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Tuskegee Syphilis Study not Americas only Medical Scandal Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Research Scandal

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Abstract

The words “human medical experimentation” conjure up visions of Nazi medicine, which has come to exemplify the worst evils in the history of humankind. Places like Auschwitz and Dachau, where human life was cheap and test subjects plentiful were used as laboratories. In 2010 the US government apologized to Guatemala for allowing U.S. doctors to infect Guatemalan prisoners and mental patients with syphilis 65 years earlier, while acknowledging dozens of similar experiments in the United States. These included studies that often involved making healthy people sick. such as in the Tuskegee syphilis study. These experiments were often life threating and took place with the direct approval and/or supervision of some of the country’s most prestigious research institutions and some of the leading medical researchers. Among these was the prestigious cancer research center in New York City, Sloan Kettering Hospital and its director of cancer research Chester Southam, MD.
Online Journal of Health Ethics Online Journal of Health Ethics
Volume 16 Issue 2 Article 3
2020
Tuskegee syphilis study not America's only medical scandal: Tuskegee syphilis study not America's only medical scandal:
Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering
research scandal research scandal
Leonard F. Vernon
Shermanm College of Chiropractic
, drvernonchiro@aol.com
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Recommended Citation Recommended Citation
Vernon, L. F. (2020). Tuskegee syphilis study not America's only medical scandal: Chester M.
Southam, MD, Henrietta Lacks, and the Sloan-Kettering research scandal.
Online Journal of
Health Ethics, 16
(2). http://dx.doi.org/10.18785/ojhe.1602.03
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Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Research Scandal
Tuskegee Syphilis Study not Americas only Medical
Scandal Chester M. Southam, MD, Henrietta Lacks, and
the Sloan-Kettering Research Scandal
Leonard F. Vernon, DC, MA
Sherman College of Chiropractic Spartanburg, SC
ABSTRACT
The words “human medical experimentation” conjure up visions of Nazi medicine, which
has come to exemplify the worst evils in the history of humankind. Places like Auschwitz
and Dachau, where human life was cheap and test subjects plentiful were used as
laboratories.
In 2010 the US government apologized to Guatemala for allowing U.S. doctors to infect
Guatemalan prisoners and mental patients with syphilis 65 years earlier, while
acknowledging dozens of similar experiments were performed in the United States.
Among these included studies that often involved making healthy people sick or keeping
sick patients ill, such as in the Tuskegee syphilis study.
These experiments were often life threatening and took place with the direct approval
and/or supervision of some of the country’s most prestigious research institutions and
some of the country’s leading medical researchers. Among these was the prestigious
cancer research center in New York City, Sloan Kettering Hospital and its director of
cancer research Chester Southam, MD.
Can you give someone cancer?
In December 2011, following his diagnosis of
cancer, Venezuelan president Hugo Chavez speculated
that American agents had induced the disease in him
and possibly other South American leaders by injecting
them with cancer cells. Despite the State Department’s
rejecting Chavez’s claims, there nonetheless was no
shortage of CIA conspiracy theorists who accepted the
charge. The media too grabbed onto the story, not only
because of the outlandish nature of the accusation but
also because of the underlying question it raised: Can
you give someone cancer? (Miami New Times, March 7,
2013; Slate, December 30, 2011).
While direct communication of cancer from one
host to another has been documented, and
transplanting cancer cells to another person in an effort
to cause cancer is possible, it is extremely rare. It has
been shown in organ transplant recipients, mother-to-
fetal transmission, and a few rare events such as one
reported in 2015 in the New England Journal of Medicine
where cancer cells from a tapeworm invaded a man’s
body, spreading to his lymph nodes and his lungs.
While ordinarily, the immune system would not allow
this, in this case the man was severely
immunosuppressed due to HIV/AIDS (Muehlenbachs
et al. 2015). Other reported cases include transmission
to a lab worker via a needle stick or a cut on the hand
and one where a surgeon’s laceration developed into a
sarcoma. In these cases, however, while the cancer cells
grew locally at the point of entry, they failed to
progress beyond the site of entry (Welsh, 2011). It is well
established that in normally functioning immune systems
such cells (including cancer cells from another person)
would be recognized as foreign and destroyed before
they have a chance to wreak havoc (Janeway 1993). The
reason we know this today is because decades ago
researchers attempted to do just such a thing: injecting
prison inmates and chronically ill hospitalized patients
with live cancer cells. These experiments, carried out with
little or no informed consent, took place in New York
City, at one of the leading cancer research centers in the
United States, despite the safeguards of the American
healthcare and research ethics systems. While the scandal
garnered headlines at the time (e.g., New York Times,
January 26, 1964),it has since been largely forgotten, as
have the people who unknowingly placed their bodies on
the line to advance scientific knowledge, and it is a story
that deserves retelling.
