In Thursday’s post, I mentioned the independent film Eggsploitation, which I criticized for its “junk science.” The filmmaker, Jennifer Lahl, asked me to clarify what I meant by that criticism. Although I’ve written about this film before, because this is a new blog with some new readers, I’m going to respond to her publicly. I hope my response also clarifies my approach to reproductive ethics.
Eggsploitation’s overall message is that the combination of infertile patients desperate for viable eggs and young women desperate for money leads to an exploitative system in which no one is looking out for egg donors’ well-being. It argues that donors, who must go through the same medical procedures as IVF patients do (daily hormone injections and surgical retrieval of eggs), are participating in a potentially risky procedure without truly informed consent.
I have no argument with this message. I have written often about how the lack of oversight of the fertility industry, combined with market pressures, seriously compromise the ability of those involved (both patients and donors) to make thoughtful, deliberate, and informed decisions about the medical, emotional, financial, and ethical dimensions of reproductive technology.
My complaint with this film is not with its message, but with its method. It relies almost solely on anecdote to illustrate the possible risks of egg donation, focusing on the admittedly compelling stories of egg donors who had serious medical complications after donation.
I love anecdote. I put a lot of stock in people’s stories of dealing with infertility, genetic disorders, troubling prenatal diagnoses, etc. So my problem with Eggsploitation is not that it puts stories front and center. (In fact, one of the things I struggle to understand is why several of this filmmaker’s colleagues and supporters have been so vocal in criticizing my “narrative,” or story-based approach to reproductive ethics, while also praising a film that is almost all story. Go figure.)
My problem with the film is that it uses several egg donors’ stories as a scare tactic to imply that fertility drugs cause serious illnesses, including potentially fatal cancers, without providing data to back up those claims.
Fertility drugs may indeed cause serious illnesses, including cancers, as I discussed in Thursday’s post. But research is ongoing, and likely not occurring at the pace it should be given the growth of fertility medicine; one of the film’s arguments is that clinicians are so focused on getting people pregnant that they are not adequately concerned with women’s health, which is a reasonable argument.
Yet this film presents several stories that are clearly intended to make the audience believe that the link between fertility drugs and cancer is absolute and certain.
For example, Alexandra is an egg donor who had terrible complications (a torsioned ovary and twisted intestine) after her egg-donation procedure, and went on later to develop breast cancer that required a mastectomy. She states that she believes that the donation procedure caused her cancer, because she has no family history of breast cancer. The filmmaker makes no effort to remind the audience that the link between fertility drugs and breast cancer is still being studied, or that the majority of breast cancers occur in people who have no family history of the disease.
The filmmaker not only doesn’t provide any sort of reality check for Alexandra’s claim, but also features a photo montage of a woman who donated eggs several times and died of colon cancer at a young age. While the film doesn’t claim outright that fertility drugs caused this young woman’s cancer, her story is clearly included to make audiences assume a link where there may not be one. Otherwise, why include it at all?
Science 101 teaches that anecdote does not equal proof. Just because people see a link between two separate phenomena does not prove that such a link exists. Correlation does not equal cause and effect. Last winter, when we in the Northeast were buried under feet of snow, people kept remarking that global warming must not be happening after all. Scientists, meanwhile, reminded everyone that daily or seasonal weather patterns are not the right data with which to measure climate change. Parents take their toddlers to the doctor for vaccinations around the same time that autistic symptoms surface, and then believe that the vaccines caused the autism, yet numerous studies have failed to prove such a causal link. It is human nature to want to figure out why stuff happens, and to make intuitive leaps that seem logical, but are unproven. (I mentioned last week that recently read Siddhartha Mukherjee’s book The Emperor of All Maladies: A Biography of Cancer, which is an accessible and fascinating look into the world of cancer research, in which many scientists have made intuitive leaps in trying to determine the causes of and best treatments for cancer. Sometimes those leaps paid off; a scientist eventually proved his or her hunch that two phenomena were related in a clear cause-and-effect relationship. And sometimes they didn’t.)
I’m not saying that Alexandra’s or the young colon cancer victim’s illnesses were definitely not caused by their exposure to high levels of fertility drugs. Rather, I’m criticizing the filmmaker’s implication of a clear causal link where one is not yet proven to exist. And even if, with the new data out of the Netherlands, we can be more certain that use of fertility drugs is linked to higher rates of cancer, that still doesn’t prove that Alexandra’s or the young woman’s colon cancer were caused by their use of fertility drugs.
Stories are invaluable for examining the ethical and emotional dimensions of reproductive medicine—as snapshots of human experience that help us to see nuances, dangers, and relational dynamics, not as scientific proof. I will continue to argue that real people’s stories make unique and necessary contributions to the ethical discourse concerning reproductive technologies. But I will never use someone’s story to try to prove anything, other than that reproductive decisions are some of the most fraught, complex, and difficult ones that we can make, and that clinicians, counselors, pastors, and others in a position to support people making those decisions often fail to do so for a whole host of reasons.
The problem with Eggsploitation is that it can’t seem to decide whether it is a film sharing compelling stories to make people think about the troubling dynamics of egg donation and fertility medicine (which I would support), or a film trying to prove that egg donation exposes young women to specific and serious health risks.
Note: The use of anecdote to prove specific risk is my main complaint with this film, thought not the only one. In my original review, I discussed some of the other problems I and a small group of friends had with the film, including horror-film–like music and editing. The filmmaker provided me with a free DVD last spring for review purposes.