Crystal Kelley got paid $22,000 to have a baby. But that wasn’t the only offer the 29-year-old Connecticut mother of two received. After an utrasound at 21-weeks revealed significant medical issues, the parents offered her $10,000 more if she agreed to an abortion.

The gross immorality of that second offer tells us that there is a lot wrong with the first arrangement. It is intolerable that our society continues to put up with an unregulated, free market in hiring cash-starved women to make babies. 

The couple, which had two other children, "were very attentive," Kelley told NBC Connecticut. "They wanted to be involved in the pregnancy. [The biological mother] said she really felt like she was living through me in this pregnancy and she wished she could experience it.”

But after the tests revealed complex heart problems, a cleft lift and palate and other issues, the would-be parents decided that the pregancy should be terminated. Kelley refused, even after the money was offered after she was told the parents would no longer adopt the baby.

Then things went from ethically bad to ethically despicable. According to a CNN report, Crystal Kelley then got a letter from an attorney named Douglas Fishman reminding her that her surrogacy contract required her to get an abortion in the case “of severe fetus abnormality.” The lawyer told her that if she did not promptly get an abortion the no-longer-wannabe-parents would sue her to get back the money they’d paid along with the money they’d spent on Crystal’s medical bills and legal fees.

This crummy story goes on and on (for those who are curious, Kelley did eventually give birth and was able to find another couple to adopt the child), but there is enough on the ethical plate to see that there is plenty wrong with commercial surrogacy if a woman can be bribed or bullied into an abortion.

Let’s do the low hanging ethical fruit first.

No one can contract with a woman to have an abortion. Under any circumstances. For any reason. Never. A woman controls her body and no one can make her do anything she does not want to do in terms of medical intervention with her body no matter what she has said before, signed or promised. The lawyer who tried to coerce and threaten Crystal Kelley to have an abortion should be subject to loss of his license to practice law. Any surrogate agency which conveyed an offer of money to encourage an abortion is guilty of at best bribery and an attempt to crassly manipulate a vulnerable woman. And any surrogacy agency that sticks abortion language into its contracts is guilty of gross misconduct.

Now let’s go for the broader moral lessons evident from this horrific tale.

Surrogacy for money is about money -- not love, or help, or altruism or doing good. Money is most attractive to those who need it most. Young single mothers with kids to feed and bills to pay and the rent in arrears are not likely to read the small print. If we are going to put up with markets in wombs, then the least we can do is mandate by law that the potential surrogate has her own lawyer that she picks but that is paid for by the couple who want to rent her womb.

In addition, we need legislation that makes it absolutely clear that if you hire a surrogate you will legally be bound to accept and raise any child that results. Would-be parents who use surrogates must understand that if a fetus is found to have problems, it is their responsibility, not the surrogate’s, to resolve them. If you enter the genetic lottery via surrogacy, you have to live with the consequences: that is the only way to insure the interests of children made via surrogacy are protected.

Lastly, we need tighter control over those in the commercial surrogacy broker business. If Crystal Kelley’s story is any indication, there are a lot of brokers out there who are far more interested in making an easy dollar then protecting the women whose wombs they offer for sale or the children who may result from surrogacy arrangements.

Technology has given us many new and valuable ways to make babies. The free market – complete with its shady middlemen and lawyers -- is not up to the task of deciding how best to use that technology.

Arthur Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center.

The case of a baby who may have been cleared of an HIV infection raises two tantalizing prospects: Is it possible to save even more newborns from infection, and is it possible that other babies may have been cured and no one knows it yet?

One thing that everyone agrees is clear: It's really too soon to say the 2 1/2-year-old from rural Mississippi is actually cured, and it's way too soon to change the standard ways that newborns are now treated to protect them from the virus.

Jim Watson / AFP - Getty Images file

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaks during the 19th International AIDS Conference in Washington, D.C., on July 23, 2012.

But researchers are already thinking about ways they can design studies to see if starting a full course of treatment in a newborn can prevent the 200 new HIV infections seen every year in U.S. babies and the more than 300,000 that happen globally.

“This is an important, but small step in the direction of understanding how we might better treat HIV-infected infants,” Dr. Anthony Fauci, who directs the National Institute of Allergy and Infectious Diseases, told NBC News.

The main goal, Fauci points out, is to prevent infection in the first place. Done right, standard procedures protect babies 95 percent of the time. If a woman has the human immunodeficiency virus that causes AIDS, she can start taking a cocktail of drugs right away that prevent her from infecting her baby in the womb or during birth. Newborns are given a light course of drugs, to, just to be sure.

If they get infected anyway, then the babies get a heavier, three-dose cocktail if drugs to keep them healthy.

