When Doctors Kill: Who, Why, and How
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Consequently, “Jintai Jikken” has become a taboo utterance in the Japanese medical establishment since the end of the War. Experimentation on humans should be taboo in all languages.
Chapter 10
Good Old Fashioned American
Ingenuity—and Evil
Never perform an experiment which might be harmful
to the patient even though is highly advantageous
to science or the health of others.
– French physiologist Claude Bernard
Both before and after the Second World War a significant number of American physicians have conducted unethical experiments on vulnerable humans resulting in serious injuries and deaths. Both the American public and the government in later years unequivocally condemned these experiments. While these studies never reached the level or magnitude of depravity manifested by the Nazis and Japanese during World War II, they nevertheless deeply marred the image of American medicine. Unethical medical experiments continued in civilian and military research establishments unabated for 35 years after World War II and more sporadically into the early 2000s. This was in spite of the 1945 Nuremberg Code and American legislation that forbid unethical and involuntary medical experimentation. The subjects of the unethical experimentations were mostly minorities, the poor and the disadvantaged as well as veterans and “captive populations” including members of the military, prison inmates and institutionalized patients, both adults and children.
In 1995, Justice Edward Greenfield of the New York State Supreme Court ruled that parents do not have the right to volunteer their mentally incapacitated children for non-therapeutic medical research studies and that no mentally incapacitated person whatsoever can be used in a medical experiment without informed consent.
In Higgins and Grimes v. Kennedy Krieger Institute The Maryland Court of Appeals made a landmark decision regarding the use of children as test subjects, prohibiting non-therapeutic experimentation on children on the basis of “best interest of the individual child.” In 1998 Professor Adil E. Shamoo of the University of Maryland and the organization Citizens for Responsible Care and Research testified to the U.S. Senate’s Committee on Governmental Affairs and to the U.S. House of Representatives’ House Committee on Veterans’ Affairs that: “This type of research is ongoing nationwide in medical centers and VA hospitals supported by tens of millions of dollars of tax payers money. These experiments are high risk and are abusive, causing not only physical and psychic harm to the most vulnerable groups but also degrading our society’s system of basic human values. Probably tens of J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 87
DOI 10.1007/978-1-4419-1369-2_10, © Springer Science+Business Media, LLC 2010
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thousands of patients are being subjected to such experiments.” Clearly, if these incidents occurred as recently as a decade ago, this is a persistent problem.
The number and type of unethical medical experimentation carried out by American physicians over the past 150 years, is rather stunning. The following examples of unethical medical research, although not totally inclusive, are representative of the various studies performed by our own physicians and scientists.
Experiments in the Old South
Between 1845 and 1849 Dr. James Marion Sims, a South Carolinian from Lancaster County, was one of the first American physicians documented to have performed numerous unethical and virtually criminal medical experiments. He was not condemned or prosecuted at the time because his victims were black slaves, which were considered property rather than humans with rights. His imposing bronze bust statue stands today in a peaceful shady corner on the statehouse grounds in Columbia, South Carolina bearing three highly praising epitaphs. One is a quote from Hippocrates,
“Where the love of man is, there is also the love of art.” On the panel to the right, the inscription notes “He founded the science of gynecology, was honored in all lands and died with the benediction of mankind.” Etched on a left panel, an inscription proclaims “The first surgeon of the ages in ministry to women, treating alike empress and slave.” Well not exactly. When he treated Princess Eugenie of France during a trip to Europe, she received a higher level of care than did the slaves.
Dr. Sims, an 1835 graduate of Jefferson Medical College in Philadelphia, was interested in the possible surgical treatment of women with vesicovaginal fistula, an abnormal communication between the urinary bladder and the vagina that results in continuous involuntary discharge of urine into the vagina. Black slave women often contracted it after traumatic, unattended labor, which reduced considerably their selling value as producers of further slaves. In Montgomery, Alabama Sims initially “treated” three Alabama slave women (Anarcha, Betsy, and Lucy) with over 30 operations each. The surgery was performed without the use of ether anesthesia that had recently become available, because Sims believed that unlike sensitive white females, black ones could easily handle a little pain. After additional experiments resulted in the death of several more slaves as a result of post-surgical infections, Sims finally perfected his technique and operated on white women with fistulas (using anesthesia, of course).
