a personal friend, family member to you. What are you suggesting they do?
- [52:29]
Dr. Aaron Kotti
I will refer them to a local specialist who will try to practice restorative reproductive medicine. I'll give a shout out to my friend Dr. Lauren Rubal. You should probably have her on the show tell me about these issues at some point. So she's very interesting. You know, Lauren, you know, at one point in her career and she's, she's talked about this, this publicly practiced ivf and then she basically got to the point where she said, morally, I don't want to do this anymore. She started seeing some of the ethical problems associated with it and felt conflicted about it and, and changed her practice, which is, you know, serious kind of professional and financial risk for someone in that, in that industry to start practicing. At the time this term hadn't quite come into vogue, but essentially practicing restorative reproductive medicine. She's doing very good work. And there are other others out there that, you know, you mentioned, a few of them that are doing very good work in this area. So that would be my first go to.
- [53:27]
Alex Clark
And that's Dr. Lauren who?
- [53:28]
Dr. Aaron Kotti
Rubal.
- [53:29]
Alex Clark
Rubal. And where is her practice?
- [53:31]
Dr. Aaron Kotti
Her practice is in Orange County, California, where I live.
- [53:34]
Alex Clark
All the good doctors are in Orange County.
- [53:36]
Dr. Aaron Kotti
Well, you know, you got to come out and visit us.
- [53:38]
Alex Clark
Dr. Bob Sears, you've got Dr. Leon Keneally. Like there's so many great people over there.
- [53:45]
Dr. Aaron Kotti
There are some great physicians around. Yeah, Dr. Sears is, is another friend. He's, you know, he's been kind of practicing medicine according to this, this philosophy for many years. So yeah, yeah, yeah, there's good people out there. You just have to know where to look and how to find them.
- [54:01]
Alex Clark
Are only non viable embryos what are being destroyed in the IVF process?
- [54:07]
Dr. Aaron Kotti
No, no, no. Many healthy viable embryos are being destroyed in the IVF process. Probably more of those than embryos that would be considered unhealthy or I don't like this term, quote, unquote defective in some way. So it's, it's very important for people to realize that these are human lives that are just never given the opportunity to basically live a full human life.
- [54:30]
Alex Clark
Is there a concerted effort by American doctors to hide the scientific evidence that children born via IVF have a significant higher risk of health issues so that they do not jeopardize a billion dollar industry?
- [54:43]
Dr. Aaron Kotti
I think there's a concerted effort simply not to look. There are multiple ways to hide things. One is to take evidence that already exists and bury it. We do have some evidence and generally what's happened now is that evidence is either ignored or it's dismissed as inadequate. Okay. Well, if you think the evidence is inadequate, at the very least it's suggestive. Right. One study in science never proves something. You always need multiple studies. You need replication, you need to look at, you know, an issue from multiple angles. It's the cumulative weight of evidence that allows us to draw conclusions. So if your conclusion, looking at the limited evidence now is that there's not enough evidence to actually prove these adverse health consequences, well, the sensible thing to do is to say, well, it's at the very least, at minimal, it's suggestive evidence and we need to research it more. And so essentially what's happening is kind of a refusal to fund this research. And you know, I mean, there may be behind the scenes efforts to try to avoid allowing research that has been done in this regard to get published. I don't have specific examples of that to cite, but, but I can say that the peer review process of journal publication is sometimes, let's say politicized, especially on a hot button.
- [55:56]
Alex Clark
To like drag their feet.
- [55:57]
Dr. Aaron Kotti
Yeah. Or to, to reject a perfectly sound paper on, on a pretense, you know, to, to find fault with its methodology when in fact its methodology is good and to, you know, claim that you're rejecting it for this reason, whereas in fact you're really just rejecting it because you don't like its conclusions.
- [56:14]
Alex Clark
Probably happens a lot with vaccines.
