Undue Risk by Jonathan D.; Moreno

Author:Jonathan D.; Moreno [Moreno, Jonathan D.;]
Language: eng
Format: mobi
Publisher: Taylor and Francis
Published: 0101-01-01T00:00:00+00:00

LEARNING FROM FAILURE

These were only a few of the studies that should have qualified for coverage under the Pentagon's Nuremberg Code-based policy but seemed to escape its requirements. Anna Rosenberg's written-consent rule prevailed within the civilian hierarchy of the Department of Defense but had little traction within the military-medical culture. Even her considerable political skills only went so far. Had Secretary Wilson's policy been more efficiently dispersed, it would have had an excellent chance of gaining more influence, because it represented a direct order from the highest official in the defense establishment. But its original top-secret status and the ambiguities about its range of application crippled it from the beginning.

Here is a lesson from Bureaucracy 101: Policies are one thing, practices another. The whole issue of the use of human beings in important scientific experiments is complex enough. Add to that national needs in a patriotic era, medical scientists who believe in their work and their own integrity, and an officer corps uncertain about the meaning and scope of an order in an unfamiliar field, and you have a recipe for failure. The folks in the field did not identify with and embrace the approach settled upon by the Pentagon leadership, if they even knew about it. As the Army's 1975 investigation pointed out, the problems that dogged the Wilson rules exemplify “the extreme difficulty of attempting to implement a complex policy by means of a relatively simple, but highly classified directive.”

Another problem with the Wilson policy was that it answered only part of the human experiments dilemma. It was clear that there had to be subject consent but vague about how much risk people could be asked to accept in the name of national security research. Declassified files of the Army Chemical Corps from 1955 and 1956 show that the corps wrestled with this problem. Like the earlier discussions about medical ethics in the Pentagon, this one was also motivated by a need to do research. At a 1955 meeting the corps' advisory board issued a recommendation: “Tests on human subjects with biological agents be given a high priority.” The immediate concern was the need for improved protection against aerosolized microbes.

The recommendation evidently provoked another internal debate, this time in the Chemical Corps. About a year later, A. R. T. Denues, a physician at Sloan-Kettering Cancer Center in New York City and a lieutenant colonel, was asked a pointed question by the chief of the Chemical Corps' research division: “How can we develop and standardize BW and CW agents when higher authority requires human dose-response data [information about what reactions are created at various exposure levels], yet these agents are considered by medical authorities to be too dangerous for human experimentation?” The familiar ethical paradox of doing important human experiments in new scientific territory was transparent.

Denues supplied a short, five-page response that essentially begged the question. “With only general background to draw on,” he wrote, “an off-hand response to this implied impasse would simply be that one cannot do

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