A brief history of ethics in medical research
While the Nuremberg Code of 1947 is generally
regarded as the first document to set out ethical
regulations for human experimentation based on
informed consent, rules to protect the welfare of people
subjected to medical experimentation were in fact in place
long before this including in Germany. The first detailed
regulation of non- therapeutic research in Wester
Online Journal of Health Ethics
journal home page: https://aquila.usm.edu/ojhe/
ARTICLE INFORMATION
Article history
Received 7 November 2020
Accepted 13 July 2020
Key words:
Cancer
Vaccine
Bioethics
Contagious cancer
Informed consent
Human subjects
Vernon, LF OJHE
Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Research Scandal
https://doi.org/ 10.18785/ojhe.1602.03
medicine came from the Prussian minister for religious,
educational, and medical affairs in 1900, following the
public outcry at the work of Albert Neisser, the
discoverer of the gonococcus (Vollmann and Winau,
1996).
In 1898, Neisser, who was attempting to
develop a syphilis vaccine, published a study that
outlined his results as well as his methods and study
participants. Public debate in the press as well as
among academicians ensued: Neisser had injected
serum from patients with syphilis into patients who
were admitted to hospital for other medical conditions,
none of whom had suffered from syphilis at the time of
the experiment. The controversy rested on two issues:
the first was that most (but not all) of these patients
were prostitutes, while the second was that none of
them had been informed about the experiment or
asked for their consent. After four of the prostitutes
subsequently developed syphilis, it raised the issue of
whether or not it was the injected cells that had in fact
caused their illness, or as Neisser insisted, they had
contracted it separately by pursuing their occupation
(Toellner, 1981).
The majority of physicians aware of the case
supported Neisser; the single exception was Albert
Moll, a Berlin psychiatrist and highly regarded
sexologist (Maehle 2012). While largely unrecognized
in the medical literature, Moll is largely responsible for
the formulation and elaboration of a theoretical
conception of the contractual nature of the patient
doctor relationship and the development of informed
consent, saying,
“I have observed with increasing surprise that some medics,
obsessed by a kind of research mania, have ignored the areas
of law and morality in a most problematic manner. For them,
the freedom of research goes so far that it destroys any
consideration for others. The borderline between human
beings and animals is blurred for them. The unfortunate sick
person who has entrusted herself to their treatment is
shamefully betrayed by them, her trust is betrayed, and the
human being is degraded to a guinea pig….” (Maehle 2009)
Moll would go on to author one of the most
comprehensive books on the subject of medical ethics,
Arztliche Ethik (Medical Ethics) (Katz, 1997).
Following increasing pressure from Moll as well
as the press, the Neisser case came under investigation
by the public prosecutor and the Royal Disciplinary
Court. The court found that although Neisser was a
well-known medical authority and may have been
convinced that the trials were harmless, he should have
sought the patients’ consent; he was fined, and was
lucky not to receive a more stringent punishment,
because two years later, upon further investigation into
the case, government lawyers stated that conducting
non-therapeutic research on a subject without consent
fulfilled the criteria for causing physical injury
(battery) in criminal law (Vollmann and Winau, 1996).
Additional action was taken by the Prussian
Landtag (parliament), which commissioned a detailed
report from the Scientific Medical Office of Health,
which was composed of leading German physicians,
including Rudolf Virchow. The commission stated that
a physician who recognized that injected serum might
cause infection had no right to inject such a serum, but
that in any case both informing the subject and
obtaining the subject’s consent were preconditions to
experimentation. Informed consent became a mandatory
precondition for any non-therapeutic research. Written
documentation and clear responsibility of an institution’s
medical director for all human experimentation became
legal doctrine, and all hospitals, clinics and medical
directors were advised that any medical interventions
other than for diagnosis, healing, and immunization were
excluded under all circumstances if “the human subject
was a minor or not
competent for other reasons” or if the subject had not
given “unambiguous consent” after a “proper
explanation of the possible negative consequences of the
intervention (Goss, 2017). Others took the somewhat
extreme position that purely scientific experimentation on
human subjects was unethical even if they gave voluntary
consent and that self-experimentation should always
precede experiments on patients, noting that the scientific
validity of the experiment did not serve to mitigate these
conditions (Vollmann and Winau, 1996).
