The Red Market (22 page)

With the shadow of regulators bearing down on them, few scientists in the Western world would rush to treat patients with experimental stem cell cocktails without first going through years of animal and toxicity trials. But in India the lack of regulation gives Shroff’s research design a modicum of freedom. And the clinical trial industry is flourishing. Patients swear that Shroff has unlocked the stem cell secret. But she doesn’t let many people see the inside of her lab, and has never said a word about her failure rate.

There’s just no way to know whether she is a hack or a vanguard. Without publishing a paper about her results, her lab gains notoriety through the anecdotes of spectacular success. And yet no respected scientist has been able to scrutinize her methods. Mridu Khullar, a journalist in Delhi who has followed Shroff’s work, had a rare and exclusive look at the lab and wrote about the story of a twenty-seven-year-old American woman who was admitted to the clinic in 2009 while suffering from chronic Lyme disease. When the patient returned home her consulting physician declared her asymptomatic. In her article, Khullar suggested that Shroff wants to eventually distribute her cure to pharmacies, saying that her treatment could be the new penicillin: “That was the beginning of the antibiotic era, and it changed the entire face of infection around the world. This is similar to that,” she writes, quoting Shroff.

The risks, of course, are huge. Left to their own devices, stem cells in the bloodstream could either be therapeutic and fix a problem, or they could morph into just about any other cellular structure. One of the most serious would be to transform into a teratoma, which is a sort of tumor that mutates freely. They’re best known for sometimes packing bits of bone and teeth inside of them. A poorly placed teratoma in the body can be fatal.

And without truly understanding how stem cells work—and under what conditions they transform into helpful structures or spread uncontrollably—testing on humans is risky. It could be that every injection of Shroff’s cocktail is a game of Russian roulette, with results that are similar to getting blood transfusions without understanding the difference between blood types. Sometimes it could be fatal. Sometimes it could save a life.

ATTEMPTING TO MITIGATE THE
risk that comes with unpredictability, a company in San Diego controls exactly where stem cells go in the body by placing them individually in a scaffold. Building on the idea that it is possible to collect enough data on human physiology, it hopes to be able to create replacement body parts from scratch. Located in a small office complex that resembles a suburban strip mall, Organovo is a tiny biotech company that uses a three-dimensional printer to build replacement organs and tissues that will one day be surgically implanted into patients.

Keith Murphy, the company’s CEO, has a background at MIT as well as a degree in business. He says that most of the industry has gotten stem cell treatments backward. “The problem is that they want to inject stem cells and let them go to work on their own. But if the cells enter the blood stream most of those cells float freely around the body. No one knows where they go.” Even if it isn’t dangerous, it’s not surprising, he says, that so few doctors have shown any sort of clinical results in a lab if the medicine isn’t reaching the areas they want it to.

Murphy believes that stem cells respond to their environment and can form into just about any organic structure as long as they are getting the proper cues. In 2007 a Missouri-based partner of his firm demonstrated that beating heart cells would beat in unison when placed in a line together. The finding demonstrated that cells could communicate with their neighbors in an artificial setting—a prerequisite for printing out an artificial beating heart.

At the moment though, the organ-printing business is taking baby steps.

Murphy has me don a set of medical scrubs, shoe covers, a face mask, and hair covering and then leads me back into the sterile room. A team of three technicians huddle over a long metal device that moves a shuttle back and forth over a cell culture like an ink-jet printer. In fact that is exactly what it is, a 3-D printer that lays cells into molds—eventually forming replacement veins and arteries. On the day I visit, a thin white streak barely wider than a single angel-hair noodle is suspended between two calipers in a refrigerator next to the printer. The small bit of tissue is still maturing, but in a few days the cells will have grown out of the scaffolding laid during the printing and bond together. Eventually it will be able to hold the equivalent of human blood pressure and be ready for transplant.

The people who designed the organ printer look at the body in the same way as a mason looks at a brick building. A human organism is incredibly complex and interrelated, but ultimately we are just a bunch of cells placed one on top of the other. If there were a detailed enough diagram that noted the position and type of every cell, then a sophisticated machine could simply build a new human. Or, more realistically, print out human spare parts as they are needed.

The process starts with a culture of cellular material harvested from the intended recipient. Most likely this means an extract of bone marrow, or perhaps a biopsy from a liver. Those cells are then grown in a lab until they reach enough mass that they can be molded into inklike dollops of printable cells. The printer then positions each cell along a preset pattern to create tissues and organs. In 2010 Organovo started animal trials with nerve cells and arteries, and hopes to move on to human trials in the near future.

