 I'm so excited to be moderating this panel. I'll briefly introduce each of the participants here. So over here, I'm joined by Evan Snyder, who's on the FDA's Cellular Tissue and Gene Therapy Advisory Committee. And he's the director of the program in stem cell and regenerative biology at the Sanford Burnham Medical Research Institute. Over here, Deborah Spar, who is the president of Barter College and the author of the book, The Baby Business, How Money, Science, and Politics Drive the Commerce of Conception. And finally, we have Camille Hammond. She's the CEO of the Tanina QK Foundation. So thank you so much to all of you for being here. And as I'm sure has been noted, this is meant to be a discussion, so please feel free to jump in whenever you'd like. You don't have to wait for me to call on you. So Deborah, I'd actually like to start with you, because you make a point in your book that I think can help us frame this very big discussion. You suggested that the highly personal nature of the reproductive and conception technology industry has had a huge impact on the way businesses and governments behave. So what I mean by that is it's hard for us to talk about fertility treatments in the same way that we would talk about hip replacements, for example. And adding to that, there's this interpretation that some of these treatments and procedures are in some ways kind of putting a price tag on a child, so that makes it even more morally ambiguous. So in that vein, you noted after your book came out that since no one likes to think of children as existing in a market, we've been very wary of discussing costs. So can you talk a little bit more about that dynamic and how it has influenced the evolution of the industry? Sure, so thank you. And I'll just start with a very, very brief anecdote that I was relating to Camille and we were just chatting before. People always ask me why I wrote this book and the assumption is that there's a personal relationship to it, which is funny because I wrote previous books on the internet and diamonds and nobody ever asked me if I had a personal relationship to either of those. But I think there is a presumption in this area that you're here for personal reasons, particularly if you're a woman of a certain age. But I came to write this book for non-personal reasons. I had written my last book on the evolution of technology and I was looking around for the next technology that was about to evolve in an exciting way and I stumbled into this field. And at that time I was a professor at Harvard Business School and so I was used to talking to businesses who bragged about how much money they made. And then I went into the fertility industry and not only did nobody brag about how much money they were making, people just completely disavowed the fact that money was having anything to do at all with their undertaking. And I must, I found that fascinating. I thought, wow, this is the only business ever where people don't talk about money and yet the sums of money that were changing hands were massive and that was the impetus to write the book and it was a sort of bizarre and provocative book to write, to talk about reproduction through the commercial lens, through the economic lens. But I actually came away after doing all the research and writing the book thinking that not only was it a provocative lens, it was actually a very useful lens because I think, and I'm sure you all know this and have spoken about this, we get so queasy talking about reproduction both because it just raises the yuck factor and also because it's so deeply personal, it's so incredibly intimate and it raises so many deep ideological and philosophical issues, particularly in this country that we're not really comfortable talking about it politically so we don't. And my argument is not that it's had any effect on policy in this area, but if I did have the magic wand to make it stick, I actually think we should have more regulation in this area, we should have more rules and rather than trying to approach those rules philosophically or spiritually, which gets us all convoluted, we can actually use the lens of commerce which does work pretty well with things like hip replacements and I always use the analogy of cancer drugs, less personal, less intimate than baby making, but close. And so that's sort of my pitch for why this may not be the only lens to use but certainly a lens that should be part of the way in which we view this world. And actually on this regulation question, I wanna turn to you now, Evan. So we of course know that there's very little government regulation in this industry and yet there are some places where government has played a role. So this past winter you were part of a committee that looked into this new procedure known as mitochondrial transfer which we heard about in an earlier panel. But could you give us a quick overview of what the government is legally able to regulate right now and what kind of power the FDA has. And then bridging off of that, what do you think the government's role should be in regulating some of the treatments in this market? Fine. That's all. Having posed all of these questions, I should mention I'm probably here under false pretenses. I'm not really a government person. I'm not in regulation. I'm a scientist. I'm a physician. I'm a pediatrician actually. And I run a lab and a center. I was simply designated as the chairman of the FDA's Cell, Tissue and Gene Therapies Advisory Committee not because of my regulatory knowledge which has grown a little bit, but because I've been in the stem cell field and the gene therapy field and the regenerative medicine field for many, many years. So what I have learned is that my committee are really physicians and scientists who look at the data. And they simply, and we have no decision making ability. What we do is we look at the data and we advise the FDA based on the data whether or not something is safe, whether it's effective, whether the data's there to