Experimentation on Vulnerable Populations

Using the Mentally Ill, Orphans, and Prisoners as Research Subjects

Sep 8, 2009

Prior to the adoption of the Nuremberg Code, most human experimentation was performed on vulnerable people who were least likely to give voluntary consent for research.

Until the end of World War II, most medical research and human experimentation was performed on people least likely to give their willing consent. Such people are said to be vulnerable. In bioethics, a vulnerable population is defined as one that is easily exploited, powerless, or naturally oppressed. Before laws and codes (such as the Nuremberg Code) were set in place to set limits on human experimentation, scientists often used vulnerable populations as research subjects. Vulnerable populations included immigrants, along with the mentally ill, orphans, and prisoners.

In 1895, a New York pediatrician named Henry Heiman injected gonorrhea into two children as well as a 26-year-old man. The children were aged 4 years and 16 years, and acknowledged by Dr. Heiman to be “suffering from idiocy.” The young man was dying of tuberculosis (TB).

Inasmuch as the two children were unable to give proper consent, it is unknown how permission was obtained. Dr. Heiman (1895) never discussed this issue in his paper. Rather than expressing doubt about the methods used on the mentally ill (or the man dying from TB), the experiment was praised. Indeed, two of the doctors who listened to Dr. Heiman’s summary presentation before the New York Academy of Medicine on May 16, 1895, were effusive in their praise for his “painstaking work.”

In 1913, the Pennsylvania House of Representatives discovered that 146 healthy orphan children had been inoculated with syphilis without their consent. An additional 15 children living in St. Vincent’s House in Philadelphia underwent involuntary TB tests in their eyes. Several of those children suffered permanent blindness as a result of the experiment.

Neither series of tests could be considered to have been performed for therapeutic reasons, as the children were healthy. Instead, the experiments were conducted purely as an act of administrative convenience. The children were available for testing by virtue of their status as institutionalized wards of the State, with consent for testing given by the orphanage administrators.

Despite public outcry, the medical profession defended the research by claiming that orphan children simply were being given an opportunity “to make a large return to the community for the care devoted to them.” In this sense, orphans donated their bodies to science in return for being housed, fed, and clothed by society.

Prison populations also were viewed as convenient sources for unwilling volunteers. Due to the nature of confinement, individual consent was not needed so long as the warden of the penitentiary gave permission on the prisoner’s behalf. According to Mellanby (1945), one American scientist justified using prisoners in research because “Criminals in our penitentiaries [were] . . . much cheaper [to use] than chimpanzees.”

In 1944, some 400 prisoners at Illinois’ Stateville Prison were solicited to help the ‘war effort’ without ever being told the exact nature of their participation. In fact, the experiment involved being injected with malaria, which had no reliable treatment then. One of the prisoners at Stateville who participated in the malaria experiment was Nathan Leopold (the notorious partner of Richard Loeb), who had been serving a ‘life plus 99 years’ prison term at the time.

In 1964, Dr. Albert Kligman (the inventor of Retin-A for acne) received funding from Dow Chemical Company to test the toxic effects of dioxin on humans. As dioxin was known to blister the skin, the research was related to chemical warfare. Dr. Kligman's test subjects were inmates at Holmesburg Prison in Pennsylvania. Rather than feeling remorse at conducting experiments on incarcerated men, Dr. Kligman told a reporter in 1966 that “All I saw before me were acres of skin,” just waiting to be tested.

Until the early 1970s, Pasquerella (2002) estimated that approximately 90% of all drug toxicity studies were conducted first on prisoners. Sadly, the main objection raised by the American Medical Association (AMA) to research on prisoners had nothing to do with the coercive nature of testing. Instead, the AMA worried that the incentives provided for participation (e.g., cash, shortening of prison sentences) might detract from the purpose of confinement, which was to punish criminals.

Following the end of World War II, the discovery of military crimes in Germany and Japan largely overshadowed American medical abuses such as the ones described above. Ironically, the prosecution of German physicians would lead to another embarrassing acknowledgment — namely, that the United States had no written guidelines governing human experimentation before December 1946. It took the Nuremberg Code (1947) to emphasize for the first time that the voluntary participation of a subject was necessary before research could begin.

References

Heiman H. 1895. A clinical and bacteriological study of the Gonococcus Neisser in the male urethra and in the vulvovaginal tract of children. J Cut Genito-Urinary Diseases. 13:384–387.

Pasquerella L. 2002. Confining choices: should inmates’ participation in research be limited? Theoretical Medicine. 23:519–536.

The copyright of the article Experimentation on Vulnerable Populations in Scientific Ethics is owned by Jeffrey Willett. Permission to republish Experimentation on Vulnerable Populations in print or online must be granted by the author in writing.