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October 22, 2000
2:48 AM   Subscribe

Lots of posts lately about the election, about other strange things, (and especially about my favorite subject to not read: Nader) and we haven't had a knock-down drag-out argument about ethics for a while. So I thought I'd start one about this. Using up humans to collect medical data is unquestionably immoral and those who do it should be hung, if not put to death by torture. The question is whether those of us who had nothing to do with the collection of that data and have not done anything immoral become immoral by using data collected that way in order to save lives. I'm going to make three posts below, so be patient.
posted by Steven Den Beste (30 comments total)

 
Post 1 of 3: Godwin's law doesn't apply. While this article references the Nazis, the Japanese were doing exactly the same thing; and it could just as easily have been Russians using up Armenians or Ukrainians, or Hutus using up Tutsis, or the Khmer Rouge using up just about anyone within reach. The Holocaust is the most famous of the attempts at genocide in this century, but by no means the only one.
posted by Steven Den Beste at 2:51 AM on October 22, 2000


Pose 2 of 3: Argument in favor The people who died such horrible deaths cannot be brought back. But perhaps their deaths can be given some meaning. Many have died so that others can live; this can be thought of as being the same kind of thing. The data on hypothermia, in particular, has turned out to be exceedingly useful over the years and many people have been saved with it. Thus though the act of killing those victims in such experiments is despicable, their deaths still have meaning. To throw that data away and refuse to use it is to condemn more people to die, and to deprive those who were consumed in the experiments of any value for their lives.
posted by Steven Den Beste at 2:56 AM on October 22, 2000


(The last should have read "Post 2 of 3" -- sorry.)

Post 3 of 3: Argument against Yes, the data can save lives. And that means that in future, when such an opportunity to commit such crimes again presents itself, the "doctors" involved will be able to rationalize their acts as being a short term evil but a long term good, with the good ultimately outweighing the bad. (The evil is confined to a finite experiment, but the data could be used forever.) If we deliberately discard the data, and adopt the policy of always discarding data collected by immoral means, then the doctors won't be able to rationalize their acts. They'll be committing evil acts with no good side -- and will be less likely to commit them. This could then save future victims of similar crimes: not merely to be killed, but to be slowly and painfully tortured to death. To use the data but condemn how it was collected with some sort of mealy-mouthed disclaimer doesn't solve the problem; the criminals would still know that the data they collect would be used, and that the functional good from it would outweigh the evil. This is intolerable.
posted by Steven Den Beste at 3:08 AM on October 22, 2000


It can happen here.

By 1943, when the Division of Venereal Diseases began treating syphilitic patients nationwide with penicillin, the men in the Tuskegee study were not considered patients. They were viewed as experimental subjects and were denied antibiotic treatment.

From a moral standpoint this is no different at all from what the Germans and Japanese were doing.

posted by Steven Den Beste at 3:16 AM on October 22, 2000


I think you're going to have a hard time getting a heated discussion here, Steven. Most people would view those experiments will total revulsion and would not be in favour of using knowledge obtained that way.

If as you say (and I know you are right), this information has been used by the unscrupulous allied victors (who also employed a lot of nazi scientists after the war), then we are kind of stuck. How do we unlearn what has been learnt? How do we unuse what has been used?

The only proactive thing left to us might be the destruction of the existing records, but it is so late now that I would think that complete destruction is unlikely to be possible.

posted by lagado at 3:48 AM on October 22, 2000


Also, I wouldn't be advocating the execution of the perpertrators, let alone execution by torture, but that's just me.
posted by lagado at 3:51 AM on October 22, 2000


Sorry, didn't read your last two posts. Yes, I would agree that we should have an international ban on the use this data, particularly in new cases where we might stand a chance enforcing that ban.

Weapons research has the same ethical conundrum. How many governments sat up watched in great detail what happened to the Iraqi Kurds when someone dropped nerve gas on them? Or when someone dropped an atomic bomb on the residents Nagasaki and Hiroshima?

What government wouldn't love to know in great detail the killing potential a technological advance? Sometimes they need to go to war just to find out.

posted by lagado at 4:03 AM on October 22, 2000


All need for "medical use of data" would be unncessary if everyone woke up one morning and just accepted that death happens and when it's your time, you just have to go. Doctors have no clue. Even today, all these Cancer research institutes (Sloan-Kettering etc.) just gathers data at the expense of some dying person.
posted by tamim at 9:22 AM on October 22, 2000


How much knowledge should we sacrifice in an attempt to counter hypothetical future "rationalization" by hypothetical future criminals?

Exactly none.

If I were tortured and murdered and somehow my opinion were still able to be solicited, it would definitely be that I would prefer that innocent people be able to somehow benefit from my suffering/death.

Of course, my first choice would still remain not to have been tortured and murdered.

How data is acquired is a matter for debate and societal controls; how to suppress and discard useful data should not be.
posted by rushmc at 9:34 AM on October 22, 2000


To tamim:

Doctors have "no" clue? Than how do you explain the cures that they DO effect (and at a much greater rate than any other humans in history have been able to do)?

