10.6092/issn.2038-3460/17098
application/pdf
2038-3460
17098
1
en
Stefano Crabu
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
Roberto Abadie, The Professional Guinea Pig. Big Pharma and the Risky World of Human Subject, Duke University Press, 2010
Text.Serial.Journal
https://tecnoscienza.unibo.it/
4
Book Reviews
2013-07-12
2023-06-02
2013-07-12
2023-07-17
191-196
TS
Stefano Crabu
2013/07/12
10.6092/issn.2038-3460/17098
191
University of Padova
2038-3460
1
en
196
Roberto Abadie, The Professional Guinea Pig. Big Pharma and the Risky World of Human Subject, Duke University Press, 2010
https://tecnoscienza.unibo.it/article/download/17098/16034
4
Book Review                                                                     191
those most foundational categories of science and technology, that is, na-
ture and culture” (Suchman 2008, 142). In conclusion, this book could be
an inspiring reading mainly for researchers interested to further under-
standing of the multidimensional interplay between technology and cul-
ture.

References
Suchman, L. (2007) Feminist STS and the Sciences of the Artificial, in E.J. Hackett,
   O. Amsterdamska, M. Linch and J. Wajcman (eds.), The Handbook of Science
   and Technology Studies, Cambridge, MA, The MIT Press, pp. 139-163.
Star, S.L. and Strauss, A. (1999) Layers of Silence, Arenas of Voice: The Ecology of
    Visible and Invisible Work, in “Computer Supported Cooperative Work”, 8,
    pp. 9-30.
West, C. and Zimmerman, D.H. (1987) Doing Gender, in “Gender & Society”, 1
  (2), pp. 125-151.

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Roberto Abadie
The Professional Guinea Pig. Big Pharma and the Risky World of Human
Subject
Durham, NC, Duke University Press, 2010, pp. 184
   !
Stefano Crabu University of Padova

    They call it the new economy, the informational economy. And the other side
of this informational economy is the mild torture economy [...] (Spam, cit. in Ab-
adie 2010, 2).

    The book written by Roberto Abadie Ph.D (Graduate Center,
CUNY) starts with the reflection above and presents the results of an
ethnography of voluntary participation processes by human research sub-
jects in phases I (screening for drug's safety), II and III (screening for
drug's efficacy) of drug trials.
    The quotation recalls the utterance of Spam, a resident in West Phila-
delphia and “professional guinea pig”, which was an informant during
the research conducted by Abadie. Spam is one of the many healthy hu-
man subjects that, for a long time, have lent his own body for clinical
pharmacological trials. Spam's words are evocative, and they have led the
book’s author through a clear and effective itinerary of research to dis-
192                                                           Tecnoscienza - 4(1)

