To the Editor: Conflicts of interest pervade medicine with sometimes profound repercussions. The unethical recruitment of oocyte donors, for example, reported by Aaron Levine in “Self-Regulation, Compensation, and the Ethical Recruitment of Oocyte Donors” (Mar–Apr 2010) threatens medical professionalism, societal trust in medicine, and possibly the health of young women. Levine shows that in violation of fertility industry standards, donors with high SAT scores are often paid more than those with lower scores. Such payments are deceptive and ethically problematic because neither intelligence nor SAT score is proven to be genetically transmitted. Moreover, some question the value of aptitude and intelligence tests because of inherent biases toward people with particular educational, socioeconomic, and cultural backgrounds.
While intelligence cannot be accurately measured or predicted, genetic prescreening can predict the probability of transmission of certain genetic abnormalities before clinical symptoms or diagnosis occurs. In spite of the potential benefits to recipients and offspring, prescreening has financial and ethical costs. Uncertainties about prescreening include questions about the clinical significance and interpretation of results, whom findings may be shared with, and how this information is communicated. Disclosing these uncertainties to potential oocyte donors would cause some to back out.
Levine shows that a subset of the fertility industry is violating ethical standards for remuneration. This suggests that other violations and deceptions may be occurring within the industry. Potential donors are typically college-age students unlikely to anticipate the distress some of them will feel years later about the child they contributed to but may never know, or the loss they may feel decades later if for some reason they never have a child of their own. Few imagine that they may have or transmit a genetic abnormality, or that such transmission may lead to future inquiries by recipients or offspring about the donor’s medical and family history.
Those in the business of promoting or conducting fertility treatments have little motivation to ensure that donors fully understand the physical and emotional stresses of fertility treatment, the absence of data regarding long-term health impacts, or the probability and repercussions of having an undiagnosed genetic abnormality. The financial and other interests of donor agencies and physicians involved render it unlikely that this information is routinely disclosed to and understood by potential donors, or recipients, during the informed consent process.
Cheryl Cox Macpherson
St. George's University
School of Medicine
To the Editor: We applaud the Report for its recent set of essays on sports (Mar–Apr 2010). These essays attempt to address the complex issues and challenges that competition in sports can raise to ensure that all athletes are provided an appropriate opportunity to excel in a manner understood to be “fair.”
Collectively the signers of this letter have been engaged for more than twenty years in just the sort of effort regarding “gender verification” (or, more appropriately, sex verification) of athletes competing in high-level, women-only events that Alice Dreger mentions in her essay, “Sex Typing for Sport.” Collectively we represent acknowledged expertise in the understanding and treatment of disorders of sex development, as well as the governance—and politics—of international sports and the women’s sports movement. Two of us (AL and EF) are former Olympians, and one (AL) is chair of the International Olympic Committee’s Medical Commission and former chair of the International Association of Athletics Federations. The other (EF) is a member of the IOC’s Women and Sport Commission. Reports from our group have been published in medical journals such as the Journal of the American Medical Association and the Lancet, and in sports specialty journals. Comprehensive reviews have appeared in review journals and textbooks like The Olympic Encyclopedia of Sports Medicine (AL). One member of our group (AC) has published a number of articles in popular media, especially those related to women’s sports, and has been a consultant for the U.S.-based Women’s Sports Foundation.
Thus, we find it regrettable that Dreger chose to ignore the long and...