In 1966, Dr. Henry K. Beecher published “Ethics and Clinical Research.” His article exposed human experimentation abuses that were ongoing almost 20 years after the Nuremberg Code had been proposed. One example cited involved medical research at a convalescent facility. According to Beecher, an unnamed physician solicited 22 ill patients for an experiment in which live cells were to be injected into their bodies. The patients, however, were never told that the injected cells were cancer.
Dr. Chester Southam and Cancer Research
The doctor responsible for injecting live cancer cells into sick patients was later identified as Chester M. Southam. Dr. Southam's research was not the product of a fringe investigator. Instead, he was a respected researcher at the Memorial Sloan-Kettering Cancer Center in New York.
Southam's cancer experiments were funded by the U.S. Public Health Service as well as the American Cancer Society. His research was considered groundbreaking, and he was admired by well-known scientists around the world. At least 18 separate scientific reports were published in prestigious journals such as Science (125:158–160) and the Bulletin of the New York Academy of Medicine [34(6):416–423].
When volunteers were in short supply, clinical investigators often relied on vulnerable populations to conduct medical research. Southam was no exception, as he had been experimenting on prisoners for years. In 1957, Time magazine published an article about his cancer experiments at Ohio State Penitentiary. The magazine reported that the cancer cells had been grown for years and were carried to the prison in the handbag of one of his associates, Dr. Alice E. Moore.
Cancer Immunology and a New Hypothesis
The specific experiment Beecher criticized was conducted at Jewish Chronic Disease Hospital (JCDH) in Brooklyn, New York. Cancer was then, as it is now, one of the leading causes of death worldwide. Southam believed that the cure for cancer could be found in the human body's immune system.
For almost a decade, Southam had been injecting cancer cells into healthy patients as well as in patients suffering from cancer. In both cases, cancer nodules grew from the cells and then disappeared, but at remarkably different rates. Healthy patients seemed to reject the foreign cancer cells more quickly than cancer patients.
Southam wondered if cancer patients were unable to reject cancer cells because they had cancer, or because their immune systems had been weakened from disease. In order to test his hypothesis, he needed to test volunteers who were ill with a disease other than cancer.
The JCDH Experiment
According to Lerner (2004), Southam first approached a physician named Avir Kagan, who was working at JCDH in 1963. Southam asked Dr. Kagan if he would “participate in an experiment in which live cancer cells [would be] injected into chronically ill patients.” Although Dr. Kagan refused, other physicians on the JCDH staff proved more accommodating.
Southam recruited 22 feeble patients who were suffering from non-cancer diseases. The patients were aged from 43 years to 83 years. The injected cells provided no benefit to the patients, so the research was non-therapeutic.
Southam told the patients that they would be injected with “some cells,” but neglected to mention that the cells were cancer. Langer (1964) quoted part of an interview with Southam, in which he later claimed that he was simply protecting the patients from their own fears. After all, “cancer patients . . . seem to develop a bizarre, defensive reaction against the knowledge they have cancer.”
A Scandal Erupts
When news of the experiment reached the New York press, a scandal erupted. Southam, his fellow researchers, and JCDH were all accused of using National Socialist (Nazi) concentration camp techniques on patients unable to defend themselves. Some of the patients were senile, or could not speak English. One patient was deaf, and all were so weakened from illness that proper informed consent could not have been obtained.
Despite the uproar, Southam remained unrepentant and defended his decision to withhold vital information from his research subjects. Defiant to the end, he denied that he had any obligation to “confront the patients with the word ‘cancer.’”
Ironically, Southam was asked if he would have been willing to inject live cancer cells into himself. He replied that such an act would be “false heroism” on his part: “But, let’s face it, there are relatively few skilled cancer researchers, and it seemed stupid to take even the little risk.”
Dr. Southam Emerges From the Scandal Unscathed
Although three physicians on the JCDH staff resigned in protest, the medical establishment defended the hospital and its researchers. A medical grievance committee convened by JCDH claimed not to have found any breach of conduct and approved Southam’s work after the fact.
In 1966, however, the New York Board of Regents placed Southam on probation for one year because of unethical conduct. After reinstatement, he returned to a successful career in research.
Dr. Southam later became president of the American Association for Cancer Research.
References
Langer E. 1964. Human experimentation: cancer studies at Sloan-Kettering stir public debate on medical ethics. Science. 143:551–553.
Lerner BH. 2004. Sins of omission — cancer research without informed consent. New Engl J Med. 351:628–630.
Moreno J. 1999. Undue Risk: Secret State Experiments on Humans. New York: W.H. Freeman.
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