Donna Dickenson is an author, activist, and academic working in the field of medical ethics. Her impressive resume includes being Professor Emerita of Medical Ethics and Humanities at the University of London, coordinating research projects for the European Commission, and winning the prestigious Spinoza Lens prize for demonstrating critical ethical reflection in her work. (She shares the latter honor with the late theorist Edward Said.) Her compelling, thoughtful, and extensively researched Body Shopping: Converting Body Parts to Profit, is recently out in paperback. Dickenson walks the reader through complex legalese and medical research to reveal the ways in which human tissue has been commodified and can now be "bought and sold on international markets." Her chapters address a broad range of topics, from the ethical dilemmas intrinsic in the recruitment of women for egg donation to the fantasy and reality behind "repair kits" generated from umbilical cord stem cells, to how building designer babies revisits centuries-old arguments about eugenics. Dickenson draws a connection between "beauty junkies" and bone thieves, and asks the reader to consider the consequences of transforming the human body into a sellable object.

Mandy Van Deven: I learned an enormous amount about the current ethical and legal struggles in the medical field from reading Body Shopping; the book is packed with information that isn't readily available to the public. What influenced you to write such an expansive and accessible book?

Donna Dickenson: In 2006 I won an international award called the Spinoza Lens prize, which is given for contribution to public debate on ethics. At that point I had written some sixty journal articles and twenty academic books, but the prize organizers felt I could do even more to bring my concerns to a wider public. So that was my inspiration to write a book that could be classified as either popular science or current affairs, for a general audience.

To be modest, much of the factual information you mention has actually been put before the public by investigative journalists and academics. My contribution was bringing my legal and analytical skills to find common threads between the very wide range of sources I've used: there are about 400 articles and books in my bibliography. I also put forward proposals for reform which haven't penetrated much beyond the academic literature, and I situate the problem in its historical context, as well as offer a new way of looking at it in terms of the way "we all have female bodies now."

MVD: What does it mean for everyone to have a "female body?"

DD: It's not that we all have biologically female bodies, but that all bodies are now seen by commercialized biotechnology as "open-access." That means we can learn a lot from the criticisms feminists have offered of the ways in which women's bodies have been turned into objects.

MVD: In the book you remind us that advertising has long objectified and commodified women's bodies and point out the gendered ways women are more susceptible to exploitation and bodily risk through egg "donation," cosmetic surgery, organ donation, and umbilical cord blood banking. It seems somewhat ironic that a culture can devalue women socially yet place such a high literal price on women's bodies. How does this coupling of oppositional value contribute to the higher rates of body shopping for women?

DD: Women's tissue is generally more valuable than men's: eggs fetch higher prices than sperm, for example - but that's got everything to do with anatomy and not much to do with advertising. So when I say that all bodies are becoming "feminized," becoming objects of commercial interest, I qualify that by adding that women's tissue remains more valuable.

Cord blood, which has a large number of stem cells that are used to treat several illnesses, is generally presented as belonging to the baby, but the advice received by the Royal College of Obstetricians and Gynaecologists' internal legal counsel held that it was the mother's. I agree with that position because of the extra work and risk the mother puts into having the blood taken and stored during delivery.

In cord blood harvesting, the blood is taken from the mother's side of the clamp, frequently while the cord is still attached to the maternal placenta. Extra effort and risk-taking are put into "harvesting" the cord blood by the mother, and normally we think of labor and risk-taking as what justify property rights. There is work involved here because the blood isn't just leftover waste. The only reason for thinking it's the baby's is its genetic basis, but we don't normally think of genetic identity as the basis for property rights. At the very least, we ought to be thinking about whether it belongs to the mother, rather than just assuming it belongs to the baby, as most commentators have done.

MVD: You also argue body shopping disproportionately harms people of color, individuals and nations with less wealth, and other marginalized populations, like prisoners. Can you talk a little about that?

International organ and egg tourism does exploit people in poorer countries. There's a good article in the Hastings Center Report this month showing the way in which payment for kidneys - often sold to wealthy foreigners - has become a major industry in Pakistan, where the sellers are inevitably the poorest peasants, who remain in debt afterwards because the broker or moneylender who arranges the kidney sale takes such a large part of the proceeds, or because the debts exceed the low price they can obtain for their kidney, and also in worsened health. All but one of the Pakistani sellers surveyed said they would never advise anyone else to do what they had to do out of desperate poverty. The authors think that Westerners who justify organ and egg sales as "free choices" by the sellers are both cynical and naïve, and I have to say that's the dominant position in the bioethics literature. I like to think I'm an honorable exception!

MVD: It can be difficult to wrap one's head around some of the contradictions in "body shopping"-like the fact that we don't own our own bodies so we are not able to sell our organs for a profit (at least, not in the United States), yet when we die our organs can be sold to medical facilities by the medical school it was donated to and we can be compensated for some of our "parts," such as eggs and sperm.

DD: People are always surprised that we don't own our bodies in law, but the traditional common law position was that once taken from the body, tissue was "no one's thing." That didn't pose any problems, because before the rise of modern biotechnology, there was little or no value in the tissue-which would probably have been removed [only when] it was diseased. The older legal position still holds in the US Uniform Anatomical Gift (1987), which makes it illegal to sell organs - except for eggs and sperm, which were exempted as renewable tissue. That medical error - sperm is renewable, but eggs actually aren't - has given rise to a vast egg-buying and egg-selling industry in the US, which isn't replicated in most European countries, with the exception of Spain and Cyprus.

Your organs can't legally be sold without your consent when you die, but I think many people would be surprised at the alleged onward sale of parts of bodies donated freely under willed-donor programs, as is said to have occurred at several US medical schools.

