Perception of risks and benefits of in vitro fertilisation, genetic engineering and biotechnology

Journal: Social Science and Medicine 38 (1994), 23-33.
Author: Darryl R. J. Macer


Abstract

The use of new biotechnology in medicine has become an everyday experience, but many people still express concern about biotechnology. Concerns are evoked particularly by the phrases genetic engineering and in vitro fertilisation (IVF), and these concerns persist despite more than a decade of their use in medicine.

Mailed nationwide opinion surveys on attitudes to biotechnology were conducted in Japan, among samples of the public (N=551), high school biology teachers (N=228), scientists (N=555) and nurses (N=301). People do see more benefits coming from science than harm when balanced against the risks. There were especially mixed perceptions of benefit and risk about IVF and genetic engineering, and a relatively high degree of worry compared to other developments of science and technology. A discussion of assisted reproductive technologies and surrogacy in Japan is also made.

The opinions of people in Japan were compared to the results of previous surveys conducted in Japan, and international surveys conducted in Australia, China, Europe, New Zealand, U.K. and USA. Japanese have a very high awareness of biotechnology, 97% saying that they had heard of the word. They also have a high level of awareness of IVF and genetic engineering. Genetic engineering was said to be a worthwhile research area for Japan by 76%, while 58% perceived research on IVF as being worthwhile, however 61% were worried about research on IVF or genetic engineering. Japanese expressed more concern about IVF and genetic engineering than New Zealanders. The major reason cited for rejection of genetic manipulation research in Japan and New Zealand was that it was seen as interfering with nature, playing God or as unethical.

The emotions concerning these technologies are complex, and we should avoid using simplistic public opinion data as measures of public perceptions. The level of concern expressed by scientists and teachers in Japan suggest that public education "technology promotion campaigns" will not reduce concern about science and technology. Such concern should be valued as discretion that is basic to increasing the bioethical maturity of a society, rather than being feared.


Key Words: In vitro fertilisation, genetic engineering, biotechnology, surrogacy, public opinion, bioethics, Japan, New Zealand


Introduction

Biotechnology is the use or development of techniques using organisms (or parts of organisms) to provide goods or services, and is a word applied especially to new technology, although we have been using "biotechnology" for many millenia. Modern medicine is using many products of biotechnology and genetic engineering, including diagnostic and therapeutic monoclonal antibodies, therapeutic proteins produced by recombinant DNA technology, genetic analysis, genetic testing, gene therapy, or infertility services [1]. Several of these new technologies have captured the public attention and evoked special concerns, such as in vitro fertilisation (IVF) and genetic engineering (a term principally applying to techniques which alter gene expression using recombinant DNA). Genetic engineering has been a controversial technique world-wide, and at a time when clinical trials of human gene therapy have begun in several countries, it is a topical issue.

There have been many children born throughout the world as a result of the use of IVF followed by embryo transfer. The number is in excess of 40,000 and is rapidly growing. The technique remains controversial, with there being opposition from feminists in many countries and the Green political party in Europe. However, it is widely supported for use by married heterosexual parents who are otherwise unable to have children. In some countries it is nationally funded, and in others it is available only in private clinics. There are numerous international reports on IVF, and many countries have enacted legislation [1, 2]. What remains contentious are some of the bioethical issues that arise from the clinical practice of IVF, such as embryo preservation, embryo wastage, embryo and gamete donation, and surrogacy. Legislation and guidelines enacted in different countries to regulate the use of assisted reproductive technology differ. There is little data on the ethical perceptions in different countries. In Japan IVF is only offered to married couples in private clinics, and it is regulated by professional guidelines of the Association of Obstetrics and Gynecology rather than by legislation, though membership is voluntary.

It is interesting to ask what public opinion to the use of these technologies is after more than a decade of medical application world-wide. It may also be an indicator of the way that people's ethical decision-making develops and changes as science and technology enters daily life and media exposure. In order to obtain comparative data on the perceptions of people from different countries, opinion surveys can be used, and one such study is described here. Surveys conducted in Japan were compared with studies that have been conducted internationally, and with other studies in Japan. A significant difference between the attitudes of Japanese and New Zealanders to IVF was observed, in both the perceptions of how worthwhile research into IVF is in each country, and the degree of concern people had.

Different population groups were sampled to examine whether there are differences in perceptions depending on the familiarity with science and technology. Two special groups familiar with biotechnology were sampled. High school biology teachers play a significant role in shaping education, and scientist's play a significant role in shaping university education and the direction of research. Additional surveys among students and nurses were also conducted. The greater familiarity of these groups with science and technology was not found to be associated with lower concern about science and technology.

Opinion Surveys

Questions that had been used in English language questionnaires concerning biotechnology and genetic engineering in October 1986 in the USA [3] and in May 1990 in New Zealand [4] were translated into the Japanese language. In one of the questions of the New Zealand and Japanese surveys, Q5, eight science developments were listed and the awareness and attitudes to these can be compared. To give a background from which to examine IVF and genetic engineering, perceptions of six other techniques were also examined, including other controversial areas such as biotechnology and pesticides, and some relatively uncontroversial areas such as developments in physical sciences. The questions were:

Q5. We will ask you about some particular scientific discoveries and developments. Can you tell me how much you have heard or read about each of these. Please answer from this scale.
1 I have not heard of this
2 I have heard of this, but know very little/nothing about it
3 I have heard of this to the point I could explain it to a friend

How much have you heard or read about?
Biological pest control Silicon chips Biotechnology
Fibre Optics Agricultural Pesticides In vitro fertilisation
Superconductors Genetic engineering

For each of these developments that you have heard of;
Q5b. Do you personally believe (DEVELOPMENT) would be a worthwhile area for scientific research in Japan?
1 Yes 2 No 3 Don't know

