It’s not Altruism, It’s Selling
sgcarney | August 18, 2010 | 1:05 pm

Savvas Koundouros can’t answer every question that I ask him. A handsome embryologist with sterling credentials from the top scientific institutions in the world, he has stimulated the ovaries of almost ten thousand women in his career—all in the pursuit of bringing new life into the world. When he walks through the streets of Cyprus women kiss his cheeks and men slap him on the back and greet him with warm smiles. He is the reason that many of them have children and so has cemented his reputation as one of the most loved men on the island. He has impregnated more women than Ghengis Khan.

But when I talk ask him about the motivations of women who donate their eggs in his program he lets out a heavy sigh and takes a break to smoke a cigarette on the roof of his clinic. “What I want to tell you, I cannot tell you,” he says.

Egg donation and invitro-fertilization, or IVF, is one of the fastest growing medical procedures in the world—and one of the most effective—ways to kick start a pregnancy when traditional methods fail. By the time a woman reaches puberty she has approximately 300,000 proto-eggs in her ovaries. These potential eggs are stored in bunches of follicles. Every month a single proto-egg, or oocyte, matures and drops into her uterus where it waits for fertilization by a sperm. Yet as a woman ages the process tends to break down, eggs mature poorly, fallopian tubes get blocked and any other number of complications can make pregnancy impossible.

With IVF, the doctor takes control of the ovulation process, and does the work that a woman’s body should do naturally under the strict controls of a laboratory. Typically this means stimulating individual follicles with hormones, maturing five to fifteen eggs in situ, and then extracting them, selecting the most promising of the batch and implanting sperm in a Petri dish to create an embryo. Presto: life via laboratory.

The clinical intervention can make a women’s own eggs come to life, however in 30%-50% of cases IVF is not enough to achieve pregnancy and the only option is to retrieve eggs from a donor. When this happens, both women synchronize their fertility cycles with hormone treatments and eggs are matured in the ovaries of the donor, fertilized in a lab, and implanted in the woman who wants to get pregnant.

IVF with egg donation is one of the fastest growing medical procedures in the world and the new social relationships that it creates challenges some of our most basic notions about the beginning of life.

Procreation is no longer an intimate act between one man and one woman. It is a heavily mediated enterprise that involves doctors, patients, donors, airlines, insurance companies, ethicists, governments and psychologists.

Pregnancy separated from passion is a strange animal, rather than rely on random chance, every facet of the future child is managed, scrutinized, valued and assessed. If they’re unable to contribute their own genetic material, infertile couples will scour the world for the very best donor sperm and eggs, and many are willing to pay any price to get the right results.

No matter the promise of the procedure, there is a bottleneck in the system that a laboratory cannot cure. It’s a problem that Savvas Koundouros contemplates every day. The demand for donor eggs vastly outstrips the available supply. Most countries have outlawed direct payments to egg donors, but in Cyprus and Spain it is legal to give donors a small amount of money to cover the time that they spend in the clinic as well as whatever lost wages they might have missed.

“Obviously the donation is described as an altruistic act and that means no contribution. But it sounds strange to all of us that a person would receive so many injections over several weeks and then go under general anesthesia just because they are so kind,” says Koundouros. He presses out the rhetorical response with his tongue pressed firmly against the wall of his cheek.

The distinction, however, is not lost on the British social anthropologist Michal Nahman, who interviewed 20 Romanian women who gave their eggs. In a 2008 article in the European Journal of Women’s Studies she wrote “To call the women I interviewed ‘donors’ would be a great misnomer. They are explicitly there to sell their ova for a specified sum of money…not out of ‘altruism’ or wanting to donate.”

Regulatory bodies perpetuate the confusion over the proper way to recruit donors. “Compensation is allowed. Paying is not allowed” says Catalana Stylianou Chief Inspector of Tissue and Cell Centers for the Cyprus Ministry of Health.

Doctors like Koundouros have to pretend that the transaction to procure eggs is based on altruistic ideals in order to avoid regulatory pressure from the government. Donors who come to his clinic are paid about $1400 to compensate them for their time.

