Article 1 and 4

In this assignment, you will critically evaluate articles in the field of adult development. Each week, you will read two articles from the Annual Editions: Human Development textbook (see the weekly readings for the chosen articles). For each article, do the following:

• Write a summary.

• Describe the main points of the article and how it relates to the week’s course and text readings.

• Evaluate the article on the basis of your own thoughts and perspectives on the topic covered.

MARKANDERSON

Ten years ago, it cost billions of dollars to map a single human genome. Today, it’s about $20,000 and likely to get even cheaper. If the average consumer can afford to have her own genetic map drawn up, what will it mean for medicine and how we approach our health care?

In early 2008, Henry Louis Gates Jr. stepped off his flight at LaGuardia Airport and began the process of having an elaborate set of blueprints drawn up: the map of himself, his entire human genome.

The Harvard professor of African American studies had at the time just hosted PBS’ successful miniseries, African American Lives 1 & 2. The miniseries, which Gates jokingly calls “Roots in a Test Tube,” traced the genealogical and genetic heritage of prominent figures and celebrities such as Oprah Winfrey, Morgan Freeman, Tina Turner and Chris Rock.

Also on Gates’ flight were officials from the Cambridge, Massachusetts-based genetics company Knome, who told Gates they were interested in working with him on other projects involving DNA testing. Already prompted by the mini-series’ fans to do a show about all Americans, Gates told the Knome representatives that this time he wanted to make a PBS series based on testing the full DNA (or “genome”) of some of his guests.

Every living thing on Earth is built from instruction manuals—an organism’s genes—found inside its cells. The complete set of instruction manuals is called a genome. For humans, the complete set is 6 billion characters long. We all inherit half of our body’s instruction manual (3 billion characters) from our mother and half from our father. When these strands bond together, the connections create units of information called “base-pairs.” Base-pairs can take on one of four values, signified by the names of the molecules from which they’re made: A, C, G or T.

Sequencing a person’s genome means discovering the value of all 3 billion DNA base-pairs—every A, C, G and T—in your body’s instruction manual. It’s the full host of biological blueprints that encodes uniquely who you are.

In 2003, only one human genome had been sequenced in the world, and it cost 50 cents per character. Today, just seven years later, the price has dropped to an astonishing 1/300,000 of a dollar per character. Within two to four years, because of rapidly advancing technology and economies of scale, the price is expected to fall by another factor of 10 or more—bringing the total cost of a full genome down to about $2,000.

The era of affordable genomes hasn’t yet arrived, but it isn’t far off—and mapping personal genomes at the price point of a laptop computer will change the face of medicine and, in a sense, the world.

For his 2009 series Faces of America, Gates traced the genealogical and genetic heritage of guests such as Eva Longoria Parker, Yo-Yo Ma, Meryl Streep, Stephen Colbert, Dr. Mehmet Oz and figure skater Kristi Yamaguchi. And, although Gates wanted to do full genomes of two of his guests, his scientific advisers recommended instead sequencing the genomes of both Gates and his father, 97-year-old Henry Louis Gates Sr. (Scientists hadn’t yet sequenced any African American’s genomes, nor had they sequenced a father-son pair.)

In fact, perhaps the most heart-wrenching moment in Faces of America comes when the program’s genetic experts subtract Gates Sr.’s 3 billion DNA base-pairs from Gates Jr.’s genome. And there, in bold blue and yellow lines, lies the stark genetic outline of the younger Gates’ mother, who died in 1987. “I put my father in this series,” Gates says. “And the big shock is, I got my mother back.” What Gates discovered about his mother was largely symbolic. He, like everyone, carries the blueprint of each of his parents inside his every cell for every moment of his life.

However, Gates also learned a boatload of information about his own life and health. A person’s genome carries crucial information about individual weaknesses to disease, susceptibility to various cancers, the effectiveness and ineffectiveness of various drugs and, ominously, some of a person’s more likely ultimate causes of death.

Human Genome Project

In 2000, President Bill Clinton announced that the government had created the first draft of the entire human genome. Ten years later, scientists still haven’t been able to apply the $3 billion Human Genome Project to curing some of our deadly, elusive diseases.

Synthetic Genome

In May, genomic researcher J. Craig Venter announced that he and his colleagues had created the first synthetic cell. Using chemicals, they recreated the genetic code of a species of bacterium and then transplanted the manufactured genome into a closely related bacterium. Then the synthetic DNA took over.