Ironically, the other main early attempt to protect a
human research subject’s autonomy would occur in
Hitler’s Germany. In the German Reich’s Rundschreiben
(Reich’s Circular) of 1931 the Reich government issued
detailed guidelines that clearly distinguished between
therapeutic (“new therapy”) and nontherapeutic
(“human experimentation”) research and set out strict
precautions for each. The rules for new therapy were
explicit: “New therapy may be applied only if consent or
proxy consent has been given in a clear and undebatable
manner following appropriate information. New therapy
may be introduced without consent only if it is urgently
required and cannot be postponed because of the need to
save life or prevent severe damage to health….” When it
came to non-therapeutic research there was no wiggle
room; the law clearly stated that “under no circumstances
[is it] permissible without consent” (Sass, 1983).
While it’s thus clear that the basic concept of
informed consent was developed long before the Second
World War and these guidelines remained in place
throughout the reign of Adolf Hitler, they failed to stop
the unethical experiments taking place in Nazi
concentration camps (Caplan, 1991). It would be these
experiments and the subsequent postwar trials of the
physicians involved in them that would lead to the
creation of the Nuremberg Code, a document among
whose 10 principles the longest is on informed consent
(Kumar 2013).
Informed consent
While it is widely believed that the Nuremberg
Code has legal standing, in fact this document has no
legal force behind it (Ghooi, 2011). In the US, legal
informed consent owes its genesis to two landmark legal
cases. Schloendorff vs. The Society of New York Hospital
(1914) established the principle of patient consent and is
considered one of the landmark legal cases in bioethics,
while Salgo v. Leland Stanford etc. Bd. Trustees is
responsible for adding ‘informed’ to the notion of
‘consent.’ A brief review of the Schloendorff case follows.
Mary E. Schloendorff agreed to have her physician
examine her under anesthesia and to have her fibroid
tumor biopsied. Prior to the procedure, Schloendorff
specified that she was not consenting to the removal of
the tumor; nonetheless, while she was anesthetized, the
surgeon, believing the mass was malignant, removed the
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Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Research Scandal
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tumor. Schloendorff then sued the hospital. the course
made its way to the New York Court of Appeals, which
found that the operation to which the plaintiff did not
consent constituted medical battery. Justice Benjamin
Cardozo wrote that in the court’s opinion:
“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.
This is true except in cases of emergency where the patient is
unconscious and where it is necessary to operate before
consent can be obtained.”
Schloendorff, however, received no monetary
gain, since she had sued the hospital and not the
surgeons; the court found that a non-profit hospital
could not be held liable for the actions of its employees
due to the legal principle of charitable immunity.
Justice Cardozo’s opinion is widely cited as the basis
for the requirement to seek consent from patients
before medical intervention is provided, upholding a
patient’s right to autonomous decision-making
(Deverette, 1995).
The second case, the Salgo decision, marks the
birth of the doctrine of informed consent as it is known
today; the term “informed consent” was first used in
this case. In 1957, Martin Salgo, age 55, consented to
undergo a diagnostic procedure to locate the source of
chronic pain in his leg; it was believed he was suffering
from arteriosclerosis and that his aorta was also
involved. He was advised to undergo diagnostic
aortography. While under anesthesia, his aorta was
injected with a contrast medium, and images were
taken of the abdominal aorta. The next morning Salgo
awoke to find that his lower limbs were paralyzed as a
result of the contrast agent used in the procedure. Salgo
subsequently sued his doctor, claiming that he was not
informed about paralysis being a risk or possible
complication of the contrast material. The court noted
that a physician violates his duty to the patient if he
withholds any facts necessary to form the basis of an
intelligent consent by the patient to the proposed
treatment. The court also noted that when discussing
risk, the physician has discretion “consistent with the
full disclosure of facts necessary to an informed
consent.” Salgo’s doctor’s defense argued that if
patients were informed of all the possible
complications, they would become frightened and
would not consent to treatment. The court rejected this
defense and ruled that simple consent was not
sufficient for medical procedures; instead, sufficient
disclosure of possible risks and complications, allowing
“informed consent,” was necessary for patients to
make autonomous decisions, whether regarding a
surgical procedure or a medical experiment (Osman,
2001).