Another of Dr. Sims’s experiments was prompted by his belief that the movement of the skull bones during protracted births caused “lockjaw” in infants, an inability to open the mouth fully due to spasm of the jaw muscles. Today this is known as being an early symptom of neonatal tetanus, an infection occurring in newborns following septic deliveries. Slaves were particularly at risk for infections associated with childbirth because their deliveries often took place under suboptimal conditions, in some instances close to manure contaminated with tetanus bacteria.
Sims tried to correct this condition surgically (obviously with poor results) by using a shoemaker’s awl to reposition the skull bones of babies born to enslaved mothers.
Experiments on the Disadvantaged
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It is true that Sims discovered a number of useful gynecological procedure and tools including the first speculum for examination of the vagina, but all those were achieved on the backs of suffering black slaves. It is worthy to note that after moving to New York, Sims apparently cognizant of the repugnant nature of his medical experiments never admitted publicly that he experimented on involuntary black patients. He is the only American physician having the dubious distinction of having practiced vivisection and experimental surgical procedures on involuntary patients. His ends did not justify the means.
Experiments on Filipino Prisoners
After the successful conquest of the Philippines in 1902, the American forces found that their soldiers were exposed to a very unsanitary environment. The country was rampant with a variety of severe infections and there were very poor nutritional conditions. The medical corps found its hands full treating both our soldiers and the Filipinos. In an effort to better understand the risks facing our troops, a series of experiments were devised that led to the death of many Filipinos.
U.S. Army doctors working in the Philippines withheld proper nutrition from 29
prisoners in order to induce Beriberi, a nutritional disease due to lack of vitamin B1; four test subjects died. Later that year, Army physicians working in the Philippines infected five prisoners with plague and in 1906 Dr. Richard P. Strong, a professor of tropical medicine at Harvard, experimented with cholera on other prisoners. The most infamous of these studies was Strong’s inoculation of 24 inmates with a new live cholera vaccine that had somehow become contaminated with plague organisms. Strong had conducted the inoculations “in the convalescent ward [where] he ordered all the prisoners there to form a line … without telling them what he was going to do, nor consulting their wishes in the matter.” All the men became sick and 13 died. These experiments were all the more unusual in that neither cholera nor plague was prevalent in the area at the time. An investigating committee suggested that Strong had forgotten “the respect
due every human being in not having asked the consent of persons inoculated.” It enjoined the Governor General to order that no one would be subjected to “experiment without prior determination of the character of that experiment by authorities … nor without having first gained the expressed consent of the person subject to it.” Nonetheless, at the conclusion of the investigation, Strong was exonerated of any wrongdoing. During the Nuremberg Trials, Nazi doctors cited this study to justify their own medical experiments.
Experiments on the Disadvantaged
Our government continued its work for the betterment of humanity in other countries as well. In 1900, the famous Dr. Walter Reed injected 22 Spanish immigrant workers in Cuba with the agent for Yellow Fever, paying them $100 dollars in 90
10 Good Old Fashioned American Ingenuity---and Evil
gold if they did not contract the disease and $200 if they contracted it. Between 1932 and 1972, the U.S. Public Health Service in Tuskegee, Alabama carried out a clinical study entitled “The Tuskegee Study of Untreated Syphilis in the Negro Male” later known as the Tuskegee Syphilis study. The study had selected 399
infected subjects (plus 201 patients without syphilis to serve as a control group) who were poor and mostly illiterate, black sharecroppers after screening more than 4,000 of them for the disease. In exchange for being in the study, the participants were provided free medical treatment, rides to the clinic, meals, and burial insurance in case of death. Initially, the intention of the study was to study the prevalence of the disease, its natural history, and the effectiveness of available treatments.
