“The backs of both my hands are a spider web of tiny white and pink scars,” writes Kathleen McLaughlin, “a roadmap showing where dozens of nurses in several cities on both sides of the Pacific have punctured the thin skin with a needle, leaving inside the vein a tiny plastic tube that allows medication to flow directly into my bloodstream.”
McLaughlin has a rare chronic illness (Joseph Heller, the author of Catch-22, had a similar condition) that can cause her immune system to attack the wrong parts of her body, threatening her hands and feet and ability to walk. She requires periodic infusions of a treatment made from the immune particles in other people’s blood plasma.
“It works like a charm,” she says by phone from Butte, Montana.
But McLaughlin, 51, has come to understand that the blood that sustains her is drawn from some of the most economically vulnerable people in America. For the past decade, the journalist has researched and reported on the global trade in plasma and all it says about class, race and inequality.
The result is Blood Money, a book that combines the personal and political to examine a for-profit medical industry literally sucking the blood of the American underclass. It also adds to a body of literature about deindustrialised towns and hollowed out communities that have haunted political discourse since Donald Trump and Bernie Sanders stormed the national stage in 2016.
But the tale begins in China, where McLaughlin went to work in 2004. Aware of virus risks in the blood supply in China, where outbreaks of hepatitis were routine, she decided to bring her own. She smuggled American plasma in her luggage as she passed through Chinese airports and was never caught.
She admits: “China is a very different place today, much more repressive. I don’t think that I’d be able to do this today and I wouldn’t do [it] today. When I was there, things were a lot looser and the rules were a little fuzzier. China felt a bit like a free-for-all back then. I was never that afraid of smuggling blood products into China. I thought that if I ever got caught doing it, that maybe I’d get a fine or something like that.”
During her years in China, McLaughlin was keenly aware of the risk to people who, like her, needed others’ blood to survive. “There’s never been an official accounting of what the death toll was caused by the blood plasma industry in China during those years. There was an immense amount of stigma around people from those [poorer] parts of China because, even though the government worked very hard to cover it up, stories got out and people throughout China knew about it.”
On one occasion she travelled to north-east China and interviewed people who, exposed to chemicals, needed infusions of immunoglobulin. “I asked them about the risk and their response was, ‘Yeah, we all know about that, but what can you do? We don’t have any other choice.’ At that time you had people living in the system in China who depended on the same things that I did, but they didn’t have the luxury of bringing it from another country. There was always so much more risk to them than to me.”
McLaughlin moved back to the US part-time in 2016 and for good in 2018. A 400-mile drive took her to Salt Lake City, Utah, and a meeting with a Chinese woman. Shuping Wang had worked at a plasma collection centre in Hunan province, discovered HIV in the system and turned whistleblower, fleeing to America soon after.
Shuping Wang took McLaughlin to a plasma centre in Salt Lake City. “To her there was this parallel with what she had seen back in China. They were open seven days a week and it concerned her that they were continually operating and paying people for their plasma.”
McLaughlin started researching the American blood industry, little known in part because the sellers she interviewed live far from the major cities where the media is concentrated. “I thought when I was living in China the plasma economy, which is what they called it, was this very dystopian thing that only China would try to do. It turned out that the United States had already done it.”
America is one among a handful of industrialised countries that allows people to be paid to donate blood. It is the world’s biggest exporter of human blood plasma, supplying about 70% of global use, its industry worth more than $24bn in 2021. Each year an estimated 20 million Americans sell their plasma, although figures are imprecise. There are more than a thousand for-profit centres operating legally across the US.
McLaughlin, a former Knight Science Journalism fellow at MIT, comments: “I have started to see it like dollar stores, pawnshops and payday lenders. It’s one of these industries that has grown up alongside the fault lines in our economic safety net. It finds a hold in communities where people are struggling and, because we have more people struggling and rising inequality, it’s really taken off.”
So who is the typical blood seller and why do they do it? McLaughlin had expected to find the poorest of the poor but, it transpires, most of them are screened out because a plasma donor must have a permanent address.