make a decision one way or the other, and what more needs to be done to be able to make an intelligent decision. So we look at the data the way we would look at a grant application or a paper submitted to us and we go through it and we suggest to the FDA the position they should take. I should also say that the FDA at least in my field which goes everywhere from academia to biotechnology is unfairly demonized. They are seen as the obstacles to healthcare or the betters of certain industries making money or not and they're not. They are also physicians and scientists who have decided to take a regulatory pass for their careers opposed, but they also will look at the data and make a recommendation. The highest bar is for safety and interestingly for this session that we had in I guess it was actually last spring, we were instructed by the FDA not to take into consideration any ethical or public policy implications in this. We are solely tasked with looking at whether the science justified moving ahead in a clinical trial and we looked at the data and we simply came to the conclusion that the preclinical data was not quite there yet. In terms of safety and then efficacy, we outlined a number of experiments that needed to be done preclinically meaning in animals and that what a clinical trial would look like if and when it ever got to that point. So having said that, again the FDA does have the ability to sanction or not sanction things, but it is not the same in this country as it is in the UK for example where this is absolutely, it's a big deal for them and they took a great interest in our deliberations because there they really need to change law. Here for whatever reason, and I think it's political and religious and all kinds of other reasons, the government actually took a backseat in the field of assisted reproduction and it looked like it stood them in good stead. They just stood on the sidelines until the advent of the stem cell field and now this and now I think they, well, it's hard to know do they regret not having been more involved or are they actually in a good place? So a lot of the decisions will be not whether or not. So where the FDA will now play a role probably will be not even judging whether this is a good thing or a bad thing. They will make a judgment as to whether it is now safe to launch into a clinical trial for those patients that wish to undergo this procedure and for those physicians that feel that they wanna do it. It'll be purely advisable. And to kind of clarify one point, one of the reasons that so many people have called for more regulation is because the cost of infertility treatments is just kind of astronomical. And of course that high cost can be a major barrier to access. In vitro fertilization for an example is I believe the most common reproductive technology currently used as an infertility treatment. And I read according to the New York Times the overall cost for one cycle using a woman's own eggs ranges from 14,000 to 16,000, which is a huge amount of money. So Camille, I wanna turn to you because you started the Tiananakute Cade Foundation to help needy families overcome infertility by providing financial support for domestic adoption and for infertility treatment. So you also have an incredible story of overcoming infertility yourself. In 2004, your 55-year-old mother, Dr. Tiananakute Cade whom the organization is named, served as your gestational surrogate and delivered her own triplet grandchildren. So that's kind of the most incredible story I've ever heard. You're also of course a trained physician. So what to you are the biggest problems surrounding regulation and access in the industry right now and particularly if we look towards low income communities? I think it's a conception that they won't have enough money and so it's not even worth considering and the situation where only people can have money is the more absolute opportunity to build their families and I don't believe, and there are many that don't believe that being a parent is, or being a good parent is determined by how much money you make. And so I think that if there are regulations that protect poor families, rights are their opportunities to pursue parenthood regardless to whether it's through fertility treatment or adoption that that should be pursued. And do you see any of the access problems being solved or exacerbated through innovations or new technologies that are out there? I see that a lot of problems being solved through new technologies. I was, as we were sitting in the back chatting just talking about the things that are possible now because of embryo freezing and egg freezing. Now, because there are large banks of embryos that have, the donors have already been screened, they've already gone through treatment and they're just there and available, first of all, the cost associated with becoming the recipient of an embryo donation has gone down because instead of paying the cost of the donor costs and having one person or one family take on that entire expense, those fees are able to be split between two, sometimes three, sometimes four families. If the donor produces 20 or 25 eggs, instead of spending the $30,000, having one family spend that $30,000, it may be that three families spend $10,000. And that would make it possible for families that had less access to money to move forward and make use of that genetic material to build their families. So that's just one example of how the evolving technology has made family building an option for families that are less advantaged and that's important. And Debra, when you were writing your book, how much, I don't know how much reporting you did into kind of the low income community access issues, but how has that, how have you seen that evolve over the past year? Well, I think it's still largely a bad news story that due to the work of Camille and Kate Foundation and a few others is getting better. But this is, I don't mean to sound like I'm pitching here, but this is