Scott Carney assesses a study of banked human blood, sperm and milk.
Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America
- Kara W. Swanson
The US medical community's view of the human body shifted in the twentieth century, when it began to be seen as a source of valuable tissues and fluids. In her thought-provoking Banking on the Body, Kara Swanson recounts how the use of human blood, semen and breast milk in medicine was made possible only by uniting interlocking and occasionally contradictory systems of body-part or product procurement and storage under the broad concept of 'banking'. The financial metaphor set the stage for a showdown between competing ideas on how the body is exchanged as either a gift or a commodity. Although she focuses on fluids, Swanson argues that the same lessons can be applied to all body parts, including kidneys or faces for transplantation, and human eggs.
Swanson reveals how the body's gradual commodification played out. She recounts how mothers in Boston, Massachusetts, were paid 60 cents a quart for their milk in 1929, but how demand for the fluid declined with the rise of formula milk. Blood was often more complex. At different hospitals, doctors either bought blood or made recipients promise to donate later. At times, the system of tissue exchange reflected contemporary national dialogue. So in the Second World War, blood was a community resource donated freely to keep soldiers alive. During the cold war, however, creeping fear of communism made “free blood” unpatriotic — a foretaste of the way socialized medicine is seen by many in the United States today. In the 1960s, when for-profit blood banks in Kansas City, Missouri, sued Red Cross-style community blood banks, the arguments hinged on defining whether blood was an interchangeable commodity or a “gift of life”. The 'currency' of sperm banking has proved less fungible: sperm's value fluctuates with the donor's genetic profile, with geniuses commanding higher prices.
In her close historical analysis, Swanson, an intellectual-property lawyer, vaults over the profit-or-gift debate by showing that pragmatism reigns. In times of shortage, physicians who support free blood exchange have routinely resorted to paying donors to bolster supplies. Blood becomes a commodity when selling it helps to build institutional profitability, as when the American Association of Blood Banks (AABB) lobbied to purchase blood in the 1950s. In the early 1960s, the AABB reversed its position when faced with the possibility of liability lawsuits after a patient received hepatitis-infected blood. Hospitals in New York argued that they were not selling blood — only the medical services to transfer it. Distinctions between products and medical services became hopelessly tangled.
Everyone seems to be making money on body parts except for the donors.
So in today's medical lingo, a person in need of blood in the United States cannot purchase a pint: rather, they rent the expertise of hospitals and surgeons to move the blood from one body to another. The blood is effectively free; the transfusion might end up costing thousands of dollars. The result is that everyone seems to be making money on body parts except for the donors. 'Altruistic donations' are often deemed gifts only while they are being procured. Once alienated from the source, the commodified body parts can be sold as services between different body banks and, ultimately, to consumers at high prices.
Swanson's solution is simple: scratch the doublespeak and start again. “Body products are property,” she writes in her conclusion. “Markets in body products can be harnessed to serve communal goals. The professional donor can be a safe and respected supplier of body products.” She makes clear that her aim is to redefine how all tissues — from blood to kidneys — are traded. What she does not quite articulate is that not all body parts are truly equal.
Blood, milk and sperm — and of more recent interest, faeces — are the body's renewables. The removal of a body part, however, entails considerably higher sacrifices. The danger, of course, is that as body products are commodified, so are people. Almost all the voices in her account are doctors, middlemen or regulators; donors and recipients are not represented. We do not hear from prisoners who have been forced to sell their blood, or the many in Pakistan and India who are so desperate for cash that selling a kidney illegally looks like a viable solution.
More importantly, Swanson fails to explore the political economy of the body business. The sale of blood and blood derivatives worldwide generates an annual US$23.5 billion, and the United States is the single largest blood exporter in the world. The country also exports corneas, coagulants, bones and ligaments. Americans, in turn, purchase kidneys, hearts, eggs and livers, and hire surrogate wombs in foreign markets. As the markets cross borders and profits grow, they render the donors invisible. Medical outcomes are important; so, too, is being sure that the donor is unharmed in the exchange. Looking to the banking structures of the past might not be the best way to create ethical supplies in the future.
For scholars interested in the narrow confines of blood, milk and sperm banks in the United States, Swanson's work is a comprehensive historical sweep. However, without an economic analysis, her examination of banking metaphors offers an incomplete picture of a complex issue.
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Carney, S. Medicine: The commodified body. Nature 508, 456–457 (2014). https://doi.org/10.1038/508456a