Transcripts For CSPAN3 After 20240704

Hi. Thank you so much for joining us. Im here today talking with kathleen mcglothlin, whos written an incredibly important and deeply reported book on the blood industry, which is kind of th almost dystopian seeming world. But its a huge economy and industry here in the United States. And kathleen, i wondered if you could start by telling us a bit about your own personal connection to this industry . Of course. So its really nice to be here with you. My interest in the blood plasma industry began about 20 years ago when i was diagnosed with a rare autoimmune disease, and the treatment for that illness is a medication that is made from pieces of human blood plasma. So its called intravenous human immuno globin or ivig for short. I think most people whove never had to take it have never heard of it. Maybe its not a common drug, but it is made from other peoples blood plasma and so for about 20 years, often on, i have been having regular infusions of this medication. And it takes a long time to have these infusions five or 6 hours each time. And so a lot of time to sit in a chair and wonder where its coming from and who are these people that are providing the plasma that i depend on in order to maintain a very normal life . So thats kind of where it all began. For me, its a really personal story. Yeah, and that really comes through in the book. It starts with this story, incredible story of you smuggling other peoples human blood into china, which sounds like it was almost routine for you. Why . Why were you doing that . Why did you have to do that . Well, shortly after i was diagnosed with this disease, i moved to china to work as a foreign correspondent. And this was a period in china that was just after an aids catastrophe that was born within the human blood plasma system. So back in the 1990s, china had tried to create something they called the plasma economy. And theres pretty substantial documentation showing that what china wanted to do was be a leading provider of blood plasma for medications around the world. And the reason they saw themselves as this country that could do this is that they did not have a big hiv aids outbreak like a lot of other places in the world. So they created this system, in particular in one poor province called Hunan Province in central china, where they would pay farmers for their blood plasma and then use that plasma to make medications. Now, at that time, we didnt know quite as much about how hiv and other viruses were spread within blood. So it was a it became a very unsafe collection system. People were reusing needles and tubing and other equipment. It wasnt sanitary and so a whole lot of people contracted hiv and aids and died because they had sold their plasma. Now, by the time i moved to china in the early 2000s, there were still concern about the safety of the countrys blood supply. And i knew that i also knew that i was using a drug that was made from human blood. So it was safer and easier for me to smuggle this medication into the country. And it was smuggling because one of the few questions on the chinese entry customs form in the entire time that i lived there about specific products was are you bringing human blood or blood products . And i always checked, no, i guess it did you say it sounded routine and to be honest, it felt routine to me. And the reason was if i was never selling it, i wasnt doing it for a personal profit was basically my own medication supply. So while it was technically against the law and the rules, i didnt ever really feel that troubled about it, i suppose. But doing it, knowing that i needed to do it really prompted me to investigate what had happened in china and the ongoing concerns of the blood system there and the risks for Chinese People who didnt have the privilege that i did to get medications from other countries. And you you know, you said yourself how useful this plasma is. I mean, essential for you and your condition. But i just think its important to establish what is this used for, you know, what is the medicine and how important is it to people with various diseases, of course. So maybe i should step back and just explain plasma. So plasma is the protein component of blood. And when you donate or sell plasma, they separate your blood into parts, keep the protein part, which is kind of this yellowish watery substance, and then they put the rest of the blood back into your veins. The plasma can be made into many different kinds of medication. The predominant medication its made into is human immunoglobulin, which is used to treat a lot of different illnesses. So people with primary immune deficiency, people with my illness, people with something called guillainbarre syndrome, there are a number of autoimmune conditions where this medication is used. There is a pretty serious childhood illness thats quite deadly. Where this medication is used, plasma is also used to make things like albumin, which is a very common drug used in surgery. Its also used for drugs that hemophilia clinics rely upon. So its made into medications that are both essential and quite common. It is made into medications u. S. Plasma is made into medications that then go around the world. And you were talking about what you saw in china and obviously what happened with aids was, i mean, badly, but it sounds like they were also quite extreme economic consequences, especially for the province where it was so common for people to donate plasma. What did you see that right. So it was quite interesting. I, i was in china a decade after the crisis had hit and went back there many times to do reporting in the years after and in that period, the early 2000 through the early 2010. And as china was booming in a particular rural areas, were really picking up and booming, you know, there was factory work, there was new development, there were entire new cities being built in the parts of the province where the blood plasma economy had gone wrong and there