Human Subject Experimentation

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Human Subject Experimentation

• The Nazis
• Lessons for Contemporary Research
• The Role of the Physician in Society
• Martin Donohoe

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• When a doctor goes wrong, he is the first of
  criminals. He has nerve and he has knowledge.
• - Sherlock Holmes to Dr. Watson, Arthur Conan
  Doyle

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Nazi Medicine

• Guiding philosophy Hegelian (rational utility)
• Social Darwinism - parallels in American and
  British Eugenics Movement
• medical journals relatively silent
• Ethics reduces morality to efficiency, economics,
  and aesthetics

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Nazi Medicine

• An arm of state policy
• Focus on racial purity
• from eugenic sterilization (370,000)
• to involuntary euthanasia (70,000)
• to large-scale genocide (over 6 million)

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Nazi Medicine

• Individual worth stated in economic terms
  propaganda re obligations to the state
• I Accuse
• Mathematics in the Service of Political
  Education

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Nazi Medicine

• Doctoring the nation more important than
  doctoring individuals - Nazism as applied
  biology (Rudolph Hess)
• Focus on preventive medicine and public health
  anti-tobacco and anti-alcohol campaigns,
  environmental toxins, organic farming -to
  improve Aryan stock
• Nazi soldiers given anabolic steroids to increase
  aggresiveness

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Nazi Physicians

• 52,000 physicians
• National Socialist Party Members
• Jews ostracized replaced by young Aryans
• today 0.2 of German physicians are Jews, c/w 17
  pre-Nazis
• 5 of non-Aryans committed suicide 25 murdered

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Nazi Physicians

• Economic hard times, physicians salaries rise,
  academic perks
• Blutkitt (blood cement)
• Rare resistance
• Catholics
• Marxists
• Dutch

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Nazi Physician-Researchers(Torturers)

• Dr. Sigmund Rascher - coagulation/amputation
  studies hypothermia experiments
• Dr. Karl Gebhart heteroplastic transplantation
  experiments
• c.f. Stalins attempts to create interspecies
  (half-men/half-apes) super-warriors
• Drs. Karl Clausberg and Viktor Brack
  X-irradiation/sterilization

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Nazi Physician-Researchers

• Drs. Joachim Mrugowsky, Erwin Ding-Schuler, and
  Waldemar Hoven IV phenol and gasoline executions
• Dr. Joseph Mengele Septicemia/twin vivisection
  studies
• Dr. Hans Eppinger - father of modern hepatology

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Indirect Participants

• Prof. J Hallevorden Look here now, boys, if you
  are going to kill all these people at least take
  the brains out so that the material could be
  utilized the more (brains) the better.I
  accepted these brains of course. Where they came
  from and how they came to me was really none of
  my business.

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Doctors and Resistance

• German invasion of Poland (1939)
• Drs Eugene Lazowski and Stanislaw Matulewicz
  created a fake typhus epidemic, using a harmless
  bacterium to innoculate non-Jews, knowing that
  infected Jews would be summarily executed
• Germans fooled, quarantined area, many Jews
  escaped death

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Nuremberg Doctors Trial

• 23 German physicians tried
• 16 found guilty
• 7 hanged (incl. Gebhardt, Brack, Hoven, and
  Mrugowsky)
• Rascher died before trial Mengele fled for
  Argentina (remains verified 1985) Hallevorden
  committed suicide before trial

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Nuremberg Code

• Voluntary consent is absolutely essential
• Avoidance of unnecessary physical and mental
  suffering
• Option to quit/responsibility to terminate
• Other safeguards

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Declaration of Geneva

• I will not permit considerations of religion,
  nationality, race, party politics or social
  standing to intervene between my duty and my
  patient
• I will not use my medical knowledge contrary to
  the laws of humanity.
• It is unethical for physicians to employ
  scientific knowledge to imperil health or destroy
  life.

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Post-WW II

• Over 700 Nazi rocket scientists and their
  families brought to the U.S. (including Werner
  von Braun) to help build nuclear missile program
• Operation Paperclip
• Japanese scientists brought to Fort Detrick, MD,
  to help establish U.S. biological/chemical
  weapons program

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Post-WW II Human Subject Experimentation

• Tuskegee Syphilis Study
• Willowbrook Hepatitis Experiments
• Henry Beecher
• U.S. govt.-sponsored radiation expts.

