WITHOUT CONSENT

A review of: Undue Risk: Secret State Experiments on Humans, by Jonathan
Moreno, WH Freeman, UKP15, ISBN 0716731428

If you made it up, nobody would believe you. Years after the Nuremberg
trials revealed the horrors of the Nazi experiments on concentration camp
prisoners, one of the world's biggest liberal democracies was still
carrying out unethical medical experiments on people. The subjects included
soldiers, prisoners and even some civilians. And the science, much of it
involving exposing people to radiation, was done with the full blessing of
the US government. When Bill Clinton created a commission to investigate,
Jonathan Moreno, a bioethicist at the University of Virginia, was put on
the panel and given access to vast numbers of classified documents. In
Undue Risk: Secret State Experiments on Humans, he recounts that
experience. Charles Seife talked to Moreno to find out what he learnt...

WITHOUT CONSENT

"THE UK , like our other allies, thinks we're out of our goddamned minds
for talking about this kind of thing in public and releasing any kind of
classified information at all, ever."

So says American bioethicist Jonathan Moreno. The topic is his own
government's past-and distinctly inglorious--record on human
experimentation. And he has a point: no other nation has allowed scholars
of Moreno's ilk to root through box after box of secret documents looking
for evidence of how scientists, backed by the military, systematically
mistreated human subjects in their studies of the effects of radiation,
chemicals and biological agents. And when other governments get around to
looking at the experiments detailed in those documents, it's fair to say
they won't be eager to unlock all of their own files.

Many boxes contained nothing more than old newspaper clippings. Yet
occasionally, there were documents that told of horrible abuses. Some
examples. In 1949, US scientists wanted to judge their ability to monitor
radioactive plumes. Their solution: deliberately release a cloud of
radioactive iodine into the atmosphere over Washington state. In the 1950s,
US generals wanted to know whether their men would panic in a nuclear
attack. Their solution: parade several hundred thousand US troops in front
of atomic explosions. Or what about the attempts the US Army made in the
1960s to develop a "supersoldier" with skin so tough it acted like a
natural body armour? To perfect the skin-hardening technology, the US Army
needed human subjects, so it turned to a prison in Holmesburg,
Philadelphia. There it found "acres of skin" to play with. The prisoners
were treated with chemical agents, which, when effective, caused
"significant inflammation and crusting".

But for Moreno, one of the worst cases happened in the 1950s when the US
Army persuaded psychiatrists to secretly inject hallucinogenic drugs into
mental patients. "That episode strikes me as the one that really epitomises
how wrong things went," he says. "Hospitals are supposed to be secure
places where you're protected."

The US Army's aim in these experiments, according to a 1951 internal memo,
was to investigate "the utilisation of psychochemical agents both for
offensive use and for protection against them". In other words, they were
looking for mind-control agents. And to this end, they supplied novel
derivatives of mescaline to psychiatrists at Bellevue Hospital in New York.
As Moreno recounts in his book, one of the guinea pigs was Howard Blauer, a
tennis pro admitted to Bellevue with depression in 1952, and who died there
after being given very high doses of a mescaline compound, possibly by
accident. Blauer seems to have known he was being given an experimental
drug. What he, didn't know, according to Moreno, was that the drug wasn't
designed to help his condition.

Of course, freak accidents can blight even meticulously ethical studies.
But what upsets Moreno is the sheer number of studies that failed to meet
the most basic ethical requirement: namely, telling subjects what the
experiment involved and what it was trying to discover before asking them
to enrol. Even the cases where no physical harm was done disturb him.

Few more so than the so-called "science club" studies of the 1940s and
1950s, in which scientists fed radioactive cereal to unsuspecting
youngsters at institutions for troubled adolescents. The experiments were
co-sponsored by the US government's Atomic Energy Commission and the Quaker
Oats company in the US, and carried out by scientists from the prestigious
Massachusetts Institute of Technology. According to Moreno, Quaker Oats
wanted to trace where the iron and other nutrients in their cereals
travelled to in the body, while the AEC wanted to learn more about how
radiation was deposited.

In 1997, Quaker Oats and MIT agreed to pay $1.85 million in compensation
without admitting guilt. Moreno acknowledges that the radiation levels were
too low to do any harm. But that's not the point, he says. The parents
weren't told radiation was involved, or that the research offered no
medical benefits. All they knew was their kids were joining a special club
which would involve outings to watch baseballand a special cereal diet.

"You probably wouldn't give kids at Andover [an expensive boarding school]
breakfast cereal with radioactive tracers in them. There is a real wrong
here. There was a form of discrimination. They were used."

