Canada’s shameful history of nutrition research on residential school children: The need for strong medical ethics in Aboriginal health research

Abstract

While both science and research have very long and detailed histories, the formal history of medical ethics is short. The discipline’s foundation arises from the medical atrocities performed in the name of science by a cadre of Nazi doctors during World War II. The actions were so despicable that 20 physicians were put on trial in Nuremberg for violation of the Hippocratic Oath and behaviour incompatible with their education and profession. A result of this 1946 trial was the Nuremberg Code of Medical Ethics (1). Last year, Ian Mosby, a food historian and postdoctoral fellow at the University of Guelph (Guelph, Ontario), revealed details of highly unethical nutrition experiments performed on Canadian Aboriginal children at six residential schools between 1942 and 1952 (2) – our own medical atrocities. The experiments were performed by the Department of Indian Affairs of Canada under the direction of two physicians: Dr Percy Moore, the Indian Affairs Branch Superintendent of Medical Services, and Dr Frederick Tisdall, a famed nutritionist, a former president of the Canadian Paediatric Society and one of three paediatricians at The Hospital for Sick Children (Toronto, Ontario) who developed Pablum infant cereal in the 1930s. In these experiments, parents were not informed, nor were consents obtained. Even as children died, the experiments continued. Even after the recommendations from the Nuremberg trial, these experiments continued. In these experiments, control and treatment groups of mal-nourished children were denied adequate nutrition. In one experiment, the treatment group received supplements of riboflavin, thiamine and/or ascorbic acid supplements to determine whether these mitigated the problems – they did not. In another, children were given a flour mix containing added thiamine, riboflavin, niacin and bone meal. Rather than improving nutrition, the children became more anemic, likely contributing to more deaths and certainly impacting development. In these experiments, efforts were made to control as many factors as possible, even when they harmed the research subjects. For example, previously available dental care was denied in some settings because the researchers wanted to observe the state of dental caries and gingivitis with malnutrition. How could we have let this happen? Why did we not know about this long before now? Why did these experiments not stop when the Nuremberg Code was put forward? Similar to the US Public Health Service Syphilis Study at Tuskeegee (3) – which, in 1932, set out with the “best of intentions” to learn about the natural history of syphilis among black men in hopes of justifying a treatment program for them – Canadian researchers used Aboriginal children in residential schools to learn about malnutrition. The problem in Tuskeegee (Alabama) was that the natural history observations continued long after penicillin became available to treat syphilis. In Canada’s case, the basics of alleviating malnutrition (adequate food) were well known even before these experiments began. The most striking fact is that both studies were performed among individuals who were already marginalized and vulnerable. No one was looking out for the best interests of these research subjects. They had no voice. While many changes and improvements have been made in the area of ethical health research since the 1940s, Aboriginal children and youth remain a highly vulnerable population. Extra care must be taken. The current issue of Paediatrics & Child Health includes a Canadian Paediatric Society position statement entitled ‘Health research involving First Nations, Inuit and Metis children and their communities’, (4) with recommendations on Aboriginal community ownership of research projects, one measure that can help to ensure the potential for research abuse is minimized. Other measures, such as data safety review committees as well as rigorous research ethics board review, are also critical. It behooves all of us who care for children and youth to ensure that research abuse and other potential opportunities for abuse are minimized by being vigilant, thoughtful and introspective.