had been this devastating aids outbreak. It was the cities and the villages and the towns were much poorer. The Economic Development didnt hit there the same way it did in other parts of rural china. There was still an incredible amount of stigma around these places. I would say there was still a lot of Government Intervention in covering up the epidemic. And so people werent so free to come and go and do the things that they might have been able to do in other parts of china. Not to mention there was a there was a massive death toll. I mean, we still dont know how many people in china died from this outbreak that was created by the plasma economy. The best estimate that i have seen, or i should say one of the most informed estimates that i have seen is around a million people. We dont know, though. We just have no idea how many people were infected and how many people died. I interviewed some some people who had survived the aids outbreak in Hunan Province. There was one man i met in particular who told me that 25 of the people in his village died. They had all been in plasma to earn extra income and everyone started getting sick. All of a sudden at that time there was very little education in china regarding aids. It was a different social situation than there was in the United States. Regarding education and awareness. And so a lot of the people he told me, got sick and died without ever knowing what had killed them. So there was this there remain warning stigma around it. Even ten and 20 years later, i think still held these places back and has never quite gone away. Yeah, it sounds like i mean, just a horrendous tragedy and so many people and you said in your book that early on, i mean, you were relying on us plasma even when you were living in china and you kind of assumed that the us had a better system than what you saw in china. When did you start to maybe reconsider that. Thats a good question. I have to think about it. So i definitely fell into that really easy trap of believing in american exceptionalism. I was writing about the plasma economy in china on a regular basis. I was meeting people who had been involved, who had exposed it. I was learning all sorts of things about it, and i thought, oh, china is the only country in the world that would ever create something called the plasma economy. Its so dystopian sounding and so odd. And i began kind of thinking about what was going on in the u. S. I knew about these Plasma Centers i had some friends who had sold plasma. I knew some people who live near Plasma Centers. And i was aware of their existence, but i didnt really understand how big the plasma economy was in the United States until i moved home in about. 2016. And i wanted to interview the woman who had blown the whistle on the catastrophe in china. Her name was wong shooting. She had fled china and was living in exile in salt lake city, working as a medical researcher. She was working on liver cancer researcher there. Wang shipping was quite interesting. She worked at the government run Plasma Centers in Hunan Province when the outbreak was happening, she was in charge of monitoring the health of donors and she noticed an uptick in donors of hepatitis c, which is a blood borne illness. And she knew that hepatitis c and hiv often traveled together. So she was very concerned. She began testing the donors for hiv, and she found that there was hiv within the system and she knew it was going to be a catastrophe. So she alerted her superiors, she alerted up the chain in the Central Government in beijing. And she was basically silenced and she lost her job. She lost her career. She tried to keep going in china as a researcher, but she was really pushed aside. So she ended up applying for a bunch of jobs in the u. S. Very quietly and eventually found herself pretty happily settled in salt lake city. So i went to meet with her there and she was she was a very interesting person. She was a little tiny woman. She had the biggest smile. She was really happy. And i had met a lot of dissidents from china who werent quite as her english name was, sunshine, and that completely captured her. I had met a lot of artists from china who probably wouldnt be called sunshine. Theyd been through a lot. She had been through a lot, but she had this incredible attitude about it. By the time i met her, she was really surprised because it was 25 years after the fact. She really surprised that anyone was still interested in what had happened back in china. So i spent a few days with her in salt lake. We really hit it off. We talked about and we did a lot of interviews. We talked about kind of everything and then toward the end of my visit with her, she said, i want to show you something. And i thought, you know, who knows what this could be . She was very interesting woman and she drove me to a strip mall in downtown salt lake, right to a Plasma Center. And she said, we need to go in and find out whats happening because this remind me of what i saw back in china. I dont trust it. So we went into the Plasma Center and she asked a bunch of questions about how they operated their cleanliness standards, how they ensured the health of the donors. And we laughed and i said, what did you think . And she said, its too fast. They are open seven days a week. This is salt lake. Its a religious town. You know, salt lake is still pretty heavily mormon and these Plasma Centers were operated at the same speed that she had seen back in china. And so i said to her, do you think theres any risk of viral contamination . And she said, no, but theres Something Else here that doesnt seem right. Its its too much. And so that really, for me, kicked off the understanding of how big and how embedded in our society this industry has become. And from there, i kind of launched into trying to figure out who was donating plasma, who needed the money, why were these centers increasing in number and what and what does it all mean . Unfortunately, once you ping passed away before