Intimate Labors: Cultures, Technologies, and the Politics of Care

The Professional Guinea Pig belongs to a social science growth area investigating the pharmaceutical industry in contemporary health care. This literature is united by a prevailing consensus that views the drug industry as the villain du jour in health policy. After focusing on unbridled professional power and the for-profit insurance industry, the critical social gaze is turned to Big Pharma. Consequently, most social scientists see it as their job to expose the scientific manipulation, the chase of profit margins, the dehumanization, the ethical transgressions, and the inequities that flow from drug industry involvement. In engaging prose, Roberto Abadie delivers the expected social science message. Abadie conducted an eighteen-month ethnography of a group of healthy people who made a living as research subjects in Phase One clinical trials in Philadelphia. Most trial participants are African-American and Latino, but Abadie spent time with a group of young, non-Hispanic white anarchists who enrolled in clinical trials. He compares these trial participants with people enrolling in HIV trials. The book examines the motivations, reflections, and practices of professionalized clinical trial participation. What does Abadie make from this data? He highlights the ‘‘commodification’’ (p. 15) of the trial subjects’ bodies in a ‘‘slow torture economy’’ (p. 46). He pays attention to the ‘‘revolt’’ (p. 54) of the professional research subjects when they felt underpaid and threatened to walk out. Instead they received an $800 bonus. He notes the ‘‘resistance of the weak’’ (p. 60), when ‘‘guinea pigs’’ (p. 21) smuggle in forbidden foods or engage in other acts of ‘‘sabotage’’ (p. 61). Abadie also examines the risk-management strategies of the trial subjects: they weigh money against potential long-term effects but tend to believe that drugs wash out of their bodies in a couple of days. He then compares the professional trial participants to those involved in HIV trials and argues that the latter are motivated by deeper existential concerns but, of course, they also have a disease and participate in different kinds of trials. In a final empirical chapter, Abadie examines the professional trial subject’s limited understanding of informed consent procedures, and argues that the drug industry deliberately uses the consent form to obfuscate the commodified relationship with research subjects. Abadie’s book has two glaring weaknesses. First, he brings much rhetorical bluster to his study but the interview quotes and observations do not bear out the core themes of ‘‘alienation’’ (p. 6) and ‘‘exploitation’’ (p. 154). The fascinating empirical puzzle of his study is that anarchists are willing to swallow their principles and vegan diet to take money from this most controversial industry. In the conclusion, Abadie pays attention to the paradox between anarchist politics and pragmatics, but throughout most of the book he tries to rationalize the anarchists’ justifications for the blood money that sustains their lifestyle of leisure. Some of his friends even minimize the trial risk because they assume that strong government oversight protects them from harm! Abadie writes: ‘‘[these] views of governmental regulation are not totally at odds with their radical [anarchist] beliefs’’ (p. 143). Really? Rather than reconcile the dissonance between what anarchists do and belief in theoretical constructs of exploitation, the explanation seems more mundane. People end up in trial after trial by choice or circumstances because it is easy money. Compared to flipping burgers, cleaning toilets, or being homeless, testing pills is extremely attractive. The job stinks, but the money is good. Abadie also wrote the wrong book. While he lived in the anarchist community, he never participated along with his research subjects in the trials. Abadie’s information comes largely from casual conversations