Podcast Review: Your Best Baby

Your Best Baby, a recent podcast and accompanying article from the Observer, interrogates the underlying intentions and ethics of emerging American start-ups that offer preimplantation genetic testing for polygenic traits (PGT-P). It focuses on the commercialisation of PGT-P, exploring the broader scientific, ethical and regulatory questions surrounding this practice.

The use of PGT-P – a technology that enables IVF patients to select embryos based on predicted genetic traits and disease risks – is becoming increasingly popular in the USA. The traits include physical features like height, eye colour, hair colour, and acne susceptibility, as well as psychological traits such as predicted IQ. These tests claim they can also estimate an embryo's relative genetic susceptibility to certain complex diseases such as type 2 diabetes, coronary artery disease, and some cancers.

Your Best Baby is particularly relevant at a time when UK patients are apparently turning to services abroad to avoid the domestic ban on PGT-P (see BioNews 1319). Parents bypass this law by claiming access to their personal data and then sending it to the USA.

This podcast raises the question of whether polygenic scores are sufficiently reliable to guide embryo selection. Professor Robert Plomin is the main advocate for polygenic scores featured in the podcast, maintaining that they provide meaningful predictive information. His position, however, contrasts with the overall scepticism of the scientific community (see BioNews 1212, 1302 and 1318).

It also examines whether these start-ups offer genuine innovation in reproductive medicine or capitalise on prospective parents' desire for control and certainty. Rooted in the practices of companies such as Orchid Health, Nucleus Genomics, Genomic Prediction and Herasight, this podcast moves beyond abstract ethical discussion around PGT-P and adds a tangible dimension to the debate: Should PGT-P be legalised in the UK?

This podcast highlighted several key themes that run through discussions surrounding PGT-P, and reproductive choice more broadly:

First, the tension between UK clinicians and their patients. UK clinicians have witnessed in their practice either a direct reference to PGT-P, as described by Dr Cristina Hickman (see BioNews 1325), or good reasons to believe that patients are orienting their embryo choice based on an overseas polygenic score. In both scenarios, clinicians face the reality that patients are sending their data abroad.

Thus, clinicians are experiencing a relational disconnect with their patients and are genuinely concerned about the information they may have received abroad. They are aware that some of them might be seeking information from less reputable clinics and wonder: 'How many will end up going to dodgy cowboys?', as Dr Hickman muses in the Observer article.

Second, and perhaps more compellingly, the article taps into a more universal discomfort. Selecting genes and creating the 'best baby' echoes eugenic ideology. The podcast underscores that the CEOs of these companies are pro-natalist, a position already laden with connotations of promoting 'the right baby'.

This immediately brought to mind another podcast by the Guardian: 'Make America Pregnant Again: the pro-natalist movement,' and struck me as a deliberate way to prompt an informed reader to draw certain conclusions about these start-ups' intentions, subtly reinforcing particular underlying views.

An informed listener is nudged to view these companies in a more critical, somewhat vilified light. Even the intervention of Professor Plomin – a strong advocate and enthusiast of the DNA revolution approach, whose book Blueprint I once found very persuasive – does not manage to fully balance the discussion.

I genuinely wonder whether a good argument in favour of polygenic scores for individual prediction can be found. The overall consensus seems to be that PGT-P has plateaued and is better applied to a broader population.

Which then leads us to the third tension: On what basis are we prohibiting PGT-P? If technology can reduce the likelihood of certain genetic diseases, and parents are aware of the probabilistic nature of the test – and willing to pay for it – where does the issue lie?

I believe that this podcast, like many others, does not directly emphasise how vulnerable parents are when resorting to IVF and how desperate they might be to have a healthy baby. Maybe parents are not striving for the 'best baby' but are simply given tools to give (from their standpoint) the best living experience to their children, succumbing to the understandable wish to control certain variables.

In that sense, this podcast and its accompanying article align with the broader reality in this field: the rapid commercialisation of reproductive technologies. Viewing this issue through the lens of start-ups was particularly thought-provoking, as it highlights the tension between money-making ventures and ethical responsibility. It prompts the question of whether consumer demand should determine which reproductive technologies enter clinical practice.

I cannot help but provide a final concluding legal remark. Both the podcast and the article prompted me to reflect on the type of regulation we might want to introduce, if and when PGT-P were to become legal in the UK.

It becomes clear to me that the problem is not merely the reliability of PGT-P, but the position parents are in when deciding to go through an additional test. And what it reveals about the kinds of children we should or think we want to bring into the world.