"My Body is One of the Best Commodities": Exploring the Ethics of Commodification in Phase I Healthy Volunteer Clinical Trials

Abstract

In phase I clinical trials, healthy volunteers are dosed with investigational drugs and subjected to blood draws and other bodily monitoring procedures while they are confined to clinic spaces. In exchange, they are paid. These participants are, in a direct sense, selling access to their bodies for pharmaceutical companies and their associates to run drugs through. However, commodification is rarely investigated as an ethical dimension of phase I trial participation. We address this gap in the literature by bringing the voices of phase I healthy volunteers into conversation with philosophical perspectives on body commodification. Querying the intersection of commodification and phase I clinical trials illuminates important features of healthy volunteers' experiences, disentangles commodification from a dominant narrative about exploitation, and brings focus to the question of what, if any, market norms will best protect the multiple ways in which healthy volunteers' welfare is impacted by clinical trial participation.

The ethical anatomy of payment for research participants

“…For the sake of the analysis to come, it is assumed that paid participation in biomedical research is a form of paid bodily services, and it should be “no more worrisome to commodify a person’s labor [bodily service— JR ] as a research subject than to commodify a person’s labor in other contexts, which happens all the time” (Lynch 2014 , p. 159). Therefore, commodification concerns against research payment, raised by some commentators (Macklin 1989 ; Chambers 2001 ; Abadie 2010 , 2015 ; Cooper and Waldby 2014 ; Walker and Fisher 2019 ) will not be explored here.…”

Ethical Criteria for Improved Human Subject Protections in Phase I Healthy Volunteer Trials

“…To some degree, healthy individuals' trial participation is even a stigmatized activity because it is equated with financial desperation and/or body commodification. 97 Perhaps for these reasons, most attention to healthy volunteers' experiences has focused on when they deceive researchers or otherwise break the rules of participation. 98 Consequently, their voices have been relatively unheard even in an era when researchers are thought to have an obligation to increase and sustain community engagement in the design and conduct of clinical trials.…”

“…As research participants, healthy volunteers are not typically recipients of compassion, whereas participants with a health condition often are. To some degree, healthy individuals’ trial participation is even a stigmatized activity because it is equated with financial desperation and/or body commodification 97 . Perhaps for these reasons, most attention to healthy volunteers’ experiences has focused on when they deceive researchers or otherwise break the rules of participation 98 .…”

Speculating on precarious income: finance cultures and the risky strategies of healthy volunteers in clinical drug trials

“…Elsewhere, we have analyzed the ethical dimensions of treating one's body as a commodity (Walker and Fisher 2019), but the important point to consider here is how healthy volunteers leverage their good health in order to earn clinical trial income over time.…”