autoimmune disease

Reversing Chronic Autoimmune Disease with Stem Cells | Dr. Richard Burt

Is it possible to reverse autoimmune disease—permanently? In this episode of Brave New Us, Dr. Richard Burt, pioneering stem cell physician and author of Everyday Miracles, joins host Samantha Stephenson to unpack his revolutionary treatment for autoimmune disorders. Hailed by Scientific American as one of the top 10 medical advances of the decade, Dr. Burt’s non-myeloablative stem cell therapy has changed—and saved—lives.

Dr. Burt opens up about his early skepticism, the medical establishment's resistance, and the patients who inspired him to push forward. Together, we explore the promise and pitfalls of regenerative medicine and what it takes to bring groundbreaking science to the clinic without losing our humanity.

If you’ve ever wondered:

  • Can stem cells actually reverse disease, not just slow progression?

  • What does "immune system reset" mean—and is it safe?

  • Why is the medical establishment slow to adopt new therapies?

  • What ethical questions come with cutting-edge biotechnology?
    This episode will challenge what you thought was possible.

Topics Covered:

  • How Dr. Burt’s stem cell therapy reversed multiple sclerosis, scleroderma, Crohn’s, and more

  • The difference between myeloablative and non-myeloablative stem cell treatments

  • Why Big Pharma and some doctors resisted the treatment—even after success

  • What “immune system reboot” really means and how it works

  • The role of patient advocacy and storytelling in transforming medicine

  • Why humility, ethics, and hope must guide the future of biotech

  • How Everyday Miracles bridges hard science with human dignity

Mentioned in the Episode

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TRANSCRIPT

[00:00:00]

Samantha: Welcome to Brave New Us, where we explore what it means to be human in the age of biotechnology. Today I'm here with Dr. Bert, a pioneer in stem cell medicine, on a mission to convert chronic autoimmune disease into one-time reversible illness. His book, everyday Miracles chronicles his journey from skepticism to breakthrough and how his discoveries now hailed among the top 10 medical advances of the decade earned him accolades from Scientific American, a place on Newsweek's list of the top 50 most influential people in healthcare, and even my favorite, the Keys to the Vatican.

Samantha: We discussed the science, the ethics, and paradigm shifting technology behind what may be one of the most revolutionary stories in modern medicine. Dr. Burt, welcome to Brave New Us.

Dr. Burt: Well, thank you for having me and [00:01:00] inviting me, Samantha.

Samantha: Absolutely. Uh, can you start by telling us what is HCST and how are you using it to reverse autoimmunity?

Dr. Burt: So HSCT stands for hematopoietic, which is a term for blood stem cell transplant. And basically we just use a person's own. They're not, uh, from another person. It's their own blood stem cell that we get out of their blood to reset their immune system. 'cause that blood stem cell will not only make all the components of blood, like red blood cells carry oxygen and things like that, it will also make your immune system. Now the stem cell itself doesn't carry oxygen and it an immune cell, but it makes those cells and it replenishes them. red blood cells that turn over every few months and have to be continually made, your immune cells once made pretty much stick with you the rest of your life. But if you. [00:02:00] Decrease that number, the stem cell compartment will remake those immune cells. one of the, the concepts of this that I had 35 years ago, 'cause I was doing transplants for using stem cells for leukemias, was, uh, you know, why not just do this autoimmune disease? Instead of trying to target a leukemia or cancer cell, try to just reset the immune compartment.

Dr. Burt: Use a more gentle regimen that knocks down your immune cells and let it without inflammation because the, when the conditioning regimen will knock down the inflammation too.

Samantha: So in this treatment, you wipe out and reboot the immune system, like rebooting a computer and then you, the patient becomes their own. With their own cells to restart and repopulate the immune system is.

Dr. Burt: Yeah. Basically when you knock [00:03:00] down the inflammation with the conditioning regimen and knock down the immune cells that are effector causing these bad autoimmune diseases, and then you give them back their own stem cells without inflammation, the stem cells regenerate new immune cells that default towards tolerance.

Dr. Burt: the idea first came to me when I was a fellow at Johns Hopkins in Baltimore. . And, um, I. They, they were bringing people in after transplant for leukemias and cancer. And they were reim immunizing them for childhood vaccines because they had lost their memory cells. So once immunized, you normally have memory cells that persist for your life, you know, or, or at least 20, 30 years or longer.

Dr. Burt: They, they may start to diminish, but they're there. So they had to reim immunize them. And I looked at my attending and said, you know, you're reim immunizing these people. 'cause they lost their immune response to these childhood antigens. They'd been immunized to measles, mumps, rubella, tetanus. [00:04:00] I didn't get a response.

Dr. Burt: It was kind of an obvious statement. It's a busy clinic. And so I said, uh, that means we could do this in an autoimmune disease and reset the immune system. And my attending was Professor William Burns, and he stopped, looked up over his glasses and said, you're right, we could do this for multiple sclerosis. I went back to my boss at the NIH who was. The head of the hematology branch and a big researcher in gene therapy and said, I want to do this. And, um, Dr. Neen kind of leaned back in his chair and he said, well, there's nobody working on your idea at the NIH.

Dr. Burt: And I said, I know, but I've discussed it with John Hopkins. They wanna do it.

Dr. Burt: And that's how it started. And we worked in animal models. So I was all charged and ready to go to start Human trials. Thought I'd have answers in five years. Long and short, it's like eight years working in animal models. It worked. So then I designed a protocol and, um. Took it, uh, through the FDA. Now we're not a [00:05:00] drug company. We don't make money. There's no patent on this. Normally people only go through the FDA, so they get a license and they can monopolize the profits and, you know, sell the drug everywhere.

Dr. Burt: That wasn't my goal. I didn't have to do that because it's Unmanipulated broad product. It was voluntary on my part, just, because I thought it was the right thing to do. And so then we eventually started treating, we developed a phase one, phase two, phase three trials. The final trial, you know, is very definitive, published in Jamma back 2019, and on the way, you know, got some grants to help support it, including a $10 million NIH grant and so forth. And there's ups and downs in doing all that, and a lot of hard work. But what it really eventually ended up showing is that this really worked, we could reset an autoimmune disease and put people in these su sustained long-term remissions without any other therapy.

Samantha: Wow, it's, that's incredible. And [00:06:00] just to clarify, when you talk about using stem cells in your conditioning regimens, you are using adult stem cells as you said, and that's none of these techniques rely on embryonic stem cell research or the destruction of human embryos. They're all derived from the patient's stem cells

Dr. Burt: we do not use embryonic stem cells for this or a product of embryonic stem cells, and we don't use allogeneic. That is from another person we use only autologous your own stem cells. And those are drawn usually out of your arm. If you don't have a good vein there. There'd be a catheter inserted here, uh, to, to uh, do the apheresis to collect the stem cells.

Dr. Burt: So they're autologous, they're your own that we take out. And then we use a regimen, knock down your immune system. Then we reinfuse those immune stem cells, which by terminology they're not called immune stem cells. They are, but they're called, uh, hematopoietic. That is blood stem cells that can be gotten from the blood or from the bone marrow.

Dr. Burt: In the old days you get 'em outta [00:07:00] bone marrow, but now people mostly get 'em out of the blood. So it's your own stem cell. And although I only work in adults, 'cause I was in an adult only university hospital, uh, it has expanded to be used in children. And some places do treat children with this technique, and in which case it's collected from the child's own, uh, blood.

Dr. Burt: So it could be, uh, an adolescent or child, but uh, it's mostly an adult and it's their own stem cells.

Samantha: you captured dozens of incredible real life stories in your book of Reading Miracles. I mean, I was literally in tears reading story after story of patients who were entirely debilitated and their lives were really stolen from them by these various autoimmune diseases.

Samantha: Um, Ms at the beginning, uh, scleroderma but they were restored after receiving these transplant transplants and it sounds too good to be true. [00:08:00] It, it really does. Um, I. But testimony after testimony of patients who gave you permission and were begging you, like, please share this, please.

Samantha: One of 'em, I think she even put it on her license plate because she really wanted to advertise this, um, this treatment. Is there one patient's story that stands out to you among these many lives that you have transformed with this treatment?

Dr. Burt: Well, one of the really enjoyable things for me is I do spend, uh, a period of time getting to know people in the process of screening 'em for the procedure and then doing the mobilization stem cells. Then in-house, they're in-house about 14 days and you see 'em every day and, and you really get to know people.

Dr. Burt: And that has made this, you know, really enjoyable when, but when you know people, everybody a story. Everybody has good and bad and everybody dealing with these diseases that are [00:09:00] traditionally not curable and you just stand drugs and solely get worse, have been so incredibly brave with such fortitude and also developed PTSD, kind of like they're always in the war zone.

Dr. Burt: They never get a break. The war's never over ed and it, it weighs on your psyche, uh, even at a subconscious level. But the incredible. You know, courage and strength of these people has is why I do it. And I bring that out in, in the book, of course. Um, but that's true for every patient. So I can't say there's any one patient.

Dr. Burt: For instance, the book I mentioned one patient who was virtually homeless, uh, and had no resources, Eritrea. I gave every patient the right. No last names were put in. And to use a fictitious first name, I encouraged all patients to use a fictitious first [00:10:00] name because I'm all about protecting patient privacy.

Dr. Burt: And of course, every patient read and okayed what I wrote.

Dr. Burt: But the point is, here was this one patient with nothing. living on the street and then, and, uh, I call it Eritrea versus Cruella. And then later in the book I talk about another gentleman who's a billionaire, private Lear Jets. And, uh, you know, what he was going through and what happened afterwards.

Dr. Burt: And an incredibly unique and outstanding individual. So I can't really say that there's, there's any one patient. Each patient's story is so worthy in and of itself.

Samantha: Right, right. Uh, they were really mind blowing to hear about these people who were suffering. And I think that, um, if I'm remembering correctly, that patient who was homeless was because of the MS That those treat, that her treatments were so expensive that and [00:11:00] her. Disease was so debilitating that she couldn't, um, she couldn't continue work.

Samantha: She went on disability, but on disability, she couldn't afford the treatment. So she would skip treatments, which made her worse, which led to the fact of her having to, um, go to the soup kitchens and eventually, um, grateful that she found you, but she was able to receive that treatment. Um, and then her life totally turned around and she's not only walking and able to work, but she's exercising.

Samantha: I think you said she's exercising multiple hours a day, uh, which is really impressive to go.

Dr. Burt: now. She can run. Uh, before, you know, had to like lift one leg to go up a step, had to use a cart in a store to keep her balance and hold herself up while she walked. Uh, she had said in the book, she would get pity looks, which always disturbed her. The remarkable thing is, but by the grace of God, that [00:12:00] could be you or me. She w she is an incredibly smart beautiful woman, it, her life and her ability to work, uh, was destroyed by MS and the system. Was contributing to that problem.

Samantha: Mm-hmm.

Dr. Burt: um, you know, the doctors would just do what they're told to do, try to give her another drug that's very expensive. The top prices in 2020 were 92, a hundred thousand dollars. That included Ocrevus, which was $40,000 in infusion. Now. Few, later, years later, it's $60,000 in infusion. So there you go. And what I showed in that book is these drugs like Copaxone that came out, started at eight to $12,000 in in infusion or the interferons, the same price range as new drugs came out that were more expensive, they just increased the price of the old one to match. They all increase to match each other's price. So they're way up there and it's like, how long can the system [00:13:00] continue this without being totally bankrupt? It's already destroying the lives of people who don't have the resources to cover it. And these are ridiculous amounts of money. That is ridiculous.

