Human guinea pigs and the ethics of experimentation: the BMJ's correspondent at the Nuremberg medical trial.

Though the Nuremberg medical trial was a United States military tribunal, British forensic pathologists supplied extensive evidence for the trial. The BMJ had a correspondent at the trial, and he endorsed a utilitarian legitimation of clinical experiments, justifying the medical research carried out under Nazism as of long term scientific benefit despite the human costs. The British supported an international medical commission to evaluate the ethics and scientific quality of German research. Medical opinions differed over whether German medical atrocities should be given publicity or treated in confidence. The BMJ''s correspondent warned against medical researchers being taken over by a totalitarian state, and these arguments were used to oppose the NHS and any state control over medical research.     

Estimating the cost of compensating victims of medical negligence.

The current system in Britain for compensating victims of medical injury depends on an assessment of negligence. Despite the sporadic pressure on the government to adopt a "no fault" approach, such as exists in Sweden, the negligence system will probably remain for the immediate future. The cost of this system was estimated to be 52.3m pounds for England 1990-1. The problem for the future, however, is one of forecasting accuracy at provider level: too high a guess and current patient care will suffer; too low a guess and future patient care will suffer. The introduction of a mutual insurance scheme may not resolve these difficulties, as someone will have to set the rates. Moreover, the figures indicate that if a no fault scheme was introduced the cost might be four times that of the current system, depending on the type of scheme adopted.     

Necrobacillosis: a forgotten disease.

Over four years five previously healthy young adults developed necrobacillosis , a severe septicaemic illness caused by Fusobacterium necrophorum. The infections were characterised by sore throat followed by rigors and the formation of metastatic abscesses and all caused considerable diagnostic confusion.     

An active interface between medical science and aeronautical technology: the physiological investigations for the XC-35.

Although the advantages of flight at high altitude were early recognized, so also were the physiological problems standing in the way of its realization. The idea of surmounting such problems by means of a pressurized cabin was advocated as early as 1909, while the first attempt to translate the concept into actuality occurred in 1921. Neither it nor several successive attempts enjoyed any real success until a project launched by the U. S. Air Corps in 1935 produced a breakthrough aircraft designated the XC-35. The major reason for the favorable termination of that venture was the thoroughness of the engineering involved. But it is equally notable that this was the first instance in the age of powered flight where there was an active collaboration between the scientists and engineers, a rather curious circumstance in view of the fact that the achievement of altitude record-setting balloon flights in the nineteenth century had owed a great deal to an interconnection of aeronauts and scientists' laboratories. This paper focuses on the physiological investigations which informed the XC-35 engineers while at the same time bringing into being a new aeromedical laboratory taking the first small step toward turning aeromedicine into space medicine.     

Where medical science and human behaviour meet.

Although we may be wrong about the details, we should try to imagine what the future holds for hospital consultants. The days of the independent consultant in the same post for 30 years are over, and there will be a change from "the" consultant to a few tiers of senior staff. Patients will increasingly demand to see specialists, so more specialists will be needed. As patients and their advocates become better informed the traditional rationing of clinical care to patients in Britain, such as restricting access to specialists, cannot continue. There is a current trend for evidence based health care, but the idea that each element of medical practice can be dictated by systematic evidence based research will prove to be naïve--such research informs practice rather than dictates it. Science will continue to act as the guide to medical practice but specialists will not be turned into a set of logical operators running programs designed by health planners.     

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.