James V. Neel (1915-2000) wanted to know about the stuff you were made of, and he dedicated his career to finding out. Hailed by a colleague as the "father of human genetics," the University of Michigan professor emeritus made his mark as the first scientist to recognize the genetic basis for sickle cell anemia, the lethal blood disease. Dr. Neel received his bachelor's degree from the College of Wooster in Wooster, Ohio. He received a PhD in philosophy in 1939 and medical degree in 1944 from the University of Rochester in New York. During his 39-year career at U-M, the university set up the nation's first medical genetics program. After World War II, he studied the genetic effects of radiation on survivors of the atomic bombs dropped on Hiroshima and Nagasaki in Japan. He served in the U.S. Army Medical Corps and directed field studies for the Atomic Bomb Casualty Commission of the National Research Council. Dr. Neel established the U-M Medical School's Department of Human Genetics in 1956, which he chaired for 25 years. Dr. Neel's array of awards and honors include the Albert Lasker Award; election to the National Academy of Sciences; the Allen Award from the American Society of Human Genetics; the Smithsonian Institution Medal, and the Michigan Scientist of the Year Award from the Michigan State Legislature.
Our hope this afternoon is to have a wide-ranging discussion of what is generally termed the "population/resources problem". The thesis advanced on many fronts is that the world will shortly be grossly overpopulated in proportion to its sustainable resources. Both private and governmental organizations have been sounding this alarm and actively promulgating population control for some decades, and as a result, population growth is leveling off. For instance, worldwide, between 1950 and 1996, births per woman dropped from an average of 5 to less than 3 (Brown et al. 1997). However, this drop is partially offset by improved infant and childhood survival. In the minds of many, this decline in fertility is still not sufficient in some parts of the world to avert some very difficult times ahead. But geneticists have been strangely silent in these discussions.
Speaking about the country I know best, I find among my American colleagues a curious insensitivity to this issue. Granted, the advances in molecular genetics are truly mind-boggling, and staying competitive both intellectually and financially is so demanding, that little time seems left to geneticists to consider our responsibilities to future generations. Among contemporary U.S. geneticists, only John Graham (cf. esp. 1971) and myself seem to have written much on the subject. But who other than the genetic community is better qualified, or has a stronger social contract, to enter into a dialogue with society about the nuances of the population issue?
Before we go further with a discussion of the population problem, let me clearly acknowledge that with respect to the other half of the issue, the over consumption of both renewable and non-renewable resources, my own country, the U.S., is far and away the most egregious offender. We are truly energy hogs, a baby born in the U.S. consuming, per capita, twice as much energy as one in Sweden, three times as much as one in Italy, and 13 times as much as one born in Brazil. Life expectancy, of course, significantly influences that figure. I appreciate the justified resentment in many countries when the U.S. speaks of population control even as energy consumption by individuals is escalating, and I endorse the thrust of Dr. Salzano's presentation -- but believe it will not succeed without continuing strong efforts at population control, and, today, my focus is on population control.
THE DEVELOPMENTS IN CHINA
The most resolute recent effort to blunt the growth of a national population is that of the People's Republic of China, with the well-known One-Child Family Policy it initiated in 1978, and reaffirmed recently. There has been considerable criticism of the element of coercion many perceive in the implementation of this policy. I suggest that these critics are not fully aware of the urgency of the situation that confronted that nation, once it had embarked on the policy of industrialization that every nation sees as its birthright, and of the way to raise, ultimately, its standard of living. In a provocative monograph, "Who Will Feed China?", Brown (1995) has marshaled a set of poorly-known, relevant facts. China's recent renewed emphasis on population control undoubtedly stems from the fact that, even with the program enunciated in 1978, the country was projected to add 490 million people between 1990 and 2030, swelling its population to 1.6 billion - the equivalent of adding four Japans. China's balance between population and the agricultural base to support it, already stressed by these projections, was clearly further jeopardized by its drive to industrialization, with the inevitable sacrifice of arable land, plus the diversion to industrial purposes of water important for a predominantly irrigation-type agriculture. In their similar transitions, Japan lost 52 percent of its grain-harvested areas, South Korea 46 percent, and Taiwan 42 percent. Even with successful population control in the near future, China, formerly more or less self sufficient with respect to grain production, will now be entering the world market as a massive importer of grain just as the world production of grain is leveling off. Grain prices are certain to rise, with what that means to countries with marginal resources. But to return to China, to be successful and stable, their transition from a predominantly agrarian to an industrialized nation requires that population growth be quenched. China is a test case for how far a nation can ethically pressure its people in the interests of the welfare of future generations. If in the face of a perceived military threat to the integrity of the nation, a government can call upon its citizenry to place its lives at risk, why isn't it equally appropriate, in the face of a civil threat perceived to be of equal magnitude, for the government to pressure its citizenry to limit its reproduction? I say this, even if the information reaching the U.S. is correct, and even though I must regard some of the reported efforts of the Chinese to limit reproduction as over-zealous.
