Sot. Sri. Med. Vol. 38. No. I. pp. 23-33. 1994 0277-9536/94$6.00+ 0.

00
Pnnted in Great Bntain. All tights reserved Copyright c: 1993Pergamon Press Ltd

PERCEPTION OF RISKS AND BENEFITS OF IN VITRO

FERTILIZATION, GENETIC ENGINEERING AND
BIOTECHNOLOGY
DARRYL R. J. MACER
Institute of Biological Sciences, University of Tsukuba, Tsukuba Science City, Ibaraki 305, Japan

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 rirro fertilization (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 U.S.A.
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 fertilization, genetic engineering, biotechnology, surrogacy, public opinion, bioethics,
Japan, New Zealand

lNTRODtiCl’lON embryo transfer. The number is in excess of 40,000

Biotechnology is the use or development of tech-
niques 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 pro-
teins produced by recombinant DNA technology,
genetic analysis, genetic testing, gene therapy or
infertility services [I]. Several of these new technol-
ogies have captured the public attention and evoked
special concerns, such as in oitro fertilization (IVF)
and genetic engineering (a term principally applying
to techniques which alter gene expression using re-
combinant 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
and is rapidly growing. The technique remains con-
troversial, 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 un-
able to have children. In some countries it is nation-
ally 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, em-
bryo 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.

23
24 DARRYL R. J. MACER

It is interesting to ask what public opinion to the Genetic engrneerrng

Brotechnology
use of these technologies is after more than a decade
ln vrtro fertrlrzation
of medical application world-wide. It may also be an
indicator of the way that people’s ethical decision- For each of these developments that you have heard of.
05b Do you personally believe (DEVELOPMENT)
making develops and changes as science and technol-
would be a worthwhile area for soenttfrc research rn
ogy enters daily life and media exposure. In order to Japan’
obtain comparative data on the perceptions of people
1. Yes 2 No 3 Don’t know
from different countries, opinion surveys can be used,
and one such study is described here. Surveys con- 05~. In the area of (DEVELOPMENT) do you have any
worries about the impact of research or its applrcatronsz
ducted in Japan were compared with studies that
have been conducted internationally, and with other 1. Yes 2 No 3. Don’t know

studies in Japan. A significant difference between the Q5d For each development where you are worned.
attitudes of Japanese and New Zealanders to IVF was could you please tell me how worried you are. usmg thus
observed, in both the perceptions of how worthwhile scale about the impacts of (DEVELOPMENT)>

research into IVF is in each country, and the degree 1 I am slrghtly worned about thus
of concern people had. 2 I am somewhat worned about thus

Different population groups were sampled to 3. I am very worned about thus

4 I am extremely worned about thus
examine whether there are differences in perceptions
depending on the familiarity with science and tech- 07 Can you tell me how much you have heard or read
about 7 Manrpulatrng genetic matenal rn human cells.
nology. Two special groups familiar with biotechnol-
microbes, plants, animals Use this scale
ogy were sampled. High school biology teachers play
a significant role in shaping education, and scientist’s 1. I have not heard of thus
2. I have heard the words but no more
play a significant role in shaping university education 3. I have heard the words and have some understand-
and the direction of research. Additional surveys tng of the Idea behind it
among students and nurses were also conducted. The
Please answer the questrons below
greater familiarity of these groups with science and
technology was not found to be associated with lower Q7b. Which. if any. of those biological methods you’ve
heard of are acceptable to you for any reason?
concern about science and technology.
1. Acceptable
2. Unacceptable (if unacceptable wnte why each one
OPINION SURVEYS IS not acceptable to you)

