He was somewhat stocky, dressed in sweats, T-shirt, and a jacket, and had just walked out onto the sidewalk to wait for his girlfriend to pick him up. He might not have even noticed the blood running down his left arm, until a woman nearby told him he was bleeding.
“Hold your arm up. You can’t put it down so soon,” she yelled to him.
The man glanced down at his arm and silently noted the stream of blood. Wanting to help, I walked up to him and offered some napkins to stem the bleeding. He took them, then elevated his arm and went back inside the building where he had just sold some of his plasma. He needed a bandage badly.
The man was a “donor.” And the building he walked back into was Biomat, a blood plasma center that sits on North Temple on Salt Lake City’s west side. On the left side of the center is an overpass built over some freight rail lines and a parking lot. To reach Biomat, pedestrians exit a concrete walkway attached to the overpass in almost complete isolation. The walkway is littered with broken glass. At night, prostitutes frequent the area. During the day, people file into the center to sell their plasma. Once inside they sit in a Spartan waiting room filled with metal chairs, an occasional sofa, and a vending machine.
There is a quiet, desperate air to the proceedings. People wait. The wait is so long, in fact, that once you’ve filled out the paperwork you can while away at least an hour, sometimes two, smoking cigarettes on the sidewalk. Some people use the phone.
The man with the bleeding arm wasn’t exactly talkative. Once his girlfriend drove up, he was gone. Most, on the other hand, are happy to talk. Some of them, however, don’t want their full names used.
Dave H., a man in his 30s, has been selling his plasma to various centers twice a week for 14 years. He’s a printer by trade, but hasn’t been able to find that kind of work in a long time. Now he’s a roofer. But even now, he still needs the money, he said, to supplement his income. “I am a week behind on my rent, and last night I ate dinner at some friends because I didn’t have any food at home,” he said.
There are several blood plasma centers, such as Biomat’s, in the Salt Lake Valley. Another center that purchases plasma is ZLB Plasma Care Services on South State Street. Standing in that center’s parking lot was Reuben Edgar, a thin male in his mid-20s. A currently unemployed house painter, he needed plasma money to buy food.
“If not for this money, I would have to go to a food bank, or be on food stamps. Luckily my older brother is able to help me,” he said.
Lest you think Dave H. and Edgar are anomalies, keep in mind that some plasma centers move as many as 100 “donors” through the door every day. People file in. They fill out the forms, wait until the moment they’re finally able to recline on easy chairs, and then pump their fists to fill plastic bottles with their plasma. Their lifeblood is literally a commodity. Some stare into space with eyes glazed. Others watch scenes from televisions that hang from the ceiling.
The quality of your experience at one of these centers can depend on the size of your veins, if they’re small, needle insertion can be painful—not to mention unproductive. And when you lie still for two hours, your arms are bound to stiffen up. Sometimes your arm can even go numb. Pumping your fist not only expedites the delivery of blood, which is later centrifuged to extract plasma. It also brings sensation back into your appendage.
A petite woman in her 30s with four children, Carmen Tucker hasn’t had work as a telemarketer for a few weeks. Because her veins are small, the last few times she attempted to sell plasma, her arms bruised. Still, she seemed remarkably upbeat.
Marc Fisher, manager of ZLB Plasma Care Services, said he went through the donation process twice and found it to be painless.
“We have a broad range of clients. We get students; people with jobs. It’s a misconception that we only get poor people,” Fisher said. “These donors make an invaluable contribution to medicine and we compensate them for it.”
And “donors” is what the plasma industry calls them, despite the fact that these people are obviously motivated by the standard $20 payment they earn. In fact, as the plasma industry sees it, these people aren’t paid for their plasma at all. Rather, they are “remunerated for their time” spent in the donation process.
First time “donors” can spend up to six hours going through the selling process before getting paid. Repeat visitors spend anywhere from four to, if they’re lucky, three hours before collecting payment. And “donors” can never sell their plasma more than twice per week. That means a person could spend up to 8 hours per week to earn $40, less than the federally mandated minimum wage of $5.15 per hour.
