The Life of a Human Guinea Pig

What do you think of when you think of American food? Probably not this. I love today’s story – it’s taken from Pit magazine’s American food special, and it provides a view of the USA’s extraordinarily varied food cultures, seen through the homogenising filter of mass-produced institutional catering. Peel back the plastic wrap and dig in…

We Americans like to imagine our food culture as one of exhaustive choice, of endless grocery store aisles, diverse regionality, and abundance, and we view our various culinary traditions as the offspring of layers of migration, displacement, and resettlement. There is, however, an alternative America that most people haven’t tasted. I am not most people. And the food culture I’m about to introduce you to isn’t one that many know about, despite its deep yet subtle integration into our country’s foodways.

I’m going to tell you a bit about a hidden American cuisine – about the institutional food I’ve eaten across the country. It is a standardized, repetitive, and manufactured food culture: the Happy Meal incarnate that’s not necessarily very happy. It is subject to federal regulations, daily caloric goals, and budgets. It is eaten in hospital beds, military mess halls, school cafeterias, and psychiatric facilities, in for-profit prisons and nursing homes – and in Phase I contract research organizations (CROs), where contract laborers such as myself are the first to test the drugs of tomorrow.

If you haven’t heard of CROs, you’re not alone. In the United States and elsewhere, drug testing is a chain of contracts. Pharma and biotech companies outsource labor to take their products to market quicker and more cheaply than if they did the work in-house. That’s where CROs come in: conducting clinical trials, preparing regulatory documents, and navigating bureaucratic red tape.

The first of three phases of testing, Phase I – fittingly dubbed as first-in-human – asks, “Is the drug safe?” and then, “What amount of the drug is safe?” While thousands of CROs, large and small, pepper the country’s landscape, only 40-odd institutions specialize in Phase I, and last year they conducted nearly 2000 studies, contracting thousands of human guinea pigs like me to test their drugs.

Inside testing facilities across the country – from Daytona Beach, Florida to Glendale, California; from the suburbs of Kansas City to the moraines of southeastern Wisconsin; and from San Antonio, Texas to Salt Lake City, Utah – human research subjects live in ad hoc dorms for the duration of each study, usually between a week and a month. There, in cohorts of ten to twenty, participants take increasing doses of an investigational drug until the side effects start to outweigh the potential benefits. Depending on the size of the CRO, 200 people from ten or more different studies are inside a facility at any given time. And those 200 people must be fed. Enter: America-the-institution and her plastic-covered, standardized foodstuffs.

The driving force behind America’s institutional CRO lab meals isn’t sustenance or enjoyment, but bioavailability: that is, how a drug metabolizes in an empty or full stomach. Some drugs are more bioavailable when served with food, and others, such as thyroid medications or Viagra, are better without. On a dosing day, the most important meal is breakfast. But if one testing group is served bacon and eggs, another might get cornflakes, while a third might go hungry – even in the same study. Nowadays, though, a great many new drugs are served with a “high-fat” breakfast.

The United States Federal Drug Administration (FDA) provides guidelines for the amount of fat (55-65 grams) and calories (800-1000) said high-fat breakfasts should contain; but CROs, which view variation as nothing more than another possible snag in a drug’s regulatory approval, simply copy the example meal in the industry guide, the result of which makes every high-fat breakfast across the country (or at least the many I’ve eaten) exactly the same: two eggs fried in butter, two strips of bacon, two slices of toast served with two packets of butter, four ounces of hash browns, and eight ounces of whole milk, all of which must be eaten within a 15-minute allotted time – butter and all (and the occasional jam).

Every day, breakfast, lunch, dinner, and “snack” are served – or skipped – according to specific study protocols. Meals are generally served as if by clockwork and eaten within strictly allotted windows. Four hours separate breakfast and lunch, six hours separate lunch and dinner, and three or four hours separate dinner and snack. Days end with a fast of twelve hours to “reset” the body as if it were the deep clean of a restaurant kitchen at night.

And then there are the eating rituals. For a typical meal, subjects are told to arrive at the cafeteria five minutes before their scheduled meal time. At two minutes ‘til, the meal is placed in front of the test subject. At one minute ‘til, you are allowed to remove the plastic over your food.

But that’s when the real anticipation begins. Hungry eyes follow the wall clocks, waiting for the staff member on duty to utter the magic words when the clock strikes eat: “You may now take your first bite.”

A reprieve from blood draws and “dosing” (taking the investigational drug), food is always the central topic of discussion inside the testing lab; it’s the only thing besides check-out that we subjects have to look forward to. Menus at most CROs tend to rotate weekly, which means that for studies longer than seven days, there are (naturally) meals subjects look forward to and meals subjects dread, such as one particularly vile vegetable soup served with a ham and Swiss cheese croissant, at PPD in Austin, Texas. While at Dr. Vince Clinical Trials, a deluxe Phase I unit in Overland Park, Kansas, the daily menu is posted on a digital wall screen, at other places, like Icon in San Antonio, Texas, what you eat every day is a surprise – until you eat it all over again.

Though sameness must necessarily characterize any aspect of the food that might affect drug data and test results, quirks still emerge from facility to facility, test to test. Differences appear in budget (both in the amount that a CRO is willing to spend on meals and on staff), in available catering options, and in local conceptions of a balanced diet. What’s called lunch at one facility can be extremely different at another. And while lunches and dinners are normally purchased from local catering companies and kept in electric hot carts, breakfast and “snack” are typically prepared in-house, and can vary from CRO to CRO. At these facilities, American institutional lab food reveals itself as regional, diverse, and strange – fodder for places such as Reddit (see: r/hospitalfood) and this publication.

