Clinical Labor: Tissue Donors and Research Subjects in the Global Bioeconomy by Melinda Cooper, Catherine Waldby (review)
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Melinda Cooper and Catherine Waldby. Clinical Labor: Tissue Donors and Research Subjects in the Global Bioeconomy. Durham, N.C.: Duke University Press, 2014. 279pp. $24.95 (978-0-8223-5622-6).

Melinda Cooper and Catherine Waldby’s Clinical Labor: Tissue Donors and Research Subjects in the Global Bioeconomy offers a highly original, gendered analysis of expansive and emergent labor forms “hidden in plain sight” in the rapidly proliferating bioeconomy. Cooper and Waldby’s feminist attention to the imbrication of labor, gendered personhood, and increasing commodification of bits of embodiment enables them to explore the current dance of bio-commodities in the volatile marketplace of health care. There, gender and class relations meet national regulatory and investment strategies. Just as Marx built his labor theory of value by universalizing the condition of the modal male factory worker, presumed to represent the current and near future of capital accumulation, Cooper and Waldby construct the near future of precarious, post-Fordist labor power by imagining how seemingly “immaterial” work, highly gendered and raced, is leading to innovations in outsourcing.

In an introductory chapter and throughout the book, they argue that emergent forms of flexible, part-time, low-waged precarious “clinical labor” is in large measure governed by a regime of bioethics. This masks the deeply regressive, exploitative individual “capitalization of the self” that sends tissue donors, surrogates, and clinical trial participants to “volunteer.” It’s a provocative, productive, unnerving claim on which the authors then base an entire theory of “clinical labor value.” Their book is divided into eight chapters, first examining the progression “From Reproductive Work to Regenerative Labor” in cross-border surrogacy and the emergent embryo/stem cell industry, unavoidably gendered. Second, “The Work of Experiment: “Clinical Trials and the Production of Risk” focuses on clinical research trials subjects, tracking their history from prisons and orphanages to the developing world where new pharmaceuticals and medical devices are now tested. Here, class/gender/national health care resources shape the contingent circumstances in which “volunteers” sell their labor.

Contracts for securing labor are different in surrogacy/gamete “donation” than for participants in clinical trials intended to amass acceptable FDA data. Yet the two sectors, they argue, should be viewed through the same analytic lens for at least three reasons: (1) both entail post-Taylorist/post-Fordist labor regimes not linked to factory or conventional workplace time; (2) both offer extremely marginal employment: low-waged, insecure, lacking safety or other contractual guarantees, such labor arrogates to itself all work risks, unlike whatever protections are offered by conventional labor contracts; (3) in both, bioethics and informed consent orchestrate and also mask extreme exploitation in similar fashion. The authors focus on how the bioethical valorization of scientific beneficence and rationality, on the one hand, and individual enlightened voluntarism, on the other, conveniently mask the emergence of a new and deeply retrogressive labor contract: its showcase document, informed consent, now functions as an invisibilized labor contract. Bioethics has its own history of medical reform and [End Page 370] regulation, ably spelled out by Cooper and Waldby. This now increasingly converges with low-paid forms of labor where wages come in lump sums, hours are neither recorded nor remunerated, and all risks—for example, those of labor and delivery, abortion after prenatal testing, the production of a “perfect”/acceptable child, or ingesting, testing, recording possibly lifelong side effects of potentially marketable drugs—are borne by the contracted worker. You don’t get workman’s comp (sic) for liver damage incurred through pregnancy or drug testing. This close examination and demystification of bioethics as a labor governance regime is a highly original contribution.

Much of the book’s power rests on acceptance of the claim that the global bioeconomy entails novel forms of capital investment, financialization, and labor contracting. Yet for over twenty-five years, economists and others have debated whether “lively capital” (anthropologist Kauchik Sunder Rajan’s title) is producing a life-science-fueled “anticipatory bio-capitalism” that actually differs substantially from prior economic forms. As to labor power, is this “just” a contemporary instance of investment in intimate bodily forms of labor that have long been gendered? The working poor have always found...