- [56:16]
Dr. Aaron Kotti
It ha. It happens a lot with vaccines. It happens a lot with, actually with, with many areas of medicine where the results would be inconvenient to a profitable industry.
- [56:30]
Alex Clark
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- [59:33]
Dr. Aaron Kotti
I think it's a terrible idea. You know, it's well intentioned. The pronatalist stance of this administration, the encouraging Americans to have more babies because we're, we're, we're below replacement levels, is that's a good thing. I'm, I'm very sympathetic to that. I think we are not having enough children for a healthy society. And a society that is at below replacement levels of birth rate is headed for economic and social disaster. You're not going to have enough young people to care for aging people. It's just one of the many problems that will be created by this demographic collapse. But we're never going to basically correct that deficit through assisted reproductive technologies. First of all, it's too cumbersome, it's too expensive, it doesn't work well enough. And I think if the administration wanted to put its energies toward encouraging people to have children, there's many, many better policy proposals.
- [60:28]
Alex Clark
What would you say if you could.
- [60:30]
Dr. Aaron Kotti
Choose, well, make it easier for people financially to have children? I mean, you could take her with a tax code and all kinds of interesting ways, child tax credits, you know, help with childcare. There's a lot of really sensible family policies that this administration could have gotten behind. My colleague at Ethics and Public Policy Center, Patrick Brown and others have proposed many, many helpful family policies in that regard that could encourage people that want to have children but feel like they can't afford them to basically make it a little bit easier for them to afford children. Make birth free is one of the proposals that's been done in some European countries that could easily be done here at a fraction of the cost of paying for ivf, for example, and then putting money and research dollars towards restorative reproductive medicine, something that doesn't destroy human life in its earliest stage of development, that doesn't involve the creation and destruction of human embryos, which is going to be ethically controversial and which roughly half of Americans are going to have some sort of problem or reservation with. So I think the intention behind that executive order was good, but I think the particular means that it's encouraging is not the right way to go about solving, you know, the problem of too few children.
- [61:45]
Alex Clark
I'm so curious, as a fun question, you're a doctor who has just been through the wringer legally, and if you had like one to two minutes in an elevator with Bobby Kennedy, what would you say to him about like, what you hope he is prioritizing and working.
- [62:01]
Dr. Aaron Kotti
On, you know, Bobby's a friend. So I've had. I have had minutes in the elevator, oh, great. With Bobby. And, you know, I mean, there's many, many policy proposals that he and I agree on. And one that was in the last chapter of my previous book, the New Abnormal, was basically direct to consumer advertising of pharmaceuticals. We are one of two countries in the world that permits that. New Zealand is the other country. People from anywhere else in the world look at, you know, our commercials on tv, ask your doctor about Viagra or whatever, and they think this is totally insane. Why are we marketing pharmaceutical products directly to consumers when doctors are the gatekeepers for these. These drugs? This does a couple of things. One, I think it leads to over prescription and over medication, and that leads to what's called iatrogenic harm, basically harm that's induced by medical interventions. That's a serious problem right now in the United States. But it also gives Big Pharma undue power and control over media companies, because when 75% of your advertising revenue at a major news network comes from Big Pharma, you're not going to run stories that are critical of that industry. And so it allows for the easy capture of basically the news media, then is hamstrung and unwilling to dig deep into the kinds of issues that you talk about. For example, on your show, which I assume is not sponsored by Pfizer.
- [63:28]
Alex Clark
It is not.