There is, in fact, in recent times an example of strong governmental intervention into population control. In the 1950s, the Government of Japan realized that the repatriation program involving Japanese living in formerly occupied territories had resulted in a population in the home islands that appeared to over-stress the resources of these islands. A program of population control, primarily by contraception and early abortion, was launched that resulted in a truly precipitous decline in the birth rate (discussion in Kawabe 1980; Muramatsu 1960; Oakley 1978;
Ohbuchi 1976; Taeuber 1958; Taeuber 1962). This development did not occur without some strong governmental persuasion. While I recall considerable discussion at the time of this program, I do not recall the note of censure that has accompanied so much of the discussion of the parallel
developments in China.
But while, then, I find it possible to argue that in the long-run, the Chinese effort to control population growth is more humane than the consequences of inaction, and deserves careful study by nations with similar problems, in its recent Law on Maternal and Infant Health Care, promulgated in 1995, the People's Republic of China has introduced clearly eugenic provisions into these efforts. To quote Article 10:
"Physicians shall, after performing the premarital physical checkup, explain and give medical advice to both the male and the female who have been diagnosed with certain genetic disease of a serious nature which is considered to be inappropriate for child-bearing from a medical point of view; the two may be married only if both sides agree: 1) to take long-term contraceptive measures or, 2) to take ligation operation for sterility."
Further, in Article 38, we read: "'Genetic disease of a serious nature' refers to diseases that are caused by genetic factors congenitally, that may totally or partially deprive the victim of the ability to live independently, that are highly possible to recur in generations to come, and that are medically considered inappropriate for reproduction..."
The Law also states that "Sex identification of a fetus by technical means shall be strictly forbidden, except that it is positively needed on medical terms" (Article 32). This presumably reflects an effort to avoid an imbalance in the numbers of males and females in a society where there is a strong preference for a male heir.
There is much to the Maternal and Infant Health-Care Law which resonates with the worldwide concern for mother and child (see discussion in Knoppers and Kirby 1997). Unfortunately, by any interpretation, the vague and imprecise sections of the Law constitute the first return to the slippery slope of eugenics as a national policy since the demise of Nazi Germany, and this on the part of the world's most populous nation. Somehow the genetic community must find a way to open a meaningful dialogue with those in China responsible for these developments, a dialogue that while supportive of the efforts at population control, is clear on the potential for abuse in the proposed eugenic program.
Before going further, I suggest we need to recognize the legitimacy of China's concern -- in a country where a male heir is of major importance -- over the potential of modern technology to alter the sex ratio. Coale and Bannister (1994) have published a penetrating analysis of how this concern is reflected in the census statistics out of China over the period 1960-1984. In the 1960s and early 1970s, in successive 5-year birth cohorts, there was about a 2% deficiency of females from normal expectation. In the mid-1970s, that deficiency began to increase, rising to 5% in 1984, the last year for which census data were available. There is every reason to believe that deficiency has continued to increase in the past decade. The authors submit two explanations of this recent trend, namely, a selective termination of child-bearing following a male birth, and, second, the emerging impact on the sex-ratio at birth, beginning in the 1980s, of sex-selective abortion. There is something of a paradox in this concern of the Chinese Government over the increasing relative deficiency of females. On the one hand, in a monogamous country such a deficiency should further the objective of lowering the birth rate. But on the other hand, in a country with a premium on a male heir, a shortage of brides could well translate into social unrest. Apparently the Chinese Government has decided that the latter issue has the greater importance.
