Monica Huelga
11/14/12
Anth 215
Ethnography
Review:
The Professional Guinea Pig: Big Pharma and the Risky
World of Human Subjects (Roberto Abadie)
Often times, anthropology is thought of to examine
low-income areas and cultures that are not familiar with in the Western world.
I wanted to look at something different. I wanted to look at something that I
am not as far removed from, and something that is not often looked at as being
a culture. I read the ethnography The
Professional Guinea Pig: Big Pharma
and the Risky World of Human Subjects, by Roberto Abadie. Abadie discusses
the life in the United States pharmaceutical industry and the people who
volunteer to test medications before they are declared safe for humans and go
on the market, known as guinea pigs. Professional guinea pigs are those who
essentially make a living out of pharmaceutical trials’ financial compensation
and do several studies annually. There are many phases and types of medications
tested, and this particular work focuses on phase I trials, which means the
medications have never been in a human before. Phase I begins after toxic
levels tested in animals are not alarming. This phase also calls for healthy
adults, which means these guinea pigs are putting their optimal health at risk
by taking a treatment for something they don’t necessarily need. The research was to examine not only what
goes behind the prominent, and growing, American pharmaceutical companies, but
also how the trials reflect the morals and values of mankind, and particularly
our nation.
Guinea pigs’ incentives express the value Americans
place on our bodies and health. The industries use financial compensation for
putting such a risk on people’s health. Human bodies are basically seen as a service
to the pharmaceutical industry, despite how they frame it. It is not the body the
industries claim to be compensating the “paid volunteers” for, but the “’time
and travel expenses’” (Abadie 2010: 9). Professional guinea pigs explain how
they think of money while getting through trials, and backing out will result
in a smaller paycheck, despite the discomfort and potential harm their body is
under (Abadie 2010: 158). It may been seen as taking care of family, but the
majority of the guinea pigs didn’t mention their family whatsoever, simply the
financial security the tests entail. Our culture is more concerned with
economic gains, than the wellbeing of their body.
One study’s participants Abadie spoke with gave a
unanimous reason of doing the study. Regardless of their education level,
ethnicity, or age, everyone explained how it was to “’make easy money,’ ‘quick
money, ’a considerable amount of money in a relatively short amount of time’”
(Abadie 2010: 30). Participating in studies requires a flexible schedule,
meaning not having a job is ideal for being part of a trial. With an open
schedule and proportionally a large sum of income, professional guinea pigs
explain that “clinical trials [are] much better than a job at McDonalds”
(Abadie 2010: 32). One would rather work in the pharmaceutical industry,
technically, than the fast food business. American’s are not only concerned
about financial gain, but also social images, determined by their field of
work.
The compromised schedule provides the guinea pigs to
feel like they are not working at all; the profession of clinical trials is
work based on enduring something, not labor taking up any of their time or
energy. One guinea pig expanded on this idea and said that he “focuses not on
his body and what is going on. Instead he thinks about the things he will do
with the money he receives” (Abadie 2010: 47).
There is a “detachment between the mind and the body experiences,” which
Abadie compared to tactics of sex workers. Frankly, I think our culture is
lazy. Mankind makes luxury of having to put the least amount of effort for the
highest amount of profit, regardless of implications and consequences. We eat
fast food ever day because a $1 hamburger is more appealing than a $10 organic
vegetable bowl, no matter what we believe is healthier. We have resorted to a
job that means going to work is going to sleep and watching TV, despite the
medication pumping through the body, rather than building a house or delivering
newspapers for the same amount of profit. Future outlooks seem little to no
concern to many people in the United States; current affairs are the prevailing
interest.
Essentially, bodies are becoming a commodity. With
the prospective of acute side effects, rather than long-term effects, it seems
as if we are beginning to take the easy way. One participant expanded on this
idea by saying, “they pay you just to demean you to animal status, you are just
letting yourself be measured by the functions of your organs” (Abadie 2010: 47).
When the pharmaceutical industry was approached on such a thought, they denied
the compensation was for their body. Therefore, their body would not be the
commodity, but the financial compensation was for their “’time and efforts’”
(Abadie 2010: 140), making their jobs just like any other profession. A job
where you swallow a pill and get studied on what organs undergo with such medication
is not work, it is being used as an object.
