The Plutonium Files (36 page)

With the expansion in medical research came a new breed of physicians who were interested not in treating patients but in finding cures that would benefit mankind. Original research and frequent publication put physicians and scientists on the fast track to academic advancement.
“Some of my peers were quite immoral or perhaps amoral.
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I realize many would do anything for academic advancement,” recalled William Silver-man, a retired physician who did pediatric research at Columbia University in the 1940s, 1950s, and 1960s.

Silverman was one of the nearly two dozen prominent researchers who was interviewed by the Clinton Advisory Committee on Human Radiation Experiments about the ethos of human experimentation during that era. The physicians, all considered leaders in their field, were drawn from a variety of disciplines, including radiology, infectious diseases, pharmacology, and hematology. Like William Silverman, many of the researchers spoke with a startling frankness about past practices. Leonard Sagan, a doctor who worked for the AEC and the Atomic Bomb Casualty Commission, or the ABCC, the organization set up to monitor the Japanese bombing victims, told committee staffers that getting informed consent often conflicted with a researcher’s professional goals:

Although times were heady and money was plentiful, doctors should have been reminded of their obligations to their patients by medical codes dating back to antiquity, and familiar to them since their days in medical school. Hippocrates, a physician who lived in ancient Greece and is often called the Father of Medicine, is credited with articulating the core principles regarding a doctor’s relationship to patients. The Hippocratic Oath states, “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked nor suggest any such counsel.…”

As clear as it is, the Hippocratic oath pertained only to patients and not experimental subjects, bioethicist Michael Grodin writes, and it wasn’t until 1803 that an English physician named Thomas Percival developed a code specifically directed at experiments in which the subject might not benefit.
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In 1833 William Beaumont, an American physician, developed a more elaborate code of ethics that had as one of its requirements the “voluntary consent” of the subject, Grodin points out.
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By the turn of the century, doctors recognized that the consent of the subject was needed before an experiment could be conducted. The
Journal of the American Medical Association
in 1890 cautioned that even consent “will not protect the physician in performing bizarre operations, or reckless experimentation.”
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In 1908 a woman named Mary E. Schloendorff sued the Society of New York Hospital, claiming that she had not given her consent for an operation in which a fibroid tumor was removed from her stomach. Following the procedure, she developed gangrene in her left arm and several fingers were amputated. Upon appeal, Benjamin Cardoza, who later went on to become a Supreme Court judge, issued his now-famous ruling: “In the case at hand, the wrong complained of is not merely negligence.
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It is trespass. Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault for which he is liable in damages.”

Under general manager Carroll Wilson, the AEC had developed strong guidelines for human experiments. The military branches also had rudimentary principles. The Clinton Advisory Committee located documents showing that by the 1920s the Army had developed guidelines for the use of “volunteers” in medical research.
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The Navy had rules by 1932. The Committee on Medical Research, which funded studies related to the war effort, warned in 1942 that only fully informed volunteers should be used in human experiments.

If these precedents seemed remote in time, the doctors could look to the Nuremberg Code, ten eloquent principles handed down in 1947 at the conclusion of the Nazi doctors’ trial. In his closing argument, James McHaney, the chief prosecutor at Nuremberg, said, “It is the most fundamental tenet of medical ethics and human decency that the subjects volunteer for the experiment after being informed of its nature and hazards.
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This is the clear dividing line between the criminal and what may be non-criminal. If the experimental subjects cannot be said to have volunteered, then the inquiry need proceed no further.”

But many American doctors believed the Nuremberg Code was written for barbarians, not for them. Columbia University’s William Silverman recalled, “The connection between those horrendous acts and our every day investigation was not made for reasons of self interest, to be perfectly frank.
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As I see it now, I’m saddened that we didn’t see the connection, but that’s what was done. We wrapped ourselves in the flag”

The 1940s, 1950s, and 1960s were decades when doctors were treated like gods and patients like children. Adults suffering from fatal diseases often were not told they were dying; children were never told. With few drugs available, doctors consciously tried to increase a patient’s confidence in their medical skills to help bring about a cure. “The model was in religion,” remembered Silverman, “that is, faith in the priest who will speak to God and get the answer.
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We were encouraged to behave like priests. We never told patients everything. On the contrary, we told them as little as possible. Just enough so they would get the general drift of what we were doing. This was conscious. It was a conscious effort to make patients feel they were in the presence of healers.”

Physicians 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. A fuzzy line existed between bona fide treatment and full-blown experimentation, and researchers often slipped over the line, rationalizing that the experiment was harmless, the procedure was no more harmful than some other accepted medical treatment, or the knowledge gained from the experiment would benefit mankind.

