If You Prick Us, Do We Not Bleed?

Blood, Extraction and Regeneration

If You Prick Us, Do We Not Bleed?

Kathleen McLaughlin is the kind of writer that makes you want to be a reader. 

She writes about class, systems and - most vitally - the people within them. I know a lot of journalists write in that space! But so many of them frame their work kind of like “this little town in the midwest is not like New York City at all!” And while I love NYC as much as the next (west coast*) woman, I don’t think it should contextualize the lives lived outside its borders. 

*which means it’s an ardent but very complicated love

Kathleen meets people where they are and tells their stories within the context of their own lives. It’s the kind of reporting that requires an extra measure of openness and a constant practice of humility. And never have both been more present than in her new book, Blood Money: The Story of Life, Death and Profit Inside America’s Blood Industry. 

Kathleen has a rare autoimmune disorder. Without treatment, the disorder takes away the use of her hands and legs. Luckily, it can be treated with a drug that is made from other people’s blood plasma. 

Plasma is the liquid part of our blood that doesn’t have blood cells. It is rich with proteins that do things like clot blood, maintain blood pressure, transport hormones and assist the immune system. It’s a kind of liquid gold, kind of literally because plasma is a golden yellow color! Transfusions of plasma, and plasma-made medicines, can really help people suffering from certain chronic conditions, autoimmune disorders, burn victims, and even people with sepsis. 

When Kathleen needs treatment, the transfusion takes up to six hours. Many of us would binge Derry Girls during the transfusion and then go home relieved. And I am sure Kathleen does that. But she also did what many of us would not do. She wondered about the people who donated the plasma that made the medicine that treated her illness. The people providing the plasma had to be healthier than Kathleen to donate, but that didn’t mean they were being treated well. How can she be relieved if they are burdened? 

So few of us are willing to question the systems our lives depend on, whether it’s the global care chain or the global plasma chain. But Kathleen spent a decade investigating the very system that keeps her hands typing and legs moving. She found a “$20-billion-a year business she found at the other end of her medication, revealing an industry that targets America's most economically vulnerable for immense profit.” 

I write a lot about how our form of capitalism is increasingly based on extraction. Kathleen’s reporting on plasma donation shows that many of us are being mined in ways more literal than data extraction. 

People in America overwhelmingly donate plasma because there is no meaningful economic social safety net. Most plasma donations take place in plasma centers where people can be paid for their “time.” If you’ve lived anywhere outside of where Marc Andreessen is willing to live, you’ve seen the centers. A lot of you have seen them from the inside. As the middle-class is hollowed out, more and more people are turning to plasma donation to pay for groceries, school supplies and diapers. Plasma centers allow donors to come in up to twice a week, despite the fact many donors report feeling fatigued and rundown after frequent donations.  

The book made me so furious, I threw it across the room three times. But I always picked up again because it’s a brilliant synthesis of history, reporting, and memoir. It moves seamlessly from the Hungarian noblewoman that sought eternal youth by bathing in the blood of young virgins to the Silicon Valley startups that promised anti-aging treatments with young blood plasma transfusion. From a busy plasma clinic in Flint, Michigan to the international corporations that depend upon blood drawn in America. 

As I read through Blood Money, I realized that care work and plasma donation are sisters. Blood and care work are regenerative resources. We all need the care of others, and many of us at one point or another will need whole blood donation from one person, or parts of blood of many.  Right now, capitalism extracts care and plasma to the point of exhaustion. It doesn’t have to be this way. But before we can make things better, we have to understand them as they are right now. Kathleen helps us understand. 

Blood Money comes out on February 28th. Please consider supporting Kathleen’s work while also gaining new understanding and pre-order Blood Money today. 

You can find Kathleen on Twitter. Okay, on to the first homeculture Q+A with the lovely Kathleen McLaughlin!

The first time I noticed plasma donation centers, I was attending college in Utah. A lot of my friends donated plasma several times a month to help cover expenses. I know this happens in a lot of college towns, but there is something unique about how plasma centers are perceived in places that have a large Mormon population.  And I think you really capture it in your book. 

