The Rebranding of Human Laboratories
In the 1950s the plasmapheresis industry was corrupt and disorganized, relied on prisoners for plasma, and caused 50 percent of American hemophiliacs to contract HIV. Fifty years later, the plasma donations industry is highly profitable, with the US being called the “OPEC of plasma”. The same is true across the board of pharmaceutical practices that rely on humans as donors or test subjects. These transitions may appear favorable to the medical industry at large, but what about those who “guinea pig” for a living? ¶ Lately, the pharmaceutical industry has been rebranding, pushing out populations who traditionally rely on clinical trials for income by attracting the growing population of white, college-educated people looking for cheap housing and extra income. An anonymous participant in Phase 1 Clinical Trials gives an insider's perspective on what this rebranding mean for those “on the inside”.
Around this time last year my close friend and I were pacing the same V-shaped hallway of the same combination-hospital-jail-hotel where I currently type these words. We were enrolled in a ten-day Phase 1 clinical study at Covance Laboratories, a contract research organization that recruits healthy adults and administers them experimental pharmaceuticals, in addition to their day-to-day torturing of other non-human animals.
It's not uncommon to see other gowned lab rats (as we call each other without insult) pacing this hallway together, hoping to burn off a few calories and kill a little time between blood draws or meals. As we briskly weaved past some of these slower old-timers, the headline of a poster taped to the laundry door caught our eye:
ENTER OUR T-SHIRT SLOGAN CONTEST! WIN $200!
Apparently Covance’s previous slogan (Test With the Best!) wasn’t cutting the mustard and they were hoping to crowdsource something a bit more hip for their free, ill-fitting T-shirts. By this point in the study, we had become so bored with our usual go-to vices that we welcomed a creative challenge to troll. As we read on, however, our creativity was stifled by a single stipulation in the fine print: we weren’t allowed to mention anything about money in the new slogan. I don’t remember giving much critical thought to this odd contradiction at the time but I know that we intentionally broke the rule several times just for the sake of good comedy:
I went all the way to Covance Laboratories and all I got was long-term liver damage, $1100, and this lousy t-shirt.
... because I majored in Film Studies.
Clearly we didn’t give a fuck about winning the actual contest and it wasn’t until this morning, when the nurses gave us our token free t-shirts, that I realized they had actually selected a winner. On the back of my stiff new charcoal gray garment, read the following:
The fuck? No I’m not.
I’m testing today to pay last month’s rent, tomorrow. I’m testing today so I can afford to run my space heater all day tomorrow. I don’t really give a shit that AstraZenica now knows that their new cholesterol medication will give its consumers the runs. To be real, these studies make me feel so anti-social that sometimes I report immeasurable side-effects like ‘suicidal thoughts’ just to sabotage their heroic science.
After this wave of drug-induced ‘angry thoughts’, I began to soberly re-consider why these pharmaceutical contractors would decline to mention anything about financial compensation in their marketing propaganda. I have come to the conclusion that these companies hope to obscure a relatively straightforward and exploitative financial transaction with a sense of charity and do-goodery, and their rationale is threefold: one, to mask the tremendous profits that are extracted and withheld from patients; two, to create an illusion that this predatory relationship is completely volunteerist and a moral choice, not an economic necessity; and three, to alleviate the shame of selling one’s body for a new class of downwardly-mobile adults.
Capital is dead labor, which, vampire-like, lives only by sucking living labor, and lives the more, the more labor it sucks. [...] The vampire will not let go while there remains a single muscle, sinew or drop of blood to be exploited.
— Karl Marx, Capital Vol. 1
This intentional obfuscation of the cash-for-body relationship is perhaps most obvious in the present-day plasmapheresis industry. As Darryl Wellington has documented in his investigative piece “The Twisted Business of Donating Plasma,” this capital sector has astonishingly re-invented itself from the struggling, corrupt industry of yesterday to the profitable, “life-saving” neighborhood clinics of today. Plasmapheresis first boomed in the 1950s with the creation of new hemophilia drugs, and by the 1960s was already paying prisoners $5-10 per batch – a considerable sum for a population that only made 12-14 cents an hour, adjusted for inflation. Unsurprisingly, it was later discovered that many of these plasma companies were left to self-regulate and many were not testing any of the prisoners’ plasma before administering it to their hemophilic customers. According to Wellington,
Roughly 50 percent of American hemophiliacs contracted HIV from bad plasma-based pharmaceuticals (a much higher infection rate than that suffered by gay men at the time), making worldwide plasma medication HIV outbreaks the industry’s most publicized scandal.
People with hemophilia filed class-action suits. These included substantial evidence that a major plasma company continued to distribute ‘old supplies’ of bad medications after becoming aware of the AIDS infection. The public was dismayed to discover that the industry operated under the protection of federal and state blood shield laws, limiting its liability.
