Wednesday, October 13, 2010

What are the lessons of the recent history of biomedicine?

Posted by Nathaniel Comfort on 10/13 at 09:28 PM

Thomas Frieden, head of the CDC, and Francis Collins, head of the NIH, are to be commended for their public confrontation of Susan Reverby’s recent bombshell.

Reverby describes a horrific episode from the golden age of human experimentation in which, from 1946 to 1948, American Public Health Service researchers, led by the distinguished John Cutler, deliberately infected prisoners and mental patients in Guatemala with syphilis, and then treated them. (A link to a preprint of Reverby’s article should be required reading and can be found below.)

Frieden and Collins bravely acknowledge the ethical lapses of their predecessors, paraphrasing Santayana and stating, “To ensure that effective protections against such abuses continue to evolve and improve, it is essential to continue to learn from historical examples.” Yet Frieden and Collins merely conclude, “The 1946-1948 inoculation study should never have happened, and nothing like it should ever happen again.”

Well, amen to that—but where is the lesson, then? How does Reverby’s research help prevent future abuses? Does it buy us more than public mea culpas in JAMA? Is there any greater benefit beyond conscience-cleansing penitence?

Reverby makes no specific policy recommendations in her article, nor is it clear what the policy implications would be. Indeed, she admits that she knew of the Guatemala story when she published Examining Tuskegee, her book on the Tuskegee syphilis study, writing, “These facts so complicate the Tuskegee story that I deliberately omitted the Guatemala studies from my book,…lest they make it too hard to explain that the men in Alabama were not infected.”

The aesthetic of academic history is to examine what we take for granted and to complicate it—to add nuance and complexity. At the same time, one of the principal justifications for the practice of history is to learn from the past. Often, though, there seems to be little moral to a story beyond, “Never again. For real, this time.”

Here are the links to Reverby's article and Frieden and Collins's piece:

Tags: biomedicine, human experimentation, syphilis