Samantha: I'm gonna back up a little bit because, um, when we were talking about the. Light bulb moment when you thought, oh, we're using this treatment in leukemia that wipes out the immune system. It has to be retrained with and revaccinated to get the, um, immune system back up to what it was in terms of immunity before.

Samantha: Um, you doctors at the time were using, uh, and correct me if the pronunciation is incorrect, but myeloablative regimen, which was really toxic or is really toxic, be rightly so, to get rid of the cancer cells. Um, but what you developed in for your patients for autoimmune disease is non myeloablative, so it's less toxic than the cancer regimen.

Samantha: Is that correct?

Dr. Burt: [00:14:00] Exactly correct because I came out of the field of oncology and was used treating leukemias, and I was using myeloablative regimens in animal models. Our first protocol was myelo ablative. It was a strong regimen and uh, it also included total body irradiation to make sure we got through the blood brainin barrier to affect any lymphocytes in the brain or spinal cord itself. And we had to start with late progressive ms, even though my animal model said it wouldn't work there, we, we were forced to start there because it's such a new therapy. You don't know. It might be a disaster. Let's start there. Well, long and short is it didn't work and I published in my paper in the title failure. But it took a long time. Other people, I put it there 'cause I wanted people to know that, but a lot of people kept using these people still do use these, my ablative regimens and they were using 'em late progressive. They finally recognize you don't wanna do late progressive, it's no longer immune mediated.

Dr. Burt: But there are people that still push these, my ablative regimen as oncologists and you don't need to do that. You can use the safer non mylo ablative. So once I realized it didn't [00:15:00] work in these light progressives, uh, with an aggressive mylo ablative regimen, I needed to do it in relapsing remitting where my animal model said it would work earlier in the disease.

Dr. Burt: But if I move earlier, I need a safer regimen. And that's why I flipped a non mylo ablative and designed SA regimens and it worked very well.

Samantha: So is that because this regimen is treating or fixing the autoimmune part of the disorder and then the later MS. Is, it's the tissue damage to the brain. Um, has already taken place so it's not able to regenerate the tissue, but it is able in earlier patients to modulate the, or fix the autoimmunity that's causing that damage.

Samantha: Um, like analogously. So I have autoimmune, I have Hashimoto's, so my immune system is attacking my thyroid, uh, to the point where my thyroid tissue can no longer produce enough thyroid hormone for my body. [00:16:00] So if I can slow the attack, I could stop the damage that's happening to the tissue, but I can't, um, by taking my replacement hormone, um, I can kind of make up for what it's not producing, but I'm not fixing the tissue.

Samantha: Is that kind of analogous to what's happening with those earlier stage MS patients versus the later stage?

Dr. Burt: Yes, it's a good analogy. Basically, your neurons are highly subspecialized cells. You know, we have about when we're born 80.

Samantha: I.

Dr. Burt: Uh, million neurons, well, each of which has about a thousand dendritic connections to other neurons. So that's about 80 billion connections that make our nervous system. So in ms, you've got all these cells that are necessary to keep your neurons functional and live and healthy. And once one of them is being destroyed, the neurons start to die back accelerated aging. [00:17:00] And that's the neurodegenerative permanent part. Now in ms, you get an attack, you get better. You may go for a long period of time, get another attack, get better. You know, I. Those are the acute immune attacks, and when you get better, you may go back to baseline or you may have a permanent deficit that doesn't get better, but it's kind of stable, those immune attacks. Your immune system is always trying to reset itself in ms. You have an attack, it tries to reset and stop itself.

Dr. Burt: It comes back out later, tries to reset, comes out later. Eventually the immune system does quiet down, but there's so much damage to the neurons that they just keep degenerating back and then you're in this irreversible decline. That's very gradual. But you know, you see a patient every month, you don't, they look the same, but a year later they're much worse.

Dr. Burt: You know, when did it happen? It's a gradual neuro. Degenerative process. You've moved into a disease that's a neurodegenerative, like a LS or Parkinson's or, uh, dementia. You know, it was just another type of degenerative disease for a specific set of neuro cells. So that's what [00:18:00] happens and that's why this treatment, all therapies for MS currently are immune-based.

Dr. Burt: And this is an immune-based therapy. It needs to be offered earlier in aggressive forms of ms. Now there are some forms of ms. You have one attack and not much happens for the rest of your life, or two, and not much. Of course, we're not gonna offer 'em a transplant, but anybody that's being offered a highly effective DMT upfront should be offered transplant upfront, and that's not being done. Transplant's really a highly effective DMT, it's the most effective. Now the next step though, is actually neuro regeneration. 'cause the hematopoietic stem cell is not a neuro cell.

Dr. Burt: It doesn't do neurogeneration. It resets your immune system, makes new immune cells tolerant to self. So you want to look at people who have progressive MS the, the neuron itself. And that's what my new technology, my IPS therapy induced pluripotent stem cells where we can take your cell and reprogram it back. an Embry state, which is called an [00:19:00] IPS cell, but it's your own adult cell reprogrammed. And then we can further modify that. I have SE seven patents. I was awarded in doing that. And we found that we can repair pretty much any organ system, whether it's from trauma or neurodegeneration.. Now we wanna get that therapy to patients with a LS because patients with a LS, it's a neurodegenerative disorder. It, it's, as I mentioned, affecting all the cells in the nervous system. And you know, once you're diagnosed, you have two to five years, usually three to four years of life before you're dead. There's really, there's some drugs out there. They don't work that well. They just don't, nothing reverses it. There's a few of 'em like antisense, RNA, that can slow it a little bit, but you still just get worse and, and dies.

Dr. Burt: So that's what I wanna do hopefully this year, get that to the FDA and move it forward. And so what I also wanna say, you know, I. Although I've never had money from a drug company, I have started a new biotech company based on our patents for the IPS cells [00:20:00] for regeneration and for aging and for traumatic diseases, uh, that I wanna bring forward.

Samantha: So a couple of follow up questions. Um, one, even though the. Conditioning regimen is non myeloablative. It still is risky. Um, so you, you necessarily wouldn't necessarily wanna run out and sign up for it as soon as you are diagnosed. So the question is, uh, who is the ideal patient and what does that patient profile look like?

Samantha: And then which autoimmune disorders has HSCT been successful in reversing?

Dr. Burt: So let me take the last one first. All your points are true and excellent points and good to bring out to the audience, but in everyday miracles, I talk about five diseases and you'll see the patients with phenomenal results. Multiple sclerosis, systemic sclerosis, which is colloquially called scleroderma, CIDP, chronic Inflammatory Deming polyneuropathy, neuromyelitis optica, NMO, or Dex Disease and [00:21:00] Crohn's Disease. And so, you know, those are diseases I brought out in there and with great results, I myself. have the time to continue that. I just spoke at the Mayo Clinic in Florida where they used my protocol for scleroderma with great results, and I'm glad to give 'em my protocol for MS as well. It's not about people having to come to me. I want it available locally for people.

Dr. Burt: Now is consent. Informed consent. People aren't getting that true informed consent. They need to be given the option of transplant, but in that true informed consent, they have to tell 'em there is a small risk. You can die during the procedure of transplant. It's about 0.5% or less with a non-myeloablative regimen. It'll vary by center experience and it'll vary by the regimen you use and it'll vary by patient selection. But now most centers using non myeloid ablative and everybody in Europe has switched virtually to my regimen, non myeloid ablative. It's less than 0.5%, 0.4, 0.2, and we can make it even less, but you can [00:22:00] never do this and make it a hundred percent zero.

Dr. Burt: And so people really have to be informed, but also as a physician because of that. You're not gonna offer it to someone that has a mild ms. who should get it are people who are having relapses despite, you know, mild to moderately effective DMTs, or people who at presentation, the neurologist wants to put on a highly effective DMT like Ocrevus. Those are the people that should be offered HSCT, but they're not given the information that they have that option. They need to get the caveat about the risk. The highest risk would be an infection while the immune system resets, which is a window of about seven days. Uh, that's really the highest risk of where you can get a problem from this. But, you know, if you. very, very good at preventing it. Uh, I did lose a patient from that. It was because it turned out that the water supply in the hospital was contaminated with legionella and it was discovered in the shower and in the sink water, [00:23:00] and that's what happened. So, you know, you, you can, hospitals are dangerous places. Uh, you don't wanna be in a unless you have to. And so, you know, bad things can happen, but you can keep that risk very, very low. But you can't make it zero. And the thing you wanna be is very honest with patients. I actually emphasize the risks of it very hard when I first meet the patient. , I want someone to be really informed and I'd rather inform them of a, of more toxicity and more risks than they could suffer. Uh, especially the risk of, of death, which can happen, but it's very limited, to my surprise, when I do this, the only people ever get mad at me is the people I don't offer transplant to. The reason they get mad is they think I have this special thing over here that I won't give them, but I won't give it to 'em because either they're late progressive and it won't help 'em, and I don't want 'em to take the risk. I don't want 'em to waste the money, the time or the risks of the complications. Uh, or they have another underlying disease that would, uh, contraindicate doing [00:24:00] it. So those are the reasons we, I, I won't do it. But, um, you know, that has been my surprise and pretty much everybody that gets this is so grateful

Samantha: From reading their stories in the book, it really sounded like these are patients, especially with Ms who are still alive, but their disease has stolen from them, everything that makes their life worth living. So that very small chance of death 0.05% to them is entirely worth the risk of potentially having their lives restored to them, their function restored to them, their ability to parent, their ability to go back to work, their ability to walk their without assistance, um, and exercise and do all of the things that they, that they wanna do and live life.

Samantha: So that chance that life is worth that very small risk of, of dying, considering the conditions that continued life would, uh, would [00:25:00] be for them.

Dr. Burt: And you're absolutely right, and that's called informed consent. And people aren't getting the options, which is part of informed consent. Once they have that option, then they need to be told all the bad things and emphasize hard to make sure they hear it and understand it. And that's still their wish. And uh, for the vast majority of people, this is what they want.

Dr. Burt: If we could get to 'em sooner, uh, we could have a much better efficacy and help a lot more people. And so you must wonder, well, why is that?

Dr. Burt: Why doesn't that happen? And it's because of that frustration that I actually wrote the book Everyday Miracles. To, to tell people from the bottom up so they can start being aware. And what, there are two reasons why this, despite its success, doesn't become mainstream. Although there's centers around the world doing it. I've talked around the world, they're using my protocols and we're helping people. Now it's becoming kind of [00:26:00] standard therapy, but it's still not offered to a lot of people when it could help 'em. And the reason for that is the people that had the basic knowledge to do this came out of the field of hematology or cancer, or both. Those people don't understand autoimmune diseases. They weren't trained in 'em. They don't understand ms. need a neurologist. And in fact, in in the field of neurologists, you have neurologists that specialize just on ms. So a regular neurologist would refer to that neurology specialist for this to really work.

Dr. Burt: And those neurologists don't know transplant. So it's kind of a voodoo thing out there. And they're not used to people being in the hospital for the, Two to three weeks needed for the transplant, where they're used to treating as an outpatient, their medications. So that's kind of how they do things.

Dr. Burt: Transplanters on the other hand. Don't know ms, they don't know the right selection of patients. They have a little trouble changing from the myeloablative regimens that destroy your bone marrow. If you don't get a stem cell, you're to replace a bone marrow, you're [00:27:00] gonna die. Uh, they to switching to a non myeloablative regimen where you don't even have to give the stem cells, you give it 'cause you recover faster. So that's one of the big problems and that's one of the problems of translationally. Based medicine that crosses divisions or departments. You're always encouraged to do that 'cause you can advance things. But once you do it, you run into the obstacle that you have. These experts in these different divisions or departments that have become so sub-specialized.

