Unit 731 and moral repair.

Unit 731, a biological warfare research organisation that operated under the authority of the Imperial Japanese Army in the 1930s and 1940s, conducted brutal experiments on thousands of unconsenting subjects. Because of the US interest in the data from these experiments, the perpetrators were not prosecuted and the atrocities are still relatively undiscussed. What counts as meaningful moral repair in this case-what should perpetrators and collaborator communities do decades later? We argue for three non-ideal but realistic forms of moral repair: (1) a national policy in Japan against human experimentation without appropriate informed and voluntary consent; (2) the establishment of a memorial to the victims of Unit 731; and (3) US disclosure about its use of Unit 731 data and an apology for failing to hold the perpetrators accountable.

Historical Origins of the Tuskegee Experiment: The Dilemma of Public Health in the United States.

The Tuskegee Study of Untreated Syphilis in the Negro Male was an observational study on African-American males in Tuskegee, Alabama between 1932 and 1972. The U. S. Public Health Service ran this study on more than 300 people without notifying the participants about their disease nor treating them even after the introduction of penicillin. The study included recording the progress of disease and performing an autopsy on the deaths. This paper explores historical backgrounds enabled this infamous study, and discusses three driving forces behind the Tuskegee Study. First, it is important to understand that the Public Health Service was established in the U. S. Surgeon General's office and was operated as a military organization. Amidst the development of an imperial agenda of the U.S. in the late 19th and early 20th centuries, the PHS was responsible for protecting hygiene and the superiority of "the American race" against infectious foreign elements from the borders. The U.S. Army's experience of medical experiments in colonies and abroad was imported back to the country and formed a crucial part of the attitude and philosophy on public health. Secondly, the growing influence of eugenics and racial pathology at the time reinforced discriminative views on minorities. Progressivism was realized in the form of domestic reform and imperial pursuit at the same time. Major medical journals argued that blacks were inclined to have certain defects, especially sexually transmitted diseases like syphilis, because of their prodigal behavior and lack of hygiene. This kind of racial ideas were shared by the PHS officials who were in charge of the Tuskegee Study. Lastly, the PHS officials believed in continuing the experiment regardless of various social changes. They considered that black participants were not only poor but also ignorant of and even unwilling to undergo the treatment. When the exposure of the experiment led to the Senate investigation in 1973, the participating doctors of the PHS maintained that their study offered valuable contribution to the medical research. This paper argues that the combination of the efficiency of military medicine, progressive and imperial racial ideology, and discrimination on African-Americans resulted in the Tuskegee Syphilis Experiment.

Does pediatrics need its own bioethics?

Pediatric bioethics raises unique issues because children are constantly growing, developing, and changing. The ethical issues that arise for newborns are different from those that arise for seven-year-olds or 17-year-olds. Furthermore, children do not develop cognitive capacities or moral reasoning skills at the same rate. Thus, it is difficult to generalize about what is appropriate or inappropriate for children in either the clinical or the research setting. This article responds to some of the issues raised by a new volume of essays about pediatric bioethics. It puts these issues into historical context by examining the implications of Saul Krugman's famous studies on the etiology and prevention of hepatitis at New York's Willowbrook State School.

U.S. Public Health Service STD Experiments in Guatemala (1946-1948) and Their Aftermath.

The U.S. Public Health Service's sexually transmitted disease (STD) experiments in Guatemala are an important case study not only in human subjects research transgressions but also in the response to serious lapses in research ethics. This case study describes how individuals in the STD experiments were tested, exposed to STDs, and exploited as the source of biological specimens-all without informed consent and often with active deceit. It also explores and evaluates governmental and professional responses that followed the public revelation of these experiments, including by academic institutions, professional organizations, and the U.S. federal government, pushing us to reconsider both how we prevent such lapses in the future and how we respond when they are first revealed.

Bartholow, Sciamanna, Alberti: pioneers in the electrical stimulation of the exposed human cerebral cortex.