they spoke was published, she died right before the pandemic, but it kind of gave me a little more fortitude to carry on with the project. I guess. Yeah, i think so. And credible that it was this whistleblower from china who first said to you something isnt right. Heres having seen the worst of it in china to say, we need to look at whats happening here in the United States. And you i mean, you wrote in your book, i think that theres the industry, see, in 2021, american blood products were more than worth more than 24 billion in worldwide sales, which is huge. Can you can you put that in context, just how significant of an industry is this . Well, i mean, the most kind of thing that people like to say is its a bigger export for the United States than soybeans. So if you think about, you know, were were a farm exporter, we export our crops, we export more blood plasma then certain popular farm crops. Its a huge industry. Its a huge export. It had a conversation a couple of months ago with someone who was asking me about the kind of global connectedness that this industry. And they said, is there a country, a developing country somewhere in the world . And that kind of provides all of the worlds plasma. Is there a country somewhere where you can really see, you know, this is the place where were getting all the plasma . And i said, yeah, its the United States. I mean, we are the country that has a big enough population and enough of that population who is living on the economic margins that we have become a primary source country for the rest of the worlds blood plasma and i mean, given how big it is, i mean, it just truly enormous, as you say, bigger than soybeans is striking that is not talked about more, but it seems in some ways in some cities in the us to almost be hidden and overlooked and you know, there hasnt been that much attention on it certainly before your book. Why why do you think it is that this industry can both be so large and yet somewhat hidden. Yeah, ive thought about that. A lot. I think that it is primarily, you know, the United States is a country that likes to pretend we dont have a class system. And i think this is a prime example of something that is deeply rooted in socioeconomics and class race. And if, you know, you know and if you dont know, you dont know. So if you are of a certain socioeconomic class or you have friends, you are its very likely that, you know, people who have sold plasma, if you grew up upper middle class or wealthy and you live in a wealthier area, its very likely you dont know anyone whos done it. And you assume that its only the poorest of the poor. And i think that as a society, were just not very good at talking about class. We as i said, we pretend it doesnt exist. We pretend it doesnt define every component of our lives in this country. And so i think that selling plasma, well, it is increase notably common and its become an incredibly important source of income for a lot of people. We dont see it as i guess we dont see people who need to do it for that reason. And at the same time, people who do need to sell plasma in order to get a higher income stream. I think that they have been discouraged from talking about it openly because a lot of people think of it as, oh, its gross, or you know, its icky. Blood is icky. Thats gross. The piece about that thats really fascinating to me is if you compare selling plasma to donating blood. So in this country and i would say around the world, its valorized to donate blood. You are a great person. If you were a regular blood donor, you are almost heroic. If you are someone who donates blood on a regular basis, you dont get paid. You are not allowed to get paid for whole Blood Donation in the United States and most other countries. If you sell plasma, which plasma is just as essential to making medications for people like me, it is seen as some sometimes kind of a joke. Ive heard people joke about it. I have heard people be dismissive of it a lot of people i have spoken with whove never had to do it think that its no big deal and think that you know why should i care about that . So there is this real divide. Its been really interesting to me since i started working on this book. The divide between who knows about this and who doesnt and the way that people have opened up to me kind of in the aftermath about difficult periods in their life where they needed to sell plasma to get by and when that happens, i asked people like, does your family know about this . And they usually say, no, i didnt want to worry them. I didnt want to concern them. So i think theres a its both sides. There is the piece of people who dont know about it. Theyre not talking about it because theyre economically more comfortable and dont know that this is a big issue. And then on the other side, the people who are selling plasma are not made to be comfortable in discussing it openly. So its just kind of this perfect storm thats created a massive thing that no ones really talking about. And you said you set out to find out who it is, whos selling plasma and why. And you mentioned just now that it seems like a top up when people fall on hard times. I mean, what did you discover . Sounds like this is really a kind of the full salary is more an additional income stream. And what else did you find out about the motivations of people who who sell their plasma . Thats right. So the only people i went to, i went to three different places for the book that are quite different demographic and different regions of the country. I went to flint, michigan and rexburg, idaho, and the usmexico border near el paso, texas. I would say that of those places, the one place where and where people really do depend on selling plasma as their primary income stream is the usmexico border. So at one point before the pandemic, there were 10,000 mexican citizens a week crossing over into the u. S. To sell plasma. Now, the reason for that is mexico, like most every other country in the world, bans the