°Experiri
Here are some excerpts from Melinda Cooper’s “Experimental Labour — Offshoring Clinical Trials to China”, in which she argues, among other things, that participation in clinical trials should be considered as a form of labour, turning around the question of how this has recently played out in the context of neo-liberalist developments which oscillate between the imperatives of labour fluidity and incarceration.
[…] The tension between incarceral and voluntary experience, objective and subjective science, self-experiment and rationalized torture, is recurrent in the history of science. But it is particularly salient in the neo-liberal era, where the marketing of drugs is so closely tied to the promise of heightened experience and the desire for positive self-transformation — enhancement as a literal surplus of life. When compared with the norms of pharmacological reason that preceded it, the drug market of the neo-liberal era is much more attuned to the desire for self-experiment than the imperatives of inhibition and social control. Indeed, it could be argued that the drug market, like any other area of neo-liberal production, has internalized into its accumulation strategies the demands for autonomous self-experiment articulated by the social movements of the sixties and the seventies.
As a consequence, the contemporary pharmaceutical industry is faced with the challenge of turning the desire for self-experiment into a form of labour on the one hand and a commodity on the other. This is already a task fraught with problems. In the era of contract-based “voluntary” participation in clinical trials, how do you channel the will to experiment into a form of compliant labour? And how do you capture the desire for experimental consumption in a marketable form? From the point of view of the pharmaceutical industry, these problems have only been compounded by the increasingly intense regulation of the clinical trial, drug approval and drug classification process (legal or illegal status of the compound, use and misuse in its consumption) over the same period.
In this paper I propose the concept of the will to experiment as a way of understanding the tensions inherent in the contemporary enterprise of drug production and consumption. The word experiment — derived from the Latin experiri — is in itself replete with interesting ambivalences. Not quite subjective and not quite objective, experiri means to experience but also to test. Stretching these ambivalences, I want to conceive of the will to experiment as lying at the interface between labour and experience. It is the will to experiment that is put to work in the clinical trial process, when a human subject is required to follow a regime of strictly controlled drug ingestion, self-observation and testing. I thus conceive of clinical trial participation as a form of labour — clinical or experimental labour – in which consumption and production of bodily effects blur together in the experience of self-transformation (Waldby and Cooper 2007). Experimental labour is self-transformation – commodified. But self-transformation, even of the biomedical kind, can be considered independently of the commodification process, even when it is difficult to separate these processes historically. […]
During the 1960s, an era of intense inventiveness and sales’ growth, pharmaceutical companies were conducting the greatest part of clinical trials amongst prison populations, even going so far as to build state-of-the-art clinical trial laboratories on prison grounds. Their concern, it seems, was not only to recruit prisoners as human subjects but also to train prison inmates as clinicians, capable of carrying out tests at a fraction of the cost outside prison walls. The commercial benefits of this move were starkly highlighted in the testimonial of a group of prisoners who brought a lawsuit against the corrections department in 1968, claiming that the companies had obtained hundreds of thousands of dollars of labour for free (Hornblum 1998: 103).
The penal-medical alliance, it seems, was at least partly motivated by changes to the FDA requirement for clinical trials. In 1962, the FDA responded to the thalidomide scandal by requiring three phases of human clinical trials, including Phase I trials on healthy subjects, before a drug could be marketed. This meant that the small number of hospital patients that had hitherto been required for clinical trials was suddenly insufficient. And as Hornblum points out, state-controlled prisons seemed to offer the perfect conditions for both industrial-scale labour and the requirements of standardized clinical experiment — highly regimented, standardized, living conditions, spatial confinement, and a workforce that is “cheap, available and confined,” not to mention already highly stratified along class and race lines (Hornblum 1998: 108).
The use of prisoners as guinea pigs came under increasing scrutiny throughout the seventies, with a spate of damning media exposés, a Senate subcommittee enquiry and a proposed bill seeking to limit the practice, leading to its gradual phasing out. It is only very recently however, in 1981 that the FDA officially outlawed the practice.