By the 1990s, the industry’s public reputation reached a low point, with American collections dwindling, U.S. federal regulators clamping down, and revelations coming to light that spoke poorly of industry oversight and humanitarianism. Even before the AIDS crisis devastated U.S. plasma collections, other controversies, such as incidents of hepatitis C infection in plasma pharmaceuticals, led corporations to keep overhead low and avoid regulation by transporting the payment-incentives collections system to penniless countries abroad.
With these massive debasements of public opinion and new expensive federal regulations regarding the screening of donors, the industry seemed on the edge of bankruptcy and irrelevancy in the United States. That is, until the economy got worse.
After the 2008 economic crisis, a massive new swath of precarious Americans became available to exploit, and the industry quickly got to work re-inventing its image as a safe and community-friendly way to give back while making few spare bucks. Since the beginning of the most recent recession, over a hundred new plasmapheresis centers have opened across the United States and the plasma pharmaceuticals market has jumped from around $4 billion to more than $11 billion annually. Presently, collections from Americans make up about 70 percent of the worldwide supply, leading Jim MacPherson (the CEO of America’s Blood Centers) to label the United States as “the OPEC of plasma.”
… which brings us back to marketing. How were these companies able to make plasma donation desirable after so many lethal decades of fuckery? Simple: by rebranding.
One only needs to look at a handful of newspaper ads or onsite propaganda to see obvious marketing patterns emerge – pictures of photogenic young people, thanking you in advance for saving their lives, interlaced with seemingly-contradictory offerings of small financial sums.
The financial component, while always necessarily present, is presented as an afterthought – offered only as a thank you or a gift for your generosity. Nothing is ever bought, sold, or taken – only passively given, received or donated. It’s not so different than the logic of the underage college party bartender, hoping to outwit the excise cops: “Nah man. Everything’s free bro, just don’t forget to donate to the party appreciation fund.”
This rebranding is clearly a thinly veiled mechanism to de-emphasize the paltry amounts of money that people receive for compromising their health, while over-emphasizing a moral duty to do the right thing, whatever the cost. As Andrew Pollack writes in “Is Money Tainting the Plasma Supply?”
based on typical industry yields and prevailing prices, it appears that a single plasma donation, for which a donor might be paid $30, results in pharmaceutical products worth at least $300.
A 1000% profit would make even the most conservative worker hostile towards his boss, but outrage of this sort could only be perceived as legitimate if this was about the money. I mean, how could one be so selfish? There are local children’s lives on the line. Put analogously, it’s the unpaid internship of the incredibly profitable non-profit sector – how could you possibly think about demanding a wage? There are African children’s lives on the line.
Earlier this week, during a compulsory orientation session in Covance’s cafeteria, the white, wealthy head researcher of our study addressed the largely non-white (and wholly-poor) population of my group with an awkward, soft-spoken icebreaker that went something like this:
“I just want to start by saying ‘thank you.’ I recognize a lot of faces in here. Without you coming back to these studies and volunteering, we wouldn’t be able to get these drugs out to the people who need them most. So, again, thank you so much.”
Her obviously forced gratitude was met with silence, save a few awkward scoffs and chair-slouches from my table. I sensed a collective, unspoken consensus in the room: The fuck is this lady talking about? She went on, slightly fazed by the palpable discomfort: “I just want to make it clear that this study is completely voluntary and that you are welcome to leave at any time if you need to. We’re not running a prison here.” Again, silence.
What she intentionally failed to mention was that we don’t get paid if we leave. But by paving over the reality that almost everyone present was there out of economic compulsion, she was able to construct a new reality of volunteerism, and thus freedom.
But why? Why go through this trouble to present this participation as voluntary and the product of benevolence, not economic necessity? Why are we “volunteering today to be someone’s hero tomorrow”? Perhaps it is that these companies recognize just how prison-like this experience actually is (with their colored scrubs, shitty tray lunches, numbers instead of names, cameras everywhere, curfews, locked doors to the outside world, and so on), and they want to negate this reality as much as possible so that anti-establishment tensions aren’t allowed to boil over, as they often do behind bars. Of course, this illusion of volunteerism isn’t only used as a form of managing risks, but also as a fundamental paradigm for attracting a whole new class of superfluous labor.
Despite the fact that the collection of plasma is in no short supply (it’s actually quickly approaching the point of surpassing demand), the industry is now making gestures towards expanding its donor pool further. In Pollack’s article he focuses on one particular clinic in the border town of Eagle Pass, Texas where new donors have ballooned exponentially with the donations from Mexican day-laborers. As a result, the payment for two weekly donations has dropped from $80 to $60 in one year alone. According to Tina Dykstra, a 52-year-old grandmother he interviewed, the clinic had also eliminated the bonus payments she once received for being a frequent donor. “Now, because it is so busy, they don’t have to give you incentives anymore,” she said.
