Wednesday, June 29, 2011

Red-handed

How much are you worth?

Scott Carney, author of The Red Market: On The Trail Of The World's Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers figures he's worth about $250,000 - skin, hair, blood, muscle, tendon, corneas, organs, and bones.

I'm probably worth a bit less - my skin's mostly useless for grafts (except for my legs and some chunks on my torso) and while I guess my corneas are better than being totally blind, you're going to need Coke-bottle glasses. But I've got working organs, and if I felt so inclined, I could get shot up with hormones and sell - I mean donate - my eggs to some sad, childless couple, although I'd make a bit less money than someone three inches taller with an Ivy League degree, good eyesight, and blond hair - that is, you really want a neurotic, nebbishy toddler who will insist on majoring in English and still sleep with a teddy bear nearly three decades later.

Scott Carney's zippy, scary little book bounces us from Cyprus to India to China and back to the United States in pursuit of the shadowy actors of a global supply net of organs, hair, skin, bones, eggs, blood, and living women with wombs for rent. Along the way, Carney explains how he's intersected with the global body trade personally, and shows us the potential next frontier for exploitation: stem cells. With its emphasis on interviews and personal anecdotes (revealing Carney's origins as a journalist), The Red Market delivers a gut punch, although overall, the book is disappointingly lightweight for the seriousness of its topic.

Carney opens with a short primer on the history of the 'red market' - trade in parts or products of the human body - in the United States. Before the 1970s, the red market was capitalistic and fairly open, from clinics that purchased blood set up in shady parts of town and near train stations to a transparent system of organ donation. That changed after a British Sociologist named Richard Titmuss wrote The Gift Relationship, which compared the British system of donation (for free, driven by altruism, patriotism, and one supposes, stiff upper lips) with the American system (for base profit - duh, we're American). Titmuss' book hit a nerve and in 1984, Al Gore championed a US law that forbade payments for human products - organs, skin, bones, marrow, etc.

However, as anyone who has spent any time looking at American legislation will tell you, the spirit of the law and the consequences thereof diverge wildly. The ultimate result was the development of a completely opaque donation system in which no one really profits but the medical industry. As Carney points out, medical privacy, which we take very much for granted today, is a relatively new concept. As medical advances made organ donation more successful and more common, hospitals and doctors encouraged donors and receivers to form a relationship, believing that it would speed the healing process and strengthen the web of social obligation. Now, however, the insistence on privacy has resulted in a shadow industry of organ selling in which medical institutions, doctors, and recipients alike can claim ignorance of the organ's origin. The result? Global exploitation. Carney argues that if recipients really knew where their bits and pieces were coming from, the organ industry would change radically.

Carney opens the book with a one-two punch: while chaperoning a group of American college students on a tour of India's spiritual sites, one of the young women in his charge committed suicide by jumping off the top of a building in Bodh Gaya. The young woman's body needed to be autopsied and the cause of death determined, but there was no way to embalm her, and if she decomposed to much, the airlines would not fly her body back to the US. In the meantime, Carney dealt with predatory Indian 'journalists' and a complicated, bureaucracy-laden process to get Emily's body examined and home as quickly as possible.

It's an odd lead-in to Carney's book - after all, Emily was not selling an organ or being exploited for eggs - but Carney writes that this experience made him start thinking about how human bodies were treated around the world, and how a body was simultaneously the same as and more than a piece of merchandise - or that it should be more than a piece of merchandise. The treatment of Emily's body left him deeply unsettled.

From this harrowing opening, Carney devotes each of the book's chapters to a different body part or product: bones, kidneys, the adoption industry, eggs, surrogacy, blood, clinical pharmaceutical trials, stem cells, and hair.

In "The Bone Factory," Carney travels to India to investigate the not-quite-underground bone farming industry. India was the primary source for skeletons and anatomical models for doctors and medical schools until the sale of bones was outlawed in 1985. Still, bones are a thriving industry, with rampant grave robbing and American and Canadian companies willing to purchase bones from Indian sellers.

In "Kidney Prospecting," the refugees from the 2004 Indonesian tsunami are stranded in a barren refugee camp, the promises of aid unfulfilled by the typically corrupt and phlegmatic Indian government. Desperate refugees sell their kidneys for a few hundred dollars in a countrywide practice that depends on doctors' complicity and forged documents. Here, Carney revists the theme of his introduction, comparing the organ industry to the oil industry, where the companies that stand to profit also control the supply. However, as Carney points out, even in countries where the state controls organ harvesting (Iran and China) the results are scarcely better, with coercion, theft, and state-sanctioned murder rampant.

