Might expect to help them. But then the side effects of the radiation will be the side effects of the cancer, and the department of defense wasnt particularly interested in the effects of radiation on people with metastatic cancer, they wanted to know what the effects of radiation were on a healthy 23yearold pilot. And that could be best studied by irradiating people whose karch cancers were not going to respond to the radiation. Most of the patients who were irradiated were poor. Most of the patients who were irradiated were africanamerican. All of them had cancer. Some of them werent all that sick. Some of them were still ambulatory, some of them were still going to work. The radiation had some pretty serious effects. Out of the 90 people who were irradiated, 21 of them were dead within a month. And heres whats there are many things bothersome about this. We know that when you irradiate people, they have side effects. You can get nauseated, you can get very nauseated. But the department of defense didnt want the patients to be given medicines to reduce the nausea because they wanted to know what the effects would be without the medicine to reduce the nausea. In fact, they didnt even want the patients to be informed the nausea might be a side effect, because that might influence them to get nauseated, so these patients were not given basic medicines that were given to other people at the time to help prevent the side effects of radiation. These experiments, as i say, ended in 1972. 1972 is a day youll remember. Thats when the tuskegee experiments became public. Well move on in a second to radiation experiments on children. Any questions about these radiation experiments . The question was, was this done with prior informed consent . This is a good question, and it raises all sorts of issues. Not to play word games, but the question, what is meant by informed consent . And the notion of informed consent as we now understand it really hadnt been fully articulat articulated, that will there is the court case with shomberg hospital where a patient has the right to decide what happens to his or her own body. The memo that i showed you earlier for the gonorrhea experiment showed that in 1992, the head of research thought informed consent was absolutely essential. Clearly that was not being followed here. Well talk about sources in a little bit, but one of the questions is, how do you know somebody had informed consent . Some of the physicians claim they got informed consent, but there is not documentary evidence of it. There was a lawsuit, by the way, and as a result there is a plaque that now sits in the hospital in cincinnati. Other questions . All right. The walter e. Ferdinand school in boston. Research funded by the National Institutes of health, and quaker oats. This was an experiment on breakfast food. Children were given breakfast food with irradiated calcium to see how that would be absorbed. Quaker wanted to get a leg up on cream of wheat. They wanted to be able to show that their cereals were better absorbed and better spread throughout the body. Im not making this up. How did they get them to do this . Heres an excerpt from a letter. A letter to parents, 1953. We have done some examinations in connection with the Nutritional Department in the Massachusetts Institute of technology with the purpose of helping to improve the nutrition of our children. I want to point out that just like we saw, if you remember, in some of the letters in the tuskegee experiments, asking a man to come in for a spinal function, and you had in the letter institutions like the tuskegee institute. Here the National Institute of technology, a very wellrespected, highly regarded institution. The blood samples are taken after one test meal which consists of a special breakfast containing a certain amount of calcium. If you sign up for this, you get to be a member of the science club. And if youre a member of the science club, you get additional privileges. You get a quart of milk daily, you get to go to a baseball game and to the beach. Nothing in here that says were going to give you radioactive pricers. This raises all sorts of questions similar to the one we talked about with the willowbrook experience. The willowbrook experience was also funded by the military. The armed forces were interested in a vaccine and thats why they conducted some of those experiments. This raises questions. First of all, can children give informed consent . Are parents being coerced . This was not a great institution, by the way. This was not a place you really wanted to be. Did parents really feel like they had any sort of choice . A quart of milk a day may not sound like a big deal, but if you dont have it, is this too much coercion . It turns out that when you look at this critically, the levels of radiation that they got probably didnt hurt them very much or at all. But nonetheless, this raises questions about whether it is appropriate to do experiments on institutionalized children without informing either them or their parents. Any questions about the fernald experiments . Okay. Lets move to oregon. So this is the cold war, and were into radiation, and the idea of Nuclear Power is very big. And the hope is that we will soon have nuclearpowered airplanes, quite seriously being discussed. Pilots who were flying nuclearpowered airplanes are going to be exposed to a lot of radiation. Who else is going to be exposed to radiation . Space flight, people that go up into space. Nasa was interested in this. People who work with Nuclear Power. If there is a nuclear attack, people will be exposed to radiation. What are they worried about . Well, when they talk to potential crew members on nuclear planes, they were especially concerned about damage to what was euphemistically considered the family jewels. Rapidly dividing cells. Thus, if there is radiation exposure, those are cells that you would expect to be more likely to be hit by the radiation, and this could produce chromosomal damage and potentially problems for your progeny down the road. Testicles have the advantage