While lacking legal standing, the Nuremberg
Code did form an outline of what are now considered a
physician’s ethical duties, which were codified in a
subsequent document created in 1964 in Helsinki,
known as the Declaration of Helsinki, which addressed
clinical research and humane treatment of study
participants as well as issues such as informed consent.
Like its predecessor, the Declaration of Helsinki has no
legal standing or power (Shuster, 1997), but together
they serve as models for regulators in most countries
and inform the current US federal research regulations,
which require not only the informed consent of the
research subject (with proxy consent sometimes
acceptable, such as for young children) but also prior peer
review of research protocols by a committee (the
institutional review board) (NIH Office for Protection
from Research Risks 1991). With such protections in
place, one might assume that US citizens were protected
against unethical or life-threatening medical
experimentation; unfortunately, as we will see, this was
not the case.
Unclean hands
In jurisprudence, there is a doctrine known as
“unclean hands”—if a defendant can prove that a plaintiff
has “unclean hands,” that is, has acted unethically, then the
plaintiffs complaint will be dismissed (Upcounsel. co m n. d.).
During the doctors trial in Nuremberg, defense attorneys
argued that this doctrine applied, stating that the German
experiments were essentially equivalent to those that had
been and were still being performed in US penitentiaries
(Weindling, 2001). This statement had more than a kernel
of truth to it. While there had been relatively little
medical research into human disease in the US during the
1930s, this would change dramatically in the 1940s, when
for the first time there would be US government funding
for such research (Baader et al. ,2005).
With the outbreak of WWII and the potential for
American involvement in the conflict, there was a push
for governmental involvement in and funding of
academic research. In 1941, President Franklin D.
Roosevelt authorized the establishment of the Office of
Scientific Research and Development (OSRD). From 1941
through 1945, the OSRD’s Committee on Medical
Research would be responsible for developing and
funding projects involving both human and animal
subjects that studied, among other things, disease
transmission and vaccine development. Susan Lederer, a
professor of medical history and bioethics, notes that the
human subjects involved in these studies were primarily
“subjects of convenience”—individuals or populations
conveniently and readily available to researchers, who
included children in orphanages, patients in mental
institutions, military personnel, and those incarcerated in
penal institutions (Lederer 1995). This was an era in
medicine when no one thought it necessary to ask
permission to remove tissue samples from a patient or to
ask permission to use such samples in medical
experiments (Javitt, 2010). One such patient was an
African-American women who, following delivery of her
fifth child by age 30, developed intense vaginal bleeding
and sought care at the Johns Hopkins Hospital, which,
although segregated, was the only hospital in her
hometown of Baltimore that would treat African-
American patients. Hopkins was a charity hospital, as its
benefactor Johns Hopkins, founder of the university and
hospital, stipulated in his will (Johns Hopkins Medicine
n.d.). Although the woman would expire on October 4,
1951, from what would be diagnosed as cervical cancer,
she would nevertheless become immortal.
Henrietta and her HeLa cells
On October 4, 1951, Johns Hopkinstrained
physician and director of the Tissue Culture Laboratory in
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the Hopkins Department of Surgery George Otto Gey
appeared on national television to announce that a
major breakthrough had occurred in cancer research
(Skloot, 2000, Hanks and Bang, 1971). Gey had spent the
majority of his career attempting to develop a method
to grow cells outside the body. The problem was that
cells cultured for laboratory studies survived for only a
few days at most; but if he were able to keep cells alive
“in culture,” this would allow researchers to
experiment on the cells in ways not possible in the
body, thus increasing their knowledge of cell biology,
especially that of cancer cells, and thus potentially
leading to a cure (Gold, 1986:16).
For Gey to accomplish his goal, he would
require a constant supply of cancerous tissue samples.
Luckily for him, he had a readily available supply at
the major medical institution where he worked;
however, these sample were obtained without the
patient’s or their family’s knowledge or permission
(Lucey et al., 2009). One such sample would come from
the 31-year-old African American women, Henrietta
Lacks, who had died earlier on the day of Gay’s
televised announcement.
