1. Human Subject Experimentation
Doctors Gone Bad
Human Subject Experimentation
(1915 – the present)
Torturers
Murderers
and
Despots
Martin Donohoe

2. “When a doctor [goes] wrong, he is the first of criminals
“When a doctor [goes] wrong, he is the first of criminals. He has nerve and he has knowledge.”
- Sherlock Holmes to Dr. Watson, Arthur Conan Doyle

3. Armenian Genocide ( )
Dr Mehmet Resid (Ottoman middle manager, started Butchers’ Brigade)
“Those Armenian bandits were a bunch of harmful microbes pestering the body of this nation. A doctor’s duty is to kill microbes…”

4. Nazi Medicine Guiding philosophy = Hegelian (rational utility)
Parallels in Social Darwinism, American and British eugenics movements
Ethics reduced morality to efficiency, economics, and aesthetics

5. Nazi Medicine An arm of state policy Focus on racial purity
Individual worth stated in economic terms
Focus on racial purity
eugenic sterilization (370,000)
Note 70,000 victims in 20th Century U.S. sterilization programs
involuntary euthanasia (70,000)
large-scale genocide (over 6 million)

6. Nazi Medicine
Doctoring the nation more important than doctoring individuals
Focus on preventive medicine and public health: anti-tobacco and anti-alcohol campaigns, environmental toxins, organic farming
to improve Aryan stock

7. Nazi Physicians 52,000 physicians National Socialist Party Members
Complicit physicians salaries rose, academic perks
Jewish physicians ostracized/killed/committed suicide; replaced by young Aryans

8. Nazi “Physician-Researchers” (Torturers)
Dr. Sigmund Rascher - coagulation/amputation studies; hypothermia experiments
Dr. Karl Gebhart: heteroplastic (inter-species) transplantation experiments
Drs. Karl Clausberg and Viktor Brack: X-irradiation/sterilization
Drs. Joachim Mrugowsky, Erwin Ding-Schuler, and Waldemar Hoven: IV phenol and gasoline executions

9. Nazi “Physician-Researchers” (Torturers)
Dr. Friedrich Wegener (formerly “Wegener’s Granulomatosis,” now granulomatosis with polyangiitis): German pathologist, Nazi party member, autopsied a prisoner with oxygen injected into his bloodstream in an embolism study; may have participated in experiments on concentration camp inmates

10. Nazi “Physician-Researchers” (Torturers)
Dr Hans Conrad Reiter (formerly “Reiter’s Syndrome”, now “reactive arthritis”): senior Nazi official
Dr. Hans Eppinger – water deprivation experiments, “father of modern hepatology”
Dr. Joseph Mengele: Septicemia/twin vivisection studies

11. “Indirect Participants”
Prof. J Hallevorden: “If you are going to kill all these people at least take the brains out so that the material could be utilized … the more (brains) the better….I accepted these brains of course. Where they came from and how they came to me was really none of my business.”

12. Doctors and Resistance
Pockets of resistance: Catholics, Marxists, Dutch
Drs Eugene Lazowski and Stanislaw Matulewicz created a fake typhus epidemic during the German invasion of Poland (1939)
Germans fooled, quarantined area, many Jews escaped death

13. Consequences for Physicians
Nuremberg Doctors’ Trials: 23 German physicians tried; 16 found guilty
7 hanged (incl. Gebhardt, Brack, Hoven, and Mrugowsky)
Hallevorden committed suicide before trial
Rascher died before trial
Mengele fled for Argentina (remains verified 1985)

14. Changes in Research Subject Protections
Nuremberg Code
Declaration of Geneva
Common Rule
Others

15. Japanese Abuses in WW II
Extensive biological and chemical weapons program involving prisoners of war
Over 10,000 doctors and researchers involved (led by Shiro Ishii, Chief Medical Officer of the Imperial Japanese Army)

16. Japanese Abuses in WW II
“Experiments:”
Deliberate infections with plague, cholera, typhoid, anthrax, and TB
Testing of drugs and vaccines not previously tested in animals
Surgeries (for training purposes) without anesthesia, followed by vivisection/death
Detonation of bombs, followed by vivisections
Number of victims unclear, likely in six figure range
Subjects referred to as maruta (“logs”)

17. Japanese Abuses in WW II
Many participants later achieved positions of prominence in Japanese medical schools and societies
E.g., Tokyo Prefectural University, Olympic Committee, Green Cross, Japanese NIH, and private sector companies