Dr. Burt: They have to, to possess that knowledge, you have to become a specialist, but then they don't bridge that gap. You, I myself have, but to get others to do it. So in the field of transplant, I've always argued you need a hematologist that gives up cancer and just focus on autoimmune disease or a particular autoimmune disease such as multiple sclerosis or systemic sclerosis to really make it work and work well.

Dr. Burt: And that just doesn't happen. Uh, people are, are kind of committed, so much energy and there's money and, and professional activity flowing in their area of cancer That [00:28:00] to. Make that flip is difficult for them. are some people who have done it, but it is difficult. Our system, you get blinders on, you get set in a certain track there.

Dr. Burt: For instance, there is no institute at the NIH, uh uh, national Institute of Autoimmune Disease, NA for instance. There should be, if there was, they could help fund people around the country on doing, focusing just on autoimmune diseases and focusing on cellular therapies for it, which would be a big advance.

Dr. Burt: The other thing that holds this back is there's no money in it. So there's no drug company. These are your own cells, and I never did it to patent it or to make money in it. nobody gets any money except just the patient care you're doing to take care of the patient. if in every field, this is in oncology too and in hematology, but especially, let's look at neurology for ms. The neurologists are always being told about this new drug. There's like [00:29:00] 17 drugs out there for MS and there's new ones turning out all the time they're run The drug companies run 'em, have neurologists at great centers, run 'em, and then their names are on it. They get their academic accolades for being on the drug company trial because the be sooner their name, especially if they're first author, and then the direct company pays for 'em to go around and talk about it, and they do. And then the drug companies pay for advertisements on every venue, television, including news programs. A large percentage of the money that goes into news programs, whether it's M-S-N-B-C or Fox News, is derived from drug advertising, which pays really big salaries. To their star broadcasters who make many tens of millions of dollars a year. of course, it's, it's greasing the system. But they do it in newspapers. They do it in print, they do it on YouTube. They, they advertise. So basically you got, and then you, you've got this law that came about in the [00:30:00] 1980s called the By Dole Act. It was by, was a by, was a Democratic Senator from Indiana Dole was a Republican senator from Kansas.

Dr. Burt: It was good intention. What they said is that when the NIH funds research at a university. That the university, if the research looks good, the university can claim intellectual property rights. Not the researcher but the university. So the university, what happens is your tax dollars fund research, but research is like gold mining.

Dr. Burt: I mean, most time you get nothing, you spend a lot of time, money, you get nothing. But if the researcher hits a gold mine, the university will then, license it to a drug company and return for five to 8% of the profits as well as benchmarks. So when they do phase one, they get a million. When they do phase two, they get a couple million on and on and on. So the universities are invested in this and what's [00:31:00] happened in our society is we have merged universities, the National Institutes of Health, that also gets money from it, and drug companies sharing profits. And so the universities as well as hospitals. 'cause if the hospital doesn't have a university, you do that. The hospital claims that intellectual property, right? So they get money. So you've got the system now entirely focused towards drug company development. these drugs are very expensive. They bring in a lot of money. And then. More and more doctors are becoming employees of organizations, whether it's an HMO or a hospital or whatever, and they, they pay you by RVs, which means you're paid by the amount of, by the amount of money you bill. So you have drugs out there like Ocrevus for ms. It's $60,000 in infusion, which is done as an outpatient over a few hours. They give it again two weeks later. So that's [00:32:00] $120,000 for a few hours outpatient, and then every six months for $60,000. That's an insane amount of money, but everybody wins within the collaborating group, the university, the hospital, the physicians who loses is the patient.

Dr. Burt: Now, if you have really good insurance, they pay for it, but the, the society loses as a whole for paying that kind of money. the problem, so what I've done, I. It's like in the old days there is no patent. I don't want any royalties, just do it to help people. But the money that lubricates the system is now absent in that approach.

Dr. Burt: And it's my voice against hundreds and hundreds and thousands of doctors that are sent out there and drug company money to talk about and teach people about these new drugs who they ran a study on. So it kind of gets drowned out. So it's up to the patients to understand that and to get that information out there. Now the frightening, frightening thing for me, 'cause I've seen it change in my own lifetime. [00:33:00] Before the 1980s, we would develop things and the universities didn't get any money out of it. And you know, it's, we would just do it for the good of humanity and society. And it was society's taxpayer dollars for the most part that went into the research we're doing. now I. The universities the money. So you have the universities and the drug company and the NIH. They get money out of it that are all on the same money train. And that is really hard to overcome when you have these phenomenal results. But they're not on the money train, for instance, Ocrevus. All it does is slow progression it and you stay on the drug until you have purely neurodegenerative disease. Whereas if you get the right subset of patients and you treat 'em with HSCT, you actually reverse the disease and they're free for very long periods of times. The majority for [00:34:00] decades without evidence of disease and marked improvement with no further treatments, you would think it would take off.

Dr. Burt: And if you look at quality of life on all these drugs, they do not improve quality of life. They're very expensive. They don't improve quality of life 'cause they only slow progression. You still have symptoms. You're paying a lot of money. You're inconvenienced, even if the drug, even if your insurance paying, you aren't getting these treatments, you have side effects from treatments. Their quality of life does not improve with transplant, it markedly improves 'cause you get a one-time treatment, you're free of doctors, you're free of the system, and symptoms are better. So your quality of life is markedly better. So you'd think everybody would be talking about this and my patients used to say to me, you know, uh, you know, why doesn't anybody talk about it?

Dr. Burt: And I would always say, well, you know, medicine's very conservative field. I've gotta prove it. Which I did years in animal work and then phase one, phase two, phase three, um, but it never took off. So the patients would say it's drug companies. And I was hesitant because, you know, I'm not thinking that way and I know no drug companies out there saying anything [00:35:00] bad about me or anything like that. But as I began to read and investigate, I realized it's the laws in our system that have changed, that have facilitated this to go forward, that everybody just clicks into. So. An important thing that's missing in our healthcare. And it's because of the OLE Act and because drug companies are allowed to advertise. What? And they, they, and pacs, that's the other thing. So drug companies can give money to a pac, political action committee and they can give as much money as they want. And the, the, the Supreme Court said that's legal 'cause you don't want to impinge on the freedom of speech of a company. In the old days though, that used to be called corruption because what a drug company does is they give money to a pack and then a PAC supports the campaign through advertising for a politician that supports the policy, the drug company. If they disagree and they [00:36:00] say like, we're gonna get rid of the by do act, the pack will support their opponent and viciously like a wolf pack, attack the politician and destroy him. So now the politicians are greased to keep the money flowing 'cause they need their job keep them in power through the current system.

Dr. Burt: What we need is to stop funding pacs, letting companies fund them. What you have is a few companies or a few very powerful people influencing, in fact indirectly, if you will, bribing people their profit instead of the good of society. Now they'll argue that's not the case, we're just giving information. But if you look at all these drug covering adver advertisements, you know, people using the drug are all smiley and happy, and the one's not using it, guilt's put on 'em. and like what? companies used to do. And finally we said cigarettes can't be advertised. Well, when I started in my career, drug [00:37:00] companies couldn't advertise.

Dr. Burt: It was much better. That should be made illegal. That was made legal in the 1980s too. And these pacs are influencing the outcome of election with unlimited money from companies or very wealthy individuals are going against the interests of people and healthcare. So that needs to change and the ole act needs to change, you know, uh, that's the system that transplant for MS is up against despite being so helpful and so effective and why nobody moves into it. so it was kind of a wake up for me. And in fact in my new book called Kill Switch, which by the way has a forward by the Vatican, really bring that out in the last chapter and bring it home. 'cause I don't really bring that home, the everyday miracles because I want people to, you know, in the last chapter, I, I barely mentioned it, but I want people to understand how this therapy can help. But those are the two major things that have limited it. So it's really weird. When I started this, [00:38:00] you know, I had all this worry, maybe it's not gonna work and so forth. You don't know until you do it. And I spent 30 years doing it and it's really worked wonderful. But. It doesn't take off. And the reason is the system has changed, so the money doesn't go with it.

Dr. Burt: Now, nobody gets up and says, I'm, I'm gonna do this for money. That doesn't happen. It's just such an overpowering, indirect influence from the top down that that's what's going on. So, you know, if you're charging $60,000 in infusion every six months for a drug, you know, it's, it's not in the administrators that are looking over you that get a lot of money or in your clinic's interest to send them early to a transplant.

Samantha: Right.

Dr. Burt: Now, does, does anybody wake up and say that's what they're doing? No, what they're constantly bombarded with is. You know, this is the way we have to do it through drug companies. And in fact, because I have no [00:39:00] patent or license, you know, you can say it's not FDA approved, which it isn't, but that's because, and so then you can say, oh, it's, uh, voodoo work.

Dr. Burt: But no, that's not true. It's not FDA approved because that process means you're gonna get a drug or license to sell it, and you have a monopoly.

Samantha: Mm-hmm.

Dr. Burt: That's the reason, that's the FDA approval process. I went ahead. I didn't need to, I sent it to the FDA. And, and did it with an F-D-A-I-N-D, even though I was never gonna get anything out of it.

Dr. Burt: No drug company would ever do that. Why would a drug company do a study that at the end of the day, anybody can do and sell and they can't get any money, they won't do it. Well, I did it, it worked. And we get nothing out of it. We've asked for no, IND never would. It's your own cells. Why would we want to a monopoly on that?

Dr. Burt: Or intellectual property rights. So, uh, but the problem is then compare. And that's the way it used to be before the OLE Act, but now because of the Act. The [00:40:00] money and the system has changed and it's not in the best interests of our society even. And people aren't recognizing that. So in Killswitch, I bring that out to make people recognize it, to start them to understand, because I didn't recognize it. were telling me it's a drug company fault. And I'm like, no, that's not true. Drug companies have their own problems and stuff. But as I read and studied, I realized there is, but it's not the drug company per se. It's our laws that were done with good intention. But this is the unin unintended consequence of money like water flowing around a, a rock for the benefit of the system.

Dr. Burt: That now is a merger of education. That is universities and hospitals with the NIH, with drug companies all on the same money train. So what I do isn't on that money train and that's the problem. That's why it's important that it come out and people understand. And it also means you'll see in Kill switch, I hope it'll galvanize [00:41:00] people to, to change the system actually in kill switch, besides the Vatican doing a forward, a forward's done by who I've come to know very well, former US congressman and senator from Illinois, Mark Kirk.

Dr. Burt: And they both do it great forward. And in there he talks about how we gotta bring this to the attention of the political system and bring about, uh, these changes. Because in the old days, if you invested in a company and the company succeeded, you got profit. If you invested in the company failed, you lost your money, you took the risk, you got the award.

Dr. Burt: Now the American taxpayer, without their knowledge, are investing in all this, that drug companies do, but all they, they don't get anything out of it except a very high bill at the end of the day. And if you don't have excellent insurance, you can't afford it.

Samantha: Right.

Dr. Burt: And so the system needs. To be recognized for where good intentions have gone wrong and changed.

Dr. Burt: So believe me, I never wanted to say what I've just said. I just wanted to do good work to help people. But when you do [00:42:00] that and then you realize, well, people aren't doing this, what is the issue? Well, the truth is, whenever there's a problem, follow the money. And the

Samantha: Yeah.

Dr. Burt: is due to these laws

Samantha: Right in, in the book, you say directly you list pharma drug companies under, um, these are, these entities are not the problem. But I was gonna push back on that because what you've just described is a system where they're the people who are in charge of making drugs and ostensibly finding cures.

Samantha: They're disincentivized from finding cures. Because once you cure a patient of, for example, you use these drugs that, uh, are very inexpensive, um, because their patent has run out. The, then you, you administer those to the patient stem cells, their own stem cells. You can't charge people for, you can charge 'em for the time, I guess, and the [00:43:00] care, but you're not going to make a profit as a pharmaceutical company off of people's own cells.

