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.
Every so often a thinker will earn a place in history through the force of a single really bad idea. Cesare Lombroso (1832-1909) was such a figure. Examining the physiognomy of known felons, living and dead, the pioneering Italian criminologist concluded that some people were organically predisposed to breaking the law. It was just in their nature. They were degenerates, in the strictest sense: biological throwbacks from civilized humanity to something lower on the evolutionary scale.
Various physical traits signaled the regression. This was the bright side of Lombroso’s theory, since it told you what to watch out for. Rapists tended to have abnormally round heads. Women with masculine faces and excessive body hair were a menace to society; a lack of maternal instinct made them capable of acts more vicious and depraved than male offenders. Left-handed men were closer to the state of "women and savage races," thus more prone to crime or lunacy than we law-abiding right-handers.
All of this proves less amusing given how influential Lombroso’s books remained into the early 20th century. Somebody probably went to jail for having a sloping forehead and asymmetrical ears.
A few years back, Duke University Press brought out translations of a couple of Lombroso’s works, which apart from their historical significance, are fascinating for the images the esteemed researcher used to demonstrate his argument. They are haunting, especially the photographs. The faces wear various expressions: hardened, hungry, bitter, confused, terrified. Each evokes a long story of bad choices or bad luck, or both. I’m not sentimental enough to believe that all of them, or even most, were innocent. There are some tough customers who look ready to stick to their story, no matter what. (“That guy was already dead when I got there.”) But the crimes are long forgotten. What remains now is the trace of misery, caught in the gaze of a criminologist who has reduced them to specimens.
On page 78 of William Garriott’s Policing Methamphetamine: Narcopolitics in Rural America, published by New York University Press, there is the reproduction of a poster called “A Body on Drugs.” The author, who is an assistant professor of justice studies at James Madison University, found it taped to the wall of a sheriff’s office in “Baker County” -- the name he has given to an area in West Virginia where he did ethnographic fieldwork in the mid-2000s.
Garriott calls the poster “reminiscent of the catalogs of criminals from which the 19th-century criminologist Cesare Lombroso sought to discern the distinctive features of congenital criminality.” I will return to this idea later, but first should describe the poster itself. Because it has been reduced to the dimensions of a single page in a book, the text is almost impossible to read, but you can still make out the photographs, which show the long-term effects of methamphetamine use on the body through a combination of mug shots and close-ups, plus brain scans.
All of it is ghastly. “The arms and legs had open sores,” recalls Garriott, “the hands were scabbed and bandaged, the mouth was missing teeth, the brains showed signs of malfunction, and the faces were prematurely aged.” If anything, the images may understate the impact of meth. The festering sores result from an accumulation of toxins in the addict’s body. They can also induce psychosis. “Cooking” meth in improvised labs, besides running the risk of explosion, generates extremely dangerous contaminants.
The social profile of crack cocaine, 20 years or so back, was black and urban, while meth’s “brand identity” tends to be white and (especially in recent years) rural. Garriott initially went to West Virginia as a cultural anthropologist to study “the treatment experiences of addicts working to overcome their addiction to meth,” he writes, “what I thought of as the ‘therapeutic trajectory of their recovery process.' ” The focus of the project shifted as Garriott noticed how often “drug problems generally, and the methamphetamine problem specifically, were framed locally as matters for the criminal justice system,” rather than as a medical issue.
To describe the relationship between addict and community, then, was impossible without assessing the role of the police. This is hardly surprising, and perhaps least of all in rural areas, where state and civil society tend to meet at the same diner and church socials. But Garriott’s analysis leaps from the ethnographic particulars to broad claims about what he calls the “narcopolitics” of meth. The term is modeled on Michel Foucault’s concept of biopolitics, which covers a host of ways the modern state seeks to monitor, classify, regulate, and control the population of human organisms within its territory. (However befuddled Lombroso’s dubious Darwinism, for example, his work is the perfect instance of a biopolitical strategy: identifying a defective and dangerous human subspecies enhances the power of the authorities over the social order. That was the plan, anyway.)
Once, the narcopolitical imperative was summed up in the slogan “War on Drugs,” which you don’t hear invoked much anymore. (To quote Detective Ellis from "The Wire": “You can’t even call this shit a war… Wars end.”) Yet the constant mobilization against illegal drugs not only continues but blurs the line between narcopolitics and the “normal” functioning of the state – including, in Garriott’s catalog, “the election of officials, the administration of justice, the practice of law enforcement and the formation of public policy (both foreign and domestic), the allocation of social services, the use of military force, the interpretation of law, and the behavior of the judiciary.”