The question of the impact of current reproductive technologies on the sex-ratio is by no means limited to China; Baird (1997) has recently provided an excellent discussion of the issue as it is emerging in Canada and the United States.
If the Chinese legislation is primarily a political gesture, then it is much less worrisome than if efforts at enforcement are underway. I can find no data concerning the extent to which this legislation is being enforced. However, a very recent article by Mao and Wertz (1997) supplies at least one pertinent fact. In China, there is a category of "genetic services providers," presumably corresponding to the "genetic counselors" of Western societies. Mao and Wertz distributed questionnaires to some 402 such persons in China, presumably attached to Government Health Clinics, the questionnaires directed at attitudes toward the provisions of the Maternal and Infant Health Care Law. Not at all surprisingly, there was overwhelming endorsement of its provision among the respondents to the questionnaire. I would suggest that this was a foregone conclusion considering that these respondents presumably all owed their livelihood to the Government, but, on the other hand, for what this is worth, there is no evidence of dissension in the ranks.
What, if any, is the appropriate response of Genetic Societies around the world to these developments in China? This is one of our primary topics for discussion this afternoon. To provide a bit of a focus, a target, as it were, I would like to reiterate a suggestion I first made some 28 years ago (Neel 1970) -- that worldwide, the various countries should work toward a population policy which strongly encourages a goal of the same number of surviving children per couple, for all couples. Recently I have suggested that number should be two (Neel 1994). We calculated that because of infertility or decisions to terminate child-bearing after only one child, or a relatively late death in the sibship. With that policy the average number of surviving children per sibship would be about 1.8. But we also estimated that even if this policy were initiated in -- say -- 1996, because of the present age composition of the world's population -- so many young people -- population numbers will increase for at least four decades, increasing from the estimate at that time of 5.7 billion to a peak of 6.7 billion in the 2030s. Thereafter it should decrease, to some 4 billion. Along the way, one might expect adjustments in the policy, as circumstances alter. This is not in any way a eugenic policy; it is a simple isogenic policy.
I suspect that each Society, each nation, and each ethnic group will view the matter of population stabilization at this time in a slightly different light, and trust that after due discussion, if there is an Ibero-American viewpoint, it will emerge.
In closing these brief remarks, I would note that the response of Genetic Societies to these developments in China can be of two types.
1) The simplest response is an expression of disapproval. This is already taking place. At the Ninth International Congress of Human Genetics in Rio in 1996, the Executive Committee for the Congress drafted a resolution of concern, subsequently forwarded by the Congress President, Professor Newton Morton, to some 7 different persons in the Peoples Republic of China thought to be key in the implementation of the policy. In 1996, the United Kingdom Genetical Society suspended its affiliation with the International Genetics Federation on the grounds that because of the Chinese eugenic legislation, it should not have selected the Republic of China as the locale for the International Genetics Congress of 1998. The Human Genetics Society of Australia has issued a mildly admonitory statement. There may well be other resolutions of which I am unaware. Unfortunately, my own primary genetic society, the American Society of Human Genetics, has not yet seen fit to take any action!
2) The second response would be more specific, and, in my opinion, more constructive. It would endorse some type of positive policy, for the world as a whole. Obviously, what comes to my mind is the 2-child policy I have just discussed. However, and this is an important qualification, I would in special cases, such as China's, have no ethical/moral difficulties with endorsing a more stringent policy, such as China's, as long as it was isogenic, i.e., carried no eugenic implications.
This concludes my remarks, and I turn the podium over to Dr. Wertelecki, who will preside over the discussion.
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