Samantha: And then there's a cure. So essentially what your procedure is doing is robbing all of those pharmaceutical companies of the potential profits that they would have from administering these. Sometimes I think one, one, the biggest figure in the book was $90,000 a year for these patients who, because if you, if patients are chronically ill, they are dependent on the.

Samantha: Drug care, uh, the care of the system and dependent on these drugs. And if they go to you for, uh, an actual cure that restores them well, then all of those profits are gone. So there's not a lot of incentive for companies to develop cures,

Dr. Burt: , Let me tell you again why this system's gone bad. I. The reason they developed Ocrevus, 'cause physicians, neurologists started using rituximab.

Dr. Burt: A drug developed for lymphomas like B-cell, [00:44:00] CL, L, and they started to use it in MS and found that they were getting, you know, results that seemed reasonable or good at first, and they started publishing little papers about that. So along comes drug company says, oh good, if rituximab works by bin, binding this receptor on B cells, we'll just come up with our own antibody that binds that receptor and we'll do the study and patent it and get a monopoly.

Dr. Burt: And that's how Ocrevus came about. basically you can pay $60,000 in infusion for Ocrevus, or you can pay a few thousand dollars for a drug that no longer has a patent, and therefore any generic company can make. And the price has really dropped to a few thousand dollars. But people in America won't do that.

Dr. Burt: They'll only give this $60,000 drug instead of like a $4,000 drug. one of the reasons is, you know, the lawyers protect them because this drug is FDA approved for ms. Rituximab is [00:45:00] not. Well, why wouldn't anybody approve Rituximab for MS? Is because of a drug company ran the expensive study to do it, which by the way is what I did for nothing. If the drug company did that, they couldn't monopolize it. 'cause there's no patent on it. It's expired. Anybody can then start making it and selling it so it's not in their interest. Why would they do that? So what happened? And it won't happen in America, neurologists in America will not take Ocrevus and do a randomized trial comparing it to rituximab. 4,000 infusion infused the same times, one's 60,000. Okay, they're not gonna do that. France did it and it found rituximab was equally effective. stop in reverse, but slowing progression of diseases. Ocrevus equally the same. So in America, in one year, you're talking $180,000 versus $12,000, and they're equally effective in the French study.

Dr. Burt: And it was because of Rituximab that [00:46:00] Ocrevus was developed. That's the corruption that has come into our system. It was never, nobody designed it for that to happen, but that's what's going on, that has to change eventually. It's already affecting many people, but eventually this system cannot afford this.

Dr. Burt: . I.

Samantha: Yeah.

Dr. Burt: And that's what I bring out in Kill Switch. And it's, it, it, our system some good intended laws that have become twisted and, and, uh, it's not in the benefit of society. Our impatience. On the other hand, you do want advances to go forward as rapidly as possible. And certainly financial reward for doing that helps it to go forward.

Dr. Burt: So those are the things. So everyday miracles really important to what you can, can be done for autoimmune disease and understanding the problems. Kill switch really takes it home to really understand those problems better in a, in a different approach, it's really gonna [00:47:00] open your mind in a whole different way.

Dr. Burt: I know my mind has opened, 'cause I always used to just tell patients for decades, oh, it's medicine's conservative. We have to prove our way. And I fundamentally believe that. But after we proved it and it doesn't change, I've realized. You know, when there's a problem, it's like it was reported, you know, uh, for, uh, Nixon's Watergate, uh, to Woodward.

Dr. Burt: You know, follow the money. You have to follow the money, and then you see where the problem is.

Samantha: And if a patient is interested or, or somebody's interested for friend, family member in receiving the treatment, um, do they go to their doctor? Do they need to find a second opinion? If their doctor says that's what you said, you called it voodoo medicine, is the accusation that you're hearing, where do they go?

Dr. Burt: Well, I use that term. I think now it's accepted more and more. 'cause so many people are doing it or if they can't get it in America, they'll go overseas to do it. And a lot of Europeans are doing it and there's more [00:48:00] and more, there are now thousands and thousands of publications on this, all supporting it as a treatment from multiple universities and hospitals around the world.

Dr. Burt: So times have changed. That's back when I first started that type of, uh, of comparison. So I think now it's accepted as you know, but. Still, a lot of people don't know and they're not informed about it. But if you're interested, just contact scripts in La Jolla, California, because I do have, uh, a nurse and a coordinator who will help screen, uh, because you're always screened first to see if it's worth your time, effort, and also expense to come out to be evaluated or it's not.

Dr. Burt: So that's how it works. Eventually a person emails you and the necessary information is requested and so forth the usual secured lines. 'cause, you know, patient information has to be on a secured system.

Samantha: Right. Well, thank you so much for your time today, um, for discussing your work, and I [00:49:00] really appreciate all of the light that you've been able to shed not only on these treatments, but also on the medical system and these flaws of these compartmentalized departments and the way that pharma and the whole system is set up and some of this policy.

Samantha: Hopefully we can see some change on these things in the next few years.

Samantha: One final question that I ask all our guests is, who is one person, a alive or dead real or fictional, who you believe exemplifies the very best of being human?

Dr. Burt: My wife. Yeah.

Samantha: What is your

Dr. Burt: I've devoted so much of my time to this, and so I've been absent so much. takes incredible understanding and, uh, a belief in humanity and in doing good overriding, [00:50:00] uh, you know, personal desires. So I'll just leave it at that.

Samantha: s Very self-sacrificing.

Dr. Burt: Yeah, she has been.

Samantha: Excellent. Well, where can people find your work and uh, by the books and access?

Dr. Burt: uh, Amazon has it, Barnes and Nobles has have it. There's probably other bookstores that do, but definitely you can go online and, and buy it. Uh, from, and, you know, I don't know all of them. Those are just two examples. There are probably several others, but you, you can get 'em online, whether it's Everyday miracles are kill switch.

Dr. Burt: I definitely recommend if you like everyday miracles, read, kill, switch, I think you're gonna like it even more. they're both. Give you the good, but they also point out the bad as we need to, uh, because life is both good and bad and you, you have to change as to go along to maximize the good and to help people, and they bring that out.

Dr. Burt: I, this may be a trilogy with [00:51:00] a third book. I already know the name of the title, but for now I've gotta focus on getting my IPS studies going for a LS. And hopefully if my animal models are right, I can, and if lightning will hit the same place twice, I can really make an impact in that disease. We will see, if not, at least I tried and followed my passion, which is what I told Dr.

Dr. Burt: Neh at the NIH long time ago when I was a fellow wanting to do this in autoimmune disease. Thank

Samantha: Well, thank you so much.

 If this episode raised questions or sparked thoughts you'd like to explore further, I'd love to continue the conversation with you over on Substack at Brave new us.substack.com. Your comments and insights there helped to build the kind of thoughtful community the show was made for to support brave us.

Please take a moment to rate and review the podcast wherever you listen. Or become a paid subscriber on Substack. Your support makes it possible to keep bringing you these ad free episodes. [00:52:00] Thank you for listening and being part of the journey into what it means to be human in the age of biotechnology.

Pronatalism, Silicon Valley, and the New Eugenics | Emma Waters

What happens when creating a child becomes a consumer choice? In this provocative episode of Brave New Us, bioethics commentator Emma Waters joins host Samantha Stephenson to break down the rising trend of embryo screening, designer genetics, and artificial wombs. From Elon Musk's child-maxxing to CRISPR enhancements and Build-a-Baby startups like Nucleus Genomics and Orchid, we explore how reproductive technologies are reshaping what it means to become a parent—and what’s at stake for the children created through these tools.

If you've ever asked yourself:
• Is embryo selection a form of modern eugenics?
• Can we separate desire from design in the future of family building?
• Are children becoming products instead of persons?
• What's the difference between healing and enhancement in genetic medicine?

Topics Covered:

  • Why "have healthy babies" is a deceptive marketing slogan

  • The ethics of picking embryos based on IQ, personality, or sex

  • The rise of child-maxxing among elites like Elon Musk

  • Why "designer babies" deepen inequality and threaten parent-child love

  • What three-parent embryos and artificial gametes mean for the future of family

  • The philosophy behind eugenics—and why it's rebranded, not gone

  • When CRISPR gene editing might cross the line from healing to hubris

  • Why strong families—not just birthrates—should be the goal of pronatalism

Mentioned in the Episode

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If this conversation made you think differently about the future of family, science, and ethics, please:

  • Rate and review Brave New Us on Apple Podcasts or Spotify

  • Share this episode with a friend or on social media

  • Keep the conversation going at bravenewus.substack.com

Transcript

[00:00:00]

Samantha: Welcome to Brave Us, where we explore what it means to be human in the age of biotechnology. I'm here today with Emma Waters, a research associate at the Heritage Foundation, and sharp cultural commentator on emerging biotech trends. In a recent article, Emma explores how Silicon Valley Elite, once known for pushing depopulation and reproductive control, are now leading a curious pronatalist movement.

Samantha: But behind the talk of baby bonuses and tech enhanced families lies a deeper question. What kind of people are we trying to create and who gets to decide? We discuss how this new wave of tism intersects with genetic screening, embryo selection, three parent children, and the quiet rebranding of eugenics for a 21st century audience.

Samantha: Is this really about saving humanity or [00:01:00] redesigning it? Emma, welcome to Brave New Us.

Emma: Hi. Thanks so much for having me today.

Samantha: Absolutely. So can you tell us about your work and how you came to be doing what you're doing?

Emma: Yeah, absolutely. So I started off in the family policy space in college studying everything related to marriage and family structure, studies and policies that could encourage or hinder the development of intact families. And from there I became increasingly interested in the role of technology as it was sort of re-imagining every aspect of our life, from digital technology to our understanding of sex with the gender ideology, movement. And then ultimately landing in this space of reproductive technology, uh, realizing that in many ways our technology is re-imagining how we think of conception and what it means to be human at that most fundamental level. Um, and so over the years I've. Worked for a number of scholars who have primarily been at the Heritage Foundation, building out our platform on reproductive [00:02:00] technology and emerging biotechnology. Always with the question of what does it mean to be human, and how do we promote family flourishing through the technologies we promote?

Samantha: Excellent. So in your recent article for public discourse, you distinguish between Tism and pro-family. What do you mean by that and why do you think this distinction is important?

Emma: This is a great question. So it's been a really exciting development in the last couple of years to see the topic of declining birth rates and tism really come into the mainstream discussion for many years. It was something that floated around academia and niche circles, but hadn't really entered into mainstream discourse.

Emma: And so in many ways we have Elon Musk and a few very prominent figures like that to thank for the awareness that's been, um, that that's been garnered over the last few years about declining birth rates. So a little bit on that. Birth rates in the United. States as of 2023. Um, so it's a bit dated now, but it takes a while to get the [00:03:00] information in, have declined to 1.62 births on average per woman. Um, and typically scholars say that in order for a nation to maintain its population levels, you need to have about an average of 2.1 children born per woman. Um, and even more than that if you want to grow your nation. And so, uh, uh, in some levels, um, it may just seem like a numbers game. What's the big deal?

Emma: We have fewer children now. We'll have more children later. Um, but a lot of folks in the prenatal. Space have recognized the continued downward trend and have been very alarmed by it. Because declining birth rates mean we have fewer people to support the nation, which means we have fewer people. Um, in our military, in our education, in research and development. it affects things like our social security, um, our, um, unemployment, our elder care, uh, and it really begins to impact multiple levels where you have countries like China or Japan, for example, whose birth [00:04:00] rates have declined to such a degree that they're concerned that the nation may not be able to sustain itself in coming years.