And because the prosecution and incarceration of drug offenders is one of the few areas of governmental action with broad public support, narcopolitics serves to legitimate the state itself. Policing the availability of illegal drugs and the behavior of their uses becomes a means through which the authorities establish and maintain public order -- or can at least be seen trying.
These tendencies become self-reinforcing. Drug abuse ceases to be a social problem. Rather, social problems, including violence and poverty, look like effects of criminal drug enterprises – which means resources should be channeled towards interdiction and incarceration.
With this notion of narcopolitical power -- as with just about any schema derived from Foucault’s work -- you soon get the sense of a juggernaut rolling over the landscape, flattening everything in its path, with nobody resisting because nobody can, and you’d pity the fool who tried.
In an epilogue, Garriott takes up the question of what reforms of the system suggested by his analysis -- then admits that none really follow. I respect his candor. If you can’t change the world, might as well interpret it, not that doing so makes much difference. But there is at times a strange disconnection between his analytic framework and his descriptions of life in Baker County.
The narcopolitical imagination, by Garriott’s account, “maps” social space according to its own imperative to track and control illegal substances. The community learns to define itself in opposition to the menace of drug dealers and addicts. Social anxieties become focused around them. The preferred response is punitive. Therapeutic treatment for meth abuse is something prescribed by the legal system; it is part of a continuum, with prison at the other end. And all of this functions in a closed loop -- with the problem always finally defined as a matter of criminality, thereby reinforcing narcopolitical power.
But Garriott’s fieldwork shows a community with every reason to regard meth as a real menace – not because it is a convenient explanation for social disorder, but every phase of its existence creates actual dangers. The author does not mention this. Cooking one pound of meth creates six pounds of toxic byproduct. Recovery from addiction is difficult and rarely lasts for very long. Nor does accumulation of narcopolitical power by the state generate confidence in its authority. Garriott notes rumors that local officials are failing to deal with the meth problem because they are somehow involved in trafficking. And while Foucault's thinking about biopower treated certain new disciplines (criminology for instance) as modes of domination over the social field, the knowledge gained by the police and citizens clearly has the very opposite effect. Garriott quotes one officer saying, "Sometimes I wish I was more naive." The awareness that a trash bag on the side of the road might be filled with deadly chemicals from a meth lab is itself a kind of "poisonous knowledge," as the author puts it.
"A Body on Drugs," the poster mentioned earlier, is a concentrated bit of such poisonous knowledge. Garriott borrowed its title for the dissertation later revised as this book. His commentary treats the images as a contemporary narcopolitical variant of Lombroso's work, "drawing attention to a generic type of criminal and the signs by which they could be identified." Recognizing the open wounds, rotting teeth, and emaciation "made possible ... understanding both their physical appearance and their criminality as symptoms of their addiction." The poster did not say they were "born criminals," as Lombroso might. But the narcopolitical gaze was linking their biology and their criminality just as closely.
Having finished reading Policing Methamphetamine, I used a magnifying glass to examine the poster closely. You could see, for example, the little jar that one woman used to collect the imaginary bugs she felt crawling under her skin and removed with a knife. So I learned from the captions. There were some mug shots taken of people who had been arrested before becoming addicted to meth and then afterward. Garriott calls them "a concrete means of imagining the temporality of the relationship between drugs, addiction, and criminality," which is certainly one way of putting it. But in spite of prolonged squinting, I never saw any mention of criminality on the poster. That was not its point. It was about suffering.
Guns, Germs, and Steel: The Fates of Human Societies has had the kind of impact that most scholarly authors can only dream about for their works. First published by W.W. Norton in 1997, the book won a Pulitzer Prize the next year for its author, Jared Diamond, a professor of geography at the University of California at Los Angeles.
For decades, but especially in recent years, social scientists have been frustrated by institutional review boards, campus bodies that must approve studies involving human subjects.
The IRB's, as they are called, are best known for their work on informed consent with medical research. But the boards also must approve projects in which sociologists conduct surveys or do interviews -- even though such work doesn't pose any of the dangers of, say, a drug whose side effects could be deadly.