Review of Jean-Daniel Rainhorn and Samira El Boudamoussi (eds.), New Cannibal Markets: Globalization and Commodification of the Human Body (Éditions de la Maison des sciences de l’homme, 2015), 431 pages, 33,00€.
Reviewed by Anouck Alary firstname.lastname@example.org
Global capitalism and advanced biotechnology led to a new medically incited “tastes” for human bodies, living and dead, for the skin and bones, flesh and blood, tissue, marrow, and genetic material of the other.
Nancy Scheper-Hughes, p. 244
Since the 1980’s, medical technologies have become increasingly dependent on the instrumentalisation of human bodies, both as wholes or in spared parts (organs, tissues, gametes, embryos, women’s wombs, etc.). These new biomedical technologies have also led to an increasing social demand for health care services (such as organ transplantation or assisted reproduction) to which public health systems in developed countries cannot respond for ethical, legal and economic reasons. In a global neoliberal environment, these growing needs for “ready for use” human biomaterials have led to global and very lucrative trades in the human body that exceed often weak national legal frameworks, and benefit from the absence of binding legislation at the international level. We see emerging globally a privileged class of patients travelling to poor or developing countries to buy or rent biomaterials, with little regard for the person from whom they come. Taking advantage of a giant pool of “sellers”, which are also socially vulnerable people, these new medical markets raise deep and urgent ethical, legal and social concerns as they lean on and exacerbate both global and national inequalities. In the opposite direction, doctors and nurses from poor regions migrate to high-income countries (or to neighboring countries that have developed highly-specialized private health services as a response to the growing demand of foreign patients) to have access to better-paid jobs, depleting sometimes very underserved areas from a much needed personnel.
New Cannibal Markets gathers the thirty contributions that were made during an international symposium held in 2014 in Geneva in order to discuss challenges linked to the liberalization of the international health market and to the global development of various markets in body parts that support medical tourism. In order to ground the discussion, four case studies were identified for the participants to examine, which were a) the market of assisted reproduction, notably of surrogate mothers, b) the “brain drain” of health professionals from poor countries to rich ones, c) the sale of organs and transplantation tourism, and d) the biobanking industry of human blood, cells and tissues. By unfolding a plurality of disciplinary perspectives (anthropology, sociology, history, law, bioethics and medicine), the book aims to investigate the diverse implications of these new medical markets, different approaches to frame them (such as development studies, gender studies or a basic human-rights approach), as well as potential legal frameworks to regulate and reduce their activities, which are currently taking place in the twilight zone of legality.
At the heart of the volume, one finds the suggestion that the practices of appropriation and commodification of human bodies on which these markets rely can be problematized as constituting a form of neocannibalism. Because human body parts of people that live in poverty are being both symbolically and materially “consumed” by “more developed, wealthier or more powerful” people (418) in order to enhance their lives, and health status; these activities can be compared to the practice of eating the enemy’s body to appropriate his strengths and powers. But one could perhaps criticize the use of a metaphor that is saturated with such symbolic meaning, because it seems to be more likely to provoke fascination or moral discomfort than to create the conditions for a social science investigation. After all, was not the imagery of cannibalism historically created in order to signify radical alterity and monstruosity, as a response to the cultural fear of being eaten by the Other (Kilani, 2006)? Could it not therefore resist social analysis?
The contribution of J.-J. Courtine shows that the rhetorical figure of cannibalism can indeed be made visible and intelligible in our own cultural context, where it can be tracked at different stages of our medical history. Through an exploration of the trades in relics of saints and martyrs infused with healing powers in Medieval Europe and an account of the dark history of dissection in 19th century England, he reveals the ways in which western medicine has always relied on the consumption of either sanctified or sacrified bodies. On the one hand, the trades in religious relics show us that “the sacred nature of the human body is no obstacle to commodification – just the opposite” (41). On the other, the historical use in anatomy lectures of corpses belonging to criminals or indigents unable to pay for their own funerals, teaches us that some bodies have always been made “disposable” and “sacrifiable” in the name of health. However, if the cannibal not only is not the Other, but can be seen as lying at the very heart of the history of our medicine, how to analyze, then, the more contemporary forms of medicinal cannibalism that this book discusses? Whereas these old practices used to be spatially localized, it would seem that what caracterizes ours is their global scope and industrial scale.