why I think an economic lens is helpful because unless you talk about the money here, you never actually uncover the fact that we, this is an area that's particularly prone to inequities. I mean, we live in a country that's already not so great on the equality scale, but if you look at the fertility area, it's particularly bad. Infertility crosses all lines. It's not in any way centered on a particular race, particular ethnicity group. It seems to be one area where mother nature at least is fair for better and worse. But so given that, and I think it's an if, but if you believe that becoming a parent is either a human right, or at least a good thing, then it seems fundamentally unfair that there's a group of people that should lose out twice. That number one, they're infertile, and B, they don't have access to the funds to do something to correct their infertility. So I think, to Camille's point, I think technology will help. I don't think it will solve. I think what we need are foundations such as hers, but also it's a less sort of sexy or obvious route to go, but insurance companies can actually be a very big player in this market. So I wrote this book when I was in Massachusetts. Massachusetts was one of the first states to unfold or wrap up infertility coverage into standard insurance, and it didn't really do, there was a little bit of a hue and cry over it, but it didn't really do much. It didn't affect the premiums of all Massachusetts citizens. It's very doable. And more states are starting to move in that direction. I believe that you will find that in states where there is an insurance mandate, particularly one where families have access to $100,000 and three attempts at IVF, they're more likely to be conservative in the treatment. The clinics are less likely to put in more than one embryo, which decreases the likelihood of having a multiple gestation pregnancy, which decreases the likelihood of both bad outcomes for the baby or babies and the mother. So we've seen that insurance does make a big difference when families don't have a lot of money. They are more likely to say, I've got five embryos. I want you to put all five back because I don't have enough to do this again, and I don't have $1,000 to freeze those embryos. So give me my best shot right now. Can you wind up with Austin on that? Exactly, well, yeah, another issue. So as you guys mentioned, there are 15 states right now, I think, that have some kind of law on the books for infertility treatments and insurance coverage. But where will policy change come from? I mean, is it going to be a state-by-state thing? Do we need some kind of overarching federal policy? Will change ever come? I mean, these are big questions, but where do we need to kind of focus our efforts in the coming years? Would it be more of a kind of state-by-state advocacy campaign or nationally? I think it will come. It'll have to come state-by-state because the country's too diverse, but it's interesting. I agree that, and I was in Boston for many, many years and now I'm in California that has state-funded research in regenerative medicine and cell biology. The way that we ultimately got that past was making an economic argument, not even a quality of life argument or increasing knowledge argument. It was an economic argument. And the reality is that if an investment is made and making healthcare available to everybody, including better reproductive medicine, that ultimately will lower the healthcare costs of families and kids in particular throughout. And that will have an economic argument. And that, I think, is the way to make the argument, even in states that might seem less predisposed to wanna do this, so. And I would agree. I mean, I'm a little bit jealous of some of the European states. I think the UK actually does quite a good job of having essential regulatory authority. But given that our Congress seems, sadly, incapable of passing a budget, I just don't see this anywhere on the horizon. So I think the states quietly have done a pretty good job. Some better than others. California is the leader. Massachusetts, New York is slowly moving in that direction. So I think the state level is our best option and insofar as people are lobbying for this, I think the state level is appropriate. I should also just say though, I think, there's two issues that are preventing regulation. The first is the Yuck factor and the abortion issue. It's very hard to have any kind of policy without defining the embryo, which is not a good political strategy for most elected officials. But I think the other issue is there's not a natural constituency to fight for regulation. The fertility clinics, like most practitioners, don't want regulation. Even though it might, in the long term, be good for the best practitioners, it's understandable. No industry wants to be regulated. The families that go through this, at least in my experience, while they're going through it, they're just focusing on the process. They're focusing on the science. They're not going to Washington. And once they're through it, they don't want to see themselves as infertile anymore. They want to be, if you will, normal again. And so unlike cancer survivors or AIDS, there hasn't been a political, there hasn't been a natural political constituency. I think that state by state is how this has evolved in the past. It didn't start off in the 15 states. It started off with one and moved to the next. So I think that that is how it's going to end up happening. You brought up earlier the UK and kind of jealousy over the way that they do things. What do you all think, are there countries beyond the UK, or perhaps it's just the UK that we can learn from? Are there any kind of transferable lessons? And of course, you know, we always in the family policy arena look at Scandinavian countries as kind of perfection, but where can we look to abroad for lessons? It is Scandinavian, I mean, I haven't looked at this in a while, but last time I looked, so Denmark had a