0 7c Which of those biologtcal methods, rf any, of those

Questions that had been used in English language
you’ve heard of could provrde benefits for Japan?
questionnaires concerning biotechnology and genetic
1. No benefit
engineering in October 1986 in the U.S.A. [3] and in
2 Benefit (If a benefit. what benefits do you belreve
May 1990 in New Zealand [4] were translated into the each one could produce?)
Japanese language. In one of the questions of the
Q7d. Which, rf any, of those brological methods could
New Zealand and Japanese surveys, Q5, eight science
present serious risks or hazards rn Japan?
developments were listed and the awareness and
attitudes to these can be compared. To give a back- 1. Risk
2. No risk (If a risk. what serrous rusks or hazards to you
ground from which to examine IVF and genetic
believe each one could present In Japan?)
engineering, perceptions of six other techniques were
also examined. including other controversial areas In New Zealand face-to-face interviews were used
such as biotechnology and pesticides, and some rela- for the public sample, and telephone interviews were
tively uncontroversial areas such as developments in used in the U.S.A. The public sample in Japan was
physical sciences. The questions were: also nationwide, but a high refusal rate was observed
when face-to-face interviews were attempted, so that
Q5 We will ask you about some particular scientific mail response sampling was adopted [5]. Question-
drscovenes and developments Can you tell me how naires were distributed by hand into letter boxes
much you have heard or read about each of these. Please
chosen at random in different areas of Japan, and
answer from this scale
mail response using enclosed stamped and addressed
1 I have not heard of this envelopes was requested. The name and address were
2 I have heard of thus. but know very little/nothing
not written, or recorded, so no reminders could be
about It
3. I have heard of thus to the point I could explarn rt to sent. This approach ensures that there are no fears
a frrend about privacy, and is cheaper, but may result in about
10% lower response rate. Mail response has one
How much have you heard or read about?
advantage over interviews in that lengthier comments
Brologrcal pest control
were written to the free response questions and at
Fibre Optrcs
Superconductors other points in the questionnaire.
Srlrcon chrps Questionnaires were distributed via post for aca-
Agrrcultural Pestrcrdes demics and high school biology teachers. Letters were
 Perception of benefit and risk
sent to the headmasters of high schools randomly
selected from the national register of high schools
in Japan, requesting them to randomly choose a
biology teacher to complete the questionnaire
(if unavailable, then 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 Uni-
versity 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 ran-
dom 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 scien-
tists (24%), government researchers (31%) and uni-
versity 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 re-
turned from the 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 3.
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
-z 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 re-
ported elsewhere [5]. Statistical analyses were carried
out with the Statview program for Macintosh com-
puters, and the term “significant” is used in this paper
when P < 0.05.
25
JAPANESE HAVE A HIGH LEVEL OF AWARENESS OF
IN VITRO FERTILIZATION, 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 differ-
ences 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 aware-
ness of all the developments than the public
(P < 0.05, Table I), as could be expected. The aware-
ness 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% say-
ing 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
a 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 develop-
ments 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 I), 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 U.S.A. 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 U.S.A. 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
26 DARRYL R. J. MACER

(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 people
in the U.K. 38% of respondents said they had heard
of biotechnology [A, 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 U.S.A., 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 (81. 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 “bio-
technology”, with 34% saying they could explain it,
compared to only 9% in New Zealand.
These results suggest that the awareness of scien-
tific and technological developments in Japan could
be better than in New Zealand, U.K. or U.S.A.
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 question-
naires. 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 “biotechnol-
ogy” 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.
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

Table I. Awareness of developments in science and technology in Japan [S] and m New Zealand
(NZ) 141

High school
Public biology teachers Scientists Nurses

Sample: Japan NZ Japan NZ Japan NZ Japan

NWTlber 538 2034 224 277 547 258 301

Biological pest conrrol

Not heard 24.8 17.8 5.8 0.4 7.0 0.8 28. I
Heard only 57. I 61.2 21.4 99.6 38.2 99.2 66.9
Can explam 18.1 20.9 72.8 - 54.8 5.0

Silicon chips
Not heard 30.6 14.3 17.5 10.1 9.2 6.6 54 8
Heard only 41.6 60.5 52.9 89.9 49.8 93.4 41.5
Can explain 21.8 25.2 29.6 41.0 - 3.7

Biotechnolog)
Not heard 2.8 43.5 3.6 8.1 0.9 12.8 4.7
Heard only 64.1 48.1 12.0 91.3 24.9 87.2 85.6
Can explain 32.5 8.5 84.4 14.2 9.1

