This is an edited version of an article that originally appeared in The Tyee.

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 its website, I put a foreskin fibroblast in a shopping cart and called its office, where a perky customer representative informed me that I can buy the flakes for a cost of $85.00 — plus shipping and handling. 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).

One foreskin can be used for decades to produce miles of skin and 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.

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, a face cream, which costs over $100 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 about “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!”

On WinfreyÃ¢â‚¬â„¢s 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 a request for an interview for this article.

Beauty engineering

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 honor 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. “It doesn’t matter if you get a fibroblast from the eyelid, the cheek, the foot or the foreskin,” Fitzgerald said in an interview for this article. “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 acknowledged 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 United States 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 said that although you can use technology to make the cell cultures from scratch, without foreskins, the process is “much more expensive.”

Sourcing foreskins

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,” he said. “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.

Ethical pain

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 the product, something the company documents on its website. Neocutis declined a request for an interview for this article.

Dr. Nikhil Mehta, director of product development for SkinMedica, spoke 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 explained why they would want to use fetal tissue: There is a period during neonatal development where wounds will heal without scarring. He said 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.”

Dr. Mehta was asked 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 didnÃ¢â‚¬â„¢t sound so bad, until I went with my six-year-old daughter to Body Worlds 3, an anatomy exhibition with approximately 200 real human specimens, in the hope of giving her an interesting medical lesson. I found myself standing in front of some plastinated fetuses, and their tiny features were 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. Neocutis would have to use the whole thing.

In a moment of panic, I wondered if I had deeply scarred my six-year-old by bringing her to the 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 tried to formulate some words to discuss the topic, my daughter — young though she is — caught sight of my face and pulled me away, saying gently, “Mommy, don’t look if it makes you upset.”