Blog | Thursday, January 23, 2014

Retrospethics [Updated.]

A few weeks ago I wrote about dubious medical research from the 1950s involving prostate biopsies on skid row alcoholics. The research had been brought back to life by an expose in the New York Times.

In what is arguably becoming a trend, the Wall Street Journal has added to the genre. The Journal’s project is well worth a look, not only because of the first-rate reporting by Michael M. Phillips, but also because the digital presentation of text, photos, and video is arrestingly beautiful (if haunting). In all, some 22 people were involved in creating this project, as the credits at the end reveal.

The series opens with a short video of an archivist (reporter? researcher?) wheeling a box of old records to a library table and unearthing Department of Veterans Affairs memos about the practice of lobotomizing mentally ill soldiers.

The accompanying investigative reports by Phillips center on one still-living lobotomized veteran, Roman Tritz, who underwent “pre-frontal lobotomy” in 1953 at the VA hospital in Tomah, Wisconsin. Tritz, now 90 years old, still receives his medical care at the same facility.

Here’s an excerpt from Part I that well captures the state-of-the-art in psychiatry for ‘shell shocked’ vets at the time. I include it because it mentions several other therapies that seem absurd and unethical to us today (notable exception: electroshock, which is still performed): “During eight years as a patient in the VA hospital in Tomah, Wis., Mr. Tritz underwent 28 rounds of electroshock therapy, a common treatment that sometimes caused convulsions so jarring they broke patients’ bones. Medical records show that Mr. Tritz received another routine VA treatment: insulin-induced temporary comas, which were thought to relieve symptoms.”

“To stimulate patients’ nerves, hospital staff also commonly sprayed veterans with powerful jets of alternating hot and cold water, the archives show. Mr. Tritz received 66 treatments of high-pressure water sprays called the Scotch Douche and Needle Shower, his medical records say.”

When all else failed, there was lobotomy.”

“You couldn’t help but have the feeling that the medical community was impotent at that point,” says Elliot Valenstein, 89, a World War II veteran and psychiatrist who worked at the Topeka, Kan., VA hospital in the early 1950s. He recalls wards full of soldiers haunted by nightmares and flashbacks. The doctors, he says, ‘were prone to try anything.’”

Lobotomy perhaps had its most famous treatment in the book and Oscar-winning film “One Flew Over the Cuckoo’s Nest.” The Journal’s project will add greatly to the historical record of the abandoned practice.

The comments by readers are worth a look, too, and highlight the inherent tensions in such a project: It’s work that’s stunning, haunting, and probably prize-winning. The project raises the level of multi-media digital reporting to a higher level. Many commenters are laudatory, finding great value in the information and artful presentation. But many vociferously criticize the project, accusing Phillips and the Journal of applying modern ethical standards to practices that were medically acceptable at the time. Moreover, the critics question the motivations of the Journal and suggest that Mr. Tritz, who still suffers with paranoia and delusions, has been exploited to sell, er, newspapers.

I believe it’s incumbent upon us to support this type of work. Rediscovering lost history helps us fill in the composite about where we’ve come from and what we value as a society. Collective memory on behalf of those that have suffered also provides catharsis and ties us to our past and our very humanity.

I also think the Journal (and other online publications) have raised the bar in terms of answering the question of how what we used to think of as ‘newspapers’ can more fully realize their digital potential. [Author’s Update: You can click here and hear an interview with Michael Phillips of the WSJ.]

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.