Working Girl: The Fundamental Role of Women in the Bioeconomy
by Anna Samsonov
Clinical labor refers to the participation of individuals in clinical trials or selling of bodily tissues in exchange for compensation. Clinical laborers play a valuable role in providing the resources required for much of the bioeconomy, but their productivity often goes unacknowledged in the creation of the final product. This essay presents a theoretical analysis of clinical labor in the context of regenerative medicine, applying the work of Catherine Waldby and Melinda Cooper to the stem cell industry. Clinical labor is situated within the intricacies of a post-Fordist economy, following the tendency to devalue labor power in favor of speculation and experimental frontiers. The creation of experimental relations between bodies, technology, and scientific expertise complicates theories of traditional industrial categories of labor, requiring new understandings of valorization and production. The stem cell industry, which seeks to redirect the natural cellular pathway by expanding the potential number of pathways that a cell may take, falls comfortably within the scope of post-Fordist experimental economies. Additionally, because the source of stem cell materials is often generated by women naturally, either through fetal material harvested from abortions or spare oocytes from the IVF process, the stem cell industry also pertains to clinical labor relations. Ultimately, this essay argues why individuals involved in clinical trials or tissue donation should be considered as laborers. Embodiment of labor does not signify that the labor is nonexistent.
bioeconomy, clinical labor, tissue donation, Marxism, feminist theory
A friend of mine recently confided in me that she made the decision to sell her oocytes in order to pay off student debt. As college-aged people with ovaries, we are some of the primary targets for recruitment for oocyte vending; however, it is rarely discussed. My friend’s decision and her subsequent narrations of self-administered medicines suddenly made an abstract form of labor much more tangible and personal. This experience inspired me to further explore the role of reproductive mechanisms in the bioeconomy, focusing on Catherine Waldby and Melinda Cooper’s concept of clinical labor. Clinical labor plays a valuable role in producing the resources required for many life science industries, but it often goes unacknowledged or is framed in altruistic terms. As a form of labor, it also has important implications for conceptualizing modes of economic productivity. After discussing the significance of Waldby and Cooper’s work, I will then focus on its theoretical application to regenerative medicine and the stem cell industry, fields that consider the body’s integral, yet overlooked, role in the innovation economy.
Clinical Labor
Clinical labor is defined as the participation in clinical trials or the selling of bodily tissues as a means of livelihood (Waldby & Cooper, 2008). A clinical laborer may sell their oocytes, act as a gestational surrogate, participate in clinical trials, or perform any number of other biomedical tasks. Clinical labor is not typically conceived of as labor because the individual is thought to simply be granting access to their already existent biology, not adding any value to the process. This view ignores all associated secondary tasks: complying with medical testing, self-monitoring, ensuring that the data is compatible with the organization’s needs, etc. Recognizing clinical labor is also an important step in acknowledging the essential economic role women play in life science industries, both by providing biological material for free in advanced industrial democracies (e.g., harnessing the placenta for stem cells) and by undertaking risky transactional procedures in developing nations (e.g., gestational surrogacy) (Waldby & Cooper, 2010). Life sciences research constitutes an important sector of several national economies, demonstrated by the OECD’s bioeconomy policy agenda (Organisation for Economic Co-operation and Development, 2009). Bioeconomic development cannot proceed without the access provided by women, yet their role often goes unidentified or is framed as a donation (even when compensation is involved).
Additionally, acknowledgement of the bioeconomy’s labor force is often in terms of the value created by the cognitive effort of the scientist. The collaboration and provision of materials by the donor is ignored, both for work and for intellectual property claims. Bioprospecting in drug development is another prominent example of this trend. When pharmaceutical companies bioprospect, they use traditional (often, indigenous) ecological knowledge for treatments, then file a patent for exclusive rights to the medical usage of the ecological resource. The indigenous groups’ work in developing the original treatment goes unacknowledged and uncompensated. The mind/body split in clinical and biomedical research parallels the overall tendency of the bioeconomy to prioritize the scientist and ignore the provider of resources.
