The Abuse of Man: An Illustrated History of Dubious Medical Experimentation (review)

Where to begin with this very unpleasant subject? Physicians have often done harm, sometimes deliberately, to fellow human beings, ignoring all the while their medical oaths and various regulatory codes and guidelines. Most of the time they have gotten away with it, according to Wolfgang Weyers, a German dermatologist, who has written a whistle-blowing, pull-no-punches account of "dubious medical experimentation."

What is most impressive about The Abuse of Man is its breadth. Every well-known episode is matched by a number of lesser-known events, equally problematic. Nazi medical experimentation in concentration camps is paired with the less widely discussed Japanese experimentation during World War II. The shameful forty-year Tuskegee Syphilis Study has been well documented. But less widely known are the hepatitis studies at the Willowbrook State School for the Retarded from 1956 to 1972, and the sometimes risky experimentation carried out using the inmates of the Holmesburg Prison from the 1950s into the 1970s, as documented by Alan M. Hornblum in Acres of Skin (New York: Routledge, 1998). The latter was distinguished by the chief dermatological researcher's quotation that the prison population seemed to him like "an anthropoid colony, mainly healthy, under perfect control conditions. All I saw before me were acres of skin" (p. 426).

Such acreage has been ample and variegated. Besides prisoners, it has included children in orphanages, the mentally ill and retarded, patients under their physicians' care, the mortally ill, medical students and junior assistants, enlisted men in the military, prisoners of war, slaves, African Americans, and other populations that have been considered inferior or subhuman. Weyers provides separate sections on them all. Although physicians have often dubbed the members of some of these groups "volunteers," Weyers argues that there can be no volunteers in the true sense of the word, except perhaps conscientious objectors in wartime who willingly agree to be medical subjects. Potential subjects either have no choice (slaves, military and civilian concentration camp inmates, orphans), fear retaliation, have hopes for positive changes, or are lured by money and other powerful inducements. Even today, as Weyers demonstrates with cases recently covered in the press, truly informed consent that faithfully presents all risks is often not achieved.

Over the past 300 years, researchers have given any number of reasons why experiments on humans need to take place. Above all, there have been the cries that science needs freedom, and that the good of the many will result from the sacrifice of the few. It has also been argued that the same civil rules do not apply to physicians because they are fighting disease. During wartime, it has been said, risky experiments without proper consent are necessary in the fight against the enemy. Weyers does not find these arguments exculpatory. So the issue of when one might legitimately experiment on humans demands further consideration.

As Weyers also points out, there have been historical circumstances that have propelled "dubious" experiments. At the end of the nineteenth century, science was often worshiped, so unethical deeds passed without much notice or care. Weyers speculates that contemporary circumstances might lead to unethical experimentation. The impersonal relationships fostered by modern medicine might make it easier for physicians to be unconcerned about the rights and health of their test subjects. The "publish or perish" atmosphere puts great pressure on researchers to accumulate articles for their curricula vitae. In recent decades, it has become possible for physicians to grow rich from knowledge gained through tests on human beings. Pharmaceutical companies desire human populations on which to test new drugs, with the potential of millions of dollars of profit if a new drug succeeds.

Weyers concentrates a great deal on the Holmesburg Prison experiments and documents a noteworthy personal connection to the event. The founder of Ardor Scribendi and publisher of this book, A. Bernard Ackerman, turns out to have participated as a resident in the Holmesburg experiments and has published an "acknowledgement of error and...