Emma: So not destroyed by the enemy outside, but destroyed by the enemy within. Um, and, and like to put this in perspective, South Korea, which has the lowest birth rates in the world, uh, I think their birth birth rates are at 0.7 for every 100 South Koreans that are alive today. They will only have on average, about seven grandchildren because of how low birth rates are. Um, so it's an incredibly, uh, I think, heartbreaking conversation when you start thinking about the real personal impact. But Tism, um, is a movement that's risen in response to that. Who's promoting, as the name implies, more babies being born. Um, and so at face value, right? Like we support more babies being born to families, um, who, who want to have them.

Emma: But it's that distinction, uh, right there that I think is so key. Tism is strictly concerned with more babies being born, but many [00:05:00] in the movement don't actually, uh, care whether those babies are being born to married, mothers and fathers. Whereas the distinction that I would make, which is the pro-family movement, where I really orient myself says that we're not simply concerned about having more babies, but we're concerned with more families being formed in the United States, and we want to see more healthy marriages as.

Emma: Established between men and women, and from those healthy marriages, couples having the children that they desire. Because ultimately, if we have a nation where artificial wombs are used just to create literally more babies, um, or in the case of Elon Musk, who has, uh, multiple women who have had multiple children either as surrogates or in these sort of like financial agreements.

Emma: While every child is a gift that's conceived and born, we have to be very honest about the quality of life that we're giving to those children. Um, and so if we're just having children who have no natural connection to their mother and father, we're actually setting those children up to have a much harder life, [00:06:00] um, based on a number of studies and research that's been done on child wellbeing and family formation. Um, and so that's why I make that distinction between, uh, TISM proper and then the pro-family movement, which I think is maybe, which I think is the better response to, um, our current cultural problems around birth and the decline in healthy marriages.

Samantha: So I obviously, I agree with you, but just to play this out, what, what is the problem with somebody like. Elon Musk, you know, reproducing with his harem or, uh, with an artificial womb. What, as long as the, uh, he might say, I have the means to take care of these children. I obviously have fam fabulous genetics.

Samantha: Look at what I have accomplished and look at my intellect. And why would I, if we need more babies, should, aren't I the best candidate? I can fund as many as we can put out there in the world? What would be the problem with that as, and why would we [00:07:00] necessarily want more families who are ill equipped or certainly less equipped financially speaking than somebody like Musk to reproduce their babies?

Emma: Yeah, and this is a fantastic question and pushback. So I think there are two, there are two things that come to mind. Two things we've already seen play out in response to this. Um, the first is materialism, and the second is the impact on the child. So taking the materialism angle. I think when it comes to this conversation, Elon Musk, literally, who is literally one of the richest men in the world, without a doubt, right, has the means to have many, many children and provide financially whatever they need. Um, the problem however, is that unfortunately, I don't have nearly as much money as Elon Musk. You probably don't, and the average American doesn't either, right? Our average median income is. I think somewhere between like 50, $60,000. Um, and so when we have these expectations, um, set by an elite class, and elite classes are very good for setting the [00:08:00] moral standards for a nation. Um, and if you have individuals like Elon Musk saying it's really not about the families, it's about the money, can you provide for them? Um, and why shouldn't I? Then I think we run into a problem where the cultural expectation that he sets is that you need to be able to provide your children the best life possible with as much money possible and everything they could want or need. Um, and he can do that, but the average American can't. And so they'll look at figures like Elon Musk, who certainly do have enough money to, um, procreate at that level and say, well, I can't do the same thing. Why should I even bother to have children if he's going to take care of it, if others with enough money are going to take care of it? Um, and whether. know, Elon Musk likes it or not, he won't literally be able to have enough children to address the declining birth rate problem. And this overemphasis on having certain kinds of children and giving them every possible material, um, thing that they need, I think could actually end up suppressing birth rates for everyone else, which is what we've actually [00:09:00] seen, um, with the rise of materialism in, in years past. And the second thing I would say is then you have to ask, what about the children who are being formed in this arrangement? So on average, non-resident fathers only spend about 30 minutes per week with their children. And even like the best fathers with the best of intentions. There's just natural barriers that come into play when you're not in the home.

Emma: And take someone like Elon Musk, who has many, many children living in many cities with different women, um, he's actually proposed the idea of a commune where they all have individual houses, um, to try to solve this problem. Right? But he, he travels a lot. And so there's this question of like, how much time does Elon even get with his children, especially if he was. A child maxing on a larger scale. Um, and so I think when we think about this issue of like, just have tons of kids, it doesn't matter or say artificial wombs, right? Say you say, well, what if we just create the babies through in future fertilization? We then implant those embryos in an artificial womb.

Emma: They raise the kids and then whomever wants the child, a single person, a couple, a throuple, [00:10:00] a same sex relationship or not can come pick them up. Well, we are actually conferring massive, um, harms and risks onto that child just to fulfill the desires of adults. And this is something Katie Falta said, um, very elegantly when she says that we can't let the, um, desires of adults come before the needs of children. Um, and I think Case in point is looking again at Elon Musk, his oldest son, um, in recent years has really rebelled against Elon Musk because of this technology and this, um, tism detached from the family that he's promoted. So Elon Musk oldest is. Son now goes by Vivian and is very openly talked about how incredibly angry he is and how frustrated he is with how his father chose to create him in a lab, select him for his sex, um, and really engineer every part of his life for the purpose of having more babies, but not really providing him with a home, with [00:11:00] unconditional love with a family to raise him. Um, and there are other articles that have, that have started coming out with children, um, sort of raised in this prenatal list mindset that have, I, I think really started to suffer the harms of that. And then just by and large, um, we know that children who are raised. An intact married mother, father, like biological mother, father, family, do the best when it comes to their psychological, their emotional, their, um, behavioral educational, and in some ways their financial outcomes.

Emma: And so if we're simply encouraging a more baby's movement detached from that married, mother and father, then we are placing children in situations where they are less likely to thrive. This doesn't mean that they will all do horribly or be unhappy, right? But we are setting them in a situation where we're, we're, we're intentionally putting them in a, a situation where it will be harder for them to do so. Um, and, and I think a lot of this really does come down to these sort of like. Big picture ideals versus like the lived experience of what is good for children. Um, and the last thing I'll say on this is there is [00:12:00] a, there was an article in the Washington Post written by a woman last year where she basically said, okay, fine, we have declining birth rates.

Emma: I'll grant you that it's a problem for our national health and security and unemployment and you know, elder care, et cetera, but what does this have to do with me? Why should I as a woman bear the responsibility of this broader issue? And so she basically, um, somewhat crassly says, um, sure if you think there's a problem with declining birth rates, then figure out a solution that doesn't involve women having babies. Um, she was like, 'cause I don't care. And I think the thing that her article most, uh, uh, really pointed out to me is that if we make this about increasing birth rates simply then it does become a bit of, um, I, I think we hit a situation where women start to opt out and they say, that's great. You want increased birth rates. Yeah, basically like, what, what's in it for me? And if I don't want kids, then why should I be engaged? And we've removed the human element, um, the family element from [00:13:00] it, that it really, I, I think, the appeal societally. Um, and this is something they've, we've actually seen in China where China's now throwing tons of money and, uh, messaging incentives, um, and cultural status to women who have babies. And women in China are literally saying, yeah, I think we're good. We're just gonna pursue our career. We really don't care about your national crisis. Figure it out yourself. Um, and, and so you detach children from the family, from married, mothers and fathers. I, I think you inevitably hit moments like that and long term that actually is going to decrease birth rates even further and sort of undermine the initial goal of tism to begin with.

Samantha: Yeah, absolutely. And something you said, and you were talking about defining the best life possible and how we are defining, uh oh, I can give the child the best life possible in purely materialistic terms, but the best life possible, I think for a child includes a mother and a father who loved them. [00:14:00] And, and I think most people who have had good parents, especially thinking about it, would say, yeah, I wouldn't trade my good parents for more stuff or more vacations.

Samantha: I that, that is completely beyond value. Um, and looking at the birth rate as just purely a number or a term to increase, totally ignores. The point of looking at what is the best life, what is the purpose of family, which are deeper cultural problems that we have to address when we think about these things?

Samantha: Um, which I think provides a good segue into the next question when we talk about what makes a good family and parenthood and child. So Nucleus genomics and IVF, genetic selection startup builds itself as a catalyst for a world without heritable diseases. Sounds great. You responded on X and in articles calling out the inherent eugenic drive in startups like [00:15:00] nucleus genomics, orchid, helio, spect.

Samantha: My own genomic prediction, I think it's very clear that these are eugenics companies. What's less clear is how to respond to someone who receives that accusation and says. So what, um, in other words, the eugenics movement spurred by Charles Darwin and promulgated with almost religious fervor in this country by Charles Davenport, Harry Loughlin Madison Grant was inhumane in its targeting of vulnerable communities and the four sterilization laws that became Hitler's inspiration.

Samantha: But that those are really problems of application and that ultimately the core of eugenic philosophy of purifying our genetic pool of humanity, that is an aspirational goal. And that now with the sequencing of the human genome and the ability to use genetic editing with crispr, we finally have the means to execute a eugenic program that is ethical and even praiseworthy.[00:16:00]

Samantha: Is there a flaw embedded in the philosophy of eugenics itself that exists apart from the practical implementation that led to past atrocities?

Emma: Yeah, it's a really good question. I think it, and correct me if I'm wrong, but I think that that final part of the question in particular is in like the 20th century of eugenics we were dealing with. People who were already born, right? People who were walking among us, they were disabled, they were maybe the wrong skin color.

Emma: They had the wrong intellectual capability. Um, but today with Nucleus genomics and Orchid and a number of these other companies, we're dealing with human beings at the embryonic stage, um, at a stage where it's, uh, one hotly contested if, if we should even attribute any personhood or value to that embryo. Um, and two, that even if we do contribute some value to the embryo, if it should really matter what happens to the embryo, right? Because that, that small, very tiny, uh, embryo right at the earliest stages of human development looks nothing like you and I do today, even though if allowed to develop normally it, it [00:17:00] would, he or she would eventually do so. Um, and so I think one of the things that. Has been so, uh, intentionally or unintentionally deceptive in that movement is the framing of, um, orchid, for example, whose, whose tagline is, have healthy babies. Um, nucleus genomics says we should remove all heritable diseases. They, they frame the conversation around health and they say, no, no, it's not eugenics, it's just science.

Emma: We're helping you have healthy babies. And that, um, right, like at, just like at face value seems great. We all want healthy babies. It's one of the most natural and in like intuitive desires every parent person has. But what I think they're very unclear about, uh, many cases just outright deceptive about, is that we're not talking about this abstract idea of wanting to heal a child. Bryo or improve their health. But what they're really saying is, is we should test each individual embryo. And then what these companies do is they [00:18:00] assign, um, a score for every disease or condition that they test for. And say, your embryo has, say, a 90% chance of getting Alzheimer's, a 50% chance of insulin resistance, um, a 25% chance of hearing loss and so on.