This strategy of creating more exploitable superfluous labor isn’t just limited to attracting those at the bottom of the social hierarchy, however; it’s now being used to target the vanguard class of our new economic reality: downwardly-mobile urban professionals. According to Pollock, “the industry has made a lot of efforts in recent years to shed its skid row image by building some centers in middle-class areas and by promoting altruistic reasons for donating plasma. Companies say donors now come from various walks of life.”
By recasting the archetype of the plasma donor as the “Fashionista Foodie Lifesaver” or “Soccer Mom Friend Lifesaver” companies like BioLife are desperately hoping to eliminate the shame and stigma associated with selling one’s body in order to absorb a whole new population of whoevers. As one flyer reads, “It doesn’t matter who you are or what you do, your plasma donation has the potential to save countless lives.” And as capitalists treat any group of superfluous labor, they will be able to lower the wages (or “gifts” or whatever) for everyone while slowly introducing more restrictive drug testing, surveillance, and zero tolerance policies in order to weed out the rebellious riff raff and replace them with more reliable (forgive me) scabs.
And since many plasma donation clinics were strategically built in proletarian neighborhoods that now are quickly gentrifying to encompass downwardly mobile students and liberal arts graduates, their marketing efforts have become the perfect encapsulation of the present moment: Looking for affordable rent? Move in to this quirky little immigrant neighborhood. Wanna save some lives and make a couple of bucks? Well come on down and donate your plasma to the local neighborhood clinic.
Laboratories for the Future
Although the 2008 financial crisis opened the doors to the plasma industry’s miraculous revival, it was but a small preview of what was to come. Capitalists of all stripes are now approaching an unthinkably larger opportunity on the horizon: the fulfillment of a fully automated manufacturing base, gutted social service apparatus, and generalized precarity and desperation for huge strata of the population.
This new dystopian paradigm appears to us as a cliché from The Matrix: Capitalism no longer needs workers, it needs bodies, and there seem to be plenty to go around. Of course this total realization of neoliberal capitalism, now in the works for over forty years, won’t come without certain unanswered questions for capitalists and state planners. So in the same way that Camden, New Jersey is being treated as a laboratory for the future of surveillance and policing, these cash-for-body clinics (and their propaganda campaigns) can and must be viewed for what they represent – laboratories to answer these questions of future class relations:
What can these bodies tolerate? Which populations are more reliable and docile? Which will accept the meager terms of altruistic charity, and which will demand more? Which will fight for more? And is it safe to have this many exploited bodies in the same place at the same time?
This last question seems the most interesting to me because, though surely asked by higher-ups, it is difficult to resolve without resorting to overtly draconian measures of isolation. Today it’s very rare to find spaces of encounter like the plasma or Phase 1 clinics, where proletarians from across the region are allowed the time and space to socialize freely without mediations like work, or television. There is a well-justified State paranoia of this proletarian gathering that can be observed in the FBI-coordinated evictions of Occupy encampments, the violent repression of block parties, the relentless harassment and destruction of homeless tent cities, and the constant relocation and isolation of radicalized prisoners. But after all, we’re not running a prison here, so in maintaining this illusion of freedom and choice, certain contradictions must be permitted to remain.
According to the owner of the bordertown clinic that Pollack detailed, “It’s kind of like ‘Cheers.’ They come here and know each other.” Though, in my experience, this rare opportunity to share common affects is often squandered in favor of talking about The Walking Dead, certain unexpected conversations will sometimes emerge. According to one man interviewed by Wellington, “...a lot talk about how much money they make off us. I say, if they’re going to exploit us they could at least pay us. I say they could pay us $100 for twice a week.”
This sentiment is much more common in the world of Phase 1 studies. Almost no one here at Covance is fooled by the company’s logic of charity; many talk openly about “screwing over these drug companies” (by vomiting up pharmaceuticals right after taking them, reporting false side-effects, pricking fingers to put blood in urine collection cups, working out in the shower rooms to raise liver enzyme levels, and so on) because they aren’t getting paid enough and they couldn’t afford to take these drugs anyway. Yesterday I overheard a lunchroom conversation about why we all need to stop participating in Covance’s referral program (Refer-a-Friend and earn up to $200!) because it’s making the studies harder to get into and they are going to start paying less if there’s more of us to choose from.
And though the opportunities for organized resistance within these clinics seem few (with their panoptic surveillance and credible threats of fines or expulsion), the humbling experience of sharing common affects and hatreds (the pharmaceutical industry, the police, and so on) with other strangers can produce experiences that carry over to the outside. Among these many exchanges I have been a part of, perhaps the most exciting occurred several months ago in a bedroom with two of my assigned roommates from St. Louis. Though they had never met before that week, they both agreed that they would carpool back to “join the war” if their city erupted after the upcoming grand jury verdict in Ferguson. With these defiant acts of sabotage and secret conspiracies may we transform these laboratories of exploitation to those of subversion and someday, destruction. As to the practical ways of going about the latter, I’ll leave that to your imagination.
Originally published in the “Hustle” issue on March 5, 2015