18. Japanese Abuses in WW II
U.S. government made secret deal with Ishii and top collaborators - 250,000 yen and immunity from prosecution in exchange for exclusive access to data
Japanese scientists brought to Fort Detrick, MD, to help establish U.S. biological/chemical weapons program
Ishii variously reported in US, South Korea, and Japan; later worked at free clinic for children; converted to Catholicism 1 yr before death from throat cancer

19. U.S. Abuses in WW II
Classified tests exposing tens of thousands of soldiers and Japanese internment camp victims to mustard gas
Veterans sworn to secrecy
Veil of secrecy lifted in 1990s, but VA only contacted 620 vets between then and late 2000s; many denied care
Investigation led to law requiring VA to re-examine all claims

20. US Abuses in WW II US Studies on prisoners in WW II: Gonorrhea
Gas gangrene
Dengue fever
Malaria

21. Post-WW II
Science Council of Japan (equivalent to US NAS) vows that Japan “will never pursue scientific research for the purpose of war” (1950)
German Medical Association apologizes for its role in the Holocaust (2012)

22. Post-WW II Human Subject Experimentation
Tuskegee Syphilis Study
“The men’s status did not warrant ethical debate. They were subjects, not patients; clinical material, not sick people.”
Dr John Heller, Director of Venereal Diseases at PHS between 1943 and 1948 (interviewed in 1976)

23. Post-WW II Human Subject Experimentation
Guatemala STD study (1946-8)
“Unless the law winks occasionally, you have no progress in medicine”
Dr. John Cutler (research coordinator)
In 1943, Cutler infected volunteer federal prisoners in Indiana with gonorrhea in exchange for cash
After Guatemala, Cutler oversaw the Tuskegee Syphilis Study
Acting dean at University of Pittsburgh in 1960s

24. Post-WW II Human Subject Experimentation
U.S. govt.-sponsored radiation experiments (e.g., Strong Memorial Hospital/University of Rochester (NY), Dr Wright Langham)
LSD/sensory-deprivation/electroshock investigations (CIA - MK Ultra)
Dr James Ketchum (psychiatrist) – psychochemical warfare studies for US Army
Ketchum later joined faculty of University of Texas Medical School

25. Post-WW II Human Subject Experimentation
Pentagon/CIA experiments on soldiers and civilians
Edgewood Arsenal Experiments (involving more than 7,000 soldiers who were exposed to at least 250 biological and chemical agents)
Including sarin, VX, LSD, ritalin
Caused long-term health effects

26. Post-WW II Human Subject Experimentation
1963: Dr. Chester Southam injects tumor cells into extremely infirm patients at Jewish Hospital for Chronic Disease in NY without informing them that the shots contain cancer cells
Southam later elected President of American Association for Cancer Research

27. Post-WW II Human Subject Experimentation
Willowbrook Hepatitis Experiments (1960s)
Henry Beecher, NEJM (1966) – documented numerous published studies involving ethical breeches (e.g., non-treatment of strep-infected patients, manipulations under anesthesia, deliberate injection of cancer cells into healthy patients)
Unmasking of researchers in 1991 attracted little public attention

28. Post-WW II Human Subject Experimentation
Human Guinea Pigs, by Dr. Maurice Pappworth, published 1967, documents unethical UK experiments
Cardiac catheterization of “mentally-deficient” babies deprived of oxygen to measure physiological responses
Insulin withheld from over 40 children and adult diabetics, followed by liver and kidney biopsies

29. Post-WW II Human Subject Experimentation
Human Guinea Pigs
Unsuspecting individuals injected with malaria parasites, meningitis bacteria, and live cancer cells
Insertion of needles into aortas of peptic ulcer disease patients, who were told it was a “treatment”
Students and junior doctors coerced into finding “subjects”

30. Research on Prisoners
Very common historically (infectious diseases, radiation, pharmaceuticals, illicit drugs)
1905: Cholera experiments on “volunteers”
1915: Joseph Goldberger – pellagra
Deadliest dietary disease in U.S. history
Prisoners volunteered in exchange for pardons
1941: William Black infects children with herpes virus

