- The Professional Guinea Pig: Big Pharma and the Risky World of Human Subjects
David Onion, Frank Little, Spam and Farm Girl are just a few of the self-defined professional human guinea pigs that live in West Philadelphia and offer their disciplined and compliant bodies to serve the needs of the research industry in exchange for money. Participating in clinical trials has become a full-time job for each of them: they might enroll in five to eight trials a year, deriving an annual income that is close to $20,000.
How does this professionalization occur? Does monetary compensation affect the way participants think about the risks and benefits involved in the studies? Do existing ethical frameworks protect paid subjects? Are they exploited in the current trial economy? Roberto Abadie, the author of The Professional Guinea Pig, uses ethnography to explore these questions. He chronicles the experiences of the human guinea pigs of the ever-growing research industry.
Abadie spent more than a year living in an anarchist community in West Philadelphia observing and interviewing individuals attracted to "guinea-pigging" because of the flexibility and income it offers. To add an additional case study, Abadie spends time with a group of poor, mainly black and Latino men and women testing HIV drugs for phases II and III of the clinical trial they are participating in.
The Professional Guinea Pig is the first ethnographic account of the experiences of paid research subjects. The work is a thoughtful anthropological contribution to the prevalent philosophical discussions of the protection of research subjects. Abadie puts the long ethical debate into social, political and economic context.
To develop and test new medications, the pharmaceutical industry depends on willing human volunteers to participate in medical research. Until the 1980s, human subjects for most studies were recruited from institutions such as orphanages, mental hospitals and prisons. After the research on institutionalized populations was banned, the pharmaceutical industry was forced to develop strategies for recruiting new, suitable research subjects. Abadie calls what the industry ultimately developed "market recruitment." Healthy, disciplined and willing bodies for clinical trials are recruited through market mechanisms, a process that transforms human subjects into commodities. [End Page 341]
The shift from an industrial economy towards a service economy that occurred in Philadelphia in the 1950s has been unable to provide enough employment and has led to the emergence of a mass of vulnerable and unemployed workers. Philadelphia makes a good place for Abadie's study because it is the home of several medical schools and more than 25 hospitals. All these factors make the area particularly attractive for major pharmaceutical industry research.
Abadie is concerned about the human subject's ability to evaluate the risks related to the research studies they are consenting to participate in. The research subject community has developed their own strategies for evaluating risks. The author provides examples of some participants who avoid trials that involve psychotropic drugs and others who believe that plenty of water, cranberry juice and some herbs will eliminate all chemicals from their blood a few days after the trial is over.
Although most participants do not nourish any illusions towards the pharmaceutical industry as a benign institution, the author states that study participants make their choices in a social context characterized by overwhelming economic constraints. In other words, it is inaccurate to view these participants purely as volunteers given the economic forces that limit their choices in the first place. In this way, the current ethical framework surrounding so-called autonomous volunteers who make informed decisions about participating in the clinical trials fails to consider the economic system under which decisions may be made in duress. In order to maintain a livelihood, some participants may also disregard critical information about the risks of a particular study, the long-term effects of which may be impossible to monitor.
The Professional Guinea Pig offers critical tools to reflect on and understand the relationship between the commodification of human subjects in clinical trials and how participant...