The Mississippi baby’s case is unusual. Her mother showed up in labor and didn’t know she had HIV. The baby was a little premature, so she was kept in the hospital for longer than normal. That gave Dr. Hannah Gay of the University of Mississippi Medical Center a chance to deliver an unusually intense course of HIV drugs to the child right away.

This drove the infection down to what’s known as undetectable levels, meaning the virus isn’t active. But it’s always still there, waiting to come back unless the patient takes a cocktail of drugs every day. And if the mother hadn’t stopped bringing her baby to the hospital for several months, no one would ever have noticed something usual was happening in her infant’s body.

But she did. The mom disappeared twice, and missed at least eight months worth of treatment. So Gay frantically checked the baby when she did come back, looking to see how bad the infection was. When she couldn’t find any evidence of the virus, she called in help. That’s when other experts found, to their amazement, that there was virtually no trace of the virus left in the child – only apparently harmless bits of genetic material: DNA and RNA.

This case raises the possibility that giving newborns that drug cocktail sooner might not just keep them healthy,  but allow them to stop taking the medications altogether someday, said Fauci.

“If the baby does get infected, if you could treat them as early as possible you give yourself a much better chance of actually curing the baby,” Fauci said.

Experts stress that it is vital that parents who have HIV-infected children keep giving them the drugs. Taking kids or adults off the treatment can allow the virus to start replicating and damaging the immune system again.

Dr. Carlos del Rio, an AIDS expert at Emory University in Atlanta and a spokesman for the HIV Medicine Association, says he worries that some parents may stop giving HIV drugs to their children. “I worry about the general message to the public. We don’t have a cure for HIV,” he said.

“People shouldn’t be stopping their therapy Del Rio added. “I call this case a miracle. The great majority of babies in this case, if they had gone that long without treatment, would have had advanced HIV. This case is the exception rather than the rule.”

That said, it’s possible that some children who were treated as babies might be able to safely discontinue the drugs, said Fauci.

“Maybe we have actually been curing some people without even realizing it and we need to carefully look to see if there's virus there,” he said.

“You don't want to just decide you're going to stop therapy in children who are doing well. That would be a big mistake, but you should at least look at the possibility that maybe the virus is now absent or essentially no longer viable in those children.”

Other experts say they’ll be studying ways to change policies in developing countries where the AIDS pandemic is still blazing.

“We think this case has the potential  to change the way babies born with HIV are treated,” said Dr. Annette Sohn of amfAR (formerly the American Foundation for AIDS Research). “That means diagnosing them in the first few days instead of waiting a few weeks.”

Sohn, who heads an office in Thailand, says it will require a careful balancing act.

Right now, the main AIDS drug used is AZT, which is available very cheaply and which has few side-effects. It is given to newborns to protect them at about a third of the dose that would be given to them to treat an actual known infection.

The problems doctors have in treating newborns, as opposed to older children, come in testing them for infection and in balancing the benefits of drug treatment against the risks. AZT can cause anemia, so doctors are cautious about giving it to babies who don’t need it.

And HIV doesn’t cause any immediate signs of infection. It takes a while to take up residence in the body, and it takes a while for the body to mount an immune response. Most tests that are used to diagnose infection in people look for antibodies – the immune response to an infection, not the virus itself.

So doctors treating newborns may have to turn to a different test, one that looks for virus.

But Sohn says many clinics already do this. They just wait a few weeks. She thinks it may pay to just speed up the process, testing babies withing hours of birth.

“We are already using these virologic tests and we are already using these medications,” she told NBC News. “I think what we are proposing actually compresses the time frame for testing. We may not necessarily be looking at more testing per se."

She thinks many overseas AIDS programs could do this without spending much more time or money. “You’re either looking at investing up front, from birth, or investing in a lifetime of treatment,” she said.

In 2011, the United Nations AIDS agency UNAIDS reported that 330,000 children had been infected with HIV at birth. “If we can get them diagnosed by 12 weeks of age and started on treatment we can reduce the risk of death by 75 percent. But we are struggling to get these babies diagnosed,” she said.

This case, she said, will raise pressure on the UN and other authorities to step up programs to get pregnant women and their newborns tested earlier.

The picture is a little different in the United States, said Chip Lyons of the Elizabeth Glaser Pediatric AIDS Foundation.

“Most women get good care and are seen and are tested. Their status is known,” he said.  But in many developing countries, babies often aren’t even tested until they are six weeks old. This finding, he said, suggests that is far too long to wait.