Although the past 25 years have witnessed increasing interest in human brain stimulation, its historical development is marked by phases of fascination and obscurity. Its history dates back to the 19th century when the first reports describing application of an electric current to an isolated point on the exposed brain made brain stimulation a major neuroscientific novelty of the time. In this article, the authors present and discuss a number of early experiments involving electrical stimulation of the exposed human brain. In this important, albeit unexplored, historical chapter of brain stimulation, the 3 investigators, Bartholow, Sciamanna, and Alberti, were the first to reproduce findings in animals with electrical brain stimulation in humans.

[Georges Schaltenbrand (26. 11. 1897 24. 10. 1979)]. / Georges Schaltenbrand (26. 11. 1897 - 24. 10. 1979).

Georges Schaltenbrand was one of the most prodigious and internationally renowned neurologists in post war Germany. Trained by Max Nonne in Hamburg, he early gained international experience during stays in The Netherlands, the United States, and China. In 1935 quarrels with Nazi representatives forced him to go to Würzburg, where he built an own neurological service. This unit subsequently grew up to an internationally recognized center. Schaltenbrand scientifically contributed to the organization and diagnostics of the motor system, to the physiology and pathology of the cerebrospinal fluid system, and to multiple sclerosis. His textbook and atlas on stereotaxy, authored with his American friend Percival Bailey in 1959, remained a standard reference in stereotactic surgery until recent years. Only late after his death his unethical scientific activities during wartime came to common public knowledge. In an attempt to confirm his hypothesis of an infectious aetiology of multiple sclerosis, he had inoculated mentally handicapped and other severely ill patients with cerebrospinal fluid of apes putatively suffering from multiple sclerosis and also of patients with verified multiple sclerosis. He explicitly accepted the risk of causing some morbidity and even mortality in his study persons. He published his experiments in several articles and oral presentations since 1940, and, comprehensively, in a monograph 1943. Although commented as early as 1949, his dubious studies were widely ignored until a critical review appeared in an American journal in 1994. Since then, the studies are frequently cited as a typical example of Nazi medical science. However, with due regard to the historical background and the personality of Schaltenbrand his experiments should rather be brought into line with a worldwide practice at that time of using patients as study objects without asking for their consent. As a response to this practice several laws had been adopted, beginning in 1900, carried on in 1931 and culminating 1947 in the Nuremberg code. As a historical fact, not only before but also after World War II these legal acts were widely ignored and became only gradually accepted.

[Research developments in neurostimulation after 1945: historical and ethical aspects of medical manipulations of the human brain]. / Uber Forschungsentwicklungen der Neurostimulation nach 1945: Historische und ethische Aspekte medizinischer Manipulationen am menschlichen Gehirn.

For nearly fifteen years, the impact of modern neuroscience has become a central focus of public debate, not just following the Decade of the Brain in the United States. Newly developed options for manipulating the central nervous system (CNS) are not only of primary medical concern but have come to be regarded as extremely questionable in recent bioethical discourse. This article provides an in-depth comparison between modern neuromanipulative approaches from "Deep Brain Stimulation" (DBS) with methods from earlier historical periods. After World War II, electrophysiological stimulation was developed, which changed the functional capacity of the human brain. It is argued that many contemporary debates questioning neuroethical applications are flawed in significant respects: A unique neuroethical position can neither be upheld philosophically nor with regard to consumer-oriented clinical practice. By drawing on individual case examples from the contemporary and recent history of neuroscience, some related problem fields and consequences are mapped out and discussed. They show an increasingly blurred conceptual boundary furnished by the complex relations between clinical research, physiological restitution, and functional enhancement inherent in modern biomedicine.

The United States cover-up of Japanese wartime medical atrocities: complicity committed in the national interest and two proposals for contemporary action.

To monopolize the scientific data gained by Japanese physicians and researchers from vivisections and other barbarous experiments performed on living humans in biological warfare programs such as Unit 731, immediately after the war the United States (US) government secretly granted those involved immunity from war crimes prosecution, withdrew vital information from the International Military Tribunal for the Far East, and publicly denounced otherwise irrefutable evidence from other sources such as the Russian Khabarovsk trial. Acting in "the national interest" and for the security of the US, authorities in the US tramped justice and morality, and engaged in what the English common law tradition clearly defines as "complicity after the fact." To repair this historical injustice, the US government should issue an official apology and offer appropriate compensation for having covered up Japanese medical war crimes for six decades. To help prevent similar acts of aiding principal offender(s) in the future, international declarations or codes of human rights and medical ethics should include a clause banning any kind of complicity in any unethical medicine-whether before or after the fact-by any state or group for whatever reasons.

