Dr. Sigmund Rascher - coagulation/amputation studies; hypothermia experiments
Dr. Karl Gebhart: heteroplastic transplantation experiments
c.f. Stalin’s attempts to create interspecies (half-men/half-apes) “super-warriors”
Drs. Karl Clausberg and Viktor Brack: X-irradiation/sterilization
Drs. Joachim Mrugowsky, Erwin Ding-Schuler, and Waldemar Hoven: IV phenol and gasoline executions
Drs. Joachim Mrugowsky, Erwin Ding-Schuler, and Waldemar Hoven: IV phenol and gasoline executions
Dr. Friedrich Wegener (“Wegener’s Granulomatosis”): German pathologist, Nazi party member, autopsied a prisoner with oxygen injected into his bloodstream in an embolism study; may have participated in experiments on concentration camp inmates
Dr Hans Conrad Reiter (formerly “Reiter’s Syndrome”, now “reactive arthritis”): senior Nazi official
Dr Hans Conrad Reiter (formerly “Reiter’s Syndrome”, now “reactive arthritis”): senior Nazi official
Dr. Joseph Mengele: Septicemia/twin vivisection studies
Dr. Hans Eppinger - “father of modern hepatology”
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.”
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.”
German invasion of Poland (1939)
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
23 German physicians tried
23 German physicians tried
16 found guilty
7 hanged (incl. Gebhardt, Brack, Hoven, and Mrugowsky)
Rascher died before trial
Rascher died before trial
Mengele fled for Argentina (remains verified 1985)
Hallevorden committed suicide before trial
Otto Ambros (chemist) – invented sarin (nerve gas), convicted of mass murder at Nuremberg Trials, later freed and worked with US chemical industry on thalidomide
Forced removal of children to English language, religious schools (c.f., Australia)
Distrust and reluctance of minorities to participate in medical research
1905: cholera experiments on “volunteers”
1905: cholera experiments on “volunteers”
1915: Joseph Goldberger – pellagra studies
Prisoners pardoned or paroled in exchange for participation
1941: Physician William Black infects children with herpes virus, paper published by J Peds
Pharmaceutical and government sponsored studies on prisoners
Pharmaceutical and government sponsored studies on prisoners
1940s and 1950s esp.
Halted in mid-1970s after drug company executives admitted prisoners were cheaper to use than chimpanzees
WW II: gonorrhea, gas gangrene, dengue fever, malaria
Guatemala STD study (1946-8)
Guatemala STD study (1946-8)
U.S. researchers deliberately infected 1,308 prisoners, military conscripts, prostitutes, orphans (provided by Sisters of Charity), and mental health patients with gonorrhea and syphilis
Scientists treated 87% of those infected (10% later required re-treatment), lost track of 13%
Guatemala STD study (1946-8)
Guatemala STD study (1946-8)
Wives, children, and grandchildren treated, but sexual contacts not traced
Study approved by Guatemalan government
Received material for resource-starved institutions in return
Subjects received cigarettes for participating
Guatemala STD study (1946-8)
Guatemala STD study (1946-8)
U.S. apologized (2010), has pledged $1 million to study research ethics, $775,000 to fight STDs in Guatemala
Class action lawsuit against U.S. government filed on behalf of 700 victims/relatives (2011)
Guatemala STD study (1946-8)
Guatemala STD study (1946-8)
Dr. John Cutler (research coordinator): “Unless the law winks occasionally, you have no progress in medicine”
In 1943, Cutler infected volunteer federal prisoners in Indiana with gonorrhea in exchange for cash
Guatemala STD study (1946-8)
Guatemala STD study (1946-8)
After Guatemala, Cutler oversaw the Tuskegee Syphilis Study
Was acting dean at University of Pittsburgh in 1960s
University of Minnesota malaria study (1940s)
University of Minnesota malaria study (1940s)
Drs. Thomas Francis, Jr. and Jonas Salk infect psychiatric hospital residents with influenza (?if consent adequate?)