Organ printing seems to have some clear advantages over stem cell therapeutics, but it is still decades away from delivering real success. Its most difficult stumbling block is managing the different cell types that exist in every part of the body. Murphy points to the artificial blood vessel that will one day make its way into a mouse. “I could print you out a cube of liver cells tomorrow, but so far we haven’t been able to create the blood vessels that are inside the liver at the same time as we print the liver cells.” Without a steady flow of nutrients the cells in the middle of the block die. The current technology takes a few days for the cells in a vascular system to set and be able to handle human blood pressure. Pumping in fluids before that would cause the tiny constructs to burst apart.

He says the main problem now is overcoming the technical obstacles of maturing a diversity of cell types inside a complete piece of synthetic flesh.

“The only thing holding us back is investment. If the government decided that this was a priority, it would only be a matter of years before this technology matures,” says Murphy when I ask how likely it would be that the company overcomes the challenges in front of it.

Organovo is in a similar position to its counterparts in India. The technology points to a possible solution to a persistent problem, but is still a long way from proving its efficacy as a viable treatment. When Organovo first appeared on the scene, media outlets across the Internet predicted that the age of replacement organs was just around the corner. However the science is still far behind the expectations we have placed on it. Murphy is hesitant to suggest that even with massive amounts of funding a working artificial organ is any less than ten years away. More than likely we will have to wait a lot longer than that.

Synthetic replacement tissues, miracle therapies, and immortal cell lines may one day be the key to fixing the problem with the global tissue shortage. Industrial production facilities could one day replace red markets that are built on harvesting human bodies to prolong lives. We all want to believe in stories where ingenious scientist entrepreneurs save the day and create alternatives to solve the problems of today. But what are the costs of putting our hopes in the fringes of science fiction before they are science facts? Today there is already an economic system that provides vast amounts of human materials for sick people who can pay for it. We already treat human tissue as if the only problem is acquiring the raw materials.

At the heart of every red market is a kernel of hope that a bit of matter harvested from another human will in some way make the recipient’s life better. In some cases it does. However, the question of supply waits patiently in the background as if it is just another technicality that can be easily overcome. There is little will to change the current situation because we all believe the ethical conundrums of today will soon seem like anachronisms from a distant past. Rather than live our lives in an uncertain future, perhaps it is best to explore what is really happening along red market supply chains.

BACK IN CYPRUS
I watch Savvas Koundouros pull out his fifth cigarette from a crumpled pack and suck in deeply. We are on the roof of the building; a small refrigerator that keeps some of his less critical biological materials, and for which there is no space in the office, hums along next to him. Somewhere inside his lab another cryogenic storage locker holds hundreds of fertilized embryos awaiting their opportunity for him to implant the genetic bundle into another woman’s ovaries.

“Yes.” He nods. “Stem cells are the future.” But for now, at least, he is in the business of harvesting and selling embryos to women who can pay for them.

Hair harvested from the heads of Hindu devotees in Tirupati, India, dries on a rack in Chennai. These bunches will eventually make their way to the United States and Europe and be transformed into wigs and hair weaves.

A
N ATTENDANT PEEPING
out of an old-fashioned bank-teller window stashes my shoes in a giant pile with a thousand other pairs. From here there is no way out. A ripe throng of humanity presses me through a series of wrought-iron gates, and I trip along crumbling bits of concrete. As we make the transition from the entranceway to the inner sanctum, cool white ceramic tiles replace the broken flooring. It takes fifteen minutes to inch my way forward through the herd of people pressed together like cattle to where a uniformed man in a booth hands me a paper token imprinted with a bar code and a picture of Venkateswara—an incarnation of the Hindu god Vishnu. The next official I meet a few feet away, clad in a stained brown shirt, hands over two razor blades: one for my head, the other for my face.

The crowd of men and women proceed down a wide staircase, whose landing is covered in a soggy mixture of tepid water and black hairballs. The air is moist and smells of rancid coconut oil. The stairs end at a vast, tiled chamber resembling a neglected Olympic swimming facility where long lines of men face tiled benches running along the walls. (Women are herded into a separate room.) In the center are four massive steel vats.

I match my token code—MH1293—to a sign on the wall and then take my place in a queue of about fifty bare-chested men in black sarongs. The pilgrim at the head of the line bows low as a man with a straight razor makes swift work of his curls. Satisfied, the barber looks up, spots me, and beckons me forward. He has a ragged cloth tied around his waist over white striped boxer shorts. No high priest, clearly. Just a worker bee for the holy hive.

