Talking Red Markets at the American Enterprise Institute on October 28th

Over the last few weeks I have been giving a string of lectures around the country about the Red Market. My audiences have been in academica, among public policy think tanks and large and small media outlets. All told they represent a very wide ideological spectrum–from the left to right wings of the American political sphere to a broad sampling of the medical, religious and activist communities. Since my book came out in June there has been a renewed interest in the ethical and economic conundrums that allow for criminal markets for human tissue to flourish. There is a bill circulating in policy circles to commercialize and regulate human tissue, and a group if activists who are planning pilot programs to reassess the National Organ Transplantation Act. The FBI has taken up the case of children kidnapped for adoption and conducted DNA tests on a child that I wrote about in the book. Meanwhile new organ brokering scandals seem to pop up ever week.  It is important that people weigh in on this debate now and get involved before a small group of people decide the future of the tissue transplant system. We are going to need a diverse group of people and viewpoints represented to ensure that upcoming revisions don’t create new holes for illegal markets to flourish.

Click on the pictures for links to two lectures: One at The American Enterprise Institute, a conservative think tank. The second at Northwestern University in Chicago.

50 minute lecture on The Red Market at Northwestern in Chicago in September

The Red Market by Scott Carney

by Daniel Grushkin

Bloomberg-Businessweek, August 4 2011

In 2008 police officers smashed open the doors of a dairy farm in northern India and found 17 people hooked to IV tubes, being drained of blood, too weak to run away. The farmer and his staff had kept them alive simply to milk their veins and sell off the contents to local blood banks. This is just one of the horrifying everyday tales of the body trade documented in Scott Carney’s The Red Market—his coinage for the mostly legal and sometimes creepy multibillion-dollar business of buying and selling the stuff of human life, including organs, bones, embryos, and blood.

As Carney explains, the body industry adheres to the same basic trade rules as “shoes and electronics.” New types of transplant surgeries, coupled with globalization, however, have conspired to create a loosely regulated, seedy enterprise that ruins lives even as it saves them. While patients wait on interminable donor lists in some countries, medical tourists are traveling to developing regions to take advantage of a nearly endless supply of “donors.” According to a McKinsey study, up to 85,000 U.S. patients dabbled in the red market in 2008.

It isn’t always pretty. When the Indian government moved victims of the 2004 tsunami into the Tsunami Nagar tent camp in Chennai, illegal organ brokers descended en masse. Carney reports that women at the camp, eventually known as Kidneyville, were offered up to $3,000 for their organs, though they often got far less. “Almost every woman in Tsunami Nagar has a story about how organ brokers took advantage of her during her most desperate hour,” he writes. Within a year, Carney notes, doctors from 52 Indian hospitals performed 2,000 illegal kidney operations—with recipients paying up to $14,000 per surgery. “Inevitably, red markets have the nasty social side effect of moving flesh upward—never downward—through social classes,” Carney writes. “Even without a criminal element, unrestricted free markets act like vampires, sapping the health and strength from ghettos of poor donors and funneling their parts to the wealthy.”

Yet the red market isn’t necessarily a bad thing. Kidney transplants extend lives. Surrogates who carry an embryo to term give couples who can’t conceive the opportunity to have children. Yet the real question has become how to regulate the market. Theories fall into two extremes. Some countries, such as Iran and the Philippines, recognize the trade with the belief that clear laws bring an already thriving business out of the shadows. Still, a regulated body market doesn’t necessarily lead to a successful business. When selling blood was legal in the U.S., from the 1940s through the 1960s, for-profit blood banks consistently failed both donors and recipients. Brokers turned up in slums to tap the poorest of the population for the lowest prices. As a result, the quality of blood stores suffered, donors and blood banks disregarded basic cleanliness, and disease spread into the supply. Eventually, hospital administrators and doctors became frustrated and turned to volunteers.