fabulous policy early on that they paid for three cycles of IVF, as long as the woman was below a certain age, which was tough, but I think appropriate. They then evolved the policy to allow for same-sex couples. I think they were sort of the first country to embrace that. Sweden, I don't know enough, I don't remember how they fund it, but they've been very vigilant in mandating the collection of data and long-term studies, which I think is crucial. We should be tracking the long-term effects on both mothers, babies and donors. And so I think they've always been in my mind, particularly the leaders. Israel's interesting. You know, on the good side, it's sort of eternal coverage. You can keep trying again and again and again, as long as you're creating Jewish babies, I believe. But I've heard, and this is totally anecdotal, but I've heard from a number of families that the fact that they will keep paying forever actually becomes an emotional burden on families. Any other thoughts? Is that a global question? No. No, okay. Just the Scandinavia, as always, all right. I mean, okay. I mean, okay. All right, great. So I can add one thing, though, that, you know, I think the point that you're saying about follow-up of the outcome is really, really important. And the fact that our history production was not regulated here meant that 20 to 30 years of outcomes were lost because there was no regulation, nobody was keeping track of things. So now when we come, like in my committee, to have to assess is nuclear transfer a good, safe, effective thing for this class of diseases? And I had to talk to the people at the UK. They said, well, a lot of what you're complaining about is no different than any woman going through assisted reproduction. Don't you guys know what the risks are and what the outcomes are? And I had to say, well, unfortunately, not really, not in any systematic fashion, but they do. And they were able to say, you know, these concerns that you had, our data indicator, not really something you need to worry about. You know, focus on this, but don't worry about that. And we really had no guidance. So some kind of follow-up is exceptionally important. And I will say, I think that the UK does provide a lot of great leadership, but there are still challenges with that system. The weight is often up to two years. And there are many restrictions depending on the country. So a lot of women or families are now coming from there where they would get it for free and paying tens of thousands of dollars because when you wanna build your family, you don't wanna wait two years for the possibility of being able to move forward. You wanna do it immediately because it does become an all-consuming focus. And so many of them are leaving that and coming here. So I think that they provide great leadership, a great model, but it's something that we can learn from and improve if we're willing to make some tough decisions. So I wanna get back to something that you mentioned a little bit earlier, Deborah, which is kind of what's holding us back from moving forward in terms of regulation, but also just in terms of the evolution of our thought on some of these issues. And it seems like we're kind of stymied by a few big unanswerable questions. And one is, is the ability to reproduce, should that be a basic right? And should it also be part of medical care? So these are these kind of big monster questions. So I wanna get all of your thoughts on some of these questions, but also what are the other big questions that still need answers if we are gonna move forward in kind of the public debate? If you wanna get started on it. So I think I have this line in the book. I don't know that I feel competent to say whether something is a human right or not. I mean, that's for the philosophers to think through, but I think most people would agree that becoming a parent is certainly one of the important things in life. Biologically, it is actually what we're programmed to do. So I think considering infertility as a medical issue is kind of a sensible approach, although it does ask, it doesn't pose some constraints. Becoming a mother at 65 or not being able to become a mother at 65 is not a medical condition. That's just tough luck. Whereas becoming a father at 65 is not. So I think we have to follow the guidelines there. And I think some of the, so that part to me is relatively easy. I think the questions we're facing now are fascinating and never-ending. In large part, and I'm sure you all studied this here, our notion of the family is fundamentally changing. So a same-sex couple can't become parents in the old-fashioned way. They by definition will be infertile in their chosen relationship. So what do we do about that? How do we address that? How do we deal with the stunning increase in single mothers? That way back when was an unnatural state to imagine a single mother. It's now quite common, but should we, a single mother again, will have to use either technology or the bar to become a parent? So how do we think about that? So I think technology will always move faster than social norms, and both of them will move faster than the law. But how do we try to sort of at least keep the law and regulation in a country that doesn't like regulation not from falling not too far behind what technology will allow and what society increasingly is embracing? And I'll just throw in one more thing here. Someone, I had two kids the old-fashioned way and then adopted my third. I don't wanna lose sight of adoption here because this is one of the risks here there. This is the public service piece. There's still a lot of kids out there who don't have families, and I think we need to keep sight of that so it doesn't all become about the technological solutions. Do you know any, I don't know. Just kind of tail it, dovetail off of what she said, but at least as far as adoption goes. I think that giving parents or giving families, however you define yourself as a family, the option of pursuing and