I assume the position as he fixes my blades to the razor handle. “Start praying,” he says. I try to remember the god’s face, but there’s no time to contemplate: the man forces my head downward and runs the blade down from the top of my head with the practiced efficiency of a sheepherder. Satisfied, he grabs my chin, sticking a thumb in my mouth as he prepares to dispense with my beard. I watch the brown hair fall away in clumps, joining the dark, wet mash underfoot.

The curly-haired guy who was ahead of me is also now bald, with small nicks in his scalp and pink streaks of blood dripping down his back. He meets my eyes and smiles broadly.

“Venkateswara will be pleased.” His wife is offering her hair in the other room. Together they will return to their village bearing a symbol of humility and devotion that all will recognize. A woman in a blue sari flashes by and scoops my hair from the gutter into a bucket. Each time her bucket fills, she stands on her tiptoes and empties it into one of the tall vats. By day’s end all four will be filled with hair destined for the auction block.

Welcome to the Kalyana Katta hair-tonsuring center at the Sri Tirumula Temple in Andhra Pradesh, India: the genesis point for the world’s most lucrative trade in human detritus. Hair collected here feeds into a half-billion-dollar beauty industry that weaves real “premium grade” Indian hair onto the heads of mostly African American women who want long straight hair. The global market for human hair tops out at almost $900 million in sales, and that doesn’t include the installation costs that salons charge.

Women seeking a high-end look know what to ask for. It’s called “remy” hair, which is more or less synonymous with hair from India. Top salons prize it for the way it’s collected, in a single cut, which preserves the orientation of the hair’s shinglelike outer layer, and thus its strength, luster, and feel. That’s what defines remy, and that’s the reason it commands a premium price. The hair’s journey, shorn from the heads of the devout and sewn onto the skulls of America’s new glamouratti, is a red market supply chain unlike any other. That’s because in this case at least, altruism, transparency, and commercialism are perfectly balanced so that there’s no black market to speak of.

Name-dropped in the ancient Hindu epic the
Mahabharata,
Tirumala is holy ground for fifty thousand annual pilgrims who arrive daily from across South Asia to seek favors from their god. In addition to monetary donations, about one in four offer their hair, which will then be offered to the gods of the marketplace, reaping a reported $10 million to $15 million each year. Including donations, the temple boasts that it takes in more money than the Vatican—a dubious claim. In any case, temple leaders announced a plan to plate the walls of the inner sanctum with gold. Profits from the hair are used to support temple programs and feed the needy.

Indian hair is sold to two distinct markets. The bulk of it, some five hundred tons per year from short-haired men like me, is purchased by chemical companies that use it to make fertilizer or L-cystine, an amino acid that gives hair its strength, but also makes an excellent additive for baked goods and other products. The more lucrative hair of female pilgrims—temple employees call it “black gold”—is tied in individual bundles and brought to the tonsuring center’s top floor, where women in cheap flower-print saris labor over small heaps of the stuff, sorting it by length. An armed guard frisks all who exit. There’s no way anyone is going to get past him with a single precious strand.

Human hair contains all sorts of secretions, including sweat and blood, plus food particles, lice, and the coconut oil many Indians use as a conditioner. Put twenty-one tons of the stuff in a room blooming with mildew and fungus and the stench is overpowering. One volunteer, her own long hair bound in a tight braid, appears to smile at me, but she’s wearing a scrap of cloth over her nose and mouth, so she might be grimacing. As the women work I watch as lumps of the black mass seem to jump and writhe on their own—suddenly a rat almost a foot long scurries out of the jumble and races across the room into a pile of canvas bags. It’s difficult to imagine that bits of this foul-smelling heap may one day adorn the heads of American pop stars.

The reincarnation of temple hair as a beauty accessory started out as a relatively humble affair. Until the early 1960s, the temple simply burned the hair it collected. Citing pollution, the government banned the practice during the 1990s, but by then the temple had already found a more profitable way to get rid of the waste. Wig makers began seeking raw materials at Tirumala. At the temple’s first auction, in 1962, the hair sold for
16 a kilo—about $24.50 in today’s dollars. Now it fetches up to ten times as much, and the auctions have become cutthroat affairs.