For many Western countries, a ban on the sale of body parts isn’t ideal, either. In the U.S., the exorbitant cost to transplant a liver ($523,000) or intestines ($1.2 million) often drives patients to countries with murkier regulations. Carney estimates that about 10 percent of the red market operates illegally. And the widespread exploitation—ranging from the rental of Indian wombs to the adoption of slum babies—hinges on the industry’s insistence of anonymity: The medical system seals the identities of donors and recipients, to protect both parties. Yet anonymity gives rise to a chain of middlemen who work unseen and get away with cheating, or worse. Carney argues for exposing the whole system by simply creating openly accessible pedigrees. Imagine IV bags with blood donors’ names on them, he argues, or adoption centers that list the birth parents. Parts of the red market might not survive, he suggests. Though it also might just shift to countries where the supply chain is even less regulated.

Growing industries rarely reform themselves when they’re making a fortune, and the red market is unlikely to be any different. “Who we are as a society depends on how we address the remaining 10 percent,” Carney writes. “Do we let blood brokers and child kidnappers ply their trade and write off the human fallout as just another cost of doing business?” The rhetorical answer is no, of course, but the realistic answer is that the supply side will vanish only when demand does. It’s up to potential customers—perhaps as much as law enforcement—to halt the growth of the red market’s illicit side. Promising advances in cell science might soon make organ transplants obsolete, but until a breakthrough comes—and is cost-competitive—the red market will continue to thrive. That’s just plain economics.

See the article on Businessweek.com

Listen to the CBC’s coverage of “The Red Market” where I talk bone thieves, blood farmers and things that go bump in the night.

Panic Button

Outside Magazine July 2011

Katalina Jimenez was cold. So cold that her fingers were sluggish. So cold that she couldn’t stop crying.

Until now, her strategy for hiking the Pacific Crest Trail had been simple and ­effective: use minimal gear and move fast. On this day—June 3, 2009—her pack weighed less than 20 pounds, and she’d swapped her hiking shoes for sandals and socks. It had taken her only 38 days to pass through the scorching Southern California desert. Jimenez was making great time as she began ascending midsize Sierra peaks inside ­Sequoia National Park, starting with 2,600-foot Sharknose Ridge, about 15 miles south of Mount Whitney.

Jimenez, 36, had made one slight departure from fleet-footed efficiency: she was carrying a small orange emergency-messaging device, made by a company called Spot, that her mother had insisted she take. Though the satellite-linked unit allowed only one-way communication—she used it to trigger a daily ­e-mail that told family and friends in Minne­sota that she was OK—it could save her life if the trip turned dangerous. A Help button would tell her contacts that she was in trouble, while a 911 button would issue a rescue alert in case of life-threatening emergency.

The morning had been perfect, with yellow sun filtering through dense evergreens. By noon clouds had moved in, the temperature had dropped, and there were snow flurries, so Jimenez decided to set up camp and let the front pass by. Her map showed a small pond and a clearing just off the trail, but by the time she reached it the area was blanketed with snow, and she couldn’t tell where the dirt ended and the water began. Her feet splooshed into the cold lake, soaking her socks and sending shivers up her legs.

Jimenez was still shaking when she found a dry patch to set up her tarp and mat. She climbed into her sleeping bag. Wet and alone, she pressed the Spot’s OK button and watched an LED light acknowledge that the message had been sent. It was still only 20 degrees out—not cold enough to put her in any real danger.

Three hours later, the weight of new snow was making the tarp sag and her mind race. This is how people die in the wilderness, Jimenez thought. You get cold and wet, and then you can’t warm up. Then it’s over. She conjured an image of a hiker coming down the trail and discovering her frozen body.

By 3:30, the loneliness and anxiety were overwhelming. She pressed Help. Then she fumbled with her compact camera and recorded a three-minute video, sobbing as she described her predicament. A few minutes later, she pressed 911—an act she would ­regret later, after the weather eased up and she walked to safety under her own steam.

At the time, though, rescuers knew only one thing: somebody was in trouble. Later that day, a California search-and-rescue heli­copter was slicing through the sky.

