Organizer's Introduction to the Symposium "Medical Research Ethics at the Millennium: What Have We Learned?"

I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath. . . . I will impart a knowledge of the Art . . . according to the law of medicine. . . . I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. With purity and with holiness I will pass my life and practice my Art. . . . While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this oath, may the reverse by my lot!--Hippocrates

So began the NIH Symposium "Medical Ethics at the Millennium: What Have We Learned?" Most U.S. physicians have taken the oath quoted above, written by our spiritual father Hippocrates. We are convinced that, through the ages, the vast majority of our confreres have taken these words to heart, and we can feel proud of this long tradition of caring. But there have also been some who have dishonored and disgraced this oath.

We gathered at the Clinical Center of the Intramural Research Program of the National Institutes of Health (NIH) on 30 March 1998, to confirm our commitment to do well by our patients at a time when biomedical research advances have created spectacular clinical opportunities as well as difficult ethical dilemmas.

The cover poster for the program (reproduced on the front cover of this issue) was chosen for the relevance of its message to this Symposium. It is an etching showing the great physician and scientist Louis Pasteur looking on as a patient is vaccinated, presumably against rabies. This representation of clinical research emphasizes the importance of the doctor, the scientist, and the patient in this endeavor. We now appreciate that the patient did not have the opportunity to give informed consent for this procedure, a moral quandary in modern terms, but we also know that what we are observing has an ethical weight all of its own: the effort of physicians through time to provide improved treatments for their patients. Thus, we must balance the inherently moral intent of biomedical research against the autonomy and rights of research subjects.

The decision to hold this Symposium was the occurrence of a discussion of how the NIH should handle the Pernkopf textbook of human anatomy, a volume contaminated in many ways by the Holocaust. This subject, discussed in detail in the Symposium, impinges on our responsibility for assuring that NIH investigators keep sight of the historical bases for the strict regulations which currently govern human subjects research. As we began these discussions several years ago, there were moments at which further discussion seemed imperiled. In another age, Dorothy Parker, reviewing what she found to be a vile book, aptly summarized the sentiments of some people at the table discussing the Pernkopf anatomy. Parker declared: "This is not a novel to be tossed aside lightly. It should be thrown with great force." That would be an understandable reaction upon learning that the illustrations in the Pernkopf anatomy were derived from corpses of political prisoners and Jewish concentration camp victims.

But we believe much would have been lost had the discussion come to an end at this point. An open discussion at the NIH of what to do with tainted data of this sort led to the decision to keep the book in a secured place in the library, but replace its space on the open shelf with an essay describing the controversial nature of the...