Citizenship, Labor, and the Biopolitics of the Bioeconomy:
Recruiting Female Tissue Donors for Stem-Cell Research
The following is a transcript of a keynote presentation that Professor
Catherine Waldby delivered at the workshop "Embodiments of Science,"
held on November 6, 2009 at Barnard College in New York City. The
"Embodiments of Science" workshop brought together scholars of science and
science practitioners to critically discuss the history of present
scientific approaches to bodies, identities, and destinies including
neurological, genetic, and epigenetic interventions.
Listen to a podcast of
Professor Waldby's talk.
I've been working on the question of tissue economies for more than
ten years now, coming at it in different ways. When I say "tissue
economies" I mean the question of how the exchange, circulation, and
recalibration of biological materials—which have their origins in
human, animal, and plant bodies—but I focus mainly on human bodies.
How do human bodies constitute various types of social relationships?
How do they create different kinds of value? How do they link
populations to each other, or indeed, repel them from each other? Tissue
economies have been central to the 20th century concept of the nation
state and to the concept of citizenship. We only need to think about the
discourse of blood banking, particularly in Western Europe, where the
giving of blood is the primary act of citizenship. The gift to the
other, the gift to the unknown fellow citizen.
One of the things I will be looking at today is how, increasingly,
tissue economies circulate between populations and across national
boundaries, creating relationships between the more and the less
privileged—the north and the south.
I will also be looking at the ways in which tissue economies suture
populations into broader forms of economic productivity; how human
bodies are mobilized into bioeconomic development, more broadly. How do
they contribute to and participate in the creation of bioeconomic value
or 'biovalue'?
Much of what I will be talking about is drawn from a new book I am
working on with Melinda Cooper (author of Life as Surplus:
Biotechnology in the Neoliberal Era) provisionally titled
Clinical Labor: Tissue Donors and Research Subjects in the
Bioeconomy. In this book we are exploring the proposition that
human medical subjects—those who give tissues to medical research and
those who participate in clinical trial research—are increasingly
mobilized not through the tradition of citizenship and voluntary
participation, but through transactional and formal labor relationships.
In some circles this is a fairly startling proposition. However, in the
U.S., I find that people tend to get what I'm saying because the
business models underpinning these informal transactional relations, in
many cases, have their origins in the United States and have been
exported around the world. Whereas in Europe, the discourse of
voluntarism and citizenship is still more hegemonic, even if it's not as
explanatory as they might think it is.
Since World War II, biomedical researchers relied on the idea of a
freely-consenting volunteer who gives to the public good, donating blood
or other types of tissue either to a fellow citizen for therapeutic
reasons or to medical research. But a number of dynamics within the
commercialization of biomedicine have made this a less persuasive form
of mobilization. In particular, the expansion of biomedical research has
led to a very large scaling up of tissue banking. National biobanks all
around the world aim to enroll very large percentages of the national
population. The U.K. biobank is aiming for half a million participants.
The Icelandic biobank aimed for the entirety of its national population
to be enrolled in its biobank, although it didn't succeed. This scaling
up of biomedical research activity, in many cases, has simply reached
the limits of the voluntary system. It is very difficult within the
voluntary system to mobilize enough experimental subjects to proceed.
There are also many historical precedents to the kind of thing we're
talking about: for example, blood vending and plasma vending,
particularly in the United States, as well as the use of prisoners for
clinical trials. The strategy here is either to recruit through fee for
service, or to turn to an incarcerated population and use institutional
leverage.
This type of transactional procurement is expanding rapidly, however
it tends to be found as kind of an exception. It is not conceptualized
in the regulatory agencies that control and regulate clinical trial
work, and it is certainly not conceptualized as labor. Rather, it is
thought of as a type of voluntary participation for which the volunteers
are compensated, where the language of volunteerism, citizenship,
participation, and public good is still very much in place in regulatory
and bioethical circles.
Turning to the reproductive aspect of this kind of clinical labor
there are two different categories: one is clinical trial
experimentation, and the other is reproductive labor. Central to this
idea is that since the beginning of the so-called 'life sciences
revolution' in the 1970s, a great deal of the achievements of biomedical
research are actually a disaggregation and a redistribution of
reproductive processes generally—genetic processes, cellular
replication and tissue cultures, embryogenesis, etc. So if we think
about biological reproduction in its many manifestations, much of the
biotech revolution is precisely about instrumentalizing biological
reproduction and being able to redirect it, recalibrate it, change its
direction to be able to do nifty things in vitro and sometimes in
vivo.
This disaggregation and redistribution of reproduction has particular
and very complex implications for women because women's bodies
necessarily have an asymmetrical capacity for biological reproduction
compared to male bodies. So it raises a series of complicated questions
about how to understand the biopolitics of the relationship between,
particularly, young women when we're talking about stem-cell research
and reproductive labor, and biomedical research and biomedical
industries, more generally.
Fertility outsourcing is one such area where these questions come
into sharp focus.
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