Read the rest of the article in Outside Magazine

http://www.outsideonline.com/outdoor-adventure/outdoor-skills/survival/Panic-Button.html

Tavis Smiley who has one of the most thought provoking talk shows on television, had me on to talk about how red market transactions disproportionately affect poor people and send flesh up the human supply chain. See the video of the interview on PBS.

Felani wore her gold bridal jewelry as she crouched out of sight inside the squalid concrete building. The 15-year-old’s father, Nurul Islam, peeked cautiously out the window and scanned the steel and barbed-wire fence that demarcates the border between India and Bangladesh. The fence was the last obstacle to Felani’s wedding, arranged for a week later in her family’s ancestral village just across the border in Bangladesh.

There was no question of crossing legally — visas and passports from New Delhi could take years — and besides, the Bangladeshi village where Islam grew up was less than a mile away from the bus stand on the Indian side. Still, they knew it was dangerous. The Indians who watched the fence had a reputation for shooting first and asking questions later. Islam had paid $65 to a broker who said he could bribe the Indian border guard, but he had no way of knowing whether the money actually made it into the right hands.

Father and daughter waited for the moment when the guards’ backs were turned and they could prop a ladder against the fence and clamber over. The broker held them back for hours, insisting it wasn’t safe yet. But eventually the first rays of dawn began to cut through the thick morning fog. They had no choice but to make a break for it.

Islam went first, clearing the barrier in seconds. Felani wasn’t so lucky. The hem of her salwar kameez caught on the barbed wire. She panicked, and screamed. An Indian soldier came running and fired a single shot at point-blank range, killing her instantly. The father fled, leaving his daughter’s corpse tangled in the barbed wire. It hung there for another five hours before the border guards were able to negotiate a way to take her down; the Indians transferred the body across the border the next day. “When we got her body back the soldiers had even stolen her bridal jewelry,” Islam told us, speaking in a distant voice a week after the January incident.

Other border fortifications around the world may get all the headlines, but over the past decade the 1,790-mile fence barricading the near entirety of the frontier between India and Bangladesh has become one of the world’s bloodiest. Since 2000, Indian troops have shot and killed nearly 1,000 people like Felani there.

In India, the 25-year-old border fence — finally expected to be completed next year at a cost of $1.2 billion — is celebrated as a panacea for a whole range of national neuroses: Islamist terrorism, illegal immigrants stealing Indian jobs, the refugee crisis that could ensue should a climate catastrophe ravage South Asia. But for Bangladeshis, the fence has come to embody the irrational fears of a neighbor that is jealously guarding its newfound wealth even as their own country remains mired in poverty. The barrier is a physical reminder of just how much has come between two once-friendly countries with a common history and culture — and how much blood one side is willing to shed to keep them apart.

Read the full story on ForeignPolicy.com

See a gallery of unpublished photos from the trip here.

Need a Kidney? A Skull? Just Bring Cash

Whereas black markets trade in illegal goods like guns and drugs, the “red market,” the journalist Scott Carney says in his revealing if somewhat scattershot new book, trades in human flesh — in kidneys and other organs, in human corneas, blood, bones and eggs. Many of the real-life examples he cites in this chilling volume cannot help but remind the reader of a horror movie, or of Kazuo Ishiguro’s devastating dystopian novel “Never Let Me Go” (2005), in which we learn that a group of children are clones who have been raised to “donate” replacement body parts.

In “The Red Market” Mr. Carney recounts the story of a police raid on a dairy farmer’s land in a small Indian border town that freed 17 people who had been confined in shacks and who said they’d been bled at least two times per week. “The Blood Factory,” as it was called in the local press, he writes, “was supplying a sizable percentage” of the city hospitals’ blood supply.

Mr. Carney also investigates the bone trade in India — for almost 200 years, “the world’s primary source of bones used in medical study” — and tries to track down the head of a grave robbing ring in West Bengal, who, according to police, was pilfering corpses from cemeteries, morgues, and funeral pyres and employed “almost a dozen people to shepherd the bones through the various stages of defleshing and curing.”