Being compensated for their time and efforts, a
traditional means of making money, there should be a traditional amount of
risk. Teachers, retail associates, lawyers, conversely, have no
informed-consent forms that they must fill out. We discussed informed-consent
forms in class and how a signature doesn’t always signify understanding and
competence of everything involved in what they are about to do, especially the
risks. Abadie said, “informed-consent forms contain hyper technical language
and avoid references to risks, suffering, and death” (Abadie 2010: 140). For instance, using the word “anaphylactic
reactions” is not a common, everyday term that people use. One form used this
term, a guinea pig approached the staff for clarification, and they explained
that it is when the heart and breathing stop. The guinea pig clarified that was
being dead, and the staff concluded that if those functions do not start again,
then he was correct. In the form, anaphylactic was used, but death was not.
Understanding the forms would being “recognition of the commodification of
their bodies [and prompt] them to challenge the ethics of clinical-trial
research under the current institutional arrangements” (Abadie 2010: 141). If word substitutes did not exist and common
language was used, professional guinea pigs’ work would be recognized as body
commodification. The simple fact that there is a consent form for this
profession deems curiosity in the ethics behind such a market.
Risk analysis is a large contributor to the decisions
and motives the profession guinea pigs possess. Similar to what we discussed in
class and how one’s history, surrounding environment, and experiences shape
perception; they also shape assessment of risk. It was explained “human
subjects’ understanding the risks in phase I research has not been studied,
however there are some studies of volunteers in later phases of drug
development” (Abadie 2010: 73). In regards to the targeting of lower-income
subjects with the financial compensation, this also inhibits their ability to
value risk. For instance, with the chance “earn a livelihood, the poor and
disenfranchised face risks that they may not recognize or are unwilling to
forgo” (Abadie 2010: 71). The works of professional guinea pigs are not as
publically stigmatized as being risky, like coal miners for example, and even
if the risks are acknowledged, financial concerns are of main interest.
The clinical trial culture is
dominated by biomedical benefit, but it often comes at a cost of individual
citizens. Besides a healthy body, there are little requirements for such a job.
This is creating a wide labor market for professional guinea pigs, and with the
financial compensation, “usually the research subjects [come] from the lower
strata of society: the poor and the disenfranchised” (Abadie 2010: 122), also
leading to more questionably ethical affairs. The Tuskegee syphilis experiment
is also a classis example of exploiting the lower class. The Tuskegee experiment
was to study the stages of syphilis, but the test subjects were not informed of
the goal of the study. They were under the impression they would receive
treatment; they were isolated for decades with no treatment given, despite
available medication. Abadie points out that this study “is a tragic example of
how racism, science, and state power interacted to shape the biomedical
research involving human subjects,” (Abadie 2010: 124). Biomedicine
advancements are used to help mankind, but the testing and process to make
those medications are becoming much more of a concern than just biomedicine. Considering evidence from Abadie’s work and
the documentary Outsourced: Clinical
trials overseas, which we viewed in class, the biomedical industry is in
favor of their benefit, at the cost of citizens, especially those vulnerable to
misunderstandings, including illiterate individuals and foreigners unaware of
their motives.
Overall, I really enjoyed this ethnography for many
aspects. I think that the medicalization and consumerism of our culture is
overlapping, and this is a clear example of the fusion between the two. I
typically support a holistic approach to human wellness, but I do see when
Western medicine is a better option. For instance, I like my loved ones to be
saved in traumatic accidents and to be eased of pain when other approached have
failed. This book, however, points out that we are taking health to a new
level. Our body’s health is being overlooked by consumerism and financial
compensation. We compensate health for money, ironically for medications allegedly
trying to enhance health. I think it is something that reflects the morals of
our people and the values our lives are based on. What will we be able to buy
with that compensation money if we are dead? I think Abadie’s concern and role
was to make us think about what we would do, make us aware what goes on in our
consumer culture, and what decisions says about what values we have. Whether
Abadie was trying to demonstrate the ways of the pharmaceutical industry or the
actions of the human subjects themselves, I believe he did his share of
demonstrating conundrums of both.