payment or bans paying people to donate plasma. And so the attraction is for mexican citizens to come into the u. S. To earn money by doing that. That was really the only group that i encountered where it could have been a primary income stream. And thats just because wages are so much lower in mexico than the United States is in rexburg, idaho, which is a Mormon University town. I found one of the primary groups of people in the United States who sells plasma, and thats College Students. I mean, this is an industry that markets to and targets College Students like maybe nobody else. So if you are in a city with a large university, particularly a Large Public University where a lot of the students arent wealthy, you will find at least one Plasma Center, rexburg, which is a tiny little town, has two. Rexburg has maybe 30, 35,000 people and they have two Plasma Centers. And it is just incredible valley common and this is, you know, University Education is expensive and we dont give College Students much help. And i think back to when i was in school and working full time, its really difficult to Pay Attention to your education and work at the same time. And so i think for a lot of students, this is seen as something that is economically beneficial. You can make a good chunk of money and you dont have to have a job that eats into your studies as much as much as you might otherwise need to. Now, in flint, there are a lot of people down on their luck who are selling plasma. I would say more so than the other towns that i went to. But i also met several people who are just doing it to supplement their incomes. You know, flint was really if you talk to people in flint, they will tell you that that city was the birthplace of the american middle class. And everything thats happened to flint in the last 30 years has sunk the middle class. And so these are people who are working full time and in jobs that would maybe used to 30 years ago would have provided a decent income and a decent life for a family. But its not enough anymore. So wages havent kept pace with inflation and other costs. So people are doing this, like you said, to really top up their income. I mean, ive met people who have who sell plasma to afford to take vacations. I met a young woman who had sold plasma to go to a friends wedding. Ive also met people who sell plasma to buy groceries. Its really runs the gamut. But i would say the primary some of the primary targets are mexican citizens who live on the borderlands. College students, and then people who live in economically deprived parts of the United States. The rust belt is full of Plasma Centers. And you interviewed so many people for this book. Was there a particular story that kind of stood out to you all or meant a lot and kind of encapsulated some of the problems that youve been exploring there . There were so many. The one person i really think of a lot is the woman i met via zoom, because this was during the pandemic in texas who had gotten into a lot of legal trouble when she was young. And it was mostly traffic tickets and they just built up and built up and built up. And she finally found herself in a situation where she had to pay off Exorbitant Court Fees and fines or she was going to end up in jail. So she started selling plasma to pay off her court fees. And it was really her story for me, really illustrated how people can get trapped in poverty in this country and punished for not being wealthy rather than assisted. You know, she really felt like she had no options. Other than selling plasma to pay these fees off. And she was a single mom. She had enrolled in college. She was really focused on her studies. She was really trying to improve her life. And it was really, really difficult for her just to earn this money. She needed to pay off a few thousand dollars in court fees and fines in something she said to me. I just sticks with me all the time. She said it twice. She said id sell a kidney if i could, and i think there are a lot of people in that situation in the United States who would be willing to sell pieces of themselves in order to get out of a bad situation or to improve their lives or to improve life for their children. So she, you know, was it hers was a sad story. I dont think it will be a sad outcome. Shes pretty driven to fixing things and making things better. But just hearing how difficult it was for her to dig out of this hole was was really powerful for me. And you said earlier, you know, some people think that selling plasma is no big deal and that, you know, at least its easier than selling a kidney. But what i mean, what is the experience of selling plasma like and what impact does it have on the people who are going through it . So i would say out of all the people that i interviewed there, there was almost no one who said they didnt notice anything. There are a few people who were like, yeah, i didnt notice anything at all. The most common thing i heard from people is fatigue. And so a lot of people get extra really tired after donating plasma. Its you imagine their pulling the protein out of your body. You imagine what that might make you feel like. I have a donated before im banned from doing so because i am recipient of human blood products. So i dont know the feeling myself, but the way its described to me is extreme fatigue. One person i interviewed described it as bone crushing fatigue. One woman i interviewed told me she had go to sleep for the rest of the day after she donated plasma. Theres also. Spoke with people who would feel sick to their stomach, headaches, lightheaded, dizzy. I think about one young woman i met outside of a Plasma Center in rexburg, idaho. I believe she was 19. She was a college student. Tiny little young woman, and she was so chilled by the process that can be very cold because theyre re injecting cold fluid into your body at the end, she was so chilled that her teeth were chattering. The entire time that we were talking. The other part about that, you hear a