The genetic counselors Gates hired for Faces of America told him he carried an innate resistance to certain forms of malaria and that caffeine breaks down quickly in his digestive system. So coffee has less effect on him than it does on most people. “For years I hadn’t drunk [coffee] after noontime, being afraid it’d keep me awake,” he says. But emboldened by his genome results, Gates tried drinking a cup of joe one night before bed. “I went right to sleep,” he says.

Other than a variant of sickle cell anemia that makes him more susceptible to a stroke at high altitudes, Gates also learned that no unexpected ticking time bombs awaited him. Thanks to the lack of grave surprises in his DNA, Gates joined a project by his colleague George Church of Harvard Medical School that posts a patient’s entire genome on the Internet (at

http://snp.med.harvard.edu

) for scientists—and anyone else—to study.

The need for publicly accessible genomes to compare and study became evident in Faces of America. An initial analysis of a single character in one of Gates’ genes suggested he also had an exceptionally good ability to digest dairy products. But Gates is lactose intolerant. “I’m the one with the stomach for 59 years,” he said. “I know I can’t drink milk.”

It was only on a closer examination of Gates’ genome—enabled by more detailed analysis of his own genes and comparisons to other peoples’ genes—that Knome researchers discovered the source of Gates’ difficulty with dairy products. His particular DNA blueprint, they discovered, also makes it hard for him to process a dairy digestive by-product, called galactose. This is why he can drink plenty of coffee, but not with milk.

One of the first full families—mother, father and children—to sequence their genomes was the West family of Cupertino, California. John West, the father, is a former executive of one of the leading genome sequencing companies in the world—Illumina of San Diego. West, his wife, Judy, and children, Anne and Paul, had blood samples drawn late last year and in January received an iMac that contained all 24 billion A’s, C’s, T’s and G’s which represented the whole West family genome.

Although the family is keeping the kids’ genomic results private, 17-year-old Anne has given a public presentation about inheriting a genetic defect from her father that in 2004 resulted in a trip to the emergency room for him. Raced to the hospital with a blood clot in his lung, John West endured a painful and frightening few days staring at his own mortality.

But now he and his daughter know the likely cause of his hospitalization. They also know the diet to follow and medications to take to drastically reduce the chances of anything like this happening to either of them in the future. West says his Illumina genome fortunately revealed no bombshells other than the known “misspelling” in a gene of his called “Factor 5.” Such genetic errors, resulting from single-character transcription mistakes soon after a child is conceived in the womb, are sprinkled throughout everyone’s genome. Most DNA mutations are harmless. But just one well-positioned mistake—imagine a car repair manual containing the typo “plug the fuel line” instead of “plumb the fuel line”—can wreak havoc.