Q5c. In the area of (DEVELOPMENT) do you have any worries about the impact of research or its applications?
1 Yes 2 No 3 Don't know

Q5d. For each development where you are worried; could you please tell me how worried you are, using this scale...about the impacts of (DEVELOPMENT)?
1 I am slightly worried about this 2 I am somewhat worried about this
3 I am very worried about this 4 I am extremely worried about this

Q7. Can you tell me how much you have heard or read about...?
Manipulating genetic material in human cells, microbes, plants, animals
Use this scale...
1 I have not heard of this
2 I have heard the words but no more
3 I have heard the words and have some understanding of the idea behind it

Please answer the questions below:
Q7b. Which, if any, of those biological methods you've heard of are acceptable to you for any reason?
1 Acceptable
2 Unacceptable (If unacceptable write why each one is not acceptable to you)

Q7c. Which of those biological methods, if any, of those you've heard of could provide benefits for Japan?
1 No benefit
2 Benefit (If a benefit, what benefits do you believe each one could produce?)

Q7d. Which, if any, of those biological methods could present serious risks or hazards in Japan?
1 Risk
2 No risk (If a risk, what serious risks or hazards do you believe each one could present in Japan?)

In New Zealand face-to-face interviews were used for the public sample, and telephone interviews were used in the USA. The public sample in Japan was also nationwide, but a high refusal rate was observed when face-to-face interviews were attempted, so that mail response sampling was adopted [5]. Questionnaires were distributed by hand into letter boxes chosen at random in different areas of Japan, and mail response using enclosed stamped and addressed envelopes was requested. The name and address were not written, or recorded, so no reminders could be sent. This approach ensures that there are no fears about privacy, and is cheaper, but may result in about 10% lower response rate. Mail response has one advantage over interviews in that lengthier comments were written to the free response questions and at other points in the questionnaire.

Questionnaires were distributed via post for academics and high school biology teachers. Letters were sent to the headmasters of high schools randomly selected from the national register of high schools in Japan, requesting them to randomly chose a biology teacher to complete the questionnaire (if unavailable, than a science teacher). The academic sample was randomly selected from national name registers of employees of government research institutes and company scientists, and from the University of Tsukuba staff. Questionnaires to academics were individually addressed. Only Japanese names were chosen, though there were few foreign names present in such registers in Japan. These methods were the same as used in New Zealand [4], except that unlike New Zealand, no lottery incentive for return of questionnaires was enclosed, and no reminders were sent. The student sample was made from random selections of students of the University of Tsukuba (N=151), excluding any students that were taught by the author because their views may have been influenced during classes on bioethics, and from university students among the public respondents (N=53). The nurses sample was from Ohtaki and Narahara hospital in Fukui prefecture, with the kind assistance of Dr. Mikio Hirayama, Fukui Medical School.

The academic and high school surveys were conducted in August 1991, the public and student surveys were conducted in October 1991, and the nurses survey in April 1993. A 45% reply rate was obtained from high school biology teachers (N=228), and a 48% response rate was obtained from academics (N=728) (including company scientists (24%), government researchers (31%) and university academics (45%)). Staff of the University of Tsukuba were also randomly surveyed (N=249), with a response rate of 37%, while academics outside the university (N=479) had a 56% response rate. Scientists (N=555) were defined as academics who had a speciality in natural sciences, medicine or technology [5]. A 26% response rate was obtained from the public (N=551). Questionnaires were returned from public in 20 of the 47 prefectures of Japan, from academics in 25 prefectures and from teachers in every prefecture. A 65% response rate was obtained from nurses and nursing students (N=301).

The sex ratio of the samples is shown in Table 4. The academic samples are representative of the male-dominated situation in Japan. The age, marital status, number of children, education, and income of the public sample were representative of the Japanese population. The student sample had younger age (all less than 27 years of age). The academic sample had a higher income than the public sample. The samples were nationwide, and replies from every prefecture of Japan were received. Detailed characteristics are reported elsewhere [5]. Statistical analyses were carried out with the Statview program for Macintosh computers, and the term "significant" is used in this paper when p 0.05.

Japanese have a high level of awareness of in vitro fertilisation, genetic engineering and biotechnology

For all developments and in all samples, there was a positive correlation between awareness and the expressed level of interest in science from the results of another question [5]. However, there were not any tests of actual knowledge of the techniques, so there could be doubt about their real understanding of these techniques. There could also be cultural differences in response, and the Japanese self-criticism could mean that the number who really understand the techniques could be relatively higher in Japan than the numbers suggest. The academics and high school teachers expressed significantly higher awareness of all the developments than the public (p<0.05, Table 1), as could be expected. The awareness expressed by nurses and University students was between that of the public and the academics [5]. The general results for scientists and high school teachers were similar, except that more teachers could explain IVF (87%) compared to scientists (68%).

IVF and its associated bioethical and legal issues has been widely featured in the news media in many countries. Among the Japanese public respondents it was of highest familiarity (p<0.05), with 95% saying that they had at least heard of it, and 50% said that they could explain it to a friend, in response to Q5a (Table 1). The result is consistent with results of an December 1985 survey (N=7441), by the Prime Minister's Office of people of at least 20 years of age [6], in which 75% said that they had heard of IVF in a list of "beneficial developments of life sciences", being the item with the highest awareness from a list of 10 developments (including cancer treatment and genetic disease, both of which 40% said they had heard of).

IVF was also the most familiar of these developments of science and technology to the New Zealand public [4], and 76% of the respondents said that they had heard of IVF, and 31% said that they could explain it to a friend. IVF was also very familiar relative to the other developments of science and technology to teachers and scientists in both countries. IVF was overwhelmingly the most familiar development to nurses (p<0.01, Table 1), which is consistent with their occupational interest.