Labor Theory
Clinical labor is situated within the intricacies of a post-Fordist economy. The Fordist family structure—male breadwinning and full-time mothering—is no longer representative of reality, with the 20th century decline of the family wage and the increase in number of women in the workforce. The feminization of labor has resulted in the tendency to devalue labor power and to designate the post-Fordist worker primarily as an independent contractor rather than a permanent employee, making wage highly conditional upon achievements or performance indicators (Waldby & Cooper, 2014). The simultaneous rise of neoliberalism and financialization (specifically, investment and speculative development) have led post-Fordist economies to divert their attention from manufacturing toward knowledge and culture industries (Waldby & Cooper, 2014). The post-Fordist economy is built around factors like brand equity, customer loyalty, and intellectual property. Analyses of post-Fordist economies argue that their modes of value and accumulation are oriented towards speculation and the creation of new sites of possibilities—these economies create value from experimentation, rather than from tangible production (Thrift, 2006). These “experimental” economies are constantly searching for new techniques, modes of communication, ways to treat the body, and other potential frontiers. In general, post-Fordist economies find value in the emergence of unpredictable and possibly harnessable relationships between consumers, technology, and science/expertise. In the life sciences, the enrollment of national populations in genetic biobanks to create economic and research value by collecting health data at a statistically powerful level is an example of such experimental frontiers (Mitchell, 2012). The post-Fordist economy attempts to squeeze as much value as possible out of the system by increasing the rate of innovation and invention, accelerating the development of potentially valuable relationships (Waldby & Cooper, 2010).
With the experimental economy in mind, clinical labor is also dependent upon the creation of
experimental relations, specifically between the body and its productive capability. Forms of clinical labor that rely on female reproductive biology view reproductive organs as a site of production and generation, diverting material that might otherwise be used in the individual’s reproduction towards the (re)generation of other bodies (Waldby & Cooper, 2008). For example, the stem cell industry relies on the innate ability of the body to create an embryo and the fetal-maternal blood system to create self-generating stem cells. These bodily products can then be transformed into cell lines (Waldby & Cooper, 2008). The participation of the donor is centered on embodied productivity; the material donated can only exist through the donor’s generative energies sustained over time. The process requires the woman’s cultivation of and permission to her biology.
Other commentators have sought to explain this form of labor by drawing parallels with industrial production and reproduction. Charis Thompson, for example, developed the idea of a biomedical mode of reproduction. Thompson contends that in the biomedical mode, reproduction is made productive in an industrial sense, “with its product being standardized molecular entities like clones and cell lines” (Thompson, 2005). The tissue donors resemble industrial workers who are alienated from their labor. Other work, like that of Margaret Lock, Sarah Franklin, and Donna Dickenson, also holds the perspective that providing material for biomedicine alienate women from the products of their reproductive labor (Waldby & Cooper, 2010). Although these theorists present comprehensive frameworks for understanding biomedical/clinical labor, Waldby and Cooper (2010) argue that these approaches reproduce a Fordist industrial model of labor that no longer holds. To explain, they note that Marx’s theories of labor and value cannot account for the biotechnological production of value.
For Marx, the relationship between labor and the commodity is retroactive (Waldby & Cooper, 2014). The living labor of force expended in the present becomes the past or dead labor in the exchangeable commodity. This principle underscores why the feminist scholars referenced above designated donated tissue as the current products of women’s past living potential/generative power. In the industrial mode, the value of the commodity is always greater than the value of the clock time used by the workers to create the commodity, and this difference in value results in profit for the capitalist. Biomedical labor, however, does not exactly operate in clock time and has little basis in retroactive value. The temporality here is more evental or contingent upon performance (again, placing clinical labor in a post-Fordist context). And in other forms of clinical labor, such as participation in biobanks, value is only created in the long-term accumulation of medical data long after the work performed by the individual (Waldby &
Mitchell, 2010). Developments in biomedicine also challenge Marx’s structural categories of labor, such as the separation between dead and living labor or the technical/machinic side of capital versus the human/living component (Waldby & Cooper, 2014). For example, how do cell lines and tissues figure into Marx’s analysis, as they are both living and machinic? In recognizing the changes made by biomedicine and the reality of a post-Fordist economy, Waldby and Cooper (2014) present clinical labor as a lens to better understand the valorization processes at work in life science industries.