Some people would be happy to sell more if they could. Brandon Treas, a 26-year-old Salt Lake City guitarist and temp worker, is a regular, twice-per-week “donor” at ZLB Plasma Care Services.
“I feel pathetic coming in here, but I also wish I could sell more than twice per week,” he said. “If everybody got a job, there wouldn’t be anybody to sell their plasma.”
Plasma, of course, cannot be artificially produced. The straw colored, liquid part of your blood is a versatile commodity. Composed of water, proteins, nutrients, salts, nitrogen waste, carbon dioxide and hormones, it’s used to make a variety of medicines that benefit burn victims, hemophiliacs, and people with autoimmune disorders. It’s also used for cancer treatments, and to make anti-bodies to cure diseases like rabies, hepatitis B and small pox.
Plasma is also big business. The glass-littered walkways near Biomat on North Temple are a world away from Barcelona, Spain, where the headquarters of Instituto Grifols S.A., a pharmaceutical company specializing in plasma derivatives, are located. Biomat, and the 43 plasma centers it operates, is a wholly owned subsidiary of Instituto Grifols, which in turn is owned by Probitas Pharma S.A., a multinational pharmaceutical giant also based in Barcelona. Probitas Pharma is a publicly held company whose largest shareholder is Deutsche Bank AG, which owns almost 40 percent of the company. Probitas expects Biomat’s 2002 profits to grow by 35 percent.
BioLife Plasma, which has a State Street plasma center along with more than 100 others in the United States, is owned by Baxter International, a multinational health-care company based in Illinois. Publicly traded, Baxter has 175 facilities in 50 countries with products sold in more than 100 countries. Last year the company posted sales of $7.6 billion. Baxter is also participating, with a company called Acambis Inc., in the production of a smallpox vaccine for the United States government.
With one plasma center in Salt Lake City and 46 others throughout the United States, ZLB Plasma Care Services is a subsidiary of CSL, a multinational biotechnology and pharmaceutical company based in Melbourne, Australia. The company has 15 offices in seven countries, and reported sales of $1.3 billion (U.S.) as of June this year.
Lastly, there is Serologicals Inc., perhaps the most upscale of Salt Lake City plasma centers. Instead of keeping offices near downtown alleyways, this company has located its blood plasma center amid the grassy hills of the University of Utah’s Research Park. It pays “donors” $50 per visit by check, not cash. Rather than using plasma for medicines, Serologicals uses plasma for the creation of vaccines from antibodies found in the plasma. This publicly held company, headquartered in Georgia, operates 13 “anti-body collection centers” in the United States and has a blood-typing facility in Edinburgh, Scotland. Currently, Serologicals is selling plasma with high counts of smallpox antibodies to a Canadian biotechnology company called Cangene. Headquartered in Winnipeg and publicly held, Cangene has a 5-year contract with the United States Centers for Disease Control and Prevention (CDC) to develop a smallpox vaccine. Serologicals’ stock is traded on the NASDAQ. The company projects its 2002 revenues in the neighborhood of $140 million.
To earn your standard $20 as a plasma “donor” you will work for it. Or, at the very least, you must hold down a job that lets you claim a valid address. In fact, proof of a current address within 125 miles of the plasma center is a requirement. The homeless need not apply. In the interest of catching would-be cheaters, most centers maintain up-to-date address lists of nearby homeless shelters, halfway houses, and motels.
There are host of criteria that could disqualify you. The underweight, those taking certain medications, or those with certain medical conditions need not apply. Ditto if you’ve lived in Europe for longer than six months. In that case, you might have mad-cow disease. Past, not to mention current, intravenous drug users are also disqualified. A body piercing or tattoo without a letter of sterility from the tattoo or piercing shop also lessens your chances, as does any history of homosexual sex or prostitution.