- [63:29]
Dr. Aaron Kotti
So. So that. That's one of the policies that, that I proposed a couple of years ago that I was happy to see Bobby take up. He's been talking about that recently. Removing liability protection for the manufacturers on vaccines is another really important policy. And we could go down a huge rabbit hole talking about vaccine. But look, if there's one policy that, again, I think people on both sides of vaccine debates should be able to agree on, I think one policy that would immediately improve vaccine safety is removing the liability protections. Yeah, Pharmaceutical companies actually know how to run good clinical trials. And when they're forced to do so, they will run good clinical safety trials. A company like Pfizer, not to pick on one company, any pharmaceutical company does not want another disaster like Vioxx. Vioxx was a drug that was given for rheumatoid arthritis that they buried some of the safety data or ignored some of the safety data in the clinical trials, turns out, later caused cardiac problems. They pulled it off the market. They paid tens of billions of dollars in fines and damages to that because they were liable for something that they could have and should have known that they chose to ignore if that, if something like that happens with a vaccine. And many people are arguing those kinds of things do happen with vaccines needs, but you're not allowed to sue the company. There's not that corrective mechanism. So the company is going to run sloppier clinical trials not because they don't know how to run good clinical trials, but because they don't have to. In this case. They can cut corners.
- [65:00]
Alex Clark
Why, why did Ronald Reagan make this?
- [65:03]
Dr. Aaron Kotti
The lobby somehow convinced the administration and Congress at the time and President Reagan that vaccines would be insufficiently profitable if we did not do this. Which I think is a, it's completely insane notion. It's one of the most profitable industries. If you get a vaccine on the CDC childhood schedule, you basically have a permanent cash cow for decades for life, for the life of the patent of, of that vaccine. So it was, it was an ill conceived policy to begin with. And if we corrected that, I think there would be immediate improvement and basically the lawyers would take care of a lot of these, these issues. And this is a common mechanism of consumer protection. The, the example I like to use for, for people who are vaccine enthusiasts and don't, you know, don't think there's any problems here is well, at least on, on this issue of liability, let's suppose you were buying a car and let's suppose Congress passed a law where car manufacturers, Toyota or Ford or whatever, reliable for the harms or the safety issues on all their cars except their minivans. You know, you could sue them if the seatbelt malfunctioned or if the car blew up at a fender bender, but not for their minivans. Would you trust their minivan? Would you purchase that particular product from Toyota? No, you wouldn't. Does it automatically mean the minivans are unsafe? No, but just this is one of the things that increases our confidence that the company's going to act in a responsible way and not allow the problem, profit motive, for example, or other motives to undermine making a good safe product. So this just seems to me to be a sensible policy that the current administration really ought to enact.
- [66:45]
Alex Clark
What new fertility technology is coming down the pipeline that should absolutely disturb couples who are wanting to have a baby.
- [66:54]
Dr. Aaron Kotti
There's a new technology coming down the pike that should concern not just couples wanting to have babies, but should concern all of society because of its profound social implications. And that's the technology known as in vitro gametogenesis, which is a bit of a mouthful. IVG for short. So everyone's heard of ivf. Most people have not heard of ivg. IVG is sometimes referred to as artificial gametes. That's basically taking a cell in the body other than sperm or eggs, other than gamete cells, skin cells, for example, and genetically programming those cells so that they become gametes. So taking your skin cells and turning them into sperm, Taking my skin cells and turning them into eggs. And I deliberately mixed up what you might expect there because you're a woman and I'm a man. But actually, this technology could be used in that way so that, for example, it's being celebrated by many in the LGBT community because this could potentially allow two men to have a genetically related child or two women to have a genetically related child if you can create sperm from women or eggs from men. So that's one of the things that it's being proposed for. And by the way, I should note at the outset, this technology is not yet available in human beings, but there are researchers doing this in mice and in other mammals. So researchers have successfully created ova, have successfully created eggs using this technology in mice, eggs that can be used in IVF for mice. So this is close to being available in other mammalian species, which means probably in principle, there's no reason why it won't be available for human beings probably in the near term future. So sober researchers doing work on IVG are saying, and I think not unreasonably, perhaps in the next 10 years, this could be available for use in human beings. So I, I mentioned the possibility of same sex couples having a genetically related child, which