Billy the Kid. Jesse James. Buffalo Bill. Wild Bill Hickok. We’ve all heard the names before: They’re the colorful and dangerous characters of America’s old “wild west” that have dominated U.S. cinema and television for decades. And that is where the connotations of entertainment end.
Today, whenever an emerging trend – usually something in technology or medicine – expands into uncharted territory, outpacing regulation, you’ll hear it being referred to as the “wild west.” (Think cyber-stalking or dietary and weight loss supplements.) The field of reproductive medicine and all it entails, especially in the U.S., is another potential example.
The U.S. remains virtually the only developed nation in the world that has no national policy on assisted reproduction. Since the emergence of the field 40 years ago, the federal government has not funded, regulated, prohibited or approved any reproductive technologies or practices, including vitro fertilization, sperm, egg and embryo donation, gestational carriers and surrogates.
“Societal conflicts involving reproductive technology – often politically and religion-based – are so deep and divisive that as a nation, we’re unable to find common ground,” said Wanda Ronner, MD, professor of Clinical Obstetrics and Gynecology at the Perelman School of Medicine, a gynecologist and medical student coordinator at Pennsylvania Hospital. “So it has been by default that we’ve allowed the market to determine access to reproductive services.”
Ronner and her sister Margaret Marsh, PhD, a distinguished professor of History at Rutgers University and fellow researcher and author, are collaborating once again to seek answers to how and why the current state of reproductive medicine in the U.S. developed and its effects on potential parents, egg and sperm donors, surrogates, researchers, health care providers, and society as a whole. Most important, Ronner and Marsh hope to devise possible solutions for change.
Funded by a three-year Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation, Ronner and Marsh are on their way to exploring the recent history of infertility, reproductive medicine reproductive and technology. “We’re both really excited to be working together again and hope our joint expertise in experiences from past collaborations will help us address the many looming issues surrounding infertility and reproductive medicine,” said Ronner.
When it comes to the sensitive and often polarizing topic of reproductive medicine and technology in the U.S., the divisions aren’t just political or religious, said Ronner. “They go straight to the core of what it means to be a family,” she said. “There are so many questions: Who gets to decide who has access to reproductive services? Should fertility be classified as a disease and, if so, should insurance cover it? Should reproductive decisions be made by individuals, regulated by professional organizations, state or federal law? Then there are issues of longstanding racial and socioeconomic disparities – all difficult but important questions my sister and I are looking forward to spending the next few years addressing.”
Ronner and Marsh plan to tackle these questions head on by offering a comprehensive historical perspective of the changing dimensions of infertility treatment and the unprecedented ways by which families can be produced using new reproductive technologies; identifying societal forces that affect patients, practitioners, donors, gestational surrogates, insurance providers, and legislators involved in reproductive decision-making; exploring how reproductive research and practice have shaped and been shaped by changes in medical practice, gender roles, family life, marriage, socioeconomic class, and race; and by using these findings as a basis for making recommendations on policy and practice.
During the three year grant period, Ronner and Marsh intend to complete a book geared toward a broad audience of policy-makers, legislators, medical practitioners, potential patients, and the public. Also during this time they plan to create a project website, lecture to both professional organizations the public, and produce journal articles for publication.
Ronner and Marsh previously co-authored two books: The Empty Cradle: Infertility in America from Colonial Times to the Present and The Fertility Doctor: John Rock and the Reproductive Revolution. Both books were funded by research grants from the National Endowment for the Humanities.
The Robert Wood Johnson Foundation Investigator Awards in Health Policy Research provides funding to highly qualified researchers to study current U.S. health care and policy issue challenges. The awards were created in 1992 to “enhance society's understanding of significant problems and policy issues related to the health and health care of Americans and to provide information that can help improve the formulation of sound policies.”
Image: Wanda Ronner, MD, left, and her sister Margaret Marsh, PhD.