Fibre optics
Not heard 4.4 43.3 3.1 19.9 2.0 I I.2 9.3
Heard only 64.5 36.7 52.0 80. I 47. I 88.8 80.3
Can explain 31.1 20.0 44.9 - 50.9 10.4

Pesticides
Not heard 3.7 8.5 3.1 6.5 2.8 6.6 9.4
Heard only 58.5 61.3 29.0 93.5 29.8 93.4 71.6
Can explain 37.8 30.2 67.9 55.4 19.0

In uirro ferrilizorion
Not heard 4.6 24.1 3.6 I.4 2.0 6.6 4.0
Heard only 45.3 44.9 9.4 98.6 29.8 93.4 55.9
Can explain 50.1 31.0 87.0 - 68.2 40.1

Superconductors
Not heard II.6 56. I 4.0 22.7 2.6 18.6 31.8
Heard only 59.7 31.5 51.6 77.3 49.0 81.4 61.2
Can explain 28.7 12.4 44.4 - 48.4 7.0

Generic engineering
Not heard 6.0 26.6 4.5 1.4 1.3 3.9 12.4
Heard only 68.0 53.5 13.8 98.6 28.4 96. I 71.2
Can exalain 25.9 19.8 81.7 - 70.3 - 10.4
 Table 2. Attitudes to develooments in science and tecbnolonv
High school
Public biology teachers Scientists NUtXCs