Mormons used to be very pro-government social safety net. This is not really surprising! In their early history, Mormons cultivated non-nuclear family kinship in a religious-state founded on communal living. Even once the nuclear family became central to their culture, they overwhelmingly supported things like the New Deal. But since the 1930s, there’s been a real top down push against the idea of government benefits. People in Mormon leadership - like Ezra T. Benson and J. Reuben Clark - were adamant that government benefits led to communism and communism led to …well…hell on earth, I guess. 

The modern LDS welfare program was created as an alternative to the New Deal.1 The idea was to keep Mormons off government benefits. In 1976, one leader compared government welfare to slavery, “slavery entered into by one’s own choice is no less slavery than that imposed upon him by external force.” Instead, struggling church members were expected to use LDS welfare services, which they were expected to work for as church volunteers. And expected to get off of as soon as impossible.

This cultural shift impacts people outside of Mormonism. Our country’s social safety net is weaker because of it. For example: 
Senator Mike Lee’s opposition to child benefits without work requirements is a direct descendant of Benson’s push against government safety nets. 

You spend a lot of time in LDS communities in your book because plasma centers are really taking off in them - from SLC to a tiny college town in Idaho. I got to talk to you about the prevalence of plasma centers in college towns, especially Mormon college towns. 

It’s no surprise they thrive there. As you note in your book, college is prohibitively expensive. On top of that, there’s a cultural expectation for Mormons to marry young and have babies early. Even with the help of limited government benefits, there’s not enough money for most married with kids mormon college students to survive. 

I really thought you did such a good job illustrating how plasma centers kind of exist in the tension of Mormonism’s communal living utopia past and single family home American Dream present.  

This is such an open-ended question, but I’d kind of love to hear any other insights you gained through reporting in  Mormon communities when it comes to their perception of social safety nets, blood donation or really anything adjacent to your work!

I’m so glad you asked about this. So many parts of the reporting of this book were interwoven, mostly by accident, with my own personal curiosity and thinking about Mormonism and the church’s influence on the West and on the US generally. That happened in large part because the six road trips I made from my home in Montana to Salt Lake and Rexburg, Idaho, led me right by the turnoff to Gilmore, Idaho, where my grandmother was born when her parents were on the run - from the Mormon church, from family, from a possible crime. From what I know, her mother’s ancestors were part of the United Order in southern Utah, so the entire family history was intertwined with these principles of collectivism in the early years of the church. I didn’t grow up with any direct Mormon relatives, just this history, and it was a gift to be able to explore it.

This may be getting down in the weeds of LDS history a bit but I really thought about this a lot in reporting in Utah and Idaho, how this history of communal living and sharing might influence attitudes today about donating plasma, which ultimately is sharing the most personal part of yourself with a complete stranger. I have no doubt there is a cultural history that makes this practice thrive in Mormon communities.

Salt Lake is different now, of course, because it’s a major city with a diverse, growing and changing population. But I think you can really see the Mormon historical influence in Rexburg, which has an almost entirely LDS population and is fairly remote. The college students I met there who were selling plasma carried very little stigma about it - that was unlike other places I visited for the book. Whereas in Flint, people might not have told their families they were selling plasma, in Rexburg it seemed that everyone was pretty open and pragmatic about it. The college kids I met didn’t see anything wrong with doing it (and believe me, I agree with that!) I also really got the sense in Rexburg that this was a true win-win for plasma donors, ethically. It’s altruism, you are giving back, you are sharing, you are helping, but you’re also getting paid for it. The ideal package.

But with that being said, I can’t stop thinking about a young woman, a student, I met outside a downtown plasma center in Rexburg who had just donated. She was so cold (the process chills some people because of fluids in and fluids out of your veins) her teeth were chattering while we spoke, and she seemed so fragile and young and small. Why are we relying on people like her to hit the plasma center as often as possible because she needs the money instead of protecting her, financially and physically, and letting her donate less frequently if she wants to? It often feels coerced, though it was not portrayed to me this way by people I interviewed. Again, the attitude just felt like pure pragmatism. 