Though institutional food aims for uniformity, the reality on the ground is a bit different. At San Antonio, Texas’s Worldwide Clinical Trials, what’s particularly unique about its school cafeteria-esque food isn’t that it’s not good, it’s that, until recently, subjects were required to eat and drink everything on their plate. This added an additional layer of difficulty to completing a study, especially for those who were full or had allergies that they didn’t report during the phone screening (dietary restrictions or allergies are grounds for testing ineligibility). During my many visits to Worldwide Clinical Trials, the toughest thing for me to consume wasn’t the chef’s salad – an unappealing bed of iceberg lettuce with slices of ham and turkey, tomatoes, and carrots, and topped with ranch dressing – but the caffeine-free sodas. Sprite (and a sugar cookie) accompanied most lunches, and Minute Maid Lemonade most dinners, and they were required to be fully consumed. To this day, I will never drink a Sprite of my own accord. Plus, at Worldwide, everything had to be eaten according to the clock and under the watchful eyes of staff in a group cafeteria – that place was obsessive about food intake.

A couple of miles away physically, but a world away food-wise, is Icon San Antonio. If Worldwide Clinical Trials is about conformity, Icon San Antonio is about options, packed in endless plastic ramekins. Mushrooms, onions, tomatoes, and jalapeños. Butter, mayo, and crema mexicana. Unlike the generic white American food at Worldwide Clinical Trials, the food at Icon is influenced by Mexican food traditions. Sliced chicken is often served with corn tortillas, and salads with sides of avocado and salsa picante. Soup is often Mexican lentil or calabacitas, while dessert is frequently arroz con leche (which I never got sick of), served in a pudding cup. On top of the Mexican-influenced cuisine, if there is one meal everyone looks forward to at Icon, it’s burger night. Unlike the facility’s white meat, which always looks like chicken, but tastes like turkey, Icon’s burger is a true beef burger, served with real, melted cheese, a bed of romaine lettuce, and a baked potato.

Due north in the heart of the Midwest, Kansas City, Missouri, is another hub for Phase I trials. The fanciest among the greater KC CROs, Dr. Vince Clinical Trials’ gargantuan cafeteria resembles an upscale food court, complete with finished wood fixtures, and walls hung with televisions and local sports memorabilia. Food is served on trays, furthering the food court ambiance. Kansas City is known for its meat, and meat is served here in bulk. While Icon San Antonio leans towards healthier and option-laden meals, Dr. Vince is the Hungry Man frozen meal series come to life. Burritos are bursting with steak, and each deli sandwich seems stuffed with an actual full pound of turkey. The menu at Dr. Vince’s features a multitude of variations on fried chicken: tenders, cutlets covered in mozzarella, and chicken-fried steak. Here, vegetables are hard to come by.

A bit further west in Utah, a state not known for its rich culinary traditions (it’s where Jell-O salad was born), eating at Icon Salt Lake City always felt like prepping for a cold front when supplies were low. What would first appear as shepherd’s pie would later reveal itself as something else entirely; though it began with a base of mashed potatoes and was then topped with layers of corn and gravy, one never found ground meat in Icon Salt Lake’s curious concoction. Their take on Frito pie, a well-known American staple, was even stranger. Instead of the traditional base of Fritos, Icon Salt Lake’s began with a bed of white rice, which was then topped with black beans, ground beef, corn, and a couple of hot sauce packets (a bag of Fritos came on the side). That is not a Frito pie. Once when I was there, a fellow participant claimed that the food was bad because the budget there was only $10 per day. The difference, he said, was spent on higher participant stipends, which was why Icon paid more than many other places. You win some, you lose some.

Unlike Worldwide Clinical Trials in San Antonio, Icon Salt Lake didn’t really care when its subjects ate. Meals were often late – sometimes by up to an hour. Sometimes they were even dropped off to our rooms by staff members who never came back to check on us or what we had or had not eaten... or return with subject-requested salt. This lax approach to meals at Icon Salt Lake meant that they could have been drawn-out European-style events. Alas, my life-long response to food – to devour it – was only exacerbated by being in environments in which I had no control whatsoever over my eating, and I scarfed everything down the moment it arrived. My stomach growled five minutes before meal time. By the time the clock struck 6:37 or 13:13 – or whatever our schedules denoted as time to eat – I began to salivate. Even though I knew what was coming. Even if I couldn’t say no.

Pit is a two-time winner of the Best Magazine Award at the Guild of Food Writers Awards. Each themed issue uncovers the most interesting and unusual food stories from around the world through people, traditions, techniques and ingredients.

C.R. Calabria is a writer, human research subject, and author of the newsletter Pharmascenery. A finalist for the 2025 Ninth Letter Literary Awards, Cory’s work appears in Brevity and Pit Magazine, and he’s working on a book about human research subjects. He lives in New Orleans, Louisiana.

Mariana Line is a Mexican illustrator and designer based in Barcelona. Her illustrations are inspired by everyday scenes, community and food but without ceasing to show a quirky side. She graduated from ELISAVA studying a master in Art Direction, and has been working ever since.