New Ethical Questions for Medical Researchers
New Ethical Questions for Medical ResearchersAs medical researchers became fixtures in the Cold War research bureaucracy, they assumed roles that, if not entirely new, raised ethical questions with which they had rarely dealt before. The surviving records of the period reveal that frank and remarkable discussions took place among military and civilian officials and researchers, all of whom had to balance the benefits of gaining knowledge needed to fight and survive an atomic war with the risks that had to be taken to gain this knowledge. They had to consider, and even debated, whether human radiation experimentation was justified, what kinds of risks entire populations could be exposed to, and what the public could and should be told.
Whether to Experiment with Humans: The Debate Is JoinedSpurred by proposals for human radiation experiments connected with the nuclear-powered airplane (NEPA) project, AEC and DOD medical experts in 1949 and 1950 engaged in debate on the need for human experimentation. The transcript of a 1950 meeting among AEC biomedical officials and advisers and military representatives provides unique insight into the mix of moral principles and practical concerns.
The participants in the debate included many of the key medical figures in the Manhattan Project and the postwar radiation research bureaucracy. For the Navy, for example, Captain Behrens, the editor of Atomic Medicine, made the point that an atomic bomb might contaminate, but not sink, ships. The Navy would need to know the risk of sending rescue or salvage parties into the contaminated area. There were questions of "calculated risk which all of the services are interested in, and not only the services but probably the civilians as well." Brigadier General William H. Powell, Jr., of the Office of the Air Force Surgeon General, added further questions: How does radiation injure tissue? Can equipment protect against the bomb's effects? Is there a way to treat radiation injury? How should mass casualties be handled?
These questions were hardly abstract. Operation Crossroads had demonstrated that postblast contamination of Navy ships was a serious hazard. The use of the atomic bomb as a tactical weapon, declared Brigadier General James Cooney of the AEC's Division of Military Applications, "has now gone beyond the realm of possibility and into the realm of probability." This meant that "we have a responsibility that is tremendous," Cooney added. "If this weapon is used tactically on a corps or division, and we have, say, 5,000 troops who have received 100 R[oentgens] radiation, the Commander is going to want from me, 'Is it all right for me to reassemble these men and take them into combat?' I don't know the answer to that question." Commanders needed to know "How much radiation can a man take?"
Cooney argued that human experimentation was necessary. He invoked the military's tradition of experimentation with healthy volunteers, dating back to Walter Reed's famous work on yellow fever at the turn of the century. Cooney urged that the military seek volunteers within its ranks--"both officer and enlisted"--to be exposed to as much as 150 R of whole-body radiation.
The AEC's Shields Warren took the other side in this debate. Warren raised two basic points in response to Cooney. First, human experimentation was not essential because animal research would be adequate to find the answers. Second, data from human experimentation would likely be scientifically useless. "We have," Warren declared, "learned enough from animals and from humans at Hiroshima and Nagasaki to be quite certain that there are extraordinary variables in this picture. There are species variables, genetics variables within species, variations in condition of the individual within that species." The danger of failing to provide data had to be weighed against the danger of providing misleading data: "It might be almost more dangerous or misleading to give an artificial accuracy to an answer that is of necessity an answer that spreads over a broad range in light of these variables."
There were, moreover, political obstacles to the program Cooney had proposed. Satisfactory answers, Warren concluded, would require "going to tens of thousands of individuals." But America was not the Soviet Union: "If we were considering things in the Kremlin, undoubtedly it would be practicable. I doubt that it is practicable here."
At the heart of Warren's objections to Cooney's proposal was a concern about employing "human experimentation when it isn't for the good of the individual concerned and when there is no way of solving the problem." To Cooney's invocation of Walter Reed, Warren responded that, in the case of yellow fever, humans were needed as subjects because there was no nonhuman host to the disease.
Cooney did not disagree with Warren "that statistically we will prove nothing." But, he pointed out, "[G]enerals are hard people to deal with. . . . If we had 200 cases whereby we could say that these men did or did not get sick up to 150 R, it would certainly be a great help to us."
Even then, Warren rejoined, the data might not be of great use: "I can think in terms of times when even if everybody on a ship was sea-sick, you would still have to keep the ship operating."
The 1950 debate over NEPA provides clear evidence that midcentury medical experts gave thought before engaging in human experimentation that involved significant risk and was not intended to benefit the subject. On paper, the debate was decided in Shields Warren's favor. Following Warren's and DBM's opposition, Cooney and the military agreed that "human experimentation" on healthy volunteers would not be approved. However, even as this policy was declared, the Defense Department, with Warren's apparent acquiescence, proceeded to contract with private hospitals to gather data on sick patients who were being treated with radiation. The government's use of sick patients for research, as we shall see in chapter 8, raised difficult ethical questions of its own.
Whether to Put Populations at Risk: The Debate ContinuesAs the medical experts debated the issue of whether to put individual human subjects at risk in radiation experiments on behalf of NEPA, they were also engaged in secret discussions about whether to proceed with the testing of nuclear weapons, which might put whole populations at risk.
It was also in 1950 that the decision was made to carry out atomic bomb testing at a site in the continental United States. President Truman chose the Nevada desert as the location for the test site. Shields Warren's Division of Biology and Medicine was assigned the job of considering the safety of early tests. Like the earlier transcript, an account of a May 1951 meeting at Los Alamos, convened by Warren, provides a window onto the balancing of risks and benefits by medical researchers.
