[Marxism] The Mild Torture Economy

Louis Proyect lnp3 at panix.com
Wed Aug 18 07:17:16 MDT 2010


http://www.insidehighered.com/views/mclemee/mclemee303
The Mild Torture Economy
August 18, 2010
By Scott McLemee

In his mock documentary Take the Money and Run (1969), Woody Allen 
plays the ambitious but remarkably unlucky bank robber Virgil 
Starkwell. He never makes the FBI’s Ten Most Wanted because, after 
all, it all depends on who you know. But he does manage to shave 
some time off one of his prison sentences by volunteering for 
medical research. He survives the experiment. There is one side 
effect, however, as the narrator explains in a solemn voiceover: 
He is temporarily transformed into a rabbi.

This sequence came to mind while reading The Professional Guinea 
Pig, by Roberto Abadie, just published by Duke University Press. 
“An estimated 90 percent of drugs licensed before the 1970s were 
first tested on prisoners,” writes Abadie. “Prisoners were in many 
ways a perfect population for a controlled experiment. Because 
they had similar living conditions they provided good control 
groups for clinical trials, while the financial and material 
benefits ensured a large supply of willing and compliant volunteers.”

Only in 1980 did the Food and Drug Administration ban the use of 
prisoners for medical research. Their circumstances made a mockery 
of informed consent. (Especially in Virgil’s case.) “Prisoners 
received one hot meal per day,” the narrator explains: “a bowl of 
steam.”) But the demand for experimental subjects for biomedical 
research had to be met somehow. And so there has emerged the new 
regime of power and knowledge analyzed by Abadie, a visiting 
scholar with the health sciences doctoral program at the City 
University of New York Graduate Center.

His book is an ethnographic account of the subculture of “paid 
volunteers” recruited to serve as subjects for pharmaceutical 
testing -- with a particular focus on what he calls the 
“professionalized” guinea pigs who derive most (or all) of their 
income from this work. Volunteers receive “from $1200 for three or 
four days in less intensive trials,” according to Abadie, “to 
$5000 for three or four weeks in more extensive ones.”

Actually the term “work” is somewhat problematic here. The labor 
is almost entirely passive. Half of it, as Woody Allen once said 
about life itself, is just showing up. You are weighed and your 
blood taken, and there might be a few other tests, along with 
quite a lot of boredom. (One of Abadie’s informants describes it 
as participation in “the mild torture economy.”) Some of the 
guinea pigs fall back on it as a supplement to “low-paying jobs as 
cooks, construction workers, house painters, or bike messengers.” 
For others, it is their sole source of income. They enlist for up 
to eight rounds of testing per year, earning “a total estimated 
income of $15,000 to $20,000 in exceptionally good years.”

Higher rates of pay are available to those willing to endure 
unpleasant procedures. Likewise, there is a premium for testing 
psychiatric drugs -- though the considered opinion of old-time 
guinea pigs is that you just don’t earn enough to make it worth 
letting someone mess with your brain chemistry.

Abadie’s description of the guinea-pig milieu -- based largely on 
interviews with a number of them living in a bohemian neighborhood 
in Philadelphia -- focuses on how they understand the risks 
involved in making a living this way, including their preferred 
means of recovering between rounds of exposure to “phase I” 
testing. (That is the term for clinical trials in which 
pharmaceuticals shown to have low toxicity when given to animals 
are tried on human subjects.) Various dietary regimens are thought 
to have a purifying effect. An informal network keeps participants 
updated on new opportunities in the human-subject market, and 
there used to be a zine called Guinea Pig Zero that still has a 
web presence.

Most of Abadie’s informants are also members of an anarchist 
counterculture that prides itself on remaining outside corporate 
capitalism. And making your living as a guinea pig is certainly 
different from joining the rat race. But the “mild torture 
economy” is well integrated into the larger and more literal 
economy. Testing is a necessary stage of pharmaceutical 
development, with some 80,000 phase I trials -- each involving 30 
to 100 human subjects -- being run each year. The development of a 
pool of reliable but poorly paid “volunteers” (consisting mostly 
of young men who, as Abadie puts it, “use their bodies as ATMs to 
fund their lifestyles”) is one sign of the effect of 
deindustrialization on the labor market.

And the effect of becoming dependent on guinea-piggery as a source 
of income is that it creates an incentive to ignore the question 
of how exposure to experimental pharmaceuticals might affect you 
over the long run. “Beginners are more worried about risks than 
professionals,” notes Abadie. “Maybe this reflects the general 
population’s anxieties about biomedical research and its 
well-publicized abuses. Volunteers’ initial uneasiness focuses on 
the unknown effects of the drugs, but it also reflects a 
discomfort with a procedure they do not yet fully understand…. 
Some volunteers mentioned that they were somewhat concerned about 
developing cancer in the future.”

Not so, evidently, with those who had been through the process a 
few times: “Dependency on trial income, trial experiences that 
have not exposed them to side effects, and interactions with more 
experienced volunteers convinces newcomers that risks are not to 
be feared.” Just drink a couple of gallons of unsweetened 
cranberry juice and it’ll just wash the corporate technoscience 
right out of your system….

Meanwhile, the FDA “inspects less than 1 percent of all clinical 
trials in this country,” writes Abadie, and paid volunteers lack 
the resources to challenge any abuses they may suffer.

Trials in phases II and III -- when a drug is tested on patients 
suffering from the condition it may help treat -- draw on a 
different pool of human subjects, with motivations beyond that of 
payment. But when the subjects are economically vulnerable, as 
with some of the poor AIDS patients discussed in later chapters of 
Abadie's study, it compounds the ethical problems facing an 
institutional review board trying to assess whether the research 
has scientific merit or is driven instead by business interests.

The IRB in this case oversees the work of a small, community-based 
organization, not a university (where many clinical trials are 
conducted), but Abadie suggests that its ambivalence is 
commonplace. Its members "recognize the benefits that can derive 
from a relationship with the industry, but at the same time they 
fear that prospective financial gains can influence the research. 
These anxieties are reflected particularly in their views of the 
informed-consent process ... in which volunteers are supposed to 
be able to evaluate risks and benefits independently of other 
considerations."

The major weakness of this otherwise intriguing and worrying book 
is that it provides no clear sense of how typical the 
“professionalized” guinea pigs in Philadelphia may be -- and how 
central such repeat-performing volunteers are to the industry 
employing them.

Abadie maintains that a cohort of full-time human subjects emerged 
after the pool of prisoners dried up 30 years ago. The needs of 
the pharmaceutical industry led to the formation of “a group of 
reliable, knowledgeable, and willing subjects who depend on 
participation in trials for income to support themselves.” Okay, 
but just how dependent is the industry on them? What portion of 
the population of human research subjects for pharmaceutical 
research consists of such full-timers?

Invocations of “the new subjectivity required by neoliberal 
governmentality” may have their place in defining the situation. 
But hard numbers would be good, too. The fact that we don’t have 
them is part of the problem. But then there aren’t too many 
dimensions of the health care industry that don’t look like 
problems, right now.




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