When the study started, the fatal outcome of syphilitic infections was well known but standard treatments for the disease (including Salvarsan, mercury ointment and bismuth) were toxic, dangerous, and of questionable effectiveness. Part of the original goal of the study was to determine if patients were better off if not treated with these toxic remedies. Some of the infected men would be treated for the disease and others would serve as a control group. If one of the treatments was proven to be effective, it would become the standard of care for this killer disease.
Unfortunately for the men in Tuskegee, the 1929 Stock Market Crash resulted in loss of funding for the treatment component of the study which then changed into an observation of the effects of untreated syphilis. This study became infamous because the uneducated sharecroppers enrolled in the program had never given informed consent. Further, they were not informed of their diagnosis or told they had a sexually transmitted disease. Instead, the United States Public Health Service informed the men that vitamins, tonics, and aspirins would help cure their “bad blood” and that these treatments would be provided free in the study. Over the first years of the project, a few men received sporadic treatment with arsenicals and bismuth but they were never told when treatment was discontinued. In some instances, they were openly lied to and informed that they had been treated when in fact they had received placebo tablets. Occasionally, uncomfortable diagnostic procedures were misrepresented to them as actual treatments. For example, midway through the study, 400 subjects were sent a letter entitled “Last chance for a free treatment” which told them that a spinal tap could help cure their symptoms.
By 1947 penicillin had become the standard treatment for syphilis but rather than starting to treat all of the study subjects with this drug the Tuskegee scientists withheld the drug and continued to study how the disease spread and killed. The subjects were also prevented from receiving syphilis treatments that were available to other people in the area by notifying hospitals and the military not to provide participants with penicillin. During World War II, 250 of the men registered for the draft and were consequently diagnosed and ordered to obtain treatment for syphilis; however, the Public Health Service blocked this directive and stated: “So far, we are keeping the known positive patients from getting treatment.” The study continued until 1972, when leaks to the Washington Star and New York Times resulted in public turmoil, congressional hearings and the appointment of an ad hoc advisory panel which determined the study was medically unjustified and ordered its termination. The Public Health Service remained unrepentant claiming the men Paying a Debt to Society
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had been “volunteers” and “were always happy to see the doctors.” An Alabama State Health officer dismissed the criticisms as insignificant stating that “somebody is trying to make a mountain out of a molehill.” Dr. John R. Heller who had led the study program in later years, including the period coincident with the routine successful treatment of syphilis with penicillin, stated “The men’s status did not warrant ethical debate. They were subjects, not patients; clinical material, not sick people.” By the end of the study, only 74 of the test subjects were still alive.
Twenty-eight of the men had died directly of syphilis, 100 were dead of related complications, 40 of their wives had been infected, and 19 of their children had been born with congenital syphilis. The victims’ families were never told that they could have been treated. As part of a settlement of a class action lawsuit subsequently filed by the NAACP, the surviving participants and family members who had been infected as a consequence of the study were awarded 9 million dollars in damages as well as free medical treatment.
The Tuskegee Syphilis Study led to the establishment of the National Human Investigation Board, and the establishment of Institutional Review Boards in 1979.
On May 16, 1997, President William J. Clinton called the Tuskegee survivors and descendants to the White House for a formal apology for the United States’ role in the study. Ernest Hendon, who was to become the last survivor, was watching from his home in Tuskegee, as President Clinton said: “The United States government did something that was wrong – deeply, profoundly, morally wrong. It was an outrage to our commitment to integrity and equality for all our citizens … and I am sorry” He added unequivocally: “What was done cannot be undone, but we can end the silence … We can stop turning our heads away. We can look at you in the eye, and finally say, on behalf of the American people, what the United States government did was shameful and I am sorry.”