Some critics, meanwhile, argue that the labor paradigm has its limits. Johanna Oksala (2019), for example, critiques the political and ethical consequences of conceiving certain acts—specifically gestational surrogacy—as labor. In an ethnographic study of gestational surrogacy in northern India, surrogates describe their uterus as a kind of empty room that should be rented out as a home for someone else’s baby (Pande, 2009). Waldby and Cooper (2014) take this scene as a sign of rentier dynamics: because a woman believes her womb is a place to rent, she has authority over its use. The commissioning couple simply establishes their rights to her biology through lease, and the fetus is the rightful property of the intended parents. Illustrating the analogy, I lease my apartment from my landlord, but anything I place within my apartment is still my property. Oksala (2019) makes clear that this view of surrogates as rentiers is inappropriate: the biological capacities of surrogates on their own have little economic worth, and their value is only realized through the help of supporting IVF processes and institutions. A woman cannot just rent out her body in the market and become a surrogate. She requires the scientific knowledge of doctors, clinics, brokers, etc. The dynamic is a collaboration, not a one-way street. Oksala (2019) also explains that the women in the study contested the view of themselves as rentiers, as their blood and milk nourish the baby, and they share substantial ties with the fetus. Instead of viewing their surrogacy exclusively as labor, the women also acknowledged the development of kinship relations. Given the creation of kinship ties, Oksala (2019) argues that the feminist political implication would be that surrogates should be given more concrete power to define their role in the relationship, as well as better labor conditions. Forming emotional ties with the commissioning parents would allow surrogates to challenge both their disposability in the global fertility market and the over-simplification of their value to their reproductive capacity. A focus exclusively on labor relations normalizes the temporary, commercial, and contractual relationships between the surrogate and the intended parents, denying the surrogate her full identity after nurturing a child.
When discussing the bioeconomy, we must also address immaterial labor. Immaterial labor explains late twentieth-century transformations in the production of commodities, specifically cases of companies using networks of individuals outside the company to produce components of their internal informational commodities (Mitchell, 2012). For example, instead of employing their own jingle writers, a company may use an already existing song. Non-corporate forms of life, especially activities that individuals would have chosen to do on their own, become sources of innovation and value for corporations. In the life sciences, we can look to biobanking strategies, such as Vanderbilt Medical Center’s BioVU DNA Databank, which extracts DNA from blood that patients believe is simply going to be disposed of (Mitchell, 2012). BioVU employs biomedical immaterial labor by not asking participants to engage in any
extra activities, and participants opt-in simply by failing to check a box to opt-out. In turn, the information gained from DNA extraction gives the Vanderbilt Medical Center a competitive advantage in applying for grants and attracting researchers (Mitchell, 2012). Biovalue is created by appropriating material that would have been produced even in the absence of the DNA registry. Similar connections can be made to processes within clinical labor, as the life sciences industry commodifies biological processes that are existent and have generative capabilities regardless of whether they are harnessed by science. Someone with ovaries will produce oocytes regardless of their capacity to be sold. However, clinical labor differs from immaterial labor because the diversion of biological processes away from their normal pathways creates a context different from individuals simply living their lives. Clinical laborers experience bodily
transformations, whether by becoming a pregnant body, experiencing the effects of new pharmaceuticals, or undergoing surgery. Though immaterial labor lacks acknowledged embodiment, the concept is still a useful tool for contextualizing the dynamics of the biomedical innovation economy, especially in finding new uses for the human body in scientific experimentation (Waldby & Cooper, 2014).
