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鈥檚 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鈥�
鈥淭HE UK, like our other allies, thinks we鈥檙e out of our goddamned minds for talking about this kind of thing in public and releasing any kind of classified information at all, ever.鈥�
So says American bioethicist Jonathan Moreno. The topic is his own government鈥檚 past-and distinctly inglorious-record on human experimentation. And he has a point: no other nation has allowed scholars of Moreno鈥檚 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鈥檚 fair to say they won鈥檛 be eager to unlock all of their own files.
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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 鈥渟upersoldier鈥� 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 鈥渁cres of skin鈥� to play with. The prisoners were treated with chemical agents, which, when effective, caused 鈥渟ignificant inflammation and crusting鈥�.
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. 鈥淭hat episode strikes me as the one that really epitomises how wrong things went,鈥� he says. 鈥淗ospitals are supposed to be secure places where you鈥檙e protected.鈥�
The US Army鈥檚 aim in these experiments, according to a 1951 internal memo, was to investigate 鈥渢he utilisation of psychochemical agents both for offensive use and for protection against them鈥�. 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鈥檛 know, according to Moreno, was that the drug wasn鈥檛 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 鈥渟cience club鈥� 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鈥檚 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鈥檚 not the point, he says. The parents weren鈥檛 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 baseball-and a special cereal diet.
鈥淵ou probably wouldn鈥檛 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.鈥�
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: 鈥淥n 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鈥檚 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鈥�-to become the first of eighteen patients to be injected with plutonium.鈥�
Moreno makes it clear that there鈥檚 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鈥檚 attitude so interesting.
You鈥檇 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鈥檛. 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 鈥渋nformed consent鈥�. 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. 鈥淭hat really blew me away because it was taking place during mid-1947 when the Nazi doctors were being tried,鈥� says Moreno. 鈥淚f [the Nuremberg trial] was in nobody else鈥檚 mind, it was in the minds of the AEC administrators.鈥�
But if the US government invented the term 鈥渋nformed consent鈥�, why did so many US Army sponsored researchers choose secrecy and deception? 鈥淭he doctors didn鈥檛 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鈥檛 identify with it because the whole idea of informed consent was anathema to them.鈥�
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鈥檚 view is surprising. Far from condemning such experiments, he suggests democratic governments actually have a duty to carry them out. 鈥淲e 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?鈥� Moreno鈥檚 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. 鈥淵ou can鈥檛 get informed consent from the whole population, so what is the moral equivalent? I guess it鈥檚 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.鈥�
For Moreno, that includes dealing with the threat of so-called genetic weapons-viruses 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鈥檚 the US Army. These days most subjects in military experiments are recruited from the Army鈥檚 own medical units at Fort Detrick in Maryland. 鈥淭hey鈥檙e informed, they have a large amount of identification with the work, they鈥檙e not getting a lot of money-if any. The Army really has learnt, and does a better job of this than academia.鈥� And most drugs companies. 鈥淲hat 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鈥檚 bodies, there would be no market for these drugs.鈥�
According to Moreno, the US military has learnt from its mistakes and the horrible abuses detailed in those boxes of secret documents. It鈥檚 time now for civilian organisations to take the documents to heart. The point for all of us, he says, 鈥渋s that history is not just history鈥�.