|Wikimedia: "The Princeton University Class of 1879, which included Woodrow Wilson, Mahlon Pitney, Daniel Barringer, and Charles Talcott."|
Princeton University’s decision to keep Woodrow Wilson’s name on a series of buildings and programs is the latest development in the recent debates over controversial historical figures. While this topic has focused primarily on Wilson, Thomas Jefferson, John C. Calhoun and other politicians who espoused racist beliefs, there is a parallel debate in the world of bioethics.
In this week’s Annals of Internal Medicine, Arthur Caplan and I look back at a series of odious experiments done by medical researchers on disadvantaged populations. Although these investigators have rightly been excoriated for their actions, we argue that it is crucial to ask why these individuals—sometimes very progressive in their thinking—nevertheless behaved so badly when it came to medical research.
What are the kind of experiments that require more than condemnation? One occurred at Brooklyn’s Jewish Chronic Disease Hospital in 1963, when Memorial Sloan Kettering physician Chester Southam injected cancer cells without informed consent into debilitated non-cancer patients. When the media found out about the experiments, a scandal erupted. Southam is routinely listed in the pantheon of unethical past physician-researchers. But, it is important to learn why a prominent researcher like Southam did what he did. Reasons included his desire for fame and recognition as a medical researcher and a belief that his work would possibly lead to a cancer vaccine that could save a huge number of lives even at the price of sacrificing a few whose lives were likely to end soon. That crude consequentialist thinking needs to be identified and discussed if we are to learn from Southam did.
From 1944 to 1974, the United States government funded hundreds of physicians to conduct research on the exposure of individuals to radiation without their knowledge. Specific experiments included the full-body irradiation of hospitalized patients, radiating the testicles of prisoners and feeding radioactive cereal to mentally-disabled, institutionalized children. When reporter Eileen Welsome outed this research in the 1990s, the press and the public were appropriately mortified. President Bill Clinton formally apologized on behalf of the government. But, what drove these researchers to do these heinous things? For one thing, these were the Cold War years in which the United States lived in dread of a nuclear attack by the Soviet Union. The researchers relied on a utilitarian logic that equated the sacrifice being made by American soldiers to those individuals being irradiated for the sake of science. In addition, many of the investigators later said they had ignored the 1947 Nuremberg Code, which mandated voluntary consent of all research subjects, because they believed it only applied to the gruesome experiments done by the Nazis in concentration camps.
Perhaps the best-known experiment from this era was the U.S. Public Health Service’s Tuskegee Syphilis Study, which ran from 1932 to 1972. The researchers, knowing that penicillin was available after WWII deliberately and duplicitously left poor Southern African-American men with syphilis untreated in order to study the natural history of the disease. Tuskegee has rightfully been condemned as blatantly racist, one of many examples of the predominantly white medical research establishment using African Americans as “guinea pigs.”
But here, too, it is interesting to ask just what drove these investigators. As the historian Susan Reverby has unearthed, many were career public health officials trying to promote the health of the very populations on which they were experimenting. One of them, John Cutler, had also participated in experiments in Guatemala in which the USPHS had actually tried to give research subjects venereal diseases in their zeal to learn more about these conditions in poor populations and how they could best be treated. Rather than simply vilify Cutler, Reverby has argued, it is more interesting to ask how the U.S. government and major medical organizations conceptualized such experiments as “right, even necessary.”
One of the other aspects of the Tuskegee study that reminds us that it was a story of more than just racism is that the local Alabama medical society continued to approve the research into the late 1960s and early 1970s—even when the group was comprised almost exclusively of African American physicians. Even these men, to some degree, saw the research as worthy enough to continue given the “investment” that had been made.
Looking at the historical circumstances that promoted unethical research is not meant to exculpate historical figures but rather to explain why they did what they did. There is too often a sense that these experiments constituted the “bad old days” of bioethics and that our modern framework, with Institutional Review Boards and better informed consent, has “fixed” the problem. Yet we would be foolish to assume that the same types of factors that induced earlier investigators to perform unethical research—patriotism, fame, personal ambition, financial incentives, racism, crude ethical thinking and the blind pursuit of scientific knowledge—are not still relevant today.
Whatever one feels about Princeton’s recent decision, leaving Wilson’s name in place provides a chance to explore how he retained such a racist ideology amidst an otherwise progressive mindset. Another educational opportunity is the recent revelation that the Jesuit priests who ran Georgetown University in the mid-nineteenth century sold slaves in order to keep the institution solvent. The horrors in our medical past similarly require that we not brush them aside as just wrong but that we look hard at why they happened.
Barron H. Lerner, MD, PhD, professor of medicine and population health at the NYU School of Medicine, is the author of "The Good Doctor: A Father, A Son and the Evolution of Medical Ethics."
Image via Wikimedia
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