that they can be irradiated without having to radiate the entire body. So, in the oregon state and in the Washington State prisons between 1963 and 1973, there were certain radiation experiments done to determine the effect of a radiation on testicles. Prisoners . These are healthy men who arent going anywhere for a while. Its also a way to give them a chance to pay back to society for what theyve done. The experiments in oregon were overseen by an extremely prominent endocrinologist. A machine was made to irradiate the testicles. Men were asked to lie on their stomach. Testicles were placed in warm water so they were hanging down and then they would be radiated. This would be followed by biopsies and then by a vasectomy, because in case the radiation caused chromosomal damage, they didnt want these men to be having any children. It quickly got out by word of mouth, and they knew the institution that was sponsoring this research saw it as sensitive, and they didnt want it to be too public. There was a rather loose and informal psychiatric examination and a consultation with the chaplain. The chaplain was required to certify that the men in question were not roman catholic. Because if they were roman catholic, they were not to have a vasectomy. Needless to say, there was no benefit to these men in terms of their health. They did get money. They were paid 25 cents a day. They got 25 for a testicular biopsy and another 25 for a va tech tomorr sec tomorrow. 25 back then is equal to about 200 today. If im reading your facial expressions correctly, i would assume the answer would be no today. So these were another set of radiation experiments that went on in the prisons. They were stopped in 1970, probably because of changing environment. The administrators were concerned that prisoners couldnt fully consent. I think thats a very valid concern. Similar experiments were done in the Washington State prison. Its interesting to think for a moment about the use of prisoners in human experimentation in general. The concerns about experimenting on prisoners in the 1940s and 50s were not the same as the ones we have today. The main concern was they would not be adequately punished. You get special privileges, you get to go into the hospital, you might get better food, and if youre in prison, youre supposed to be punished for your crimes. It was affirmed in the journal of the American Medical Association as being a legitimate way to do experiments. By 1972, 90 of the subjects were phase one drug trials. Phase one drug trials are when you have a new drug and you want to try it out and see what happens, gradually increasing doses not as a treatment for disease but just for the toxic effect. The experiments on prisoners were seen as being a privilege, perhaps not surprisingly, fit into more the white than the africanamerican prisoners. We were in the United States way out of touch with the rest of the world, and almost the entire rest of the world experimentation of prisoners were seen as not ethical and not appropriate. The nuremberg code says you cant force people to do experiments, and if youre in prison, you cant really make a free choice about what youre doing, and so prison experiments in the United States became nonexistent. They came up in the tu srskegee experiments that the president had for only one day. Any questions about the prisoner experiments . This is han foford, washington. Its a lovely town on the columbia river. Its remote. And in 1942, it was the site for a plutonium plant and for many years it was the place where a lot of plutonium was made. It was picked for a couple reasons. One is there was ready access to fresh water for cooling in the columbia river. The second reason is that it was out of the way. And if youre making plutonium when plutonium is top secret, you want to be secret. So heres a billboard, dont talk, silence means security. And another sign, loose talk is a chain reaction. And this is how they advertise. Richmond is very near hanford. Atomic frontier days. A new light on the old frontier. Youll recall that the soviet union launched its first atomic bottom in 1979. How do we know what the soviet union is doing . We know because when you put it up in the atmosphere, it shines in the whole world and we can see evidence of radioactivity here. How do we interpret that . Thats hard. So we wanted to figure out what radiation was like when it was put into the atmosphere. How did it come down . Where did it come down . How could you detect it . And what better way to find out what thats like than to intentionally release radiation from a plant, like hanford . These are the socalled green run experiments because the fuel that was used was young, or green. So they started releasing radioactivity into the atmosphere so that they could study how and when and where it came down. Because this is top secret, of course, theyre not bothering to tell the people in the area that, oh, by the way, well be putting a lot of radiation into the atmosphere. There were problems. The weather wasnt what they expected or desired. They got more exposure at local sites. We now know that drinking milk compels the grays of pasture. The cows drink the water, they make the milk, the children drink the milk. When they did look to see how the radiation spread around, they did so with considerable secrecy. They pretended to be Animal Husbandry experiments going out and checking the animals and the cows. If youre a spy, you think about this, but this is in the United States, this is in your backy d backyard. You have someone working for the Atomic Energy company who claims to be an Animal Husbandry expert who wants to check your cows. Its unclear how much damage was actually done, how many people were actually injured. Its also clear that there was probably more radiation released from the normal operation of the plants from 1944 to 1947. They released about 80 times as much radiation by accident. But there is an enormous sense of distrust and personal violation that comes from this. Heres a cartoon showing hanford in the 1940s and 1950s, you