Guinea Pigs, the Poor, et al.

LATE ONE NIGHT a couple of weeks ago, I was sitting in front of the tube watching a horrow classic. When the film, starring Bela Lugosi, ended, I decided to go to sleep. As I got up shuddering to turn off the T.V., a voice interruped: "Stay tuned for Horror Classic II. This week's feature presentation, The Crime of Dr. Hallet."

And so I watched. But to my surprise, and dismay, what ensued could hardly be deemed a "horror classic:" a cast of unknowns, a script right out of a booby prize collection (neither of which had ever disturbed me before), and a story of a dedicated missionary-type healer-researcher in his quest for the cure of red fever. The crimes: forgery and assuming a false identity. Having expected this "classic" at least to provide me with some of the horrification stimuli of Frankenstein or Dr. Jeckyl and Mr. Hyde, you can probably understand my disappointment. Nevertheless, I watched the entire flick.

The plot in brief: The brilliant middle-aged Dr. Hallet, accompanied by the young, but also very brilliant, protege, are in Indonesia, or the like, finding a cure for the fatal tropical disease. When Hallet thinks he has found it, he prepares to infect himself with the desease, to try out his proposed innoculation. But the young, impetuous (and either stupid or suicidal) assistant preempts his mentor by infecting himself.

Well, that was only 20 minutes into the movie, so as you might have expected, the "cure" fails. Before his death, however, the young doctor records what he has determined to be the real cure. Dr. Hallet then assumes his young assistant's identity and forges his travelers checks, the funding for the research having been cut. And he procedes, all in the name of science, to develop the cure based on his protege's notes, and in his protege's name.

The point to all this has, no doubt, eluded you. Dr. Hallet's crime was merely to forge the travelers checks of a dead man--no great loss. What would have made for a much more horrifying film would have been a story of Dr. Hallet--vis a vis 1973--conducting his research with hundreds of black or Chicano subjects. The film credits would have read: "This is a true story although the names of the characters have been changed to protect the innocent and the not-so innocent."

Most of us would like to think that abuse of human subjects at the hands of maniacal experimenters went out of style with Hitler. Those of us who actually believe this are dreamers. In Hitler's heyday, Jews were forcibly subjected to "experimental" and not-so experimental abuse. In 1973 America, blacks, Chicanos, poor whites and prisoners are effectively bribed into selling their bodies (and souls) to researchers. David D. Rutstein, Watts Professor of Preventive Medicine at the Medical School, points out that the Nazi experiments horrified the world because they were designed to answer unethical questions like "How long can a human being survive in ice cold water?" Specific facets of such research become irrelevant. In many ways the current research is umpteen times worse, because the research is performed under the guise of valid scientific curiousity in the spirit of progressive medicine.

And perhaps that is the essence of the first question we must ask in assessing any sort of bio-medical research that involves human beings: What is the scientific validity of the research at hand? Certainly ethical behavior in experimentation depends upon the ethics of the question being asked by the investigator. Rutstein explains how an unethical experiment can be transformed into an ethical one by rephrasing the question:

"In drug testing, for example, it is not ethical to design an experiment to answer the question: 'Is treatment of the disease with the new drug more effective than no treatment at all?' In answering such a question, the patients in the control group would literally have to receive 'no treatment' and that is completely unacceptable. Instead, if the patients in the control group are given the best possible current treatment of the disease, we may now ask an ethical question: 'Is treatment with the new drug more effective than the generally accepted treatment for this particular disease?'"

The first assumption then must be that research that involves human subjects is directed at some beneficial end for the human populace. Questions of unspecified ends other than the morbid curiosity of a psychotic researcher are unacceptable.

There are two other rather important prerequisites. The first is that the risk to the patient be negligible and that it not impede his progress if he is under treatment for an ailment. If that progress can be accelerated by another means, then the experimenter should not try a dubious treatment. Second, the subject must provide informed consent to participate in any experiment.

Three studies only recently unveiled to the public exemplify abuse that stems from the absence of these considerations. Last year it was divulged that the State of Alabama had initiated--40 years earlier--a study of syphillis. The predominantly black participants, unaware of the nature of their disease, were offered elaborate free funerals and other appetizing fringe benefits in exchange for their cooperation in the study. Even after penicillin became readily available the researchers of the Tuskegee study withheld the cure from their subjects.

And then there was the doctor investigating the side effects of the pill. In his zeal to prove that the side effects were largely psychosomatic, he prescribed a sugar placebo to unknowing Chicano women who had approached him for the contraceptive. The game ended when, nine months later, they all gave birth to unwanted babies.

Gerber Products and Baker Laboratories funded an interesting study to determine the appropriate quantity of a certain fatty acid to be put in their baby foods. The study--conducted at the University of Texas--involved depriving mostly black infants of linoleic acid, a component of milk necessary for growth and development. Because the black babies were apparently all orphaned and wards of the state, no consent was awarded in the babies' interests. The few white infants, children of interns, served as the "controls" receiving the normal diet of the essential nutrient.

Clearly, the progress in medical technology made in recent years particularly in surgical techniques, depended on some daring and consequent risk. But Hans Jonas, professor of Philosophy at the New School for Social Research, appropriately notes that there are moral values "whose loss, possibly caused by too ruthless a pursuit of scientific research, is not worth of our efforts or our approbation."