Human Genome Project
In 2000, President Bill Clinton announced that the government had created the first draft of the entire human genome. Ten years later, scientists still haven’t been able to apply the $3 billion Human Genome Project to curing some of our deadly, elusive diseases.
Synthetic Genome
In May, genomic researcher J. Craig Venter announced that he and his colleagues had created the first synthetic cell. Using chemicals, they recreated the genetic code of a species of bacterium and then transplanted the manufactured genome into a closely related bacterium. Then the synthetic DNA took over.
The genetic counselors Gates hired for Faces of America told him he carried an innate resistance to certain forms of malaria and that caffeine breaks down quickly in his digestive system. So coffee has less effect on him than it does on most people. “For years I hadn’t drunk [coffee] after noontime, being afraid it’d keep me awake,” he says. But emboldened by his genome results, Gates tried drinking a cup of joe one night before bed. “I went right to sleep,” he says.
Other than a variant of sickle cell anemia that makes him more susceptible to a stroke at high altitudes, Gates also learned that no unexpected ticking time bombs awaited him. Thanks to the lack of grave surprises in his DNA, Gates joined a project by his colleague George Church of Harvard Medical School that posts a patient’s entire genome on the Internet (at
http://snp.med.harvard.edu
) for scientists—and anyone else—to study.
The need for publicly accessible genomes to compare and study became evident in Faces of America. An initial analysis of a single character in one of Gates’ genes suggested he also had an exceptionally good ability to digest dairy products. But Gates is lactose intolerant. “I’m the one with the stomach for 59 years,” he said. “I know I can’t drink milk.”
It was only on a closer examination of Gates’ genome—enabled by more detailed analysis of his own genes and comparisons to other peoples’ genes—that Knome researchers discovered the source of Gates’ difficulty with dairy products. His particular DNA blueprint, they discovered, also makes it hard for him to process a dairy digestive by-product, called galactose. This is why he can drink plenty of coffee, but not with milk.
One of the first full families—mother, father and children—to sequence their genomes was the West family of Cupertino, California. John West, the father, is a former executive of one of the leading genome sequencing companies in the world—Illumina of San Diego. West, his wife, Judy, and children, Anne and Paul, had blood samples drawn late last year and in January received an iMac that contained all 24 billion A’s, C’s, T’s and G’s which represented the whole West family genome.
Although the family is keeping the kids’ genomic results private, 17-year-old Anne has given a public presentation about inheriting a genetic defect from her father that in 2004 resulted in a trip to the emergency room for him. Raced to the hospital with a blood clot in his lung, John West endured a painful and frightening few days staring at his own mortality.
But now he and his daughter know the likely cause of his hospitalization. They also know the diet to follow and medications to take to drastically reduce the chances of anything like this happening to either of them in the future. West says his Illumina genome fortunately revealed no bombshells other than the known “misspelling” in a gene of his called “Factor 5.” Such genetic errors, resulting from single-character transcription mistakes soon after a child is conceived in the womb, are sprinkled throughout everyone’s genome. Most DNA mutations are harmless. But just one well-positioned mistake—imagine a car repair manual containing the typo “plug the fuel line” instead of “plumb the fuel line”—can wreak havoc.

Cloning

Many will remember Dolly, a Finn Dorset ewe that in 1996 became the first mammal to be successfully cloned from an adult cell. She was cloned at the Roslin Institute in Scotland and lived there until her death in 2003. Before that, however, a tadpole was the first vertebrate to be cloned, in 1952. Since Dolly’s death, many animals have been cloned, including a camel and a water buffalo.

Genetics in Pop Culture

Spit Parties

Spitting isn’t au courant at New York Fashion Week, but that’s what notables such as Rupert Murdoch and Ivanka Trump were doing in 2008 at 23 and Me’s genetic testing spit party, hosted by founders Anne Wojcicki (wife of Google co-founder Sergey Brin) and Linda Avey.

Mapping Your Past

The Genographic Project, driven by National Geographic Explorer-in-Residence Dr. Spencer Wells, is “seeking to chart new knowledge about the migratory history of the human species.” If you wish to participate, a $99.95 kit is available to test your DNA and determine your ancestry along your maternal or paternal line.

Ancestry on TV

Two shows on television this spring, Faces of America and Who Do You Think You Are, featured prominent people who went looking for their lineage. NBC’s Who Do You Think used old-fashioned, document-based genealogy, while PBS’ Faces paired genealogy with genetic testing.

DNA Portraits

Talk about one-of-a-kind art. DNA 11 takes a sample of your DNA and reproduces it in color on a canvas you can hang on your wall. You can even mingle your DNA with your spouse’s, for a truly unique anniversary gift. It’s genetics as home décor.

Ozzy, Decoded

After years on the road with Black Sabbath and a 40-year “bender,” how has Ozzy Osbourne survived? That’s what DNA research company Knome is going to try to find out by sequencing the 61-year-old’s entire genetic code. The company is reportedly interested in Osbourne because of his “extreme medical history.”

Although genetic testing is still in its infancy, West says there is one way to enjoy access to every genetic test in the world—and every one yet to come. “There are hundreds of genetic tests. And if you were to take every single one of them separately, it’d cost you a fortune and you’d have to pay attention to all these individual pieces,” he says. “The advantage of having your genome sequenced is you’re doing all possible genetic tests all in one shot.”

There are hundreds of genetic tests. And if you were to take every single one of them separately, it’d cost you a fortune and you’d have to pay attention to all these individual pieces. The advantage of having your genome sequenced is you’re doing all possible genetic tests, all in one shot.

Mike Spear, communications director for Genome Alberta, a genetics funding organization in Calgary, Canada, has had small snippets of his genome tested by genetic-test companies deCODE and 23andMe. He learned, for one, that he’s at high risk for early onset Alzheimer’s disease. And he already knew that longevity runs in his family—a grandmother lived to be 101 and his father is still in the work-force at age 85.

