What is the value of human parts? I am at the Body Worlds 3 exhibit with my six-year-old, and what I thought was going to be an interesting medical lesson for my daughter is turning into a strange art show and commentary on our varying degrees of values around human flesh. We are standing in front of a body called "Skin Man." Once a living, breathing human, he now stands with a thoughtful expression on his face, holding one skinned arm outstretched with his entire human dermis aloft, like a coat to be hung. I'm trying to think of some interesting ethical discussions around the value of human bodies with my child, but all I can think of is how much money his skin is worth.
In an article for The Tyee, Dr. Paul Tinari estimated that a single male foreskin can be worth upwards of $100,000. He argued that men who are circumcised have a right to the revenue made off the resale of their foreskins (just as someone who sells their hair for wigs would, for example).
But that's not the only issue in the debate over how people use and profit from foreskins. Many people are challenging the ethics and medical necessity of male circumcision, which means that any use of the foreskins after that is also in question. Then there's the fact that foreskins aren't just being sold for the medical flesh trade; rather, they're joining a few other body parts being sold in the service of vanity. And if the ethics of using human body parts, skin and stem cells for medical research and treatments are contentious, the ethics of using them for vanity's sake is a whole other conundrum.
Shopping carts for skin
The flesh trade isn't as elusive as people might think. Like porn, human body parts are easily available online, for the right price. The Coriell Institute is only one of dozens of websites that offer foreskin fibroblast for sale. On their website, I put a foreskin fibroblast in a shopping cart and called their office, where a perky customer representative informs me that I can buy the flakes for a cost of $85.00 US -- plus shipping and handling. "We send them up to Canada all the time," she chirps. In the end, I didn't buy, but it surprised me to find out how easily I could have.
That's because foreskin fibroblasts are big business. A fibroblast is a piece of human skin that is used as a culture to grow other skin or cells -- like human yogurt kits. Human foreskin fibroblast is used in all kinds of medical procedures from growing skin for burn victims and for eyelid replacement, to growing skin for those with diabetic ulcers (who need replacement skin to cover ulcers that won't heal), to making creams and collagens in the cosmetics industry (yes, the product that is injected into puffy movie-starlet lips).
Foreskin-derived skin, sourced from circumcisions (now considered by many experts to be painful and also unnecessary) is still often considered the "cruelty free" alternative to testing cosmetic products on animals. One foreskin can be used for decades to produce miles of skin, much of which helps people in genuine medical need. And that's the reason one foreskin can generate as much as $100,000: that's not the fee from a one-time sale, but the fees from the fibroblasts that are created from those original skin cells.
But not all uses of foreskin fibroblast are "medical" in nature. One of the most publicized examples of the foreskin-for-sale trend involves a skin cream that has been promoted by none other than Oprah Winfrey. SkinMedica'sa face cream, which costs over $100 US for a 0.63 oz bottle, is used by many high-profile celebrities (such as Winfrey and Barbara Walters) as an alternative to cosmetic surgery. Winfrey has promoted the SkinMedica product several times on her show, and her website, which raves, there's "a new product that boosts collagen production and can rejuvenate skin called TNS Recovery Complex. TNS is comprised from six natural human growth factors found in normal healthy skin...the factors are engineered from human foreskin!"
During the show, the doctor promoting SkinMedica cream warned that some people may have ethical questions regarding using a product that is made from the derivative of foreskins (to which Winfrey made no response). Why ethical questions? The foreskins come from circumcisions, and male circumcision is now a controversial topic. In a discussion on Mothering.com, one querent asked, "If the cream was made from the bi-product of baby afro-American clitoral skin, would Oprah still be promoting it?" There's no answer to that question on Mothering or Winfrey's site, and Winfrey declined The Tyee's request for an interview.
Using foreskin fibroblast for medically necessary procedures generates less controversy than using it for optional "beauty" treatments. So how does Dr. Fitzpatrick, who invented SkinMedica, defend his company?
To start with, he argues that using foreskin fibroblast to make cream is ethical, because the company does not put any actual human tissue in their products -- only the growth hormone left over from growing artificial skin (not actual tissue or skin cells). And he adds that the original company that supplied SkinMedica with the hormone grew cultures from a single foreskin donated 15 years earlier. That company made artificial skin for wound healing.
