by Cina, Joshua A. Perper, Stephen J. ; Cina, Joshua A. Perper, Stephen J.
The MKULTRA projects resulted in a number of deaths but the exact number will never be known. The details of many of the experiments fall into the “I could tell you but I would have to kill you” category. Of all the hundreds of human test subjects used during MKULTRA, only 14 were ever notified of their involvement and only one receives a paltry compensation of $15,000.
Doing Your Civic Duty
Between 1962 and 1973 the U.S. Department of Defense conducted a variety of experiments with a variety of code names such as Whistle Down, Elk Hunt, Devil Hole, Sun Down, Swamp Oak, Red Cloud, Watch Dog, Dew Point, Rapid Tan, DTC Test 69-75, Tail Timber, Pine Ridge, Green Mist, and DTC Test 68-53. These catchy nicknames involved exposing civilians to some “simulated” agents as part of a control group examining the effects of live chemical and biological agents. The land-based tests were conducted in Alaska, Florida, Hawaii, Maryland, Utah, Canada, and the United Kingdom. Sea-based tests that were part of Project SHAD
(Shipboard Hazard and Defense) were also conducted. The tests used both live chemical or biological agents and “simulants” (ostensibly non-harmful materials that behaved in a manner similar to real agents). Some of the substances included in this study were very toxic such as Sarin, VX, Soman, Tabun, ester of benzilic acid, and bacterial organism such as Francisella tularensis and Puccinia graminis Why Did American Doctors Perform Unethical Medical Experimentation?
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var. tritici. The government began investigating the records of these experiments in September 2000 at the request of the Department of Veterans Affairs and acknowledged that unwitting civilians were used in the study on October 9, 2002.
In a public statement William Winkenwerder, the Assistant Secretary of Defense, stated: “The purpose of these operational tests was to test equipment, procedures, military tactics, et cetera, and to learn more about biological and chemical agents. The tests were not conducted to evaluate the effects of dangerous agents on people.” He added, “Things were learned at that time that would have been useful”
for the offensive use of chemical or biological agents against our enemies. Further, he was “highly confident that civilians were not exposed to live chemical or patho-genic biologic agents.” Nevertheless, civilians in Hawaii, Alaska, Florida, and Puerto Rico, might have been exposed to biological and chemical stimulants that were considered harmless at the time of the tests, but were later found to pose a potential health risk to people with weak immune systems. In addition to the civilian
“volunteers” approximately 5,000 service members were involved in the sea-based tests and another 500 in land-based studies.
Before we become nostalgic for the good old days of government experimentation, let us understand that studies are still going on in this decade. In 2001, the U.S.
Air Force and rocket maker Lockheed Martin sponsored a Loma Linda University study that paid 100 Californians $1,000 each to eat a dose of perchlorate. This is a toxic component of rocket fuel that causes cancer, damages the thyroid gland, and hinders normal development in children and fetuses. To test the effect of cumulative dosage, these Westcoasters snacked on this noxious chemical every day for 6 months.
The dose eaten by the test subjects was 83 times the safe dose of perchlorate set by the State of California which has trace amounts of perchlorate in some of its drinking water. This Loma Linda study was the first large-scale study to use human subjects to test the harmful effects of a water pollutant. Though the environmentalist goals were laudable, these experiments border on unethical. Even on Californians.
Why Did American Doctors Perform Unethical
Medical Experimentation?
As Mr. Spock said in Star Trek 2: The Wrath of Khan, “The good of the many outweighs the good of the few – or the one.” This excuse has been used by many doctors accused of unethical medical experimentation or fudging on the Informed Consent paperwork. The crux of this argument centers on the fact that although a few people may be damaged or killed during a risky clinical trial or while undergo-ing an experimental surgical procedure, many will be saved if it works. This mentality has been a driving force behind a great deal of American and international human experimentation. This rationale is quite logical, of course, unless you are one of the “few” or the very unlucky “one”.
It may well be that the way to Hell is paved with good intentions, but in the annals of American medical experimentation the good intentions were very rarely 100
10 Good Old Fashioned American Ingenuity---and Evil
directed towards the experimental subjects. In many cases, the only potential beneficiary of the results of these tests was the U.S. military. Although some physicians truly believed that a little human suffering now could avert global tragedy later, most American doctors performing illegal or unethical experiments on people most often did so for one of the following three reasons:
1. An excessive curiosity to better understand the causes, mechanisms, and development of diseases and injuries in order to determine how they can be effectively treated. In the case of military-oriented programs the study of injury patterns and the effects of drugs can lead to more effective warfare and espionage. While it is questionable whether curiosity ever killed a cat it is certainly very true that scientific curiosity may kill any sense of humanity and make researchers see human beings as life support systems for organs, “acres of skin” or “objects” of research
2. A motivation to advance professionally and, occasionally, to get rich. We have seen examples of several prominent physicians who were involved in questionable research but rose to the pinnacle of their respective specialties, or 3. Moral blindness and a complete lack of sensitivity to the suffering of the human subjects. These physicians conveniently forgot that once these patients enrolled in an experiment under a doctor’s control they were automatically covered under the umbrella of the Hippocratic Oath
How American society could produce such insensitive physicians is not easy to answer. One possibility is that American medical schools, like many other institutions throughout the world, have historically concentrated obsessively on teaching the cold, hard facts with little focus on the ethical aspects of medical care. Many schools have argued that the requisite memorization of a mountain of medical information does not leave students time for the exploration of the seemingly less important hills of the moral vista. This is a grave mistake which should be promptly corrected since a physician without a caring soul cannot be a humane provider of medical care. Only recently have allopathic (“M.D.”) medical schools added medical ethics to the curriculum and given adequate consideration to the feelings and emotional needs of vulnerable human beings. In many ways, schools of osteopathic medicine (“D.O.”) have been ahead of the game on this front by taking a more holistic approach to patient care.