So, unfortunately, were others. Not least the human subjects who were
secretly injected with plutonium by US government researchers in the
1940s--the very experiments that propelled Moreno into the political and
media limelight six years ago.

The Manhattan Project produced a new element, plutonium, which was not only
radioactive but difficult to handle. The US government wanted to know how
it would behave in the human body if it was accidentally ingested. What
happened next, Moreno explains in his book: "On March 24, 1945, a black,
53-year-old cement worker named Ebb Cade had a car accident near Oak Ridge,
Tennessee. Suffering from broken bones in his right arm and both legs, Cade
was taken to the nearby Manhattan Project Hospital. Because Cade's injuries
required several operations to properly set the bones, he was kept in the
hospital for a few weeks. It was long enough, also, for Cade--code-named
'HP [human product] 1'--to become the first of eighteen patients to be
injected with plutonium."

Moreno makes it clear that there's never been any evidence that these
injections caused cancer or other illnesses. The radiation levels were too
low (Cade died eight years later from unrelated causes). Even so, most
people would unreservedly condemn the idea of such research. Which is what
makes Moreno's attitude so interesting.

You'd think that studying such cases for so many years would have turned
him into one of the biggest anti-science and anti-government voices around.
But it hasn't. For Moreno, the offence in these experiments was not that
human subjects were injected with plutonium: given that people were
handling the stuff to make bombs, the US government was right to study
possible adverse effects. No, the offence, says Moreno, was that nobody
asked them first. All but one of the 18 subjects were-like Cade-unaware of
what was happening. And nor can that secretive approach be attributed to
simple ignorance. Quite the opposite.

Among the boxes of declassified documents, Moreno found evidence that US
officials were aware of the need to treat subjects ethically long before
bioethics was born. Take the term "informed consent". Medical ethics books
say that it was coined in 1957 in a legal case. In fact, it appears a
decade earlier in a letter from the general manager of the AEC to a
radiologist who wanted to publish his research from the Manhattan Project
era. The letter remains classified but appears to have forbidden
publication on the grounds that no attempt had been made to obtain informed
consent from the subjects. "That really blew me away because it was taking
place during mid-1947 when the Nazi doctors were being tried," says Moreno.
"If [the Nuremberg trial] was in nobody else's mind, it was in the minds of
the AEC administrators."

But if the US government invented the term "informed consent", why did so
many US Army sponsored researchers choose secrecy and deception? "The
doctors didn't identify with it, because at that time there was a
paternalistic attitude towards people who were your patients or your
research subjects. The military people couldn't identify with it because
the whole idea of informed consent was anathema to them."

Into the early 1970s, the US government continued experimenting on
ill-informed troops and prisoners, as well as unsuspecting civilians. For
some of these experiments, such as the release of harmless bacteria in
airports and subways, the government could never have received informed
consent from each person who would be affected.

Again, however, Moreno's view is surprising. Far from condemning such
experiments, he suggests democratic governments actually have a duty to
carry them out. "We live in a world where small groups that hate the US
enough might be quite interested in creating generalised terror. Is it
politically acceptable for elected officials to decide to do experiments
about how to protect against stuff and in the process perhaps expose some
of us to some risk?" Moreno's answer is yes, but with a big proviso:
governments should find a moral way of carrying out the research.

Even experiments that involve releasing bacteria in subways? Absolutely,
says Moreno. "You can't get informed consent from the whole population, so
what is the moral equivalent? I guess it's letting the public know that
these things may have to be done, and we vote for representatives knowing
they make the decision that these things have to be done."

For Moreno, that includes dealing with the threat of so-called genetic
weaponsviruses or bacteria engineered to harm specific racial groups. Some
believe fears about these hypothetical agents have been overblown, but
Moreno sees them as the biggest reason why governments are going to have to
continue to think imaginatively about how to do human experiments ethically.

And who would Moreno most trust to carry out the research? Ironically, it's
the US Army. These days most subjects in military experiments are recruited
from the Army's own medical units at Fort Detrick in Maryland. "They're
informed, they have a large amount of identification with the work, they're
not getting a lot of money-if any. The Army really has learnt, and does a
better job of this than academia." And most drugs companies. "What
percentage of the funds spent by the American pharmaceutical industry on
research are being spent on research into informed consent? Zero. And yet,
we know that without these people's bodies, there would be no market for
these drugs."

According to Moreno, the US military has learnt from its mistakes and the
horrible abuses detailed in those boxes of secret documents. It's time now
for civilian organisations to take the documents to heart. The point for
all of us, he says, "is that history is not just history".