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History of Medicine |

Exposing Unethical Human Research: The Transatlantic Correspondence of Beecher and Pappworth

Allan Gaw, MD, PhD
[+] Article and Author Information

From the Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, United Kingdom.


Acknowledgment: All quotations from the unpublished Beecher–Pappworth correspondence are reproduced with kind permission of the Center for the History of Medicine, Francis A. Countway Library of Medicine, Boston, Massachusetts, and the Wellcome Library, London, United Kingdom. This work would not have been possible without the assistance of Jessica B. Murphy and Jack Eckert, Center for the History of Medicine, and the staff of the Rare Materials Viewing Room, Wellcome Library.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2069.

Requests for Single Reprints: Allan Gaw, MD, PhD, Clinical Research Facility, Centre for Public Health, 2nd Floor, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BJ, United Kingdom.

Author Contributions: Conception and design: A. Gaw.

Analysis and interpretation of the data: A. Gaw.

Drafting of the article: A. Gaw.

Critical revision of the article for important intellectual content: A. Gaw.

Final approval of the article: A. Gaw.

Administrative, technical, or logistic support: A. Gaw.

Collection and assembly of data: A. Gaw.


Ann Intern Med. 2012;156(2):150-155. doi:10.7326/0003-4819-156-2-201201170-00012
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Henry K. Beecher and Maurice H. Pappworth were the 2 most prominent medical whistleblowers in research ethics of the 20th century. Independently, both wrote highly controversial and ultimately influential articles and books. Although their work is now well-known in clinical research circles, their collaboration is not. Pappworth's article “Human Guinea Pigs: A Warning” was published in 1962; in it, he discussed a series of published studies that he considered unethical. Beecher read it and wrote to Pappworth seeking help. The current article reconstructs, from Beecher and Pappworth's correspondence in 1965–1966, an important juncture in the genesis of modern clinical research ethics. Although they shared much in common, they differed radically in the strategies they adopted: Beecher chose to conceal the identities of individuals, whereas Pappworth believed that only by naming and shaming could any exposé act as a deterrent. Their correspondence reveals how the 2 men shared their ideas and their material and provided each other with much-needed support. It also tracks the development of Beecher's shift from a position initially indistinguishable from Pappworth's toward the one he adopted when his seminal article of 1966 was published.

Figures

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Figure 1.
Henry K. Beecher (1904–1976).

Photograph reproduced with permission of the National Library of Medicine.

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Figure 2.
Maurice H. Pappworth (1910–1994).

Photograph reproduced with permission of N&H Watson.

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Figure 3.
Cover of Twentieth Century.

Photograph by the author.

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Research with Patients
Posted on January 24, 2012
Howard, Spiro, MD, MACP
Emeritus Professor of Medicine Yale Medical School
Conflict of Interest: None Declared

Allam Gaw's report of the Beecher-Pappworth correspondence deserves widespread discussion, for unless academic physicians over and over again discuss sins of the past, how can we hope to prevent them in the future?

A 1947 graduate of Harvard Medical School, and intern at the Peter Bent Brigham Hospital in the mid-1940's, I remember learning of an unspoken though implicit medical compact between ward patients and hospital doctors: we took care of them for free, and in return they gave us their bodies to study.

Did I "learn" that - did someone say it out loud- or was it in the air? Too much time has passed for me to be sure, but somewhere in that developing academic scene, it became evident that our "labs" were not only rooms with benches and hoods, but also rooms with patients and beds. Patients could be our subjects for study--therapeutic and more. How else could Minot and Murphy have won the Nobel Prize for treating pernicious anemia?

Another hint of this linkage between patient care and scientific study comes from an old plaque at Yale on the ground floor of the Hope Building, in 1901 erected as the "Dispensary" (Clinic) of Yale Medical School. It reads, in part: "This building has been erected by her daughter for the relief of the poor and the advancement of medical science."

My physician teachers back in Boston were, almost all, respectful of their patients, considerate, competent, and compassionate, and we learned how to care for our patients from their example. But we had no such idea as "informed consent," burnished in the 1960's - I like to think- by Jay Katz at Yale Law School.

When Pappworth came out with his reports, most of us resisted any suggestion that in our studies we were like the Nazi doctors -who intended the death of their imprisoned subjects.

Conflict of Interest:

None declared

Personal experience as ethical impulse
Posted on January 31, 2012
Zackary D., Berger, Assistant Professor
Johns Hopkins General Internal Medicine
Conflict of Interest: None Declared

Gaw's comparison of Beecher and Pappworth is instructive. However, while he ably detailed the reasons why their approach to divulging names of unethical researchers might have differed, I believe there is one he failed to give proper weight. Pappworth, a Jew who (Gaw notes) directly experienced anti-Semitism in his professional life, was also a war veteran. Thus the Holocaust perpetrated against the Jews and other minorities must have been prominent in his moral outlook, and the comparison between ethical violators in Britain and the US, and Nazi doctors, not merely a rhetorical exaggeration.

While the principles of research bioethics required formulation by Beecher and Pappworth, among others, it required moral sensitivity to realize the enormity of the violations. Such sensitivity - at least in Pappworth's case - might have been supplied not by abstract conceptions, but by very concrete history that was not so very long past.

Today we would also do well to keep in mind past violations (by our profession and others) as we keep an eye out for present ethical dangers.

Conflict of Interest:

None declared

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