I appreciated that Abadie included perspectives from
the pharmaceutical industry and what their thought are, for example, what they
believe they are compensating trial subjects for. However, I think he could
have talked about the positives of the studies what findings came out of this
structure. With so many ethical concerns and health risks, it seems as if the
pharmaceutical industry is simply too imperil of a business to be allowed to be
continued. Yet, these tests are needed to develop new medications, which have helped
countless people. I still don’t think they are being ethical, I don’t think
people should have to resort to harming their body for money, and I think our
culture needs to be less focused on profit and effortlessness, but I do
recognize that there is some positive gain that wasn’t weighted appropriately
in the reading.
Despite not speaking about the positive outcomes of
the trials, Abadie did a great job getting firsthand explanations from the
professional guinea pigs themselves. From the outsiders perceptive, I just see
a new drug commercial, or assume that the medications I use are safe. I had
never thought what people go through behind the scenes. When I hear that a new
product trying to combat disease, for example a HIV/AIDS antivirus drug, I
don’t really think of all the tests that are going on, or if someone has been
harmed to conclude that something is not safe for public use. Abadie did well
at exposing behind the scenes of a market we encounter on a daily basis.
This work focuses primarily on trials in the United
States, and a few instances from Canada. Nevertheless, I do think of this as a
global health issue, especially considering the film we watched in class about
India’s people being tested for our drugs. Tests are being exploited into
low-income countries with faulty informed-consent forms because of language
barriers and illiteracy. Also, I think this is a problem with biomedical
culture, not necessarily the American culture. Medical schools in the United
States foster many international students, who go back to their home country
and server their citizens. The ideologies and feelings developed and taught in
medical school, I think, are what have lead to the desensitization in clinical
drug trials and pharmaceutical industries thinking of the body as a commodity.
Bodies are not seen as people or attached to a life; they are seen as a body
for testing, simply a subject, with no emotional attachment. Although guinea
pigs aren’t a statistic in Global Health
Watch, these trials are going on for diseases included in such. Global Health Watch also discusses
research funding and medicalization, which is the root of pharmaceutical
trials. Biomedicine leaves the United States boarders, and now the unethical
trials that create the products are impacting other areas as well.
Prior to reading this book, I have always thought
that the pharmaceutical industry’s main concern is profit. Sure, helping combat
diseases and condition is a concern, too, but in a desensitized, removed way. I
think it is too scientifically based, and this ethnographic research proves it.
The industry has created a community for healthy people to put their lives at
risk at the sake of financial benefit. Subjects’ first priority is not to find
a medication to help their condition or a condition of loved ones, especially
if they are classified as a professional guinea pig and do multiple tests a year
for a wide range of health conditions. If their intentions were besides money,
I think it would have been an entirely different research topic.
With a better understanding of what goes on behind
the production of pharmaceutical drugs, I have confirmed that our society
always wants more and something better. These drug trials are going on because
companies want to gain profit and make something better than what is already
working on the market. Testing whether a medication is actually better than those
already on the market, though, is at a different stage than what is mostly
examined in this ethnography. Regardless, the phase I trials that these guinea
pigs are putting their health in jeopardy for are part of the cycle our
consumerism is producing.
Consumers
should take this insight and think before they demand more. On the other hand,
industries need to start thinking of their consumers, not just their profit. I
do not have a solution, nor do I think there is a simple solution, to stop this
market, but I do believe that individual pride and a business mindset is at the
root of the pharmaceutical industry, which needs to change. Abadie’s work did
not give a solution either, but his work is definitely a step in the right
direction to find a healthy balance of technological advancement and safe
citizens.
The
Professional Guinea Pig needs to be
read by anyone who has ever taken a medication in his or her life, because they
are a major contributor to this detrimental pharmaceutical prevail. The fact
that there are people willing to not be healthy for some extra money reflects
some disheartening things about our country. Health, to me, is one of the most
important things, and undoubtedly more than money. I find a problem when
companies who are supposed to encourage a healthy body, too, are the ones
initiating this harmful profession. Roberto Abadie gets inside the dirty background
of one of the largest industries in the world and opens our eyes to a new
standard of work and values on the human body.
References
Abadie, Roberto
2010 The Professional Guinea Pig: Big
Pharma and the Risky World of Human
Subjects. Durham and London: Duke
University Press.
Awad, Zeina
“Faultline: Outsourced: Clinical trials
overseas.” Project: Report.
YouTube.
Global Health Watch 3:
Alternative World Health Report
2011 Global Health Watch 3: Alternative
World Health Report. New York: Zed Books
Ltd.
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