lot from donors are the scars. So anyone who does this long term ends up with these divots in the crook of their elbow. And, you know, you know the place on your body where you might have blood drawn. Theyre really easy, juicy vein. Thats normally where the Plasma Center will stick the needle to extract plasma. If youre having that done twice week, its going to leave scars. I had dinner a couple of weeks ago with some friends who are in their early thirties, and i didnt know they had sold plasma, but they were telling me that they did it when they were first starting out in their careers, and they did it for about three years, twice a week, and theyre stapled still have the scars. And this is six or seven years later. So the scars are a big thing. People i think that a lot of people are concerned about the stigma that comes with the scars ive ive had plasma donors tell me that they worry even though the scars look nothing like intravenous drug use scars, they worry that if someone sees them, theyll think theyre a drug user. So that is a part of it. I will say so theres theres been a few long term studies about the potential Health Impacts there. Theres one that indicates peoples protein lowers pardon me, protein levels are lower. If they donate long term. There was a long term study in china of plasma donors that fatigue led a lot of people to stop working early. So it really had that impact. I will say anecdotally that people who donate long term their Health Problems or their teenage seems to go away when they stop. So it doesnt seem to be something that lingers in for years on end. It seems to be symptomatic of when youre doing it. And also, i would say the the physical effects do seem to tend to depend on how often people donate. So the people that go twice a week are the ones that ive heard the most from uncomfortable side effects or fatigue or headache or things like that. I want to read a bit from your book where you talk about, you know, the people who donate plasma. You know, theyre expected to have a good diet, say that theyre healthy. And youre right in thinking about the nutrition aspect, i find it hard not to make brutal comparisons through the loing glass of the plasma economy. Human beings treated as livestock, kept alive anfed, just barely well enough to ensure the blood flow is coming. The industs success, at least as measured in the number of clinics and their humming busynessseems an insult on top of the decades of injury that flint has already suffered. And i think that idea of human beings as livestock is really devastating. But what what did you see that made you think that and make do you draw that comparison said, oh, oh, it was. I went inside a Plasma Center in flint, michigan, and a tour and its so mechanized and structured and sanitary, it just feels like Science Fiction. Theres real rows and rows of chairs and people are seated in the chairs reclining, strapped up to these machines. Thats part it. The other part of it was talking to donors about what they have to eat in order to feel okay when theyre doing this. So whats really interesting to me is, again, ill go back to the Blood Donation comparison. If you donate blood that at least gives you a cookie and some juice to make you feel better at the end. If you donate plasma, they wont give anything unless youre on the verge of passing out. So the profit margin is so much more important. I think, than tiny Little Things that would make people feel better. People are instructed and when they donate frequently, the companies will tell them a proper diet. And to heidi rate appropriately. But theyre not being given subsidies to pay for these things. You know, theyre told eat high protein diets like thats well known among plasma donors but theyre not being compensated to to pay for high protein diets. So it is this it is this almost dystopian thing of expecting people to eat certain things and then extracting parts of their body. That made me feel very much like it was agricultural in nature. And i did have a couple of plasma donors say this me that they felt like cows being milked which sounds like a very grotesque comparison. But when you see it, its hard to unsee it and you spoke to one person outside of a Plasma Center where, you know, if you donated incredibly regularly several times month, you could be paid 1200 dollars a month. I think for several donations. And, you know, you told them when you look at your bills from your the medicine you receive a dose of plasma costs, your Insurance Company, 12,000. What makes up that difference . The very good question. I mean, these are private companies that arent transparent about whats happening in the middle. So what i can tell you is this first of all, the price of my specific drug has gone up. This year. Its now 13,000 a dose. It seems to go up every year, but its gone up since i wrote the book, which is kind of staggering. What happens in the middle, though, and i can tell you for my specific drug, my drug is made from the immune particles of the plasma of potentially thousands of different people. So its not a 1 to 1 equation. Its not paying someone 40 for something. And then me paying, you know, my Insurance Company paying 13,000 at the end there is a lot that goes on in the middle. There is treating the plasma with heat pasture, raising it so it doesnt carry the risk of infection. There is making it into this mix of this proprietary mix of chemicals that then works as my drug. But we dont really know. I mean, theres profit in the middle a lot of it is profit. Theres certainly is technology. And. I would say, you know, years of research have gone into making these drugs, these are pretty old drugs, though. These are not revolution theory drugs. Ivig has been around for a long time. So this is not a cutting edge medication. Its just made from the pieces of a lot of different people and there is a lot of profit in between. As you noted at the beginning of this, were talking about more than 20 billion in profit