Sample: Japan NZ Japan NZ Japan NZ Japan

Biological pesf conrrol
Heard of (N) 403 1668 211 276 511 256 215
Worthwhile 84. I 85.8 94.8 99.3 96.3 96.9 92.0
Not worried 43.7 49.7 45.4 34.1 60.3 32.4 32.5
Slightly worried 14.1 6.0 12.8 47.8 7.2 48.4 24.1
Somewhat worried 16.9 11.3 20.9 9.4 11.4 12.5 24.1
Very worried 10.9 22.2 12.3 3.6 8.4 3.9 10.8
Extremely worried 4.2 9.6 4.7 0.7 2.2 0.8 3.3
Don’t know 26.0 0.7 8.2 0 3.7 2.0 5.2
Silicon chips
Heard of (N) 366 I743 184 249 500 241 135
Worthwhile 66.4 62.4 87.5 29.3 92.8 28.6 60.9
Not worried 54.1 86.5 69.0 68.7 87.0 83.0 36.9
Slightly worried 10.7 0.6 8.7 8.8 6.4 5.8 21.1
Somewhat worried 7.1 I.6 6.0 0.4 3.6 I.2 23.3
Very worried 4.1 5.7 4.3 0.4 1.8 0 6.0
Extremely worried 1.6 4.6 I.6 0 0.4 0 2.2
Don’t know 36.6 10.0 19.6 0 5.6 10.0 10.5
Biotechnology
Heard of (N) 516 115-l 217 2.53 542 225 285
Worthwhile 84.9 71.7 93.5 84.6 97.4 81.3 90.4
Not worried 38.2 68.4 35.0 42.3 53.7 46.2 37.9
Slightly won-Led 14.1 2.5 8.3 39.5 II.4 39. I 19.9
Somewhat worried 16.9 6.0 22.6 6.7 16.4 6.2 22.7
Very worried 13.0 14.3 20.7 2.0 11.6 0.4 7.8
Extremely worried 8.5 7.2 8.3 0.4 6.1 0 3.5
Don’t know 21.5 I .6 6.9 9.1 4.4 8.0 8.2
Fibre oprics
Heard of (N) 507 II53 216 222 540 229 271
Worthwhile 85.8 65.9 94.0 36.9 97.1 32.3 85.9
Not worried 68.4 91 .o 83.3 76. I 90.6 84.7 50.6
Slightly worried 14.6 0.4 9.7 4.1 7.0 2.6 21.2
Somewhat worried 6.7 0.8 3.2 0.5 I.5 0.4 11.9
Very worried 2.0 3.1 0.5 0 0.9 0 4.7
Extremely worried 0.4 3.6 0.9 0 0.7 0 1.9
Don’t know 25.1 1.0 12.1 19.4 4.6 12.2 9.7
Peslicides
Heard of (IV) 509 1861 217 259 533 241 271
Worthwhile 89.2 84.5 87.6 79.2 94.7 82.2 91.8
Not worried 27. I 38.9 24.0 7.7 43.9 15.4 16.4
Slightly worried 7.9 14.2 6.0 22.4 7.1 30.7 13.8
Somewhat worried 14.9 18.1 13.4 32.4 16.7 28.6 30.6
Very worried 25.1 22.1 29.0 18.9 20.6 13.3 22.0
Extremely worried 18.1 6.3 22.6 13.1 II.1 8.3 9.3
Don’t know 16.1 0.4 7.3 0 2.6 3.7 7.9
In vim ferrilitolion
Heard of(N) MS 1544 216 273 538 241 287
Worthwhile 57.6 70.5 78.7 51.6 81.0 49.0 75.9
Not worried 20.8 61.9 22.2 26.4 33.5 34.4 16.3
Slightly worried II.8 6.2 6.9 37.7 10.4 35.7 16.0
Somewhat worried 17.3 7.3 15.7 17.6 20. I 12.4 27.3
Very worried 23.0 14.6 34.7 7.0 22.7 7.1 22.3
Extremely worried 17.5 8.9 14.4 4.4 Il.5 3.3 II.0
Don’t know 18.6 I .2 7.8 0 3.5 7.1 7.1
Superconducrors
Heard of (A’) 465 893 214 214 536 210 204
Worthwhile 84.7 58.3 92.5 36.4 96.6 27. I 82.7
Not worried 64.1 87.2 78.5 72.9 89.6 85.2 48.0
Slightly worried 12.0 0.8 7.5 4.7 7.5 4.8 17.8
Somewhat worried 8.2 1.6 6.5 0.9 3.0 0.5 17.8
Very worried 3.0 3.7 3.7 0 0.9 0 3.0
Extremely worried I.5 5.4 0.9 0 1.3 0 I .o
Don’t know 25.8 1.3 II.7 21.5 3.7 9.5 12.4
Genelic engineering
Heard of (IV) 495 1492 214 273 540 247 262
Worthwhile 76.2 57.4 91.6 85.7 94.4 79.8 86.9
Not worried 19.4 43.8 16.4 10.6 43.3 14.2 20.8
Slightly worried II.1 14.6 7.9 37.4 II.3 39.3 19.7
Somewhat worried 18.2 13.8 14.5 31.9 16.5 22.3 19.7
Very worried 21.4 18.6 31.3 10.6 17.2 13.8 18.9
Extremely worried 19.8 8.2 25.2 8.4 12.8 8.9 10.5
Don’t know 19.8 0.9 7.9 I.1 3.2 1.6 10.4
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 and
Fink-Jensen 141.

27
 28 DARRYL R. J. MACER

than all other developments (Fig. 1). Two develop-

Public perception of science
ments. silicon chips and IVF, were perceived to be
developments in Japan
less worthwhile than the others. Silicon chips are
important for the Japanese economy, and this result Bbkgkal
is an anomaly resulting from the word, not the past contrcl
q Pesticides
technology. When the word “computer” is used there I
nn . ‘Notechnology
appears to be no anomaly (data from another survey Subermnductors n
currently in progress). Scientists and high school Genetic engineering
II Silin chps
teachers thought that all the areas of science were
worthwhile areas of research for Japan, with most a IVF

areas seen as worthwhile by over 90%, except for IVF

research, which was seen as worthwhile by about
80%.
IVF was seen as worthwhile by about half the
scientists and high school teachers in New Zealand,
and by 7 1% of the public [4]. It was considered to be
much more worthwhile for research in New Zealand
compared to fibre optics, silicon chips or semiconduc- ” I

tors (Fig. 1). The lower proportion of New Zealand 0 20 40 60 80 100

% of those who had heard of the developments
respondents who said that these later techniques were who were worried about their impact (October 1991)
worthwhile is probably a realistic reflection consider-
ing the small size of New Zealand. This clear distinc- Public perceptions of science
tion in the support for research in biological fields
developments in New Zealand
compared to physical science fields could reflect the