Similarly, if everyone has a predestined "time" when they must "go," why is it that on average people's time is coming so much later in life now than at any time in the past?
posted by rushmc at 9:37 AM on October 22, 2000


why is it that on average people's time is coming so much later in life now than at any time in the past?

It's because The Doctors are interfering with destiny. The moral thing to do, the act most in accordance with the Dao of Death, would be to take the Zyklon-B to the intensive care units.
posted by EngineBeak at 10:05 AM on October 22, 2000


rushmc:

You misread my "accept death" with "predestined time." Death is unavoidable. It might come the next minute. Or ten thousand years later. At some point in time, you will die.

I personally think all doctors have no clue. They are all guessing at what ails you. They are trying to "experiment" with the various chemical reactions of medicine to "try to cure" you. This is why they need all these "historical data" of all the reactions gone bad.

Here is a simplified "medical process": "Patient sneazed - we gave pepsi - patient died - never again should we give pepsi to a sneazing person. -- Patient sneazed - we gave sprite - the sneazing went away - we have found a cure." And this cycle goes on forever.

The only people in medical profession I respect are surgeons who can cut you open, replace your organs, stich you back. (I also have great respect for auto mechanics who can disassemble and then fix a transmission.) You need mechanical skills to be a good surgeon. All other doctors are just guessing what ails you. (And just replacing a diseased organ is not "curing.")
posted by tamim at 10:14 AM on October 22, 2000


That's simply not true tamim. I know cardiology pretty well, and although transplantation, open heart surgery and other surgical procedures like stenting etc. are important, they are very much on the decline in cardiology (esp. in the US) in favour of effective drug therapies. In fact - in combination with drug therapies - you can't have one without the other. Surgical procedures are studied experimentally just like any drug is studied - that's a development of the last 15 years.

Take stroke - most of which are identical to the most common kind of heart attack, only in the brain (cardiology and neurology are coming together in realizing this) - if you get to an emergency doc within 3 hrs of the onset of a "brain attack" they can administer TPA in many situations. 30 years ago strokes were a sure ticket to death or severe loss of motor and brain function. Today that is simply not the case. It's too much to say that they've been cured, but it's pretty close. And trained emergency physicians know how and when to use TPA - it's not experimental.

That's just one example. In any given month there are over 10000 pages of academic cardiology studies published in the world - not on blue sky "wouldn't this be neat" research but on ever-more-minute precisions of existing information. It's not some conspiracy to spend trillions of dollars - this research yields tangible benefits - cutting the amount of invasive surgery done, improving people's lives, keeping people alive.

On the question of Nazi data - I think that the whole question revolves around consent. Since we may assume that the victims of the experiments didn't consent, like it or not we should bury the data. In any case, there are much more sophisticated ways of gathering data that will help us recreate any knowledge that the studies may or may not have found available now, so the point is pretty much moot in 2000.
posted by mikel at 10:54 AM on October 22, 2000


Nonsense and other words, tamin. We know quite a bit about the molecular machinary that runs the body, and the one thing that impresses me over the years how more targetted our therapies have become over the years. And thanks to advances in computing/imaging/information dissemination, it's getting better, faster, all the time.

Example: For years, we treated heart attacks with different blood thinners and blood clot busters. First aspirin (it worked, but we didn't know why at first). Then streptokinase, then r-tPA; they broke up clots but but in a very nonspecific manner. Now we have a class of medications (the IIb/IIIa inhibitors) that bind to the specific molecular attachment site allows platelets - the blood cells that start a clot/heart attack - to bind to other platelets, without interfering with their other functions.

The lines between surgeon and internist are blurring, as well. Interventional cardiology is practiced by cardiologists (non-surgeons) who open up coronary arteries from the inside with catheters inserted in a peripheral artery and guided to the obstruction by x-ray. Cardiac surgeons now do bypass surgery through small chest incisions using remotely guided robotic arms. Both use remotely guided instruments to fix coronary artery blockages. Which one is practicing surgery? Both? Neither?

I really don't think I'll change your opinion, but I think you're terribly underinformed about the state of medicine today. Somewhat accurate 35 years ago, not very today.


posted by alhawkins at 10:56 AM on October 22, 2000


How to cure "sick" knowledge? Perhaps we should ban its application and consider it scientifically invalid until it is cured. We would cure it by testing all of its assumptions and results using our common codes of ethical and professional behavior. This delays its use until we have a moral certainty that we would have reached these conclusions anyway, it demonstrates that perpetrators were wrong in their means, and it does not waste the victim's contribution.
posted by evanwolf at 10:58 AM on October 22, 2000


Using up humans to collect medical data is unquestionably immoral

Oh yes? Even if it cures many more people than it "uses"? So you'd also object to people dying in WWII to "stop Hitler" (I realise it's a crass comparison, but the logical point remains). If someone had to die by lottery to cure cancer, would you object?

and those who do it should be hung, if not put to death by torture

Oh yes? So capital punishment is aceptable? And torture is OK too? Maybe you're American and find killing people (and children) by the state acceptable, but a large chunk of the civillised world does not.

