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If you want to find out what side effects a drug will have, you have to test it on people. Human guinea pigs subject their bodies to experimental medications by choice. And as NPR's Rae Ellen Bichell reports, some do it for a living.
RAE ELLEN BICHELL, BYLINE: A lot of people who do this job keep it a secret, but not Robert Biafore.
ROBERT BIAFORE: I am 100 percent lab rat (laughter).
BICHELL: Biafore lost his job as a car salesman six years ago and soon after, he did his first clinical trial. He hasn't looked back.
BIAFORE: The fact is that I would do a clinical trial for two weeks and make a check for $5,000. Well, why the hell would I want to go to work for Wal-Mart? Why do I want to go back to selling cars and be on a car lot 12 hours a day, six days a week?
BICHELL: He's a guinea pig in phase one studies. They involve small groups of healthy people. The point is to find out how much of a drug is safe and get an initial idea of what the side effects might be. A drug that passes these first tests will then be studied in a lot more people to see if it actually treats what it's supposed to. Biafore says the worst that's happened to him is that he got a rash and vomited.
BIAFORE: It's all part of the game. You're letting scientists use your body to get data for, you know, clinical results. You've got to understand that going into it. You can't be afraid of it.
BICHELL: He'll sometimes live in a clinic for weeks on end popping experimental pills, getting his vitals checked and reporting how he's feeling. It's an easy way to make a living, he says. And he's uninsured, so participating is like getting free medical checkups.
BIAFORE: Where else am I going to go that I'm going to get labs done, physicals done, ECGs done, you know, MRIs looked at? And people are going to look at my body and tell me what's wrong with me even before I know something's even wrong with me.
BICHELL: This works for Biafore, but some researchers worry about exploitation, like Jill Fisher. She's a sociologist at the Center for Bioethics at the University of North Carolina in Chapel Hill.
JILL FISHER: And so I am very concerned about the fact that we're really using a segment of our population who might not ever be able to afford the drugs that they're part of testing and not compensating them perhaps to the degree that we really should.
BICHELL: Pay varies, but she says it's about $200 a day. And, she says, while most stages of medical research skew white, these earlier phases - the studies on healthy volunteers - tend to be on low-income minorities. Fisher says they're essentially renting their bodies to companies that could potentially make billions off of the products they're testing.
FISHER: I mean, I think that there is a justice concern here, that if we're thinking about phase one trials, we're really talking about studies that have no medical benefit for the people who enroll in them.
BICHELL: And they are risky. It's really rare for something to go wrong, but it can happen, like in a trial in France earlier this year where one man died and five others were injured.
FISHER: And so I think there is a lot of concern when we think about how we're distributing those risks of medical research across society.
BICHELL: She says people who participate repeatedly in these trials tend to be strapped for cash and don't have great health care coverage or a lot of job options. Some go to extreme lengths to make sure they'll qualify for trials, like one guy she interviewed.
FISHER: He doesn't want to hang out with his friends who are smokers because he doesn't want to get the effects of nicotine in his system and possibly get disqualified from a study.
BICHELL: And he eats healthy and exercises. Those kinds of choices are sacrifices for the job, says Biafore, just like the risk of taking part in a trial.
BIAFORE: And to me, it's not a big deal. It's not a big deal at all. I mean, I grew up in the '80s in New York City, please (laughter).
BICHELL: Biafore says the kind of people who recoil when they hear what his job is don't understand how much they need people like him. Like any time someone goes to pick up a prescription, he says.
BIAFORE: How do you think they got that? If it wasn't for people like us, you wouldn't get that medication.
BICHELL: And there, he's got a point. Someone's got to do it. Rae Ellen Bichell, NPR News.
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