“So I’m going to live long, but the last 30 years will be in a corner,” he says. He also says, though, that most genetic test results just weigh the dice a little, so it’s important not to get too carried away.

Spear learned, for instance, that he has twice the risk of baldness compared to the average man. “Your genome is what you are, but there are so many factors involved,” he says. “So I’m at higher risk for baldness, but … I have a full head of hair, and I’m 56. I’m at very low ‘risk’ for asthma, but I have always been an asthmatic.”

Spear says anyone who already tends toward hypochondria or excessive worrying might want to think twice about personal genome sequencing or genetic testing—especially since the marketplace is still so new and people are still only beginning to learn how to interpret the results. “When you get these tests done, you sign a lot of pieces of paper that say you know what you’re walking into,” he says. “They even at one point in your waivers say, in caps, ‘You may find out things you don’t want to know.’”

Knome founder George Church of Harvard Medical School says the U.S. Genetic Information Nondiscrimination Act of 2008 prevents insurance companies from upping their premiums or dropping consumers who discover bad things from genetic testing. However, he adds, the act “doesn’t stop consumers from gaming the system.” If a patient finds out her genome gives her a clean bill of health, she might cut back on insurance coverage—reducing the pool of money insurance companies use to pay for expensive care for sick subscribers. Or if a patient learns he’s at a high risk for something such as Lou Gehrig’s disease, he may preemptively sign up for all the medical coverage money can buy. Such scenarios ultimately aren’t fair to insurance companies, Church says. He suggests that the insurance industry now needs to team up with geneticists to brainstorm ways to work within GINA while still discouraging abuses of the system.

Genetics in Criminology

DNA Testing

While it’s common practice now, DNA evidence wasn’t used to convict or exonerate criminal suspects until 1986, when Richard Buckland was exonerated despite having confessed to rape and murder near Leicestershire, England. A year later, the first person was convicted in America on the basis of DNA evidence. According to the Innocence Project, more than 250 people in the U.S. have been exonerated through postconviction DNA testing since 1989.

Victor McElheny, author of the new book Drawing the Map of Life: Inside the Human Genome Project (Basic Books), says some cancer patients today are already having parts of their genome—and sometimes a tumor’s genome—sequenced. “When you do cancer chemotherapy, you’re operating pretty much by guess and by God,” he says. “An awful lot of cancer drugs only help maybe one-third of the people who get them. … You’d like to know what the person’s own genetic predispositions are, so you can start picking the right drug the first time.”

Cancer treatments are the first in a line of predicted “personalized medicine” breakthroughs, in which a person’s genetic information helps doctors tailor the treatment to the patient’s specific body chemistry. One big problem, however, is that well-trained doctors in genetics are still a rare breed today. And patients, more and more, will need good genetic advice.

Matthew Bower, a genetic counselor at the University of Minnesota Medical Center in Minneapolis, says his field is entering an age of data overload. A’s, C’s, G’s and T’s can crowd out useful medical knowledge and counseling as much as it can help bring it on. “There are not enough genetics professionals to be managing everyone’s genome out there,” he says. And without good counseling, he says, people can still make bad decisions.

For instance, Bower says he recently spoke to two journalists who had small parts of their genome sequenced and learned that they didn’t have one particular gene mutation that increases the risk of breast cancer. “They said, At least I don’t have to worry about breast cancer,’” Bower recalls. But breast cancer is caused by both environmental and genetic factors. And its genetic causes alone, he says, could come from dozens or hundreds of possible mutations in a person’s genome.

“People tend to perceive genetic information as black-and-white, all-or-nothing,” he says. “So if they don’t have the Parkinson’s marker, then they’re not going to get Parkinson’s. That’s false. Or if they have the Parkinson’s marker, then they’re going to get Parkinson’s. That’s also false.”

The likelihood for confusion as the personal genome marketplace heats up has recently inspired the federal government to act. In June, the U.S. Food and Drug Administration informed the top consumer genetic-sequencing companies in the country—such as Knome and Illumina—that the agency could soon be regulating the personal genome and consumer genetics marketplace.

