'Blood Money': Inside the global business of selling plasma

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This rebroadcast originally aired on February 28th, 2023.

Millions of Americans sell their blood plasma every year. It’s part of a global, multibillion dollar business.

"If you go to the Red Cross ... you are limited to donating 13 times a year — once every 28 days," Kathleen McLaughlin, author of the new book Blood Money, says.

"If you go to a for-profit plasma center to sell plasma, you can do it twice a week, up to 104 times a year."

But what is plasma used for, and why is it a big, largely hidden business?

Today, On Point: Inside the for-profit business of selling blood plasma around the world.

Kathleen McLaughlin, journalist. Author of the new book Blood Money: The Story of Life, Death and Profit Inside America’s Blood Industry. (@kemc)

Dr. Morey Blinder, hematologist. Professor of medicine at the School of Medicine at Washington University in St. Louis.

Patrick Herdener, longtime blood plasma donor who donates more than 100 times per year.

Darryl Wellington, journalist who has reported on the plasma economy. Poet laureate of Santa Fe, New Mexico. (@darrylwellingto)

Cory Lyons, Columbia, South Carolina resident who sold plasma in college.

Jenni Hecht, Sturgis, Michigan resident and plasma seller.

Kathi Young, Cameron, North Carolina resident and plasma seller.

Mary Seebach, Middletown, Ohio resident and plasma seller.

Part I

MEGHNA CHAKRABARTI: There’s a billion-dollar product flowing through your veins. No matter who you are, it’s in you. And if you wanted, it could be part of a global, for-profit business.

It’s your blood plasma.

Patrick Herdener donates his roughly 100 times a year.

PATRICK HERDENER: Tomorrow, I have to donate. So I've had a gallon of water in my fridge chilling all night. Then I will drink that one gallon by the end of today, because you have to stay hydrated. You do not want to try to donate dehydrated. It will be the most miserable experience of your life.

CHAKRABARTI: Now, donation really isn’t the right word here. Because Patrick gets paid. He is selling his blood plasma.

Patrick lives in Tulsa, Oklahoma. The night before, he tries his best to get eight hours of sleep. He avoids eating too much fat or dairy. The next day, he drives to his closest plasma center — a place called CSL Plasma in downtown Tulsa. The company is one of the world’s largest collectors of human plasma.

Patrick fills out a form with some medical history questions — things like whether he’s gotten any recent tattoos, what medicines he takes. Then it’s time for the plasma extraction.

HERDENER: I have certain people I like to stick me. Because my veins are big, but it's easy to go right through them. The center manager does know my veins and I can always request them.

CHAKRABARTI: Patrick lies propped up on a bed while a worker sticks a large needle into a vein and hooks him up to a machine. The machine draws Patrick’s whole blood, then it separates out the plasma, a yellowish fluid. It returns all the other parts of Patrick’s blood into his body.
Patrick goes through this whole process twice a week, every week — it's the maximum frequency allowed by the U.S. Food and Drug Administration. And he has the deep scars in the crooks of his elbows to prove it.

HERDENER: So I will sit there and I will swap out arms. like I might go three or four months using my right arm. Then when I realize it's getting hard for them to push the needle through I'll swap over to my left. And then you just put the vitamin E gel on the area to soften up the scar tissue.

CHAKRABARTI: While the machine is clicking and beeping and processing his blood, which takes about an hour, Patrick says he usually puts in his earbuds and jams to music. He also texts his wife to let her know how he’s doing. Sometimes if he starts to feel tired or sluggish, he says she’ll make sure there’s some food waiting for him at home.

HERDENER: Anything with meat is usually pretty good because it's mostly the proteins you're losing that causes the feeling. So she'll usually have like a couple roast beef sandwiches or something like that with some chips and some water waiting for me when I get home. And that usually picks me up pretty good.

CHAKRABARTI: Patrick stumbled on plasma donation about 25 years ago. He’s been selling his plasma twice a week almost every year since … at this point, you’re wondering why. Simple. Money. When Patrick first started, he was unemployed and really needed money.