Experimentation and the Law
Although Americans were instrumental in the drafting of the Nuremberg Code establishing the guidelines for the performance of ethical medical experimentation, the actual implementation of its provisions through federal legislation and enforcement of the law proceeded at a snail’s pace. Unethical human experimentation is and has been officially and publicly condemned by our government and its leaders; however, the main offenders in this arena appear to be governmental agencies and Experimentation and the Law
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the U.S. military. Thirty-five years after Nurenberg, Secretary of Defense Charles Wilson issue the “Wilson Memo”, a top-secret document establishing the Nuremberg Code as the official Department of Defense policy on human experimentation. The Wilson memo required voluntary, written consent from a human medical research subject after he or she had been informed of “the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and effects upon his health or person which may possibly come from his participation in the experiment.” If this has been the government’s position for over two decades, one mu
st ask why unethical experiments are still going today.
There have been some signs that the situation is improving. Medical experiments performed at academic institutions have to be approved by institutional review boards (IRBs). An IRB is an independent ethics committee (also known as an ethical review board) that is formally charged with approving, monitoring, and reviewing medical and behavioral research involving humans in order to protect the rights and welfare of the subjects. The composition of these Boards is specifically regulated to ensure their objectivity and fairness. Many reputable journals will not publish the results of a study without documentation that an IRB has reviewed the experiment prior to its inception. Of course, many experimenters, such as those employed by the CIA, may not care if their research is published and may see little need for IRB approval.
There have also been significant actions at all levels of government in the past few decades. In 1969, President Nixon officially ended the United States’ offensive biowarfare program including the human experimentation studies at Fort Detrick.
Nixon wouldn’t lie about this. In 1971, the biowarfare lab was converted to the Frederick Cancer Research and Development Center, now known as the National Cancer Institute (NCI). In addition to cancer research, scientists at the NCI now study virology, immunology and retrovirology (including the HIV). The site also has become home to the U.S. Army Medical Research Institute which studies drugs, vaccines and countermeasures for biological warfare. It would seem that the old Fort Detrick could not completely free itself from its biowarfare past.
There have been other significant steps toward limiting the abuse of humans through unethical medical experimentation. In 1977, the Senate Kennedy Hearings led to a Presidential Executive Order prohibiting intelligence agencies from experimenting on humans without informed consent. The enforcement of this Order is still questionable. In 1977, the National Urban League held its National Conference on Human Experimentation. They succintly stated the shared sentiments of many scientists and physicians: “We don’t want to kill science but we don’t want science to kill, mangle and abuse us.” In 1979, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research released the Belmont Report. This publication mandates that researchers follow three basic principles: 1. Respect the subjects as autonomous persons and protect those with limited ability for independence (such as children)
2. Do no harm, and
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3. Choose test subjects equitably and justly – being sure not to target certain groups because they are easily accessible or easily manipulated, rather than for reasons directly related to the tests
For any physician remotely familiar with the Hippocratic Oath these truths should be self-evident.
In 1980, the FDA finally prohibited the use of prison inmates in pharmaceutical drug trials leading to the advent of the experimental drug testing centers industry.
Many college students have earned invaluable “beer money” by participating in these studies. However, in 2006 the New York Times reported that “An influential federal panel of medical advisers has recommended that the government loosen regulations that severely limit the testing of pharmaceuticals on prison inmates, a practice that was all but stopped three decades ago after revelations of abuse.”
Ethicists are firmly against such relaxation of these rules pointing out that an imprisoned population lacks the ability to give free and unfettered consent. College students would also be very upset.
In 1995, President Clinton formed the National Bioethics Advisory Committee.
The role of this body is to advise the President on ethical issues that may emerge as a consequence of advances in medical science and technology. In connection with its advisory role, the mission of the Council includes the following functions:
1. To inquire into the human and moral significance of developments in medical and behavioral science and technology
2. To explore specific ethical and policy questions related to these developments 3. To provide a forum for a national discussion of bioethical issues (such as ethical issues related to fetal research, cloning, growing of organs from isolated tissues)
4. To facilitate a greater understanding of bioethical issues, and 5. To explore possibilities for useful international collaboration on bioethical issues
It is then up to the President to do something with this information. Presumably, this type of bioethical advisory input was sought by President Obama when he gave the O.K. for stem cell research.