Application to Regenerative Medicine
Regenerative medicine and the stem cell industry are ready examples for examining Waldby and Cooper’s ideas. Regenerative medicine is an umbrella term referring to a variety of disciplines that treat clinical conditions associated with damaged tissues, like cardiac damage, osteoporosis, and diabetes. The goal is to produce in vivo tissue regeneration. Regenerative technology relies largely on stem cells, which can be found in in vitro embryos, umbilical cord blood, and other fetal tissue. Pluripotent stem cells are mainly found in in vitro embryos, while cord blood has high concentrations of hematopoietic (blood producing) stem cells (Waldby & Cooper, 2010). Oocytes can also contribute to regenerative medicine, not as a source of stem cells, but as a component in Somatic Cell Nuclear Transfer (SCNT) research. SCNT produces genetically compatible transplantable tissues. Tissues with regenerative capabilities are valuable because of their position in the generative nexus of the maternal-fetal connection, continuously producing material that has the potential to develop within any number of biological pathways (Waldby & Cooper, 2014). The stem cell industry aims to redirect this generative power into regeneration. Stem cell technologies seek to disrupt the natural cellular pathway by expanding the number of pathways that the cell may take. The scientific value of the stem cell resides in its promised capacity to provide infinite reserves of transplantable tissues.
Harnessing allogeneic stem cells (i.e., cells originating from a donor rather than the patient) for regenerative therapy is also economically attractive to corporate development (Waldby & Cooper, 2014). Companies can establish intellectual property claims over the cell lines they produce, providing licensing revenue and supporting stock market performance (Waldby & Cooper, 2014). This is especially true if the lines can be standardized and scaled up to act as treatments for larger patient populations, beyond just the individual. The donor’s participation in the process is conceptualized as contractual and based on informed consent, transferring nonreversible rights of ownership to the scientists. Meanwhile, the scientists are free to establish intellectual property claims through the addition of their cognitive labor. As an industry reliant on harnessing new possibilities, stem cell technology falls comfortably within the
scope of post-Fordist experimental economies. To have any material to experiment on, the stem cell industry must first negotiate with potential donors. These negotiations have a common trend: the labeling of tissues as “spare” or “waste” in order to convince women to donate (Waldby & Cooper, 2010).
For example, fetal material is often harvested from abortions. In the UK, women planning an abortion at a clinic with links to research institutions may be approached by a nurse asking for consent to donate the
tissue to research; this is presented as making use of “what would otherwise be a shameful waste” (Waldby & Cooper, 2010). The judgement of the unappropriated aborted fetus as waste serves to guilt women into giving up the tissue for research: the woman had already generated this material, so she may as well make it useful instead of discarding it. This is another example of clinical labor connecting to immaterial labor, as stem cell researchers step in to acquire something that the woman would have created of her own volition and use it for their own commodity and value creation. Similarly, oocytes for SCNT are primarily acquired by IVF clinics soliciting their fertility patients for “spare” embryos, those which cannot be implanted (Waldby & Cooper, 2010). The embryo is already created, and the individual has the option either to donate or to dispose of it. In both of these cases, generative tissues are labeled both as a form of waste and a valuable surplus that should be donated so that its value to others can be
actualized.
Framing this process as a donation to science also reinforces social expectations and gender stereotypes of women as generous and altruistic, and places the transaction within a bioethical rather than an economic framework (Waldby & Cooper, 2010). However, the stem cell industry is acquiring both the product of the donor’s biology and energy sustained up to that point and the potentiality of the donor’s tissue. Those giving consent to donation to regenerative medicine are giving access not just to the material they produced, but to their body’s potential. HeLa cells, for instance, are the first human cell line that could grow “immortally,” dividing on their own in a laboratory (National Institutes of Health [NIH], n.d.). HeLa cells have been instrumental in major biomedical advances because of their immortality. However, neither Henrietta Lacks (the woman that HeLa cells were taken from) nor her descendants received compensation for this contribution (NIH, n.d.). Though HeLa cells pose a complicated scenario
in terms of informed consent, as cancer rather than stem cells, this example illustrates the disparities in the acknowledgement of labor in biomedical research. By employing the perspective of clinical labor, we can see that the stem cell scientist is not the exclusive laborer. The donor—given their collaboration with the scientific process, their provision of generative energy and materials, and their involvement in secondary activities and risks leading up to donation—must also be recognized. Just because their labor is embodied does not imply it does not exist.
