39 september 2010
could often get a feel for a clinical trial sim-ply by walking down the hall. Now youmight need to go to India or Uzbekistan.Even if you restricted yourself to domesticstudies, you would log a lot of miles tryingto visit all the various stations in the pro-duction line. The trial itself might takeplace at fifty different sites, ranging fromIvy League teaching hospitals to a businesspark near Toronto airport. The ethics com-mittee approval would probably come fromOlympia, Washington; the subject recruit-ment could be managed in Dallas, Texas;and the trial results might be written up inPrinceton, New Jersey. It is no wonder only industry insiders seem to know exactly what is going on. When
reportersdiscovered that SFBC International waspaying immigrants to be test subjects in adilapidated former Holiday Inn in Miami,SFBC had recently been named one of thebest small businesses in America by
magazine. The Holiday Inn testing facility was the largest in North America, and hadbeen operating for nearly ten years beforeinspectors noticed there was anything wrong.Lodged somewhere between the secrecy and the scandals is the work of a new gen-eration of ethnographers who are quietly studying the way the clinical trials businessoperates. What interests Jill Fisher, AdrianaPetryna and Roberto Abadie is not so muchthe occasional outrage uncovered by in- vestigative reporters, or even the formalregulation of clinical trials. They are moreconcerned with the everyday pressures andmoral choices facing the workers who manthe production line: the private-sector phys-icians who conduct the trials, the study monitors and trial co-ordinators who over-see them, and the research subjects whotake experimental drugs, often in exchangefor free medical care or a wage. What doesclinical research look like when everyone isin it for the money?For a start, it looks a lot less like science.‘I do not do original research; I do con-tractresearch,’ says a private physician- researcher in
Medical Research for Hire
. A con-tract researcher does not come up withoriginal ideas, or design research proto-cols, or analyse research results, or writethem up for scientific publications. All of this is done by the pharmaceutical company or its hired specialists. What a contract re-searcher does is recruit subjects, monitortheir clinical care and sign off on the paper- work. Not a lot of original work is done,and in some cases, not much work at all(a running joke has it that physicians doclinical trials in order to improve their golf games). The industry term for these near-absent physicians is ‘phantom investig-ators’. Usually they will ‘come in on a daily basis, on most days, and they’ll sign off onall the things they need to sign off on, seeany patients they need to see, and they’regone,’ a study monitor says to Fisher. Theresearchers are usually on-site for no morethan an hour or two a day.Contract researchers may not do muchintellectual work, but this doesn’t meanthey are not well paid. A part-time contract researcher conducting four or five clinicaltrials a year can earn an average of $300,000in extra income. In 2000, a full-time clinicaltrial site earned an average of $1.6 million.