1
agricultural basis of the New Zealand economy. 100
Genetic engineering was perceived to be more pest &ntrcl
=
worthwhile than IVF in Japan, but less worthwhile a Pesticides

than IVF research in New Zealand. We need to ask Fibre Biotechnology

Ootics ’ q tiVF
what benefits were perceived. Question Sb was delib- ‘0
erately framed in terms of reference to the perceived 0 Siliconchips
ta q Genetlc engineering
value of the research “in Japan”, or “in New Superconductors
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 o! I 1

for genetic engineering and pesticides (P < 0.05). 0 20 40 60 80 100

Rather than tying benefit to economic or humanitar- % ofthose who had heard of the developments who were
ian reasons, it may be that Japanese have a less worried about their impact (Couchman CLFink-Jensen, May 1990)

selective response, reflecting the size of the country Fig. 1. Comparative perceptions of science developments
and its positive attitude to science and research between Japan and New Zealand. The results are based on
(Table 3). Both Japan and New Zealand have a the number of respondents who said that they had heard of
each development (Q5a). and are presented as scattergrams,
pronatalistic outlook. supporting population growth.
with number of respondents who thought each development
The higher support for IVF in New Zealand may be was worthwhile for their country vs the number of respon-
due to the greater emphasis given to protection of dents who were worried about the impact of the develop-
individual liberty, but conversely it could simply be ments. Results from New Zealand are from the survey by
that the public in New Zealand are not worried about Couchman and Fink-Jensen [7].
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 of scientist total respondents said that there was a
to a following question (47) on the perceived benefits benefit from genetic manipulation of human cells
and risks of genetic manipulation for Japan. People [5, IO]. About half of these cited examples of medical
were asked whether they thought genetic manipu- benefit, including treatment of genetic disease and
lation was acceptable, and what benefits and risks disease control. In all groups there were more total
they saw from it. They were asked to cite their respondents who saw benefits from genetic manipu-
reasons, and these allowed an in depth analysis of the lation of plants, microbes and animals than for
reasoning behind their perceptions. 38% of the public human cells, with more agricultural or environmental
and nurses, 52% of student, 54% of teacher and 61% benefits cited for these organisms (P < 0.05).
 Perception of benefit and risk
Of the public who expressed a benefit from genetic
manipulation in 47 (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% respect-
ively, 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 ques-
tions [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 there 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 depen-
dency 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 FERTILIZATION
Q5c and Q5d examined how worried people were
about the impact of these different developments. The
techniques that the Japanese public were most wor-
ried 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 tech-
niques, than for other developments (Table 2). Bio-
technology 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
Table 3. Does science lead to more benefits than harm?
Sample: Public Students
Number 530 200
Male 53 53
Female 47 47
Overall do you think science and technology do more harm than good, more good than harm. or aboul
. ,
the same of each? f%j
More harm 5.8 12.0
More good 55. I 38.0
Same 39.1 50.0
29
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 per-
formed 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 choose 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 under-
standing 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
[ 121.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 psycholo-
gists 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
High
school Univ. of
biology Total Tsukuba Total
NWSeS teachers academic staff scientists
271 223 713 242 544
14 90 a9 78 90
86 IO II 22 IO
II.1 3.1 2.4 4.1 1.8
19.5 57.9 72.9 57.0 77.8
70.4 39.0 24.7 38.8 20.4
30 DARRYL
Japan Association of Obstetrics and Gynaecology,
despite the fact that sperm donation has been prac-
tised 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 uncer-
tainty, 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 lim-
ited 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 U.S.A. to be implanted with a donor
egg from an Asian American fertilized 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 [ 181.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 scien-
tists and teachers in Japan and New Zealand, which
both used mailed questionnaires, may be more stat-
istically reliable for international comparisons. How-
ever, these generally mirrored the comparative public
results, as seen in the tables. The responses of high
school biology teachers in Japan and New Zealand
R. J. MACER
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 = 3000), in 1982, 41% would
consent, while 47% said they “don’t know”, and in
1990, 51% said they would consent, with 3 1% saying
“don’t know”, and 16% saying they would not
consent [ 171. If we compare this to the approval of
IVF quoted above, where in 1990, 49% disapproved
of IVF [A, 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
organized protest groups, such as those in the Canton
of Base1 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 stor-
