Human Experimentation: Before the Nazi Era and After
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"First animals, then orphans, then the mentally retarded."
David J. Rothman, Strangers At The Bedside
In 1907, Dr. Albert Leffingwell concluded his booklet, Illustration of Human Vivisection, with this chilling prophecy:
"At the beginning of a new century we are confronted by great problems. One of these is human vivisection in the name of scientific research. We appeal, then, to the medical press of America to beak that unfortunate silence which seems to justify or, at least, to condone it. Now and henceforth, will it not join us in condemning every such vivisector of little children, every such experimenter upon human beings? We make this appeal to it in the name of Justice and Humanity and for the sake of millions yet unborn."
The intellectual and philosophical rationalizations, as well as much of the practice of human experimentation, was well advanced by the end of the nineteenth century, and presents a continuing danger to human rights today, particularly when faced with the stimulus of crisis and war.
The history of human experimentation in the West is usefully divided into two eras: before the Nazi era and after. Human experimentation neither arose with the Nazis, nor ended with them. But the Nazi era, to paraphrase Samuel Johnson's famous statement that "Nothing concentrates a man's thoughts so much as the knowledge that he is to be hanged on the morrow"--the Nazi era concentrated our thoughts about human experimentation and, to some extent, halted its momentum. But it did not end the practice of what Dr. Leffingwell called at the beginning of the century, "the secret creed."
Vivisection was practised in the Roman era on gladiators and slaves. But this vivisection, monstrous to the living victim, was sporadic. The real history of vivisection begins in the nineteenth century with the rise of the experimental method in science, and subsequently in medicine. It arises from and accompanies animal experimentation which, with the work of Claude Bernard in the mid-nineteenth century, became the standard methodology in modern medicine. As soon as animal vivisection became standard practice, the question arose about experimental research on human beings. Animal researchers recognized that an inescapable problem had been created: the only way animal research could really be validated for human medical problems was to finally conduct the experiment on human beings, for there is no assurance from animal research itself that a given drug would be valid for human application. A famous example is the fact that aspirin kills rabbits, and if researchers had been guided in their use of aspirins by this laboratory research, human beings would have been denied a valuable drug. Michael Krater summarizes the process in his book, Doctors Under Hitler.
" One of the prerequisites that turned into a sort of fetish of this exact-scientific attitude was the experiment--it, too, a child of rationalization in the past century. At the universities, the theories had to be validated by experiments. It was unquestioned that advances in medicine (as in natural science) could be achieved only through the inductive method of formulating a hypothesis and testing it, by subjecting it to revision and verification in a controlled series of empirical observations."
However, Michael Krater's further statement is only partially true: "Throughout the 1920s and well into the Third Reich, German medical scientists were ruled by a consensus that as desirable as human experiments were, for moral reasons animals had to suffice as objects of empirical experimentation." That was the desideratum, but by the turn of the century experimentation on human beings was on its way to becoming respectable. The famous chemist, E.E. Slosson wrote on Dec. 12th,1895, in the New York Independent, "A human life is nothing compared with a new fact in science....the aim of science is the advancement of human knowledge at any sacrifice of human life....We do not know of any higher use we can put a man to." Professor Starling of University College, London, openly declared in 1906 to Britain's Parliament at its investigation into vivisection pracises, "The last experiment must be on man."
What animal research does is to provide a seemingly safety net and guidelines for procedure with human beings. Sometimes this safety net works, sometimes it doesn't; sometimes it's misleading, but it is standard procedure, so that animal and human experimentation are two sides of the same coin. An article in The New Republic (April 26 and May 2, 1999) by Jerome Groopman, quixotically entitled "Merciful Medicine," describes the system very well:
"After extensive testing in small animals, drugs are tested for toxicity in human beings during what is known as Phase I trials. This first phase is designed to guage the side effects of the drugs, usually on groups of three or four people that get very low doses of the drug, followed by groups that receive successively higher doses until intolerable toxicity is reached [like LD50 drug testing in animals]. There is no expectation of clinical benefit in this first phase. Furthermore, Phase I studies take virutally all comers."
