Doctors Gone Bad

1. Doctors Gone Bad Human Subject Experimentation (1915 – the present) Torturers Murderers and Despots Martin Donohoe

2. “When a doctor [goes] wrong, he is the first of criminals. He has nerve and he has knowledge.” - Sherlock Holmes to Dr. Watson, Arthur Conan Doyle

3. Armenian Genocide (1915-1917) • Dr Mehmet Resid (Ottoman middle manager, started Butchers’ Brigade) • “Those Armenian bandits were a bunch of harmful microbes pestering the body of this nation. A doctor’s duty is to kill microbes…”

4. Nazi Medicine • Guiding philosophy = Hegelian (rational utility) • Parallels in Social Darwinism, American and British eugenics movements • Ethics reduced morality to efficiency, economics, and aesthetics

5. Nazi Medicine • An arm of state policy • Individual worth stated in economic terms • Focus on racial purity • eugenic sterilization (370,000) • Note 70,000 victims in 20th Century U.S. sterilization programs • involuntary euthanasia (70,000) • large-scale genocide (over 6 million)

6. Nazi Medicine • Doctoring the nation more important than doctoring individuals • Focus on preventive medicine and public health: anti-tobacco and anti-alcohol campaigns, environmental toxins, organic farming • to improve Aryan stock

7. Nazi Physicians • 52,000 physicians • National Socialist Party Members • Complicit physicians salaries rose, academic perks • Jewish physicians ostracized/killed/committed suicide; replaced by young Aryans

8. Nazi “Physician-Researchers”(Torturers) • Dr. Sigmund Rascher - coagulation/amputation studies; hypothermia experiments • Dr. Karl Gebhart: heteroplastic (inter-species) transplantation experiments • Drs. Karl Clausberg and Viktor Brack: X-irradiation/sterilization • Drs. Joachim Mrugowsky, Erwin Ding-Schuler, and Waldemar Hoven: IV phenol and gasoline executions

9. Nazi “Physician-Researchers”(Torturers) • Dr. Friedrich Wegener (formerly “Wegener’s Granulomatosis,” now granulomatosis with polyangiitis): German pathologist, Nazi party member, autopsied a prisoner with oxygen injected into his bloodstream in an embolism study; may have participated in experiments on concentration camp inmates

10. Nazi “Physician-Researchers”(Torturers) • Dr Hans Conrad Reiter (formerly “Reiter’s Syndrome”, now “reactive arthritis”): senior Nazi official • Dr. Hans Eppinger – water deprivation experiments, “father of modern hepatology” • Dr. Joseph Mengele: Septicemia/twin vivisection studies

11. “Indirect Participants” • Prof. J Hallevorden: “If you are going to kill all these people at least take the brains out so that the material could be utilized … the more (brains) the better….I accepted these brains of course. Where they came from and how they came to me was really none of my business.”

12. Doctors and Resistance • Pockets of resistance: Catholics, Marxists, Dutch • Drs Eugene Lazowski and Stanislaw Matulewicz created a fake typhus epidemic during the German invasion of Poland (1939) • Germans fooled, quarantined area, many Jews escaped death

13. Consequences for Physicians • Nuremberg Doctors’ Trials: 23 German physicians tried; 16 found guilty • 7 hanged (incl. Gebhardt, Brack, Hoven, and Mrugowsky) • Hallevorden committed suicide before trial • Rascher died before trial • Mengele fled for Argentina (remains verified 1985)

14. Changes in Research Subject Protections • Nuremberg Code • Declaration of Geneva • Common Rule • Others

15. Japanese Abuses in WW II • Extensive biological and chemical weapons program involving prisoners of war • Over 10,000 doctors and researchers involved (led by Shiro Ishii, Chief Medical Officer of the Imperial Japanese Army)

16. Japanese Abuses in WW II • “Experiments:” • Deliberate infections with plague, cholera, typhoid, anthrax, and TB • Testing of drugs and vaccines not previously tested in animals • Surgeries (for training purposes) without anesthesia, followed by vivisection/death • Detonation of bombs, followed by vivisections • Number of victims unclear, likely in six figure range • Subjects referred to as maruta (“logs”)

17. Japanese Abuses in WW II • Many participants later achieved positions of prominence in Japanese medical schools and societies • E.g., Tokyo Prefectural University, Olympic Committee, Green Cross, Japanese NIH, and private sector companies