Gey had earlier observed that Lacks’s cells were
the first he had come across that could be divided
multiple times without dying, and so on the day of her
death, Gey had had Mary Kubicek, his lab assistant,
take additional tissue samples while Lacks’s body lay in
the Johns Hopkins morgue (Gold, 1986:1922). Gey was
able to start a cell line from Lacks’ sample by isolating
one specific cell and repeatedly dividing it, meaning
that the same cell could then be used to conduct many
experiments. They became known as HeLa cells,
because Gey’s standard method for labeling samples
was to use the first two letters of the patient’s first and
last names (Gold, 1986:18). These HeLa cells were in
high demand by other researchers and were put into
mass production. They were mailed to scientists
around the globe, and the cell line would be used to
make many important breakthroughs in biomedical
research. For example, by 1954, Jonas Salk was using
HeLa cells in his research to develop the polio vaccine;
the cells used in the vaccine were mass-produced in the
first- ever cell production factory at the Tuskegee
Institute, in Tuskegee, Alabama, where African-
American scientists not only helped to grow the HeLa
cells but also evaluated Salk’s vaccine (Brown and
Henderson 1983). In a twist of irony, “Black scientists
and technicians, many of them women, used cells from
a black woman to help save the lives of millions of
Americans, most of them white. And they did so on the
same campusand at the very same timethat state
officials were conducting the infamous Tuskegee
syphilis study” (Skloot, 2010:97). What many people
are unaware of, however, is that the HeLa cells were
also participants in one of largest ethical breaches in
cancer research (Prison Legal News, March 15, 2008).
Chester Southam, MD
Chester Southam earned his BS and MS degrees
from the University of Idaho and received his MD
degree from Columbia University in 1947. Following a
one-year internship at New York City’s Presbyterian
Hospital, he began training at Memorial Hospital for
Cancer (the forerunner to Sloan-Kettering Cancer
Hospital), also in New York. Over the next 4 years he
would rise to become a research fellow and eventually
director of the hospitals Division of Virology/Immunology. In
1951, he joined the faculty of Cornell’s medical college,
where he was eventually awarded a full professorship
(New York Times, April 10, 2002).
From 1954 through 1966, Southam would
concentrate his research on two main questions: whether
cancer could be transmitted from person to person and
whether certain virus antibodies had anti-neoplastic
properties. To answer these questions, he would utilize
society’s most vulnerable citizens, including patients
already diagnosed with cancer and undergoing
gynecological surgery at Memorial Sloan-Kettering
Cancer Hospital, incarcerated inmates, and frail,
chronically ill nursing home patients (The BMJ Opinion,
July 3, 2017). It was research that would raise ethical and
moral issues that government regulators would later
compare to those raised by Nazi experimentation (Arras
2008:75).
In 1953, Southam began what appear to have been
his first human experiments to test his theory about virus
antibodies with anti-neoplastic properties. To do this, he
and various colleagues routinely inoculated cancer
patients with dangerous viruses, including West Nile,
Ilheus, and Bunyamwera viruses. A review of their published
work makes the following statement:
“All patients were volunteers who had advanced
neoplastic disease of an extent, type, and stage which
precluded the possibility of therapeutic benefit from
surgery, x-ray, or anti-neoplastic chemotherapeutic
agents.”
The general physical condition of these patients
varied extremely, from apparently well to terminal. There
was a wide range of diagnostic types, including
epidermoid carcinomas, adenocarcinomas, lymphomas
and leukemia and other sarcomas. Blood for antibody
studies was obtained immediately prior to each virus
inoculation and usually at weekly intervals thereafter
during the period of hospitalization, and as frequently as
was practicable after patients had been discharged to
their homes. (Southam and Moore, 1954)
Nowhere in the statement is there any indication of
informed consent having been obtained from the patients;
what is clear is the overreaching attempt to make it
known that these patients were terminal, with the
implication that they were going to die anyway. These
early studies, not unlike Southam’s later ones, would at
times have serious consequences for the patients
involved. An earlier paper authored by Southam noted
some of the negative reactions suffered by some patients:
“…caused mild encephalitis in 3 patients, and in the other
patients caused no symptoms. Bunyamwera virus caused
a very severe encephalitis with residual mental damage in
one patient” (Southam and Moore, 1951).
Sloan-Kettering and cancer immunology
Beginning in February 1954, Southam and his
colleagues initiated their first human experiments in
cancer immunology by injecting 14 previously diagnosed
terminal cancer inpatients at the Memorial Hospital
(which became Sloan-Kettering in 1948) with cancer cells.
