Blog | Friday, December 6, 2013

The long arm of medical ethics

Skid Row Study
The New York Times ran a fascinating piece about a dusty old medical experiment that was brought back to life recently after one of its perpetrators … err, researchers, decided to come clean to a medical historian after having read the book The Immortal Life of Henrietta Lacks.

The unnamed confessor was a surgical resident in the 1950s under Dr. Perry Hudson, the man in charge of the experiment. Dr. Hudson (a urologist, still alive at age 96, and adamant that he did nothing wrong) had funding from many sources, including the National Institutes of Health.

The experiment involved recruiting “skid row” alcoholics from flop houses in the Bowery, New York City, and offering them “free medical care” for their participation. The researchers made incisions in the subjects’ nether parts and took wedge-shaped biopsies of their prostate glands. Only problem with this was that the men were not given full information about what would happen to them. Their consent was coerced with false promises and not, as we like to say, informed.

The goal of the research was to learn how to diagnose and treat prostate cancer earlier in men, a worthy goal, to be sure, but handled in a very unethical manner.

The test subjects had their rectums perforated. Some got life-threatening infections. A third developed impotence, another third couldn’t control their urine after the biopsies.

Obviously the standards of the time were much different. But we would think that something like this could never happen after Nuremberg (Wait! this was after Nuremberg). How could an American surgeon, so soon after the horrors of the Nazi doctors, use vulnerable men in dubious research, research that wasn’t designed well enough to include a control group?

The Times article assessing this not-too-distant past ends with three paragraphs that are particularly haunting, in light of the Pandora’s Box that is our current state of the art in prostate cancer diagnosis and treatment:

A federal panel of experts recommended in 2011 that men no longer get the P.S.A. blood test to screen for prostate cancer because clinical trials had found that the test’s benefits are uncertain and its risks—treatments that needlessly cause incontinence and impotence—are severe.

But many urologists believe screening saves lives, and the American Urological Association recommends that men consider starting it at age 55.

“Ethical tragedies are difficult to recognize in the present,” [the author] wrote. “Future observers may view the massive evidence-challenged expansion of our screen-and-treat paradigm in prostate cancer in the same way as we now view the Bowery series practices.”

I think we all need to believe that as problematic and thorny as this issue is, men today are more informed than those of previous generations. But we must do a better job of giving the full picture of all the risks of not only treatment, but screening, too.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.