A contributing editor at Wired magazine, Mr. Carney writes with considerable narrative verve, slamming home the misery of what he has witnessed with passion and visceral detail. His book does not attempt to provide a comprehensive picture of red markets in the world today. Much of Mr. Carney’s reporting focuses on India (where he lived and worked for a decade), while dealing only cursorily with human organ trafficking in other hot spots like the Philippines and Brazil.

In one chapter Mr. Carney describes an impoverished Indian refugee camp for survivors of the 2004 tsunami that was known as Kidneyvakkam, or Kidneyville, because so many people there had sold their kidneys to organ brokers in efforts to raise desperately needed funds. “Brokers,” he writes, “routinely quote a high payout — as much as $3,000 for the operation — but usually only dole out a fraction of the offered price once the person has gone through it. Everyone here knows that it is a scam. Still the women reason that a rip-off is better than nothing at all.” For these people, he adds, selling organs “sometimes feels like their only option in hard times”; poor people around the world, in his words, “often view their organs as a critical social safety net.”

Toward the end of the book Mr. Carney notes that “criminal and unethical red markets are far smaller than their legitimate counterparts.” According to the World Health Organization, he writes, “about 10 percent of world organ transplants are obtained on the black market.” But he emphasizes that “red markets are now larger, more pervasive, and more profitable than at any other time in history,” and that “globalization has made the speed and complexity of these markets bewildering.”

The most alarming allegations cited in this book come from a 2006 report released by David Kilgour, a former member of the Canadian Parliament, and the human rights lawyer David Matas, which suggested that vital organs (including kidneys, corneas and livers) had been harvested on a large scale from executed members of Falun Gong, a banned spiritual group in China. The Chinese government denied the allegations.

“No one is saying the Chinese government went after the Falun Gong specifically for their organs,” Mr. Carney writes, “but it seems to have been a remarkably convenient and profitable way to dispose of them. Dangerous political dissidents were executed while their organs created a comfortable revenue stream for hospitals and surgeons, and presumably many important Chinese officials received organs.”

Mr. Carney is not able to verify the Kilgour-Matas report independently. For that matter, his overall approach here tends to be heavily anecdotal and selective, focusing on horror stories like the kidnapping of a young Indian boy, who, the police said, was brought to an orphanage “that paid cash for healthy children” and then “exported the children to unknowing families abroad.” .

As Mr. Carney sees it: “Eventually, red markets have the nasty social side effect of moving flesh upward — never downward — through social classes. Even without a criminal element, unrestricted free markets act like vampires, sapping the health and strength from ghettos of poor donors and funneling their parts to the wealthy.”

His book is filled with harrowing stories in which the destitute and desperate end up sacrificing their bodies for the sake of a few dollars that fail to change their lives.

In one chapter Mr. Carney writes that most egg donors in Cyprus — which “had more fertility clinics per capita than any other country” — come from the relatively small population of poor Eastern European immigrants who are “eager to sell their eggs at any price.” A donor in Cyprus will probably get paid a few hundred dollars for her eggs, Mr. Carney estimates, while customers — often from Western Europe — will pay $8,000 to $14,000 for full-service egg implantation with in vitro fertilization in Cyprus, “about 30 percent less than the next cheapest spot in the Western world.”

Globalization has also brought what Mr. Carney calls the “fertility tourism industry” to India, which, he says, “legalized surrogacy in 2002 as part of a larger effort to promote medical tourism.” At the Akanksha Infertility Clinic (which was featured in an “Oprah” segment), he says, surrogates, who make between $5,000 and $6,000, live in residential units, where “they will spend their entire pregnancies under lock and key.” The clinic charges between $15,000 and $20,000 for the entire process, he reports, “whereas in the handful of American states that allow paid surrogacy, bringing a child to term can cost between $50,000 and $100,000.”

“Before India, only the American upper classes could afford a surrogate,” Mr. Carney writes. “Now it’s almost within reach of the middle class. While surrogacy has always raised ethical questions, the increasing scale of the industry makes the issue far more urgent. With hundreds of new clinics poised to open, the economics of surrogate pregnancies are moving faster than our understanding of its implications.”