Patrick says CSL Plasma pays him around $55 per visit to the center. Because of how often he goes, CSL considers him a “Platinum member.” These days, Patrick has a full-time job. He’s a cook for Tulsa’s minor league baseball team, the Drillers. But he’s still selling his plasma because he says the payments are nice extra cash for things like his kids’ birthday or Christmas presents. Plus, he feels good about donating.

HERDENER: You know, as time went on, I learned that, you know, it's not just me getting money. There are people who actually use the plasma for all sorts of life threatening diseases that they have. I was like, “Oh, so now I get to help people and get paid.”

CHAKRABARTI: Patrick is one of millions of Americans that sells his plasma every year – into a global market that is expected to grow to nearly $50 billion by 2029, according to an industry report from Fortune Business Insights.

And while the plasma extraction market is both regulated and legal, our guest today calls the business the “vampires of capitalism.”

She’s Kathleen Mclaughlin, and her new book is “Blood Money: The Story of Life, Death and Profit Inside America’s Blood Industry.”

And she joins us from Portland, Oregon.

Kathleen, welcome to On Point.

KATHLEEN McLAUGHLIN: Hi, Meghna. It's so nice to be here.

CHAKRABARTI: So, first of all, just react to what you heard in Patrick's story about how long he's been selling his plasma, why he does it, how he does it. Was there anything familiar in his story to you?

McLAUGHLIN: I would say that all of his story is familiar in different ways.

So in the course of reporting this book, I've spoken with more than a hundred people who sell their plasma and Patrick's story hits all of the familiar notes, you know, people very often start doing it because they need money. And then people whose health isn't extremely poorly affected by it will continue doing it even when they don't need the money per se to buy groceries or whatever.

What's interesting to me is he started out talking about, he knows which employees of the plasma center can hit his veins. And in my own experience, I'm not a plasma seller. I am a recipient of the drug. I have the exact same experience with people with needles. So I know exactly who can get my veins and who can't.

So that's also quite familiar. But yeah, I mean, his story is remarkable because he has been doing it for, did you say 20, 25 years?

CHAKRABARTI: 25 years. Yeah.

McLAUGHLIN: Yeah. That's amazing. There are very few people that last that long. So I would say he's a remarkable person.

CHAKRABARTI: Hmm. Well, so then you just hinted about why you first started doing the research for your book, Blood Money.

Can you tell us about the story behind that? Yeah, sure. So about 20 years ago, I was diagnosed with an autoimmune disease, quite rare. And the treatment for it is a medication that is made from human blood plasma. It's called intravenous human immunoglobulin. So it's the immune particles that are extracted from plasma.

And I have, on average, a half a dozen to 10 infusions per year to keep this illness at bay. They're very long, boring, tedious infusions of kind of a lot of medication. They take about six hours each time. And I have a lot of time to think sitting in a chair, just sort of watching this infusion fluid drip into my own veins. And for 20 years off and on, I've thought about where this medication comes from and who is donating and selling plasma to provide it.

And I just got to the point where I needed to try and figure that out.

CHAKRABARTI: So tell us then about the first steps that you took. Because even just chapter one starts with quite an action from you. Go ahead. (LAUGHS)

McLAUGHLIN: (LAUGHS) Chapter one was kind of wild. I mean, my life was kind of wild for a little while.

So I lived in China full time for 15 years. I was a reporter there and I moved there knowing that I needed this plasma drug. I also moved there knowing that China had had a big plasma debacle. So back in the 1990s, China had tried to create what they called the plasma economy, where they were paying poor farmers for their blood plasma.

And then the plan was to turn it into profit making drugs like the one that I take. Right around that time, HIV entered the blood system. We hadn't yet figured out how to kill viruses in blood and it spiraled into an AIDS catastrophe in rural China that killed a whole lot of people. So I knew about this.

And I also knew that China had banned foreign blood products because AIDS was viewed as a foreign disease and a foreign virus. So my solution was to smuggle in my own plasma drugs. I would pack them in my suitcases and every time I would come across the border, I had to check a little box on the customs form that said I was not carrying blood products, because they were very explicit about it.