18. Japanese Abuses in WW II • U.S. government made secret deal with Ishii and top collaborators - 250,000 yen and immunity from prosecution in exchange for exclusive access to data • Japanese scientists brought to Fort Detrick, MD, to help establish U.S. biological/chemical weapons program • Ishii variously reported in US, South Korea, and Japan; later worked at free clinic for children; converted to Catholicism 1 yr before death from throat cancer

19. U.S. Abuses in WW II • Classified tests exposing tens of thousands of soldiers and Japanese internment camp victims to mustard gas • Veterans sworn to secrecy • Veil of secrecy lifted in 1990s, but VA only contacted 620 vets between then and late 2000s; many denied care • Investigation led to law requiring VA to re-examine all claims

20. US Abuses in WW II • US Studies on prisoners in WW II: • Gonorrhea • Gas gangrene • Dengue fever • Malaria

21. Post-WW II • Science Council of Japan (equivalent to US NAS) vows that Japan “will never pursue scientific research for the purpose of war” (1950) • German Medical Association apologizes for its role in the Holocaust (2012)

22. Post-WW II Human Subject Experimentation • Tuskegee Syphilis Study • “The men’s status did not warrant ethical debate. They were subjects, not patients; clinical material, not sick people.” • Dr John Heller, Director of Venereal Diseases at PHS between 1943 and 1948 (interviewed in 1976)

23. Post-WW II Human Subject Experimentation • Guatemala STD study (1946-8) • “Unless the law winks occasionally, you have no progress in medicine” • Dr. John Cutler (research coordinator) • In 1943, Cutler infected volunteer federal prisoners in Indiana with gonorrhea in exchange for cash • After Guatemala, Cutler oversaw the Tuskegee Syphilis Study • Acting dean at University of Pittsburgh in 1960s

24. Post-WW II Human Subject Experimentation • U.S. govt.-sponsored radiation experiments (e.g., Strong Memorial Hospital/University of Rochester (NY), Dr Wright Langham) • LSD/sensory-deprivation/electroshock investigations (CIA - MK Ultra) • Dr James Ketchum (psychiatrist) – psychochemical warfare studies for US Army • Ketchum later joined faculty of University of Texas Medical School

25. Post-WW II Human Subject Experimentation • Pentagon/CIA experiments on soldiers and civilians • Edgewood Arsenal Experiments (involving more than 7,000 soldiers who were exposed to at least 250 biological and chemical agents) • Including sarin, VX, LSD, ritalin • Caused long-term health effects

26. Post-WW II Human Subject Experimentation • 1963: Dr. Chester Southam injects tumor cells into extremely infirm patients at Jewish Hospital for Chronic Disease in NY without informing them that the shots contain cancer cells • Southam later elected President of American Association for Cancer Research

27. Post-WW II Human Subject Experimentation • Willowbrook Hepatitis Experiments (1960s) • Henry Beecher, NEJM (1966) – documented numerous published studies involving ethical breeches (e.g., non-treatment of strep-infected patients, manipulations under anesthesia, deliberate injection of cancer cells into healthy patients) • Unmasking of researchers in 1991 attracted little public attention

28. Post-WW II Human Subject Experimentation • Human Guinea Pigs, by Dr. Maurice Pappworth, published 1967, documents unethical UK experiments • Cardiac catheterization of “mentally-deficient” babies deprived of oxygen to measure physiological responses • Insulin withheld from over 40 children and adult diabetics, followed by liver and kidney biopsies

29. Post-WW II Human Subject Experimentation • Human Guinea Pigs • Unsuspecting individuals injected with malaria parasites, meningitis bacteria, and live cancer cells • Insertion of needles into aortas of peptic ulcer disease patients, who were told it was a “treatment” • Students and junior doctors coerced into finding “subjects”

30. Research on Prisoners • Very common historically (infectious diseases, radiation, pharmaceuticals, illicit drugs) • 1905: Cholera experiments on “volunteers” • 1915: Joseph Goldberger – pellagra • Deadliest dietary disease in U.S. history • Prisoners volunteered in exchange for pardons • 1941: William Black infects children with herpes virus

