The Exposé

What happens when you ask a clinician about Clara cells, Reiter’s Syndrome or Wegener’s Granulomatosis?

Odds are, you will hear a near emetic response about lung physiology, inflammatory arthritis and necrotizing granulomatous inflammation with pauci-immune vasculitis respectively.

Apart from the medical jargon to make myself sound intelligent to non-clinicians, all 3 are ‘Third Reich eponyms’ with an infamous history. Max Clara’s Leipzig Centre was where all the prisoners executed in Dresden were dropped off for the ‘German Anatomist’. Wegener was an ardent member of the ‘Sturmabteilung’ (Brownshirts of the early Nazi movement). Last but not, in the faintest sense, least, Hans Conrad Julius Reiter, who probably tops them all, with his fatal experimental typhus vaccine study at Buchenwald.

The Nazi’s killed thousands in the name of medical science but, aside from understanding the effects of high altitude and hypothermia, the work of Mengele and others didn’t really add anything substantial to clinical medicine. It did, however, bring about the institution of the Nuremberg Code and the Helsinki Declaration.

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This, sadly,  isn’t the only example of ‘Guinea Pigging’ in Medicine.

Syphilis: The history of Syphilis is one as excruciating and morbid as the disease itself. The Guatemala Syphilis Study was an example of collaboration on a despicable scale with the then Guatemalan president cooperated with the US Government and deliberately infected over 5000 soldiers, prostitutes, prisoners, and psychiatric patients with syphilis and other sexually transmitted diseases. This was done in an attempt to track their untreated natural progression and test different therapeutic agents. The morbid experiment resulted in at least 30 documented deaths.

The Tuskegee Study in 1932 by the U.S. Public Health Service sought to track the natural progression of untreated syphilis in 600 poor, illiterate, male sharecroppers in Alabama. They were told they were receiving free healthcare, meals, and burial insurance but didn’t receive any penicillin. The study continued until 1972! Besides the study subjects, their wives contracted the disease, and many children were born with congenital syphilis. The US administration publicly apologised for both experiments.

Gynaecology: J. Marion Sims is widely acknowledged as the founder of modern surgical gynaecology for his pioneering efforts in the surgical closure of the vesicovaginal fistulas (which remain a major health issue in developing countries). He performed surgeries without anaesthesia on enslaved women, including 30 times in one woman with a particularly ‘difficult’ recurrent fistula. He too has gone down in medical folklore through the Sims’ speculum, Sims’ position, and Sims’ catheter.

The Rest: The list hardly ends there but it would make this blog overtly morbid to include the experiments by the Japanese in WWII, those in Stalin’s Gulags, Statesville Penitentiary’s experiments with Malaria, Vanderbilt’s experiments with radioactive substances in pregnant women, Project 4.1 to study radioactive exposure in the Pacific Islands and other horrors.

Modern Day Atrocities

The “cost” of clinical trials: In the day and age of ‘Evidence-based medicine’ you need a multitude of study subjects but one would imagine, that those unethical days of yonder are behind us. You are gravely mistaken; the strategy remains the same the tactics have changed.

In 2008, the Center for Research on Multinational Corporations released a document highlighting the detrimental effects of unethical clinical trials from the 1990’s and throughout the 2000’s in the developing world. It included clinical trials in Uganda with the anti-transmission drug Nevirapine where women experienced thousands of serious adverse effects resulting in the deaths of 14 women, which, surprise surprise, were unreported.

In 2003, in Hyderabad, 8 test subjects, unaware that they were subjects of a trial, died during the testing of the anti-clotting drug Streptokinase. Between 2005 and 2012, 2,644 deaths linked to unethical clinical trials occurred in India alone. A more recent report in 2019 claimed that since 2005, more than 5,000 people enrolled in clinical trials have lost their lives as a direct result of the study itself. In most developing countries ‘free’ medication/medical care and remunerations are still more profitable than many employment opportunities. The underprivileged bear the brunt of science. Sounds familiar?

The next time you treat a patient with a venereal disease, malaria or even administer a vaccine, think not of Edward Jenner but the naive 8-year boy he experimented on. We may no longer have the likes of Auschwitz and Dachau but the fact remains that we still have a scant few, sworn to the hypocrite-ic oath, looking furtively for their next opportunity.

Rohan D’Souza: About the Author

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