Regulation, says Church, could entwine companies in red tape and slow the market down. On the other hand, he adds, it may not hurt much. The FDA’s intervention could actually help the fledgling genome industry: “Reading about this in the news and seeing the FDA seal of approval,” he says, might also lead consumers to want to try out consumer genetic testing.

Grant Campany, senior director of the Archon X-Prize for Genomics, says the FDA’s move itself constitutes a kind of endorsement. “The industry is going through a natural state of evolution,” he says. “It’s in everybody’s best interest that there’s a certain standard or benchmark—what quality really means.” FDA regulation of the marketplace also means that the June 2010 price tag for complete genome sequencing from the top two companies—Knome ($39,500, which includes genetic counseling) and Illumina ($19,500)—may soon be subject to change.

Campany particularly has his eyes on the future of the marketplace, as he’s supervising the privately funded $10 million “X-Prize,” which will be awarded to the first company that can sequence 100 genomes in 10 days or less at no more than $10,000 per genome.

Biotech journalist David Ewing Duncan says it’s still early, but at least a subset of the world is fascinated at the prospect of being the first generation in human history to read their own blueprint. In 2009, he published Experimental Man, a book that traces his sometimes enlightening, sometimes-confounding experiences subjecting himself to genetic tests from companies such as 23andMe and deCODE. (Duncan hasn’t yet had his whole genome sequenced, however.)

His conclusion, in short, is that a lot of genetic and genomic tests are scattershot: A little bit of information here, a little bit there and a lot of confusion elsewhere. Yet the field is progressing at great speed, too. It’s not just looking at individual DNA base-pairs, but also making sense of larger patterns within the genome—discovering, for instance, that one DNA base-pair may suggest that a person is good at digesting milk, but a larger grouping suggests he’s actually, on balance, lactose intolerant.

“We’re a lot closer than I’d have thought. But it’s like a thousand points of light that need to be connected,” he says. “We took apart the human body. Now we have to put it back together.”

Article 4 Unnatural Selection

MARA HVISTENDAHL

The gaping gender gap in Asia-the result of sex-selective abortion—has a burgeoning (and to some, equally alarming) counterpart here in the U.S.

New Delhi, India

For Dr. Puneet Bedi, the intensive care unit in Apollo Hospital’s maternity ward is a source of both pride and shame. The unit’s technology is among the best in Delhi—among the best, for that matter, in all of India. But as a specialist in high-risk births, he works hard so that babies can be born. The fact that the unit’s technology also contributes to India’s skewed sex ratio at birth gnaws at him. Seven out of 10 babies born in the maternity ward, Bedi says, are male. He delivers those boys knowing that many of them are replacements for aborted girls.

A tall, broad-shouldered man with a disarmingly gentle voice, Bedi stands in the unit’s control room, gazing into a sealed, temperature-controlled room lined with rows of cribs. He performs abortions himself. For sex-selective abortions, however, he reserves a contempt bordering on fury. To have his work negated by something as trifling as sex preference feels like a targeted insult. “You can choose whether to be a parent,” he says. “But once you choose to be a parent, you cannot choose whether it’s a boy or girl, black or white, tall or short.”

A broad interpretation of parental choice, indeed, is spreading throughout India—along with China, Taiwan, Vietnam, Georgia, Azerbaijan, and Albania. Preliminary results from India’s 2011 census show a sex ratio of only 914 girls for every 1,000 boys ages 6 and under, a decline from 2001. In some Chinese counties the sex ratio at birth has reached more than 150 boys for every 100 girls. “We are dealing with genocide,” Bedi says. Sex-selective abortion, he adds, is “probably the single most important issue in the next 50 years that India and China are going to face. If you’re going to wipe out 20 percent of your population, nature is not going to sit by and watch.”

If you’re going to wipe out 20 percent of your population, nature will not sit by and watch.

Bedi speaks with an immaculate British accent that hints at years spent studying at King’s College London. The accent helps in this part of Delhi, where breeding can trump all else. His patients are the sort who live in spacious homes tended by gardeners, belong to bucolic country clubs, and send their children to study in the United States. India’s wealthy are among the most frequent practitioners of sex selection, and in their quest to have a son Bedi is often an obstacle. His refusal to identify sex during ultrasound examinations disappoints many women, he says: “They think it’s just a waste of time and money if you don’t even know whether it’s a boy or a girl.”