31. Research on Prisoners • Pharmaceutical and government sponsored studies on prisoners • >90% of pharmaceutical industry research through early 1970s • Rapidly curtailed by state/federal laws and new university regulations in mid-1970s after drug company executives admitted prisoners were cheaper to use than chimpanzees

32. Contemporary Experiments/Abuses • Unethical use of placebo controls • Anti-HIV medications and maternal-fetal transmission(sub-Saharan Africa) • Surfactant for neonatal RDS (Brazil, Bolivia) • Trojan/meningitis/Nigeria (control = inadequate ceftriaxone dose) • Chinese organ transplants from extrajudicially-executed enemies of the state (e.g., Falun Gong, Uighurs)

33. Contemporary Issues and Ethical Dilemmas • Large majority of phase 3 US drug company trial sites outside US, many in developing countries • Uninsured become research subjects to receive needed care • Human guinea pigs (professional lab rats)

34. Contemporary Issues and Ethical Problems • Only 40% of US citizens have a positive overall impression of clinical trials (2016) • Only 4% of cancer patients enroll in clinical trials each year (2016) • Physician-industry links, proprietary nature of data may deter altruistic volunteers, lead to secrecy, selective or even non-publication

35. Contemporary Issues and Ethical Dilemmas • Under-representation of women and minorities in clinical trials • Racial minorities often wary of participation in medical experiments • Most clinical trial participants never informed of trial results • Research Fraud – rare, but damaging to research enterprise

36. Doctors as Terrorists Pediatrician George Habash – founder of Popular Front for the Liberation of Palestine Behind aircraft hijackings of Black September (1970) Dr. Fathi Shiqaqi – founder of Palestinian Islamic Jihad (1981) Ikuo Hayashi – chief of circulatory medicine at a leading Japanese hospital Pleaded guilty to planting sarin gas on Tokyo subway (1995)

37. Doctors as Terrorists • Dr Bilal Abdullah convicted in bungled Heathrow Airport car bombing (2007) • Psychiatrist Major Nidal Hasan – awaiting trial for Fort Hood shootings (2009) • Humam Khalil Abu-Mulal al-Balawi: Jordanian suicide bomber, killed 7 CIA agents in Afghanistan (2009)

38. Doctors as Murderers • Radovan Karadzic (psychiatrist) – former leader of Bosnian Serbs - convicted by International Criminal Tribunal for war crimes against Bosnian Croats and Muslims (2016) • Ayman Al-Zawahiri – leader of Al Qaeda • Bashar al Assad (Syrian President, ophthalmologist) –bombings of civilians and hospitals, use of sarin nerve gas, has killed hundreds of thousands of Syrians

39. Doctors as Murderers, Serial Killers • H. H. Holmes, - "the torture doctor," • Linda Burfield Hazzard - "the starvation doctor“ • GP Harold Shipman (British) – world’s most notorious serial killer (250-400 victims) • Michael Swanger (American - 60 victims) • Harry Bailey (Australian - 75 victims)

40. Physician Criminals • Violent crimes, including rapes of patients • Performance of unnecessary, dangerous procedures • Illegal opioid distribution • Medicare fraud, kickback scams • Ethical violations through participation in executions

41. Doctors as Racists • Long history • Common slave era diagnosis = drapetomania • The tendency to run away • Controversy over statue of J Marion Sims (father of modern Ob/Gyn) in NYC

42. Doctors and the Death Penalty • Electric chair - invented by dentist Alfred Southwick • Lethal injection - developed by anesthesiologist Stanley Deutsch • Death cocktail (3 drug regimen) developed by pathologist Jay Chapman

43. Physician participation in “War on Terror” Design torture methods that do not leave physical evidence Monitor health of detainees to prolong interrogations Falsify medical records and death certificates Carry out torture Between 1975 and 2015, 85 doctors in 16 countries were punished for abetting torture or war crimes; hundreds more unpunished (See http://doctorswhotorture.com/) AMA, AAP, APA oppose physician involvement in interrogation/torture

44. Preventing/Stopping Bad Doctors • Early identification • Education • Treatment/remediation • Criminal Justice System

45. The role of the doctor in society • World Health Organization: • “The role of the physician … in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”

46. Contact Information Public Health and Social Justice Website http://www.publichealthandsocialjustice.org http://www.phsj.org martindonohoe@phsj.org