What is so jarring to me is how selling plasma has become part of the social safety net, with almost no interrogation of that from us as a society. It’s as though it’s become a replacement for higher wages, actual pensions, reasonable education costs, child and family care costs and universal health care. Blood money doesn’t replace all these things, but it fills the cracks where these things used to be and could be, if we prioritized caring about other people and building a stronger and more stable society.

You argue that plasma donation is labor. I think you’re right. As I was reading your book, I really kept thinking about the care crisis. Care work is regenerative and necessary for our shared survival. But capitalism extracts care work to the point of exhausting it as a resource. Plasma donation really feels analogous to care work  - paid and unpaid - in so many ways. Including in the way the plasma industry has so heavily depended people crossing the Mexican border. to Care work has a global care chain and plasma donation has a global plasma chain. 

I’ve been reading a lot lately about labor movements and coalition building. I don’t think we’ll see any change in how we treat care work without collective action. Plasma donors and care workers seem like they’d been good strategic allies in a coalition fighting for a universal living wage. 

You talk in your book about the brief formation of a union for blood donors. I was so delighted to see one once existed. Do you think a union could be possible again? What are the obstacles? I think one thing I was struck by in your book is how friends go to donate together sometimes. They also seem to pull from already coherent communities - like college campuses. So it seems like the sense of community needed for organizing might already be there. But maybe people just don’t donate long enough to make organizing possible? Are there other strategic allies you can think of outside of care workers? 

I was also delighted to find there was once a blood sellers union! Although it was very short-lived.

When I first began working on this book, years ago, I really thought it was going to be a science book. I worked for years as a science reporter in Asia, and it felt like an extension of that kind of reporting and research. When I thought it was that kind of a book, I assumed there would be some science–based recommendations on how to do this all better, but that’s just not at all where I wound up. It is much more about our society. Some people do have a negative physical reaction to donating plasma, and I do believe long-term endless donation takes a negative toll on a person’s physical health. But it’s the nature of the payment schemes and how they draw people in, and how reliant so many people are on them, that concerns me most. 

Around the time I started interviewing plasma donors I realized Blood Money is really about socioeconomics and the collapse of our social safety nets. And part of that became thinking labor and organized labor, the rise and fall and rebirth of union popularity, and what constitutes labor. To that point, there’s been an ongoing legal battle over the US-Mexico border and whether selling plasma constitutes labor. It’s quite interesting to me that one agency of the US government has staked a position that it does - if that stood, it could have huge implications for millions of Americans who have or want to sell plasma.

Do I think plasma sellers can organize a union like blood sellers did in New York a century ago? Sure, maybe, but of course it would be a massive effort. I think what is critically important right now is that people know they are not alone in this, that the practice is common and they don’t have to be at the mercy of the system. They can join with others to advocate for more power in the equation.

A real revelation from the book was the way other countries keep their hands clean - or their veins untapped - while relying on medicine made from the blood industry in America. International corporations are deeply invested in the blood industry. Foreign pharmaceutical companies have blood banks across America because selling plasma is legal here. 

In your interview with Anne Helen Petersen you talk about how America’s lack of a safety net is really propping up a lot of the world, “I realized pretty quickly this all about the United States’ failed financial safety net. The world depends on it. Full stop.” 

That really makes smug proclamations about great health systems from people in Scandinavian countries feel a little more grim. I think it’s another example of how even the economic models celebrated by progressives are often very exploitative - the exploitation just often happens beyond their own borders. And it definitely illustrates that we’re more dependent on one another than soundbite supply chain analysis can demonstrate. 

Making any difference in a system this complex feels completely overwhelming. Like, I don’t just need to take on the American system, I also need to tackle some pharmaceutical conglomerate in Spain! Where do you suggest someone who wants to help starts? 

I have spoken with more than a few Eureopeans who are shocked and appalled to learn about the US plasma economy, but hello, it’s theirs as well as ours. The world benefits from it.

For me the larger problem (believe it or not) is less about challenging the companies than shoring up the systems that have made this kind of exploitation so common, if that makes sense. Multinational companies are always going to do what they do, work to make profits in the most efficient way possible. That’s what they are doing here. 