Groopman goes on to describe Phase II and Phase III of human experimentation, in an article intended as a plea to allow those who wish to to volunteer for human experimentation. It was only a matter of time until medicine would arrive at this point where the need for volunteers for human experimentation would become inescapable and would mandate a "merciful plea." As Michael Krater describes the escalation under Nazi Germany, "Because animal experimentation was known to be a poor substitute for experiments on humans, for only analogous inferences could be drawn, the crossover to human experimentation during the war became a logical consequence of prior practices that had been fettered."
The evolution from animal experimentation to human experimentation is a logical consequence of laws governing the experimental process, whether in Nazi Germany, or elsewhere, and not the result of preferring humans to animals. As Krater writes, "...the often-encountered theory that Nazis spurned human life in preference for that of animals, in particular house pets, is without basis in fact--nonsuspect societies love pets also."
The Weimar law passed in 1931 with respect to animal and human experimentation required that German and, subsequently Nazi, doctors must first conduct their experimental procedures on animals before proceding to human beings. This law was never abrogated in Nazi Germany and is similar to laws in the United States today. All experiments with human beings are and were first conducted on animals, and experimenters in and out of Nazi Germany had to validate this procedure. Thus,when Dr. Karl Rascher made his request on May 15, 1941 to the Reich Leader Himmler, "for two or three professional criminals," for high altitude test experiments of eighteen thousand meters, he pointed out that this experiment had been tried on monkeys, but that monkeys outlived their usefulness at 12,000 meters, and he now had to proceed to the use of humans. Research on animals does not protect human beings from becoming experimental guinea pigs.
The literature of the nineteenth century illustrates a continuing increase in the use of human beings for medical experiments, beginning in the last two decades of that century. With the rise of the germ theory and of the pharmaceutical companies, testing on both animals and humans proliferated at dizzying speeds. In her book, Subjected to Science: Human Experimentation in America Before the Second World War, Susan Lederer writes:
"The science of bacteriology engendered substantial experimentation on human beings and animals....Isolating and identifying a disease germ under the microscope was the first step. After growing the microorganism in a pure culture, the physicians needed to use the germ to produce the disease in a healthy organism.
"The use of human beings to confirm that a microbe caused a particular disease to demonstrate the mode of transmission was a harsh legacy of the germ theory of disease. Unable to find a suitable animal model in which to study the disease, physicians turned to human subjects. Before the discovery that monkeys could be infected with syphili and gonorrhea, the search for microbes of venereal disease prompted more than forty reports of experiments in which individuals were inoculated with the suspected germs of gonorrhea and syphilis. In 1895 New York pediatrician Henry Heiman...described the successful gonorrheal infection of a 4-year-old boy ("an idiot with chronic epilepsy"), a 16-year-old boy (an "idiot") and a 26-year-old man in the final stages of tuberculosis"
This information is in the medical journals of its time, The American Journal of Syphilis of 1943, and the Journal Cut. Genito-Urinary Diseases of 1895. It is germaine to the problem of informed consent that two of the subjects are described as "idiots," therefore presumably incapable of giving informed consent. Who then gave it for them, and should others have the right to give such consent for others? Should a parent in need of money have the right to give consent for a child to be experimented upon? Would this be considered "selling" a child to science. These are problems that degrade the integrity of the concept of informed consent.
Usually the human beings used for experimental purposes were--and are-- the disenfranchised, populations of prisoners, orphans, the mentally retarded, charity patients of all kinds. Dr. Leffingwell's study uncovered decades of experiments on human beings in charity wards and on children in orphan asylums. None of these experiments were as horrific as those conducted by the Nazis, but they were quite serious enough. Leffingwell documented experiments by Dr. Sydney Ringer of University Hospital of London, who experimented with poisons, such as overdoses of salicin, nitrate of sodium, gelseminum and other toxic agents, often on children under the age of ten. Due to the experiments,the children suffered from severe headaches, vomiting, twitching of limbs, burning sensations in the eyes, and other painful symptoms. Dr. Leffingwell commented:
"A distressing feature of many of these experiments is the fact that the men and women upon whom they were performed were not only ignorant, but under constraint. In this horrible case certain patients in the hospitals were not merely poisoned once, but were obliged 'on compulsion' to undergo the convulsive paroxysms and all the other agonizing symptoms a second time"
Dr. Ringer's experiments were published in a book called Handbook of Therapeutics. Far from receiving criticism for his experiments on children, Dr. Ringer's book went through eight editions and was regarded as a respectable medical book.