Emma: And then you can look at those scorings for each of the embryos and say, what are the embryos that I want to use and what embryos do I want to destroy? And so it's picking winners and losers at this, um, be like inherent level of human life. Um, that's just far beyond anything we've seen, um, in like the 20th century eugenics movement. Um, but I would say is no less eugenics because ultimately what you're doing is you're placing a conditional value on human life. Um, and, and apart from any like moral pro-life language. scientifically speaking, an embryo is a distinct and living organism with its own unique set of DNA that if placed in the right environment will grow, into like a, a human being as you and I [00:19:00] recognize one. Um, and so there doesn't necessarily need to be moral language to recognize that. And what these companies are doing is then taking those embryos and assigning winners and losers based on their, um. Best tech, best technological guess at the content of this embryo. Um, and I think what's important to note is the ability to test for certain diseases, what we would call monogenetic diseases or like single gene diseases. Um, and to test for the sex of the embryo has been around for a very long time. I like to joke that there's no gender confusion in a fertility clinic, um, because they can tell right away if they're looking at a boy embryo or a girl embryo. And so in the United States we have about 450 fertility clinics. 75% of those clinics allow for pre-implantation genetic testing to look at single gene diseases like Down Syndrome, Tay-Sachs disease, cystic Fibrosis, something like that. About 73% of those clinics allow you to test for things like the sex of the [00:20:00] embryo. Um, and it, and it's very notable because most states don't allow abortion based on sex.

Emma: Um, even our, our most blue states, right? You can't go in and say, I want abortion 'cause it's the wrong sex. But in fertility clinics, that is in many cases just an assumed state. can go in and say, I really want to have a girl and help me pick the girl embryo from the set that's most likely to succeed and then destroy all the other human embryos.

Emma: But these companies like Nucleus genomics take it to a whole new level where they're testing for 900 to 1200 polygenic conditions, which means conditions that develop based on the interplay between multiple genes, which means it's even more unreliable or more complicated to assess that. Um, but they're going even further.

Emma: And they're not simply looking at the health or the sex of the embryo, but they're assessing things like the potential IQ of the embryo or the potential personality of the embryo. So what genetic combinations tend to create, [00:21:00] um, a more docile child, what, uh, combination tends to create a more kind or a more, um, aggressive or a more ambitious child, and they're offering parents not just the opportunity to have a healthy baby. But to have the exact kind of baby they desire, but instead of being upfront and saying, you are picking and choosing winners and losers, right? You're not increasing the intelligence. You're just trying to choose the embryo with the highest IQ based on the number of embryos you have. Um, and so that's why I've really framed it as this consumerist eugenics.

Emma: If you have enough money you can create, uh, and select the kind of child you desire. Um, but yeah, and so in many ways it is just a modern version of 20th century eugenics, but because it's dealing with embryonic life, I, I think it's a lot harder for people to, um, grapple with in the same moral terms.

Samantha: Well, and, and also that it's just to play devil's advocate. Some of them are going to make it and some of them are gonna be discarded, so why not [00:22:00] choose the one that most closely matches? I am, I am a buyer of a product. Why not choose the best product has, however, I define that.

Emma: Right? Yeah. Uh, and this is what many of them frequently say, unfortunately. Um, and so in those cases, if, if you frame it in that language, right, of like, I am, yeah, I'm the buyer. I can get whatever I want, why shouldn't I pick the best possible child? Um, I think that's where, um, one, uh, I make the distinction between intentional and unintentional.

Emma: So, um, throughout conception there are unintentional, um, times where an embryo or a child doesn't make it right. An embryo, um, doesn't continue developing. Um, or even a, an. Plant a child doesn't continue developing and you have a miscarriage or you have other complications, those are unintentional and unnatural deaths to that child at each stage of development that are incredibly heartbreaking, right? Um, and are far outside the control of [00:23:00] parents. But what we're dealing with here is the intentional selection and destruction of human life. Um, and so one intention matters and then two, I would say that our society. I, I think by and large, like many people would agree that there, well, not everyone would agree though that there are some things that ought to be beyond the scope of the market and ultimately having enough money is not a good enough justification for what you can and shouldn't do.

Emma: And we have laws governing every aspect of society that says no. There's some things that are far too intimate, far too sacred to simply be subjected to a monetary, um, transaction. Um, so prostitution is largely banned, um, even if it happens outside of the law, right? As largely banks, we recognize that sex and that's sexual intimacy, ought not be governed by the market. When it comes to reproduction, this is, I think where we have one of the last holdouts, um, of this debate, right, where we have surrogacy, where we have, um, buying egg and [00:24:00] sperm, where we have the creation of human life. Where, where there has been this permissive view that if you can buy it, you should be able to.

Emma: And I think that's where you just see a, a moral disagreement, right? Like just radically different worldviews at play with each other. Um, that should have good policy governing them. They should have, um, very clear limitations placed on what can be done to human life. Um, and a lot of that comes down to, I think, uh, a longer and larger debate in the public square to really shift think the thinking on this topic.

Samantha: Why do you think a philosophy of eugenics seems to emerge from so-called elite classes intellectually and socioeconomically? And what do you think we lose by defining those markers as the pinnacle of human achievement?

Emma: Yeah, so the, so the eugenics movement with embryonic genetic screening really comes out of a larger, um, movement towards [00:25:00] longevity and transhumanism, um, that was largely birthed in Silicon Valley, and it is sort of making waves across the United States culturally speaking. So for many years you had individuals from Brian Johnson, Peter Thiel, um. To, you know, more normal researchers who were asking how can we optimize human health to the highest degree. Um, in some ways the Maha movement is a sort of like normal, healthy version of this, right? Where it's like, how can we just like provide people with the best water, the best food, the best lifestyle so that they can thrive? but out of that movement, you had a number of individuals who started asking, we are, started saying really like, we're spending so much time and money trying to optimize the health of an individual once they're born, once they're in their twenties, thirties, or older. What if we started at the most intimate state, um, of embryonic life and actually optimized, um, the longevity, the health of the embryo from the very beginning where we have maximal control over the outcomes of the embryo. and so largely [00:26:00] an elite, and, and this is sort of, I think this philosophy is like a. Is natural among like our elite class of like, you want the best and you want to be the healthiest and the best you can be. And on like, on face value. That's great, right? We should all pursue excellence. Um, this movement though, of course, has taken it to a far different level where it's not simply pursuing excellence, right?

Emma: But it's like picking and choosing which children are even born in the first place and then can pursue excellence from there. Um, and so I think that's, like if you. Saw online like Brian Johnson was at Nucleus Genomics opening. Um, there's a really close connection between the transhumanist longevity movement and this embryonic genetic screening movement. but what's so interesting to me is that embryonic genetic screening is only looking at the genetics of the embryo. Many of the conditions that they're testing for are not primarily genetic conditions, but environmental connections, conditions. So take for example, Alzheimer's. About [00:27:00] 96% of all Alzheimer's cases are traced back not to the genetics of the person, but to the environment and lifestyle that they lived. Only 4% of cases on average are due to a person's genetics. So you may use breon genetic screening and say, wow, this embryo only, you know, barely has a chance of Alzheimer's. This is amazing. We should choose this embryo that only accounts for 4% of the possibility. Right. The other 96% will be governed by how they live their lives.

Emma: So I think there's an expectation among certain elite circles who are using this technology that they will ensure that their kids then follow through with the lifestyle and have access to the things to ensure that they're the healthiest possible that they can be throughout every stage of their life. Um, such that that 96% is not as big of a deal. Um, but it's just no guarantee. Right? And this is the case for almost all of the polygenic conditions that they're, um, testing for, is that so much of it comes down to our environment and the life that we live. Um, and even things, right? Like we can be [00:28:00] exposed to something that we don't expect, that we don't intend to be exposed to that can cause any number of conditions. So it, it, it really in some ways, like, I think doesn't fully achieve what I think they're trying to do because there's so much that could go wrong, um, go wrong, quote unquote, right in their worldview after that. but I think it's very appealing nonetheless. Um, and, and it sort of follows like our. our marriage and dating trends too, right?

Emma: Our marriage rates have been declining long before birth rates were declining, um, with hookup culture. Um, the sexual revolution, no fault divorce. And in today we've sort of reverted to this maybe somewhat dystopian approach to marriage that's reduced to dating apps with profiles and constant swiping.

Emma: And we know that that's actually continued to suppress marriage rates. Not necessarily help them, even though I know and probably, you know, people who have met and gotten married on these apps. And very similarly, I, I think we're seeing as. We will see a similar outcome here where there are stories of individuals in [00:29:00] Silicon Valley who say, well, why should we have kids now? Why not wait five years, 10 years, 15 years, when the technology is even better, when we can just use an artificial womb when we have the ability to even edit the embryo to the exact kind of child that we want. Why would we have a kid now when we have even better technology to have a kid in the future? Um, and now of course, there's a couple of levels to this one. What happens if you do have a kid in the future, but five years after that the technology is even better. Are you, are you going to have buyer's remorse for the child that you have? Like it's sort of this infinite regression of there will always be better technology promised. Um, and then two, think that also just like tends to suppress birth rates in a very real sense where if you make it about having the best possible kid who has the best possible life, then that's really, again, only possible for a certain, very small percentage of society. With that, those level of means where then the average person won't be able to use IVF, they won't be able to pay for this advanced technological screening. Um, and, [00:30:00] and so I think it will cause like this further fracture in our society of who's having kids and why they're having kids. Um, yeah, but that's a long answer. I, I think like the

Samantha: Yeah.

Emma: is just like going a couple of different directions. Um, yeah.

Samantha: Yeah. Well, I, I think it's interesting too about this kind of, uh, way of obtaining and optimizing. Children really flies in the face of what I think should be the ideal of parenthood, which is to offer unconditional love and sort of be drawn beyond yourself and stretched and become a more virtuous person by the self gift of oneself to your children.

Samantha: That's very opposite of designing a child that fits your desires. Those are two very different paradigms, and I think one tends to lend itself better to the building of virtue and generosity [00:31:00] and love and acceptance that we, I think most people would agree is ideal in parenthood. Um, still, but yeah, it's, it's a little bit, uh, it's a little bit frightening to follow that line of thinking

Emma: Yeah.

Samantha: the way to its natural ends.

Emma: 'cause

Samantha: Um.

Emma: your children to sacrifice for you rather than you, the parent, learning to sacrifice for your children, even when that means having a child with additional complications, right? That's maybe not the child you had in mind. Um, but I think there's this, uh, just hubris in the industry that's just, that's incredibly foolish. Um, assuming that we somehow know what's best for future generations to, to the point of like what kind of children are best for future generations. Um, and not recognizing that to some degree providence in nature right. Do govern it, um, for our good right. And reshape who we are as people through this self-sacrificial gift of parenthood. Um, and also open the door for new kinds of people and new personalities, um, to be born in the world that we would [00:32:00] never have imagined our guests. Um, and so I think a little beyond even what you're asking, there are two just like. Broader concerns that I have of one, we see trends in buying, uh, markets all the time, right?

Emma: Like the new iPhone comes out, everyone wants the new iPhone. Uh, this new dress comes out. Everyone has a variation of this dress. And I think there's a very, there, there's a very real concern that there will also be trends in the kinds of, um, things that people select for. Um, so I, some people actually think that autism or autism is a strength.

Emma: So there's like a swath of parents actually choosing embryos based on autism or what happens when people think like, oh, like kindness is the highest personality. We should have all the kind people, which is great, but people who were overly dispositioned to kindness for a whole generation probably don't protect your borders in a time of war very well.

Emma: Um, or if you choose a very aggressive generation, right? Like it's probably not good for like the domestic health of your nation. And so there's a real concern that like these sorts of trends in children, um. Weaken society [00:33:00] overall. And then the second thing, um, and I mean this like somewhat humorously, but I think the point stands is imagine if the boomer generation or fill in the blank generation had access to this technology. What kind of children and personalities and IQ and health would they have chosen? Is that really what you or I wanted to be created and born and lived as? Um, and based on the like pretty strong like reaction to boomers and older generations, I think most people would say absolutely not. Like we actually really like the sort of cultural generational distinctions that we have, um, that have by and large developed sort of naturally in response to, um, our own context and previous people. But how much, yeah, but like how much of that do we actually lose with embryonic genetic screening because we take away that natural variation, um, at a very fundamental level if it's adopted wide scale.