India outlawed fetal sex identification and sex-selective abortion in 1994, but so many physicians and technicians break the law that women have little trouble finding one willing to scan fetal sex. Bedi says sex-selective abortion has caught on in Delhi because it bears the imprint of a scientific advance. “It’s sanitized,” he says. The fact that sex selection is a medical act, he adds, neatly divides the moral burden between two parties: Parents tell themselves their doctor knows best, while doctors point to overwhelming patient demand for the procedure.

Hospital administrators, for their part, have little incentive to do anything about the problem because maternity wards bring in substantial business. (At Apollo, a deluxe delivery suite outfitted with a bathtub, track lighting, a flat screen television, and a large window looking out onto landscaped grounds runs to $200 a night.) “When you confront the medical profession, there is a cowardly refusal to accept blame,” Bedi says. “They say, ‘We are doctors; it’s a noble profession.’ This is bullshit. When it comes to issues like ethics and morality, you can have an opinion, but there is a line which you do not cross, Everybody who [aborts for reasons of sex selection] knows it’s unethical. It’s a mass medical crime.”

For as long as they have counted births, demographers have found an average of 105 boys born for every 100 girls. This is our natural sex ratio at birth. (The small gap neatly makes up for the fact that males are more likely to die early in life.) If Asia had maintained that ratio over the past few decades, the continent would today have an additional 163 million women and girls.

For Westerners, such a gender gap may be difficult to fathom: 163 million is more than the entire female population of the United States. Walk around Delhi’s posh neighborhoods, or visit an elementary school in eastern China, and you can see the disparity: Boys far outnumber girls.

At first glance, the imbalance might seem to be the result of entrenched gender discrimination and local practices. Scholars and journalists typically look to the Indian convention of dowry, which makes daughters expensive, and to China’s one-child policy, which makes sons precious, to explain sex selection in Asia. (Sons have long been favored in China, as in many other parts of the world.) But this logic doesn’t account for why South Koreans also aborted female fetuses in large numbers until recently, or why a sex ratio imbalance has lately spread to the Caucasus countries—Azerbaijan, Georgia, and Armenia—and the Balkans, or why sex-selective abortion occurs among some immigrant communities in the United States.

What impact will hundreds of million of “surplus” men have on everything from health care to crime?

The world’s missing females are an apparent paradox: Sex selection is occurring at a time when women are better off than ever before. “More and more girls are going to school and getting educated,” says T.V. Sekher, a demographer at the International Institute for Population Studies in Mumbai. And in India, educated women are more likely to have a son than those with no degree. The women who select for sex include lawyers and doctors and businesspeople. Economic development has accompanied a drop in fertility rates, which decreases the chances of a couple getting the son they want without resorting to technology.

We might have seen this coming. Decades ago, Western hysteria over what many saw as an impending “population explosion” led American scholars and policymakers to scour the world for solutions to reducing the global birth rate. Studies from India and East Asia showed the major barrier to acceptance of contraception was that couples wanted at least one son. The advocates of population control saw that the barrier might be turned into an opportunity, however: If parents could be guaranteed a son the first time around, they might happily limit themselves to one or two children.

Beginning in the late 1960s, influential U.S. experts sounded their approval for sex selection everywhere from the pages of major scientific journals to the podiums at government sponsored seminars. “[I]f a simple method could be found to guarantee that first-born children were males,” Paul Ehrlich wrote in The Population Bomb in 1968, “then population control problems in many areas would be somewhat eased.”

Meanwhile, another group of scientists was figuring out how to determine fetal sex. These scientists’ efforts focused on amniocentesis, which entails inserting a needle through a pregnant women’s abdomen into the amniotic sac surrounding the fetus and removing a small amount of protective amniotic fluid, a substance rich with fetal cells that reveal its sex. They saw sex determination as a way to help women carrying sex-linked diseases like hemophilia have healthy children. But when amniocentesis, and later ultrasound, found their way to Asia decades later, it was their use as a population-control tool that stuck.

Sex selection’s proponents argued that discrimination against women and girls wouldn’t endure. As women became scarce, several prominent Western theorists proposed, they would also become more valuable, prompting couples to have daughters again. But in fact the opposite has happened. In their scarcity, women are being turned into commodities to be sold to and exploited by what demographers call “surplus men”: the ones left over in an imagined world in which everyone who can marry does so. Scholars have begun to calculate the impact hundreds of millions of such men will have on everything from health care to crime.