In 1906, the British Parliament conducted The Second Royal Commision into Vivisection Practices. H.H. Levy, the Honorable Secretary of the Personal Rights Association, told the Commission, "These experiments are not confined to animals and never have been confined to animals; they have always been performed on human beings, as well as on animals." Indeed, the Commission uncovered decades of evidence of routine human experimentation. Some of these experiments were published in 1949 in E. Westacot's book, A Century of Vivisection and Anti-Vivisection. Westacott's book describes the experiments of Professor Neisser of Vienna who, on March 29, 1899, reported in the Medical Press of Vienna, how he had inoculated eight healthy children with syphilis. Three of the children developed symptoms of the disease, and a fourth suffered later in life from a cerebral tumor. While Professor Meisner was condemned and fined by the disciplinary court of Breslau, he was rewarded by the West London Chirugical Society in England in 1911, with the Cavendish Gold Medal for his research, and a reception was held in his honor. Apart from the Nazi doctors, it is hard to find a single doctor who was seriously punished for human experimentation, and who was not in fact professionally rewarded.
In the United States, in 1913, the Pennsylvania House of Representatives recorded that 146 children had been inocluated with the syphilis virus, "through the courtesy of the various hospitals" and that 15 children in St. Vincent's House in Philadelphia had had their eyes tested with tuberculin. Several of these children became permanently blind. The experimenters were not punished. Moreover, this case further illustrates that the doctrine of "informed consent" proves to be practically inoperable in the case of instutionalized people, particularly children, because in most of these circumstances it is the institution's supervisor who is responsible for giving"informed consent" and usually gives it.
Experimentation on human beings was not confined to bacteriological research. J. Marion Sims, the "father of gynecology" performed experimental surgery, before the days of anesthesia, on several slaves, and performed thirty-four experimental operations on a single black female slave for a prolapsed uterus.
One of the most famous cases in human experimentation involves an Irish servant girl, Mary Rafferty, who entered Good Samaritan Hospital in Cincinnati in 1874, with an ulcerated tumor on the side of her head, which had been caused by a bad burn. Mary Rafferty's case demonstrates the characteristics usually inherent in cases of human experimentation: the ambiguity involved in determining whether informed consent had been obtained, the shadowland between experimentation and therapy, the fact that only the attending physicians really know the truth of what occurred. Her physicians diagnosed the ulcer on her scalp as cancerous and apparently attempted to treat her condition surgically. When they believed that her situation could not be remedied, they proceeded to experiment on her. One of Mary's physicans, Roberts Bartholow was interested in experiments Dr. David Ferrier had made with dogs using electric shock to determine the localization of epilepsy. The experiments with Mary are described as follows:
"When the needle entered the brain substance, she complained of acute pain in the neck. In order to develop more decided reaction, the strength of the current was increased by drawing out the wooden cylinder one inch. When communication was made with the needles, her countenance exhibited great distress, and she began to cry. Very soon, the left hand was extended as if in the act of taking hold of some object in front of her; the arm presently was agitated with clonic spasm; her eyes became fixed with pupils widely dilated; her lips were blue, and she frothed at the mouth; her breathing became stertorous; she lost consciousness and was violently convulsed on the left side. The convulsion lasted five minutes, and was succeeded by a coma. She returned to consciousness in twenty minutes from the beginning of the attack, and complained of some weakness and vertigo."
The Mary Rafferty Case illustrates a persistent pattern in issues of human experimentation: she died a few days later, and her death certificate stated that she died from cancer. There was criticism of Dr. Bartholow's experiment: it was condemned by the American Medical Association, but Dr. Bartholow did not suffer professionally. Indeed, he advanced professionally. Scandal arises, then scandal subsides, and the researcher is rewarded.