In 1997, California prefaced the Protection of Human Subjects in Medical Experimentation Act by stating, “The Legislature hereby finds and declares that medical experimentation on human subjects is vital for the benefit of mankind, however such experimentation shall be undertaken with due respect to the precious-ness of human life and the right of individuals to determine what is done to their own bodies.” This should be simple common sense and reaffirms our inalienable rights stated so eloquently in the Constitution. This being the case, why do our own scientists and doctors violate them again and again? It may be shocking to read the chapters in this book describing Nazi and Japanese scientific atrocities in the 1940s.
Perhaps the hypocrisy of American morality is even more disturbing.
Chapter 11
Physician Kill Thyself: The Story
of Dr. Gwinn E. Puig
Suicide may also be regarded as an experiment – a question
which man puts to Nature, trying to force her to answer.
– Arthur Schopenhauer
Humans are self-experimenters from birth. In fact, we cannot prevent ourselves from being so. Our entire life is a string of self-experiments, whether pleasurable or painful, beneficial or disastrous. As children we are fearless and simply don’t appreciate danger. It is the duty of our parents to train us to recognize and avoid the hazardous situations that we invariably seek out. As adults, if we have learned our lessons, we avoid treacherous experiments that may cost us life or limb based on the experience (often tragic) of others and our own reasonable but not infallible judgment. “Not infallible” would be the key words in that sentence.
Self-Experimenting Physicians
When physicians attempt to discover the causes of disease and mechanisms of injury or devise treatments through self-experimentation, it is obvious that they are engaged in medical research (rather than masochism). There is virtually unanimous agreement that physician self-experimentation has been of great benefit to the development of medicine. Many experiments that physicians have performed on themselves were potentially fatal. A successful experiment meant a great leap forward for medicine; a failure led to a pine box. Prior to the eighteenth century medical research was based on studies of just a few people with a given condition, sometimes only one, resulting in conclusions of dubious scientific merit. In modern times, this somewhat subjective “research” has been replaced by clinical trials and retrospective analysis of large groups of people with the same disease giving rise to statistically sound data.
Accordingly, self-experimentation (on a sample size of one) is generally frowned upon these days and its scientific validity may be harshly questioned.
Nevertheless, medical self-experimentation continues to occur. Some modern self-experimenters have clearly contributed to medical progress and have enjoyed universal fame. Others have paid for their achievements with their lives and J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 103
DOI 10.1007/978-1-4419-1369-2_11, © Springer Science+Business Media, LLC 2010
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11 Physician Kill Thyself: The Story of Dr. Gwinn E. Puig
many more have failed miserably despite their sacrifice and died in obscurity. There is one consistent truism regarding self-experimentation; it always seems to involve significant discomfort, risk, and/or pain to Dr. Guinea Pig, the victim of his own experiment.
Boldly Going Wher
e No Man Has Gone Before
British physicians have a penchant for self-destructive chivalry in the name of Science. In 1767, Dr. John Hunter, a surgeon to King George III, injected venereal pus from a prostitute with gonorrhea into his penis. He then successfully treated himself with mercury and eradicated the infection. Unfortunately for him, the woman also had syphilis and Hunter died subsequently of late complication of this disease. Had he explained the experiment to his wife he likely would have died much sooner.
In 1769, Dr. William Stark, a London physician, studied the benefits of a simple vs. complex diet. He began the experiment by placing himself on a very strict diet of bread, water and meat. He was adding different food groups to the regimen in order to study the impact of the nutrients afforded by various consumables. Much to his consternation, just before adding fruits and vegetables to his diet he died of scurvy, a disease caused by lack of vitamin C, a critical vitamin found in citrus fruits and in vegetables.
In the nineteenth century, the medical establishment still believed that a woman’s pain during labor was a biological necessity, a conviction perhaps also influenced by the biblical injunction punishing Eve for eating the forbidden fruit from the tree of knowledge. A young Scottish obstetrician, Dr. James Simpson, did not believe that this agony was an immutable punishment and applied himself to the idea of facilitating a painless delivery. In one of the seemingly more enjoy-able self-experiments in this chapter, he sniffed a large number of substances in search of one that would dull or eliminate pain. To test the analgesic effect of each agent he pricked himself with a sharp instrument or asked a colleague to kick him in the shin. Eventually he found chloroform most suitable and in 1848
he tried it on 30 women in labor; all experienced a painless delivery. Simpson’s colleagues were scandalized by his unorthodox treatment, which they believed was a danger to both mother and fetus. The criticism quickly died down after Queen Victoria allowed Simpson to use chloroform on her to deliver her eighth child, Prince Leopold (as if she needed it by then). She subsequently knighted Dr. Simpson.