There was a high expressed level of awareness of genetic engineering in Japan, with 94% saying that they had heard of it and 26% of the public saying that they could explain it. We can compare this result with a question in the USA in November 1986 [3] in which 32% said they did not know the meaning of "genetic engineering", whereas 66% said that they thought they knew the meaning of the word. It would appear that awareness may be higher in Japan, though the USA result is from five years previous, and they are different questions.

The greatest difference appears to be the awareness of biotechnology in Japan and New Zealand (Table 1). In Japan 97% had heard of it, similar to IVF, but in New Zealand 57% said they had heard of biotechnology. In a 1988 survey of 2000 public in the U.K. 38% of respondents said they had heard of biotechnology [7], considerably less than in New Zealand, and compared to 97% in Japan in this survey in 1991. In a 1992 telephone survey (N=1000) in the USA, 25% said that they had not heard of it, 38% said a little, 30% said some and 8% said they had heard a lot about biotechnology [8]. The public sample used in this study may be a reasonable sample of the Japanese public, because in another survey conducted on the Japanese public in February 1991 using specially chosen survey monitors (N=1363), 97% said they had heard of biotechnology [9]. The result of Q5 suggests that the Japanese public is comparatively very well exposed to the word 'biotechnology', with 34% saying they could explain it, compared to only 9% in New Zealand.

These results suggest that the awareness of scientific and technological developments in Japan could be better than in New Zealand, U.K. or USA. However, the sampling method used in Japan was return of a mail questionnaire, and only 26% of the public responded. The response rate may be related to familiarity with the subject matter of the questionnaires. There were no significant correlations between response rates or question responses with educational qualifications, occupations, or age, within any of the sample groups [5]. The awareness of IVF, genetic engineering and biotechnology among the Japanese public in June 1993 (N=320+) using the same method and same question are the same, from the progress results of another mail response survey I am conducting. A mail response survey is also being conducted in New Zealand, Australia and several other countries in 1993 (results to be published in 1994). The early results suggest that awareness is higher among respondents to mail surveys compared to telephone surveys, and that the word "biotechnology" is significantly (p<0.05) more understood in Japan than other countries, whereas the apparent higher familiarity of IVF and genetic engineering may not be statistically significant.


Table 1 Awareness of developments in science and technology in Japan [5] and in New Zealand (NZ) [4].

Sample:
Public
High School Biology Teachers
Scientists
Nurses
Japan NZJapan NZJapan NZJapan
Number538 2034224 277547 258301
Biological pest control
Not heard24.8 17.85.8 0.47.0 0.828.1
Heard only57.1 61.221.4 99.638.2 99.266.9
Can explain18.1 20.972.8 -54.8 -5.0
Silicon chips
Not heard30.6 14.317.5 10.19.2 6.654.8
Heard only47.6 60.552.9 89.949.8 93.441.5
Can explain21.8 25.229.6 -41.0 -3.7
Biotechnology
Not heard2.8 43.53.6 8.70.9 12.84.7
Heard only64.7 48.112.0 91.324.9 87.285.6
Can explain32.5 8.584.4 -74.2 -9.7
Fibre optics
Not heard4.4 43.33.1 19.92.0 11.29.3
Heard only64.5 36.752.0 80.147.1 88.880.3
Can explain31.1 20.044.9 -50.9 -10.4
Pesticides
Not heard3.7 8.53.1 6.52.8 6.69.4
Heard only58.5 61.329.0 93.529.8 93.471.6
Can explain37.8 30.267.9 -55.4 -19.0
In vitro fertilisation
Not heard4.6 24.13.6 1.42.0 6.64.0
Heard only45.3 44.99.4 98.629.8 93.455.9
Can explain50.1 31.087.0 -68.2 -40.1
Superconductors
Not heard11.6 56.14.0 22.72.6 18.631.8
Heard only59.7 31.551.6 77.349.0 81.461.2
Can explain28.7 12.444.4 -48.4 -7.0
Genetic engineering
Not heard6.0 26.64.5 1.41.3 3.912.4
Heard only68.0 53.513.8 98.628.4 96.177.2
Can explain25.9 19.881.7 -70.3 -10.4


Table 2 Attitudes to developments in science and technology

Values are expressed as %'s of the number of respondents to Q5 that had heard of, or could explain, each development (N). Results from New Zealand are from the survey of Couchman & Fink-Jensen [4].