The second issue is that while Dr. Bartholow conceded that his experiment had perhaps gone too far, he asserted emphatically that Mary had given informed consent and that his experiments did not cause her death. But even if the experiments did not cause her death, she was entitled to die without unnecessary pain. The argument that "the patient was going to die anyway" is a gross argument, and one that was used by the Nazi doctors. Bad enough the patient is going to die; it is no excuse for the patient to be tortured while dying. We do not permit condemned prisoners to be tortured on the excuse that they're going to die anyway. (However, there are constant proposals from research medicine that prisoners on death row be used for experimental purposes. Would such "experiments" constitute torture or not?)
The third issue is that of Mary Rafferty's consent. Dr. Bartholow argued that she was not feeble-minded and understood his questions to her. There is a contradiction in this argument. If Mary Rafferty really understood Dr. Bartholow's description of what he was about to do, common sense tells us she would not have consented. This is the crux of the issue with most "informed consent" problems. Examination of particular experiments invariably suggests that the patient did not understand what he or she was consenting to. "Informed consent" proves to be a treacherous deception in many cases. At a conference on "The Nazi Doctors and the Nuremberg Code" at Boston University in 1989, Dr.Arthur Caplan stated that the principle of informed consent, which is the cornerstone of protection for human rights in a medical context, is now so eroded that it has evolved into "protection of the researcher" and a license to experiment.
"Informed consent" does not respond to the more common types of experimentation on human beings, where the area between therapy and experimentation is blurred, and where it is difficult to pass judgment on medical procedure. An article in The New York Times (Nov., 1996) by Gina Kolata, demonstrates the ubiquity of the problem. The Food and Drug Administration gave permission to lift the requirement of informed consent for patients who have been brought into a hospital, suffering from a head injury which has rendered them unconscious, and who have no identification. Who is to give consent in this case? Though this step marks a grave departure from the Nuremberg Code, it has aroused little public reaction. Of course, the argument in defense of the lifting of this ban is the necessity to treat a patient, even experimentally, who cannot speak for him or herself. But how many people are wandering about without any identification? The population of "unidentifiable" people is immediately identifiable: the homeless and probably illegal immigrants.
Even with alert and identifiable patients, as Jay Katz observed at the Boston University Conference, informed consent is meaningless unless the patient is educated and medically very knowledgeable, but most sick people, as Dr. Katz pointed out, are not in a position to argue with their physicians: they are "coerced by disease," by pain, by fear of death, and often by ignorance.
In real practice--not theoretical practice--the concept of "informed consent" has led to the duplicitous practice of what Bradford H. Gray calls in his book, Human Subjects in Medical Experimentations, "the engineering of consent." His study unsurprisingly reveals that "informed consent" is often a mirage, often coerced from frightened people who are in too much pain and confusion to withstand a request from a doctor. In the introduction to Gray's book, Bernard Barber exposes the myth of medical experimental outrages as the aberration of a "few bad doctors."
"There is a mistaken belief held by some medical researchers, and even by those who deplore the defects in present practices in this field, that the shortcomings and scandals that occur can be traced to a handful of individuals who lack the requisite personal qualities. They recommend that 'the honest, conscientious, compassionate physican' be the ultimate safeguard of the human research subject. But Gray's book shows that 'honest, conscientious, compassionate' physicans have been led into bad practice by a bad system."
Experimentation on human beings is not the work of a few aberrant doctors; it is systemic, because it is the system by which modern western medicine works. Exposés of outrageous experiments, such as Dr. Henry Beecher's book, Research and The Individual, written in 1966, often endorse research on human beings. Dr. Beecher wrote, "The well-being, the health, even the actual or potential life of all human beings, born or unborn, depend upon the continuing experimentation in man. Proceed it must; proceed it will. 'The proper study of mankind is man.'"
