Here’s a familiar script: medical researchers in the 1950s in a democratic country conduct forgotten experiments which yield no useful data on a vulnerable population. This week’s revelation comes from New York’s skid row, the Bowery. An oncologist from Columbia University recruited alcoholics for his study of prostate cancer by offering them three square meals, a clean bed and free medical treatment if they had cancer. In return they agreed to have a medical biopsy.
What the men were not told was that the biopsy could cause impotence and rectal tears and that treatment would probably involve removal of the prostate and testicles – but would not necessarily prolong their lives. “The failure to provide full informed consent and exposing a vulnerable population to undue risk—are disturbing. Yet the [research was] published in leading medical journals and frequently cited, joining the long list of unethical studies performed in full public view,” says Robert Aronowitz, the author of a highly critical essay in the American Journal of Public Health.
The study was started in 1951 by a young urologist, Dr Perry Hudson, and ran for more than a decade. Now 96 and living in Florida, Dr Hudson told the New York Times that he believed that the treatments would prolong their lives.
Even at the time, some doctors objected to the research on ethical grounds. “Among urologists, I got called a collection of really fancy names,” Dr Hudson told Aronowitz. “I didn’t pay any attention to them.” The people Hudson admired “understood what I was doing. So I paid no attention to it.”
A “retrospectoscope” is a clear lens for ethical mistakes. But Dr Aronowitz’s real target is contemporary screen-and-treat programs for prostate cancer. He says that they, too, are “a mass experiment conducted on ill-informed men”. “Ethical tragedies are difficult to recognize in the present. They do not necessarily appear in the same guise as past ones,” Dr Aronowitz writes. “Future observers may view the massive evidence-challenged expansion of our screen-and-treat paradigm in prostate cancer in the same way as we now view the Bowery series practices.” (See also a similar article in the Bulletin of the History of Medicine.)
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