Sample:
Public
High School biology teachers
Scientists
Nurses
Japan NZJapan NZJapan NZJapan
Biological pest control
Heard of (N)403 1668211 276511 256215
Worthwhile84.1 85.894.8 99.396.3 96.992.0
Not worried43.7 49.745.4 34.160.3 32.432.5
Slightly worried14.1 6.012.8 47.87.2 48.424.1
Somewhat worried16.9 11.320.9 9.411.4 12.524.1
Very worried10.9 22.212.3 3.68.4 3.910.8
Extremely worried4.2 9.64.7 0.72.2 0.83.3
Don't know26.0 0.78.2 03.7 2.05.2
Silicon chips
Heard of (N)366 1743184 249500 241135
Worthwhile66.4 62.487.5 29.392.8 28.660.9
Not worried54.1 86.569.0 68.787.0 83.036.9
Slightly worried10.7 0.68.7 8.86.4 5.821.1
Somewhat worried7.1 1.66.0 0.43.6 1.223.3
Very worried4.1 5.74.3 0.41.8 06.0
Extremely worried1.6 4.61.6 00.4 02.2
Don't know36.6 10.019.6 05.6 10.010.5
Biotechnology
Heard of (N)516 1151217 253542 225285
Worthwhile84.9 71.793.5 84.697.4 81.390.4
Not worried38.2 68.435.0 42.353.7 46.237.9
Slightly worried14.1 2.58.3 39.511.4 39.119.9
Somewhat worried16.9 6.022.6 6.716.4 6.222.7
Very worried13.0 14.320.7 2.011.6 0.47.8
Extremely worried8.5 7.28.3 0.46.1 03.5
Don't know21.5 1.66.9 9.14.4 8.08.2
Fibre optics
Heard of (N)507 1153216 222540 229271
Worthwhile85.8 65.994.0 36.997.1 32.385.9
Not worried68.4 91.083.3 76.190.6 84.750.6
Slightly worried14.6 0.49.7 4.17.0 2.621.2
Somewhat worried6.7 0.83.2 0.51.5 0.411.9
Very worried2.0 3.10.5 00.9 04.7
Extremely worried0.4 3.60.9 00.7 01.9
Don't know25.1 1.012.1 19.44.6 12.29.7
Pesticides
Heard of (N)509 1861217 259533 241271
Worthwhile89.2 84.587.6 79.294.7 82.291.8
Not worried27.1 38.924.0 7.743.9 15.416.4
Slightly worried7.9 14.26.0 22.47.1 30.713.8
Somewhat worried14.9 18.113.4 32.416.7 28.630.6
Very worried25.1 22.129.0 18.920.6 13.322.0
Extremely worried18.1 6.322.6 13.111.1 8.39.3
Don't know16.1 0.47.3 02.6 3.77.9
In vitro fertilisation
Heard of (N)505 1544216 273538 241287
Worthwhile57.6 70.578.7 51.681.0 49.075.9
Not worried20.8 61.922.2 26.433.5 34.416.3
Slightly worried11.8 6.26.9 37.710.4 35.716.0
Somewhat worried17.3 7.315.7 17.620.1 12.427.3
Very worried23.0 14.634.7 7.022.7 7.122.3
Extremely worried17.5 8.914.4 4.411.5 3.311.0
Don't know18.6 1.27.8 03.5 7.17.1
Superconductors
Heard of (N)465 893214 214536 210204
Worthwhile84.7 58.392.5 36.496.6 27.182.7
Not worried64.1 87.278.5 72.989.6 85.248.0
Slightly worried12.0 0.87.5 4.77.5 4.817.8
Somewhat worried8.2 1.66.5 0.93.0 0.517.8
Very worried3.0 3.73.7 00.9 03.0
Extremely worried1.5 5.40.9 01.3 01.0
Don't know25.8 1.311.7 21.53.7 9.512.4
Genetic engineering
Heard of (N)495 1492214 273540 247262
Worthwhile76.2 57.491.6 85.794.4 79.886.9
Not worried19.4 43.816.4 10.643.3 14.220.8
Slightly worried11.1 14.67.9 37.411.3 39.319.7
Somewhat worried18.2 13.814.5 31.916.5 22.319.7
Very worried21.4 18.631.3 10.617.2 13.818.9
Extremely worried19.8 8.225.2 8.412.8 8.910.5
Don't know19.8 0.97.9 1.13.2 1.610.4
Perceived Benefits of Science and Technology

The responses of people who had heard of the developments in science and technology were used for the analysis of Q5b, c, and d (Table 2). Among the public respondents who had heard of IVF, it was seen to be a worthwhile area of research by 58%, lower than all other developments (Figure 1). Two developments, silicon chips and IVF, were perceived to be less worthwhile than the others. Silicon chips are important for the Japanese economy, and this result is an anomaly resulting from the word, not the technology. When the word "computer" is used there appears to be no anomaly (data from another survey currently in progress). Scientists and high school teachers thought that all the areas of science were worthwhile areas of research for Japan, with most areas seen as worthwhile by over 90%, except for IVF research, which was seen as worthwhile by about 80%.

In vitro fertilisation was seen as worthwhile by about half the scientists and high school teachers in New Zealand, and by 71% of the public [4]. It was considered to be much more worthwhile for research in New Zealand compared to fibre optics, silicon chips or semiconductors (Figure 1). The lower proportion of New Zealand respondents who said that these later techniques were worthwhile is probably a realistic reflection considering the small size of New Zealand. This clear distinction in the support for research in biological fields compared to physical science fields could reflect the agricultural basis of the New Zealand economy.

Genetic engineering was perceived to be more worthwhile than IVF in Japan, but less worthwhile than IVF research in New Zealand. We need to ask what benefits were perceived. Question 5b was deliberately framed in terms of reference to the perceived value of the research "in Japan", or "in New Zealand". IVF was perceived as being worthwhile by more New Zealanders than Japanese. It is of no direct economic benefit to society, so the perceived benefit may be due to humanitarian motives. The low level of optimism in research on IVF in Japan may be partially related to the high level of concern over its use, but the same level of concern was also expressed for genetic engineering and pesticides (p<0.05). Rather than tying benefit to economic or humanitarian reasons, it may be that Japanese have a less selective response, reflecting the size of the country and its positive attitude to science and research (Table 3). Both Japan and New Zealand have a pronatalistic outlook, supporting population growth. The higher support for IVF in New Zealand may be due to the greater emphasis given to protection of individual liberty, but conversely it could simply be that the public in New Zealand are not worried about its use (Table 2), as discussed in the following section.

We can ask whether people saw economic benefit to their country by reference to the responses made to a following question (Q7) on the perceived benefits and risks of genetic manipulation for Japan. People were asked whether they thought genetic manipulation was acceptable, and what benefits and risks they saw from it. They were asked to cite their reasons, and these allowed an in depth analysis of the reasoning behind their perceptions. 38% of the public and nurses, 52% of student, 54% of teacher and 61% of scientist total respondents said that there was a benefit from genetic manipulation of human cells [5, 10]. About half of these cited examples of medical benefit, including treatment of genetic disease and disease control. In all groups there were more total respondents who saw benefits from genetic manipulation of plants, microbes and animals than for human cells, with more agricultural or environmental benefits cited for these organisms (p<0.05).