becoming parents, whatever that means, whether it's through domestic adoption, international adoption, embryo adoption, fertility treatment using your own gametes, fertility treatment using donor womb. You know, the pathways to parenthood are varied and I would not begin to tell one person that their pathway is better than another, but I do think that people should have the right to choose and to pursue, and I do not feel that income should be a barrier to making that choice. So because this event is called the Future of Reproduction, I would be remiss if I didn't throw that in here. I was struck by an Atlantic piece that was written by Alexis Madrigal this past June, and he writes that future reproductive innovations are likely to be led by practitioners with little U.S. government oversight. Few people, it seems, want to stand in the way of someone who desires a biological family. So I'm curious to see if all of you think this is true, if this is likely to just kind of remain the same for the next few decades, and then I'll start with you. So rephrase the question again. Sure, sure. So Alexis, after doing many interviews with doctors and reproductive health experts, says that innovations are likely to be led by practitioners with little U.S. government oversight. So few people want to stand in the way of somebody that desires a biological family. You know, I think the science will get better, the costs will come down, coverage will get broader. So that will change. But I think, as was mentioned before, the desire to be a parent, desire to be part of a family, that has existed since the dawn of mankind. I think, as a pediatrician, my biggest concern is not the technology or the definition of the family or how the parents are defined. It's the well-being of the child. And that, as a pediatrician, that's my major focus. If the child is healthy and happy, then however that child came to be and whatever environment that child is, is the right way to go. And I think we see that evolution. Every time there's a new technological breakthrough, particularly in this area, but in other areas as well, we get scared. We dub it as unnatural, against the will of whatever religious authority people may believe in. And yet we get used to it pretty quickly. And I think, so long as these technologies are capable of producing healthy children, what you get at the end of the technology is just a baby, and we like babies. And I think cloning may take us there. This is way closer to your field than mine. Who knows, mitochondrial transfer is gonna make people very, very nervous until it starts becoming more common and then people will become less nervous. So I think it's part of a fairly natural course. I should also say, getting to the baby is the easy part. It's then raising the kid that takes the real talent. I hope that that quote is correct. I think that it should be driven by practitioners. I have seen an increasing number of attempts on the legislative side of things to regulate family building that have given me cause for concern. And so I think that it's unclear. I do think that policy is coming and I think that it can be a very important tool to make it possible for all families to pursue parenthood. But I think it can also be very dangerous if people use different lenses, whether it's a faith lens, whether it's a lens of race, ethnicity, and a belief. People can look at policy through different lenses and I think that it can be very positive but it can also be very destructive and it can prevent people from moving forward. So on that note, I wanted to open it up to any questions we might have in the audience. So if mitochondrial replacement therapy that they talked about both on your panel and the first panel were to move forward, how do you see insurance coverage dealing with that in the sense that women are not truly infertile but they're unable to have a healthy child? And Camille, how does a foundation like yours maybe look at an issue like that? Kate Foundation requires a diagnosis of infertility in order to have a family be able to move forward for funding and we do get calls all the time from families that have had sick babies and with requests for help. And while the information that we provide is open and available to everyone, we are very limited. We're a small non-profit and so we just can't afford to fund everyone. So you have to have a letter from your doctor that says that you have infertility in order to qualify for our grant. Hi, Christine Scheller, I'm here from the American Association for the Foundation, I'm sorry, the American Association for the Advancement of Science and I'm wondering about what you just said about regulation. It's my understanding that a lack of regulation can compromise health of women in part because of the, I'm sorry, I just got so nervous, in part because of the extra amount of drugs and things that are given to them for the hyper-stimulation of their ovaries and also the exploitation of women for egg donation and that regulation would help those things. Can you tell me what kinds of regulation you're concerned about? So I think that the regulation would never supersede the physician's ability to practice medicine and the amount of drugs that women receive for fertility treatment for stimulation, that's a physician choice, that's not necessarily a regulation choice. I think if you look to the example of the United Kingdom where families have the opportunity to have a free cycle of IVF, there is a lower incidence of multiple gestation because the government's paying for it and they're only allowing you to put one embryo back. So there's a lower, unless the baby, unless the embryo splits and becomes twins, that's just the likelihood of a better maternal and fetal outcome is there because you're not putting in multiple embryos versus here. If I'm a low-income family or a family that just can't afford to have IVF more than one time and we have five healthy, good-looking embryos, I may want my doctor, I may pressure