Samantha: Yeah, taking that stereotype of the former quarterback of the high school football team who wants his son to continu his footsteps, [00:34:00] but his son just wants to pursue science or musical theater and. But at a very genetic level, trying to exert control over who your child becomes rather than allowing them to flourish and unfold as as a gift.

Emma: Yeah. Yeah.

Samantha: So the inventor of CRISPR technology for gene editing, Dr. Jennifer Duna, who in good faith has been very vocal about insisting on ethical uses of this technology, has commented that one day we might regard it as unethical not to use CRISPR to edit out genetic defects. One, do you think this is a likely prediction?

Samantha: And two, what do you see as the relevant differences between making these changes in people who are already born, say to ameliorate disease or designing embryos to exhibit particular characteristics?[00:35:00]

Emma: Yes. Very good question. Um, so the first part of like, how is this technology even possible is a, it's a really good question. So I think there's, yeah. So there are a number of scientists, um, just across the board, not, you know, coded as any one set of beliefs or another who have really called into question the viability of this technology.

Emma: Um, like how well are we actually able to select or even edit a given, uh, gene? Like how accurate is our, is our effort in this space? Um, so I think right now, um. It's still very uncertain from what I've seen, like how accurate our, our attempts actually are. I think in the next five to 10 years, we potentially could see a high level of, um, in the genetic editing space.

Emma: Um, and I hesitate to see ac say accuracy because I, I think like so much of it, while we've like made incredible advances, so much of it is still uncertain. Um, that, and there's so many complications that could arise, right? Because like [00:36:00] even on a basic level, you need the tools. That make it possible to do the editing.

Emma: So like, theoretically this is all possible, but even when it comes to like, do you have a tool that's small enough to, uh, literally change a given gene, which is right, like beyond like our ability to even see with our, with our eyes, have a tool that can actually go small enough, that can inject, that can change, that can, uh, make the, yeah, like, make the changes necessary. Um, they're still working on that aspect of it, such that genetic editing is incredibly expensive and time consuming and it, and for those reasons hasn't been the first stop for people, which is why you have seen the rise in genetic selection because it's far easier technologically speaking to analyze and select than it's to actually make changes to an embryo, even just with the tools we have necessary. and then the second part of your question of would it be, uh, do we hit a point where it actually becomes unethical not to use it? Um, and I think this line of thinking. Comes [00:37:00] from a place where if you assume that just because techno technology can do something, it therefore should do something. Um, and, and this is I think a broader problem in our technological discussions is that it's all about if we can, we should not, if we can, is this actually good for humans? Um, and so, uh, yeah, so I think on that one, I think it will be very realistic that will have people who encourage the use of genetic editing because it's somehow unloving to your children not to use it. yeah. And you had, sorry, you had another part of this question that I'm now forgetting. Um, maybe about the kinds of things Oh, the enhancement versus like diseases.

Emma: So I think when it comes to genetic editing, I am actually far more open. in having a discussion about the technology because the, the, the wide array of genetic therapies is incredibly broad. So you have the sort of designer baby, what if you had an embryo and you could just change whatever you wanted to have the child you like and we'll, we'll call that like the [00:38:00] enhancement side of things.

Emma: So it's not just that I have a healthy child, but I wanna child with blue eyes, who's really good at soccer. Um, I, I think when it hits the realm of enhancement, then that becomes incredibly problematic because you are conditionally choosing the child and you're taking away. like nature's ability to give you the child that you need, right?

Emma: Or that child to develop their own interests or desires outside of the selection. But I'm far more interested in what it looks like to use genetic therapy to heal actual diseases or, um, problems within a child. Um. And so once the child is born, that seems like a really obvious and positive example. So you have baby CJ that was recently born where they were able to use genetic editing to change the proteins within his DNA so that it actually healed him of this like incredibly rare disease that he had. Um, and it didn't change the genes that he would pass down. It was just focused on that child. Um, and so that's something that I was by and large praised throughout, [00:39:00] um, all communities, right? Is a very good use of genetic therapy to actually heal a child and also limit the negative impact that can have on future generations, right?

Emma: Because if you change DNA that will be changed in your offspring, then that's a really big question of like, okay, what if we do something wrong? And now you've not only harmed one person, you've harmed every child that comes from their line. Um, but then I'm also really interested in things like. I think at the embryonic level, like what would it look like if you could heal conditions like Down syndrome? Um, I think that it doesn't change the value of right, and like the goodness of the child either way, but I think that's where people become far more, um, on edge because it's just, it's such a big question, right? And it hits the disability community of like, how do we think, are these differences in the human person or these limitations?

Emma: Are they gifts in and of themselves? Should we try to heal them if we have the opportunity? But I think that's the space where at the, either the embryonic or the born level, I'm very interested in seeing the development of [00:40:00] these genetic therapies that could actually heal a given child. Um, but I'm far more wary of like, moving into the realm of enhancement, right?

Emma: Like it's not just to have a healthy kid, but you want a healthy kid who's like six three and greater football. Um, that seems like far more problematic, but I don't think that we have the moral imagination or the moral, um. Ability to really make that distinction in our society. So part of me thinks like we, we, we don't have the wisdom to govern this technology reliably. Um, because there isn't an agreed upon, um, view of the human person that would allow us, I think to reliably say, we can agree that this is healing versus this is what's enhancement and we should be able to get there. But I, I am just not confident that we're there right now.

Samantha: Yeah, something we'll have to unravel as we go.

Emma: Yeah.

Samantha: So you have written extensively about the problems that arise when we use technology as a substitute rather than a supplement to human flourishing. [00:41:00] Can you explain the difference and why this distinction is so critical?

Emma: Yes. So that distinction of substitution versus supplement comes from Joshua Mitchell, who is a professor at Georgetown University. and he's used this, um. Many different contexts. I've applied it specifically to the question of technology. So what I mean and what Joshua Mitchell means, um, or at least my interpretation of what Joshua Mitchell means when he uses this, is that for a technology to substitute the human person, it is, it means that in some way, our use of that technology is replacing a natural human function or natural human experience. So take, um, the, the topic of IVF, for example, right? IVF, um, results in the creation of a human embryo if everything goes correct. But in order to create that human embryo, you're actually substituting the human person or the human body and creating it not through the natural intercourse between a man and a woman, but in a laboratory setting, um, with [00:42:00] technicians who are like artificially, like placing your egg and sperm in a Petri dish and hoping that it turns into an embryo. And that scenario, I would say that we're actually subs, we're using IVF to sub. A natural human function in a way that I, that at, at base value, right? Like introduces a number of complications into our understanding of what it means to be human, um, the wellbeing of the child, and so on. When we say, when I talk about technology supplementing, at that point, we're talking about ways that technology, um, can actually help, encourage, or help achieve a natural human outcome.

Emma: So a very basic example of this is like the use of glasses or a prosthetic arm, right? It's not substituting your ability to see, but those glasses are helping supplement your natural eyes so that they can see in a way, uh. they ought to, right? Without any, um, issues or like natural weaknesses that come with time and age. And so I'm very interested in the development of technologies that will further supplement the human person and human [00:43:00] flourishing. So things like, um, the development of, uh, different approaches to treating infertility, for example, um, broadly fall under the category of like restorative reproductive medicine. But this can mean everything from, um, addressing tubal blockages, um, that may prohibit a woman from, uh, naturally conceiving a child or addressing conditions like endometriosis or any number of factors, right? And it actually involves a high level of technological sophistication, not only to identify and diagnose the cause of infertility, but then to actually address all the factors contributing to it. Um, but I think any, any use of technology in that sense, right? It's just supplementing what the body naturally does. It's not necessarily substituting the body with this like outside, um, meat. Creating a child. Um, so yeah, that's the distinction at a

Samantha: Yeah, no, absolutely. And, uh, this season we will be having on, uh, Dr. Stacey Tringo to talk about IVF in a little bit more detail and Grace [00:44:00] Emily Stark, the editor at Natural Womanhood, to talk about her policy wishlists and other things about, um, restorative reproductive medicine. So keep an eye out for those episodes.

Samantha: Um, speaking of technologies that either substitute or supplement, can you explain the process and purpose behind three parent children and what are the concerns around this technology?

Emma: So this is something that, um, has, has sort of had a few different moments in our cultural conversation. Um, and most recently in like the mid 20, like before and after 2020s. And so with three parent embryos, what we're talking about here is, um, typically there's a few variations, but like typically when we talk about three pair embryos, we're talking

Samantha: I.

Emma: the replacement of a, of embryo or a cells nucleus with another embryo or cells nucleus.

Emma: And so what that means is if you have, say, a. Um, one [00:45:00] embryo that is, or say like you have like sperm, egg, egg and like the sperm and the egg of like the intended parents who want to raise the child, uh, may have like the egg for example, may have a condition where it's less likely to, um, create a viable embryo or it could convey some heritable disease to the child.

Emma: What they would do is they would actually take that woman's egg with another woman's egg that didn't have those same conditions and they would replace key parts of her egg with, um, genetic material from the other egg. And so you would end up with a child who had genetic parents in three different places, one man, two women, in order to sort of offset and piece together the healthiest possible egg to create the healthiest possible embryo, in the United States.

Emma: That technol or that process is not it. not allowed. So if you were to apply to the FDA and say, I'd like to create a three point embryo, they wouldn't even respond. It's like, it's, it's illegal. We don't pursue that route. [00:46:00] Um, but it hasn't been tested or really like pushed back on in a number of years.

Emma: So the United Kingdom is one of the most prominent countries that has developed this technology primarily for the purpose of addressing or trying to like sidestep any potential health concerns that may be present in that woman. And so it, in many ways, it's sort of trying to walk this middle ground where if you are concerned about using your own egg, your own genetic material in creating a child, but you don't just want to buy another woman's egg to create a child, right?

Emma: Such that you as the intended mother would have no biological connection to the child. This sort of provides a way, um, where you quote unquote get the best of both worlds where you're still passing down genetic material to the child. But you're removing the parts that you find problematic and supplementing it with, or substituting it really with someone else's. Um, so that's like a very basic description of three parent embryos. Um, it hasn't gained as much, um, stamina in the United States, but it is [00:47:00] certainly something, like I said, that the United Kingdom is utilizing.

Samantha: Now, as I understand it, researchers have also been able in animal models to reprogram adult stem cells into gametes eggs and sperm, thus enabling genetic conception between same sex pairings or even uh, from a single person. How far are we from human use and what are the implications of this type of technology?

Emma: Yes. So what you're describing is, um, called in vitro gametogenesis or IVG. and as you said, there are two different variations depending on if you're working with egg or sperm. But at the most basic level, you are taking, um, a stem cell, some DNA. So, um, some of my skin cells, hair, um, or blood for example, or even like your saliva, right? And you are genetically transforming that, [00:48:00] um, into. Uh, a viable egg or sperm. So this is a very, like, complex process, obviously. Um, but as you noted, this has been achieved in mice in Japan in particular, where they were able to genetically modify, um, think DNA from a mouse's tail into viable egg, and then use that in reproduction to create multiple generations of mice from it. Um, so it requires the use of IVF, right? 'cause you're then extracting egg or sperm. But because you can genetically, uh, modify or transform that given DNA into egg or sperm, it means that your biological sex is actually secondary to the process. So women naturally create eggs. Men naturally create sperm in the process of procreation. Um, but using IVGA man could contribute his own sperm and then genetically modify one of his skin cells. Into being a viable egg. That's [00:49:00] totally from his DNA. So it'd be his DNA, right, like his person, but in a genetically modified egg. And then through IVF, he could actually have his sperm, um, fertilize his egg to create an embryo that was 100% related to him. The same could also work with same sex couples where a woman could contribute her egg and her partner could then genetically modify a skin cell into sperm and then fertilize that egg, such that two women would actually be the genetic parents of a given child. Um, if you look in Japan, for example, where they're most advanced in this technology, the primary motivation that they have noted is to help women who are born without eggs. Now, this is a very rare condition, um, but it's certainly a condition that, um, women throughout the world suffer from where they physically. have any eggs to have children. Um, which is, can be incredibly heartbreaking 'cause it, it means that there, there isn't anything you can really do right. To naturally restore that.

