by Sylvia Baedorf Kassis, MPH
We often think of our current ethical framework as having been born out of the atrocities of World War II Nazi experimentation, the subsequent Nuremberg trials, and the resulting Nuremberg Code of 1947. Did you know, however, that some principles for the ethical conduct of research date back to the 1800s?
This fact was discussed at a recent lecture I attended titled, “Deadly Medicine in the Nazi Era: What Turned Physician Healers into Killers?” In examining the issue of how scientists, physicians, public health professionals, and academics legitimized the Nazis’ murderous program of racial hygiene , Matthew Wynia, MD, MPH, debunked as a fallacy the notion that modern ethical codes of medical research originated in Nuremberg.
In a related article, Wynia and his co-author note that the world’s first legislated code of conduct for medical research came about in Prussia in the 1890s as a result of public outcry against an experiment in which prostitutes and orphans were intentionally infected with syphilis in order to test new treatments. In the early twentieth century, Germany went on to adopt national regulations for physicians that called for “unambiguous” consent from research participants. This set of regulations remained in place throughout the Nazi era. Furthermore, German concerns about the ethics of research even extended to animals, as evidenced by a 1933 ban on vivisection of laboratory animals on the grounds that it was unethical.
Given that ethical codes clearly existed, how did so many professionals not just accept, but support, the Nazi agenda? And, are there any lessons to be learned today?
I can’t count how many times I’ve heard a researcher say, “times have changed,” or “we would never do that now,” referring to some egregious violation from the past. And while it may be true that there are now international standards of conduct and research oversight bodies , ethical codes must consistently be taught and discussed as living, relevant documents that require supportive policies and social structures to buttress the standards they set.
Our responsibility, as champions of ethical research, is to make the past relevant by encouraging researchers to recognize that the people who committed some of the worst crimes against humanity were in fact professionals who were internationally respected and scientifically innovative. If laws were so easily ignored in the early part of the last century, couldn’t they be ignored again? Consider the role that medical professionals have played in the US government’s illegal medical experimentation on detainees in its custody post 9/11 .
If you are interested in learning more about medicine under the Nazi regime and will be in Boston this spring, consider attending the exhibition “Deadly Medicine: Creating the Master Race ” produced by the United States Holocaust Memorial Museum (USHMM).
PRIM&R is pleased to be partnering with the USHMM to offer PRIM&R members a complimentary private tour of the “Deadly Medicine: Creating the Master Race” exhibition, a lecture by Dr. Michael Grodin, and a reception in Boston, MA, on Wednesday, May 18 . To learn more about this event or to register, please visit PRIM&R's website.
Tracing the roots of research ethicsTags:
by Sylvia Baedorf Kassis, MPH
Years ago – what year was it Joan – the theme of the PRIM&R conference centered on this very topic. We went to an exhibit on how the physicians could have crossed so many ethical borders. The lectures were fascinating as was the information on the governmental social policies that led doctors to do what they ordinarily would not.
I think about this as I think about the complexity of the links between our social health policies and our medical choices. Is there any way to avoid ethical conflict as we try to get universal health care without having the government make medical decisions? Choice: is that a medical or political statement?
All I know is that the need to be ethically vigilant is never-ending. No audit process will ever be able to protect us if we stop thinking.
A couple of years ago at PRIM&R following a "great debate" with Berie Lo and ??? there was an excellent question from the audience.
The woman simply asked what research are we now doing that in 50 years people will look back on as being completely unethical?
None of the men at the podium, which included Bernie, Bob Levine, and another (Glantz?) had a good answer.