my physician to put all five embryos back into my womb to increase the likelihood that I would get one baby out of it and the data would suggest that the likelihood of getting one baby is also the same likelihood of getting a multiple gestation birth. So you're more likely to get pregnant, it's just you're more likely to get pregnant with more babies. But wouldn't that suggest regulations because in Europe they actually regulate you have to do single embryo transfer? So I agree that that is a good thing, that there are a lot of bills being considered, not just involving whether or not people should have the right to have IVF or as is the case in Europe, whether or not it's free or if it's paid for, but also you talked about abortion and the status of the embryo as a person. There are a number of personhood bills that have been introduced throughout the country that would have long-term effects on this if an embryo is considered a person and a family has five embryos and can't afford to freeze four, what happens to those four remaining embryos? Now that they are people, if you don't freeze them, you kill them. And so that may limit or actually in some case prevent families from being able to move forward because killing people is homicide, you go to jail for that. I think that there are a lot of issues that come into play when you look at some of the personhood laws that have been proposed. So I think that there's just a lot to consider, but I do agree that some policy is a wonderful thing. And I think as I said before that the model that is in place in the United Kingdom is a great one and one that if we're able to perhaps tweak can be just wonderful for so many families. I should add that in this country in lieu of governmental regulation, the professional societies do a great deal of policing of the physicians. And there are policies that are issued by ACOG, the American Academy of Pediatrics and things of that sort, such that a physician who wants to be held in good standing among his peers really does adhere to what the guidelines are of this particular professional society. So for example, the physician who allowed the octomom to give birth was sanctioned. Not legally, it wasn't criminalized, but he was sanctioned by the professional society that deals with assisted reproduction. Sometimes that can even flow over to losing your medical license in a state. So we could debate, maybe that's even a more potent kind of regulation than having it, having it by statute in that it does preserve the clinical judgment that often has to exist. You don't wanna legislate or trying to be your physician or your obstetrician, but there's a whole history and data that dictates what is or is not good practice. And if somebody deviates from that, if a physician deviates from that, he really is sanctioned. So it's not governmental, but it is his peers. Although it is a weaker sanction. It's a weaker sanction. I mean, there's probably some midpoint. There probably needs to be a little bit in certain really grievous areas. You've talked about issues with regulation in the United States and in Europe. And I'm curious about, do you think that this technology is ever going to reach a point where it extends to parts of the world where reproductive practice is, say, at the midwifery level? Is it ever going to happen that this becomes a kind of biohacking that would, for example, in vitro fertilization become available in areas where there's not the kind of high-tech assistive reproduction that's available here? Well, some of it's happening already. I mean, in sort of fragments. So India has become quite a large market for surrogacy. So that's fairly high-tech, but less high-tech over time. China, and China's clearly not a developing country, but China are very big users of all of these technologies. And in some ways, because they have different constraints around stem cell technologies, doing a lot of things that in fact you can't do in this country, Singapore has created a whole sort of business hub around a lot of these technologies. South Africa is another big market for surrogacy. So again, those are all relatively developed countries. But it's out there. I have to say my concern about the high cost of high-tech medical interventions goes beyond just assisted reproduction. There are so many things that we do in the States or in the Western world that we don't even think, we don't even bat an eyelash that cost hundreds of thousands of dollars that would be unthinkable in the third world. And I reflect on this very, very, I'm a neonatologist, that's one of my specialty. And I know that we will spend hundreds and hundreds and hundreds of thousands of dollars to keep a 24-weeker alive, whereas this is not even a discussion that can be had in the third world. And so there's, and I often feel that this is really unfair. So it's, this kind of disparity as to what patients can expect goes beyond just assisted reproduction. It's every area of our high-tech medical enterprise right now. Questions up front, I think, yeah. I'm Roger Gilkerson. I just have heard about, and it touches on the commerce issue with the wealthy person who wants a baby and goes through a book, picks this sperm donor and the egg donor who plays the violin and he wants that kind of person and then gets someone to get a surrogate for him. Then the baby is defective and legal stuff happens. And I've heard that it did happen in California and the first thing was that the baby was an orphan but then it got changed. But I wondered about legal aspects of some of this. Well, I think the good news is that those stories are rare. The bad news is that they happen. And when they happen, they don't happen in the abstract. It's the life of a child. And so this is, I think this sits at the core of my concern, I wish we did have more of a legal structure around the process so that at least in that case, and this varies a lot from state to state, there's some kind of an underlying legal contract that the surrogate