Emma: And so their hope is that [00:50:00] this technology could then use their own DNA to create eggs so that they can have the children they desire. the context of the United States, um, the primary company, um, working on this is Biocon concepts. Biocon Conception says that their primary motivation is to allow same-sex couples to have children.

Emma: Um, and there are a number of same-sex couples working at this company in the United States and really across the world. So we know that Japan has started testing with, um, human DNA to try to, uh. Create a mature egg. In particular, they've not achieved this goal yet. Um, I think they've gotten like very rudimentary versions, but it hasn't continued developing to the point of a mature and viable egg in the United States.

Emma: Biocon concepts has claimed that they are, biocon concepts is working with human DNA. They claim that they're making proce progress on it. But even folks in the industry have said, we haven't seen the paper, we haven't seen the research. We have no [00:51:00] idea really how far they've gotten. So I think the folks in this space have said that it's anywhere, maybe around like 10, five to 10 years before we expect to see a viable human br egg created through this process or sperm. Um, but who knows, right? Like maybe it works, maybe it doesn't. Um, but the concerns with this are, I, I think very clear. Which is one, um, it, it will radically change our understanding of human conception because it will no longer require a given man and a given woman to create a child. Um, any number of children, uh, really an infinite number of children could be created from any given individual, um, with or without the support of another man or woman. Um, and, and what's even more heartbreaking is you don't even have to have a fully developed person, right? Uh, or like human being, like grown human being. You can have an embryo and you can take the genetic material from that embryo and then [00:52:00] genetically modify that into ex sperm embryo, right? And continue the process of procreating multiple generations, um, just from the embryonic stage, not even from like the born adult human stage. Um, and so there's, I think, a number of. Concerns or like a number of problems this introduces. Um, but in many ways what it's doing is it's taking our legal redefinition. And where states like California say that any person or persons can be the parents of a child, right? They have parent number one, parent number two, it doesn't matter your sex use IVF, you can be a parent and it takes that legal definition and it turns it into a biological definition where quite literally should the technology succeed, any two men could actually be the biological parents of the child. But we know that, again, when it comes to childhood wellbeing and parenthood, it's not just about, um, do you have the parts available to have a child? Do you have the financial support? Do you have two people who love you? There's an incredibly [00:53:00] important relationship of a. father, a biological mother raising a child, and what they bring to the table when it comes to the child's identity, um, their sense of self, who they are and, and the nurture and care and protection they need.

Emma: That come uniquely in some ways from a given mother and a given father. Um, it totally, um, evaporates that and says, oh, any parent will do, any genetic material will do, as long as you can create a child. It doesn't really matter. Um, and so in many ways, like the concerns that people have with surrogacy or with donor egg and sperm donation, it just magnifies those on a whole new level, um, where it, it's biologically sort of erasing the necessity of a mother and a father to a child's life.

Samantha: Yeah, sure. Mind blowing societal questions and issues. Um, to take it back to the research a little bit though, if they're using the genetic material of a single person to create a new [00:54:00] human embryo, is this a new type of cloning and reproductive cloning has been unilaterally banned, but is this something that is a clone or is it resulting in a genetically different individual using the same pool of genetics just mixed up a little bit differently, um, to create progeny from the genetics of one person instead of two?

Emma: Yeah, very, very good question. Um, you know, it's a really good question. Um, I don't actually know the answer to that. It's really good. So it could result in, in a cloning situation, I don't know if it's possible to reconfigure the genetic such a way that like you could actually have a total, because Yeah, I mean, you're a hundred percent genetically related, so there's no. variation in the child that's created, but can you emphasize a certain genetic, uh, a certain gene over another in a way that's different from that individual? [00:55:00] Um, it seems like you could, but I'm not totally sure. Um, it's a really good question actually. I'll need to like Yeah. Bug some of our researchers about this and see.

Samantha: Yeah, good to follow up on, um, do you have like a litmus test or simple way to sort out the types of technologies and research that we should pursue and fund and those that are revolutionary or incredible? Um, scientifically though they may be, are fundamentally opposed to human flourishing.

Emma: This is a great question. Um, this is something that like, going forward, I, I want to develop out even further than what we have, but a few of the litmus tests that I like to apply, um, is one at a very basic level asking, does this technology restore human life or restore human function, or does it circumvent it?

Emma: Or the question of supplement versus substitute. Um, I think it's a really important first question to ask, um, when we're assessing the goodness or potential concerns of a technology. So if you can say, know this technology clearly is restoring the [00:56:00] health or the genetic health, the, the physical health of a person, um, and doing, then that, then that's a good thing, right? Um, whereas if we're actually removing a human element, that should be a concern, but it's not a total answer, right? 'cause like prosthetic arms or prosthetic arms are technically like replacing. A human arm, right? Um, but in a way that like, we'd actually say it's a good substitution 'cause it's sort of enabling, like what would've been a natural human function. Um, the next question, um, something for me that's a non-negotiable is the, are we destroying human life in pursuit of that given goal? So the moment that a human embryo is formed, um, and is that unique, uh. Complete embryo. Any technology that destroys or harms or, um, commodifies that embryo, I think should be an absolute no when it comes to our society.

Emma: If we cannot value and protect life at that most intimate and sacred stage of development, then we will have no moral authority or ability [00:57:00] to protect life at any other stage of development. Um, whatever the situation may be, right? And so any technology that is destroying or commodifying, um, human life at any stage, including the embryonic, um, I think is across the line to begin with.

Emma: Um, so the question of does it restore circumvent and does it destroy life, are sort of the first two litmus tests that I go to. Um, and so yeah, if you can find a technology that's not destroying human life that seems to be supplementing, it's good. I think the second level of questions then I would ask come from Marshall McCluen. Um, and he has. These sorts of four. He had, he, he puts forward four questions that you can ask about any technology and Marshall McCluen is, um, a 20th century philosopher just writing about the nature of technology itself

McCluen puts forward four questions that you can ask of a given technology to assess. Merit or its consequences in the world. So he asks first, what does it enhance or intensify? Um, so what does this technology encourage? Second, um, what does it render, obsolete or displace? So what does this technology intentionally or unintentionally actually deter in our society? Third, um, what does this technology retrieve that was previously obsolete? Um, so is it bringing back something, um, right, like nucleus genomics is actually retrieving 20th century eugenics.

Emma: Um, and [00:59:00] not in a way that I think any sane person should be in favor of. And then fourth, what does it, what does this technology produce or become when it's pressed to an extreme? Um, so this question, right, is meant to say like a given technology, like at its most basic level may be fine or like morally neutral or even potentially good for society. But what happens if we were to take this technology and press it to its most extreme expression? So for example, um. chat, GPT, Hey, I am looking to create a meal with these ingredients. Uh, what can I create with these ingredients I have? That's great. I love using chat GPT to like, like brainstorm solutions to everyday problems. Um, but what happens when chat GT's ability to communicate with you isn't just helping you like brainstorm, like problems like that, but actually becomes the sort of partner that you talk to where you then have your chatbot girlfriend or boyfriend, um, or your romantic partner where they aren't just like, you know, a tool you use to solve domestic problems, but it becomes [01:00:00] a replacement, a substitute for people in your life and you're actually in love with and proposing to your chatbot romantic partner, right?

Emma: Which is already happening in the world. Um, chat, GBT pressed to the extreme in that sense is actually really, really bad for human relationships and human wellbeing. and so those four questions aren't meant to say that something is inherently good or bad, depending on where it falls, but. prompt, they allow us to ask and understand the nature of a technology, I think a little bit better.

Emma: So we can actually say, okay, like what is a, what is a responsible use of this technology? 'cause in many cases, aside from things like genetic screening that we've talked about, things like genetic therapy, I think there, like you and I said, I think versions of it that are very good for society that I think would be very good to develop.

Emma: And there's versions of it that I think are very, very bad for society. And it's going to require asking those very particular questions about the given tech, the given, um, approach or like the given technique used, um, to [01:01:00] really understand what is good and what we should avoid, um, or prohibit in that space.

Samantha: Yeah, one. One of the ways that you have. Distinguish between and those things is, uh, hacking humans through like surrogacy, gender surgery, um, euthanasia versus healing them. And I love that distinction, not just because of the alliteration, but I think it's very useful way to think about.

Emma: Yeah. Also, yeah, that was, uh, that's a new Atlantis article. Um, the Hacking of the Human Person, which is I wrote with two of my colleagues. But yes, it goes into that distinction. Um, yeah.

Samantha: I can link that in the show notes also.

Emma: Awesome.

Samantha: thank you so much for your time. I have one last question to ask you that is a standard question to ask all our guests. So, who is one person, alive or dead, real or fictional, who you believe exemplifies the very best of [01:02:00] being human?

Emma: Oh, that's such a good question. Um, yes. It's such a fun question too. Um, I, the person that comes to mind, yeah. I dunno, I've gone back and forth on this question a few times. Um, yeah. The person that comes to mind. Right now, um, is my daughter. Um, she is two years old and while she's still very young in her, you know, development and growth as a human person, she's at this incredible stage where she's learning and discovering a million new things every day from her speech, from her experiences, um, and had this a really lovely. Speak perspective on the world from her little tiny stature in her mind. Um, and so what I've loved to see is the way that, like, I, I think she like exhibits the human condition in such a raw and honest way where one second she just covers you and hugs and has this like pure joy [01:03:00] and delight when she meets another human.

Emma: Um, to the point where we have to tell her, you shouldn't actually like give a stranger a hug from behind. They might think it's a little aggressive, and she's like, I'm so excited to see you, and you're like, please don't get upset. Um, to like having these horribly selfish and like terrible moments where she just like takes a toy from her sister just because she can and she wants to. Um, and it, yeah, it's just, yeah, I think she does where it's like this desire to like be hospitable, give whatever she has in one moment. Um, and then other moments where yeah, she's a sinful toddler and it's just like terrible and meme, but is learning to really interact with the world and realize her own limitations.

Emma: Right. Um, so she. Climbed out of her crib today, um, which was a terrifying development for me. Um, and so l but seeing her like grapple with her human limitations where sometimes she overestimates them and she gets hurt, and other times you see her like rightly navigate it. Um, and it's so exciting and encouraging.

Emma: And I think those very basic lessons that we're learning that age apply on all levels, [01:04:00] right? Because ultimately with technology and with the opportunities before us, we are asking that question of what is a good human limitation? What is, um, yeah, what is the fullness of the human person? What are limitations we should respect? Um, and what is this like joy filled, cheerful way that we should interact with the world that really views life itself as a gift?

Samantha: It's beautiful, beautiful way to reflect on parenthood and a, a lovely way to close. Um, where can listeners connect with you, follow your work and read more of your work?

Emma: Yes. So you can follow me on X or Twitter at e ml waters, or you can look up My Heritage Foundation profile. Um, just the Heritage Foundation, Emma Waters, um, where most of the articles that I publish are linked, um, for yeah, your enjoyment later on.

Samantha: Excellent. I'll put all of those things in the show notes. Thank you so much for your time today. Um, especially [01:05:00] generous. We've gone a little bit over and really appreciate your time and your reflection. Um, thank you. God bless.

Emma: Thank you.