would obviously create a new kind of human being that does not have a mother or does not have a father. And even, even children that are raised by same sex couples now were obviously created by some other means, but by IVF or through adoption. Every child living in the world now, every person living in the world now has a biological father and a biological mother. So what would it mean for our sense of lineage and identity and the relationship between generations to have a human being that did not have a mother, did not have a father, created out of nothing, created essentially out of two people of the same sex? It gets even weirder from there. So some advocates of IVG are proposing what they call multiplex parenting. Let's suppose you had four people that wanted to have a genetically related child of any combination of sex. Take two of that, Take two of that. Four, take their skin cells or take their gametes, create an embryo, take the other two, create an embryo, extract embryonic stem cells from Both of those two embryos, using ivg, create sperm and eggs from those embryos, create yet a third embryo, discarding the first two embryos, bring that third embryo to birth. You have an embryo that's related genetically to all four of those original people. Technically, that embryo is the grandchildren of those four people, biologically speaking. But the child's parents were simply embryos that were created and destroyed in a laboratory. And in fact, you can run that cycle theoretically many times over, from embryo to embryonic stem cell to gamete, to creating another embryo on down four or five times, then bringing that embryo to birth and creating a human being whose parents, grandparents, great grandparents, great, great whatever, were all embryos that were created and destroyed in a laboratory, that they have no living existing relatives who have lived a full, flourishing human life before conceiving them. So taking the, the generations and compressing them in space and time, if you will. And one of the problems with IVG is that we just, we don't even have the, the categories, the language to begin thinking through the implications of, of what this means for the radical restructuring of family and familial ties, the relationship between generations, one sense of identity. I mean, we're basically talking about a Promethean project of creating human beings in ways that we, I think we, we can't even begin to wrap our heads around the implications of this. And there's other weird scenarios that this would, that, that, that this would make possible as well. So, you know, imagine, imagine the maid at the hotel where Brad Pitt is staying wants to have Brad Pitt's baby, but she fails to seduce him and have his baby in the old fashioned way, no problem. After he checks out, she can just go to his pillow and scrape some of his skin cells off the pillow and bring it to a rogue IVG clinic and have his sperm made out of those skin cells.
- [72:33]
Alex Clark
That's like genetic theft.
- [72:35]
Dr. Aaron Kotti
It's so the possibility of this kind of genetic theft, the possibility of someone having a genetically related child out there that was conceived without their knowledge and consent.
- [72:47]
Alex Clark
That's disturbing. Very disturbing and terrifying. And I can't imagine. Sorry, but even progressive leftists who would be all for, you know, two men or two women having a baby this, this way. Like Taylor Swift, for example. Taylor Swift. This would. I just, I am like her biggest fan. Even though we see nowhere near eye to eye politically.
- [73:08]
Dr. Aaron Kotti
Okay, I'm gonna tell you a secret, but I like a lot of Taylor Swift's music too.
- [73:13]
Alex Clark
All the good ones do.
- [73:14]
Dr. Aaron Kotti
Don't tell my boys I said that.
- [73:16]
Alex Clark
All the good ones do. But like, like, this is exactly. She's so scared of stalkers and these different things. I totally could see her being like, this is now my new biggest fear is that one of my crazy fans could. Yeah, I write them a note or I shake their hand and then, you know, they're getting skin cells and then they're creating children with my DNA. I feel like this technology, everyone would be lobbying for it and really all for, for the LGBT perspective.
- [73:41]
Dr. Aaron Kotti
Yes.
- [73:41]
Alex Clark
But then when you get into that part, I feel like we're going to hit some bumps, hopefully from a legal standpoint.
- [73:48]
Dr. Aaron Kotti
I sure hope so. I mean, I would advocate for a total ban, a total moratorium on ivg, because I just don't think it's gonna, It's a project that's going to turn out well, but it will be sold even, even to conservatives who may have concerns about, you know, same sex parenting or generation of children. It's going to be sold with the wedge case, the, the, the heart rending case of the woman with cancer whose ovaries were removed. And, you know, she's married in a stable family and, you know, she's going to raise her kids with the values that you would raise your kids with. And is, wouldn't it be beautiful if she could have a child and since she doesn't have any eggs left because of her cancer, we could just take some skin cells and create. So that's going to be the opening case. It's not going to be the LGBT case. It's not going to be the, you know, multiplex parenting case. It's not going to be the genetic theft possibility. It's going to be the, you know, the case that, that everyone is going to have sympathy for from the medical world.