But that company went bankrupt. And Dr. Fitzpatrick, whose invention of this cream earned him the dubious honour of being named Allure magazine's "physician who has most influenced beauty," now works with a supplier that uses foreskin fibroblast to make injectable collagen. So the foreskins used to make the cream have only ever been used for "vanity" purposes.
Further in his defence, Fitzpatrick says that using foreskins in the first place was simply a matter of convenience. Fitzpatrick told The Tyee, "It doesn't matter if you get a fibroblast from the eyelid, the cheek, the foot or the foreskin. That cell is still a fibroblast; it does the same thing. Foreskins were used because that is a common surgery and the skin is thrown away, so why not use it for benefits? Twelve years ago when this was done there would have been no objection to using foreskin tissue."
But Fitzpatrick acknowledges that using foreskins now is about more than convenience. Circumcision rates in Canada have dropped below 10 per cent and they are dropping in the U.S. as well, which means that it will be more difficult to source them. And foreskin samples do eventually run out and need to be replaced. But Fitzpatrick says that although you can use technology to make the cell cultures from scratch, without foreskins, the process is "much more expensive."
Things have changed from the time when using foreskins was an objection-free endeavour. In fact, many websites are now dedicated to the preservation of baby foreskins, and long streams of discussion on mothering websites argue against the use of baby skin for cosmetics purposes. Vancouver is home to the Association for Genital Integrity whose mandate is to end male circumcision.
I asked Dr. Fitzpatrick about using foreskins from older men instead who want to earn the purported $100,000 windfall. Apparently, it's a no-go. "Fibroblasts that are made from young skin are more active than fibroblast from a 60- or 70-year-old. The skin reproduces better in young tissue; you are using that cell as a factory...eventually the tissue samples need to be refreshed...a young cell produces more and lasts longer."
Newborn tissue is particularly valuable, not only because of its vitality, but also because it is usually guaranteed to be healthy. Tissue for medical use obviously needs to be free from disease.
Fitzpatrick adds that foreskin tissue has been the easiest tissue to access -- ethically -- up till now "because you are not having to use stem cells or fetal tissue in order to still get young tissue."
Neocutis is another face cream -- but this one uses cells grown from a terminated fetus to make their product, something they document on their website. Neocutis declined The Tyee's request for an interview.
Dr. Nikhil Mehta, the director of product development for SkinMedica, talked to The Tyee about his opinion of Neocutis, their competitor. "They are actually taking cells, literally chopping up the cells, and putting them in cream."
Another page on the Neocutis website describes how they harvested the tissue of a terminated two-month-old fetus, "in the period of scarless wound healing." It is out of this tissue that they developed the cell culture used in creating their special "bio restorative skin cream" with their patented secret ingredient.
Myth of scarlessness
Dr. Fitzpatrick explains why they would want to use fetal tissue: there is a period during neo-natal development where wounds will heal without scarring. He says no one really understands why the cells are scar-free at that time, but that even so, there are no scar reduction benefits to be gained by using them -- those properties aren't transferable: "To take cells at that age, and imply that you can have that happen to an adult is incorrect. No one has shown that to be correct; if there was some reason to believe that could occur it would be a very hot topic."
The Tyee asked Dr. Mehta how much tissue Neocutis would need to "harvest" from a two-month-old fetus in order to develop a cell culture, since this kind of skin can grow for years. "You don't need very much. Think of how small a baby foreskin is. Maybe the amount of skin that is on the tip of a finger."
This doesn't sound so bad, until I am standing in front of the plastinated fetuses at Science World. They are the only dead humans at the exhibit with skin, and their tiny features are drawn into expressions one might imagine on a puppy having a bad dream. The two-month-old fetus is perfectly formed; a small spine curves its back. Tiny fingers curl. It is barely an inch long. They would have to use the whole thing.
In a moment of panic, I wonder if I have deeply scarred my six-year-old by bringing her to this exhibit. In this world where doctors can make art shows out of human flesh -- ostensibly in the name of science -- how can we judge pharmaceutical companies who chop up unwanted fetuses, or grow cells from foreskins, to put on our faces?
As I am trying to formulate some words to discuss the topic, my daughter -- young though she is -- catches sight of my face and pulls me away saying gently, "Mommy, don't look if it makes you upset."
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