Thursday, December 13, 2012

The Dark Ages of scientific ethics

In modern scientific research, a lot of time, efforts and money is used to satisfy ethical requirements. Much of it seems to me pure waste, especially concerning the humane treatment of animals. However, when we feel annoyed by the unreasonable obstacles and neverending paperwork, it helps to remember the dawn of modern science when ethical constraints were nonexistent and realize that today's situation is progress after all.

The best-known example of ethics violation is Edward Jenner's work with smallpox vaccination. I remember how at university, hearing that Jenner deliberately innoculated first his baby son and then another man's child with smallpox in order to prove that they were immune, and was later awarded a life pension, a friend commented that he should have been given life imprisonment instead. Now, for the purpose of this post, I have learned some ghastly details about Jenner's work on his baby. Quoting from Tom Kerns's article Jenner on Trial, part 2:

"In 1789, when Jenner was 40 years old and married only a little more than a year, there was in Gloucestershire an outbreak of swinepox, a disease very like cowpox except that it attacked pigs rather than cows. Jenner decided (just after he had been elected as a Fellow of the Royal Society) to try immunizing his ten month old son, Edward, Jr, and two of his neighbor's servants, by inoculating them with swinepox. He had learned well from his famous teacher, Dr John Hunter, that one will learn more by "trying the experiment" rather than by just speculating about it. So Jenner performed the experiment by making a small scratch on the servants' and the baby's arms with a lancet and then infecting the scratch "with matter from a pustule of the baby's nurse, who had caught the swinepox infection." Eight days later baby Edward took sick and developed sores, but then (as anticipated) later recovered. Some months after that his father attempted to deliberately infect him (and the nurse also) with smallpox itself, not just once, but five times, in order to test the efficacy of the immunization. No smallpox symptoms of any sort ever developed. The porcination - dare we call it - "took." The protection was effective. Then, two years later, Jenner again challenged his son with smallpox, this time, however, with unhappy results.

This time there was a reaction, and a severe one, but not [probably] from the smallpox. The inoculation material turned out to be contaminated - a constant danger that later threatened to undermine Jenner's work altogether. Young Edward contracted a fever and his arm swelled all the way to the armpit. But he quickly recovered, and a year later Jenner inoculated him with smallpox once again. And once more there was no reaction. Apparently, the Swine-pox protected against smallpox.

Unfortunately, however, in the years following these experiments, young Edward "became a sickly child and exhibited signs of mild mental retardation," though there is no direct evidence that these sequelae were related to the inoculation experiments. Young Edward unfortunately died at the age of 21 from tuberculosis. His father's grief was severe."

I think no comment is needed.

Jenner's Wikipedia page gives a little known detail about the later experiment on 8-yr-old James Phipps: Phipps was the son of Jenner's gardener. So we have all reasons to think that Jenner abused his position of employer to press his gardener into surrendering the boy for dangerous experimentation.

Another example of ethics violation (or plain nonexistence) is the story of "closing" the life cycle of pork tapeworm Taenia solium. The quote below is from Hunter's Tropical Medicine (ed. G. T. Strickland), 7th edition (1988), p. 843, chapter 101. Larval cestode infections (by P. B. McGreevy and G. S. Nelson):

"In 1850, Von Siebold suggested that "bladder worms," which were found frequently in animals and occasionally in humans, were the larval stages of adult tapeworms. He confirmed this in 1852 by feeding hydatid cysts to dogs and recovering adult Echinococcus. The most dramatic demonstration of this alteration of generations was provided by Friedrick Kuchenmeister in 1853 when he fed bladder worms from a pig to a convict who was "scheduled to be dispatched from this life to death by the Guillotine." At autopsy, the adult tapeworm Taenia solium was recovered from the intestine."

While the prisoner's fate was hardly much worsened by forcing him to eat tapeworm larvae, my gut feeling is that it is deeply wrong to do this.

Moreover, in the described form, the experiment doesn't prove much. It is quite possible that the poor man had been host of the adult tapeworm all along. To prove anything, you must feed bladder worms to a group of convicts and later to compare their autopsies to those of a control group. In fact, Kuchenmeister's Wikipedia page reports that he did the experiment on a group of convicts on death row, but again, no controls are mentioned.

How do you think, did Kuchenmeister try to obtain any sort of informed consent from his subject(s)?

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