In the meantime, the conduct of clinical trials in the US has shifted to a “voluntary” system, which is not without its own forms of control. While drug trials no longer take place within the walls of a state prison, the circumstances that drive a patient to volunteer in a clinical trial and a medical practitioner to undertake contract pharmaceutical work may be no less coercive. Indeed it would seem that the very process of health care liberalization has led to the decline of the prison-based biomedical complex — liberating the experiment from the confines of the state institution — only in order to re-establish its new methods of control in the open, unconfined space of the free market. […]
[…] It is only against the background of these reforms that we can understand the growing importance of clinical trial participation as a form of labour in the new Chinese economy. As in the US under Reagan, the Chinese government has shifted its priorities from ensuring a general level of public health to investing in and promoting high-return biomedical services, which will only be available to the wealthiest, insured sectors of the population. This shift is in keeping with reform-era China’s vision of its future role in the global economy. China is no longer content to play host to off-shored industrial production. It now aspires to compete with the US and EU as an innovation economy and biomedical research is one of the key foci of its high-tech programs (Salter, Cooper and Dickins 2006). Thus at the same time as it has withdrawn from universal health coverage, China has made considerable investments in such experimental areas as stem cell science, genetics and biochips. But this is only one side of China’s unique approach to global competition. For it seems that while it is seeking to promote its domestic science laboratories as centres of high-tech innovation and contenders in the world IP market, it is also targeting its poorer populations as potential clinical trial participants and tissue sources — both for domestic and foreign interests. […]
As I suggested above, the introduction of clinical trials into China is parasitic on these developments, since the patients who are most likely to be recruited into clinical trials are also those that are over-represented amongst China’s floating populations. As a part of the informal economy, clinical trial work should therefore be placed alongside prostitution, drug trafficking and consumption, blood sale and various forms of service labour (domestic or in the tourist industries) as absolutely pivotal to the success of China’s special economic zones. These are all forms of labour that generate value from the transversal circulation of desires, affect, body fluids and pharmacological substances; and labouring bodies whose surplus exposure to biomedical risk (from unprotected sex, needle sharing, unsafe blood donation or simple lack of health care) is precisely what makes them valuable from a clinical point of view. […]
Here it becomes clear how the production of risk – in this case, a mortal risk to the blood donor – can be recycled and capitalized as a form of experimental labour, without any comparable risk to the investor. This is a regime of capital formation in which the exposure to biomedical risk has become an actual motor of accumulation. With its active investment in the biomedical innovation sector, the Chinese state is no longer in a position to simply clamp down on formerly illegal practices such as drug taking and prostitution or to pursue an excessively punitive line in public health. On the contrary, it needs, at least a certain extent, to facilitate the continual emergence of new biomedical risks; to channel rather than prohibit the circulation of the floating poor and their sicknesses. […]
Melinda, more recently, I’ve tended to avoid talking about neoliberalism because most people understand it in terms of, let’s say, one pole of that oscillation you mentioned - as a deregulatory tendency; and so, both as an implicit call for a return to regulation and with very little attention to forms of regulation/discipline. So, I like your insistence that it there is both fluidity and incarceration.
But I’m wondering whether that might not be more emphatically put by talking a little more about how the hokou system (accompanied, of course, by massive land clearances) exemplifies this doubled aspect of fluidity/control. Which is another way of saying that I think I read somewhere earlier this year that there were changes to the hokou system, but not sure of the details.