While hospital administrators stated that informed
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Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Research Scandal
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consent was given by these patients, it was highly
questionable whether this consent met the standards
for informed consent, both from a legal and an ethical
standpoint. In explaining their consent policy, the
hospital administration said this: “…these patients
knew that they were receiving cancer cells, understood
the reasons for the experimentation, and consented to it
orally” (Langer, 1964). In a paper (Southam et al., 1957)
reporting the results of this experiment the description
of informed consent is somewhat vague: “…All
recipients were volunteers who were aware of the
general purposes of the study and the nature of the
implanted materials and who were agreeable to
subsequent biopsies.” This loose interpterion of
informed consent would continue throughout
Southam’s professional career.
While the results of the study showed that the
transplanted cancer cells did grow in the cancer
patients, producing small nodules that if excised did
not return and if left alone would continue growing for
46 weeks and then spontaneously disappear, this
wasn’t the whole story. Two of the patients died before
the anticipated regression; while they had been
diagnosed as terminal at the time of implanting the
cells, the fact that they died before regression had
occurred meant that one could only assume that these
patients’ nodules were not excised. Nonetheless, their
deaths were attributed to their existing cancer. In four
patients, cancer regrowth occurred at the implantation
site following removal of the nodule, and in one
patient, the implanted cells were found to have
metastasized to the axillary nodes. This patient had been
suffering from uterine adenocarcinoma, which
according to Southam could “readily be distinguished
from the implanted cells,” and at autopsy her
adenocarcinoma was found to be confined to the
abdomen and perineum, confirming that the metastasis
that had occurred was a result of the implanted cells
(Katz et al., 1972:11).
With this information, Southam believed he
could argue that cancer patients lacked immunity to
the cancer cell implants and were in fact suffering from
an immune deficiency to cancer cells; however, to
prove this theory, it would be necessary to demonstrate
that the effects observed with cancer patients did not
also occur in healthy individuals. Of course, being able
to recruit subjects willingly volunteering to be injected
with cancer cells was unlikely, and as a result, in
situations like this, many researchers have used
themselves as their subject; when asked if he ever
considered using himself, Southam replied that “I
would not have hesitated,…if it would have served a
useful purpose. But, he continued, “to me it seemed
like false heroism, like the old question whether the
General should march behind or in front of his troops. I
do not regard myself as indispensable if I were not
doing this work someone else would beand I did not
regard the experiment as dangerous. But, let’s face it,
there are relatively few skilled cancer researchers, and
it seemed stupid to take even the little risk.” While
Southam would later say that this statement regarding
self-injection was misquoted (Katz et al., 1972:49), it was
a moot point, as he would find a ready supply of test
subjects in the state of Ohio.
The prison volunteers
“CANCER RESEARCH VOLUNTEERS NEEDED”
was the headline of a notice posted in the May 19, 1956,
issue of the Ohio Penitentiary News, a weekly newspaper
written and published by prisoners that was distributed
throughout the US for annual subscription fee of $.50. The
notice went on to explain that one of the ongoing issues in
cancer research was why and how individuals without
cancer (can) fight off cancer cells and prevent them from
multiplying. But the explanation went furtherit almost
was made to sound diagnostic in nature, with the
implication in the verbiage that any volunteer who had a
previously undiagnosed or “hidden” cancer would be
able to be diagnosed early and perhaps have a greater
rate of survival. Below is such an example from the
British Medical Journal.
For many years there has existed, one of many
puzzling phenomena in the growth of cancer cells that
still needs an answer; is still unsolved. Live cancer cells
can be transferred from one individual to another. In the
person who has cancer, the cancer cells will live and
grow. In the person who has no cancer in his body, all of
the transferred cells will die, eventually, after a short
period of growth. It is this part of the problem that
requires some further observation and study. Just how
the normal individual who does not have cancer can kill
off the transplanted ‘Foreign’ cancer cells, is the present
important problem. So far, in past experiments, all
attempts at growing one person’s cancer cells in another
individual, who does not have cancer, have ultimately
failed. This is so, definitely, as far as we know now,
that if transplanted cells do not grow, when injected into
another person, it follows, that the injected person does
not have cancer. If the cells do grow, it would indicate
that the person injected probably does have a hidden or
lurking cancerous growth somewhere in his body. (BMJ,
1956)
Researchers may have worried that they would
have difficulty recruiting volunteers, or they may have
honestly believed that the project was so benign that
selection criteria were not neededin any case, those
criteria were almost non-existent. Inmates with history of
TB, syphilis, osteomyelitis, cardiac disease, or
hypertension would all be eligible to participate in the
study. The researchers need not have worried: while the
study called for 25 volunteers, the warden received
applications from 130 of the 3,800 convicts in the
penitentiary. While using prisoners for medical
experimentation was common practice in the US at the
time, most studies offered some form of financial
incentive or a reduction in sentence, whereas in this case
no incentives were offered. Most participants indicated
that their reason for volunteering was that someone in
their family had died of cancer, while others felt that this
would be a way of redeeming themselves in the eyes of
society: they had been “blanks all their lives” and were
glad to have the opportunity to do something useful.