It is an amount that begs the question: Can altruism be bought?

The altruism/payment double speak creates the exact sort of social stratification that regulators wanted to avoid in the first place. An altruistic system is supposed to take the lure of financial reward out of tissue donation programs and draw flesh from across social classes. However by offering low payments, only the most desperate women are going to come forward to sell their eggs. It’s a Catch-22 where people on the fringes of society start to see egg selling as their only option. It can also turn fertility clinics into predators who face out of control demand for their product, but are constrained by low fees. In order to maintain a strong supply of donors they are sometimes forced to recruit only the most desperate women to give their eggs.

Meeting Natasha: The Scout
sgcarney | August 14, 2010 | 12:26 am

The second of eight posts that will appear simultaneously at the Pulitzer Center for Crisis Reporting which helped fund my research.

CENTER, LIMASSOL, CYPRUS
Published on August 13, 2010
Natasha flashes an inviting smile in my direction and bows her head slightly when she shakes my hand. Pretty at thirty-five, she’s the first face that patients see when they get off the plane to receive and egg donation. She ferries customers to and from the airport and helps ease their cultural transition from abroad. As a medical coordinator her skills are in demand, but it’s not just because of her hospitality. For the less public side of her job she locates and recruits egg donors from wherever she can find them.

In country with an influx of legal and illegal Russian immigrants, she says that many women find themselves in a place where they have few other options to earn cash. “They start relationships with Cypriots who they meet on the Internet. They come and think that they are going to have a good life. Two or three months later they are no longer together and the girls find themselves helpless. She has no place to live, she has no job, and she has no visa to get a job.

For Russians now it is hard for them to get papers. She is in trouble. She starts to think where to get money. But she has her health, and she is quite beautiful,” she says to me in an upscale café on the Cypriot coast. These are the people who come to sell their eggs.

Natasha agreed to speak with me on three occasions on the condition that I would change her name and not mention the name of the specific clinic that she recruits for.

She tells me about her friend Doylana who came from Russia and was sleeping on friends floors because she had no way to get home. “She visited me and I told her about how she could make money selling her eggs. She gave them and then used the money to buy a plane ticket home.”

She says that donors earn between $1100-$1400 for their effort and pain, and while she says that the money can be a motivation, she isn’t sure what sort of risk it entails. “You would have to be stupid to do this several times?” she says, “Who knows how dangerous this is down the line?”

Whatever the risks, the money that clinics offer is enough attract an almost endless supply of Eastern European egg sellers. While not every clinic uses scouts, the situation is similar in both Cyprus and Spain. Small amounts of cash are incentive enough to attract only a certain low-income group of donors.

Scott Carney is an investigative journalist, his first book about the international trade in human bodies will appear in Harper Collins in 2011, see his updates at redmarkets.com

The Cyprus Scramble: An investigation into human egg markets
sgcarney | August 13, 2010 | 11:24 am

For the next week I am presenting a series of posts about the global trade in human eggs which will appear simultaneously at the Pulitzer Center for Crisis Reporting which helped fund my research.

Dr Krinos Troukudes slaps his hand loudly on my back after I turn off my tape recorder and turn to make my way down the Pedieos Clinic’s dark stairwell. For the last hour we’ve been talking about the biological goldmine inside every woman’s uterus: human oocytes, or in common English, eggs. Clinics like his make a fortune selling eggs to infertile couples who will travel across the globe for a chance to get pregnant. Through a trick of favorable currency exchange and lax laws the island nation of Cyprus is one of the fastest expanding markets for human eggs. Here a full-service egg implantation costs between $8,000 and $14,000, where in the United States the price floats between $20,000 and $30,000. As he sees it, the only roadblock to becoming a baron of the market in human eggs is controlling a steady supply. “If you have the donors, you have everything,” he says. Everything.