MVD: The specialized nature of the knowledge surrounding body shopping (legal, scientific, medical) seems to makes these industries particularly ripe for corruption and misuse. How can this type of information be disseminated to a lay audience?

DD: My goal in writing the book was to take these developments out of the scientific or academic literature and describe them for a non-specialist audience. I've had a lot of experience in writing texts, as well as appearing on TV and radio to talk about medical ethics, which helped a great deal. I think the greatest difficulty isn't so much that a popular audience can't easily understand the science and medicine, but that we live in a very polarized society. Anyone who isn't one hundred percent behind every new development in biotechnology is often portrayed as either ignorant or doctrinaire - frequently, at least in the UK, as a religious zealot.

Many people have been persuaded - falsely - that's if we want the genuine benefits that modern biomedicine can bring us, we have to accept all the scientific developments uncritically. So the difficulty is getting a "lay" audience to "lay" aside this presumption that "you're either with us or against us" and accept that you can be entirely pro-medicine - as I am, having spent my academic life working with doctors-but also concerned about the ethical issues. I try to present both sides of the ethical and legal arguments for and against commercialization of the body throughout the book, and to play devil's advocate to my own views.

MVD: There seem to be two dichotomous arguments regarding body shopping: abolish the practice or let the market/individuals decide. Both are impractical and will not abolish the black markets and other abuses that exist internationally. Do you think a middle ground is possible?

DD: Yes, in the sense that I think body shopping can, and should, be regulated-although that will also involve outlawing some of the worse developments altogether. Letting the market decide just isn't tenable. Particularly after the collapse of major banks and firms like General Motors following the sub-prime mortgages lending disaster, we've seen that total market deregulation isn't a practical choice. There can't be very many extreme free-marketers left out there; the argument that "you can't buck the market because the market is always right" is clearly untenable when markets are imploding. In any case, many of the new developments in biotechnology, like mapping the human genome, were largely paid for out of public money. It's only right that the public and the state should have a role in regulating both the profits and the practices.

MVD: And privatizing the market can actually have negative consequences on the progression of medical research.

DD: I'm very worried that medical progress is being hampered by the way in which the body has become a product. For example, because one in five genes is now under patent restriction, medical research teams often can't carry out much-needed studies unless they pay a license fee to the private company that holds the patent - if the company will allow access at all. Commercialization of the human body isn't always necessary to medical progress, and in some cases it's actively bad for science.

MVD: It seems like regulation and legislation are always lagging behind when it comes to body shopping. Why is that?

DD: It's difficult for law and regulation to keep up with the sheer pace of scientific change, but not impossible where the political will exists. I think the difficulty is that often it doesn't exist, partly for the reasons I've given already: the assumption on the political Left that science is always a progressive force, and the belief on the Right that markets are never wrong. So when you have massive market investment and commercialization in bioscience, people on both sides of the spectrum assume it must be a good thing.

MVD: Do you have any suggestions for shifting this dynamic?

DD: The first step is to make people aware that commercialization can be actually be bad for both science and individual patients. The example of private cord blood banks is very telling: here in the UK the Royal College of Obstetricians and Gynaecologists has put out two reports showing evidence that while public banking is beneficial, private commercial banking is potentially harmful. We now have a UK government body called the Human Tissue Authority that regulates the private banks by requiring them to register and to pass certain tests for a license.

There are a number of legislative moves afoot throughout Europe, and also in the US, China, and India - although all three of those countries do have large private markets in egg sales, now on an international scale. There are also very active pressure groups like the Corner House or Genewatch in the UK, the Centre for Genetics and Society in California, and Korean Womenlink, as well as a number of alternative models-like benefit-sharing or pooled gene patenting - where patient groups share the profits from discoveries with biotechnology companies. And there's the very important new court case against the expensive license fees that patients have to pay on genetic patents on two genes implicated in some breast cancers, which was launched by the American Civil Liberties Union and other concerned groups.

I believe egg sale - it should be called "sale" rather than "donation" - should be prohibited. The only reason the vast market arose was due to the physiological misunderstanding underpinning the US Uniform Anatomical Gift Act. The Act wrongly assumed that eggs are renewable tissue like sperm, but it's generally agreed that a baby girl is born with all the egg follicles she'll ever have. It would be consistent with the reasoning in the rest of the Act to include eggs with non-renewable organs and prohibit their sale. All European jurisdictions except Spain and Cyprus do just that.

MVD: When Body Shopping was initially released some people used words like "horrifying," "shocking," "disturbing," and "alarming" to describe it. Did you expect to elicit such strong reactions?

DD: I did not set out to shock, horrify, disturb or alarm, but to explore the ways in which modern biotechnology is commodifying areas of our life from BC (before conception) to AD (after death), and what we can do about it. My background as a professor of medical ethics and law, and as someone who has taught generations of medics and nurses, makes me practically minded. Instead of focusing on the sensational cases, I concentrate on everyday instances of "body shopping," like the patenting of human genes which forces patients to pay a license fee for diagnostic tests, or the development of private umbilical cord blood banking, which has been described by leading medical bodies as potentially dangerous for both mother and baby.

Fay Weldon said Body Shopping was written "gently, thoroughly and reasonably calmly," and I was particularly pleased that The Lancet and New Scientist said I'd got the science and medicine right - that the book was objective and accurate. I think it would be a mistake to portray the book as sensationalistic. That said, people are genuinely shocked by such events as the illegal sale of bones from funeral homes, or the scale of the international organ trade. I don't want to denigrate such reactions - their heart is in the right place - but I would be dismayed if they diverted attention away from the much more widespread and less sensationalistic instances of "body shopping," which are the main subject of the book.