in i believe that was 20, 20. And the number has gone way up since. And who is profiting is that the predominantly the Plasma Centers . You know, there a companies i think all over the world buying this plasma. You know who is profiting . Yeah. I mean, think its a lot its like a lot of things in our health care system, which is a lot of the profits come out in the middle. So the plasma industry is very interesting in the u. S. The u. S. Is the big plasma source, but its very much a global industry. A lot of these companies are multinationals that own the system from beginning to end. So, for example, my particular drug is made by a Company Called gryphon. Rs that company is based in spain. You can sell plasma at a riffles Collection Center in the United States. Grifols products are sold all around the world, so they csl is in Australian Company that has a system. I would say. So a lot of these companies own the plasma Collection Centers. They also own the places where the plasma is made into medication. They also make the medication and sell it back to patients. So they kind of own it from beginning to end. Theres there are a lot of other companies that make medication, plasma that dont own the Collection Centers. But the three biggest do and its whats interesting to me is to the three biggest are not based in the united so the United States is really a source provider for these companies which then turns into medication and sells them around the world. And a lot of countries, i mean, you mentioned, especially in europe its you cant sell plasma, but those countries it sounds like its not like they have a different solution are just depending on the supply from the United States where it is sold that right thats and i think that again were talking earlier about how this is kind of a hidden industry. Certainly hidden to people in other countries. When i wrote the book, there were five countries that allow people to be paid for plasma donations. The United States is far and away the largest of the five. So ive had conversation since when i was first working on this book, i had a conversation, well, several conversations with people in switzerland. I happened to be there doing some work and i was telling them about it and they were just appalled, oh, people in the United States could get paid for plasma donation. You know, you go to a country that has universal health care and some other guarantees of basic living allowances. There really werent right that americans asked to do this. But at the same time, countries like that are dependent on americans because a voluntary plasma donation system does not provide enough plasma to meet the global demand. And he said as well, i mean, youve mentioned already what happened when you visited paso. I mean, as you said, i think 10,000 mexicans prior to the pandemic would go across the border to sell that plasma every week just how important is that supply . Is mexican blood supply to the us plasma economy. Thats a really interesting situation there. I was not i knew that the mexican one component of the plasma industry was big, but i did not know just how big it was until i started working on this book. And since the pandemic, there has actually been a major lawsuit that has exposed those to the importance of it. And basically, when the pandemic hit the land border between the United States and mexico was closed, and that cut off these thousands of people who had crossed into the u. S. And depended on selling plasma as an income stream. And in the interim, the border reopened. One branch of the u. S. Government. We reclassified mexican citizens selling plasma as labor, the plasma companies. Then to overturn that class of classification, saying it wasnt labor. But in their court filings, they detailed how important this piece of the plasma economy is. So one of the documents calls the Mexican Border plasma stations the most productive in the United States, meaning they are gathering more plasma than any other collection across the country. At this point, there has been a new ruling that has really allowed mexican citizens to cross into the u. S. To sell plasma. So come back and forth a couple of times since the lawsuit started. I actually spoke with since the latest decision in the lawsuit, i spoke with a couple of the donors who are in my book from mexico and they have returned back to the u. S. To start selling plasma again because the money is just so good. One of the people i spoke with recently, a couple of weeks ago was an english teacher in juarez and he just said, you know, its the its the way to make some decent money on top of my the income that i already get. So its been its really interesting to watch. You know, i think that the plasma companies are probably terrified no good being classified as labor because then that would have implications for everyone who sells plasma in this country. But as it stands right now, the legal situation is that mexicans citizens can return to the u. S. And they have started returning to sell. And davis says its really striking in your book just how much this industry thrives on inequality in it. But talking about the border where, you know, mexican salaries are so much lower than those in the us, you know, people who are struggling to get by. I mean, do you think thats of a necessary feature of this industry . You know, and if so, why . Why does it so depend on that inequality . Yeah, i think that i mean, i think i have begun to see this industry really as a symptom of the problems with the United States economic system. So its like and you often see these businesses together, its almost like a dollar store or a pawn shop or of predatory furniture business. These kinds of businesses that collect in communities where people have been economically marginalized or is by necessity. I do think that we can do better. I dont think that we have to have these predatory industries. I dont think that we need to have all of that profit motivation and margin in the middle