Atlanta, Alabama, and Terre Haute prison gonorrhea studies (1940s and 1950s)
Atlanta, Alabama, and Terre Haute prison gonorrhea studies (1940s and 1950s)
Study evaluating effects of antibiotics on growth rate (1950s, Navy recruits, mentally disabled, Guatemalan schoolchildren)
Patuxent prison Asian flu experiment (1957)
U.S. govt.-sponsored radiation, LSD (MK Ultra) experiments
Pentagon/CIA experiments on soldiers and civilians
Edgewood Arsenal Experiments (involving more than 7,000 soldiers who were exposed to at least 250 biological and chemical agents)
Including sarin, VX, LSD, ritalin
Caused long-term health effects
Deliberate release of Serratia over San Francisco Bay; radioactive cadmium over St. Louis
1963: Dr. Chester Southam injects tumor cells into extremely infirm patients at Jewish Hospital for Chronic Disease in NY without informing them that the shots contain cancer cells
1963: Dr. Chester Southam injects tumor cells into extremely infirm patients at Jewish Hospital for Chronic Disease in NY without informing them that the shots contain cancer cells
Southam later elected President of American Association for Cancer Research
Willowbrook Hepatitis Experiments (1960s)
Willowbrook Hepatitis Experiments (1960s)
Pre-WW1: Joseph Goldberger’s pellagra experiments on Mississippi prisoners
Henry Beecher, NEJM (1966)
Ongoing sterilization programs
Ongoing sterilization programs
Buck v. Bell (USSC, 1927) – 60,000 Americans sterilized
WI, NJ, CA, IN, NC, OR, others
Alabama’s 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
2012 – NC to compensate victims
Iowa elementary school race experiment (1968; good or bad?)
Iowa elementary school race experiment (1968; good or bad?)
Large majority of phase 3 US drug company trial sites outside US, many in developing countries
Large majority of phase 3 US drug company trial sites outside US, many in developing countries
Majority of developing nation trial sites without institutional review boards
Victims may seek redress under “Alien Torts Statute”
ICE drugging immigrants for deportation
Nerve-sparing clitoroplasty as substitute for female genital cutting
Nerve-sparing clitoroplasty as substitute for female genital cutting
AAP reversal of position (2010)
Kennedy Krieger Institute (Johns Hopkins) lead paint abatement study (1992)
Uninsured become research subjects to receive needed care
Uninsured become research subjects to receive needed care
Human guinea pigs (professional lab rats)
Parent investigators
Neonatal analgesia
Under-representation of women and minorities in clinical trials
Under-representation of women and minorities in clinical trials
Trust issues:
Racial minorities often wary of participation in medical experiments
2009 survey
2009 survey
50% of adults afraid that physicians will not try as hard to save their lives if they have agreed to donate organs
44% fear their organs might be sold on the black market
May explain in part why only 45% of U.S. adults have registered as organ donors
Informed consent for treatment – physician/patient negotiation vs. unilateral decision-making when treatment options limited
Informed consent for treatment – physician/patient negotiation vs. unilateral decision-making when treatment options limited
Relaxation of international research standards by eliminating Declaration of Helsinki standards (FDA, 2008)
2003: Ban on industry experiments testing safety of pesticides/other potentially toxic chemicals in humans lifted by NAS and EPA
2003: Ban on industry experiments testing safety of pesticides/other potentially toxic chemicals in humans lifted by NAS and EPA
2013 – EPA adds safeguards, issues regulations prohibiting studies on pregnant women and children
Monsanto’s Roundup purchased by US government for aerial spraying in Colombia as part of “War on Drugs”
2008: Former director of UCLA School of Medicine’s donated body program pleads guilty to 5 year scheme to sell donated body parts to medical, drug, and research companies, netting more than $1 million
2008: Former director of UCLA School of Medicine’s donated body program pleads guilty to 5 year scheme to sell donated body parts to medical, drug, and research companies, netting more than $1 million
Physician participation in “War on Terror,” Abu Ghraib, Guantanamo, Black Ops sites
Physician participation in “War on Terror,” Abu Ghraib, Guantanamo, Black Ops sites
“Basic Science Consultation Teams”
Co-optation of anthropologists in Iraq, Afghanistan
Nurses injecting psychotropic drugs to forcibly sedate deportees
AMA, AAP, APA oppose physician involvement in interrogation/torture
Eduard Pernkopf’s Atlas; Dachau Hypothermia Experiments; Phosgene gas experiments; biological weapons data (offensive vs. defensive)
Japan’s Unit 731 and biological warfare experiments
Move to rename “Hallevordan-Spatz syndrome”: “pantothenate kinase-associated degeneration” or “neurodegeneration with brain iron accumulation”
Move to rename “Hallevordan-Spatz syndrome”: “pantothenate kinase-associated degeneration” or “neurodegeneration with brain iron accumulation”
Breast cancer cure scenario
All proposed experiments using human subjects should undergo proper ethical evaluation by a human studies review board before being undertaken.