Conclusion
Waldby and Cooper (2014) use the term clinical labor to draw attention to the tasks and risks associated with economically unrecognized biomedical donation-oriented procedures. Their work also recognizes the reality of a post-Fordist and innovation economy, or at least the contemporary conditions of the life science industries that limit the applicability of industrial categories of labor. Clinical labor prioritizes embodied productivity as labor, paying respect to those who are involved in biomedical research in a very physical sense. However, this labor paradigm is lacking in some aspects. The authors’ focus on labor relations erases the emotional experiences of the individuals involved. Questions arise of other political and ethical possibilities: could processes like oocyte vending and gestational surrogacy be framed as efforts to create alternative kinship relations, as Oksala (2019) suggests? Are there perspectives that better address the inconsistency of bioethical frameworks in tissue regulation, a topic with significant consequences for both donors and recipients? How do clinical laborers contribute to
the Global North’s desire for endless regeneration and extension of life, manifesting in the global trade of organs like kidneys (Scheper-Hughes, 2000)? The practices around tissue donation continue to have multifaceted implications, not only in terms of labor theory, but also in interpreting cultural contexts and local realities.
References Cited
Mitchell, R. (2012). US biobanking strategies and biomedical immaterial labor. BioSocieties,
7(3), 224-244. https://doi.org/10.1057/biosoc.2012.9
Mitchell, R., & Waldby, C. (2010). National biobanks: Clinical labor, risk production, and the
creation of biovalue. Science, Technology, & Human Values, 35(3), 330-355.
https://doi.org/10.1177/0162243909340267
National Institutes of Health. (n.d.). Significant research advances enabled by HeLa cells. https://osp.od.nih.gov/scientific-sharing/hela-cells-timeline/
Organisation for Economic Co-operation and Development. (2009). The bioeconomy to 2030: Designing a policy agenda. OECD Publishing.
Oksala, J. (2019). Feminism against biocapitalism: Gestational surrogacy and the limits of the
labor paradigm. Signs: Journal of Women in Culture and Society, 44(4), 883-904.
https://doi.org/10.1086/702031
Pande, A. (2009). “It may be her eggs but it’s my blood”: Surrogates and everyday forms of
kinship in India. Qualitative Sociology, 32, 379-397. https://doi.org/10.1007/s11133-009-9138-0
Scheper-Hughes, N. (2000). The global traffic in human organs. Current Anthropology, 41(2),
191-224. https://doi.org/10.1086/300123
Thrift, N. (2006). Re-inventing invention: New tendencies in capitalist commodification. Economy and Society, 35(2), 279-306. https://doi.org/10.1080/03085140600635755
Waldby, C., & Cooper, M. (2008). The biopolitics of reproduction: Post-Fordist biotechnologyand women’s clinical labour. Australian Feminist Studies, 23(55), 57-73. https://doi.org/10.1080/08164640701816223
Waldby, C., & Cooper, M. (2010). From reproductive work to regenerative labour: The female
body and the stem cell industries. Feminist Theory, 11(1), 3-22. https://doi.org/10.1177/1464700109355210
Waldby, C., & Cooper, M. (2014). Clinical labor, tissue donors and research subjects in the
global bioeconomy. Duke University Press.
Acknowledgements: I would like to thank Dr. Happe for her mentorship and guidance in both
writing skill and critical feminist thought. I would also like to thank Emma Hale for her editing
assistance.
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