"Meet the Parents" opens with Carney traveling to the American Midwest to talk to a family who has adopted two children from India, one of whom Carney is convinced is the same boy who was kidnapped as a toddler by an orphanange and sold, using forged papers, with an American adoption agency as the middleman. Carney has promised the boy's parents, who have spent years fruitlessly battling India's court system, to locate their son and beg his adoptive parents to let him contact his biological family. Predictably, Carney runs up against the impenetrable Indian bureaucracy, the American adoption agency's refusal to cooperate (or to acknowledge that they're dealing with unscrupulous orphanages), and the adoptive parents' denial that their son is who Carney says he is.

Next, it's on to Cyprus, the Greek/Turkish island nation that has become a destination for couples from the UK, Europe, and America who need eggs. The UK has banned compensation for egg donation, and after the resultant plummeting of the egg supply, Cyprus stepped in to fill the gap. Cypriot clinics fly donors from Eastern Europe, especially Russia and Ukraine (where the donors are likely to be tall, white, and educated), and harvest the eggs. Egg harvesting is a dangerous process, because the astronomically high levels of hormones injected into donors' bodies can be extremely dangerous or fatal.

From eggs for sale, it's an easy leap to rental wombs, and back to India and the Akanksha Infertility Clinic, where women serving as surrogate wombs are kept confined for nine months in a barren dormitory until it's time for their C-sections. This chapter is particularly chilling on a few points: first, Carney includes a quote from a woman who uses one of the Akanksha's surrogates. Ironically enough, she's an ethics teacher, who sees no problem with saying "the way they [Akanksha] have things set up here is that the surrogate's sole purpose is to carry a healthy baby for someone." Yes, this way you don't have to worry about your surrogate doing things like drinking or smoking while pregnant - if using another human like a brood sow squares with your conscience. Sadly, the Akanksha surrogates are probably the most humanely treated out of all of the quote-unquote 'donors' in Carney's book. They're paid the amount they've been promised and they receive aftercare.

Carney continues on through the blood industry and a singularly gruesome case in India where an enterprising dairy farmer expanded into the blood business, keeping people locked inside a shed and draining their blood several times a week for years. In chapter eight, Carney recounts his own experience as a guinea pig for an erectile dysfunction drug, which sounds like the setup for a joke but is, in reality, a disturbing experience. Since clinical trials benefit from cheap laber and no regulation, like most other American industries, it gets outsourced to China and India with fatal results. In a horrible loop, blood harvesting practices in Henan, China that resulted in massive amounts of HIV infections eventually led to clinical trials by biotech companies of AIDS drugs on the same HIV-infected farmers.

Carney argues that the next frontier of the red market is likely to be stem cells, a claim that is plausible given the ethical imbroglio over stem cells in the US (someone less scrupulous will do it anyway, and Americans who can afford it will still benefit). The Egg King of Cyprus, a doctor at one of the largest infertility clinics, agrees, and is already looking into exploiting stem cells for (fun and!) profit, although Carney is vague on how he sees this unfolding.

The Red Market follows a pattern that's apparent a few chapters in - Carney opens with a personal anecdote or story about an individual affected by a particular facet of the red market, then traces the industry back to the lack of transparency, vasts profits by the medical industry and the middlemen, and reiterates the need for less willful blindness and more openness in the supply chain of human parts. The Red Market returns to India again and again, although this may be due to a combination of Carney having lived there for many years and India's notoriously lax and bribe-happy regulatory system coupled with an atrocious human rights record.

The book will definitely leave you wanting more - aside from Carney's personal interviews, shocking as they are, there's not a tremendous amount of research on display here. Even a single chapter of The Red Market could easily be a book-long study. The expectations created by the ambitious title aren't really fulfilled, although The Red Market is a good primer on the various industries created around certain human products and body parts.

2 comments:

  1. Alas that is always the problem. Either delve deeply into a narrow subject, or survey a broader range of issues more generally.

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  2. Whoah, Scott Carney, for real?!

    The question of organ donations came up on Amy Alkon's blog, Advice Goddess at this link:
    http://www.advicegoddess.com/archives/2011/07/05/im_an_organ_don.html#comments

    The British Medical Association is trying to flip the organ donation policy to one of "presume consent" (that is, unless you opted out, you've opted in!) and I'd love to hear what your perspective on that is from an ethical standpoint. I left a comment telling everyone to read your book, because I think the most valuable thing that Red Market does is explain why the organ donation system operates the way it does.

    I've been pushing your book pretty hard to people I know and will probably be buying a couple of copies when the paperback version is out. It's one of those books I know I'll be loaning out repeatedly and not getting back!

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