- [74:47]
Alex Clark
You understand how this stuff works more? I mean, I don't. So, like something like this where we're in the beginning stages of just testing this on mice and all of that.
- [74:54]
Dr. Aaron Kotti
Yeah.
- [74:54]
Alex Clark
What is a realistic timeline? Like, this is something like, look for it in 40, 50 years, look for it as little as 10. I mean, how does it work?
- [75:01]
Dr. Aaron Kotti
I think it's very, very possible. You never have a crystal ball in science.
- [75:05]
Alex Clark
Sure.
- [75:06]
Dr. Aaron Kotti
You know, prognostications about how long something is going to take are often very wrong. But it's. I would say I would not be surprised if this was available in humans in the next 10 years.
- [75:17]
Alex Clark
Oh, my gosh.
- [75:17]
Dr. Aaron Kotti
So it's not something way, probably. It's not something way down the road. It's something that will be with us Here soon. It's something that we need to start thinking about now because there's some people working very, very hard at this, and people are publishing research articles on this in the medical literature and also in the bioethics literature. I mean, this multiplex parenting was published several years ago in a bioethics journal from people advocating that. Wouldn't this be a wonderful thing? This is something that's probably not too far around the corner.
- [75:47]
Alex Clark
Do you watch Severance?
- [75:48]
Dr. Aaron Kotti
I have not seen Severance. People keep recommending this show, so I need to.
- [75:52]
Alex Clark
This is. Well, it's going to be your number one favorite show because this is literally the whole premise of the show is this type of stuff. Because it's the bioethics of. Well, wouldn't it be great if we could just create, like, this subset of human beings? It's like your mirror person. Exactly. And they go to work for you and you don't. But the thing, the ethical thing. And in the show, there's, like, protesters of should we allow severance in America? Should we not? The problem is that this other human being, which is your counterpart, that goes to work for you, they never leave the workplace. They are you, but they're trapped down here. And so they have dreams and hopes and aspirations of what is it like outside? You know, I wonder what my real family is doing, what my real outer self is like as a husband, Do I have kids? Like, they don't know anything about their Audi, the person on the outside of work. And so it's this ethical issue of, like, could we. We have this technology, we could create somebody. Wouldn't be great to be able to shut off and sever, you know, your work issues versus your family issues and whatever. But what you're talking about so reminds me of that show in that, you know, we could create these types of human beings, but it's like, you know, is it right? And the ethical issues of, you know, if they are another human being, then don't they deserve, like, the full gamut of human rights and, you know, taking things from them, like their lineage and knowing where you come from and having a biological mother and a biological father. Like, are all of these things human rights or are they not? And I don't know, it just reminds me of that show.
- [77:19]
Dr. Aaron Kotti
Yeah, there's a principle in ethics that. It sounds like very beautifully illustrated by this show, which. Which is illustrated in terms of violating this principle known as the. The personalist principle. And it goes back to a philosopher named Immanuel Kahn. And one of the formulations Is basically, you have to treat other people always as ends in themselves and never as a means to another end. So I talked earlier about instrumentalizing people. What does that mean? That means basically taking someone and using them for an extrinsic purpose. I'm creating this human being to do the untidy or undesirable aspects of my life that I don't want to do. I'm instrumentalizing them. I'm not treating this person as an end in themselves with their own aspirations, hopes, dreams, dignity, freedom, hopefully that the rest of us enjoy. But instead, I'm creating them for this purpose. So, you know, with ethical issues like cloning, it becomes, you know, it becomes clear that if we were to clone human beings, that would introduce certain expectations on those human beings simply because we created them to be like someone else. Right. What do you mean you're not interested in playing basketball? You're a clone of LeBron James. That's the whole thing was to get another really good basketball player out of this project? Well, I don't, I'm not interested in basketball. I'm interested in ballet, you know, so leave me alone. Right? That's. All of these assistive reproductive technologies that we've talked about so far from IVF to IVG have the, the very real potential and pro and likelihood of leading us in that direction of basically instrumentalizing other people for our purposes rather than treating them as their own distinct individual with, with dignity that deserves respect, regard the same freedom and rights as the rest of us.