s0metim3s [August 5, 2007 @ 12:18 pm]
Well there is always that danger with the word neoliberalism of descending into neoliberal governance speak, but I like to retain the term, if only to highlight the novelty of its forms of violence. One problem I have with a theorist such as Agamben is his insensitivity to historical shifts in the mode of violence, so that a neoliberal politics of security collapses back into a disciplinarian politics of the mid 20th century camp, which in turn collapses back into something a little Heideggerian. This conflation of violences doesn’t help much in terms of political and critical response, and i think there’s a real danger of leftist nostalgias, so I really want to emphasize that the turn to self-consciously neoliberal modes of labour exploitation and market liberalization in China was accompanied by new forms of ‘traffic’ control that require their own response. I agree with you that reforms in the resident permit system are absolutely integral to this. The fact that rural to urban mobility was ‘loosened up’ in the nineties, allowing rural workers to enter the industrial centres such as Shanghai as ‘temporary residents’ and workers, has been absolutely pivotal to China’s post-reform economic take-off. This is an interesting and precarious situation because it means that China’s floating populations have a kind of resident alien status in their own country and confront many of the same problems as itinerant/illegal or semi-legal worker migrants in Europe and North America. The push-pull is two way - land clearance giving a nice little prod to workers who might not be enticed by liberalized work permit laws. Mark Dutton has written this excellent book called Street Life China which I can only recommend, where he compares this double movement in China with Marx’s work on primitive accumulation and the enclosures. The politics of health is right at the centre of this, as the rural poor have been summarily dispossessed of health insurance and medical care as well as land - while being simultaneously invited to participate in the emerging Chinese bioeconomy. Where post-reform China differs so starkly from socialist China is in its political response to the circulation of street life - traffic in all its guises - because the point is no longer to maintain the agricultural collective and criminalize migration outright, but to selectively encourage and valorize it. This is nowhere more visible than in changing responses to prostitution. I think what you might sense in this piece of writing is a desire to play the devil’s advocate and to say well what if we think of the political potential of fluidity, while recognizing that it is currently an obligation more than anything else. Wang Hui in his work really wants to retain this idea that the reform era in China is not just about market liberalization but also a desire for social experiment that isnt reducible to the commodified form. I feel its important to maintain this position because some of the most vocal responses to market liberalization these days are highly reactionary ones, as if cultural deterritorialization were a problem in itself. Usually this gets interpreted as a moral problem - hence, say the need for a return to ‘traditional’ Confucian values or whatever…
Melinda [August 6, 2007 @ 5:35 am]
Thanks for that - it’s really nice to read a commentary on a text, a concise emphasis of the stakes.
And reading over your remarks, I’m also struck by the sense in which it isn’t maybe just a question of avoiding a dehistoricisation a la Agamben, but also of refusing a certain sense of history that I think is retained by, for instance, Negri. Namely, one in which there are stages, say, from ‘primitive accumulation’ to ‘real subsumption’. But navigating that without conflating is, of course, a persistent question.
Some time ago, I started writing about ‘invisible hands and iron fists’ - and I’m not sure I’ve stopped writing about that problematic in one way or another. It’s that around which racialisation (and difference) pivots, the border as it were. And I agree that there’s no question of the borderline acting more as a filter than an outright exclusion - also about the reactionary temptation of positioning experimentation (or, indeed, precariousness) as something to be feared.
(If you’ve references for Wang Hui’s work, drop them in, btw.)
s0metim3s [August 7, 2007 @ 1:43 pm]
Hi Melinda, Ange,
is it Michael, not Mark Dutton - I went looking for his stuff that’s all.
Also very interested in Wang Hui references.
Thanks!
liz [August 7, 2007 @ 4:10 pm]
whoops yes its Michael Dutton - StreetLife China.
Have a whole lot of Wang Hui PDFs that I’ll forward. In one of his articles he has some very interesting stuff about how neoliberal theory a la Hayek was translated into Chinese recently and how its been received - another reason I think for targeting ‘neoliberalism’ as a discourse.
Melinda [August 9, 2007 @ 12:11 am]
I put the pdf of Wang Hui’s “The Year 1989 and the Historical Roots of Neoliberalism in China” up here. Thanks M.
s0metim3s [August 9, 2007 @ 10:50 am]