Final Report of the Advisory Committee on Human Radiation Experiments (review)

Abstract

Reviewed by: Final Report of the Advisory Committee on Human Radiation Experiments Robert Martensen Final Report of the Advisory Committee on Human Radiation Experiments. Oxford: Oxford University Press, 1996. xxxii + 620 pp. Tables, graphs. $39.95. In November 1993, Eileen Welsome, a reporter for the Albuquerque Tribune, published a series of articles recounting the U.S. government’s sponsorship of 1940s human plutonium experiments performed by physicians and physicists at leading research universities (UC Berkeley, University of Chicago, and University of Rochester). Previous reports of governmental sponsorship of human radiation experiments without adequate consent, such as the 1986 congressional investigation that resulted in the “Markey Report,” had not aroused significant national popular interest. But Ms. Welsome’s did, perhaps because she provided individual names and stories. [End Page 166] Subsequently, President Clinton in January 1994 created the Advisory Committee on Human Radiation Experiments (ACHRE) and charged it with the task of reviewing human radiation experiments and trials conducted between 1944 and 1974. Although most of the approximately 4,000 experiments and trials involved the use of small doses of relatively safe radioisotopes, many patient/subjects were not informed of the exposures, and often no consent was obtained. Clinton also ordered the Advisory Committee to make findings that addressed past federal wrongs, and to formulate policy recommendations to minimize present or future transgressions in federally sponsored human-subject research. Composed of fourteen members, the Advisory Committee was chaired by Ruth Faden, Ph.D., M.P.H., and provided with an operating budget of $3,000,000. Both the Clinton administration and the Advisory Committee merit deep admiration for their willingness to engage with the government’s shadowy past in human radiation experiments. The Report represents a milestone in responsiveness of the executive branch to public outrage about past government-sponsored behaviors. In admirably clear prose it depicts some contours of a heretofore lost research landscape, as it attempts to analyze in many dimensions the significance of this past for the present. The Committee’s Final Report is serious, thought provoking, and replete with intelligent policy recommendations—even if it is, as I will argue, wrong in important areas. The Report, while careful in handling of sources, limits its analysis to the recovery and presentation of past facts: what, who, when, and where concerning the kinds of experiments and trials, patient consent forms or waivers, governmental directives, etc. However, it lacks any sustained analysis of interests (governmental, institutional, professional) or other explicit interpretive framework for the past it purports to chronicle. The Report’s historical narrative conveys little sense of what was at stake for the research physicians and scientists, their institutions, and the involved federal agencies, beyond their collective desire to serve the war effort and conquer cancer. Reading its pages, one would never learn that military patronage of medical physics in the early 1940s helped create the modern U.S. medical research university, deflected cancer research in a radiological direction for the next three decades, and propelled several physicians who were involved to the top of the academic medical hierarchy. Nor would one learn that even when some of those researchers were suggesting or performing research activities that their colleagues adjudged to be ethically dubious, not one was ever negatively sanctioned by a professional organization or by the government. These are important developments, and they merited substantive engagement by the Committee. President Clinton’s charge to the Advisory Committee also directed them to generate “advice and recommendations on the ethical and scientific standards applicable to human radiation experiments carried out or sponsored by the United States Government.” 1 According to Committee chair Ruth Faden’s introduction to a summary version of the Final Report that was published separately in [End Page 167] October 1995, the “greatest harm from past experiments and intentional releases [of radiation into the atmosphere] may be the legacy of distrust they created.” 2 I am troubled by several aspects of Faden’s shift of “greatest harm” from the experience of some patient/subjects during the period of the radiation experiments, to skepticism about the ethics of today’s federal biomedical research enterprise. It is as though the real purpose of the Committee’s work is the...