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.”