If Americans earned higher wages, if university education weren’t expected yet priced out-of-reach, if we had universal, functional health care and child care, if if if. If we had these things - and you and I both know this country has the money and support to fund these things - we wouldn’t have so many people living in precarious financial situations. Plasma donation would feel less *coerced.* I still struggle with whether I think it’s ethical to pay people for their plasma, if that can ever work in a moral society. But I do believe we can have a system like that in which we pay and treat people better, and allow them to feel less compelled financially. I found one country in my research that requires plasma donors be given a day off from work in return for their contribution - seems like a great idea to me!

If we shore up our safety nets and try to rebuild the middle class, in whatever manner, businesses won’t be able to operate in such exploitative ways because people won’t need that money. Plasma donation could become more purely altruistic.

One thing that really struck me while reporting the book is how the practice of selling plasma truly is not reserved to the poorest of the poor. This has become something that middle class people do all the time, for any number of financial reasons. If you look at paid plasma donation as a way to trace economic fault lines in American society, you start to really see who’s hurting and what could be fixed. For example, selling plasma is so common among college students now, what does that tell us about the price of higher education – both in terms of actual money and what we expect of young people to attain an education? Is this really who we want to be? A country that expects a certain class of 19-year-olds who aren’t wealthy to sell pieces of themselves to get through college? Because that’s who we are right now. I suspect knowing that would make a lot of people uncomfortable.

I just really think we need to ask these questions as a society, as voters, about who we want to be and what we expect of people who aren’t rich or powerful. That, to me, is the place to start and the place to begin making changes.

The book really engages with a fundamental shift we’re seeing in capitalism everywhere - from middle class-supporting industry based on production to an impoverishing kind of industry based on extraction. 

I mean, so much of tech is really dependent on data extraction. A lot of that extraction is performed in people’s homes without them really understanding the value of what is being taken from them. I think if people were more aware of how their interactions on platforms and Alexa-like smart home devices were being used to create products and then sell those products back to them - they’d be more adamant about demanding a cut of the profits. And some would stop participating in the ecosystem altogether. 

Your book really does that for the plasma industry. But it didn’t make me want a cut of any profits, or to never donate plasma. It had the opposite effect. I want to give plasma for the first time to help make medicine for people like you - while also fighting for a better system overall. What advice do you have for people like me? Where should I give? How can I advocate?

This is a really important point. There is unpaid plasma donation, and you can donate plasma at the Red Cross and a couple of other non-profit organizations around the country. They are easy to find, just look for the reputable places that don’t pay. Most plasma extracted in the United States does come through the paid, for-profit side of the business, but I have also talked with family and friends who donate through the Red Cross and plasma donation - I have to emphasize this - truly does do good in the world, it’s made into essential medicines and research.

One interesting little side note that will tell you about business practices: If you donate plasma at the Red Cross, you are limited to doing it a maximum of 13 times a year. If you go to a for-profit center that pays you, you can sell plasma up to 104 times a year as long as you pass the health checks. Quite a difference in volume and it says a lot about what the Red Cross believes to be safe and healthy versus corporations. 

With that being said, the larger paid plasma centers are clean and well run. The system is organized to keep people safe physically, from what I’ve seen. If you want to donate and get paid - do that too! What troubles me is the frequency and the fact that we expect certain classes of people to do it, then stigmatize it and make jokes about it without addressing the underlying issues that got us here and keep us here. That’s the part I find abhorrent. 

In your book you talk about Ambrosia, a startup that offered clients transfusions of “young blood” plasma as an anti-aging treatment. That was the second time I threw the book across the room. The idea was horrible, but I’d heard of the general concept before. This particular business’s name sent me over the edge. Ambrosia is the food that the gods eat. ICHOR is the fluid that runs through their veins. (In fact, in my notes in the book I wrote ICHOR IS RIGHT THERE and then underlined it five times.)

A thing I run into again and again in the startup space is a complete lack of knowledge of history or culture outside of what can be found in Wikipedia article or conversation at Burning Man. You get at this wonderfully in your book when you talk about the cultural/historical misconceptions or, maybe intentional misdirection, you saw in the blood money industry. 