Suining County, China

In a village in eastern China’s agricultural belt, I meet Zhang Mei, a 37-year-old woman clad in men’s pants and a black-and-white polka-dot shirt that billows around her thin frame. Zhang is from distant Yunnan province, a poor mountain region near the border with Tibet. Her neighbors say she arrived 20 years ago, after a long journey in which a trafficker took her east to deliver her into marriage. She had no idea where she was headed beyond the vague promise that she would find work there, and yet she had some faith in the trafficker, for she hadn’t been kidnapped. Her parents had sold her.

The man who became her husband was gentle, but 15 years her senior, undeniably ugly, and one of the poorest residents of the village. Zhang learned that she had to work hard to make ends meet, and that she could not leave, even for a short trip home. Soon after she married, she found herself under pressure to have a son. One came on the third try, after two girls. But as the children grew, her husband complained it cost too much to educate their daughters, and since it is sons that matter in Suining, he sent one of the girls back to Yunnan to be raised by Zhang’s parents: a return, one generation later, of a lost girl.

Today Zhang copes with lifelong detention by gambling at raucous majiang games, burying herself in soap operas, and praying. (She is Christian.) “I carry some burdens,” she tells me, as we sit on the couch in her one-room home. “If I didn’t pray, I would keep them all in my heart.”

Zhang’s story is perhaps the most obvious way in which the gender imbalance is altering societies in Asia. The U.S. Department of State lists the dearth of women in Asia as one of the principal causes of sex trafficking in the region. Some of those women, like Zhang, are sold into marriage. Others become prostitutes. But what happens to the men who can’t find partners is significant as well.

Nothing can fully predict the effect of gathering tens of millions of young bachelors in one place for years on end. But preliminary conclusions can be drawn from places where the first generation touched by sex selection has reached adulthood. One line of speculation centers on testosterone, which occurs in high levels among young unmarried men. While testosterone does not directly cause violence in a young man, it can elevate existing aggressive tendencies, serving as a “facilitative effect” that predicts whether he will resort to violence. Gauging whether millions of high-testosterone men together spark more violence is complicated, particularly in China and India, which have experienced great social change in the past few decades. But some answers can be found through breaking down crime rates by region and time period.

In a 2007 study, Columbia University economist Lena Edlund and colleagues at Chinese University of Hong Kong used the fact that China’s sex ratio at birth spiked in some provinces earlier than others to explore a link between crime rates and a surplus of men. The researchers found a clear link, concluding a mere 1 percent increase in sex ratio at birth resulted in a 5-to 6-point increase in an area’s crime rate.

Other scholars speculate the gender imbalance is yielding depression and hopelessness among young men-which may explain why China has lately been hit with the sort of senseless violence that was once America’s domain. In 2004 and 2010 the country saw separate waves of attacks on elementary schools and child care centers in which murderers went on rampages and bludgeoned and stabbed children to death.

Eight out of the 10 killers (all male) lived in eastern Chinese provinces with high sex ratios at birth; several were unemployed. One man told neighbors, before he was arrested and summarily executed, that he was frustrated with his life and wanted revenge on the rich and powerful. Another apparently told police he was upset because his girlfriend had left him.

Los Angeles, U.S.

“Be certain your next child will be the gender you’re hoping for,” promises the Web site of L.A.’s Fertility Institutes. Dr. Jeffrey Steinberg founded the clinic in 1986, just as in-vitro fertilization was taking off.

Today 70 percent of his patients come to select the sex of their baby. Steinberg’s favored method is preimplantation genetic diagnosis, PGD, an add-on to in-vitro fertilization that allows parents to screen embryos before implanting them in the mother. Like amniocentesis and ultrasound before it, PGD was developed to test for defects or a propensity toward certain diseases.

But lab technicians working with eight-celled embryos can also separate XY embryos from XX ones, thus screening for sex-the first nonmedical condition to be turned into a choice. PGD thus attracts Americans who are perfectly capable of having babies the old-fashioned way but are hell-bent on having a child of a certain sex. So determined are they that they’re willing to submit to the diet of hormones necessary to stimulate ovulation, pay a price ranging from $12,000 to $18,000, and live with IVF’s low success rate. Decades after America’s elite introduced sex selection to the developing world, they have taken it up themselves.