Of the public who expressed a benefit from genetic manipulation in Q7 (of all four organisms), 13% included a comment such as "the whole world will benefit", while 6% included a comment that Japan's exports or economic situation will benefit. Among academics, the proportions were 8% and 5% respectively, and among high school biology teachers, 6% and 0.5% respectively. Thus it appears that people perceived benefits in terms of humanitarian benefit not economic benefit, a point made even more strongly by about 1% of respondents who refused to answer the question because it included the phrase "benefits to Japan", writing that they thought that these techniques should be judged by their benefit to the world. New Zealand respondents to these questions [4] were more equally divided in these two categories of comments. Their comments were more dependent on the organism in question, and 10% of those who said their was a benefit from plant or animal genetic manipulation cited an economic benefit, with 4.5% citing humanitarian concerns. They recorded no respondents refusing to answer such framed questions, suggesting a more economic outlook, which would be consistent with the worse economic conditions in New Zealand and the dependency of the New Zealand economy on agriculture. This would be an interesting sociological question to examine, but better data is needed before drawing any conclusions on the economic outlooks of New Zealanders or Japanese.

Concerns about in vitro fertilisation

Q5c and Q5d examined how worried people were about the impact of these different developments. The techniques that the Japanese public were most worried about were IVF (61%) and genetic engineering (61%). Pesticides were also of similar concern (57%). The degree of concern (Q5d) was also highest with these techniques, with more people saying that they were extremely or very concerned about these techniques, than for other developments (Table 2). Biotechnology was of significantly lower concern, though still 41% had some worry.

The high level of concern expressed about IVF in Japan is one feature of these results, and it is not unexpected. In December 1985 (N=7441), and in October 1990 (N=2209), the Prime Minister's Office surveyed people of at least 20 years of age [9, 13]. In December 1985, 29% approved of IVF being performed on humans, 55% disapproved, and 17% were unsure of their views towards IVF; and in 1990, 30% approved, 49% disapproved, and 21% were unsure. In 1990, 24% said that IVF was a field of medicine that needed careful ethical consideration, a similar number said the same for "genetic therapy" and "prenatal diagnosis". If people are asked to answer yes or no to IVF on balance they may chose no, but if they are given the option of expressing hopes and concerns they can express both. This second type of question provides more useful information for understanding the social acceptance of a technology.

The wording of questions may also be critical, as shown in divergent levels of approval of IVF in Japanese surveys. A Japanese survey of married women aged 20-50 years in May 1984 (N=2759) gave approval ratings for the use of IVF by a married couple if it was their only means of having children of 62%, with disapproval by 33% of respondents [12]. This difference in approval could be explained by the leading question, that an infertile couple wants to have a child. Because these questions included the comment that these couples could only have children using this method, the results may have been more positive than the Prime Minister's Office survey. In selected samples of the population, Buddhist priests (N=160) were surveyed at the end of 1986, and 43% approved of IVF for married couples with 22% disapproving and 35% undecided [13]. The reasons given for approval of IVF by Buddhist priests were compared with reasons given by Japanese psychologists in a survey conducted in May 1983 (N=186) of which 55% approved, 16% disapproved and 27% were undecided [14]. The major reason given was that IVF could treat infertility, but the psychologists gave more diverse comments than the priests. The major objection to IVF was that it was seen to be against nature.

Recently, and following the gathering of survey data, IVF has been subject to more media exposure in Japan. Surrogacy and oocyte donation is not permitted in Japan according to guidelines of the Japan Association of Obstetrics and Gynaecology, despite the fact that sperm donation has been practised for 40 years. In 1992 the first babies were born from surrogacy contracts with American and Korean surrogate mothers. The results of questionnaires given to 83 women receiving infertility treatment regarding the questions of surrogate motherhood found that 18% would use surrogate mothers with their husband's sperm, but 41% would use surrogate mothers with their husband's sperm and their own egg, and in both cases 40% said they did not know [15]. This survey is subject to high statistical uncertainty, but it is consistent with an observed concern for direct genetic relationship to children, even in infertile couples desiring a child. There has also been controversy regarding the high payment, of about US$80,000 for such arrangements with the Japanese branch of the U.S. Infertility Center of America, though this international surrogacy trade is not limited to Japan. The Japanese-based agents appear to be charging Japanese much more than American-based agents, exploiting the wealth of Japanese couples. In 1993 the first case of a Japanese woman travelling to the USA to be implanted with a donor egg from an Asian American fertilised by the Japanese husband has been reported. The debate promises to continue. Given these circumstances it is not surprising that Japanese concern about IVF research does not appear to have decreased with time.

In a New Zealand survey conducted in 1984, relying on responses from a women's magazine (N=1400) [16], 37% said that they were concerned about IVF in 1984, which is the same as those who had "worries" in 1990 [4]. 88% of respondents were in favour of IVF for use by married couples, and only 8% were against [18]. In 1990, 74% of the high school teachers and 66% of the scientists had worries (Table 2), more than the public. There may be some selection of people who express concern in mail surveys compared to interviews, which could explain part of the difference.