Terminally ill patients were perhaps the most vulnerable group of all. Stuart Finch, a physician who specialized in research related to iron metabolism, leukemia, immunology, and radiation effects, told the Clinton Committee, “It’s very easy when you have a dying patient to say, ‘Look, you’re going to die.
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Why don’t you let me try this substance on you?’ I don’t think if they have informed consent or not it makes much difference at that point.”

Women, children, unborn fetuses, minorities, the mentally retarded, schizophrenics, prisoners, alcoholics, and poor people of all ages and ethnic groups were targeted. Several doctors told the Advisory Committee that poor patients often were selected because they were easily intimidated, didn’t ask questions, and belonged to a different social class.
Acknowledged Silverman, “I must also tell you that I am ashamed about the fact that those on the lowest rungs of the social ladder had their rights trampled on much more than those who were on high rungs.”
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“In what way?” asked committee staffer Gail Javitt.

“When doctors’ children or young children of important persons were enrolled in studies, the parents were informed.”

“Because you couldn’t get away with it?”

“Exactly,” he responded. “Most of these clinical experiments were carried out in children whose parents didn’t know what questions to ask.”

“Patients on charity wards?”

“Charity wards, the so-called ward patients.”

Paul Beeson, a renowned physician who specialized in infectious diseases and immunology, said that attitude also prevailed among his colleagues. At Emory University’s Grady Hospital, where Beeson worked from 1942 until 1952, researchers flocked to the emergency room on hot summer nights to study the effects of shock in stabbing and gunshot victims. They biopsied syphilis patients not to cure them but to study the disease, and inserted catheters and needles into organs to study blood flow or the circulation of bacteria. “We were taking care of them and we felt that we had a right to get some return from them, since it wouldn’t be in professional fees and since our taxes were paying their hospital bills,” Beeson told Susan Lederer, a historian and member of the Advisory Committee.
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Sometimes accidents occurred. Beeson told Lederer about an investigator who was studying the effects of potassium, which can stop the heart from beating and is used today to kill prisoners sentenced to die by lethal injection. “One of the fellows in the cardiac section was following the effect of intravenous drip of potassium on the electrocardiogram and the patient died,” Beeson disclosed.
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The admission appeared to startle Lederer, who interviewed Beeson in November of 1994 at the Seattle airport: “I may be phrasing this crudely but I’m struggling to get this right.
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Is it your sense that clinical investigators felt they could do anything they wanted to these patients?” “Pretty much, yes,” responded Beeson, continuing:

The total-body irradiation experiments, such as the wartime studies sponsored by the Met Lab at hospitals in New York, Chicago, and San Francisco, also caused suffering and premature deaths. As for the radioisotope experiments—the so-called tracer studies—many contemporary scientists contend the doses were too small to have caused harm.

But some of the tracer studies delivered whopping doses of radiation to the patients. In Memphis, Tennessee, for example, researchers gave two young African American mothers 100 microcuries of iodine-131 as part of their “routine medical follow-up.”
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Both mothers had four-month-old infants whom they were breast-feeding. The younger mother received another 100 microcuries two months later. A dose of 100 hundred microcuries would have delivered approximately 200 rads to the adult thyroid, or twenty times the amount that the Agency for Toxic Substances in 1997 said could cause thyroid nodules. The two infants would have been subjected to even larger doses because their thyroids were so much smaller.

The Advisory Committee compiled a data base of some 4,000 radiation experiments, including both the radioisotope and TBI studies conducted during the Cold War. But this list does not represent all the studies that were done. The Department of Health and Human Services, for instance, was unable to determine how many experiments the department or its predecessors had sponsored because much of the information was on paper and would have required tens of thousands of hours to retrieve.
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To make matters more complicated, various federal agencies used different criteria in compiling their lists of radiation experiments. Some agencies included experiments in which radioisotopes or external radiation were administered for bona fide medical purposes, even though these studies were not what the Advisory Committe was looking at.

Only fragmentary records exist on the thousands of experiments performed after World War II. But in cases where documents have been retrieved, the evidence indicates overwhelmingly that the radioactive materials were administered without the subjects’ informed consent. The experiments violated the consent rules promulgated by the AEC’s Carroll
Wilson and the blue-ribbon Medical Board of Review. Furthermore, an extraordinary memo that was made public only recently shows that AEC officials were aware of the contradiction. The 1947 memo, which appears to have been written by Albert Holland, the medical director at Oak Ridge and an ally of Shields Warren, laid out the pros and cons of tracer research, “some of which,” he admitted, “is of no immediate therapeutic value to the patient.”
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The pros and cons included: