Health and Medicine
The Business of Bodies
Dorothy Nelkin
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Medical research nowadays increasingly sounds like business. Gene sequences are patented; cord blood is a hot property. Geneticists talk of "prospecting" for genes. Body tissue is "extracted," "harvested," and "banked."
This language reflects the growing ability to transform human tissue into research materials and clinical products. Blood can serve as the basis for immortalized cell lines in biological studies and in developing pharmaceutical products. Snippets of infant foreskin are used for generating artificial skin. Biopsied tissues are used to manufacture therapeutic genetic material. Human tissue, organs and cells are used in place of animal tissue for testing pharmaceuticals and cosmetics because animals are expensive and using them incites protests.
Body tissue also has commercial value beyond medicine. Placenta is used in shampoos. Kiotech, a British biotech firm, harvests human sweat to extract pheromones for a product called "Xcite," towelettes saturated with a sexual hormone that "boosts the wearer's sexual smell signature." Kary Mullis, a Nobel Prize-winning geneticist, founded a company called "Star Gene" to market jewelry containing DNA cloned from rock stars. Stranger still is "GeneLink," which markets DNA kits to funeral directors to help them extract DNA from the deceased.
Research and clinical uses of body parts have been controversial since the early days of anatomical dissection, which once evoked Dante-esque visions of Hell. As the Renaissance brought growing interest in anatomy, body snatching became a lucrative business with cadavers obtained through grave robbing, bribing hospital attendants, or even murdering beggars. The commercial calculus behind this business sometimes caused riots until anatomy laws allowed the bodies of executed murderers and the unclaimed dead to be used, thus reassuring middle and upper class individuals that their bodies would not be involved.
These old tensions have assumed new dimensions as the commercial potential of human tissue catches the entrepreneurial imagination. But few laws are in place to address the uses of cells, tissues, and genes.
The most familiar case concerning the body as property is that of John Moore, a patient who developed hairy cell leukemia and had his spleen removed at the UCLA School of Medicine in 1976. His physician patented certain chemicals in Moore's blood without his knowledge or consent, set up contracts, and sold the rights to a Swiss pharmaceutical company to produce drugs from the "Mo" cell line.
Moore became suspicious when UCLA cancer specialists kept taking samples of his blood, bone marrow, skin and sperm for seven years. When Moore discovered in 1984 that he had become patent number 4,438,032, he sued for malpractice and property theft. His physician claimed that Moore had waived his interest in his body parts by signing a general consent form. But Moore felt that his integrity was violated, his body exploited, and his tissue turned into a product.
The Court held that clinicians must inform patients in advance of surgery that their tissue could be used for research, but denied Moore's claim. Who should profit from parts taken from an individual's body? The court decided that the doctor and biotechnology company, not the patient, should profit. It argued that giving Moore a property right to his tissue would "destroy the economic incentive to conduct important medical research." This privileging of biotechnology companies incited today's genetics gold rush.
Disputes such as this raise fundamental questions: who profits? who loses? Can exploitation be avoided? Is body tissue to be defined as waste, like the material in a hospital bed-pan and thus freely available as raw material for commercial products? Or does body tissue have inherent value as part of a person? Are genes the essence of an individual and a sacred part of the human inheritance? Or are they, as a director of SmithKline Beecham purportedly claimed, "the currency of the future."
Commodifying human tissue - often without knowledge or consent - is troubling because it violates social assumptions and beliefs about the body. Commercialization can undermine trust in science and medical practice by inciting fears of exploitation. John Moore's experience suggests that the commercial interests of doctors can encourage them to take more tissue than needed for their patients' benefit. Physicians or institutions with economic interests can also influence the decisions of vulnerable hospital patients who are reluctant to consent to certain procedures.
Market incentives to treat body tissue as a commodity may also threaten personal beliefs. During WWII, the Dutch for example, were reluctant to give blood that could help German soldiers. Because of past exploitation, some African-American women refuse to allow amniotic tissue to be collected for prenatal diagnosis as they fear the uses that could be made of this tissue.
The business of bodies intrudes on privacy, too. Banked cord blood and collected tissues can yield not only research materials, but information about future genetic conditions as well. Body tissue can be used to identify the genetic predispositions of individuals (of interest to insurers), or to redefine political entitlements (as Native Americans fear), or to reinforce social stereotypes (say, through research on diseases of specific race groups).
Although the law remains unsettled with respect to controlling commercial interests in body tissue, we are beginning to see the principles of consent and non-commodification, developed to regulate organ donation, extended to this area. Certain professional organizations are emphasizing the need to obtain patient consent even if tissue has already been removed from a patient's body.
Today, there are brain tissue banks, breast tissue banks, blood banks, umbilical cord banks, DNA banks and tissue repositories for studying various diseases. Virtually all of us have tissue on file somewhere. Who should have access to these samples? For what purposes can they be used? How can we assure informed consent for future uses of human body materials? In the context of growing commercial interest in human tissue and the potential for abuse, greater regulation is essential.
Dorothy Nelkin is Professor of Arts and Science at NYU. She is co-author with Lori Andrews of the recent book, Body Bazaar: the Market for Human Tissue in the Biotechnology Age, Crown Books 2001.
Copyright Project Syndicate 2012
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