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Post-WW II Human Subject Experimentation

• Ongoing sterilization programs
• WI, NJ, CA, IN, OR, others
• Alabamas Governor Graves vetoed law in 1930s law
  citing hazard to personal rights
• Oregon governor Kitzhaber apologized in 2002 for
  the over 2500 state-forced sterilizations that
  occurred between 1917 and 1983

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Post-WW II Human Subject Experimentation

• Elementary school race experiment (good or bad?)
• Milgrams obedience studies
• Soviet psychiatry
• US military/pharmaceutical vaccine and medication
  trials in the developing world

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Research on Prisoners

• 1905 cholera experiments on volunteers
• 1915 Joseph Goldberger pellagra studies
• Parole in exchange for participation
• WW II gonorrhea, gas gangrene, dengue fever,
  malaria

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Research on Prisoners

• gt90 of pharmaceutical industry research in early
  1970s
• Rapidly curtailed by state/federal laws and new
  university regulations
• 2006 IOM approves with safeguards

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Contemporary Issues and Ethical Dilemmas

• 90 of research dollars spent on diseases
  affecting 10 of the worlds population
• Research on special populations (cultural
  minorities, prisoners, developing world, etc.)
• Role of institutional and for-profit IRBs
• Use of placebo controls

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Contemporary Issues and Ethical Dilemmas

• Uninsured become research subjects to receive
  needed care
• Informed consent for treatment
  physician/patient negotiation vs. unilateral
  decision-making when treatment options limited
• 2003 NAS advisory panel considering ban on
  industry experiments testing safety of
  pesticides/other potentially toxic chemicals in
  humans

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What to do with data acquired via unethical means?

• Eduard Pernkopfs Atlas Dachau Hypothermia
  Experiments Phosgene gas experiments biological
  weapons data (offensive vs. defensive)
• Japans Unit 731 and biological warfare
  experiments

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What to do with data acquired via unethical means?

• Move to rename Hallevordan-Spatz syndrome
  pantothenate kinase-associated degeneration or
  neurodegeneration with brain iron accumulation
• Breast cancer cure scenario

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Ethical Perspectives on Scientific Research and
War

• Denial of moral responsibility for consequences
• Recognition of moral responsibility but competing
  obligations
• Recognition of moral responsibility and refusal
  to participate
• Responsibility to inform or lead public opinion

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Scientists and War Research

• Archimedes, da Vinci, Galileo, Haber, Fieser
• Farraday
• Nobel, Einstein, Szilard

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Doctors as Terrorists

• George Habas founder of Popular Front for the
  Liberation of Palestine
• Behind aircraft hijackings of Black September
• Mohammed al-Hindi founder of Islamic Jihad
• Ayman Al-Zawahiri - 2 in Al Qaeda

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Doctors as Terrorists

• Ikuo Hayashi chief of circulatory medicine at a
  leading Japanese hospital
• Pleaded guilty to planting sarin gas on Tokyo
  subway
• Radovan Karadzic (psychiatrist)

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Primo Levi

• A country is considered the more civilized the
  more the wisdom and efficiency of its laws hinder
  a weak man from becoming too weak or a powerful
  one too powerful.
• (US largest maldistribution of wealth of any
  industrialized country)

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The role of the doctor in society

• Public health versus individual health
• Roles, responsibilities, and obligations
• patients
• society
• institutions
• families
• government
• world

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The role of the doctor in society

• Theodore Billroth
• If the whole of Social Medicine needs to be part
  of the curriculum of the medical student, it must
  not take more than two hours per semester
  during the last two semesters otherwise, it will
  surely be detrimental to his other studies

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The role of the doctor in society

• Rudolph Virchow
• Doctors are natural attorneys for the poor If
  medicine is to really accomplish its great task,
  it must intervene in political and social life

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The role of the doctor in society

• World Health Organization
• The role of the physician in the preservation
  and promotion of peace is the most significant
  factor for the attainment of health for all.

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Ethical Issues Relating to Mixed Agency of
Military Physicians

• Triage and return to combat
• Confidentiality
• Communication
• Loyalties/Command
• Experimentation
• The Sea and Poison

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Ethical Issues Relating to Mixed Agency of
Civilian Physicians

• Physician participation in torture and executions
• Pharmaceutical company provision of agents used
  in lethal injection executions

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Contact Information

• Public Health and Social Justice Website
• http//www.phsj.org
• martindonohoe_at_phsj.org