Each inmate was given a release to sign that
indicated that the experiment was being carried out by
the Division of Medical Research, College of Medicine,
The Ohio State University, and the Sloan-Kettering
Institute for Cancer Research, New York City. The release
text ran as follows: “This study, as it has been explained
to me, is intended to determine whether or not
Vernon, LF OJHE
Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Research Scandal
https://doi.org/ 10.18785/ojhe.1602.03
presumedly live cancer cells can be successfully
transplanted, indirectly, from one individual to
another. I have been told that the cancer cells will be
transplanted to my body by means of direct needle
injection under my skin….” The principal investigators
were listed as “Doctors Charles A. Doan, Alice E.
Moore, and Chester M. Southam, or their associates.”
While Southam’s prison inmate experiments
raised ethical concerns, and some of his peers in the
medical community believed that the research had
violated the bioethical principles of informed consent,
non-maleficence, and beneficence, the research would
nonetheless continue for 12 years, eventually involving
over 200 inmates. Sloan- Kettering received between
$300,000 and $500,000 (between $3 million and $5
million in today’s dollars) in federal funds from the
National Cancer Institute and funding from the
American Cancer Society (AP News, August 16, 1985).
With his reputation as a cancer expert, and
emboldened by the backing of prestigious institutions
such as Sloan-Kettering, the American Cancer Society,
and the federal government, Southam would now find
a new research study for his HeLa cells, which he had
injected into the Ohio State Penitentiary inmates
(Skloot, 2010:168). This next project would not go as well
for Southam, however.
The Jewish Hospital for Chronic Diseases
In 1963, with funding from the United States
Department of Public Health and the American Cancer
Society, Southam and colleague Emanuel Mandel
began a study to test Southam’s hypothesis that
chronically ill patients who were not suffering from
cancer would be able to reject implanted cancer cells as
rapidly as patients who were not suffering from any
disease and faster than those who were already
afflicted with cancer. Southam hoped to be able to
demonstrate that the apparent absence of immunity in
the cancer patients was in fact attributable to cancer,
and not simply to the general debility that accompanies
any severe, chronic illness.
While his theory was proven correct and was
recognized as one of the leading research experiments
in the cancer field, there was a problem: how he had
reached that conclusion. When it was revealed, the
press had a field day, with magazines such as Good
Housekeeping blaring vivid and critical headlines like
“How doctors use patients as guinea pigs” (October,
1965:79). Science Magazine put it thus:
“A number of circumstances made the case particularly
newsworthy. The patients in question were 22
seriously ailing and debilitated inhabitants of a
relatively obscure Brooklyn institution, The Jewish
Chronic Disease Hospital(JCDH).
Nazi doctors?
In August 1963, a group of three physicians at
JCDH, Avir Kagan, David Leichter, and Perry Fersko,
expressed their concern about the methods used in
Southam’s research, and the issue was brought to the
Hospitals Medical Grievance Committee for
investigation however, instead of condemning these
practices, the committee found no irregularities and
instead commended the research. The three physicians
resigned in protest and took their concerns to William
Hyman, a hospital board member and an attorney. When
Hyman asked the hospital for the relevant patient
records, he was refused; then, believing that the hospital
board of directors would side with him, he asked for their
support,
but the board instead endorsed the findings of the
grievance committee. This forced Hyman to go through
the courts and the press, with the latter quoting Hyman’s
description of Southam’s experiments as “acts which
belong more properly in Dachau” (Katz, 1972) and
labeling the case “the hottest public debate on medical
ethics since the Nuremberg trials of Nazi physicians”
(Langer, 1964).
On July 7, 1964 in another twist of irony, the
Appellate Division of the State Supreme Court ruled that
a member of a hospital’s board of directors did not have
the right to inspect the medical records of patients, citing
patient physician privacy protection (New York Times, July
7, 1964). This ruling would eventually be overturned by
the New York State Court of Appeals on the grounds that
“[t]he privacy of the patient could be protected, as the
trial court had pointed out, by a simple order requiring
that the patient’s name be concealed (Ratnoff 1966).