age [18]. The limits of legislation vary among
countries, for example, being very strict in Germany
[19] and less strict in the U.K. [20].
The clearest answer may be related to the structure
of Japanese society, the public views are not influen-
tial in deciding whether a technology will be permit-
ted, 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 poli-
ticians 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 (211. 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 practice.
Physicians are also one of the groups of “sensei” in
Japan, and are paternalistic. Self-regulation by the
Association of Obstetrics and Gynaecology is pre-
ferred. 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 GENETlC ENGINEERING
As noted above, genetic engineering was of a
similarly high concern as IVF in Japan (Table 2). The
 Perception of benefit and
reasons why genetic manipulation was seen to be
unacceptable were asked in a separate question, Ql,
of this Japanese survey [S], 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 un-
known. Less concern was expressed about possible
human misuse of genetic engineering for eugenics or
cloning and insufficient regulatory controls. In Japan
[5], New Zealand (41 and the U.S.A. [3], genetic
manipulation of plants was most acceptable, with
genetic manipulation of microbes next, then animals,
and human cell genetic manipulation was least ac-
ceptable. This could represent two major thoughts, a
scale of biological complexity associated with increas-
ing ethical “status” from plants to animals to hu-
mans. 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 biotech-
nology [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 the U.K., 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 the U.K. 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 manipu-
lation of humans was equivalent to about 4% of the
total respondents, half of the proportion who ex-
pressed concern because of environmental reasons,
and much lower than the number of respondents who
cited reasons based on interfering with nature, play-
ing God, ethics, or fear of the unknown [5, IO].
Because free response questionnaire data is unavail-
able 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-acknowledge-
ment of the past eugenic abuses in Europe, and due
to media coverage of the eugenic concerns raised by
organized feminist and Green groups in Europe. Free
response questions may provide a better estimate of
people’s opinions and provide a better picture of
risk 31
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 associ-
ated 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 Fig. 1. There are some
differences in the position of the eight science devel-
opments on the scattergrams from Japanese and New
Zealand results. Pesticides stay 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 consider-
ably, 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 vs
harms of science, and these responses were over-
whelmingly favourable. 46 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 choosing the neutral response, the science had
both a good and bad side. They showed increased
general concern compared to the public in 46, and
they had rather similar views to the public for the
32 DARRYL R. J. MACER
specific developments, IVF, biotechnology and gen-
etic engineering. The hospitals surveyed are in Fukui
prefecture, in West Japan, which may be more tra-
ditional than East Japan. The survey was also con-
ducted 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 the British may be less optimistic in
outlook about science and technology than the
Japanese. In Australia people may be more opti-
mistic, in 1989, 757 people 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 tech-
nology 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 U.K. 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 birthplace 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 develop-
ments, extending Q5 style to ask the “why” question.
As mentioned above, awareness of the developments
of science and technology in QS was not directly
correlated with the perception of these technologies.
The responses are more complex than 46 may indi-
cate, 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!
CONCLUSION-NO MORE SIMPLE YES/NO VOTES?
People of various cultures, ages, educational train-
ing, 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 engin-
eering evoking mixed emotions of benefit and risk.
Overall, most people in industrialized countries per-
ceive 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 U.S.A., or a developing econ-
omy 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 argu-
ments 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 scien-
tists in the U.S.A. [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 [S]. Their
 Perception of benefit and risk
goal is to reduce what is seen as a high level of
concern about the technology, which seems unobtain-
able 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 ma-
turity 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 technol-
ogy. 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 indi-
vidual’s informed consent. Awareness of concerns
and risks should be maintained, and debated, for it
may lessen the possibility of misuse of these technol-
ogies. Other important principles of bioethics such as
autonomy and justice need to be protected and
included in the benefit/risk balancing which is import-
ant for the ethical application of biotechnology in
medicine.
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