its really interesting to me. One aspect since writing this book is i think that people who sell plasma arelso of talking about it because it could jeopardize an important income stream stream for them. But in my opinion, what we should be talking about, theres no rolling back this industry. Were not going to be able to say, oh, we cant pay people for plasma anymore. Its just its too embedded in everything right now. Actually. You think we should be talking about paying people more and making it more of a fair system . You know, unless were actually going to attack things like income inequality, universal health care, the insanely high cost of college education, which we should be talking about, all of those things. There are some steps we could take on the plasma selling and to make it better for people. So it has become you asked if its by necessity. And i think that it has been designed in that way. I dont think it necessarily has to be that way. I do think we can make things better and i mean, as it stands at the moment, one thing i found kind of just a detail that was surprising is how people are incentivized to give repeat donations. Why would it be set up that way . Whats the thinking behind it that dont just come in once you get paid more and more, if you go regularly. I mean, i think its like anything else we do to economically marginalized people in this country. We are not to use too heavy handed of a metaphor, but we bleed them dry. You know, we take back from people in service of profits as much as we possibly can. So the way plasma extraction is set up, if youre a regular donor, you get paid more for the second donation in a week. You will often get an end of the month bonus. You will get friend refer calls, youll get all sorts of bonus points, donating a certain number of times in a month, and thats just too feed this insatiable demand. I think the companies have realized that one of the most valuable things for them is to get repeat donors, tie them into the system, and keep them coming back again and again and again. And one of the ways to do that is the way that we like to do things in the u. S. , which is to gamified things, right . So you talk to people who are plasma donors. They will have a whole system worked out. Theyll have an app on their phone which will tell them their points and their bonuses and their referrals. How much extra they can make in a month by donating x number of times. So its really a thing where plasma Companies Want people to come as often as possible because there doesnt seem to be an end to the demand for this substance. Its an you mentioned that the effects seem to be more severe than people who do it frequently and seem to ease after the selling the plasma stops. But we know with certainty about long term effects and you know, the people you were speaking to, it did sound like that was a concern for some people. Right. That we just dont know what the impact for sure will be. I think a lot of donors are very concerned. I think that a lot of long term donors are not comfortable with what they have been told. I think particularly a lot of people sell plasma when theyre young and think about it ten years later and think, oh, my god, what did i do . I will i will say i dont think there have been enough long term studies. I think that there should be more investment in studying the potential Health Impacts long term, not just immediate risk. I think there should be serious investment from plasma companies in a long term studies on what happens to long term donors. If this is something that they want to continue doing and believe it is safe, they should be able to back that up with science. I dont really know what to say when plasma donors asked me, do you think there is a risk . Do you think that i damaged my health . At this, point there is no evidence that there is or that they did, but i think there should be more robust study to i think that responsibility falls on the plasma companies. At the same time, this is relegated to people who experience poverty or who are in the working class or who are in the poor and working class. Those are people that i am also often that is a piece of what has happened here. Their problems are not quite as interesting as wealthy people. You talked a lot about the stigma and the fear and hesitancy. It sounds like the fact that you benefit from this and you have that personal connection made it easier for people to talk to you. Is that something that you have felt . Absolutely. My method for talking to people in this book is i would stand outside the Plasma Center and wait for people to come out. You can always tell who has been donating. They will have usually a colored elastic bandage around their arm, like a war wounds. I would just grab people like a survey taker and say, hey, did you donate plasma . Can i talk to you about it . Usually, the second or third thing i would tell them is that i am a beneficiary, i am a long term user of plasma drugs. I think several of the people that i meant they have been told as long as i have been donating plasma to save blood. I think it was gratifying for someone to know that this was going to a real person. Selling plasma is a way that you can make money but also give it back. Its promoted as something that is beneficial to society. I think a lot of people who sell plasma dont often meet the beneficiaries like me. That would have felt quite dishonest to me. It was important for me to tell people, hey, i might have some of your plasma. Thank you. It definitely did break the ice. I think that it gave us the connection and beyond the regular source which could be super uncomfortable. It was interesting to see peoples reactions to it. I think some people were not telling the truth at first. It was a weird thing to have. Each talked about being altruistic. I think those are themes in this book. That altruism becomes kind of forced or you have to do it to survive. It starts to feel beyond uncomfortable at times. There was the