But in fact, I was, and then this was, I would say a very different time in China. I don't think I could do this now. This was throughout the 2000s and early 2010s. I would take my plasma drugs that were made and sold in the United States to a hospital in Beijing or Shanghai where I lived and ask them to infuse them into my veins.

So if you can imagine doing that, just showing up at a hospital with drugs and saying, can you put these in for me? But they did. And I lived like that for years. So that was the beginning of my experience. And then when I moved back to the U.S. in 2016, I realized that the United States had actually created the plasma economy that China sort of tried to create.

We did it while nobody was paying much attention.

CHAKRABARTI: Sorry, I'm still stuck at the part where you're like, you bundled up your plasma drugs in your suitcase?

McLAUGHLIN: Well, you know, they're kind of big, so you can't really put them, I mean, I did carry on in the beginning, because that was pre different airline regulations. But I did try to ship them through legal channels one time and the drugs are so expensive that the declared value was like, I don't know, $60,000. And the Chinese customs authority thought that I was trying to open a medical clinic because the value, the price of these drugs is so high.

They didn't believe that it could be for my own personal use. And, you know, I mean, I had to do some other strange things. Like I bought a little mini refrigerator to keep them in because they needed to keep cold and I probably, I try to think how many times I smuggled them in, and it definitely was dozens of times that I did this.

But like I said, I don't think you could do that now and you probably shouldn't be able to do that if I'm being honest.

CHAKRABARTI: Yeah. It's absolutely fascinating. But actually, so, you just said something that is also part of a major sort of subplot in your book about that the declared price of the final medical products, at least in your case, that was coming from the plasma was $60,000, you said, but as we heard earlier, people like Patrick are getting paid.

$55 per donation. So there's a big sort of market and development and process in between the beginning and end point there, wherein both great science is happening, lifesaving science and profit-making is happening.

McLAUGHLIN: For sure. So at the current moment, my medication costs $13,000 per dose and I might have 10 of those in a year.

So we're looking at $130,000 a year, just rough calculation. And yeah, there's a massive gap between plasma donors getting paid $55 and my insurance company shelling out $13,000 per dose.

Part II

CHAKRABARTI: Kathleen, I want to actually just bring another voice into the conversation for a little while, because I feel like there's a lot about, you know, the science and the medical science of blood plasma that most people, me included, may not know enough about.

So joining us now is Dr. Morey Blinder. Dr. Blinder is a hematologist and professor of medicine at the Washington University in St. Louis. Dr. Blinder, welcome to you.

MOREY BLINDER: Hello.

CHAKRABARTI: Okay, so first of all, just like, give us the basics on what is plasma and why is it important just as a normal part of the human body.

BLINDER: Certainly, plasma is the liquid part of blood, which is about 55% of the total blood volume. The rest of the blood is composed of the cells, such as red cells and white cells and platelets. And there are ways to donate the blood as whole blood. Usually through volunteer donor programs, and then there are ways to donate just the plasma that we've been speaking about.

The plasma is usually collected in for-profit centers, and the whole blood that's collected is generally volunteer. The donors are not reimbursed for this financially. And so there is a difference there. And in fact, the FDA requires that products be labeled as volunteer or a paid donor.

CHAKRABARTI: We're going to come back to that in a second, but I still want to get a little bit more about a deeper understanding about why plasma is important.

So it's the largest liquid part of your blood. Can you tell me more about what's in it that makes it such a medically valuable resource.

BLINDER: Certainly. There are thousands of proteins that are in plasma. Some of them are at very high concentration. All of the plasma donor collections that are made are fractionated. They are not directly given back into individuals from a paid plasma donor. So the fractions that are most commonly used are albumin.

Which is needed in blood. It helps as a volume expander. If you will, it's used in a lot of clinical situations. A second product is the immune globulin that Kathleen has taken. It can be typically as an IV, IG or intravenous immune globulin. And then the third group of products are the blood clotting factors that were used predominantly for hemophilia's and related bleeding disorders, but other blood clotting problems as well. So that is where most of the plasma is processed and turned into.

CHAKRABARTI: I see. So for those three classes of compounds that you just talked about, Dr. Blinder, after they are fractionated out of the plasma, do they have to undergo any more, you know, development or transformation in the lab before they are then given to recipients?