see people surrounded by fumes, kind of skeletal. On the back it says, yes, sir, its reassuring to know if we were in any kind of danger here, our government would let us know right away. So you risk enormous trust when you start dumping radiation into an empty field. This was not only done in hanford, it was done a number of other places. There were Nuclear Explosions that were released to the atmosphere that impacted holy sites for the pueblo indians who lived in very close relationship to the land which was obviously in the southwest. And there was some concern and some observations that the spanish and native american residents of these areas tended to find themselves in these areas more downstream than in others. Before i transition to how we know about this and how these experiments came to light, any questions about the experiments . How many of you knew about these experiments before this class . Word of mouth or reading about them . Word of mouth. [ inaudible ] they were top secret. There were early reports and rumors that some americans had been injected with plutonium. A congressional report in 1986 was called Americas Nuclear guinea pigs. Fairly land congressional language. A journalist by the name of Eileen Wilson working for the albuquerque talk tribune wrote about the story the way journalists write about stories like this. Which is to say, she got names and faces and the stories are much more compelling when there is an actual Person Associated with them. I mention aed a few names of people here. She wrote some incredible stories. Shes got a wonderful book out called the plutonium files. But really, we started to find out a lot more about these with this book that came out of a commission. This is a rather thick book. This is from the Advisory Committee on human radiation experiments. It was created in january of 1994. President bill clinton ordered all federal agencies to comb their files and make them public. He said, i want all the information about these radiation experiments out there. And as a result, a ton of stuff was declassified, and one of the things thats happened as a result of this book and this mission was that those declassified documents are now publicly available. And lots of people have gone to them and written about them. The commission that he formed was made up of historians, philosophers, lawyers, radiologists, if i sphycisists. A typist shared with me that his father was actually in hanford in this period. You wonder just what was going on. They held lots of hearings, there were lots of groups of people who felt aggrieved, veterans, combats, mothers who were in the wrong place at the wrong time. How do you differentiate between wrongness of actions and blameworthiness of actions . Its one thing to say they were wrong, its another to say who was to blame. They were asked to say who was to receive monetary damages . Who deserves money for this . Who was wronged by the government and deserved to be paid. They came up with a rather short list and they were criticized for that. Their report was released, and president clinton apologized on october 3, 1995. And on the evening news that night, i dont think it was even mentioned because also on october the 3rd, 1995, the jury came down with a verdict in the o. J. Simpson trial. So its an example of bad timing to release a report. A quaker outside of this independently settled for 1. 85 million for the experiments. This is a wonderful book. This is really a tremendous job of historical and policymaking research. You may notice that some of what ive been telling you might not be as Crystal Clear as it might be, and that is that the nature of historicalresearch, many of the records of what happened are just incomplete. Some things we dont have protocols for. You asked about informed consent. We dont know for many of these experiments. Maybe because it was done in wartime, maybe because it was top secret, maybe because nobody boa bothered to write it down. Maybe because maybe what were doing here is a little dicey and maybe we dont want to keep records. We dont know. I think the committee did as good a job as they possibly could finding out as much as they possibly could about this. A fundamental question to grapple with is how do we make retrospect with judgments . How do we assess the past from our own perspective . Again, taking informed consent as an example, a lot of the concepts of informed consent were not fully articulated until after this time. Its not fair to go back and say, they didnt do things the way we would have done. They did say the committee came up with a tri parte method of making judgments which i think makes a lot of sense. First they had there are lot of basic Ethical Principles that stand the test of time and place. They then pointed out all those Ethical Principles have exceptions. Then they said there are certain policies of Government Departments or agencies. You ought to follow the policies of wherever youre working. The problem here is that if the policies are secret, how do you know about them . Finally, they said there are the rules of professional ethics that people need to Pay Attention to. They did conclude, and i agree, that its not okay to just use people because theyre dying. Some of the rationale for some of the plutonium experiments and the other injections was that these people are dying and we might as well get some information from them. Being ill and hospitalized does not justify using people as mere means to the ends of others. You still have to respect them as people. So what are the key lessons in these radiation experiments . Ive only scratched the surface. And i really hope that you will go and read more about them in books like Eileen Wilsons book. Jonathan marino has a wonderful book on the history of these radiation experiments. They have m6r lot more detail. One of the lessons is that medicine and the quest for knowledge has to be looked at in a specific social, political and economic context. It just cannot be understood if you take it out of the context. And these radiation experiments started in