incident of the judge who would make people selling their plasma. There were some incidents as well. What did you think about those examples and how they relate to the system . Yeah, i think that there is a history of unethical incidents and behaviors that go along with this entire industry. Essentially, they coerced people to give up a piece of themselves in exchange for money. There really is not another way to look at it. I think the ethics are shaky at all times. I think people also now have agency and i think people do not want to be treated as victims in this situation. It is very tricky to figure out the ethics of all of it. You know, i do wonder how many people would donate plasma if it did not pay. I do not think that, i dont think we would have a plasma economy. I dont think we would be this massive source provider of the world plasma. I think it would look a little bit more like the blood system which is something that is domestic rather than a global industry. The ethics of it are very tricky. I dont want to say they dont have agency or the ability to decide to do this. At the same time, i would say every Single Person i talked to, and i interviewed more than 100 plasma donors, money was the primary reason they were doing it. There were a lot of people who saw a benefit to it as well, all truism, giving back to society, they felt good about it, but the number one reason they were doing it was money. I dont know how you can have an ethical system like this when the primary motivation for most peoples financial. You interviewed more than 100 people. At one point, you also went undercover. Why did you do that . What tell us what you saw when you did. Sure. I think i mentioned it before, i cant donate plasma. I just wanted to see the inside of a Plasma Center. Obviously, they are not going to let strangers come in and walk around for kicks. The next best thing that i can come up with was to pretend to have a Job Interview. I showed up at a Plasma Center in michigan for a Job Interview. I spent about an hour and a half theyre getting a tour and a rundown of the operation. I never lied about who i was. I kind of just amid it a lot of things. What was interesting to me is i felt like in the Job Interview itself the primary concern was the management of customer service. They really wanted to hire people who knew how to keep donors happy and keep them coming back. By bad things, i mean missed needle sticks are a major issue. If a donor comes in, a technician misses their vein, it can leave a bruise that will then prevent the donor from and donating for a week which interferes with their financial situation. Customer service was a big thing. It was kind of Science Fiction to me. It looks like there are rows and rows of chairs and people stretched out in them with a needle in their arm that is connected to a centrifuge drawing out of their blood in the plasma and returning the rest of the cells. It is a very well organized thing. People were great. It was extremely unsettling, almost because it was so organized. I dont really know how else to explain it. It felt like i was watching a Science Fiction movie. There was this overwhelming smell of blood which is like copper in the air. Anyone who has donated plasma knows all about this. It is a very clinical, i would say. I did not, i dont know what i expected when i went in. I did not really have expectations, to be honest. I just wanted to learn about it. It was much more sanitized than i had expected which was troubling in its own way. It just felt removed from normal life, i guess. We just have a few more minutes left. Im going to ask a couple more questions. You talked about the things that, the higher salaries. Did you think that will happen . What would it take to get there . It sounds like the kind of thing that people would have to unionize for. Is that feasible . I mean, i think there is power in collective action, right . There are potentially millions of people in the United States who sell their plasma every year. They have a lot of power if they come together and demand better. I think that there is a research theres a researcher at the university of michigan who has discussed plasma minimum wage, transparency around what people get paid, less gamification of the system. Why do you get paid more for a second donation in one week than the first . What is the actual logic behind that . What is the fee for services . I think that what needs to happen is a bigger public discussion about all of this. What do we want from the system . Are we okay with 19 year olds selling their plasma twice a week for the four years that they are in college . Would it be better if we funded University Education and for gave a student debt instead . I think there are all in these connected societal questions that we need to ask. First and foremost, the two things that i think need to be looked at are the payment and also the frequency of donation. Someone who is healthy and meets all of the qualifications can sell plasma at 104 times a year. That seems like an awful lot to me. I think the payment should be higher. Just last minute, one last quick question and then we are going to wrap up. Have you changed your opinion on the u. S. Blood industry being so much better than what you saw in china having seen in both now . How have you compared them . [laughter] i mean, i was just fascinated and intrigued and appalled when i lived in china by this idea of something called the plasma economy. I came back to the u. S. And discovered we created it while nobody was really paying all that much attention. Yeah, i had made the classic american mistake. I am humble about it now. Thank you so much for talking today a thank you for your book, blood money. It is a really important read. I thank you for all your work on the subject. Thank you. This was wonderful. Book tv, every sunday on cspan 2, featuring leading authors discussing their latest nonfiction books. 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