In addressing such ethical questions throughout this grisly but fascinating volume, Mr. Carney forces the reader to think about the moral issues raised by advances in medicine. His book also asks us to re-evaluate the roles that privacy, anonymity and altruism play in the current “system of flesh exchange” — which, as disturbing as it is to contemplate, is subject, like those for other commodities, to the brutal marketplace equations of supply and demand.

See full review on the New York Times

Invasion of the Body Snatchers

Kidneys are the most popular — bought and sold on the global black market at a rate of at least 20,000 per year. Blood, tissue, skin, corneas and eggs are also highly valued. Human bones are a centuries-old mainstay.

The demand outstrips the supply, and so millions of variations on that old urban legend — some unsuspecting victim waking up in a bathtub in Vegas, missing a kidney — actually exist: People snatched off the street in India and China, held for years as chained-up blood donors. Prisoners in China forced to donate body parts, plucked apart, sometimes alive, sometimes without anesthesia. Entire villages, like the Baseco slum in the Philippines, where the bulk of inhabitants have only one kidney — having sold the other off for a few hundred dollars to pay rent or buy food or medicine for a sick relative.

Read Maureen Callahan’s full story at the NY Post

Journalist Scott Carney figures he’s worth about $250,000, but that number isn’t based on his savings or his assets; it’s what Carney thinks his body would fetch if it were broken down into individual parts and sold on what he calls the “red market.” In his new book, also called The Red Market, Carney explores the shadowy but lucrative global marketplace for blood, bones and organs. He tells NPR’s Melissa Block that despite being underground, there’s no question the red market is thriving. ”It’s really hard to get accurate figures on what the illegal market is on body parts, but I’m figuring it’s definitely in the billions of dollars,” Carney says.

‘When You’re At Your Most Desperate Place … The Brokers Come In’ As part of his research, Carney visited an Indian refugee camp for survivors of 2004′s massive tsunami. Today, the camp is known by the nickname Kidneyvakkam, or Kidneyville, because of how common it is for the women who live there to sell their kidneys. ”The women are just lined up,” Carney says. “They have their exposed midriffs and there are all these kidney extraction scars because when the tsunami happened, all these organ brokers came in and realized there were a lot of people in very desperate situations and they could turn a lot of quick cash by just convincing people to sell their kidneys.”

Listen to the story on NPR

Doctor Nayna Patel, Akanksha’s founder, has just finished washing up after delivering twins by cesarean section. A team of nurses ushers me into her office from an adjoining one where I’ve had a chance to peruse a stack of press clippings lauding her accomplishments and contributions to international fertility. For the last three to four years, Patel has been the subject of dozens of gushing articles in addition to that game-changing 2007 Oprah segment, which all but heralded Patel as a savior of childless middle-class couples and helped open the floodgates for the outsourcing of American pregnancies. Patel took the publicity to the bank—autographed photos of Ms. Winfrey are displayed prominently throughout the clinic, which claims a waiting list hundreds deep and receives at least a dozen new inquiries from potential surrogacy customers each week.

The doctor, clad in a bright red-and-orange sari, sits at a large desk that covers about a third of the room. Heavy diamond jewelry dangles from her neck, ears, and wrists. Her wide grin projects a mixture of politeness and caution as she beckons me to sit in a rolling office chair. I showed up here without an appointment, fearing Patel would refuse to see me if I phoned in advance: Despite all the laudatory press, in the weeks prior to my visit a spate of critical articles had appeared, focusing on the clinic’s controversial practice of cloistering its hired surrogate mothers in dormitories. Among the claims: Akanksha is little more than a baby factory. “The world will point a finger at me,” Patel responds when I ask about the criticism. “She will point, he will point. I don’t have to keep answering people for that.”

As if to prove it, she politely evades my questions for 20 minutes, and then escorts me out. I had hoped to get her take on the residency units, but it’s not a topic she cares to discuss.

Read the full story on MotherJones.com