If you are still in the running, you sign a consent form. You are then given a physical and urinalysis by the plasma center’s “physician substitute.” This is a euphemism for a registered nurse.
After your physical, a phlebotomist measures the iron and protein levels in your blood. These levels are indicative of a person’s overall health, and their ability to withstand the loss of plasma. The phlebotomists employed by the plasma centers are usually high school graduates with either a certificate in phlebotomy or equivalent training.
If your protein and iron levels are high enough, and if the phlebotomist can find a large enough vein, a 16-gauge needle is inserted into your arm. Your blood is drawn out into a centrifuge that separates your plasma from your red blood cells. Your plasma is collected in a bottle and your red blood cells are returned to your arm via the 16-gauge needle. Between 690 and 900 milliliters of plasma will be taken depending on your weight. Once the job’s done, keep your arm up for a while. The 16-gauge needle makes a sizable hole.
The work schedule for some phlebotomists at plasma centers can be grueling. Moreover, if you’re starting out in the profession, chances are the pay might not be much better than what “donors” themselves receive.
Because she didn’t have a certificate in phlebotomy when she was hired, a phlebotomist who worked at Biomat for eight months was given a starting wage of $7 per hour. “We would work between 9 and 11 hours a day. We each handled about 25 donors. There was a lot of pressure on the job, and because the pay is so low, there is a high turnover rate for phlebotomists,” she said.
The phlebotomist asked that she not be named because she still works in the plasma center industry.
Many would-be “donors” at Biomat did not pass protein and iron-level screenings. Fainting was not uncommon.
“Some people would faint when they saw the needle and some would faint because they felt weak,” she said. “We had some people faint because they got up too soon after they finished having their plasma taken. Biomat doesn’t have any food or juice there for the people, but they do have icepacks for them to put on the backs of their necks.”
She said “donors” are desperate to come in more than twice a week because they need the money.
Plasma centers first appeared on the American urban landscape some 30 years ago, but it could be argued that the forces that put them into motion are as old as American capitalism itself.
American labor and natural resources have been exploited whenever the opportunity has arisen. In the early 20th Century, immigrants worked 80-hour weeks for low pay in Chicago’s meatpacking plants, New York City’s garment industry sweatshops, and the dangerous conditions of Colorado’s coal mines. When workers had the temerity to organize unions, the consequences were dire. They were arrested, beaten, and sometimes even tortured. During this period, more than a quarter million children aged 10 to 15 worked in mines, factories, and mills. Child labor remained common in the United States until WWII.
Eventually, some of the worst conditions changed for the better due to the public outcry caused by books such as Upton Sinclair’s The Jungle, not to mention the horrific events of the Triangle Shirtwaist Company fire. The organizing efforts of activists Big Bill Haywood, Eugene V. Debs, and Mother Mary Jones helped bring bargaining power to American workers.
Of course, workers are much better off today than they were in the early part of the last century. Americans have been granted the minimum wage, workers’ compensation, weekends off, health insurance (sometimes), overtime pay, and the right to organize a union. But even today it’s still possible to find illegal immigrants working the nation’s sweatshops. And everyone acknowledges that the labor movement is stalled. Union membership is in decline. Companies such as Wal-Mart employ hundreds of thousands, none of whom belong to a union.
Now more than ever, it could be argued, the nation’s low-income wage earners are dispersed over a wide array of companies and employment sectors. That dispersion has effectively diminished their collective power. As Abraham Joshua Heschel, a noted author and respected leader of Judaism’s Conservative denomination, said, “As a rule, those who know how to exploit are endowed with the skill to justify their acts, while those who are easily exploited possess no skill in pleading their own cause.”
Anyone tired of a low-wage employment naturally takes one of two courses. Take a more profitable job—if you can find it. Or acquire more valuable skills through education—if you can afford it. Along the way, those in a real bind may visit the local plasma center.
It’s impossible to produce plasma in a laboratory, of course. To get it, you need living, breathing people. And pharmaceutical companies have turned a nice profit from plasma-derived products. At the “donor” end, $40 per week for about 8 hours of work amounts to less than the minimum wage.