High-tech sex selection has its critics. They point to a litany of ethical issues: that the technology is available only to the rich, that it gives parents a degree of control over their offspring they shouldn’t have, that it marks the advent of designer babies. But in surveys of prospective American parents over the past 10 years, 25 to 35 percent say they would use sex selection techniques if they were readily available; presumably that means more affordable and less invasive.

A squat, balding man who exudes a jovial confidence. Dr. Steinberg talks as if he has all the time in the world, peppering his stories with Hollywood gossip. (To wit: The producers of the show CSI once stopped by the clinic to evaluate a sperm cryopreservation tank’s potential as a weapon.) The patient response to his clinic offering sex selection, Steinberg tells me after ushering me into a spacious corner office, has been “crazy.”

The fertility doctors who perform preimplantation sex selection take care to distinguish it from sex-selective abortion. In America, they point out, patriarchy is dead, at least when it comes than the global balance of males to choosing the sex of our children. As late as the 1970s, psychologists and sociologists found that Americans were far more likely to prefer sons to daughters. Not anymore.

National figures are not available, but two of America’s leading clinics—HRC Fertility in Los Angeles and Genetics and IVF Institute in Fairfax, Virginia—independently report that between 75 and 80 percent of their patients want girls. The demand for daughters may explain why at Steinberg’s clinic everything from the entrance wall to the scrubs worn by the laboratory workers are pink.

For the most part, however, Americans don’t talk about gender preference. We say “family balancing,” a term that implies couples have an inherent right to an equal number of boys and girls. (Many patients seeking sex selection via PGD already have a child of the opposite sex.) We talk about “gender disappointment,” a deep grief arising from not getting what we want. The author of the reproductive technology guide Guarantee the Sex of Your Baby explains: “The pain that these mothers feel when they fail to bear a child of the ‘right’ sex is more than just emotional angst. The longing that they hold in their hearts can translate into real physical pain.”

Rhetorical differences aside, “family balancing” is not in fact all that different from what is happening in China and India. In Asia, too, most parents who select for sex do so for the second or third birth. And examining why American parents are set on girls suggests another similarity: Americans who want girls, like Asians who opt for boys, have preconceived notions of how a child of a certain gender will turn out.

Bioethicist Dena S. Davis writes that people who take pains to get a child of a certain sex “don’t want just the right chromosomes and the attendant anatomical characteristics, they want a set of characteristics that go with ‘girlness’ or ‘boyness.’ If parents want a girl badly enough to go to all the trouble of sperm sorting and artificial insemination, they are likely to make it more difficult for the actual child to resist their expectations and follow her own bent.”

When Dr. Sunita Puri surveyed Bay Area couples undergoing PGD for sex selection, most of them white, older, and affluent, 10 out of 12 wanted girls for reasons like “barrettes and pink dresses.”

Some mention that girls do better in school, and on this point the research backs them up: Girls are more likely to perform and less likely to misbehave, while boys have lately become the source of a good deal of cultural anxiety. Others mention more noble goals. They talk about raising strong daughters; women mention having the close relationship they had—or didn’t have—with their own mother.

But regardless of the reason, bioethicists points out, sex selection prioritizes the needs of one generation over another, making having children more about bringing parents satisfaction than about responsibly creating an independent human being.

At stake with preimplantation sex selection is much more than the global balance of males and females, as if that weren’t enough. If you believe in the slippery slope, then sex-selective embryo implantation definitely pushes us a little further down it.

In 2009 Jeffrey Steinberg announced that the clinic would soon offer selection for eye color, hair color, and skin color. The science behind trait selection is still developing, and some later doubted whether he in fact was capable of executing it. Still, Steinberg might have eventually gone through with the service had his advertisement not set off an uproar. The press descended, the Vatican issued a statement criticizing the “obsessive search for the perfect child,” and couples who had used PGD for medical reasons balked, fearing frivolous use of reproductive technology would turn public sentiment against cases like theirs. For the moment, at least, Americans had problems with selecting for physical traits, and Steinberg retreated.

Having children has become more about bringing parents satisfaction than creating independent human beings.

“The timing was off is all,” he tells me. “It was just premature. We were ahead of our time. So we said, ‘OK, fine. We’ll put it on the back burner.’” In the meantime, he says, couples obsessed with blue or green eyes continue to call the office. He keeps their names on a mailing list.