close the controversial world of pharmacological experimentation on hu-
man subjects. Human beings, in fact, whether they are volunteers who
are, or who are not, patients, are increasingly more and more involved in
biomedical research processes, during which their bodies are exposed to
risk, medical monitoring, the “clinical” gaze (Foucault 1963) by physi-
cians and the “molecular” gaze (Clarke et al. 2003) by scientists.
    What happens when a new molecule – potentially therapeutic – over-
comes the porous walls of the scientific laboratories and is tested for the
first time on a human being? What are the perceptions and the represen-
tations of the sanitary risk correlated to the drug trials? How can the
monetary compensation lavished by the pharmaceutical industries shape
the perception of the risk? Can pharmacological experimentation on hu-
man beings – the weakest link of the pharmaceutical commodity chain –
be considered a commodified form of the biological self?
    These questions comprise the starting point that inspired the empiri-
cal research conducted by Abadie. They have long circulated in the social
debate on biomedical research and, particularly, in the investigation of
the pharmaceutical industry as it pertains to the wider scenario of techno-
science in the neo-liberalist society. It is a complex literature that has of-
ten given unsatisfactory answers to these questions, focusing the attention
on the uncontrolled professional power of scientists and physicians and
on their collusion with the for-profit insurance industry. So, a critical so-
cial look towards the so-called BigPharma has more and more strength-
ened. Consequently, the pharmaceutical industry has been seen as an ex-
pression of a technoscientific branch responsible for the hyper-medi-
calization of the human experience. In this sense, human beings seem to
be exposed to violent scientific manipulation through the subordination
of the ethical dimension to the logic of profit (Conrad 2005). Such reflec-
tions are based primarily on institutional documents produced by public
and private bodies (institutional archives, scientific magazines, different
kinds of media productions and so on) and have contemplated the direct
observation of the biomedical research practices in a very limited meas-
ure.
    Abadie’s book, to the contrary, charts a discontinuity with these theo-
retical and methodological assumptions. Through a captivating prose, ra-
ther, the author searches for a theoretical bridge with the richer debate
ripened in range to science and technology studies as they relate to the
biocapital and to the commodification and commercialization of biologi-
cal materials within the financial and industrial circuits (Sunder Rajan
2006).
    The text represents an attempt to reconstruct the complex network of
actors and relations through which the commercialization of a new drug
or a new therapeutic regime is articulated. In particular, Abadie focuses
on the professionalization processes of the volunteer human subjects in-
volved in the drug trials (the so-called professional guinea pigs) and on
the commodification of their bodies inside the biotechnological global
Book Review                                                                  193
economy. It is about an empirical field that is particularly difficult to in-
vestigate since, both in the United States and in the rest of the world, the
governmental agency responsible for supervision of pharmaceutical drugs
(i.e. the FDA) publishes only a list of all drugs that receive approval. At
the same time, the pharmaceutical companies do not publicize statistics
related to the different typologies of the achieved drug trials or the demo-
graphic statistics of the enlisted human research subjects. So, the experi-
mental subjects remain invisible and carefully hidden.
     For this reason, Abadie has preferred to point towards an ethnograph-
ic methodology for the purpose of investigating motivations for partici-
pating in the trial economy, the professionalization practices and the
commodification processes of the human subjects’ bodies involved in the
clinical trials. The ethnographic research led by Abadie occurred between
2003 and 2004, throughout 18 months of participant observation during
which he lived in an anarchist community in West Philadelphia. The
greatest part of the community's residents worked in the informal econ-
omy, and they voluntarily took part in the phase I trials. Abadie, through
a first case study (chaps. I, II and III), investigated the life stories and dai-
ly-experience constructions of 18 healthy human research subjects, focus-
ing his attention on motivations related to their participation in the phase
I trials, during which they systematically exposed their bodies to risk in
exchange for an economic reward. First, Abadie pays attention to the dis-
cursive productions and the risk representations promoted by the phar-
maceutical industries. It is interesting to underline how the industries in-
volved deny the clinical-experimental work to which the healthy human
subjects – labelled "paid volunteers" – enlisted in the drug trials are sub-
mitted. In this regard, the monetary wage is lavished by the pharmaceuti-
cal companies, not so much as payment for the experimental activities to
which the volunteers are submitted, but rather as mere symbolic compen-
sation for travel expenses and the time spent within the boundaries of the
experimental institute. Such elements are reiterated throughout the
course of chapter VII (pp. 137-156), in which the informed-consent form
is discussed as a tool that darkens and mitigates the risk through the use
of euphemistic expressions and hypercriptic language.
     Nevertheless, as shown by the author, the volunteers participating in
the phase I trials dissent from this public representation, which is sus-
tained by the pharmaceutical industry. They strongly refuse to be labelled
as "paid volunteers," and prefer to represent themselves as "professional
guinea pig”. During the first three chapters of the book, the author de-
scribes the daily routine of a healthy human subject enlisted in the phase I
trials. In a very complex way, he underlines how the profit perspective is
the main motivation that pushes the professional guinea pigs to rent their
own metabolism out to biomedical experimentation practices and to take
unnecessary drugs. Like a refrain, many subjects clearly asserted that the
drug trials represented an activity which is “better than a job at McDon-
ald's” (p. 32). The risk, in this case, becomes a mere variable depending
194                                                          Tecnoscienza - 4(1)