All proposed experiments using human subjects should undergo proper ethical evaluation by a human studies review board before being undertaken.
Responsibility for revealing that the data are from unethical experiments lies in the hands of authors, peer reviewers, and editors of medical texts that publish results of experimental studies.
Each publication should adopt a standard regarding publication of data from unethical experiments.
Each publication should adopt a standard regarding publication of data from unethical experiments.
If data from unethical experiments can be replaced by existing ethically sound data and achieve the same ends, then such must be done.
If ethically tainted data that have been validated by rigorous scientific analysis are the only data of that nature available, and such data are necessary in order to save lives, then the utilization of such data by physicians and editors may be appropriate.
If ethically tainted data that have been validated by rigorous scientific analysis are the only data of that nature available, and such data are necessary in order to save lives, then the utilization of such data by physicians and editors may be appropriate.
Should editors and/or authors decide to publish an experiment or data from an experiment that does not reach standards of contemporary ethical conduct, a disclaimer should be included. Such disclosure would by no means rectify unethical conduct or legitimize the methods of collection of data gathered from unethical experimentation.
This disclaimer should:
This disclaimer should:
(1) clearly describe the unethical nature of the origin of any material being published
(2) clearly state that publication of the data is needed in order to save human lives
(3) pay respect to the victims
(4) avoid trivializing trauma suffered by the participants
(5) acknowledge the unacceptable nature of the experiments
(6) endorse higher ethical standards.
Based on both scientific and moral grounds, data obtained from cruel and inhumane experiments, such as data collected from the Nazi experiments and data collected from the Tuskegee Study, should virtually never be published or cited.
Based on both scientific and moral grounds, data obtained from cruel and inhumane experiments, such as data collected from the Nazi experiments and data collected from the Tuskegee Study, should virtually never be published or cited.
In the extremely rare case when no other data exist and human lives would certainly be lost without the knowledge obtained from use of such data, publication or citation is permissible.
In such a case, the disclosure should cite the specific reasons and clearly justify the necessity for citation.
Certain generally accepted historical data may be cited without a disclaimer, though a disclosure of the ethical issues would be valuable and desirable.
Certain generally accepted historical data may be cited without a disclaimer, though a disclosure of the ethical issues would be valuable and desirable.
Denial of moral responsibility for consequences
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
Publication of research on dangerous/novel pathogens
Archimedes, da Vinci, Galileo, Haber, Fieser
Farraday
Nobel, Einstein, Szilard
Played major role in development of chemical warfare in WWI
Played major role in development of chemical warfare in WWI
In violation of Hague Convention of 1907
“During peacetime a scientist belongs to the world, but during wartime he belongs to his country”
3 future Nobel laureates served in his unit, which developed Zyklon A (insecticide used in gas chambers)
3 future Nobel laureates served in his unit, which developed Zyklon A (insecticide used in gas chambers)
Irony: Jewish, fled Germany in 1933, ultimately took position at what is now the Weizmann Institute in Israel
Pediatrician George Habash – founder of Popular Front for the Liberation of Palestine
Pediatrician George Habash – founder of Popular Front for the Liberation of Palestine
Behind aircraft hijackings of Black September
Dr. Fathi Shiqaqi – founder of Palestinian Islamic Jihad
Ayman Al-Zawahiri – leader of Al Qaeda
Ayman Al-Zawahiri – leader of Al Qaeda
Ikuo Hayashi – chief of circulatory medicine at a leading Japanese hospital
Pleaded guilty to planting sarin gas on Tokyo subway
Radovan Karadzic (psychiatrist) – on trial for war crimes against Bosnian Croats and Muslims
Dr Bilal Abdullah convicted in bungled Heathrow Airport car bombing (2007)
Dr Bilal Abdullah convicted in bungled Heathrow Airport car bombing (2007)