Currently, the plasma industry and the nation’s economic underclass are locked in a symbiotic relationship. The underclass needs the cash they get for their plasma to eat and pay rent, and the plasma centers need the underclass for their plasma. If plasma centers stopped taking plasma from those under the poverty line and relied only on middle class “donations,” they’d no doubt find themselves paying more for plasma. Paying the poor for their time spent “donating” seems much more cost-effective.
Plasma centers must tolerate a variety of inspections and oversight. The Food and Drug Administration, the Centers for Medicaid and Medicare Services, the Occupational Safety and Health Act, as well as various private licensing agencies, all regulate them. However, the playing field is even since the plasma industry has its own organization, the Plasma Protein Therapeutics Association (PPTA), to advocate for them. One of the PPTA’s primary roles is to “develop strategic initiatives that enhance the industry’s regulatory environment.” Of course, “donors” have no such organization advocating on their behalf.
It’s certainly true that plasma collected from these centers is used for the development of many crucial medicines. Representatives with the PPTA, which keeps its North American office at Annapolis, MD, elaborate at length about how plasma plays an integral role in blood-clotting products for hemophiliacs, immune deficiency therapies, protienase inhibitors for those with specialized genetic deficiencies, and is a vital ingredient in albumin, which is frequently used in the military for soldiers experiencing shock or extreme loss of blood.
Without the collection of plasma, many people with terminal medical conditions would live lesser lives—or die. Whether or not “donors” supplying this vital substance receive fair compensation is open to debate.
Kevin King, communications manager for the PPTA, readily admitted that the association has no hard and fast figures on who most donors are.
“I don’t know who would be the average donor, but I don’t think it would be inaccurate to say that they’re a wide variety of people,” he said.
What he can state with utmost certainty is that every donor at plasma centers nationwide must be deemed healthy enough to donate after a rigorous screening process.
But while the PPTA might not possess a profile of the average “donor,” that doesn’t mean some sort of profile can’t be discerned. Interviews with more than 35 “donors” conducted over a one-month period offer one picture of who these people are. Only five of those interviewed said they visited a plasma center solely to help others. Of these five, none said they had ever donated to the Red Cross, which does not pay its donors. The remaining 86 percent said they did it for money to pay rent, heat, or purchase food.
Though currently unemployed, Scott Kooring, a male in his early 20s, has held various low-paying jobs over the years. He’s worked as a landscaper, janitor, and in the fast-food industry. Money he makes selling his plasma is used for trips with his young son.
Keisha Carbone, a woman in her late 20s, works full time with the disabled at a local community center, but still sells her plasma for gas money.
Wayne M., a 39-year-old ex-con who once worked making plastic flooring, has no illusions about finding another job any time soon. “This is a conservative state, I don’t stand a chance at getting most jobs because nobody will hire an ex-con. Six years after being released from prison, I’m still being punished for what I did,” he said.
For him, plasma “donation” is a last resort. “If not for the money I wouldn’t be trying this. People shouldn’t be selling their blood, but I have no choice. My rent is paid through the end of November, after that I don’t know what will happen.”
The Red Cross takes a diplomatic approach when talking about plasma centers.
“Plasma centers have their own role to play,” said Judy Christensen, communications manager for The Red Cross’ Salt Lake City office.
Christensen plays down the fact that plasma donation centers compensate people for their time, while the Red Cross traditionally does not.
“The Red Cross is known to donate blood to those who need it. It is seen as a direct conduit to the needy. Perhaps the connection between those who need blood products and the plasma centers is not as clear in people’s minds,” she said.
That, perhaps, is the point. Plasma centers are conduits for the profits made from plasma-based products. They are commercial entities. Biomat’s newspaper advertisement declares: “Earn $155 a month while saving lives!”
