Curing Obesity through Sterility: California 's Controversial Program Under the Microscope


Beginning last November, the city of San Francisco began a program whereupon clinically obese men between the ages of 18 and 55 could undergo a procedure whereupon approximately 1/2 an inch is removed from each vas and the ends are sealed - commonly referred to as a vasectomy - completely free of charge. The overwhelming turnout led the State of California to follow suit, and now California is the first state in the Union to offer state-funded vasectomies to men who have been diagnosed as obese.

Why would a state adopt such a controversial program? The basis is simple: vasectomy is a popular method of birth control (in 1983, figures showed that approximately 10 million men had been sterilized in the U.S. since 1969). By offering such a highly effective form of birth control freely to men who, by clinical diagnosis, have been deemed genetically inferior to the normalized median of homo sapien development, such a gene line would effectively be eliminated.

The program's roots began in countries such as India and China , where the respective governments of those countries are attempting to stem the tide of overpopulation. Sums of money are paid to men who submit to voluntary vasectomy. The program is highly effective, given that the incentives for action are both a limit to overcrowding (societal concern) and monetary gain (personal concern). Given the effectiveness, The San Francisco Medical Society took note and took action.

Nationally recognized geneticist William A. Doty and clinician Joseph Peacock began a program in private practice whereupon overweight men in the Bay Area could receive vasectomies free of charge. Their philosophy: When engaging in clinical decision making, physicians tend to value primarily information about the effect of treatments on physiological functioning and disease progression, rather than information about the impact on the patient's quality of life [9-11]. By focusing on the quality of life of future generations, we greatly improve the psychological impact of genetics on the human condition. The response was positive, and they published the results of the clinical trials in the San Francisco Medical Society's Journal. Soon, other private care physicians spoke in favor of Doty's controversial new theory on the cure for obesity, which led to the program's establishment as a city-funded project and eventually lead to the State of California 's Committee for Exploratory Medicine to set aside funds to trial the project on a State level.

Of course, the major concerns for such a practice reside in the psychological factors as they pertain to the patient. Researchers have examined the possible negative physiological effects of vasectomy, but there is no conclusive evidence that any link exists between the procedure and disease. Study after study reports positive states of minds in observed cases, thus the psychological basis for barring such a practice is rendered ineffective. A major challenge for physicians when dealing with quality-of-life measures in subjects is that many patients with serious and persistent disabilities (such as obesity) report that they experience a good or excellent quality-of-life, when to external observers these individuals seem to have a diminished quality of life. Two articles examining this disability paradox [14] critique this paradox, and it has been established that often times, the physician involved must make a determination on their own as to the best interest of the subject. Thus far, the program has been purely voluntary, which means that people who undergo the procedure are doing so of their own free will and thus emphatically understand that they have a low quality of life. If we are to make this procedure mandatory, we must clearly draw the lines where physician judgment is concerned.

And what of societal concerns? The medical community at large have long established that obesity has surpassed the levels of simple concern and has become an epidemic. Children born of obese parents inherit genes predisposed to physiology which supports obesity - thus, eliminating such a gene line from the overall pool would greatly benefit society in the long run.

When establishing such a program, simple concerns still remain, such as the possibility that those undergoing vasectomy for reasons of obesity and gene-line cleansing might have preserved their fertility by depositing semen in sperm banks. Such semen samples are frozen in liquid nitrogen below -300°F (-185°F) and are considered to be viable for an indefinite period. However, there is considerable debate over the scientific and ethical aspects of sperm freezing, and the practice is still considered experimental. To truly cure the epidemic of obesity through this manner, the community at large would need to properly motivate our representative lobbyists in Washington to make such a practice illegal.

One potential solution to the permanence of sterility would be conjunctive reproductive analysis based on the physical condition of the subject. Efforts to overcome the irreversibility of vasectomy have also led to experimentation with the implantation of faucetlike devices that can be made to open or close the sperm duct in a simple operation. Such devices have functioned successfully in animals but are still considered experimental in humans because of their unproved reversibility, high cost, and the degree of surgical skill needed to implant them. Should sufficient strides be made in this field, it could be monumental in the motivational efforts of the medical community to bring clinically obese people to a sufficient level of fitness by rewarding such people with permission to procreate and switching on the control valves implanted in the subject.

So the question of whether or not sterility is valid and socially responsible solution to the obesity epidemic plaguing this country no longer remains. The physicians' job, as professor M. Sullivan from the University of Washington said, is "to focus on patients' lives rather than patients' bodies" [8]. It is paramount that the overall condition of life for people be improved to the point where poor genes do not hold one back from proper development of fitness and overall well-being. The State of California has established commitment to this way of thinking - and this researcher only hopes that the rest of the nation follows suit.

Joseph Williams


1. Abbott JA, Hawe J, Garry R. Quality of life should be considered the primary outcome for measuring success of endometrial ablation. J Am Assoc Gynecol Laparosc. 2003;10:491-495.

2. Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders. Introduction. Spine. 2000;25:3097-3099.

3. Greenfield S, Nelson EC. Recent developments and future issues in the use of health status assessment measures in clinical settings. Med Care. 1992;30 (5 Suppl):MS23-41.

4. Hollnagel H, Malterud K. Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice. Fam Pract. 1995;12:423-429.

5. Nelson ND, Trail M, Van JN, Appel SH, Lai EC. Quality of life in patients with amyotrophic lateral sclerosis: perceptions, coping resources, and illness characteristics. J Palliat Med. 2003;6:417-424.

6. Bovier PA, Chamot E, Perneger TV. Perceived stress, internal resources, and social support as determinants of mental health among young adults. Qual Life Res. 2004;13:161-170.

7. Hesselink AE, Penninx BW, Schlosser MA, et al. The role of coping resources and coping style in quality of life of patients with asthma or COPD. Qual Life Res. 2004;13:509-518.

8. Sullivan M. The new subjective medicine: taking the patient's point of view on health care and health. Soc Sci Med. 2003;56:1595-1604.

9. Van der Molen T, Pieters W, Bellamy D, Taylor R. Measuring the success of treatment for chronic obstructive pulmonary disease--patient, physician and healthcare payer perspectives. Respir Med. 2002;96 Suppl C:S17-21.

10. Rameckers E. Using health outcomes data to inform decision-making: patient perspective. Pharmacoeconomics. 2001;19 Suppl 2:53-55.

11. Solomon MJ, Pager CK, Keshava A, et al. What do patients want? Patient preferences and surrogate decision making in the treatment of colorectal cancer. Dis Colon Rectum. 2003;46:1351-1357.

12. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273:59-65.

13. Beauchamp T, Childress J. Principles of Biomedical Ethics. 5th ed. New York , Oxford : Oxford University Press; 2001:113-164.

14. Albrecht GL, Devlieger PJ. The disability paradox: high quality of life against all odds. Soc Sci Med. 1999;48:977-988.

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