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Clinical Labor: Tissue Donors and Research Subjects in the Global Bioeconomy, by Melinda Cooper and Catherine Waldby[1]

 Reviewed by Alexandra Gruian, PhD Candidate, University of Leeds

Melinda Cooper and Catherine Waldby’s book, Clinical Labor: Tissue Donors and Research Subjects in the Global Bioeconomy (2014), is an in depth analysis that offers a comprehensive, well-articulated view of the novel types of labor in the current post-Fordist bioeconomy, centered around reproductive technologies and clinical trials. Through neomarxist lens, Cooper and Waldby map today’s global biomedical outsourcing chains that are articulated along racial, ethnic and class lines. Ova procurement, surrogacy and clinical trials are employed as examples to illustrate the workings of an already established neoliberal bioindustry revolving around the promise of an ever-expanding bodily potential.

Cooper and Waldby focus on labor as a central concept, a choice motivated by the lack of attention it has been given in previous literature, which “did not probe what that [labor] might mean, how it might count, and what it might tell us not only about the organization of the bioeconomy, but about the broader organization of labor and value today” (Cooper, Waldby, 2014, p. VII). Thus, they establish a new category of labor, clinical labor, defined as the sale of tissues and reproductive services such as surrogacy, highly stratified across class and race lines. The authors argue that bodily labor is devalued through the use of an altruistic discourse that frames tissue procurement as tissue donation; in comparison to bodily labor, intellectual work is seen as the true source of value. Nevertheless, Cooper and Waldby devise clear criteria for which clinical labor should be seen as labor: it is intrinsic to the process of valorisation in the bioeconomy, and it implies “the endurance of risk and exposure to nonpredictable experimental effects that may be actively harmful, rather than therapeutic” (Cooper, Waldby, 2014, p.8).

The vulnerabilities attached to clinical labor are, in Cooper and Waldby’s view, deepened by outsourcing, a precarious work model through which companies prefer to agree  contracts for services with third parties. In this case tissue donors, surrogates or clinical trial subjects – who thus become responsible for the risks they undertake, lacking the protection once offered by the state in terms of insurances and other social support schemes. These clinical laborers have to personally deal both with embodied risks, associated with potential side-effects or accidents during their labor, and market risks, especially unemployment – a double responsibility circumscribed by Cooper and Waldby (2014) as risk outsourcing. Through such a scheme, companies reduce their losses due to failed research and development activities, while benefiting from the vulnerable position of those who provide tissues and reproductive services, and participate in clinical trials. For Cooper and Waldby, capital accumulation in the bioeconomy is the result of the “unequal exchange between the speculative risks of innovation and the speculative, but visceral risks of clinical labor” (Cooper, Waldby, 2014, p. 32). The value extracted through regenerative bodily labor is of a promissory nature and its increase is dependent on a growing bodily potentiality.

The assymetry of  risk is located not only between companies and clinical laborers, but also between clinical laborers themselves. Cooper and Waldby discuss a service economy  stratified along the lines of gender, race and class. With a focus on ova procurement in Europe, surrogacy in India and clinical trials in the USA, the authors underline that risk redistribution is made at an individual, as well as community level, with populations from a specific background being preferentially targeted for clinical labor. Gender arises as a central theme especially in the case of ova procurement and surrogacy, reframing the issue of women’s agency and reproductive control as deeply intertwined with market pressure. purchase power differentials are at work in drawing fertility maps, acting as the main criterion for choosing outsourcing destination places, alongside national legislation. Taking the example of ova procurement, Cooper and Waldby argue that in spite of the ethical concernes about exploitation that have framed regulation, the need for ova in reproductive and research purposes has led to the emergence of a prosperous, but legally dubious market.

Cooper and Waldby’s book succeeds at covering the complex phenomenon of clinical labor, tending to its various manifestations across the world. Although all highly relevant to their core argument throughout the book, the discussions about ova provision and surrogacy on the one hand, and that of clinical trials on the other are somewhat disconnected, as the material processes underlying each of them are considerably different. Also, speaking as a Romanian national, there were a number of  assertations and generalisations about the reproductive and ova procurement contexts in Eastern Europe that did not reflect the current situation fully. Nevertheless, Cooper and Waldby offer an insightful conceptual framework for understanding clinical labor and the stakes pertaining to a neoliberal bioeconomy.