31. Research on Prisoners
Pharmaceutical and government sponsored studies on prisoners
>90% of pharmaceutical industry research through early 1970s
Rapidly curtailed by state/federal laws and new university regulations in mid-1970s after drug company executives admitted prisoners were cheaper to use than chimpanzees

32. Contemporary Experiments/Abuses
Unethical use of placebo controls
Anti-HIV medications and maternal-fetal transmission(sub-Saharan Africa)
Surfactant for neonatal RDS (Brazil, Bolivia)
Trojan/meningitis/Nigeria (control = inadequate ceftriaxone dose)

33. Contemporary Experiments/Abuses
Chinese organ transplants from extrajudicially-executed enemies of the state (e.g., Falun Gong, Uighurs)
African volunteers paid 69 cents/hr to allow themselves to be bitten by mosquitoes, risking malaria, in trial of genetically-modified mosquitoes (funded in part by Gates Foundation)

34. Contemporary Issues and Ethical Dilemmas
Large majority of phase 3 US drug company trial sites outside US, many in developing countries
Uninsured become research subjects to receive needed care
Human guinea pigs (professional lab rats)

35. Contemporary Issues and Ethical Problems
Only 40% of US citizens have a positive overall impression of clinical trials (2016)
Only 4% of cancer patients enroll in clinical trials each year (2016)
Physician-industry links, proprietary nature of data may deter altruistic volunteers, lead to secrecy, selective or even non-publication

36. Contemporary Issues and Ethical Dilemmas
Under-representation of women and minorities in clinical trials
Racial minorities often wary of participation in medical experiments
Most clinical trial participants never informed of trial results
Research Fraud – rare, but damaging to research enterprise

37. Doctors as Terrorists
Pediatrician George Habash – founder of Popular Front for the Liberation of Palestine
Behind aircraft hijackings of Black September (1970)
Dr. Fathi Shiqaqi – founder of Palestinian Islamic Jihad (1981)
Ikuo Hayashi – chief of circulatory medicine at a leading Japanese hospital
Pleaded guilty to planting sarin gas on Tokyo subway (1995)

38. Doctors as Terrorists
Dr Bilal Abdullah convicted in bungled Heathrow Airport car bombing (2007)
Psychiatrist Major Nidal Hasan – awaiting trial for Fort Hood shootings (2009)
Humam Khalil Abu-Mulal al-Balawi: Jordanian suicide bomber, killed 7 CIA agents in Afghanistan (2009)

39. Doctors as Murderers
Radovan Karadzic (psychiatrist) – former leader of Bosnian Serbs - convicted by International Criminal Tribunal for war crimes against Bosnian Croats and Muslims (2016)
Ayman Al-Zawahiri – leader of Al Qaeda
Bashar al Assad (Syrian President, ophthalmologist) –bombings of civilians and hospitals, use of sarin nerve gas, has killed hundreds of thousands of Syrians

40. Doctors as Murderers, Serial Killers
H. H. Holmes, - "the torture doctor,"
Linda Burfield Hazzard - "the starvation doctor“
GP Harold Shipman (British) – world’s most notorious serial killer ( victims)
Michael Swanger (American - 60 victims)
Harry Bailey (Australian - 75 victims)

41. Physician Criminals Violent crimes, including rapes of patients
Performance of unnecessary, dangerous procedures
Illegal opioid distribution
Medicare fraud, kickback scams
Ethical violations through participation in executions

42. Doctors as Racists Long history
Common slave era diagnosis = drapetomania
The tendency to run away
Controversy over statue of J Marion Sims (father of modern Ob/Gyn) in NYC

43. Doctors and the Death Penalty
Electric chair - invented by dentist Alfred Southwick
Lethal injection - developed by anesthesiologist Stanley Deutsch
Death cocktail (3 drug regimen) developed by pathologist Jay Chapman

44. Physician participation in “War on Terror”
Design torture methods that do not leave physical evidence
Monitor health of detainees to prolong interrogations
Falsify medical records and death certificates
Carry out torture
Between 1975 and 2015, 85 doctors in 16 countries were punished for abetting torture or war crimes; hundreds more unpunished (See )
AMA, AAP, APA oppose physician involvement in interrogation/torture

45. Preventing/Stopping Bad Doctors
Early identification
Education
Treatment/remediation
Criminal Justice System

46. The role of the doctor in society
World Health Organization:
“The role of the physician … in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”

47. Public Health and Social Justice Website
Contact Information
Public Health and Social Justice Website