According to physician and researcher in international health J.-D. Rainhorn, the “sacrifiable” bodies of our times are the “hundreds of millions of people” who have been “left behind”, that is excluded from international development (28), having no more in order to survive than their own bodies to sell. He warns, in a dystopian view, against current trends towards the constitution of what he calls a new “object-person proletariat”, that is a mass of people “whose function would be to sell and rent their own bodies to produce human products that would improve the health of the better off” (29). Because most of the developing countries where body resources and health professionals are “purchased” by global enterprises or countries that have a colonial history, these “cannibal markets” are often channeled in a neocolonial direction – for instance, India, a former British colony where the privileged groups speak English, is the leading exporter of health professionals in the World and the most developed country regarding assisted reproduction and organ transplantation for foreign patients; Philippines, a former American colony, is the leading exporting producer of nurses for the United States and the Gulf countries and a reserve of organs for the privileged ones in Japan. Extending to the bodies of poor people from the Global South the exploitation of raw materials that was operated during the colonial period, these markets rest on deeply entrenched asymmetrical relationships of power. Furthermore, because they affect women in particular ways and rates (e.g. women are the vast majority of kidney sellers and the ones selling or renting parts of their bodies within the market of assisted reproduction; Filipinas nurses working in the Gulf countries often live near conditions of slavery), they also raise other questions relative to gender issues. The book therefore calls for an ethical discussion on body commodification that goes beyond our domestic context, and the classical bioethical issues of choice, personal autonomy and informed consent, in order to consider structural challenges of global distributive (and sometimes gender) justice and exploitation.
Of particular interest is also the book’s emphasis on the role that medical professionals play in the extraction of the human body parts that feed these medical markets – an issue generally left unaddressed in social sciences and bioethical literature on the topic. Since one cannot reasonably think that the doctors who participate in these lucrative trades are unaware that they are involved in unethical and often illegal practices, Rainhorn suggests that “at this stage, we can even wonder if the use of new technologies to improve the health of some by using the body functions and resources of others is not in the process of changing the objectives of medical practice” (30). While that may sound excessive, it is true that the many physicians involved in these activities move extremely far away from their Hippocratic obligations, or from any guidelines formulated by national and international medical associations (30).
Beyond a rich comprehensive investigation of these poorly regulated medical markets along with the many issues that they raise, this volume is a bold and courageous contribution to the public debate by reflecting on diverse strategies for reducing their growth. The editors straighforwardly assume the inalienability of the human body because they consider it to be a sacred object, inseparable from the human subject’s identity and imbued with intrinsic priceless value. One of the strengths of the book is, however, to recognize that a) the sacredness of the body has never been a good protection against its commodification as we already observed, and that b) the non-commodification principle, which is currently consensually defended by international regulatory documents but increasingly questioned, can indeed be easily deconstructed. It is the case firstly because the leading world religions hardly evoke the inherent inalienable value of the human body (the essay from S. El Boudamoussi is very informative in that regard) suggesting that, in a pluralist world, societies may react very differently to the question of commodification. In a legal perspective, as bioethicist S. A. Hurst demonstrates in her exploration of the pros and cons of legalized and regulated markets in organs, the arguments against such a regulated market in organs are also theoretically feebler and more contradictory that one could assume – even if she argues that we should continue banning these markets for practical reasons.
The book thus draws our attention on the need to look for more realistic solutions than an outright ban on all forms of commodification of human body parts. It offers for that purpose an original discussion of the alternative approaches that are currently being explored, like strengthening national legislations by forbidding these practices for foreigners (physician Mahdavi-Mazdeh’s contribution discusses for example the many issues raised by the recent legalization by Iran’s government of a market of kidneys, in which however, both “paid donors” and buyers need to be Iranian citizens), or creating an international legal framework like the World Health Organization (WHO) has done in other areas. Given the current absence of tools for global governance on trades in organs, tissues and cells and the specific responsabilities of health professionals in these medical markets, I find particularly noteworthy the contribution from ethicist A.M. Capron. He suggests that the highest priority could be for the medical profession to create a professional normative consensus on these practices and to advocate for governments’ action by collaborating with international organizations such as the WHO, like it has been done quite successfully in the past in order to reduce transplant tourism (411).