Psychiatrist Major Nidal Hasan – awaiting trial for Fort Hood shootings (2009)
Humam Khalil Abu-Mulal al-Balawi: Jordanian suicide bomber, killed 7 CIA agents in Afghanistan (2009)
Bashir Assad (Syrian President, ophthalmologist) – 2011/12 civilian bombings and use of sarin nerve gas
Bashir Assad (Syrian President, ophthalmologist) – 2011/12 civilian bombings and use of sarin nerve gas
GP Harold Shipman – world’s most notorious serial killer (up to 400 victims)
South African cardiologist Wouter Basson (aka “Dr. Death”) – ran “Project Coast” in 1980s (clandestine military program linked to chemical and germ warfare, assassinations, poisonings, kidnapping, and plots to sterilize the country’s black population)
South African cardiologist Wouter Basson (aka “Dr. Death”) – ran “Project Coast” in 1980s (clandestine military program linked to chemical and germ warfare, assassinations, poisonings, kidnapping, and plots to sterilize the country’s black population)
Aquited of 67 criminal charges in 2002
Still practicing, Health Professions Council of SA considering revocation of medical license
Others
Violent crimes, including rapes of patients
Violent crimes, including rapes of patients
Performance of unnecessary, dangerous procedures
Medicare fraud, kickback scams
Ethical violations through participation in executions
Long history
Long history
Common slave era diagnosis = drapetomania
The tendency to run away
More recent: Ophthalmologist John Taunton – anti-immigrant, white supremacist
Doctors involved in torture, extraordinary renditions
Doctors involved in torture, extraordinary renditions
Investigations, outcry, but no real consequences
Capture of Osama bin Laden involved (unsuccessful) sham CIA hepatitis B vaccination project to collect DNA (violation of public trust, has harmed international efforts to eliminate polio and put health care workers lives at risk)
Capture of Osama bin Laden involved (unsuccessful) sham CIA hepatitis B vaccination project to collect DNA (violation of public trust, has harmed international efforts to eliminate polio and put health care workers lives at risk)
USAID social media program designed to overthrow Cuban government
“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.”
“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.”
(U.S. – largest maldistribution of wealth of any industrialized country)
Public health versus individual health
Public health versus individual health
Roles, responsibilities, and obligations
patients
society
institutions
families
government
world
Theodore Billroth:
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”
Rudolph Virchow:
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…”
World Health Organization:
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.”
Triage and return to combat
Confidentiality
Communication
Loyalties/Command
Experimentation
“The Sea and Poison”
2007 survey: 5,000 medical students at 8 medical schools, 35% response rate (Int J Hlth Serv 2007;37(4):643-50)
2007 survey: 5,000 medical students at 8 medical schools, 35% response rate (Int J Hlth Serv 2007;37(4):643-50)
94% received < 1 hr. instruction on military medical ethics
3.5% aware of legislation already passed making a “doctors’ draft” possible
34% did not know Geneva Conventions require physicians to treat the sickest first, regardless of nationality
34% not aware Geneva Conventions prohibit ever threatening or demeaning prisoners or depriving them of food or water
34% not aware Geneva Conventions prohibit ever threatening or demeaning prisoners or depriving them of food or water
34% could not state when they would be required to disobey an unethical order (answer = always)
AMA, APHA, ANA, and ABA (anesthesiologists) oppose participation of health professionals in executions
AMA, APHA, ANA, and ABA (anesthesiologists) oppose participation of health professionals in executions
Only 7/35 death penalty states incorporate AMA ethics policy, including barring doctors from taking an active role in the death chamber
2001:
2001:
3% of physicians aware of AMA guidelines prohibiting physician participation
41% would perform at least one action in the process of lethal injection disallowed by AMA
Physician participation in torture and executions
Physician participation in torture and executions
Most torturers never identified/held accountable
2008 study at University of Illinois at Chicago
35% of medical students said torture could be condoned under some circumstances
Pharmaceutical company provision of agents used in lethal injection executions
