Hypocritical oaths

Journal name:
Nature
Volume:
482,
Page:
132
Date published:
DOI:
doi:10.1038/482132a
Published online

History judges some research as unethical, despite approval at the time.

Ethical boundaries for experiments on humans can be stated very simply. “The limits of justifiable experimentation upon our fellow creatures are well and clearly defined,” Canadian physician William Osler, one of the grand old men of US medicine, wrote more than a century ago. “For man absolute safety and full consent are the conditions which make such tests allowable.”

Although US standards have evolved, the concepts of informed consent and safety still underpin research on humans. How, then, could leading health officials in the United States approve a set of barbarous experiments in the 1940s, in which government physicians intentionally infected hundreds of people in Guatemala with venereal diseases?

The people were labelled volunteers, but evidence suggests that they did not provide consent. And as the News Feature on page 148 shows, records indicate that some of the people exposed to syphilis, gonorrhea and chancroid subsequently went untreated.

Such recklessness seems abhorrent now, but this is far from an isolated case. In 1941, US physician William Black infected children, including a 12-month-old baby, with the herpes virus. When Black submitted his paper to the Journal of Experimental Medicine, it was rejected. Francis Peyton Rous, the journal's editor, told Black that his work was “an abuse of power”. Nonetheless, the paper was published soon after by the Journal of Pediatrics.

And Rous was less concerned about a study in which residents of a psychiatric hospital in Michigan were infected with influenza, even though it seems that at least some of the patients could not give their consent. It might be tempting to explain away such research abuses as the work of rogue scientists, but the Michigan study was conducted by a leading researcher of the time, Thomas Francis Jr, and his young colleague, Jonas Salk, who went on to develop the polio vaccine.

And two decades later, in 1963, a team run by Chester Southam injected tumour cells into extremely infirm patients at the Jewish Hospital for Chronic Disease in New York without informing them that the shots contained cancer. Southam was later put on probation by the New York State medical licensing board, but many researchers defended the work and he was later elected president of the American Association for Cancer Research.

What kind of work deemed as accepted today will be denounced by future generations? The question is one that all researchers should bear in mind, because history may judge them more harshly than their peers do. One example could be denial of treatment to sick people through the use of placebos in clinical trials and the ways in which some of these trials are carried out in developing nations, amid accusations of abuse of poor, uneducated participants. Broadening to other types of research, attitudes to work on embryonic stem cells may harden. And future generations may extend the protection currently in place for humans to cover other species, such as chimpanzees.

In the case of chimpanzees, Gabon and the United States are the only nations known to still use them for research, and a committee of the US National Research Council last year recommended that the United States should sharply limit their use, but stopped short of calling for a complete ban. Meanwhile, some researchers have been able to avoid bans in their own countries by travelling to the United States. Since 2005, foreign scientists have conducted at least 27 experiments at US chimpanzee centres (see Nature 474, 268271; 2011).

There is, of course, clear water between the Guatemalan experiments and chimpanzee research. The Guatemala research was illegal, even in the 1940s, and most of the data did not prove useful and went unpublished. Still, as with research on embryonic stem cells, there is considerable debate about the ethics of using chimpanzees as experimental subjects. In these and other cases, nations would do well to heed some of the lessons that emerged from the investigation of the experiments in Guatemala. Governments and other funders of research must exert full oversight, provide as much transparency as possible and ensure that regulations are clear, strong and evolve with the times.

Comments

  1. Report this comment #38443

    Martha Ruben said:

    I cannot stop wondering why soldiers from a country with endemic cholera were sent, without previous testing, to a country without appropriate sanitation and suffering from a natural disaster which made the situation more disorganized and less controllable. Just human negligence?

  2. Report this comment #38444

    Martha Ruben said:

    I cannot stop wondering why soldiers from a country with endemic cholera were sent, without previous testing, to a country without appropriate sanitation and suffering from a natural disaster which made the situation more disorganized and less controllable. Just human negligence?

  3. Report this comment #38472

    Anurag Chaurasia said:

    Human as guinea pig are still being used specially in the developing countries like for safety assessment of eatable transgenic crops. Let us stop such heinous activity.

    Anurag chaurasia,ICAR,India,anurag_vns1@yahoo.co.in,anurag@nbaim.org.in,+919452196686(M)

  4. Report this comment #38474

    Gopalan Raghavan said:

    Pharmaceutical companies frequently test drugs in developing /third world countries without informed consent. Quite often, "consent" is obtained in English, which language, the locals do not understand. The victims are frequently illiterate, extremely poor, and are unaware that they are being used as guinea pigs. Sadly, such tests are often conducted in collusion with local authorities. Any drug company which routinely uses poor countries to test their drugs should prima facie be considered suspect. It is time we have an inter-governmental body to supervise and control such practices.
    G. Raghavan

  5. Report this comment #38477

    Otto Albrecht said:

    From the articles I have read about this problem I see that all people, involved in such ?unethical? research, refer to superiors as: ?They would be very pleased!? or ?They regard it as very important.? This means the people who actually did the experiments were aware that something was wrong – they try to balme somebody else for it.
    The problem appears to be that too many researchers do not do what they think is right but what they think somebody else (the surgeon general, their supervisor, the king or God) might want to be done ? then they do anything because it will be done anyway and better they get the credit than somebody else.
    We have to educate young people to follow their own judgment. I am sure that this would prevent a lot of abuse. The main rule of any ?compliance education? has to be: ?If you think it is wrong do not do it!?

    Otto Albrecht

  6. Report this comment #38960

    richard feinman said:

    There are various kinds of unethical practice and denying adequate treatment, as in the Tuskegee experiments is one aspect. The thing that shines through here is the answer to the cover question "How could they." There is substantial ability to deceive oneself, rationalize or to live in an environment of cognitive dissonance. To many people, the current recommendations of high dietary carbohydrate to people with diabetes, crosses the line into unethical behavior, however hard it is to understand the motives of the physicians. I suggested one view of how history might judge this on my blog at http://rdfeinman.wordpress.com/2011/01/05/from-a-future-history-of-diabetes/.

    Richard David Feinman

  7. Report this comment #63541

    Davy Jones said:

    I don't think ethics and oaths matter all that much in a world where people die because they don't have enough painted paper in order to get saved. Everything is connected to money and if you have enough of it, you can break oaths and bend ethics

    Cook @ gatit

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