When the first baby was born from a scientific IVF embryo transfer in a London hospital on July 25th, 1978, the market for human eggs took off like a jet plane. Birth control coupled with IVF means that women can delay having children until their professional careers are well under-way. In the last 32 years hundreds of thousands of children around the world have been born to donor eggs. While the miracle of assisted reproduction has changed the way the middle-and-upper classes view childbearing, behind the miracle of each birth is a hidden supply chain where eggs are procured by any means necessary.

Crimes in the egg trade are not hard to come by.

Between 1996 and 1999 and Israeli doctor named Zion Ben-Raphael began stealing eggs from his patients by doping them with hormones without their consent. In once case he stole 181 eggs from a single unknown donor and implanted them in 34 of his paying patients. In the course of his tenure 13 women were hospitalized because of the massive doses of hormones that he delivered triggered a dangerous conditions known as hyper-stimulation syndrome (HSS). Once the Israeli newspaper Haaertz reported on his spree he attempted to evade charges by bribing investigators. Shortly after the scandal, Israel banned all paid egg donation procedures.

Over the years similar crimes have been reported in Cyprus, Ukraine, Spain, Russia and most recently in Romania where a 16-year-old factory worker was in critical condition after she sold her eggs to an Israeli- run clinic. A government raid of the clinic last summer led to the arrest of 2 Israeli doctors who were offering fertility tours to Israeli patients who were unable to buy eggs domestically.

Most doctors and administrators believe that paying for a body part— including human eggs—creates a system that disproportionately draws raw materials from the bodies of the poor to sell them to the rich. In order to cut back on possible negative social consequences the European Union and the United States have laws that restrict commerce in human tissue. The only way to legally acquire a human egg (or kidney, liver, blood or cornea) is to receive it as a donation, so that money does not unduly influence the transaction. To do otherwise is considered tissue trafficking: An allegation that is the modern equivalent of slavery.

The United Kingdom outlawed even minimal compensation for egg donations in 2007, while simultaneously passing a law that made it possible for children born to donor eggs to be able to track down their genetic parents when they reach eighteen. Many egg-donation advocates say that this one-two punch was the knockout blow for British IVF industry. Since the new laws the waiting list for an egg now stretches two years long. For women already cresting the upper limits of even assisted fertility, the restrictions feel a lot like an outright ban. And yet, most of Europe has passed, or is passing similar laws.

But there are a few holdouts in the European union. Cyprus and Spain have looser restrictions on IVF and have turned into destination spots for the reproduction industry.

In Cyprus, a country with fewer than one million people, there are now more fertility clinics per capita than any other place in the world. In the absence of a formal law to regulate egg selling, or even one that offers clear enforcement guidelines for what to do to clinics that violate ethical norms, Cyprus is something of the fertility industry’s wild west. So many people come here for egg donations that it seems to have caught the government by surprise and stretched its donor pool past the breaking point.

There are approximately 76,000 women in Cyprus between the ages of 18-30 who are eligible to become egg donors. Dr. Trokudes estimates that there at least 1,500 egg donations performed each year in the country’s dozen IVF centers. Some back of the envelope math indicates that approximately one in 50 eligible women have donated their eggs. It’s a startingly high number that dwarfs the comparable rates in America where one woman out of every 14,000 elects to donate their eggs.

Perhaps even more alarming, is that most of the egg donors in Cyprus come from a relatively small population of poor Eastern European immigrants who are eager to sell their eggs at a pittance. In January and February 2010 I visited a half dozen clinics and doctors in Cyprus, most of whose egg donors were of Ukrainian, Moldovan, Russian or Romanian descent. Several clinic directors told me that these women are favored because of their lighter complexion, eyes and hair color. British, German, Italian and American customers tend to favor children with Caucasian phenotypes. While no clinic gave me direct information on their donor registries, all said that Eastern Europeans represent the bulk of donors. There are approximately 30,000 Russians on the island nation and it’s possible that in this population the frequency of egg donors of eligible women is as high as 1 in 10.