has signed, which has made provisions for what's going to happen if the child has, I mean defective's a complicated word to use, but that's where the gray area causes problems. Oh, hold on, let's wait for that. J.D. Hansen, I work at the Center for Food Safety and it's a sister organization have been particularly looking at some of the genetic engineering of animals and cloning of animals, and which is why I'm glad to hear that your committee is recommending more animal studies. I think the 12 that the Oregon folks have is a pretty small sample for the mitochondrial nuclear transfer experiments that I'd like to see multi-generations. That's not my question though. If we don't have regulations, what we end up in our country with is tort law, and tort law actually works relatively well for things I have two sisters in law who have had failed hip replacements and that's a product actually approved by the FDA, even getting a $250,000 settlement from Johnson doesn't make up for the suffering you go through. But when we're talking about experiments that are really gene transfer experiments like the nuclear transfer, it's one thing if you have a hip that fails within five years, it's another thing if you change a gene that doesn't express until later in life, tort law doesn't work very well for that. I think that's yours. I would like to involve the generation studies. Well certainly, and that was one of the recommendations of our committee for this particular intervention, but if you're, I interpreted your question as being broader than just something that has the potential of changing the germline, but any kind of manipulation of the cellular genetic component of a patient in their somatic cells, not just their germline. And I think this, in the field of regenerative medicine, we wrestle with this all the time. Some of the initial studies either with gene therapy or cell replacement, initially are in tissues that are very accessible. So the eye, because if something goes wrong, you enucleate or you do something like that. But there's a big clamor, and rightfully so, to deal with brain diseases and heart diseases. And right now, we do routinely bone marrow transplantation where talk about a person who's composed of three parents, anybody who's gotten a bone marrow transplantation is completely chimeric, and every organ that's perfused by blood, which is everything, by another donor. And it's hard to get rid of. So the lesson is you just need really, really careful pre-clinical studies and stage clinical studies where you do an intervention, you stay back, and you wait long enough to see whether something bad is happening. So we just have time for one more question. So going back to the commerce question, I'm interested in how that lens, what that lens helps you see when you look at the way that egg retrieval is done in this country, because the young women who are being recruited to provide eggs for other people's fertility treatments or for stem cell and other research for that matter, they're being offered money to do this, to undergo this process. And their relationship to the doctor that's administering, that's conducting the procedure is a little bit different than other people who are involved in fertility treatment, for example. They're not the patient of that doctor, although the doctor does supposedly have that duty, a medical duty to them. But they're not the paying client. And so I wonder how you see that, and also how does commerce play into this push, very aggressive marketing push now for women to freeze their eggs? So I think these are some of the most interesting questions, at least in my mind. First of all, the language is just funny. We call it egg donation, and we pay lots of money for it. So right away, you can sense this unease with acknowledging that this is a commercial transaction. The second thing that in my mind is totally screwed up, although getting a little bit better, is that in this country, we will allow a young woman to be paid kind of anything to, quote, donate her eggs for reproductive purposes, but in most states, she cannot be paid, literally even bus fare, if she donates exactly those same eggs through exactly the same procedure for stem cell science. And so I think there's a fundamental really inexplicable lack of symmetry there. If I had the magic wand, which I don't, I would say, let's focus on the medical issues first. Is it safe for women to be producing eggs in this manner? Are we overstimulating? Are there certain women who shouldn't be allowed to go through this procedure? We should regulate in my ideal world the information that these women are receiving, and we probably should limit the number of times they can do the procedure until we have much better long-term studies about what the long-term effects might be on their offspring. Once we put those standards in place, I don't actually care how much they're paid. I think as in other areas where women are selling body parts, we actually focus too much on the price, and not enough on the underlying issue. So I think this area is sort of a mess. Egg freezing, evolving, and we were talking, in my role as a college president, I do feel I have a public service commitment to tell young women, don't see this as the magic cure-all. It may be an insurance policy, but it doesn't give you the ability to control your life in this neat and packaged way that I see many young women now grabbing onto. They believe that if they freeze their eggs, get their career, make partner, then they will magically find the right partner, unfreeze the eggs and produce the babies at 42. It doesn't always work that neatly. So I think we need to be very clear at understanding what these practices are. They're very, very, very clever marketing operations for very interesting technology, but it's not a cure-all for how to lead the perfect life. On that note, we unfortunately understand, but very interesting food for thought, so thanks so much to all of you. Thank you. Thank you.