The Nuremberg trials brought to light the horrors of medical experimentation on human beings, and tried to articulate a restraining formula by stressing the concept of "informed consent," but the trials also recognized that "Medical science cannot, unless it is to be brought to a standstill, dispense with the application in suitable cases of new remedies and procedures not yet fully tested. Nor can it do entirely without scientific experiment on human beings itself." In 1931, Germany already possessed a good bioethical code which contained almost all the points of the Nuremberg Code. Yet it failed to curb the rapacious desire to experiment. By the time of the Nazi experiments, the legal procedure and conduct of experimentation with human beings had been laid down in Germany, the United States and England. Experimentation on human beings was not condemned. What was condemned in Germany was the political and racial uses of human experimentation, and its excesses. The defense of the Nazi doctors rested on the argument that their procedure was standard Western medical practice, and they submitted cartons of documentation of experiments on human beings in Western hospitals to prove their case, including an exhaustive volume, entitled, Experiments on Human Beings in World Literature, by Dr. Erich H. Hahlbach," which describes such experiments as those conducted on "eight hundred convicts from three American prisons" artificially infected with malaria, who presumably volunteered for this experiment, prisoners in Turkey sentenced to death, infected with typhus, prisoners sentenced to death infected with plague, etc. The defense pointed out that "Out of fifty-three printed sources quoted, seventeen state that the subjects consented. In thirty-six the matter was not mentioned in any way and in several of these cases it appeared that the subjects might not have presented themselves willingly." The defense's argument was that experimentation with human beings had been accepted medical procedure. The question, they asked, is whether "medical experimentation can be considered a crime." The prosecution did not argue this, but condemned the experiments because they had been used for political and racial purposes. A half hour's reading in The Encylcopedia of Bioethics , under "human experimentation," "minority subjects," reveals that it had been thus for half a century. The Encyclopedia documents cases of experimentation on human beings of minority populations and Third World populations.
Eileen Welsome's book, "The Plutonium Files," (Dial Press, 1999), documents radiation experiments on human beings in the United States from the 1940s, after the exposure of Nazi experiments and the articulation of the Nuremburg Code. Some of the doctors who conducted these experiments and were later interviewed about them, confessed that they knew of the Nurmeberg Code, but did not think it applied to them--that code was for the barbarian Nazis. William Silverman of Columbia University, said:
"'The connection bween those horrendous acts andour every day investigation was not made for reasons of self inerest, to be perfectly frank. As I see it now, I'm saddened tha e didn't see the connection, but that's what was sone. We wrapped ourselves in the flag....'" (p. 214.)
Welsome writes, "Physcians performed experiments on healthy people and sick patients without informing them of what was going on or getting their consent. Sick patients were preyed on most frequently. They were convenient, plentiful, and vulnerable, since nontherapeutic procedures could be administered easily under the guise of medical treatment....Terminally ill patients were perhaps the most vulnerable group of all....Women, children, unborn fetuses, minorities, the mentally retarded, schizophrenics, prisoners, alcoholics, and poor people of all ages and ethnic groups were targets." (p. 214-215)
There are exaples of experimentation on human beings that is more democratic. Ed Regis' book, "The Biology of Doom: The History of America's Secret Germ Warfare Project," ( Henry Holt & Co., 2,000) writes of those experiments when U.S. Nay ships "without, it seems the knowledge of Congress, sprayed the Virginia coastal communities of Norfolk, hampton and Newport News with BG (bacillus globigii--used to stimulate the spread of anthrax) [and] 800,000 people around San Francisco ay were exposed to clouds of these microbes." ("The New York Times Book Review, Jan. 22, 2,000). Prior to this, in October, 1940, "Japanese planes dropped a mixture of grains and fleas over Chinese towns, causing two major oubreaks of bubonic plague south of Shaghai." (Ibid)
The race to develop genetic medicine has opened new temptations for doctors to experiment on human beings. The death of Jesse Gelsinger, 18 years old, who suffered from a non-threatening liver ailment, and was induced to undergo genetic treatment for it at the University of Pennsylvania, has exposed appalling practices that are now a century old: the cavalier behavior of the experimenters, the hasty patched-together "informed consent" form--after his death---other procedural misconduct.("The New York Times, Jan. 27, 2,000, page. 1, " Youth's Death Shaking Up Field of Gene Exerpiments on Humans.)