The gender did not have a significant affect on the perceptions of benefits and risks within any sample in Japan, nor between the nurses sample (86% female) and the other samples. The teacher sample was 90% male in Japan, and 64% male in New Zealand. The scientist sample was 90% male in Japan and 87% male in New Zealand. A striking feature of the survey reported here, is that high school teachers were significantly more concerned about the impact of genetic engineering and IVF than the public (Table 2). Like Japanese teachers, New Zealand teachers also expressed more concern about IVF than the public. The trends among the responses of scientists and teachers in Japan and New Zealand, which both used mailed questionnaires, may be more statistically reliable for international comparisons. However, these generally mirrored the comparative public results, as seen in the Tables. The responses of high school biology teachers in Japan and New Zealand were more similar to each other than the public or scientist responses [5]. It would be interesting to look at the attitudes of high school teachers in various countries, as they may exert significant influence in the future public perception of these issues.

In Japan there continues to be much concern about IVF research among individuals, shown in the results of this survey, though paradoxically, the issue has not become a major issue of bioethical concern in Japan, unlike brain death which is controversial, despite opinion poll data that suggest strong public support. Asked the question "would you donate your brain dead kin's organs?" (N=3,000), in 1982, 41% would consent, while 47% said they "don't know", and in 1990, 51% said they would consent, with 31% saying "don't know", and 16% saying they would not consent [17]. If we compare this to the approval of IVF quoted above, where in 1990, 49% disapproved of IVF [7], we can ask why IVF is not publicly controversial but brain death and organ donation are? In Europe such a degree of opposition would probably result in the introduction of laws. Some organised protest groups, such as those in the Canton of Basel in Switzerland have attempted to ban IVF, though in a recent referendum, 74% of Swiss people overall supported assisted procreation (and genetic engineering), subject to restrictions on embryo storage [18]. The limits of legislation vary among countries, for example, being very strict in Germany [19] and less strict in Britain [20].

The clearest answer may be related to the structure of Japanese society, the public views are not influential in deciding whether a technology will be permitted, despite the often heard contrary, and some would say false, claim that "a public consensus is needed before a technology can be used". We can ask whose views are influential in policy-making in Japan, and it is a complex question. The answer may be politicians and industrialists, those in power, who are called teacher ("sensei"), even though they have no teaching role. The term is a paternalistic phrase, that is one of the main legacies of Confucian influence of the past [21]. In the case of IVF no group with sufficient power has a strong interest in pushing for a law in this area, and the lawyers who did show some interest were unable to influence a powerful medical group who are unwilling to allow IVF to set a precedent for new laws regulating medical practise. Physicians are also one of the groups of "sensei" in Japan, and are paternalistic. Self-regulation by the Association of Obstetrics and Gynaecology is preferred. The surrogacy and donated gamete debate do pose some problems for Japanese family law, but the parenthood issue also still lacks sufficient momentum to effect legislation.

CONCERNS ABOUT genetic engineering

As noted above, genetic engineering was of a similarly high concern as IVF in Japan (Table 2). The reasons why genetic manipulation was seen to be unacceptable were asked in a separate question, Q7, of this Japanese survey [5], and in the New Zealand survey [4]. The most common reasons cited in both countries by all groups were that it was seen to be unethical, playing God, or interfering with nature. There was also concern about the fear of the unknown. Less concern was expressed about possible human misuse of genetic engineering for eugenics or cloning and insufficient regulatory controls. In Japan [5], New Zealand [4] and the USA [3], genetic manipulation of plants was most acceptable, with genetic manipulation of microbes next, than animals, and human cell genetic manipulation was least acceptable. This could represent two major thoughts, a scale of biological complexity associated with increasing ethical 'status' from plants to animals to humans. This is complicated by the higher perceived danger of genetic manipulation using microbes, which are associated with disease and which are environmentally more mobile, and animals which are mobile.

In a 1990 European public opinion poll in the U.K., France, Italy and Germany (N=3156), the respondents were asked to choose the largest benefit that they saw coming from biotechnology, between one of four possible benefits from biotechnology [22]. Over half rated cures for serious diseases as the most important benefit, consistent with Japanese results [5]. The respondents were asked a similar question about their largest concern. 40% of French, 35% of Germans, and 25% of British and Italian respondents chose eugenics, and overall slightly lower proportions chose environmental harm, 34% in Britain, 33% in France, 22% in Italy and 21% in Germany. Potential health hazards from laboratory genetic research were named by 29% in Italy, 17% in France, 11% in Britain and 10% in Germany. Overall one third of respondents said that biotechnology is ethical and one third feel that it is unethical, and one third thought it was in between, "neither". However, in this Japanese survey and in the New Zealand survey [4], the proportion of people who cited eugenic concerns from genetic manipulation of humans was equivalent to about 4% of the total respondents, half of the proportion who expressed concern because of environmental reasons, and much lower than the number of respondents who cited reasons based on interfering with nature, playing God, ethics, or fear of the unknown [5, 10]. Because free response questionnaire data is unavailable from Europe we cannot directly compare the apparently higher concern about eugenics in Europe as opposed to New Zealand or Japan. One could speculate that it may be related to self-acknowledgement of the past eugenic abuses in Europe, and due to media coverage of the eugenic concerns raised by organised feminist and Green groups in Europe. Free response questions may provide a better estimate of people's opinions and provide a better picture of actual perceptions than agreement with suggestive concerns.

Benefits and Harms from Science and Technology

It is apparent from the results of this survey that ordinary people can simultaneously think of benefit and risk from a scientific technology. In areas of the application of science and technology that are associated with benefits and risks, it may be useful in opinion surveys to ask at least one question about both benefit and risk perception, as done in Q5. The relative benefits and harms expressed by respondents to Q5 are represented in Figure 1. There are some differences in the position of the eight science developments on the scattergrams from Japanese and New Zealand results. Pesticides stays at a similar position, of high benefit and high concern, and silicon chips, fibre optics and superconductors stay at positions of low concern and high benefit. IVF shifts considerably, being more favourably considered in New Zealand than in Japan. Genetic engineering stays at the position of high concern in both samples.

