Book Blog Post: Banking on the Body

In 2008 a 44-year-old woman, Anna Kasper, from my home town of Cleveland, Ohio, died of a heart attack.  With her family’s wishes, her body became the source of replacement parts for more than fifty other strangers, including the first American woman to undergo a face transplant.  Kasper’s family was prohibited by law from receiving any compensation for these body products, even if they had been left destitute by her death.  In the United States it is illegal to buy and sell human organs for transplant, despite the fact that supply comes nowhere near meeting demand, and many people die while awaiting replacement organs.  Why did Americans decide that it was acceptable to donate body products for love but not for money?  Where did our use of shared body products begin? 

            Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America looks into the origins of shared human body products.  Blood and milk were some of the first human products able to be transferred from one human body to another in the later Progressive era.  As technology improved throughout the early 20^th century it eventually became possible to remove these biological products from one human, store them for a limited amount of time, and transfuse them into a different, needy body.  In 1937 a Chicago physician, Dr. Bernard Fantus, referred to his brilliant new plan to organize blood donations at Cook County Hospital as a blood bank.  “The banking metaphor has encouraged us to think of body products in terms of money and markets….also as a commodity that was under complete medical control.” (7)  This gift/commodity dichotomy that dominates American thinking about body products is Swanson’s main concern.  She builds a case to show that this dichotomy permeates how we construct gender, race, disease, the law, government, and market economics. 

            Like Mintz, Swanson takes a critical stance toward the commodities she investigates.  But the real concern in Swanson’s book are not the commodities themselves, but those who control them. In an excellent October 5 blog post Benjamin seemed to channel the spirit of Appadurai when he wrote: “I think that anything has the potential to become a commodity if a particular culture makes that determination.  In that case the thing itself is deemphasized, and the various meanings attached to it take precedence.”  Swanson is not intrigued by the biological make up or characteristics of blood, milk, and sperm but rather she is interested in the social meanings Americans have attached to them.  This is more of a biography of social values than a commodity chain or web.  She does, however, follow each of these products through production (collection and storage in banks), transportation, and consumption by doctors and ultimately the patient, but they do not experience any international exchange. The dynamism of the book is provided not by geographical exchange but rather by change over time; changes in how we view those individuals donating and receiving blood, milk, and sperm, and the changing nature of the banking model.

            One of the most interesting facets of the book is Swanson’s charting of the change in public opinion toward blood banking after World War II.  As Gabriela Soto Laveaga charts the changing views of the barbasqueros in Mexico as the government’s political reality shifted, Swanson shows us how the Cold War era mentality changed opinions of blood donations.  World War II gave rise to a blood-collection model provided by the Red Cross - one in which every citizen, male and female, donated a “gift of life” at a conveniently located collection site.  The collected blood would be put into a vast national reservoir, ready to be tapped into, free of charge, in the service of anyone who needed it whether it be a wounded soldier abroad or a sick child at home.  Following the war, however, this ideal, which the Red Cross viewed as a kind of “democratic citizenship” bolstered by American generosity and spirit (and supported by the government), became linked to the sinister idea of “socialized medicine.” by groups who disliked the “free and open” aspect.  Free commodities provided by a national institution smacked of communism and promoted irresponsibility and social decay, these groups said.  Doctors, in particular, worried that patients receiving blood for free would begin to expect other medical services free of charge.  In their view blood was not a national resource, but rather a vital therapeutic that should be controlled by doctors, not governments, and all recipients should pay for it as the banking model and American capitalism intended.  This, of course, leads to the larger (and still familiar) question of whether health care itself is a public good provided to all citizens by the government, or is it a market commodity, to be sold to those with the ability to pay?   

            So groups like the AMA loudly and publicly insisted that blood was a commodity – until people who had contracted hepatitis or syphilis from blood transfusions sued for purchasing a defective product.  In this section Swanson is evocative of the article Banana Boats and Baby Food: The Banana in U.S. History by Bucheli and Read (Chapter 8 in Topik).  In addition to examining factors that affected the consumption of a particular commodity in the U.S., much like Swanson, Bucheli and Read also dig into operations of major companies like United Fruit, as Swanson does with the Red Cross and companies like Prolacta Bioscience (human milk-based formula producers).  Bucheli and Read, like Swanson, are also interested in the involvement of the U.S. government in regulating markets and prosecuting legal cases.  Swanson notes that groups supporting commodification quickly muted their rhetoric when the first lawsuits were filed and the FTC and IRS got involved with interstate sales of blood plasma.  Eventually these companies convinced states to enact “blood shield laws” that remove banked blood from laws regulating sales of goods, in effect adopting the argument that banked blood is a service, not a good.  This also left patients who had received bad blood without legal recourse, even in the case of death.

            Despite the fact that Swanson is a law professor at Northeastern, it is not the legal cases that show us the most significant aspects of her argument.  As Norton uses commodities like Mesoamerican chocolate and tobacco to chart the development of European social and cultural anxieties, Swanson’s socio-cultural conclusions are likewise profound.  “The adoption of the banking metaphor, with its assumption that all blood was equivalent, had never been strong enough to resolve the deep-rooted cultural anxieties that all blood was not the same.” (140) She deftly links this to issues of racial segregation (blood was segregated by race until the 1950s, 1969 in Louisiana), fear of the poor, worry over communism, and the association of disease with poverty.  She makes prescient observations about gender as well.  The chapter on 21^st century sperm and egg donations notes, “No matter how payments are structured…when the donor body is male, he has been a ‘professional,’ and when the donor body is female, she has been a nurturing mother or potential mother.”

            As our ability to transplant more elaborate body parts (a double hand transplant was completed recently) will challenge the banking model as human milk stations and egg and sperm banks have done.  Swanson’s book is a necessary close examination of the metaphors we use to explain our world and how we will define and value body commodities in our immediate future.