For fertility clinics bent on increasing their market share of international patients, controlling and cultivating donors is the most crucial part of the business. During my research I found that clinics in both Spain and Cyprus have to play a difficult balancing act between meeting almost insatiable demand from abroad and the recruitment of donors. While many doctors strive to keep the industry safe and legal, internal contradictions in the language of cultivating egg donors makes the boom in international IVF a potential flash point for dangerous practices.

Scott Carney is an investigative journalist, his first book about the international trade in human bodies will appear in Harper Collins in 2011, see his updates at redmarkets.com

This is the first post by Scott Carney in a series of dispatches on the human egg trade that will be featured on Untold Stories over the next week. Read his Fast Company article on the global egg trade.

Volunteers Needed
sgcarney | July 7, 2010 | 7:45 am

In a strange way, this comic pretty much sums up the problems with Red Markets.

A Nepali Spectre in the Thai Protests
sgcarney | May 19, 2010 | 11:14 am

For as long as I can remember Thailand has a been a patch of tranquility in the turbulent waters of South East Asia. In the Vietnam war the country was a resort for American GI’s who took a break from the fighting on its placid beaches. During the era of the Khmer Rouge killing spree Thailand took in refugees and despite sharing a border with Burma it has never visited totalitarianism on its own people. Thai people are surprisingly un-political in conversation, rarely expressing dissent from the party line. Indeed, most Thais hold unbridled respect for the King and wear yellow and blue shirts in his honor every week. His pictures line the highways as a symbol of unbridled affinity.

Which is precisely why the violent political struggle that is engulfing the capital city of Bangkok this month seems so out of character.It is hard to believe that any society can be politically tranquil. What seemed to be a veil of peace and non-confrontation was a thin veil for burning resentment against the status quo. In 2001 there was a similar situation in Nepal where the Royal family was almost universally adored. At the time a disparaging remark about him to an ordinary could start a fight. Then in 2001 a royal heir slaughtered the rest of the Royal family and the country descended into chaos. For centuries the king had been able to quell distrust between the impoverished rural hinterland and comparatively wealthy major cities. Since the 1950s or so Kathmandu and Pokhara had been inundated with development aid, most of which transmuted into graft and only developed the cities, leaving the rest of the country desperately poor. It was fertile ground for Nepali Maoists to organize and grow a rebel movement. When the Royal family died the revolution was unstoppable.  By 2006 the Maoists won and the country abolished all Royal powers.

The protests this month in Bangkok could be Thailand’s Royal massacre. Simmering resentment beneath an a-political facade has broken through in a violent orgy. Unused to dissent police open fire on protesters who magnify the violence by setting fire to the city’s landmark buildings and hurling grenades.  Yesterday I saw a video on Youtube that has since been taken down of a protester being shot in the head by a military sniper. He died in a pool of blood as other protesters surged forward without regard to  the danger. Even as the leaders of the protest surrender to police today, the violence just seems to magnify. As I write this the city hall is still smoldering.

Thailand is the only country in SE Asia that was never under the control of a colonial power. The tradition of self-rule has continued unbroken because of savvy partnerships between the royal family and western powers. Nepal was also never a colonial subject.  While self-rule has helped Thailand become one of the most developed countries in SE Asia, its mode of governing is an anachronism in a modern world.  The protesters demand new elections to oust the sitting government. Most protesters still seem to support the king, but the party that has kept him in power is losing its popularity fast.

I don’t know what is going to happen in the coming months. But I don’t think that Thailand will ever be the same. We may be witnessing a new revolution. Or we might see the protesters quashed into oblivion, only to rise up again years down the line.

New Blog Address: Red Markets.com
sgcarney | April 28, 2010 | 7:08 am

This blog will be moving to a new address to help promote my upcoming book Red Markets: Every Body Has a Price. Last week I finished a first draft of the manuscript while at the Ledig House International Writers Residency and am very excited to start getting the word out. The book is a fast paced investigative romp that opens with a crime scene on the Indio-Nepal border and traces the spread of tissue economies across the globe.

