Ron Wetherington on the Common Reading
Humans Subjects in Scientific Experiments Timeline
Issues for Discussion by Ron Wetherington
Living standards and poverty in the 40s-50s: Black and White (pp. 24-26. 79-80, 119)
Some facts: the Fair Labor Standards Act of 1938 set minimum wage at $.25/hr (the equivalent of $4.50 in 2010), rising to $.75 in 1950, so 80-cents was a good wage for blacks and whites. In 1940, though, black males earned 48% of the earnings of white men ($149/week vs. $308/week). In 1950 these figures were 63% ($251 vs. 401). In 1945, two boxes of Wheaties, one quart of p-nut butter, and a pound of coffee all cost 19 cents and 10 lbs of sugar cost 50 cents!
Segregation and discrimination in health care and employment (pp. 19, 26, 64)
In general physicians treated all patients equally, and discrimination in hospitals (black and white wards, etc.) was often based as much on ability to pay as on race. “Benevolent deception” was a popular approach to informing patients of all races.
Ignorance + superstition = false knowledge (pp. 52-53, 59-62, 142, 165-166, 195-197, 230-231, 237)
Hybrid Men (p. 142), Night Doctors (p. 166), and other myths find many analogs in today’s world, and students should be able to identify many of these. H.L. Menken in 1949: “The most common of all follies is to believe passionately in the palpably not true.” Only part of this is based on ignorance (what exactly is a cell?); part is based on traditional culture as well, and still more is based on quasi-fact (experimentation on humans without permission, or with deceptive information). Even Debora’s diary (pp. 195-197) includes misinformation, despite her detailed research. Students may wish to explore how much arcane knowledge ought to be presented to patients incapable of fully understanding it.
Informed consent (pp. 29-31, 33, 89, 131-135, 167, 186)
Medical consent (consent to have a procedure) and informed consent (full disclosure of risks and intent) are not the same. Consent to perform surgery (p. 31) was simply written permission required for legal purposes, but did not include any information about the surgery to help the patient’s decision. Moreover, the consent never addressed the use of any tissue samples removed. Similarly, consent for an autopsy (p. 89) was required, but did not involve the future use of any removed organs.
Nature of experimentation (pp. 50, 96, 130)
Students should discuss Southam’s (p. 130) justification for withholding “emotionally disturbing but medically non-pertinent details.” Appended here is a representative list of experiments conducted on human subjects since 1900—often without their knowledge or understanding, and almost always without informed consent.
Cancer and cell culture
Obstacles in the 40s-50s (pp. 35-36,98-99, 138-141, 152-157, 216-217)
Students should become aware of two major issues in cell culture: 1) cultured cells behaved like normal cells in having a finite lifetime of cell division (about 50X: the “Hayflick limit”). This normal and programmed cell death (apoptosis) severely limited creating a cell line for any kind of immunological or epidemiological purpose (see pp. 216-217); 2) when cells did survive they became transmuted into cancerous cells due to contamination of the original tissue culture, and the contamination implicated the hundreds of HeLa cell cultures now growing in worldwide labs (see pp. 138-139; 152-154).
Diagnosis and treatment (pp. 28-29, 32, 172)
Henrietta was diagnosed on the cusp of important diagnostic breakthroughs in medicine. Until the pap-smear was developed in 1941, for example, only biopsy could diagnose cancer (p. 28). On the other hand, Henrietta’s misdiagnosis as having non-invasive epithelial (the epidermal cell lining of organs) cancer instead of invasive organ cancer delayed appropriate therapy. The accurate diagnosis was made more accurate in 1972 (p.172). The investigative pathway for improved diagnosis was human experimentation, as was the pathway to effective treatment—and medical scientists widely believed at the time that such experimentation was necessary and ought not to require informed consent. This is a good point of discussion.
Henrietta’s cells in research (pp. 93-94, 96, 100, 142) The accounts of polio vaccine propagation, discovery of the actual human chromosome number, and even the hybridization of cell lines are all spinoffs of Henrietta’s contribution, and further raise the question of exploitation without consent.
Throughout history humans have been subjects in scientific experiments. Ron Wetherington created this timeline below to show the history of research involving human subjects.
- 1900: Walter Reed injects 22 Spanish immigrant workers in Cuba with the agent for yellow fever - paying them $100 if they survive and $200 if they contract the disease.
- 1906: Dr. Richard Strong, a professor of tropical medicine at Harvard, experiments with cholera on prisoners in the Philippines killing 13.
- 1913: Pennsylvania House of Representatives recorded that 146 children had been inoculated with syphilis, "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.
- 1915: A doctor in Mississippi, working for the U.S. Public Health Office produces Pellagra in twelve Mississippi inmates in an attempt to discover a cure for the disease
- 1927: Carrie Buck of Charlottesville is legally sterilized against her will at the Virginia Colony Home for the Mentally Infirm.
- 1943 Refrigeration experiment conducted on sixteen mentally disabled patients who were placed in refrigerated cabinets at 30 degrees Fahrenheit, for 120 hours, at University of Cincinnati Hospital., "to study the effect of frigid temperature on mental disorders."
- 1946-1953: Atomic Energy Commission sponsored study conducted at the Femald School in Massachusetts. Residents were fed Quaker Oats breakfast cereal containing radioactive tracers.
- 1946: Patients in VA hospitals are used as guinea pigs for medical experiments. In order to allay suspicions, the order is given to change the word "experiments" to "investigations" or "observations" whenever reporting a medical study performed in one of the nation's veteran's hospitals.
- 1962: Injection of live cancer cells into 22 elderly patients at Jewish Chronic Disease Hospital in Brooklyn. Administration covered up, NYS licensing board placed the principal investigator on probation for one year. Two years later, American Cancer Society elected him Vice President.
- 1966: NIH Office for Protection of Research Subjects ("OPRR") created and issues Policies for the Protection of Human Subjects calling for establishment of independent review bodies later known as Institutional Review Boards.
- 1995: Thirty-four healthy, previously non-aggressive New York City minority children, boys aged 6 to 11 years old, were exposed to fenfluramine in a nontherapeutic experiment at the New York State Psychiatric Institute. The children were exposed to this neurotoxic drug to record their neurochemical response in an effort to prove a speculative theory linking aggression to a biological marker.
About Dr. Ron Wetherington
Professor of Anthropology and Director of SMU's Center for Teaching Excellence
Phone: (214) 768-2927
All around good-guy. Historical artifact of the SMU Campus. Has held every committee chair possible. Likes to dig up dead people in his spare time. Hobbies include wine, cheese, and walnuts. Retired civil war colonel.