“What I found instead was a lot of people who, say, 25 years ago would have been middle class, and they just don’t make enough money for that lifestyle any more. I get the sense that one of the biggest demographics is college students. We’re talking about like big public universities where there are a lot of students who don’t come from wealthy backgrounds; I’ve talked to people who use this money to buy books, to pay to go out for a night, for ‘beer money’.
“You will also find people in communities like Flint, Michigan, where I spent a lot of time, who used to be able to expect to have this very normal American middle-class lifestyle and wages and benefits no longer keep pace with that. There are people doing it to buy groceries and to pay for housing. There are also people who are selling plasma to take a vacation.
“It’s these places where people are economically fragile, not necessarily desperately poor. The kind of fragility that we didn’t have 25 or 30 years ago when there were more social-safety protections.”
She devotes a chapter of the book to Flint, a majority Black city which infamously endured one of the worst human-caused environmental disasters in US history when lead leached into its water system. It has six plasma centres serving fewer than 100,000 people.
“Flint to me says something more about the state of America than anywhere else I went because there is this incredible pride in being the birthplace of the American middle class. People will tell you they had this amazing labour movement that built all these great jobs on which you could raise a family. That has just been hollowed out to the point where you don’t have a lot left.”
But the most productive plasma centres are clustered along the southern border, where Mexican citizens cross over to sell plasma in the US. “Our political leaders like Trump don’t want them in the United States but we have been allowing people to cross over to mine their bodies for blood plasma, so what does that say about us?”
Rates of pay for blood vary across the country. A person might, for example, make $40 their first donation, then $50 for their second, and receive a bonus if they make four donations in a month. “It tries to incentivise you to go as often as possible.
“I know at one point when I was in El Paso and the border had been shut down, so this pool of Mexican citizens who had been coming over to sell plasma was not allowed to come in, the payment rate was up to $1,300 if you went in twice a week, which is one of the highest I’ve seen.”
McLaughlin did not find significant evidence that giving blood frequently has negative health effects in the long term. “A lot of people get extremely tired. There is a lot of fatigue. A lot of people I talked to didn’t notice anything at all and they’re totally fine with it. It seems like it’s a very personal, individual thing.”
But she does point out that when people donate blood to the nonprofit Red Cross, they are limited to once every 28 days, which works out at 13 times per year. Those who sell to a for-profit centre can do it 104 times a year. “The disparity between those two limits is shocking.”
And whereas donating blood for free is lauded, donating it for money is stigmatised. “If you think about blood donation, it’s something that we consider quite heroic. If you go to the Red Cross and donate blood, you’re saving a life, you’re not getting paid for it.
“But somehow this practice of donating plasma for pay comes with a pretty heavy stigma. A lot of the people I interviewed who do sell plasma had not told their families that they do it because they were afraid of what their families would think: there would be some kind of judgment or their families would be worried about their health or concerned that they don’t have enough money.
‘The stigma is entirely linked to the fact that we stigmatise poverty in the United States. We look down on it. We don’t respect people who aren’t wealthy in the same way that we respect wealthy people. It’s been interesting for me to see the way that people view selling plasma as being somehow problematic and that’s definitely contributed to the fact that this industry is kind of hidden.”
Still, should we make a moral judgment about the blood industry? It is not, after all, pushing an addictive substance like opioids, but rather is helping the health of people in America and around the world, McLaughlin included. She replies: “We need to ask ourselves that. From my perspective as someone who depends on this substance, what people are doing is incredibly altruistic.
“I also think a lot of people are being financially coerced to do it and, the way the system is set up, you get paid more per donation for each donation you make. It’s gamified in such a way that people are encouraged to donate quite often and because it is a hidden industry, most Americans haven’t really considered if this is who we want to be.
“If you know that there are potentially millions of Americans who have sold their plasma to pay for things like groceries and vacations, are you OK with that? For me, it’s more a matter of getting people to think about it, that our economic situation is such that this is part of our fabric now and are we comfortable with being that way or do we want to think more deeply about how we can make this more feel more of a choice for people?”
She adds: “The industry itself isn’t necessarily the problem. The problem is that we have let this industry become a part of people’s incomes. I don’t know that that’s the kind of society we want to be.”
Blood Money is out now
