In the early 1900s, when scientific research truly began being a systematic study, the American Medical Association (AMA) set up a list of regulations to follow when dealing with animal experimentation. It made it clear that the animals should not suffer. However, ethical codes were not truly followed until the 1940s when the AMA required consent of the subject and animal testing before human subjects were tested on. The opening of the Rockefeller Institute started of the era of animal testing. Anti-vivisection groups formed to prevent the testing on animals. They stressed that researchers were insensitive when it came to testing on children, when the Tuberculin experiment was being carried out. The Rockefeller Institute was criticized because its founder, John D. Rockefeller, was deemed a robber barron who only started the organization to prolong his own life. This short history shows how researchers put their own agendas before ethics. As with public health, researchers sometimes put the needs of the many before those of the few. Politics and economics comes into play because sometimes, good intentions may be tarnished by the man in question’s past, namely John D. Rockefeller. Pharmaceutical companies still come under fire for tainting medical data and making a drug look like it works better than it really does, just because a successful drug can make billions of dollars in profits, making the lengthy, expensive trials worth it.
What we learned from the Tuskegee Syphilis Experiment had to be how not to conduct clinical trials. Even though ethical guidelines were already in place, there were so many things wrong with how the experiment was conducted, perhaps the biggest being that there was already an effective treatment against Syphilis at the time the experiment began, meaning that the results would just show what would happen if the disease was not stopped. The sample of individuals was not diverse; it targeted poor, black males, who were said to have “strong sexual appetites” (Brandt, 3). The sample was chosen based on stereotypes and not on a scientific basis at all. The participants were not informed properly. They believed they were receiving free treatment but they clearly were not. The physicians also found the subjects more interesting post mortem, waiting for the autopsies more than result while the subjects were alive. Fearing that the hospitals would lose its black patient population if this fact got out, the researchers kept this step in the procedure a secret. It is not clear if even the blacks helping the physicians were aware of this. In the conclusions, the doctors admitted that they had contributed to an early death of the patients. Even after a CDC panel met to discuss the trials, they recommended continuation. All in all, the Tuskegee Syphilis Experiment showed more about race relations at that time than about the disease itself.
In America, the ACTG 076 is “the standard of care for HIV positive women” (Lurie & Wolfe, 853). It reduced the incidence of HIV infection of one in every seven infants born to HIV positive mothers. However, this treatment is too expensive in places like Sub-Saharan Africa. There have been debates about how to best go about researching for a less expensive alternative to reduce perinatal transmission of the virus. In 1994, World Health Organization came up with the statement that placebo controlled trials are the best at determining whether the potential treatment is effective. But the use of a control group in this manner is unethical when a potential treatment method is being proposed. In trying to find a less expensive or less toxic regimen, how can researchers find solutions without compromising their ethical values? The answer may lie in the way the researchers plan their experiment. Instead of using a placebo group as a control, they can compare the standard, administering ACTG 076, with the new trial. This way, transmission can still be prevented and effective data can be compared. Some researchers are defending the use of placebos by saying that the unproven regimens or no treatment is the standard of care in place in that country so administering the placebo is the same as if they received the standard of care. The problem is that this is not based on scientific information but on economics. The government cannot afford to give expensive drugs to their people. The double standard is exposed when the “acceptance of a standard care that does not conform to the standard in the sponsoring country” (Lurie & Wolfe, 855). This means that some researchers get away with placebo driven trials because they are conducting it in another country where treatments are not the standard but they are ethically bound to ensure this does not happen. Those in poor nations are being manipulated into participating in research trials and setting an international standard of ethical research will ensure that this practice will not continue.
The selections covered in this week’s reading raise several questions. Are researchers justified in hiding information from test subjects if their research produces results that may save lives? Should research being conducted in third world countries be held to the same standards of studies being conducted in the US, even though they may have fewer resources than we do?
I agree with Pranitha about this week’s articles and the ethical implications of the experiments covered. I think one interesting fact to point out is that the Tuskegee experiment was mostly kept under wraps while the antivivisectionists and anti-smokers protested loudly against animal/child experimentation and the selling of cigarettes in the United States. Both child experimentation and the sales of cigarettes affected the majority population of the United States and those of a white, middle class while the Tuskegee experiments affected the poorly educated working class of African Americans. It seems that public health is focused around utilitarianism with the “greatest good for the greatest number”. Blacks did not make up the majority of the population and therefore there were no severe protests against their treatment, just the idea that they were sub-human and that their syphilis was different than “white” syphilis. On the other hand, child experimentation and smoking affected a majority of the population and therefore these issues received protest.
In these readings we learn that public health is tied with the needs of the population with the most social power and unfortunately, those with lesser social standing may be taken advantage of. Because they were of a lower social status, the Blacks in the Tuskegee experiment were treated unethically. They were used as “guinea pigs” for the researchers and were not looked at as humans, but rather animals.
Unfortunately, this also leads to another issue of the usage of public health. Should public health be used primarily to research over curing symptoms or vice versa? In the readings about third-world countries, we learn that the United States funded public health programs may be conducting unethical practices in the name of research. The Tuskegee experiments were also created with research in mind first, and a cure as an afterthought. Therefore, I pose a question, what balance is needed between research and curative methods in public health?
Ethics have been a chief concern in scientific experiments and have continued to be in the twenty-first century, especially in experiments involving cognitive psychology. This week’s readings, however, focused moreso on the fallacious mindset of “you have to crack a few eggs to make an omelette.” The problem with the Tusckegee experiments, however, was that eggs weren’t be cracked; humans were. Like Joe explained, there was definitely a dichotomy between the African American subjects and White subjects – the “black syphilis” was different from the “white syphilis” and thereby impacted not only the way the black subjects were treated, but also how the attention their resulting sicknesses and death warranted. Also, as Pranitha cited–in accordance with Brandt’s assessment of black males having “strong sexual appetites”–this stereotype negatively affected how the subjects were treated. Ethics are extremely precarious in scientific experimentation and, in my estimation, require more thought than the scientific inquiry and experiments themselves.
I think this week’s readings brings up another question- just how public is public health? As we see, the Tusckegee Syphilis experiments were very biased as unbiased as those conducting the experiments have tried not to make it seem. Unfortunately, whether consciously or unconsciously, the stereotypes that are attached to certain ethnic, minority and social groups have affected how the clinical trials were to be conducted, who were chosen, how those patients were treated and even if the testing drug was supposed to be effective at all in terms of a potential help to the patients. This leads me to think if those statements that you see on public posters, etc. relating the percentage of a particular gender or background getting a certain disease have come about through the same mindset. Also, Pranitha brings up a great quote that still applies to today’s society, “…acceptance of a standard care that does not conform to the standard in the sponsoring country” (Lurie & Wolfe, 855). No matter the expense, every test subject, human or animal should have the same opportunities at these kinds of drug tests. As Pranitha has stated, a lot of these experiments lacked in diversity, but only diversity could really show how effective the drug is and how it works. It’s common sense; what applies to one can certainly not apply to another. Take out all of these political, social and economical underlying issues and pharmaceutical companies could probably see greater growth in their business and also be ethical when science is the basis, and not your gender, race or economic status.