BLINDER: Well, certainly a big component of it is a viral inactivation in case any virus is present or other pathogen. And so all products are further treated with different processes. Some of them are filtration processes. Some are as simple as pasteurization, like you would do with milk to help ensure the safety of the product.

CHAKRABARTI: I see. I guess I'm asking because I'm just trying to understand how much more value, if I can put it in those terms, quote-unquote value, are the plasma companies adding to the product once it comes from the donor's body and before it goes into, you know, the recipient's body?

BLINDER: Certainly, well, one component of this is that plasma from many, many different donors are pool into large vats, if you will, of product. So there may be 20,000 or so donors that are all having their plasma mixed together in a laboratory. Processed further to make these other products that we've talked about, virally inactivated and then aliquot it out, which means to redistribute it in smaller volumes to be then used for treatment.

It does increase the efficiency of the processing, but it's also important, for example, in somebody needing immune globulin to have a repertoire of antibodies for many different donors. Different donors have been exposed to different pathogens in their life, different bacteria and germs. And so by mixing this blood together, this plasma together, you have a broad array of antibodies in the mix.

And that's thought to be an advantage of this product.

CHAKRABARTI: I see. Okay. So let's get back to what you said a little bit earlier, Dr. Blinder, that unlike sort of whole blood, plasma is usually collected by for-profit companies at for-profit centers. Do you know or care to hazard a guess about why the difference exists?

BLINDER: I think that whole blood donation is more of an altruistic adventure for many people. They do feel like they see a problem and they're trying to help. And some people have other motivations, such as maybe a family member has used a lot of blood products, and they feel that that's a way to give back. I think the motivation for the plasma centers is more financial. This has been going on in the United States for more than 50 years. And it has evolved as a for-profit center. And you can do it much more frequently as you mentioned. And so I think the motivations for people are different and it does require this financial motivation, I think, to be able to have enough people to donate, to make enough of this product.

CHAKRABARTI: Okay, Kathleen, let me turn back to you here. Because the motivation of the people who are giving plasma is one thing, but I'm still trying to get to the bottom about why this human product, right, plasma is just treated differently, has evolved into a for-profit business, versus, as Dr. Blinder accurately pointed out, just a whole blood donation.

It seems to me that the two, from a regulatory standpoint, maybe shouldn't be all that different.

McLAUGHLIN: Well, I think it is a choice we made. Accidentally, if you will. I don't think that most people have really thought about why we decided to do things this way. There hasn't been a big national debate over what should we pay for and what shouldn't we pay for.

I think that most people draw the line at, you know, you shouldn't be able to sell a kidney, right? So there are three things that we can do that you can get paid for in the United States, plasma, sperm and eggs. And I don't think we've had a big debate about that. I mean, most countries in the world ban the payment of, or ban paid plasma donations.

So we are very unusual in the context of the rest of the world. I will say though, I think that our thinking on this is a little bit confused because people do get paid for it. A lot of people donate or sell their plasma, right? But I also see this as a very altruistic thing. And many of the people that I interviewed, you know, the person that you interviewed at the top of the show, who is selling his plasma a hundred times a year, he has continued doing it because he wants to help people.

And this was really, yes, most people I have spoken with do it because it pays, and they need the money. And at the same time, they're very happy to be able to contribute something back to people who need it. So if you're poor, you don't often have the opportunity to help out in an altruistic way. In terms of like giving money to a charity or, you know, donating in other ways because you don't have a financial cushion that allows you to do that.

Selling plasma kind of offers this ideal in that way where you're getting paid. But you're also giving back. And I just wonder how we came up with the societal view on this, that donating blood is heroic. You know, it's a great thing to do and, you know, people should be celebrated for it. People talk about it all the time.

If you donate blood, you get a little sticker, you tell your family, but if you're donating or selling plasma, it's stigmatized as something that people don't generally talk about, even with their own family. The fact is, as a recipient of plasma products, I know that what people are doing is very altruistic.

I mean, it allows me to live a very normal life.

CHAKRABARTI: Well, so, I mean, the question that you just asked about how did we get here, I mean, as you reported the book, Blood Money, do you have your answer, or do you have an answer to that question?

McLAUGHLIN: I mean, my answer is this industry grew and flourished to the point that we're at right now without many people taking notice of it.

There was a decision made at some point, several decades ago, that people could be paid for their plasma in the United States in spite of UN or World Health Recommendations. To the contrary, we made a different decision. The industry was much smaller when we made that decision, but I don't think anyone has gone back and said, wait a minute, should we be doing this?

Should we maybe be paying people more? Should we be limiting the number of times that they can donate more strictly? Should we have better health regulations surrounding the industry? I just think that because the practice is so stigmatized, we haven't really stepped back and said, wait a minute, is this what we want to do?

CHAKRABARTI: Well, Dr. Blinder, let me turn back to you. Because what do you make of the fact that as Kathleen pointed out, the United States is an outlier in terms of the fact that people can get paid for their plasma donations here, which apparently go, what, goes against some international recommendations or even international best practices.

BLINDER: I think that's true. And I think we're an outlier for other reasons as well, including the frequency of donations that are allowed in the United States, which is two per week, separated by at least two days. Those are the guidelines. Whereas most other advanced countries that do allow this, it's usually once a week or sometimes even every other week.

So I think, in part, we have become the OPEC of plasma donation. I think I've read that about 70% of the plasma that's used is collected, in the world, is collected in the United States.

CHAKRABARTI: The OPEC of plasma donation. Wow. Well, does donating as frequently as people can in the United States, and I mean, I'm going to guess that not everyone does it 100 times a year like Patrick does. But does donating within just a day or two, Dr. Blinder, could it have any potential negative effects on the person donating the plasma?

BLINDER: You know, I think that's a very important question that's not really well described.

So there are short term risks, local reactions, bruising reactions right at the site of the IV and then deterioration of the veins, like Patrick had explained. Then there are other reactions related to something called citrate, which is what the plasma is diluted into. It's an anticoagulant.

Some of that citrate then circulates back into the donor. And so there are concerns that has some short-term side effects as well. And then there are concerns about potential long term side effects that haven't really been well defined. And there's mixed data, for example, on whether or not a lot of citrate over a long-term period causes osteoporosis or leaching of calcium from bone. So things like that.

There are randomized studies to look at long term plasma donors, and you can see effects on their antibody levels, for example. But the studies in general have not shown a long term clinical effect to the donors.

On the other hand, though, these studies do not go 20 years, they're more like one- or two-year studies. So I think these questions are still not fully answered.

CHAKRABARTI: I just want to let listeners know, because I failed to say this earlier, you are a hematologist, Dr. Blinder. So how long does it take for the plasma and the particular compounds that are so important in the plasma, to regenerate in the body of the person who's given the donation?

BLINDER: It depends somewhat on which product you're talking about. So albumin, for example, or the blood clotting factors regenerate fairy quickly. Allowing for the twice a week donation, to some degree.

The antibodies that are removed probably do take longer to regenerate. Our immune system is protected by the cells that have been exposed to infections. So we have memory cells that can generate more antibody, if needed, if you're re-exposed. But I think there may be some effect on the immune system.

Antibody levels for sure, and maybe on the immunity of the donor as well.

CHAKRABARTI: Okay. Well, let's listen just briefly to some other people that we reached out to who have donated, I keep using that word donated, slash sold their plasma. Here's 38-year-old Cory Lyons from Columbia, South Carolina. And he remembers selling his plasma during his junior and senior years in college in Indiana.

He did it with a couple of friends and they mainly used the money for things like food.

CORY LYONS: We all kind of just thought we would try it together, because nobody wanted to do it by themselves. So we all went, and then after the first time, we just kind of, it kind of became just something we did every week.

I think it usually took about like an hour for the whole process, so we would just sit there and talk and hang out. And I haven't done it since, so it's been a long time, but I still have the little scar. (LAUGHS)

CHAKRABARTI: That's Cory Lyons in Columbia, South Carolina. And this is Darryl Wellington. Back in 2014, Darryl and his girlfriend needed extra money, a hundred extra bucks to make rent on their home in Santa Fe, New Mexico, and Wellington saw an ad in the local paper about selling plasma. And his first time at a plasma center, which he later wrote about in The Atlantic, it kind of upset him.

DARRYL WELLINGTON: Think of a doctor's office. ... And it was buzzing.

You had a medical exam, you had various other things you had to sign, and you finally sat on couches and the couches are all in a big, big room where you laid down on them right next to each other. This to me was all too sci-fi. Why do they want this from you? What are they doing with this? And what effect will it have on me? Was already very in my mind.

CHAKRABARTI: So Kathleen McLaughlin, in the United States, the OPEC of plasmas, Dr. Blinder put it, I understand, I mean,  from your book, that we actually supply two thirds of the world's plasma, is that right?

McLAUGHLIN: Yeah, I mean, I think this is something that a lot of plasma sellers, plasma donors are not familiar with. Is these products that American's blood is being made into is being exported around the world.

So we have a lot of people, we're a big country with a big population, and we have an outsized number of people who need extra cash. So this is very, we are a market ripe for the picking, I would say.

CHAKRABARTI: So we've got about 30 seconds before our next break. Kathleen is there any commonality amongst the people who are frequently selling their plasma? Who is doing this in the United States?

McLAUGHLIN: I mean, there are a lot of different kinds of people. There are a lot of college students. There are a lot of people who are working full time but need extra money. And then there are people who are unemployed and broke.

So, I mean, it just runs the gamut of Americans who need cash.

Part III

CHAKRABARTI: Kathleen and Dr. Blinder, I just want to, again, share some voices from other people who have been touched by the plasma industry, if I can put it that way.

Jenny Hecht is one of them because she and her husband drive about 40 minutes to the plasma center in Elkhart, Indiana, twice a week. Now, Jenny had to stop donating blood after she was diagnosed with an autoimmune disease. Autoimmune disorder, but she was told she could continue to donate plasma. And she's saving the money for a plane ticket to visit her daughter in Washington state.

And she says she does it because the payouts are both nice, but she also missed the good feeling that she got by giving blood.

JENNY HECHT: I just feel like one day it could be me that needs the blood or the plasma. And I've always felt like that. And we also, my stepdaughter's friend this year got in a horrible accident.

And so I think about like all the things that she needed while she was in the hospital recovering. And then when you walk into the plasma centers, they have, and I know it's like advertisement, right, but they have people on the little signs that are like, thank you for your donation for, you know, like Josh, so and so or whatever needs plasma to live.

And I'm like, Josh, I got your back. (LAUGHS)

CHAKRABARTI: That's Jenny Hecht. This is Kathi Young, who began donating her plasma just a few months ago. She lives in Cameron, North Carolina, and recently learned that plasma is used to help treat blood clotting disorders, like hemophilia, as Dr. Blinder told us a little earlier. And that has personal significance to her because of something that happened in 1986.

KATHI YOUNG: When I was 19, my boyfriend, who was a hemophiliac, had contracted HIV from a blood transfusion and subsequently passed away from the disease. And I try to donate twice a week. You can donate twice a week. And I try to, to meet that level of donation. Because it takes, I think, they said 300 donations for one patient who needs it.

CHAKRABARTI: That's Kathi Young from Cameron, North Carolina. So Kathleen McLaughlin, I have to say I'm having a little bit of trouble here understanding what the problem is, right? I mean, because if you said a little bit earlier that people from many walks of life are donating, you know, we may not know exactly the long-term implications of giving plasma frequently, but at this point in time, that's allowed by FDA.

And yes, companies are making money off of it, but profit in health care is not unheard of. So where is the harm?

McLAUGHLIN: Well, I think the No. 1 thing that we need to consider is what Dr. Blinder mentioned earlier, which is we really don't know the long-term effects. These studies are not long term. And I think that people who are doing this deserve as much care and concern, as wealthy people in our society do. And to me, what's going on right now, because this is a hidden economy, because it is stigmatized, because a lot of people tend to look down on this practice, is we are not giving adequate care and concern to people who sell plasma. I also think that really in many ways, this industry is just a symptom of the problems in our society.