In the current survey, 58% of the people who had heard of IVF thought it was worthwhile for Japan, though 71% were worried about its use, and 41% of the total were either very or extremely worried about its use. A very different picture can be painted by reference to either figure, we need to consider both perceived benefits and harms to get a realistic picture. There was no measure of perceived benefit which could have allowed better comparison of the relative intensity of these competing perceptions.

From the results of this question it appears that people had a mixed view of the benefits of science, however the following question in the survey asked them about their general perception of the benefits versus harms of science, and these responses were overwhelmingly favourable. Q6 addressed the general attitude to the benefit and/or harm perceived to be done from science in general. The Japanese high school biology teachers and the public gave similar responses, with 58% and 56%, respectively, thinking that they did more good than harm (Table 3). Only 6% of the public and 3% of the teachers thought that science and technology did more harm. Scientists had a more optimistic picture, with 78% saying science and technology did more good and only 2% saying it did more harm than good. However, academics that were not scientists had a similar view to the public (N=164, results for Q6; 3.7% harm, 57.3% good, 39% said the same). Students had a more negative view, despite the fact that most were science students.

The most negative view was from nurses, with 70% saying chosing the neutral response, the science had both a good and bad side. They showed increased general concern compared to the public in Q6, and they had rather similar views to the public for the specific developments, IVF, biotechnology and genetic engineering. The hospitals surveyed are in Fukui prefecture, in west Japan, which may be more traditional than the East Japan. The survey was also conducted in April 1993, 18 months after the public sample. One event that may have increased concern is at the time of that survey the reports of Russian dumping of spent nuclear reactors into the Japan Sea were released. There are still too many unknown factors to draw general conclusions that Japanese nurses have a more critical view of science than the public from this sampling of two hospitals.

The results are consistent with the results of a question asked in Japan in January 1990 (N=2239), asking whether people thought scientific development led to more "plus" or more "minus", the same, with a "don't know" option. 53% said "plus", 31% said the "same", 7% said "minus" and 10% said they "didn't know" [23]. These results were similar to results obtained in 1987. In a 1989 public survey in the U.K., (N=1020) for the same question, only 44% answered "more good", 37% said "about the same", 9% said "more harm", and 10% "didn't know" [24]. These results were similar to the U.K. in 1985, and indicate that British may be less optimistic in outlook about science and technology than Japanese. In Australia people may be more optimistic, in 1989, 757 public were asked the same question, and 56% said "more good", 26% said "about the same", and 10% said "more harm", with 2% saying they "didn't know" [25]. Internationally, the most optimistic respondents to this question were respondents to a 1989 survey in Beijing, China (N=4911), where 82% said more good, 2% said more harm, 12% said the same and 5% said "don't know" [26].

In most countries the benefits of science and technology are promoted to people, by government and industry. These promotion campaigns appear to be working in most countries, especially in China. One could speculate whether a lower perception of good coming from science and technology in the UK is due to the lower profile of such campaigns there, or exposure to more of the bad effects of science and technology, or the current bad economic conditions in the U.K., in what was the birth place of the industrial revolution. The views that people have may be influenced in a positive way gradually, but a negative event such as the Chernobyl disaster may cause a sudden drop in confidence.

To reach a better understanding of what reasoning people have, they must be asked why they think what they do about general science and specific developments, extending Q5 style to ask the "why" question. As mentioned above, awareness of the developments of science and technology in Q5 was not directly correlated with the perception of these technologies. The responses are more complex than Q6 may indicate, for example, New Zealand scientists and high school teachers expressed more general concern about the impact of all developments in Q5 than their peers in Japan, whereas the New Zealand public expressed less concern about all these developments than the Japanese public!


Table 3 Does science lead to more benefits than harm?

Sample:
Public
Students
Nurses
High

School Biology Teachers
Total

Academic
Univ. of Tsukuba Staff
Total Scientists
Number530 200277 223713 242544
Male53 5314 9089 7890
Female47 4786 1011 2210

Overall do you think science and technology do more harm than good, more good than harm, or about the same of each? (%)

..

more harm5.8 12.011.1 3.12.4 4.11.8
more good55.1 38.019.5 57.972.9 57.077.8
same39.1 50.070.4 39.024.7 38.820.4


Conclusion - No MORE SIMPLE YES/NO VOTES?

People of various cultures, ages, educational training, occupation and outlook on life perceive both benefits and risks from developments of science and technology (Table 2). Technology that touches life is perceived to be just as worthwhile as technology which does not directly affect living organisms, but people may perceive more risks from technology that directly affects living organisms than from those physical science developments which do not. This is similar internationally, with IVF and genetic engineering evoking mixed emotions of benefit and risk. Overall, most people in industrialised countries perceive more benefit than harm from science (Table 3) and believe that improved quality of life depends on scientific knowledge [5]. This is true of countries with a long history of technological use, such as Europe, a dependency upon agriculture, such as New Zealand or Australia, an industrial economy such as Japan, a mixed economy as the USA, or a developing economy such as China.

Medical benefits are perceived from the use of biotechnology and genetic engineering, while at the same time people are clearly aware of some risks. The balancing of benefits and risks is one factor important in making decisions about these techniques, and it appears that people of Japan and Western countries have at least some cognition of this. Simplistic arguments based on benefits from new technology are often used to promote the use of these techniques, and the proponents of such views who are seeking to introduce these technologies attempt to dismiss the risks and concerns of people. However, people who have high familiarity with such techniques, such as scientists and high school biology teachers, are also concerned about such technology, and the emotions concerning acceptance of technology are varied and complex.