- [79:16]
Alex Clark
You hold a lot of opinions that are really countercultural and controversial to most socially, really.
- [79:23]
Dr. Aaron Kotti
I thought, I figure everyone, everyone just thinks about these things in the way that I do.
- [79:28]
Alex Clark
But what you have on your side is truth. And that while it may be uncomfortable or inconvenient to hear the things that you said today in this interview, the facts are on your side. So my question is for you from just a human perspective, especially for my listeners that really lack the courage or confidence to be able to share these views with friends and family members, even though they know that they agree with you, but they're like, I just can't tell my sister who did IVF that I feel this way. Or I, I, I don't know how to explain, you know, to my friends that even though I'm going through infertility, that I will not be pursuing those technologies to have a child. Like, where do you gain that confidence and what encouragement or advice could you give them when faced with that situation?
- [80:10]
Dr. Aaron Kotti
Yeah. So, I mean, you can, you can make Me the bad guy and just send them this podcast. Hey, this is interesting. I don't know, you know, tell me what you think of it.
- [80:19]
Alex Clark
I always tell them to, like, well, I share, say share this episode. And don't even say that you agree. Just be like, wow, this was crazy. What do you guys think? Don't even say anything.
- [80:28]
Dr. Aaron Kotti
You can always, always make me the bad guy. But I would say, you know, these kinds of difficult conversations, you know, try to begin with a point of understanding and agreement. Right. Try to try to first find some common ground and help the other person feel understood. And then on the basis of that, maybe introduce something that might challenge the other person to think. So, for example, with ivf, IVF is a really neurologic issue, very difficult to talk about. But one common starting ground is, isn't new human life? And wouldn't be, you know, wouldn't having a baby be a great thing? Yes, I totally agree with you on that. And isn't infertility a really painful and anguishing thing for people? And shouldn't we as a society be doing more to address that? Yeah, I'm totally with you on that. So maybe introduce where, you know, I understand your. Your reasons for this. I understand your intentions, I understand your sort of your motives, and I'm sympathetic to that. But now let's think about the means that we're. That we're using. Do. Do you realize that in most cases of IVF there are embryos that are put on cold storage or that are destroyed in the process? Have you looked at some of these complicated IVF cases where the disposition of these embryos creates difficult legal problems? Have you thought about this aspect of gestational surrogacy that maybe you hadn't considered before? So begin with common ground, and then if. If it's someone that you think is going to react really negatively, sometimes just asking a pointed question is better than, you know, making a strong and sort of overbearing.
- [82:11]
Alex Clark
Yeah, like, put it on them to defend it.
- [82:13]
Dr. Aaron Kotti
Exactly, Exactly. Well, what about this? Or have you considered that for most people, a really thoughtful and incisive question might feel less threatening than, I'm coming down hard with my conclusion or sort of. You're going to feel like I'm moralizing to you if I'm telling you, don't do this thing that you want to do? So I'll be the first to acknowledge that these are difficult conversations. And, you know, it's easier for me to have a conversation with you about this if, you know, if we have Some common ground. But if there's a hostile interviewer in the room, you know, I might. Might approach this differently. I may be a little less strident in my conclusions, but at the same time, I think we don't want to be so careful. And so we want to be congenial, but we don't want to be so careful that we lack the daring to challenge some of these things. It is important also sometimes to take risks and tell the truth, even if the truth is inconvenient, even if it's going to cost you something, even if the other person, you know, might feel a little bit threatened by it. So you try to do that in a way that can be received by the other person. But also there are circumstances in which I think sometimes people are too timid and they back away. Just, I. I don't want to offend anyone, and I don't want to get on the wrong side of this person. So I'm not going to say anything. And, you know, bad things happen when good people fail to speak out.