And what I mean by that is there are a lot of college students, for example, who sell plasma, and to me, that's just a symptom of the problem, which is university education is too expensive and the fact that we're expecting 19 year olds to figure it out and go out and sell parts of their blood is quite disturbing without having a national conversation of, you know, Is this who we want to be?

Do we want to really be the kind of country where we expect 19- and 20-year-olds to sell pieces of themselves to fund their education? So I haven't found, you know, strong evidence that there is something wrong with this industry or this practice. I just think most people who haven't been broke before are unaware of it.

And we need to change the stigma around it, because it's all related to a stigma against poverty that we have in this country. So it's more to me a matter of figuring out if this is who we want to be. I also think that people should get paid more. You know, I think we shouldn't understand how much profit is being made, who's making that profit.

And why aren't the people who are selling plasma getting more of that money? You know, and I think that as Dr. Blinder pointed out, the lack of long-term studies, we actually need to invest in long term studies on the health of plasma donors and see if 104 times a year, twice a week, is actually okay for a person's health.

CHAKRABARTI: Hmm. But in the book though, you go farther, right? You're quite strong in your view about why this is an industry worth greater scrutiny, right? Because you write, leeching blood from the poor and selling it for profit created a calamity in China. That story that you told us about earlier, Kathleen.

And something equally calamitous could happen here again. Tell me more.

McLAUGHLIN: Yeah. So, you know, my exploration of this in the United States really began with a Chinese doctor. So the woman who blew the whistle in China on the AIDS crisis that was born of the plasma economy, her name was Wang Shuping. She fled to the U.S. and was living in Salt Lake City as a cancer researcher. And we met because I wanted to hear the story of what she had experienced in China and the reason that she fled into exile in the United States. And I spent a few days with her the first time we met, and you know, we did ongoing interviews, and I was trying to figure things out and I was really focused on China.

And she said to me, "We need to go see something. I need to show you something." And we drove to a plasma center in a strip mall in downtown Salt Lake. And we went in, and we talked to them to try and figure out things. And she said to me, "This is how it was operating in China. This is the same kind of thing that we saw in China."

And I said, "Do you think there's a risk of a viral infection?" And she said, "No. But they aren't treating people well." And so she could just see the potential harm of a system that was expecting people to give and give and give and give.

CHAKRABARTI: When she said they aren't treating people well, what did she mean?

McLAUGHLIN: I think the thing that disturbed her the most from our conversation was that people were expected to go twice a week for as long as they possibly could. She had felt that the system was operating at too fast of a pace. I think that was her concern. And also, the payment scheme disturbed her because, and I don't know if the people that you've interviewed have explained this, but you actually get paid more the more you donate.

So if you go twice a week, you get paid more. If you go eight times in a month, you get a bonus oftentimes. So the system incentivizes people to go as frequently as they possibly can.

CHAKRABARTI: Dr. Blinder, what's your view on the way the plasma industry works here in the United States. Do you share the same concerns that Kathleen has?

BLINDER: I do share some of these concerns, and I would also say that we've had our own calamity here in the United States. Plasma collection was started in the 1960s, predominantly for hemophilia patients to collect the factor that was needed to treat the hemophilia. And it flourished in the 1970s until it all came crashing down in the AIDS epidemic.

It's wiped out, a generation of hemophiliacs were infected with either hepatitis or HIV.  Predominantly in the late 70s and early 80s, and the plasma industry in the United States had dried up to some degree after that. So we have had our own catastrophe with this. It's always seemed to me that it's been a little bit unsavory.

It's not usually on the fringes of it, it's more on the fringes of medical care. There aren't doctors that staff these clinics or even nurses. So I think that there is some certainly good that comes from this, but the way it's done does seem a little bit uncomfortable. And I think that may be the angst that we're all having here.

CHAKRABARTI: I mean, but uncomfortable doesn't make it wrong. You see, I know this is going to sound terrible when I say it, but Kathleen, you're exactly right that, look, we have a country that does not provide an adequate safety net for millions of people, and we see businesses that grow up around that fact, right?

It's kind of a hallmark of American capitalism. Like, where are the lottery tickets sold, right? Where are the payday lenders located? It seems like you're saying, where are the plasma donation centers located? They're located in neighborhoods that are socioeconomically distressed, right?