I’d love to hear what you think the layperson is missing when it comes to blood. What don’t we understand - culturally, historically, or scientifically or all three - about blood that you wish we would?

There is so much art, literature, history woven around blood it’s hard to know where to begin. We’re so obsessed with blood, I think, in part because it’s the substance that binds all of us. We all have it, we all think about it, transferring it between bodies seems like a miracle if you really consider what it took to get to this point in medicine. Just consider the amount of poetry alone that’s been written about and around blood and our ideas of it, and what it’s been used to symbolize. That alone could fill volumes. 

Beyond just the existence of blood, the long-running fascination we humans have with real and imagined vampires, and extracting and consuming other people’s blood is so riveting to me. Vampire movies are almost always great. We love these stories and have been playing with them for centuries. Silicon Valley discovering the idea and doing full Tech Guy with it is just the latest machination of the same old thing, in many ways. 

One of the more disturbing moments for me was learning about early experiments in Europe of blood transfusions, in which they infused the blood of a sheep into the veins of an ill woman, because women and sheep had similar capabilities. Thinking about that history in the context of our current moment where the patriarchy is swinging back any way it can was  more than a little bit disturbing.

It’s very funny to me, especially as someone who is literally consuming parts of other people’s blood. It’s not actually fun although it is pretty magical how well it works for me. It is transformative (thought only for a few of us) and that’s part of why I think people who are willing to donate this substance should be treated better. The thing that struck me in reading and researching the history of moving blood around between people is how often that history involves stories of extracting the blood of poor people to deliver it to the wealthy and powerful. Humans have been doing this little trick for centuries, using the bodies of people with less power to improve and extend life for the powerful. 

Some people have always been more expendable than others and it’s especially apparent right now in the United States, which likes to pretend it doesn’t operate on a class system. Spoiler! We very much do.

Okay the way the plasma from thousands is mixed together and then made into a drug - feels like generative AI. And like generative AI, the tool is cool but capitalism’s incentives mean that people are doing bad things with it. I get that the corporations are not great and that the extraction is exploitative and all of that. And we have spent most of our time on that during this q+a but now I’d just love to know…what is the coolest thing you learned about the future of blood tech? Any hopeful developments? I mean…how great is it that blood CAN HEAL?!

It blows my damned mind. I’m being very honest here. With the trajectory of my specific illness, I can go from barely being able to walk one day to perfectly fine 48 hours later, after I have an infusion of particles that come from other people’s blood. That is mind-blowing and sometimes I can’t even process how cool it is. It also feels weirdly primitive, somehow. Advancements in the treatment of my illness have basically stopped because there is very little money available to research and develop new tools - our primary concerns in biomedical research become the ones that can lead to the greatest profits, so that’s where you see advancements.

It also makes me squeamish, both because I don’t like to think too much about needles but also knowing that so many people have given up their plasma because they needed the money. But one thing I learned in this reporting is there is always altruism involved. The people I interviewed seemed genuinely pleased to meet someone who was benefiting from their generosity. 

As far as the future of blood science, most of the studies and experiments I’ve researched haven’t come up with much of anything that will actually help large numbers of people. It’s revealing to me how this kind of medical research used to be driven by war - the advancements made in storing and separating blood parts were propelled forward by the demand to get stable blood supplies more quickly to wounded soldiers on the battlefield in the 20th century. What appears to be driving a lot of the research now is simply a desire for eternal youth and eternal life. With apologies, that’s kind of boring to me, because if it ever did come to pass it would be reserved only to a few who have the most. Why not look for tools that can improve people’s lives right now instead of trying to iron out the crease in your forehead? Why not spend this effort and money on things that can make society more equitable? 

Pssst. Here’s the preorder link again.

1 Powell, R. (2019). Social Welfare at the End of the World: How the Mormons Created an Alternative to the New Deal and Helped Build Modern Conservatism. Journal of Policy History, 31(4), 488-511. doi:10.1017/S0898030619000198