Lessons for HIV from Tuskegee.

We are fortunate to live in an era in which research allows significant progress in the therapy of the major diseases that affect us. However, evaluating their efficacy and safety is expensive, laborious and involves the study of human subjects in an appropriate manner. The principles of such trials have a heterogeneous basis encompassing the principles of utilitarianism, distributive justice, the protection of individual rights and the investigators' commitment to patients. The Tuskegee study of untreated syphilis is the longest non-therapeutic experiment on human beings in medical history. It continues to cast its shadow on the relationship between black Americans and the broader biomedical community. Parallels and the relationship with the HIV pandemic are discussed.

The West's dismissal of the Khabarovsk trial as 'communist propaganda': ideology, evidence and international bioethics.

In late 1949 the former Soviet Union conducted an open trial of eight Japanese physicians and researchers and four other military servicemen in Khabarovsk, a city in eastern Siberia. Despite its strong ideological tone and many obvious shortcomings such as the lack of international participation, the trial established beyond a reasonable doubt that the Japanese army had prepared and deployed bacteriological weapons and that Japanese researchers had conducted cruel experiments on living human beings. However, the trial, together with the evidence presented to the court and its major findings--which have proved remarkably accurate--was dismissed as communist propaganda and totally ignored in the West until the 1980s. This paper reviews the 1949 Khabarovsk trial, examines the West's dismissal of the proceedings as mere propaganda and draws some moral lessons for bioethics today. As an important historical case, set in the unique socio-political context of the Cold War, the West's dismissal of the trial powerfully illustrates some perennial ethical issues such as the ambivalence of evidence and power of ideology in making (or failing to make) cross-national and cross-cultural factual and moral judgments.

Stowaways in the history of science: the case of simian virus 40 and clinical research on federal prisoners at the US National Institutes of Health, 1960.

In 1960, J. Anthony Morris, a molecular biologist at the US National Institutes of Health conducted one of the only non-therapeutic clinical studies of the cancer virus SV40. Morris and his research team aimed to determine whether SV40 was a serious harm to human health, since many scientists at the time suspected that SV40 caused cancer in humans based on evidence from in vivo animal studies and experiments with human tissue. Morris found that SV40 had no significant effect but his claim has remained controversial among scientists and policymakers through the present day--both on scientific and ethical grounds. Why did Morris only conduct one clinical study on the cancer-causing potential of SV40 in healthy humans? We use the case to explain how empirical evidence and ethical imperatives are, paradoxically, often dependent on each other and mutually exclusive in clinical research, which leaves answers to scientific and ethical questions unsettled. This paper serves two goals: first, it documents a unique--and uniquely important--study of clinical research on SV40. Second, it introduces the concept of "the stowaway," which is a special type of contaminant that changes the past in the present moment. In the history of science, stowaways are misfortunes that nonetheless afford research that otherwise would have been impossible specifically by creating new pasts. This case (Morris' study) and concept (the stowaway) bring together history of science and philosophy of history for productive dialog.

The race to discover the insect vector of kala-azar: a great saga of tropical medicine 1903-1942.

In the 19(th) century, a devastating epidemic of visceral leishmaniasis (kala-azar) swept through northeast India. After identification of the pathogenic agent, Leishmania donovani, in 1903, the question of its transmission remained to be resolved. In 1904, thanks to work by L. Rogers on cultures of this parasite it became probable that a haematophagous arthropod was responsible for transmission. J.A. Sinton suggested, in 1925, the distribution of the sand fly Phlebotomus argentipes was similar to that of the disease and, thereafter, two independent teams led by H.E. Shortt in Assam and R. Knowles and L. Napier in Calcutta concentrated on this potential vector. Parallel work was in progress in China, directed by E. Hindle and W. S. Patton for the Royal Society Kala-azar Commission, on another species of sand fly. In 1942 the Assam workers transmitted L. donovani to five human volunteers by the bites of colonised P. argentipes and the race was over.