Kathleen?

McLAUGHLIN: That's right. That's correct.

CHAKRABARTI: Okay. So, I want to acknowledge that this is a pattern that we see in American life. I'm not disputing that. But I'm also saying that here's a case though, that people actually are getting paid, rather than like spending $30 on a scratch ticket, which they won't win any money in return. Or having to take on usury rate loans just to get their paycheck cashed.

And at the other end of this, other people are being helped as well, so I'm just trying to understand what changes you would want to make that would make this industry less unsavory.

McLAUGHLIN: I mean, to me, I think we need more long-term studies of the potential impact on people's health.

I think there isn't enough evidence about frequent long term plasma donation. To feel comfortable about it. In addition to that, I think people should be paid more. And I think that perhaps the industry should be more transparent. But I've said this before, I don't necessarily think the industry is the problem.

I think the problem is that our social safety net in the United States has frayed. To the extent that this has become part of it. So selling plasma has become woven into our society. And I don't think that people know that. And I don't necessarily think that it has been, I don't think it's been revealed to the extent that it's actually happening.

So it's fine to say, yeah, well, people are selling their plasma. So what? But have you ever been poor enough to need to sell a part of your body to get by?

CHAKRABARTI: No. I mean --

McLAUGHLIN: That's really the question.

CHAKRABARTI: I acknowledge that.

McLAUGHLIN: And so are we comfortable, are we comfortable with having a country where millions of people are in that situation?

And do we need to look at systemic things like the cost of education, the cost of health care, the fact that wages do not keep pace with the cost of living, inflation and everything else and at least talk about these things and acknowledge that it's problematic that people have to sell parts of their body?

CHAKRABARTI: So, yes, it's problematic, but it's a decision that was also made. Which is where we are this outlier. I wonder what would happen, say, if the country made a regulatory change and said, well, you cannot get paid anymore for donating, for giving plasma. I mean, Dr. Blinder, do you have any guesses on how that might change things?

BLINDER: I wondered about that. I think some plasma has been collected at places like the Red Cross, for example, convalescent plasma in the early COVID era was collected and then used. So I think the needs are so great to fulfill the requirements, that we have set up for ourselves, as far as how much plasma is needed.

I think it would be difficult to change this system and say, we're not paying anymore or something like that. I think the financial incentives are too high at this point, even though they're still modest, but I think this is going to be difficult to change. I would also like to comment on one other thing.

I looked at the 14 or 15 plasma collection centers on a map in the St. Louis area. And they are in blue collar and firmly middle-class areas too. So I don't think the stigma of it being just in perhaps the skid rows of the major U.S. cities. That's not the case.

McLAUGHLIN: Well, no, it's not.

It's pretty clear in the book that this has become a middle-class endeavor. There are plenty of people in Blood Money that I interviewed who work full time in what used to be middle class professions, but they don't make enough money to make it anymore.

CHAKRABARTI: So, we've got one more voice here of someone we talked to who gives plasma.

This is Mary Seebach, who lives in Middletown, Ohio. She has been recovering from opioid abuse disorder for about 10 years now and works as a peer recovery supporter. And she told us that she started selling her plasma about 14 years ago when she needed money when she was suffering from her addiction.

MARY SEEBACH: For, honestly, drugs. Because I used to be an addict myself. I didn't really know what they would test for. Because they ask what medications you're on and all that and of course back then I lied and said I wasn't on anything. But recently I started again. Just like a few months ago for school, to go back to school to become a nurse, so I've just been using that money for like cost of tuition and books or whatever I need that I can't afford with my job.

CHAKRABARTI: Well, Kathleen, we've got about 30 seconds left. What are the questions that you think listeners should be taking away in their minds when they think about, you know, the plasma industry.

McLAUGHLIN: Yeah. I mean, number one to me, honestly, is why do we stigmatize this practice? As we kind of laid out in this conversation, it is helping people.

It's helping people like me. It is a very altruistic endeavor. So why do we think about this in a way that is just about, you know, poor people doing something unsavory. And if we want to continue having a paid plasma system, shouldn't we treat people better who are engaged in that system?