on the proposed compensation. On the whole, it outlines what the author
defines in evocative terms as “a weird type of work” (p. 47), directed not
as much to produce something tangible, but rather to endure something
throughout the subjection of one’s own corporeity to the disciplinary re-
gime of the life sciences.
    The second case study (chaps. IV and V) discussed by Abadie focuses,
instead, on the experiences of HIV patients who voluntarily lend their
biological selves to the final experimentations (phases II and III) of inno-
vative drugs to treat HIV infection. As well illustrated inside the book,
participation in the drug trials by this group of patients is not motivated
by a mere economic purpose. In fact, their participation in the experi-
mental processes is prompted by a desire to gain access to the best availa-
ble therapies. Different from the “professional guinea pig”, these volun-
teers do not perceive themselves as having been inserted in the trial econ-
omy but rather as patients, and they feel treated as such by the biomedi-
cal staff members that manage the experimentation. The clinical trials of
phases II and III, in this case, are not seen as strategic moments for col-
lecting economic resources. They represent, rather, a complex process of
empowerment in the wider collective struggle against the illness, a way for
the subjects to better know their bodies and an attempt to remove them
from the mercy of the pathology.
    To fully understand the sociological importance of such complexity
and ambivalence, in chapter VI (pp. 121-136), the author contextualizes
his research work inside the ampler metropolitan setting where the eth-
nographic investigation has taken place. So, Abadie reconstructs the his-
torical development of the pharmaceutical industry in Philadelphia start-
ing from the ‘70s, a development that extends to the present day with an
explosion of leading biomedical research organizations. Philadelphia rep-
resents, in fact, the second city in the United States – after New York – as
a location for medical schools, with more than twenty-five hospitals and
other ancillary health care institutions. The growth of a biomedical
knowledge-based economy did not happen through a linear and neutral
process, but it has been accompanied by a constant de-industrialization of
the manufacturing compartment. Over the years, mass layoffs have fol-
lowed one after another, and that portion of the population having a ra-
ther marginal social position has rapidly increased. This happened be-
cause, besides the emersion of an economy founded upon biotechnolo-
gies, the technical competences held by traditional industry employees
revealed themselves to be obsolete and incompatible with the capitalist
re-composition processes. Recalling Marxist analytical categories, Abadie
reads this process as a typical reconstruction phenomenon of the neolib-
eralist capital that has caused the surfacing of an industrial reserve army
of labour representing, to this day, an essential source of human research
subjects. In the absence of alternative sources of revenue, the unem-
ployed consider the lease of their body to the pharmaceutical companies
as an instrumental action for their sustenance and reproduction.
Book Review                                                               195
    Inside the text, on the whole, Roberto Abadie was able to investigate
the ambivalence of the commodification processes and the exposure of
the body to those associated with risk. Participation in the drug clinical
trials is not only seen as a selfless act, but as a complex activity in which
the boredom, the physical pain and the self-discipline supplant as ex-
change elements of a financial transaction within a disciplinary regime
that the author – recalling the words of one professional guinea pig – de-
fines as a “slow torture economy” (p. 46). Through this concept, Abadie
emphasizes not only the logics of commodification of the body, but also
the motivational elements that bring the subjects to mortify their own
body, to expose it to risk and to submit it to pharmaceutical treatments
for the purpose of receiving monetary compensation. These treatments
leave their signs “embedded” on bodies. As Abadie tells us, many volun-
teers bring with them tangible signs of their participation in the drug tri-
als, permanent signs caused by numerous needle punctures or by the re-
moval of tissue to obtain samples for biopsies: signs, wounds and scars
that show how such people have incorporated – carnally – their participa-
tion in the drug trials and their “rules of engagement”.
    The author, by exploring the sociocultural processes that attempt to
turn the body into a valued good, intends to contribute to the ampler so-
cial reflection about the body commodification (Sunder Rajan 2006; Lock
and Farquhar 2007). In this sense, the most original contribution to the
debate is represented by an attempt to hybridize social studies related to
risk with anthropology of the body, for understanding how the commodi-
fication processes can shape, themselves, specific and peculiar percep-
tions of risk. Nevertheless, one must question the degree of persuasive-
ness of Abadie’s answers to the great questions that he put to himself at
the beginning of his book. In my opinion, the main theoretical issue, or
rather the relation between technoscience and capitalism, results to be
one more time faced not in depth in its possible dimensions. Following
the author's principal reasoning, the human subjects involved in the ex-
perimentations seem to be mainly subjugated to a mere economic ration-
ality that leads their options, strategies and preferences.
    Such a reductionism leaves the reader feeling that this social world
needs to be explored further, not only in its technoscientific dimensions,
but also in relation to the process of subjectification. Besides, the re-
course to a generalist-type literature is accompanied by the absence of a
solid theoretical frame that is able to reflect the complexity of the relation
between knowledge, technologies and bodies. Moreover, the scientific
knowledge implicated in the experimental processes is often taken for
granted by the author, and the technological dimension is omitted.
    Nevertheless, science and technology studies researchers interested in
the complex field of biomedical research can obtain a precious recon-
struction of the ecology of social interactions that sustain the process of
bringing a new drug to the market. Abadie's work clearly demonstrates
how such a process is far from neutral, but invests the entire body in a
196                                                                Tecnoscienza - 4(1)

way that appears to be flexible, ambivalent, restive and exposed to tech-
noscientific and marketing logics that are strongly intertwined together.

References
Clarke, A. E., Mamo, L., Fishman, J. R., Shim, J. K. and Fosket, J. R. (2003) Bio-
    medicalization: Technoscientific Transformation of Health, Illness, and U.S. Bi-
    omedicine, in “American Sociological Review”, 68 (3), pp. 161-194.
Conrad, A. (2005) The Shifting Engines of Medicalization, in “Journal of Health
   and Social Behavior”, 46 (1), pp. 3-14.
Foucault, M. (1963) Naissance de la clinique. Une archéologie du regard medical,
   Paris, Presses Universitaires de France.
Lock, M. L. and Farquhar, J. (eds.) (2007) Beyond the Body Proper: Reading the
   Anthropology of Material Life, Durham, Duke University Press.
Sunder Rajan, K. (2006) Biocapital. The Constitution of Postgenomic Life,
   Durham, Duke University Press.
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                                       ***
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Ann Rudinow Saetnan, Heidi Mork Lomell, Svein Hammer
(Eds.)
The Mutual Construction of Statistics and Society
London, Routledge, 2010, pp. 314
   !
Orazio Giancola University of Roma “La Sapienza”
      !
    To read a book like The Mutual Construction of Statistics and Society
for a social research methodologist who works daily with numbers, pro-
ducing them, analyzing them, and then providing – sometimes – policy
indications, is an interesting experience. This both for the estrangement
approach, and the language and style of argumentation. Furthermore, this
book forces us to deal with the “unsaid” and “taken for granted” typical
in the use of “big data” or official data collected and organized at various
levels, when using socio-economic indicators as those produced by na-
tional or international organizations, as well as large scale dataset based
on big social surveys.
    The construction of samples, of instruments created for data collec-
tion and their organization in matrix ready to be analyzed, their publica-
tion in the form of reports and indicators often used as a tool for “evi-
dence-based” policies is a set of operations at the same time autonomous
and connected with each other.