When I first pitched the idea to Harper Collins/William Morrow in 2008 I came up with this sample cover art. Hopefully we’ll find a more talented illustrator to make this look even sharper.
So come along for the ride and check out my new blog address http://www.redmarkets.com. I’ve also started a new homepage for my work http://www.scottcarney.com which should be online soon.

“Meet the Parents” wins Payne Ethics in Journalism Award
sgcarney | April 12, 2010 | 11:14 am

I’m honored to have been recognized by the University of Oregon and the Payne Award for Ethics in Journalism for my Mother Jones story “Meet the Parents.” I’m even more honored to have worked with one of the most diligent and thorough editorial teams in the business. Special mentions for senior editor Mike Mechanic who honed the story with me through every stage, Editor in chief Monika Bauerlein who had faith in my reporting and was my sounding board for the hardest decisions. Also Jennifer Phillips who checked my facts and kept the story accurate.

See: Payne Award Announcement

Also see a nice write-up about it on the MoJo website.

Temple of Do
sgcarney | March 26, 2010 | 11:50 am

The international trade in human body parts is by no means confined to essential organs, tissue and muscle. In fact, one of the most lucrative markets is human hair. On Nostrand avenue in Brooklyn where I live dozens of bodegas and beauty parlors sell top-quality Indian locks for big money–mostly to African American women who want to change their hairstyles rapidly. In this month’s issue of Mother Jones I reported on how Indian temples shave the heads of their devotees and ship tons of hair from one side of the world to another. I attended a hair auction where distributors broke out in to fistfights with one another as they tried to corner the hair market and had a temple devotee shave my own head. So check out the piece here, and don’t forget to see Sonja Sharp’s related story on how some of that hair ends up in the American food supply.

Tiffany at the Grooming Room on Nostrand Avenue curls the hair of her client. She specializes in extensions.
Laborers in a hair factory in Chennai sort through thousands of poinds of hair, remove lice and prepare raw hair for export.
Processed hair is hung on racks to dry before bundled for export.
A tribal man in a small village outside of Chennai has learned to make money collecting shorn locks from barbershops and selling them to international hair suppliers. This cottage industry is entirely tribally run.

Further reading: The New York Times wrote a very interesting piece on how hindu hair became a major issue in the orthodox Jewish community who shave their heads and wear wigs as a sign of humility. When they discovered that the hair was offered in a pagan sacrifice they started to burn wigs.

Interview on NHPR: Word of Mouth
sgcarney | March 25, 2010 | 2:32 pm

This month Mother Jones published a story of mine about surrogate mothers in India. Today I New Hampshire Public Radio interviewed me about the article on their show “Word of Mouth.” Listen to the interview here

I’ll post a link to the story in Mother Jones once they post it online. In the meanwhile you can check it out on newsstands across the country.

On Anthrojournalism
sgcarney | March 4, 2010 | 3:08 pm

There are two fields that explore the little known facets of the world and bring them to the light of day that are on the verge of collapse. Journalism is facing the scourge of dwindling profits and a severe cutback in jobs, while anthropology has been struggling with making itself relevant to the modern world for decades. But the problems facing both could also be an opportunity for a path forward.

My own work as a journalist is deeply indebted to my anthropological training. I was one of a very few American journalists in India who spoke Hindi, and the features that I write tend to delve into the analytical ambiguities that are the stock and trade of anthropology. Specifically, my work on the commercialization of human tissue (and my forthcoming book “Red Markets”) parallels the last ten years of Nancy Scheper-Hughes’ career.

But anthropology is in trouble. The problem can be boiled down to simple economics. The supply of anthropology Ph.D.’s vastly outpaces career opportunities. Every year departments mint several hundred new doctorates for only a handful of jobs. Tenure track positions are dwindling with the economic crisis and even top candidates are lucky to find low-paying adjunct positions. Relevant jobs for anthropologists outside the academy almost never require a Ph.D.