To see for myself, I drive a few miles to the bustling town of Tirupati, where the temple’s marketing unit operates out of a string of warehouses filled with drying hair. In a large boardroom, Indian traders representing forty-four companies are crowded around tables, prepared to drop millions of dollars in a complicated process of backroom negotiations. “The hair business is unlike any other,” says Vijay, who owns a hair-exporting house called Shabanesa, and like many South Indians goes by a single name. “In any other business, buying a commodity is easy; it’s the selling it to retailers that is difficult. Here it’s all reversed. It’s simple to sell hair, just difficult to buy it.”

In a sense the Indian hair trade resembles other red markets in that the human materials are difficult to harvest and overall a scarce resource. Men and women who give up their hair do so in the name of God. While the temple has constructed several buildings to accommodate the thousands of people who come to offer up their hair every day, it doesn’t advertise to its flock to further profit from an engorged supply. Unlike other red markets, however, human hair is ultimately a waste product, and the recent trade in it created its market value. (The same could be said about other body parts. Before medical technology allowed for kidney transplants there was simply no market.)

Which is why when sold in bulk, hair is the only human tissue that can be treated like an ordinary commodity, bought and sold by the pound instead of as a specific entity with an important biological history. It’s the only case of pure altruism actually working in a market for human materials. But that doesn’t mean hair sellers don’t squabble over the profits.

I can see the tensions at the auction. The temple is pressing for a better price than last year’s, and traders are worried that the global economic meltdown will batter the extensions market. Halfway through the evening India’s largest hair reseller—K. K. Gupta, whose Gupta Enterprises did a brisk $49 million in sales in 2008—accuses the temple directors of trying to set an inflated price and walks out. After an hour, which Gupta spends in the parking lot making calls and threatening to go to the papers, the price is set slightly lower. Then another reseller loudly charges that Gupta is trying to corner the market. A muscular bidder has to step in to prevent fisticuffs.

Another three hours and it’s approaching midnight. The price for the longest and most durable product hovers around $193 per kilo ($70 less than the previous year, I’m told). Over the next few days trucks will deliver the hair to the distributors’ factories, where the alchemy of transforming human waste into a luxury product takes place.

SOME EIGHTY-FIVE MILES FROM
the auction site, in an industrial lot on the outskirts of the coastal metropolis of Chennai, George Cherian, chairman of Raj Impex, one of India’s largest hair-export houses, awaits his delivery. The hair must be checked for lice, painstakingly untangled, washed in vats of detergent, and combed until it’s of export quality. “The real value of what we do is right here, when we grade the hair and transform it from waste into something beautiful,” Cherian says. He pulls out a handful of smoothed hair the size of a riding crop, noting that it will fetch $15 on the international market.

The bulk of hair sold in India isn’t tonsured, he notes—it comes from garbage bins, the floors of barber shops, and the combs of long-haired women. Nomadic families and small businesses go door-to-door bartering hair clips, rubber bands, and trinkets for it. “This work supports tens of thousands of people across India in cottage sorting and collecting industries,” Cherian says. “The rule is simple: Remy hair goes to the US, the rest goes to Africa.”

In a storage room, he shows me 400 kilos of remy hair packed in boxes and bound for cities throughout the world. His warehouse contains several tons more, ready to ship. “The demand is huge,” Cherian says, “but I don’t think that anyone outside of India would ever be able to do this. We survive because of the cheap labor. No one in Italy, or California, could prepare the hair for less.”

When I asked him about the nonremy industry Cherian suggests that I contact a band of gypsies who live by the railroad tracks north of Chennai. He tells me though that I’ll have to leave early if I want to catch them.

At eight in the morning I’m behind the wheel of a black Hyundai Santro dashing north through the city’s narrow streets. Beside me is one of Cherian’s agents, named Damodharan, who relays with gypsies and buys their product in bulk. He points me down a dirt road offshoot near a former colony for railroad workers and we turn into what looks like a barren field. But as I look closer I can make out a group of people squatting in the shadows over a small open fire. Damodharan jumps out and pulls me over to meet Raj, a slender twenty-something man with a thick crop of black hair on his head. When I tell him I’m interested in knowing about hair selling, he smiles broadly and walks back to his encampment and fishes around inside a large pipe that looks like it is there to drain runoff. Then, with a flourish, he pulls out a giant plastic bag and brings it to me.

I look over curiously and he reveals a pillow-sized greasy black hairball. “You can find hair almost anywhere,” he says. In the mornings he shoulders a large canvas sack on his back and trolls the side streets looking in trash cans and along roadsides. “People just throw it out, or sometimes if they save it up for us we will trade them,” he says. Damodharan gives Raj
800 ($20) for the full sack of cast-off nonremy hair that he has collected.