From Nuremberg to the ethics committees in human experimentation

During the Nuremberg trials, the accusation prompted the creation of an ad hoc committee to advise on human experiments carried out on prisoners during wartime in the USA. Precisely a charge that had been brought against Karl Brandt and his colleagues. This committee was the forerunner of the Independent Committees, to which the Declaration of Helsinki assigned a role in analysing the ethics of research projects in humans. From 1980 onwards, in industrialised countries, the legislation regarding clinical trials began to incorporate similar structures, IRBs in the United States of America, Ethics Committees elsewhere, and the 'Committee for the Protection of Persons" in France. However, at that time, in spite of the misleading words, we went from ethics to law, from rules of conduct intended for researchers to legal regulations organising relations between sponsors, investigators and persons participating in biomedical research, which is not the same thing.     

Informed consent in human experimentation before the Nuremberg code.

The issue of ethics with respect to medical experimentation in Germany during the 1930s and 1940s was crucial at the Nuremberg trials and related trials of doctors and public health officials. Those involved in horrible crimes attempted to excuse themselves by arguing that there were no explicit rules governing medical research on human beings in Germany during the period and that research practices in Germany were not different from those in allied countries. In this context the Nuremberg code of 1947 is generally regarded as the first document to set out ethical regulations in human experimentation based on informed consent. New research, however, indicates that ethical issues of informed consent in guidelines for human experimentation were recognised as early as the nineteenth century. These guidelines shed light on the still contentious issue of when the concepts of autonomy, informed consent, and therapeutic and non-therapeutic research first emerged. This issue assumes renewed importance in the context of current attempts to assess liability and responsibility for the abuse of people in various experiments conducted since the second world war in the United States, Canada, Russia, and other nations.     

Nuremberg lamentation: for the forgotten victims of medical science.

Fifty years after the Nuremberg medical trial there remain many unanswered questions about the role of the German medical profession during the Third Reich. Other than the question of human experimentation, important ethical challenges arising from medicine in Nazi Germany which have continuing relevance were not addressed at Nuremberg. The underlying moral question is that of the exercise of professional power and its impact on vulnerable people seeking medical care. Sensitisation to the obligations of professional power may be achieved by an annual commemoration and lament to the memory of the victims of medical abuse which would serve as a recurring reminder of the physician''s vulnerability and fallibility.     

Endotoxin and prostaglandin fever of newborn guinea pigs at different ambient temperatures.

At an ambient temperature (Ta) of 30 degrees C, injection of 0.2 micrograms E. coli endotoxin into the lateral cerebral ventricle (icv) of three-day-old or younger guinea pigs was followed by a biphasic febrile rise in body temperature (Tc) and oxygen consumption (VO2), interrupted by a transient fall. At Ta 20 degrees C the change in Tc and VO2 was still biphasic, the first rise was similar as that seen at Ta 30 degrees C, but the subsequent fall was more pronounced. Thus, Tc became lower than before endotoxin and remained below the pre-injection level during and after the second rise. Injection of 10 ng PGE1 icv caused sustained monophasic hyperthermia at both Ta-s. Icv injection of 0.9% NaCl did not affect Tc and VO2 at either Ta. Accordingly, prostaglandins might contribute to, but cannot account for, the whole febrile response to endotoxin.     

An audit of the BMJ's correspondence columns.

OBJECTIVE--To see whether some sections of the BMJ attract more comment than others, whether letters submitted in response to different sections of the journal are rejected at different rates, and whether the balance between letters that agree and disagree with articles in the published correspondence reflects that in submitted letters. DESIGN--Retrospective audit of letters submitted for publication in the correspondence columns of the BMJ in response to articles published between 1 January and 21 May 1989. SUBJECTS--A total of 1319 letters received by the journal, 974 submitted in response to the 1501 published articles and a further 345 raising new issues. MAIN OUTCOME MEASURES--The total numbers of letters submitted in response to the four main sections of the journal--editorials, news, papers, and middles--and the numbers published. Submitted and published letters were analysed according to whether they agreed or disagreed with articles. RESULTS--The overall rejection rate was 63% (831/1319), but among letters relating to articles it was 56% (543/974). Editorials and middles attracted proportionately more letters than papers, but letters relating to papers had a lower rejection rate (43% v 57% for editorials and 43% v 66% for middles). For all sections more letters disagreed than agreed, but a higher proportion of letters in response to editorials and middles disagreed than those submitted in response to papers (64% and 72% v 53%). Among the published letters, however, broadly equal numbers of letters agreed and disagreed with articles, irrespective of section. CONCLUSION--Those sections of the journal that aim at stimulating debate succeeded in attracting the most comment. The relative importance of original scientific research papers was reflected by the priority given to letters submitted in response to papers, and the final correspondence column was a balanced platform of debate despite an unequal submitted response in terms of letters that agreed and disagreed with different sections of the journal.