The meeting focused on the radiological hazards to populations downwind from underground testing planned at the Nevada Test Site. Those in attendance realized that the testing could be risky. "I would almost say from the discussion this far," Warren summarized, "that in light of the size and activity of some of these particles, their unpredictability of fallout, the possibility of external beta burns is quite real." Committee members considered the testing a "calculated risk" for populations downwind, but they thought that the information they could gain made the risk worthwhile. According to the record of the meeting, Warren summarized the view of Dr. Gioacchino Failla, a Columbia University radiological physicist: "[T]he time has come when we should take some risk and get some information . . . we are faced with a war in which atomic weapons will undoubtedly be used, and we have to have some information about these things . . . if we look for perfect safety we will never make these tests." Worried about the potential consequences of miscalculation, the AEC's Carrol Tyler observed, "We have lost a continental site no matter where we put it." Still, Tyler argued, "If we are going to gamble it might as well be done where it is operationally convenient." A proposed deep underground test did not take place, and a test evidently considered less risky was substituted. Ultimately, in a summary prepared at the end of the 1951 test series, the Health Division leader of the AEC's Los Alamos Laboratory recorded that perhaps only good fortune had averted significant contamination: "Thanks to the kindness of the winds, no significant activity was deposited in any populated localities. It was certainly shown however," he wrote, "that significant exposures at considerable distances could be acquired by individuals who actually were in the fallout while it was in progress."
The NEPA debate and the advent of nuclear testing confronted biomedical experts with a set of conflicting, and even contradictory, objectives. First, they were called upon to offer advice on decisions that might inevitably put people at some risk. The risk had to be balanced against the benefit, which in most instances was defined as connected with the nation's security. In many cases, the experts agreed, it was better to bear the lesser risk now, in order to avoid a greater risk later. Second, these experts were also called upon, as in the 1951 Nevada test, to provide advice on minimizing risk. Third, as in the Nevada test, these same experts saw the tests as opportunities to gather data that might ultimately be used to reduce risk for all.
Whether and What the Public Should Be Told About Government-Created Radiation RiskScientific research had a long and celebrated tradition of open publication in the scientific literature. But several factors caused Cold War researchers to limit their public disclosures. These included, preeminently, concern with national security, which necessarily required secrecy. But they also included the concern that the release of research information would undermine needed programs because the public could not understand radiation or because the information would embarrass the government.
The tension between the publicizing of information and the limits on disclosure was a constant theme in Cold War research. When, in June 1947, the Medical Board of Review appointed by David Lilienthal reported on the AEC's biomedical program, it declared that secrecy in scientific research is "distasteful and in the long run contrary to the best interests of scientific progress." As shown by its organization of the medical isotope program, the AEC acted quickly to make sure that the great preponderance of biomedical research done under its auspices would be published in the open literature.
However, recently retrieved documents show that the need for secrecy was also invoked where national security was not endangered. At the same time that biomedical officials, such as those on the Medical Board of Review, spoke openly of the need to limit national security restrictions, internally they sometimes sided with those who would restrict information from the public even where release admittedly would not directly endanger national security. Thus, as we shall see in chapter 13, Shields Warren and other AEC medical officials agreed to withhold data on human experiments from the public on the grounds that disclosure would embarrass the government or could be a source of legal liability.
A further important qualification to what the public could know related to research connected with the atomic bomb--including the creation of a worldwide network to gather data on the effects of fallout from nuclear tests. In 1949, the AEC undertook Project Gabriel, a secret effort to study the question of whether the tests could threaten the viability of life on earth. In 1953, Gabriel led to Project Sunshine, a loose confederation of fallout research projects whose human data-gathering efforts, as we see in chapter 13, operated in the twilight between openness and secrecy.
Finally, while documents show that medical experts and officials shared an acute awareness of the importance of public support to the success of Cold War programs, this awareness was coupled with concern about the American public's ability to understand the risks that had to be borne to win the Cold War. The concern that citizens could not understand radiation risk is illustrated by a recently recovered NEPA transcript. In July 1949, the nuclear airplane project gathered radiation experts and psychologists to consider psychological problems connected to radiation hazard. To the assembled experts the greatest unknown was not radiation itself, but the basis for public fear and misunderstanding of radiation.
"I believe," General Cooney proposed, "that the general public is under the opinion that we don't know very much about this condition [radiation]. . . . We know," he ventured, "just about as much about it as we do about many other diseases that people take for granted . . . even tuberculosis."
Yet, said the Navy's Captain Behrens, "there are some peculiar ideas relative to radiation that are related to primitive concepts of hysteria and things in that category. . . . There is such a unique element in it; for some it begins to border on the mystical." A good deal of the public's fear of radiation, declared Berkeley's Dr. Karl M. Bowman, a NEPA medical adviser, "is essentially the fear of the unknown. The dangers have been enormously magnified." As Dr. Bowman and others noted, the public's perception was not without reason, for "we have emphasized for purposes of getting funds for research how little we know."
The perspective expressed in the NEPA transcript would lead, as shown in chapter 10, to the use of atomic bomb tests to perform human research on the psychology of panic and, as shown in other case studies, to decisions to hold information closely out of concern that its release could create public misunderstanding that would imperil important government programs.