The financial incentive maintains the steady stream of plasma pharmaceutical companies need. The proclamation to “saving lives!” could be seen as a salve to people’s pride. It lets them believe there are some out there worse off than they.
“This money will buy food for my family, but some poor sap would die but for my plasma,” they might say to themselves. Understandably, the plasma industry embraces this view, at least when you read between the lines of some of its advertising.
On the other hand, the industry steadfastly maintains that the people providing its most important ingredient come from all income levels. Andre Buechner, head of marketing and corporate communications for Baxter, is confident that, “People who donate want to help people who need plasma-based products.”
That draws a smirk from some who work on behalf of the less privileged.
“Oh sure, of course they do,” said Gina Cornia, executive director of Utahns Against Hunger. “I’ve never encountered a person who donates out of the goodness of their hearts. It’s always to get money they desperately need. I can’t believe someone would say that with a straight face.
“We see people doing it to pay rent and utility bills. They’ll go to the pantry for their emergency food needs, then they’ll go to the plasma center to pay for their other needs, like heating or rent.”
Cornia said Utahns Against Hunger’s food pantry has seen an increase in visits from regular patrons, as well as an influx of new faces. “It’s getting progressively worse for folks,” she said.
It’s certainly not news to Jeremy Rosen, staff attorney with the National Law Center on Homelessness and Poverty, that low-income people might form the majority of those selling their plasma. “What’s particularly undignified is that people are doing it to make ends meet. That needs to be contrasted with emergency times, when people donate blood for free. That’s an example of a philanthropic spirit.
“The ethical and moral dilemma is that, in this case, people feel almost forced into doing it because, if they don’t, they could find themselves out on the street. I feel they do it as a last resort.”
Rosen recalls seeing advertisements for plasma donation centers during his own years as a student. Thankfully, he says, he never needed to resort to selling his plasma. But it always seemed implicit to him that such centers worked on the understanding that students represented a low-income population that could use the extra money.
“We believe there should be other choices for people rather than having to sell their plasma. Access to social programs, jobs, and affordable housing is the answer,” Rosen said.
Chris Healey, executive director for PPTA North America, takes exception to such comments. “When I attended college at the University of Florida I was a frequent donor there during my student days and found it a rewarding experience. Then, when I got my job in the plasma industry, I donated here in Washington, D.C.,” Healey said.
The fastest-growing locations for plasma donation, in fact, are located not only near college and university campuses, but near military bases and even in the suburbs. Many suburban donation centers, said Healey, come equipped with play centers for children. Parents may “donate” knowing their kids are kept safe, then perhaps run an errand to the grocery store. The only discrimination the plasma industry makes is between healthy and unhealthy people.
“Beyond that, we don’t keep personal inventories of their ethnic or socio-economic backgrounds. We draw the line at the fact that they’re there of their own volition, that they’re a repeat donor committed to the process and, first and foremost, that they’re healthy.”
And plasma donation centers aren’t the only entities compensating people for their time on behalf of science, medicine, and the general welfare of the public. Universities pay people participating in studies. Therefore, plasma donation centers simply follow that line of precedence.
“I think it’s wonderful that, no matter what your socio-economic status is, you find time to make this gift. I think it’s a wonderful thing,” Healey said. “I know of staffers on Capitol Hill who make these donations. I know people from all walks of life who make these donations. Some will even take the money they’re paid for their time and contribute it to a medical charity.”
And business seems to be booming for the plasma industry. According to the PPTA’s own figures, donations have risen by some half million. From January to June of 2001, there were roughly 6.3 million donations at plasma centers across the United States. From January to June of 2002, there were roughly 6.8 million donations at plasma centers across the United States. That’s half a million more fists pumping out plasma nationwide.
Ultimately, economic reality is on the side of the plasma centers. With the current recession, there’s no shortage of people indifferent to the question of whether it’s their time, or plasma, that they’re selling.
As Treas said, while standing in the ZLB Plasma Care Services parking lot after selling his plasma, “Dysfunction is necessary for these places to survive.”