As far as whether or not "tainted" data can be used - why not let the people it can save make the choice? I would use it to save my life... Would you refuse? How is refusing it going to help anyone?

Better to put some effort into avoiding the same thing happening again than try and assuage any cultural guilt by attributing some weird kind of anthropomorphic guilt to data. It's just that - data.
posted by andrew cooke at 11:32 AM on October 22, 2000


>Maybe you're American and find killing people (and children) by the state >acceptable, but a large chunk of the civillised world does not.

Ummm...Andrew....Bit of a generalisation, don't you think?

Signed,
An American who finds killing of anyone, by anyone, unacceptable
posted by Optamystic at 12:16 PM on October 22, 2000


Andrew: Look at post 3/3. Refusing to use the data, even to save my own life, could help prevent similar crimes from happening in the future.

Anyway, I did my best to try to present both sides fairly, and I did not present my own opinion, which I'm reserving for the moment.

Tamim, I suspect you're not as old as I am. I remember the very first organ transplant, done in South Africa. And shortly thereafter, surgeons all over the world wanted to get into the act, and there was a flurry of heart transplants. And all the surgeons proceeded to watch their patients die as the hearts were rejected by the immune systems of the patients.

So they stopped doing them. Now it's a routine operation, with several different organs. Why? Because one doctor realized that the transplant was the easy part. Prevention of rejection was the hard part, and he started doing basic research on immune suppressants, to try to find drugs which would prevent rejection of the organ while at the same time not leave the person completely defenseless against disease. (Total immune suppression guarantees death within a month or two.) And he found it. (Better ones have been found since.)

And only then could the surgeons start doing transplants again, because now they could have a pretty good chance that their patients would live more than six weeks after the operation.

posted by Steven Den Beste at 1:28 PM on October 22, 2000


I don't see how complaining about the elections and nader should even be in the description on the front page. Talking about completely unrelated things in the description is just as bad as the 'click here dudez' posts.

"I think Steven Den Beste's posts are too much in favor of torture, click here for some pictures of monkeys kissing."



posted by skallas at 1:58 PM on October 22, 2000


The Human Genome Project means, that either we will be the last to die, or the first to live forever.
posted by Zool at 8:05 PM on October 22, 2000


The above statement is false.
posted by EngineBeak at 8:54 PM on October 22, 2000


Enginebeak: How did you come to that conclusion?
posted by Zool at 9:06 PM on October 22, 2000


It's because The Doctors are interfering with destiny.


There is no destiny. Only predisposition.
posted by rushmc at 10:36 PM on October 22, 2000


tamim:

I fail to see how the fact that death is "inevitable" precludes my doing everything within my power to postpone it as long as possible.

And my point about your previous post was that while I agree that doctors don't know nearly as much as they'd like us to think they do (or even as much as they think they do), they do have some knowledge, so your statement that they do not have a clue is simply false. Or hyperbole, which is almost as bad.
posted by rushmc at 10:40 PM on October 22, 2000


The data can not be suppressed, you can not "un-know" something. The vast majority of a population can forget, but the information will still be there somewhere. You might as well use it if you can, data is just data, regardless of it's source. I agree that in a perfect world we would not have the data because the experimentation would not have happened. That does not mean that we get any closer to that perfect world by not using the data and pretending it didn't happen.
posted by Nothing at 10:52 PM on October 22, 2000


I can't believe no one touched on a related subject: medical testing on prisoners. People in jail for heinous crimes, some will die anyway, and some people think giving them experimental drugs is a better use of their lives. But it's torture, plain and simple. Isn't it?
posted by mathowie at 10:55 PM on October 22, 2000


Aren't prisons full of HIV infected prisoners already? If i was HIV infected i'd be volunteering for some experimental drugs, which is how most testing is done currently. There are more volunteers than there are experimental drug trials.
posted by Zool at 11:17 PM on October 22, 2000


mathowie,

Well there's at least one neanderthal at Northern Illinois University. Let's cut her up and examine the mind of a simple savage creature from the distant past.

"Ah yes, this proto-human's brain lacks any sense of justice, compassion, and cannot question the tribal elders. Their rules and decisions are perfect to go against them would require indepedant thought, something she cannot accomplish." Very uninteresting, no wonder the humans won out.
posted by skallas at 11:51 PM on October 22, 2000


huh? come again?
posted by lagado at 12:07 AM on October 23, 2000


The prisoners in those programs "give informed consent" though it's an open question of just how informed it is, nor how coerced the consent is. They're paid for their participation in those programs, and use the money for cigarettes and girlie magazines which they otherwise couldn't get.

But in principle, they're not involuntary victims. That's a qualitative difference.

Another is that it was the intention of the efforts I cited to actually kill the subjects. The modern tests in prisons are quite deliberately designed so that while they may cause significant negative side effects, they don't kill.
posted by Steven Den Beste at 1:31 AM on October 23, 2000


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