Following this ruling, Hyman pressed his case
with New York Attorney General Louis L. Lefkowitz,
who rejected Southam’s assertion that oral consent had
been given, saying that the patients “had not sufficient
mental or physical ability to comprehend what was being
told to them or what was being done to them,” and that
those patients with such capacity had been misled.
Lefkowitz’ who was outraged, saying “every
human being has an inalienable right to determine what
shall be done with his own body,” and sought to revoke
Southam’s license to practice medicine (Katz 1972).
Following a lengthy hearing, the New York State
Board of Regents said that the “[z]eal for research must not
be carried to the point where it violates the basic rights
and immunities of a human person,” and found both
Southam and Mandel guilty of “fraud or deceit” and
unprofessional conduct, voting to suspend their licenses.
However, this was later changed to a period of probation,
Mand the disciplinary action had little if any effect on
Southam’s professional career, as he eventually published
the results of his study from the JCDH in the Annals of the
New York Academy of Sciences, where no mention was made
of the lack of informed consent.
In 1968, Southam was elected president of the
American Association for Cancer Research. He died in
2002.
While the 1966 expose on the shortcomings of
patient consent procedures penned by Harvard professor
Henry Beecher (1966) in the New England Journal of
Medicine cited the Southam case, it would take more than
a decade until the post-Tuskegee outcry propelled the
formation of the National Commission for the Protection
of Human Subjects of Biomedical and Behavioral
Research, the publication of the commission’s Belmont
Report, and,
ultimately, the proliferation of institutional review boards
to monitor experimentation.
Conclusion
One might wish to believe that unethical medical
experimentation on human subjects is a thing of the past
Vernon, LF OJHE
Chester M. Southam, MD, Henrietta Lacks, and the Sloan-Kettering Research Scandal
https://doi.org/ 10.18785/ojhe.1602.03
and that today’s modern medicine still hides its
collective head in shame for its ethical stumbles in the
mid20th century, unfortunately this is not the case.
While stricter enforcement of rules and the
introduction of IRBs have had a dramatic effect on
unethical practice in the United States, this cannot be
said of other some countries, where US-based
companies and research organizations continue to
exploit the absence of adequate laws to protect human
subjects. While these issues are beyond the scope of
this paper, it is important to understand that they do
continue.
A 2008 report published by the Center for
Research on Multinational Corporations revealed
details of many such unethical trials, carried out in
India, Nigeria, Russia, Argentina, and Nepal, among
others. It revealed, for instance, the unrecorded deaths
of 14 women in Uganda during a trial of the anti-HIV
transmission drug Nevirapine, in a study sponsored by
Boehringer Ingelheim and the US National Institutes of
Health (NIH). It also revealed that eight patients in
Hyderabad, in India, had died during a trial of the anti-
clotting drug streptokinaseand that none of them
were aware that they were part of an experiment
(Somo.nl, n.d.) Even at Sloan-Kettering, almost 60 years
after Southam’s research, the institute would again
make headlines when, in December 2018, a report in
the New York Times disclosed that the hospital’s chief
medical officer, José Baselga, failed to disclose
corporate ties in dozens of scientific articles he
authored.
In fact, Baselga received millions of dollars in
payments from companies involved in medical
research, potentially compromising the work (New York
Times, September 8,2018)
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In When Medicine Went Mad, one of the nation's leading bioethicists-and an extraordinary panel of experts and concentration camp survivors-examine problems first raised by Nazi medical experimentation that remain difficult and relevant even today. The importance of these issues to contemporary bioethical disputes-particularly in the thorny areas of medical genetics, human experimentation, and euthanasia-are explored in detail and with sensitivity.
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One of the remarkable features of medical ethics in Imperial Germany was its ambiguous and sometimes openly controversial relationship with the law. An area where a conflict between doctors’ and lawyers’ differing conceptions of the therapeutic relationship was played out was the issue of patient consent to medical interventions, in particular to surgical operations. This chapter traces the debate on this issue from its beginnings in the early 1890s to the First World War. As I will show, the traditional paternalism of physicians and surgeons was challenged in court decisions, which forced them to adopt practices of consent-seeking and to consider the appropriate amount of patient information before treatment. However, in spite of those new requirements, doctors kept a paternalistic attitude.