Research ethics require action and vigilance

Allen M. Hornblum

is the author of Acres of Skin and Sentenced to Science and is working on a book dealing with institutionalized children as research test subjects

This month in the nation's capital, the Presidential Commission for the Study of Bioethical Issues heard testimony on human-subject protection in the aftermath of recent revelations that high-ranking American doctors and public-health officials, including the surgeon general of the United States, purposely infected hundreds of Guatemalans with syphilis in the late 1940s.

The panel's final report on this repugnant example of unethical scientific research will be released later this year, but one thing is already clear: The government's response can be counted on to be underwhelming, and the panel's lukewarm recommendations - if any - will be as fleeting as the news reports that American doctors used syphilitic prostitutes to infect Guatemalan prison inmates.

Government expressions of shock and regret regarding wrongdoing are a familiar drill at this point. Unfortunately, the American medical establishment has given little more than lip service to human-subject protection, and research ethics remain an orphan rather than the centerpiece of medical-school curriculum. Although we like to trumpet our superiority as ethical advocates and cultivate our reputation as defenders of the proper way to do medical research, an honest historical accounting illuminates numerous instances of physician, university, and pharmaceutical company self-interest trumping prudent and ethical decision-making.

No better example of this hypocritical approach may exist than the Doctors Trial after World War II, in which the United States put 23 high-ranking Nazi doctors and administrators on trial for their brutal and deadly medical experiments on concentration-camp prisoners. Prosecutors and medical experts harangued the defendants for months on end, and after they won convictions, seven doctors were executed and others were sentenced to long prison terms.

To underscore their commitment to safeguarding the lives and rights of test subjects, American jurists drafted the Nuremberg Code of medical conduct for researchers. Many believe the 10-point code - that begins with "The voluntary consent of the human subject is absolutely essential" - is the best document of its kind.