- [83:42]
Alex Clark
Yeah, we saw that in the pandemic.
- [83:43]
Dr. Aaron Kotti
Exactly.
- [83:44]
Alex Clark
And you spoke out.
- [83:46]
Dr. Aaron Kotti
I did. You know, and it, you know, I lost some friends and it cost me my job at the university when I challenged their vaccine mandate in federal court. But I don't regret doing it. It was one of the best decisions I've ever. I've ever made. And, you know, there's nothing better than waking up in the morning with a clear conscience.
- [84:03]
Alex Clark
If you could offer one remedy to heal a sick culture, and that could be physically, emotionally, or spiritually, what would it be?
- [84:10]
Dr. Aaron Kotti
Well, we need to start connecting with one another face to face. There's a lot of loneliness in society. There's an epidemic of loneliness, and it has profoundly adverse consequences on us psychologically, spiritually, and physically. The health consequences of loneliness are very profound, comparable to smoking two packs of cigarettes a day on things like heart disease and cancer. So we need to get away from our screens and start connecting with one another face to face in real communities of people encountering. I love that we're doing this interview in person. It's so much better than so much better on a screen. So, yeah, thank you for flying me out to Phoenix here to be with you. It's a little less convenient, but it's a lot more engaging and real. So that is one piece of advice. Get away from your screens and connect with real people in face to face encounters. And I think we're a culture that has lost touch with God, so we need to reconnect with God through prayer as well. People have a hard time being in silence. We're surrounded by noise. And so spending some time every day in silence, in contemplation, away from the devices and away from the noise and away from the things plugged into our ears, I think is also important for psychological and physical and spiritual health and, and sanity.
- [85:38]
Alex Clark
Where can people follow you on social media?
- [85:41]
Dr. Aaron Kotti
So I'm on X. Aaron Kotti, MD. I am on substack. I have a substack called Human Flourishing that I post regularly, once or twice a week to that my articles and my interviews are all found there. Aaron Cariotti.com is a website that I have that has prior interviews and articles as well.
- [86:03]
Alex Clark
And where you can buy your books.
- [86:04]
Dr. Aaron Kotti
Yeah, you can buy my books too. So I'll plug the books. The last book was called the New Abnormal and it was about some of the things that were rolled out during COVID And more importantly, it's not so much a retrospective on the pandemic, but how those things are going to be used in the future to undermine our civil liberties. And my next book is on contemporary healthcare and medical education. It'll be out in September. It's called Making the Cut. So I don't think it's available yet for pre order, but probably in a couple of months.
- [86:32]
Alex Clark
Well, Dr. Kirioti, this was one of my most favorite interviews of the year. So thank you so much for coming on Culture Apothecary.
- [86:39]
Dr. Aaron Kotti
I enjoyed it.
- [86:43]
Alex Clark
Not to toot my own horn, but tutor, tutor. That was a groundbreaking, phenomenal episode if I do have to say so myself. Like I couldn't stop thinking about this for days afterwards. I just loved this conversation. I'd love to have Dr. Aaron back because I don't know, it's just fun for me to get to interview people who are so smart, like way smarter than me on these topics. And I knew how I felt about certain reproductive technologies and you know, different services or whatever that are available to people that are wanting to become parents. But hearing the way he puts it just from like an evidence science based backing was so helpful for me to hear if you enjoy this show even if you hate this episode because you disagree. Leave a five star review, say that you appreciate us having different points of view to kind of help challenge you and learn something new. We are on a mission to heal a sick culture twice a week. I'm Alex Clark and this is Culture Apothecary.