Paying a Debt to Society
When a person is sent to prison for rehabilitation, the intent is not to give them a disease to rehabilitate from. Nonetheless, over the past century American physicians have found prison inmates to be handy subjects for a variety of experiments.
In 1915, Dr. Joseph Goldberger, induced pellagra, a niacin deficiency that damages the skin and the central nervous system, in 12 Mississippi inmates in an attempt to find a cure for the disease. One test subject later said that he had been through “a thousand hells.” In 1935, the director of the U.S Public Health Office admitted that officials had known for some time that pellagra was caused by niacin deficiency but did nothing about it apparently because most victims were poor African-Americans.
During the Nuremberg Trials, Nazi doctors used this study along with Dr. Strong’s trials in the Phillipines to try validate their experiments on concentration camp inmates. While the Nazis do have a point, the subjects in the Mississippi study were truly volunteers who were eventually treated in an attempt to restore their health. In the Nazi experiments, there was usually no health left to restore.
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Between 1919 and 1922 researchers performed testicular transplant experiments on 500 inmates at San Quentin State Prison in California, inserting the testicles of recently executed inmates and goats into the abdomens and scrotums of living prisoners. This of course begs the question “why?” In 1942, U.S. Army and Navy doctors infected 400 prison inmates in Chicago with malaria to study the disease and hopefully develop a treatment for it. The prisoners were told that they were helping the war effort not that they are going to be intentionally infected with a potentially fatal disease. Three years later another 800 prisoners were inoculated with the same pathogen. In 1942, Harvard biochemist Edward Cohn injected 64 Massachusetts prisoners wit
h cow blood in a Navy-sponsored experiment. The rejection of this foreign material by the victims was catastrophic. In 1944, Dr. Captain A. W. Frisch, a well-known microbiologist, performed experiments on four volunteer inmates from the state prison at Dearborn, Michigan inoculating them with hepatitis-infected specimens obtained in Northern Africa. One prisoner died; two others developed hepatitis but lived, and the fourth developed severe symptoms but did not actually contract the disease. In a follow-up study in the 1950s Dr. Joseph Strokes of the University of Pennsylvania infected 200 female prisoners with viral hepatitis to study the disease. The list goes on and on.
In 1952, at the famous Sloan-Kettering Institute, Dr. Chester M. Southam injected live cancer cells into prisoners at the Ohio State Prison to study the progression of the disease. Half of the prisoners in this National Institutes of Health-sponsored (NIH) study were black, igniting racial suspicions stemming from the Tuskegee incident which was also an NIH-sponsored study.
In 1956, Dr. Albert Sabin tested an experimental polio vaccine on 133 prisoners in Ohio. This was prior to his receiving the Nobel Prize for his efforts. In 1963, researchers at the University of Washington directly irradiated the testes of 232
prison inmates in order to determine radiation’s effects on testicular function. When these inmates later left prison and had children, at least four fathered babies with birth defects. The exact number is unknown because researchers did little follow-up on the men to see the long-term effects of their experiment. In 1967, researchers injected 64 prison inmates in California with a neuromuscular compound called succinylcholine, a chemical which paralyzes the diaphragm leaving a person suffocating. When five prisoners refused to participate in the experiment, the prison’s special treatment board gave researchers permission to inject them with the drug against their will.
Between 1964 and 1968, the U.S. Army paid $386,486 to University of Pennsylvania Professors Albert Kligman and Herbert W. Copelan to run medical experiments on 320 inmates of Holmesburg Prison to determine the effects of seven mind-altering drugs. The researchers’ objective was to determine the minimum effective dose of each drug needed to disable 50% of any given population. Though Drs. Kligman and Copelan claimed that they were unaware of any long-term effects the mind-altering agents might have on prisoners, documents released later proved otherwise. The same Dr. Albert Kligman conducted skin product experiments on hundreds of inmates at the same prison. “All I saw before me,” he said about his first visit to the prison, “were acres of skin.” Between 1964 and 1967, the Dow Taking Advantage of the Weak and Innocent