Home Forums Other Specialities Medico Legal Topics & Ethics Darker side of Medicine

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    I happened to read an article on a site named Science Museum. It exposes the darker side of medical profession as practiced in the not so distant past. Some of the excerpts I reproduce below:

    We usually imagine medical science and doctors never doing anything except making revolutionary discoveries and saving lives. Is this realistic or a rose-tinted view? History shows medicine and doctors can ‘go bad’ spectacularly. Some medical controversies were accidents, but many have resulted from deliberate actions. Sometimes doctors believed the greater good (as they saw it) was more important than ethical behavior. Many of these incidents were not problematic at the time, and only became controversial when society’s values and opinions changed.

    The Hippocratic Oath was introduced in ancient Greece as a guide for new doctors on how to behave in their work. However, in Europe it was forgotten after the fall of the ancient Greek civilization. It was ‘rediscovered’ after the Second World War and the discovery of human experiments on concentration camp prisoners by Nazi doctors. The oath was re-established as ethical behavior guidelines for medical practitioners.

    In the 1800s and early 1900s scientists examined human difference using the language of racial difference. Assumptions of European superiority influenced how data were collected and interpreted. The conclusions drawn are now discredited, but were considered mainstream science at the time
    Eugenics emerged in the late 1800s. Eugenicists argued the human race was ‘degenerating’, losing its ‘normal’ qualities. They believed individuals with ‘superior’ qualities should have children to improve the population. Eugenics was popular in many countries, and was seen to ‘improve’ the population. Sometimes this meant improving poor people’s living conditions and health. More often it focused on preventing those deemed inferior from reproducing.

    Family-planning campaigners such as Marie Stopes and Margaret Sanger embraced eugenics in calls for birth control. In the 1930s, government programmes in the USA and in countries across Europe sterilised ‘unfit’ individuals such as the severely disabled. In Sweden, this practice only stopped in the 1970s.

    Ideas of degeneration and racial superiority became extreme in the Nazi ideology of a pure Aryan race. This ‘superior’ race needed to be defended against degeneration by systematically exterminating the biologically ‘inferior’ in concentration camps. This included disabled people, homosexual men and women, and Jewish and Roma people. Nazi doctors such as Josef Mengele also used camp prisoners in human experiments. Doctors’ use of torture in the name of science was examined during the Nuremberg trials. It shocked the medical profession into accepting medical ethics and moral responsibilities.

    Unethical experiments and research did not end after the Second World War, and included cases in which drugs were deliberately withheld. For example, in the 1932-72 Tuskegee Study of Untreated Syphilis in the Negro Male, US doctors secretly withheld penicillin from black patients to see what happened if they were left untreated for decades. The scandal led to another overhaul of medical trials involving humans.

    Insufficient clinical testing can have a huge human cost. This was the case with thalidomide. The drug was thought harmless, but around 1960 it resulted in thousands of babies born with limb malformations. There were many other examples where drugs were tested on patients without permission, even when outcomes had been positive. The 1960s debate over ‘human guinea pigs’ led to tough controls on the testing and release of drugs. New drugs had to be formally tested before release.

    Testing drugs on human volunteers who may feel under pressure has also been problematic. Until the early 1970s, prisoners were sometimes used to test drugs in the USA. Experiments on uninformed patients in poor parts of the world have also been condemned.

    Patients in developing countries are increasingly used as cheap and available subjects to test new drugs. Critics ask how they can give informed consent when many are illiterate and the financial reward is more important than any risk.

    UA Mohammed

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