Related stories:

• Case of HIV-free baby has doctors talking 'cure'
• Test of gel, pills to prevent HIV fails in real-life study
• Pills prevent HIV infection
• First pill approved to prevent HIV

Florida Atlantic University

On their way to learning to talk, babies, like this one in a study at Florida Atlantic University, become good lip readers, new research shows. That discovery could help doctors detect autism earlier.

By Joan Raymond

For years, the conventional wisdom was that babies learned how to talk by listening to their parents. But a new study in the Proceedings of the National Academy of Sciences shows that our little angels are using more than their ears to acquire language. They’re using their eyes, too, and are actually pretty good lip readers.

The finding could lead to earlier diagnosis and intervention for autism spectrum disorders, estimated, on average, to affect 1 in 110 children in the United States alone.

In the study, researchers from Florida Atlantic University tested groups of infants, ranging from four to 12 months of age and a group of adults for comparison.

The babies watched videos of women speaking either in English, the native language used in the home, or in Spanish, a language foreign to them. Using an eye tracker device to study eye movements, the researchers looked at developmental changes in attention to the eyes and mouth.

Results showed that at four months of age, babies focused almost solely on the women’s eyes. But by six to eight months of age, when the infants entered the so-called “babbling” stage of language acquisition and reached a milestone of cognitive development in which they can direct their attention to things they find interesting, their focus shifted to the women’s mouths. They continue to “lip read” until about 10 months of age, a point when they finally begin mastering the basic features of their native language. At this point, infants also begin to shift their attention back to the eyes.

The researchers believe this second shift in attention is due to the emergence of speech, and their burgeoning ability to better understand “social cues  shared meanings, beliefs, and desires,” explains lead author David J. Lewkowicz, a professor of psychology.

In a second part of the study, the researchers looked at the role of early experience with a specific language and how it relates to lip reading in infancy.

Videos of a Spanish speaking woman were shown to English-learning babies between 4 and 12 months of age. The researchers found these infants also shifted their attention to the mouth by 8 months of age, but they continued to lip read as late as 12 months of age, unlike the babies who were exposed to the English video.

“These babies were experts at English, and now when they heard Spanish, it was like ‘Ok, this is weird, I better start looking at the mouth again, instead of the eyes, so I can figure out what’s going on.'”

The study data suggest that infants who continue to focus most of their attention on the mouth past 12 months of age, “... are probably not developing age-appropriate perceptual and cognitive skills and may be at risk for disorders like autism,” Lewkowicz says.

Although more research is needed, the finding may be able to provide about six months of earlier intervention for autism, which currently can be diagnosed with behavioral testing beginning at about 18 months of age. “The earlier we can diagnose it (autism), the more effectively we can ensure the best possible developmental outcomes,” says Lewkowicz.

James Cheng / msnbc.com

Babies can tell if an adult is reliable nor not, a new study finds.

Babies may be a lot more savvy than we think.

A new study has found that babies little more than a year old can tell whether we’re trustworthy enough to listen to, according to a report published in Infant Behavior and Development.

“Even at a young age, children do not blindly swallow information,” said the study’s lead author Diane Poulin-Dubois, a professor of psychology at the Centre for Research in Human Development at the University of Concordia. “Doubtful or contradictory information is automatically screened by their cognitive system. Young children are not gullible.”

To determine whether babies took everything at face-value or whether they actually mull over the credibility of the people around them, Poulin-Dubois and her colleagues set up an intriguing experiment involving 60 babies aged 13 to 16 months.

Half the babies would interact with a “reliable” adult, while the other half would interact with an “unreliable” one, while playing with a box that in some cases contained a toy and in others was empty.

In the first part of the experiment, the adult would look inside the box and express excitement and happiness. Then the babies were invited to look inside the box themselves to see what the fuss was about.

Unreliable adults were the ones who ooo’d and ah’d over empty boxes, while reliable ones made a fuss only when there was a toy inside.

The second part of the experiment used the same adult-baby pairs. This time the adult used her forehead instead of her hands to turn on a push-on light. The idea was that babies who trusted their new adult friends would try to imitate them.

Sure enough, babies were much more likely to try using their heads to turn on the light if they’d played the “what’s in the box?” game with a “reliable” adult, compared to those who’d played with an “unreliable” one.

For little ones, what it all comes down to is survival.

“We are a very social species and human offspring are dependent on their caregivers for a long time,” Poulin-Dubois explained. “Learning from others is key to cultural learning but it comes with potential costs, such as inaccurate information. Being equipped with an ability to detect ‘unconventional’ or unreliable people is a protection against acquiring false information.”

One of the simplest examples of this is the credibility conferred on adults, Poulin-Dubois said.

“Age is one of these cues and is used by infants and preschoolers,” she added. “They will imitate an adult more than a child unless the adult seems unreliable and the child reliable.”