Preimplantation genetic testing for polygenic disorders (PGT-P) has been commercially available since 2019. PGT-P makes use of polygenic risk scores for conditions which are multifactorial and are significantly influenced by environmental and lifestyle factors. If current predictions are accurate, then absolute risk reductions range from about 0.02% to 10.1%, meaning that between 10 and 5,000 in vitro fertilization patients would need to be tested with PGT-P to prevent one offspring from becoming affected in the future, depending on the condition and (...) the number of embryos available. Survey and interview data reveal that patients and the public have largely favorable views regarding the use of PGT-P for disease prevention; however, clinicians and professional organizations have many reservations. The use of PGT-P raises multiple social and ethical concerns including the need for adequate counseling, the setting of realistic expectations, the application of distributive justice, the impact of environmental and social determinants of health, and the potential exacerbation of health inequities. Clinicians expressed significant concerns relating to the cost of PGT-P, the potential time-consuming counseling for reproductive endocrinologists and genetic counselors, the intentional creation of supernumerary embryos, and patients’ unrealistic expectations regarding “healthiest disease-free” embryos. Furthermore, current evidence lacks long-term outcome data and generalizability. Prior to offering PGT-P to patients, additional clinical validation studies are needed. Also, ethical and social considerations raised by PGT-P should be carefully delineated. Systemic practices to increase equitable access to unbiased genetic counseling and reproductive services would be desirable prior to the ethical implementation of PGT-P. (shrink)

Providing equitable food security for a growing population while minimizing environmental impacts and enhancing resilience to climate shocks is an ongoing challenge. Here, we quantify the resource intensity, environmental impacts and nutritional output of a small (0.075 ha) low-input subsistence Mediterranean agroecological farm in a developed nation that is based on intercropping and annual crop rotation. The farm provides one individual, the proprietor, with nutritional self-sufficiency (adequate intake of an array of macro- and micro-nutrients) with limited labor, no synthetic fertilizers (...) or herbicides, and zero waste, effectively closing a full farm-table-farm cycle. We find that the agroecological farm outperforms conventional farming as practiced in the same country in terms of both lower environmental burdens, across all examined environmental metrics (63% lower on average) per kg produce, and higher nutritional score (66% higher on average). Per equal farmland, the environmental lopsidedness was even higher (79% lower than conventional farming on average), with nearly the same nutritional score (3% lower on average). Moreover, when considering total land area, which includes farmland and supporting non-agricultural lands, as well as postgate impacts and food losses, the advantage of the agroecological system over conventional farming is even more pronounced. Situated within a Mediterranean region that is undergoing rapid climate change, this food system is a unique case study of nutrition- and environment-oriented food production system. While its deployment potential is limited by lack of supportive policies, it nonetheless represents one of the most starkly bold alternatives to current food systems. (shrink)