Before concluding, I would like to briefly discuss the book’s proposition to consider “brain-draining” of health professionals as a form of “cannibal market”. It is an interesting step given its almost complete omission from the debate on body commodification, and more importantly the very little attention that it has received in the debate on the liberalization of the global health market. Due to global shortages in health professionals, doctors and nurses are now “produced, exported and imported”(143). Because the skills that are involved in the service that they provide are “indivisible from the person/body”(147), the book suggests that their bodies could be considered as “a global commodity subject to trade practices”(148). That leads to important issues related to the depletion of basic health services in already very underserved areas of the world. It is, however, never clearly explained why “health labor” – more than any other form of labor – is claimed to be “indivisible from the body/person”, neither why commodification is thus in that case more problematic than in other cases, enough at least so we would want to use the language of cannibalism. If that point has been left rather vague in the book, I want to suggest that commodification can indeed be considered as more problematic in the case of “health labor” for the reason that it is a critical basis of what materialist feminists identify as social reproduction (Dempsey & Collard, 2013). Because just like water, food, shelter or clean air, health care is determinant in allowing human bodies, households, communities and societies to maintain themselves, it should not be able to be bought and sold like any other commodity, and left entirely subject to market laws. In fact, the book does a very good job at demonstrating that leaving health care distribution to the market is not always the best way of protecting human lives and societies.
Overall, this collection of cross-national and cross-disciplinary essays is an ambitious and compelling covering of a very timely and concerning topic. Because social science researchers are often disconnected from the moral issues and potential policies being discussed in bioethics or health law with regard to body commodification (and, vice versa, bioethics often frames its questions around abstract concepts, which are sometimes very decontextualized from concrete social practices), the volume’s effort to engage in the public debate by opening a dialogue between social science scholars, doctors and ethicists is a welcome contribution. It is finally an eye-opening read on the absolute necessity to approach these complex issues from a global standpoint. This book will definitly appeal to a large readership that includes social science scholars with an interest for health and medicine, globalization, neoliberalism or/and global justice, scholars in medical ethics or health law, and physicians.
Anouck Alary has recently completed a M.A. in Sociology at the Université de Montréal.
Her research interests focus on the financialization of life sciences, new forms of privatization of biological “commons” in the context of neoliberal governance and the biopolitical reconfigurations they are expressing as they problematize the traditional role of the welfare state in regulating their circulation along redistributive circuits.
Collard, R.-M. and J. Dempsey, “Life for sale? The politics of lively commodities”, Environment and Planning, A, 2013, vol. 45, p. 2682-2699.
Kilani, M. “Le cannibalisme, une catégorie bonne à penser”, Étude sur la mort, 2006, vol. 1, n°129.
Readers may also be interested in the following Body & Society material:
- Special journal issue “Medical migrations : Global Quests for Health and Life”, edited by Elizabeth F.S Robert and Nancy Scheper-Hughes, Body & Society, June/September
- Ciara Kierans, “Biopolitics and Capital. Poverty, Mobility and the Body-in-transplantation in Mexico“, Body & Society, vol. 21, Issue 3, 2015, p. 42-65.
- Nancy Scheper-Hughes, “Commodity Fetichism in Organs Trafficking”, Body & Society, vol. 7, Issue 2-3, 2001, p. 31-62.
- Nancy Scheper-Hughes, “Bodies for sale – Whole or in Parts”, Body & Society, vol. 7, Issue 2-3, 2001, p. 1-8.
- Lawrence Cohen, “The Other kidney: Biopolitics beyond reconciliation”, Body & Society, vol. 7. Issue 2-3, 2001, p. 9-29.
- Margaret Lock, “The Alienation of Body Tissues and the Biopolitics of Immortalized Cell Lines”, Body & Society, vol. 7, Issue 2/3, 2001, p. 63-91.