The philosopher Hans Jonas proposed that experimentation on human beings must be reserved not for the disenfranchised, but for the scientists and intellectuals themselves--both for scientific and moral reasons. Scientifically, because the class that designs the experiments can best report on the probity and results of the experiments. There were outstanding examples of this procedure in the nineteenth century, and occasionally one still hears of a medical doctor experimenting on himself (or a member of his family), but as human experimentation went from what David Rothman called "a cottage industry" in the nineteenth century to its present dimensions as an indispensable part of modern medicine requiring ever larger populations, "voluntary science martyrs" disappeared. The reasons for this are not hard to find: If Mary Rafferty had understood what she presumably was consenting to, she would not likely have consented. Some who do consent are usually those in desperately dependent positions.
Jerome Stephens offers another, more chilling reason why the medical research community does not seek out "volunteers' from the higher socio-economic brackets. Researching on the ignorant and the disenfranched allows the researchers to maintain control of the research process.
"Medical researchers, of course, are quite aware of the social, economic, and political backgrounds of those who serve as subjects, and while the researchers are interested in developing an ideology that does imply societal authority for experimentation, the primary goal seems to be to maintain their power over the neglected. It is highly unlikely, for example, that researchers would even want to include large numbers of educated and affluent individuals as subjects, because to do so would almost certainly threaten the status quo by requiring that more information be imparted, and by requiring research to be better designed to avoid the completely useless experiments now conducted. It is also obvious that more stringent regulations would emerge to control experimentation if groups with well-defined and powerful constituencies were used. At the present, the researchers, by confining their experiments primarily to the neglected, are potentially useful to the more affluent in that they may discover new knowledge, and the researchers provide no threat to the middle class. Tacit consent to exercise power, then, does reside in researchers, but it is the exercise of power, not individual choice to submit to experimentation or overt societal authority that is the core to understanding the whole process of human experimentation."
Not quite. Animal experimentation is "the core to understanding the whole process of human experimentation," for if the poor, the mentally retarded, the homeless, the orphaned and the imprisoned have little voice, the animals have no voice, and it is voicelessness and rightlessness that invests the whole procedure from animal to orphan to the mentally retarded.
We are not done with Auschwitz and Nuremberg. Their shadows are long. The silence of the medical communities in Germany and the United States after the Second World War revealed the desire of the medical communities to distance themselves from the outrages of Auschwtiz, by silence and by spreading the myth that the German experiments was the work of deranged scientists. In his anthology, When Medicine Went Mad, Arthur Caplan asks why bioethics has so little so say about the Holocaust:
"There has been almost no discussion of the roles played by medicine and science during the Nazi era in bioethic literature. Rather than see Nazi biomedicine as morally bad, the field of bioethics has generally accepted the myths that Nazi medicine was either inept, mad, or coerced. By subscribing to these myths, bioethics has been able to avoid a painful confrontation with the fact that many who committed the crimes of the Holocaust were competent physicans and health care professionals acting from their moral convictions....A fog of excuses, lies, and exculpation has been laid over the crematoria and laboratories of the concentration camps."
When the Nazi doctors were asked in the Nuremberg trials how they could have brought themselves to perform such experiments, they responded that they had been trained by doing them on animals. Time is exposing the desperate myth that animal experimentation replaces or disposes of the need for human exprimentation, and that the work of the Nazi doctors was that of "mad scientists." Some of it was bad science, but some of it wasn't, and the work of the Nazi doctors has been entering mainstream Western medicine for decades.The Columbus Dispatch in 1984 revealed that a researcher in British Columbia had been using the information from Nazi experiments on hypothermia. The Jerusalem Report of Feb. 22, 1996 revealed that Dr. Howard Israel, an oral surgeon at Columbia Presbyterian Medical Center in New York was dismayed to discover that his valuable and trusted book, Pernkopf's Topographical and Applied Human Anatomy contained illustrations that may be based on the cadavers of concentration camp victims. Caplan's question in When Medicine Went Mad, "Should Nazi data from the experiments be used?" has been answered: Nazi data has been used by many scientists from many nations.
Our moral horror at the Nazi medical experiments was dissipated by our government's decision not to prosecute the Japanese for almost identical experiments on an almost identical number of victims, three thousand (many of whom were American prisoners), in exchange for the information from those experiments. As Raoul Hillburg wrote in The Destruction of the European Jews, "If the world was so shocked at what it discovered to be the extremes to which experimental medicine would go, it has yet to condemn the method or find the means to control it."