I believe that this is in part due to the fact that the supply of anthropological writing far exceeds the demand. While anthropologists produce a huge amount of literature every year, very little of it ever gets read by more than a few interested specialists. Professors get promoted to tenure based on a point system that marks the number of publications, not necessarily their relevance. Most dissertations gather dust in libraries, and journals circulate around a very small audience and conferences. Anthropologists frequently lament how little influence their research has on larger public discourses, and yet steadfastly argue that “knowledge for knowledge’s sake” is a sufficient reason for the work that they do.

In effect, there is a mismatch in the sort of products that anthropology produces and its reception in the community. Jobs in anthropology can’t be tied only to the education of new anthropologists. The current model is a ponzi scheme that is perched to topple like the sub-prime mortgage industry once academic budgets begin to contract.

I spent three years at the University of Wisconsin-Madison pursuing my Ph.D. in anthropology before switching over to journalism. I left the program disappointed. I felt that there were very few career options other than teaching, and that the courses focused almost exclusively on theory and lacked any methodological training. With few and fewer job opportunities available on graduation, sometimes the degree program is a Faustian bargain. On top of that graduating with a Ph.D. takes anywhere from 5 years (at the absolute fastest) to ten (increasingly common). It is worth it to point out that a medical degree takes only four years, and a law degree three.

The thing that attracted me to anthropology in the first place was its ability to rigorously reexplain the world based on hard observations and theoretical insight. At their best, anthropologists are thorough researchers who can contextualize important social phenomenons across geography, time, space and cultures. Even today, the heart of an anthropology degree rests on years of fieldwork, often in remote locations. They learn the local languages, and seek to get involved in the community as much as possible in order to get a holistic vision of their subjects.

But there is a solution to the problem. The world needs people who are skilled at bridging the gaps between cultures. 80% of the planet doesn’t even have an e-mail address, let alone speak each other’s language. Even more importantly, the long term skill sets of an anthropologist is the perfect background for long-form journalism. As we all know, journalism is having a crisis of its own as profits plummet and cheap online content leeches the marrow out of the backbones of the print industry.

The trend in journalism has been to cut back on costs and quality of writing leaving a gaping hole in our knowledge base. I believe that the hole could be filled by a new mode of anthropology that realigns itself to reach out to a popular audience. Let’s call this new mode “anthrojournalism”. It wouldn’t be too hard to for anthropologists to leverage their positions in the communities into hard-hitting and intelligent feature stories. Anthrojournalists could do more than just write about global inequalities: they could expose them. Ethnographic filmmakers could drop the academic title and become documentary filmmakers.

On the other hand, journalists could realign themselves with anthropology and make a serious long term investment in their stories. While anthrojournalists could never supplant the need for daily reporting, we need investigative journalism more now than we ever have.

This year Nation correspondent Jon Nichols and professor of communications Robert McChesney released The Death and Life of American Journalism, a ground breaking analysis of the current failure of journalism. In it they argue that journalism is more than just a profit factory, but a public trust and valuable organ of democracy. They argue that news-making should be subsidized and protected by the government so that it can continue to exist now that profits have been sucked out of of the business model.

For the last hundred years the entire field of anthropology has only continued to exist because of massive amount of government funding by way of grant programs, publicly backed academic departments and in a few cases, institutional endowments. Maybe it’s time for a few academic departments to invest in training a new generation of anthropologists who write for the public at large. Why not carve out a space for well researched and well written investigative anthropology within the mass media? There are more than enough anthropologists with no outlet for their work. Meanwhile there are fewer and fewer investigative reports being produced in the mainstream media. It seems like there is an opportunity for synergy. Clearly this isn’t a solution to the total problems facing both fields, but there is enough energy and money available to produce some interesting work.

I’d love to see collaboration between the two fields. However it would require some mutual understanding between two entrenched disciplines. Few anthropologists respect the publishing process and don’t realize how rigorous fact checking and editing can be. Meanwhile few journalists think that anthropology has been relevant since the days of Margaret Mead.

I would love to hear from people in both fields. Perhaps there is a way forward? What do you think?