There is a significant public policy decision to be made regarding public education programs. There has been an information campaign underway for a decade in Japan supported by members of the Japan Bioindustry Association, involving government and industry, to promote biotechnology. It appears to have resulted in high awareness of biotechnology, with mixed perceptions. Recently, surveys of scientists in the USA [27] and Europe [28] engaged in recombinant DNA research, found that more saw public attention on genetic engineering research as beneficial or neutral than harmful to their research. The view in America was more positive than in Europe. Further public education programs to stress the benefits of biotechnology have been called for by others in North America and Europe as well [8]. Their goal is to reduce what is seen as a high level of concern about the technology, which seems unobtainable given the views of educated groups surveyed in this paper.

Such a goal is also undesirable for the long term health of social debate. Rather than attempting to dismiss feelings of concern, society should value and debate these concerns to improve the bioethical maturity of society. We could call the bioethical maturity of a society the ability to balance the benefits and risks of applications of biological or medical technology. It is also reflected in the extent to which the public views are incorporated into policy-making while respecting the duties of society to ensure individual's informed consent. Awareness of concerns and risks should be maintained, and debated, for it may lessen the possibility of misuse of these technologies. Other important principles of bioethics such as autonomy and justice need to be protected and included in the benefit/risk balancing which is important for the ethical application of biotechnology in medicine.


References

1. Macer D. R. J. Shaping Genes: Ethics, Law and Science of Using Genetic Technology in Medicine and Agriculture. Eubios Ethics Institute, Christchurch, 1990.
2. Knoppers B. M. and LeBris S. Recent advances in medically assisted conception: legal, ethical and social issues. Am J. Law & Medicine XVII, 329-61, 1991.
3. U.S. Congress, Office of Technology Assessment. New Developments in Biotechnology, 2: Public Perceptions of Biotechnology - Background Paper. U.S.G.P.O., Washington D.C., 1987.
4. Couchman P. K. and Fink-Jensen K. Public Attitudes to Genetic Engineering in New Zealand, DSIR Crop Research Report 138. Department of Scientific and Industrial Research, Christchurch, 1990.
5. Macer D.R.J. Attitudes to Genetic Engineering: Japanese and International Comparisons. Eubios Ethics Institute, Christchurch, 1992.
6. Japanese Prime Minister's Office. Life science. Monthly Public Opinion Survey April 1986, 53-99 (in Japanese).
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8. Hoban T.J. and Kendall P.A. Consumer Attitudes about the Use of Biotechnology in Agriculture and Food Production. Raleigh, North Carolina State University, 1992.
9. Japanese Agency for the Environment. Results of a Survey on Biotechnology and Environmental Protection. Agency for the Environment, Tokyo, 1992 (in Japanese).
10. Macer D.R.J. Public acceptance of human gene therapy and perceptions of human genetic manipulation. Human Gene Therapy 3, 511-8, 1992.
11. Japanese Prime Minister's Office. Medical ethics in practice. Monthly Public Opinion Survey May 1991, 41-57 (in Japanese).
12. Bai K., Shirai Y. and Ishii M. In Japan, consensus has limits. Hastings Center Report 17, Special Supplement (June), 18-20, 1987.
13. Shirai Y. Attitudes of Buddhist priests toward new reproductive technology. Studies in Humanities (Shinshu University, Matsumoto) 24, 27-34, 1989.
14. Shirai Y. Bioethics and intervention in human life (IV): ethical and social considerations in human in vitro fertilisation and embryo transfer. Annual Report of Social Welfare Institute for Developmental Research (Japan) 11, 13-26, 1986.
15. Japan Times 1 Sept. 1992, 3.
16. Daniels K. R. 'Yes' to AID, in vitro fertilisation. New Zealand Women's Weekly 29 April 1985, 60-62.
17. Nudeshima J. Obstacles to brain death and organ transplanation in Japan Lancet 338, 1063-4.
18. Bulletin of Medical Ethics May 1992, 8-11.
19. Deutsch E. Fetus in Germany. The Fetus Protection Law of 12.13.1990. Int. J. Bioethics 3, 85-93, 1992.
20. Bolton V. et al. The Human Fertilisation and Embryology Act 1990 - A British Case History for Legislation on Bioethical Issues. Int. J. Bioethics 3, 95-101, 1992.
21. Macer D. The 'far east' of biological ethics. Nature 359, 770, 1992.
22. Dixon B. Biotech a plus according to European poll. Biotechnology 9, 16, 1991.
23. Japanese Prime Minister's Office. Scientific technology and society. Monthly Public Opinion Survey August 1990, 2-40 (in Japanese).
24. Kenward M. Science stays up the poll. New Scientist 16 Sept. 1989, 39-43.
25. Anderson I. A first look at Australian attitudes toward science. New Scientist 16 Sept. 1989, 42-3.
26. Zhang Z. People and science: public attitudes in China toward science and technology. Science and Public Policy 18, 311-7, 1991.
27. Rabino I. The impact of activist pressures on recombinant DNA research. Science, Technology & Human Values 16, 70-87, 1991.
28. Rabino I. A study of attitudes and concerns of genetic engineering scientists in Western Europe. Biotech Forum Europe 10, 636-640, 1992.


Tables not on-line. Copyright Kluwer Publishers, The Netherlands (reprints available from author). See reference Macer, D.R.J. (1992). Attitudes to Genetic Engineering: International and Japanese Comparisons. (Christchurch: Eubios Ethics Institute).


Figure 1 Comparative perceptions of science developments between Japan and New Zealand (Not on-line)

The results are based on the number of respondents who said that they had heard of each development (Q5a), and are presented as scattergrams, with number of respondents who thought each development was worthwhile for their country versus the number of respondents who were worried about the impact of the developments. Results from New Zealand are from the survey of Couchman & Fink-Jensen [4].


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