Twentieth Century Ethics of Human Subjects Research: Historical Perspectives on Values, Practices, and Regulations
http://www.100md.com
《新英格兰医药杂志》
The essays in this book arose from a conference dedicated to the "History of Human Experimentation during the Twentieth Century," held in 2001 at the University of Lübeck in Germany. Eight of the 23 contributors (including the editors) live in Germany; the remaining authors are from the Czech Republic, France, Israel, Japan, Russia, the United Kingdom, and the United States, which gives this book an international flavor.
Roelcke and Maio point out in their preface that "historical arguments are frequently used to propagate or attack" positions in current bioethics debates. And they rightly assert that when players in these debates use such arguments, the past is often oversimplified. They also point to the strangely ahistorical aspect of many discussions within bioethics, with the observation that "there seems to be a lack of awareness of the historical dimensions implicit in today's value preferences."
Roelcke ends the introduction by stating that the book can be understood as "an argument for the necessity to include systematic historical reflection in present day ethical debates on human subjects research." He identifies diligent research as crucial to historical scholarship and bemoans the tendency among bioethicists to rely on "deficient, faulty, or misconceived secondary or tertiary [historical] literature." He also calls on historical researchers to avoid interpreting the past largely (or exclusively, in the worst cases) by making comparisons with the present. In his introduction, Roelcke alludes to an additional advantage that arises from careful historical work — an appreciation for the contingency of change. This gain is stated with more force by Nadav Davidovitch in a valuable essay on changing perceptions of the placebo: "The advantage of the historical perspective is that it offers the possibility of a de-familiarization of the existing situation, by understanding that the state of affairs is not a `given,' but is part of an ongoing struggle, with the possibility of negotiation and change."
Some of the contributions to this book are excellent, with Davidovitch's essay heading the list. Paul J. Edelson's piece contrasting the contributions of two whistle-blowers, Henry K. Beecher (of the United States) and Maurice Pappworth (of the United Kingdom), is also very useful. Edelson convincingly builds his analysis around a juxtaposition of Beecher as "the quintessential `insider'" and Pappworth as the "very definite `outsider.'" Edelson, however, misses an interesting layer of complexity with respect to Beecher's status as an insider. Henry Beecher was born Henry Unangst. Young Henry changed his surname to Beecher when he left Kansas for Harvard Medical School, correctly calculating that Boston would be more impressed with a moniker that matched the prominent abolitionist clan (to which he was distantly related through his maternal grandmother). Edelson concludes his essay with perhaps the most interesting general point in the book. He asserts (drawing on the work of Robert A. Nye) that we can properly understand the reaction of physicians to the regulation of human experimentation only by taking into account the "culture of honor" — the central concept from which professions (of medicine or anything else) arose.
Much of this book, however, fails to live up to the standards and expectations set out by the editors. Many of the essays are so poorly organized that the basic points are difficult to discern. Some of the authors fall into the unenlightening trap of presentism. One contributor tosses out the statement that "the process of establishing modern experimental medicine . . . was often, but not exclusively[,] based on unethical experimentation." Simply to label experimentation of the past as "unethical" is to close off some of the most interesting lines of historical inquiry. And, given the editors' call for careful historical scholarship, their choice of citation style is a frustrating mystery. The particular combination of footnotes and reference lists they use is awkward for published works and all but unworkable for archival sources.
The editors are to be commended for rendering all of the contributions into one language, and I am grateful they chose English. The copyediting challenges inherent in working with authors who are not writing in their native tongue are often considerable. In this case, the final results fall well short of any reasonable standard. The text has dozens of clunkers such as the following: "It was quite usual to use hospital patients for experiments." And trite expression seems to have gone largely unchallenged. For example, we are offered the following worn (not to mention inaccurate) metaphor that racism "was the 2000-pound elephant sitting unremarked-upon in the center of the laboratory." (A ton is more like the weight of a water buffalo; a standard elephant weighs about 12,000 pounds.)
Jon M. Harkness, Ph.D.
University of Minnesota
Minneapolis, MN 55455
harkn008@umn.edu(Volker Roelcke and Giovan)
Roelcke and Maio point out in their preface that "historical arguments are frequently used to propagate or attack" positions in current bioethics debates. And they rightly assert that when players in these debates use such arguments, the past is often oversimplified. They also point to the strangely ahistorical aspect of many discussions within bioethics, with the observation that "there seems to be a lack of awareness of the historical dimensions implicit in today's value preferences."
Roelcke ends the introduction by stating that the book can be understood as "an argument for the necessity to include systematic historical reflection in present day ethical debates on human subjects research." He identifies diligent research as crucial to historical scholarship and bemoans the tendency among bioethicists to rely on "deficient, faulty, or misconceived secondary or tertiary [historical] literature." He also calls on historical researchers to avoid interpreting the past largely (or exclusively, in the worst cases) by making comparisons with the present. In his introduction, Roelcke alludes to an additional advantage that arises from careful historical work — an appreciation for the contingency of change. This gain is stated with more force by Nadav Davidovitch in a valuable essay on changing perceptions of the placebo: "The advantage of the historical perspective is that it offers the possibility of a de-familiarization of the existing situation, by understanding that the state of affairs is not a `given,' but is part of an ongoing struggle, with the possibility of negotiation and change."
Some of the contributions to this book are excellent, with Davidovitch's essay heading the list. Paul J. Edelson's piece contrasting the contributions of two whistle-blowers, Henry K. Beecher (of the United States) and Maurice Pappworth (of the United Kingdom), is also very useful. Edelson convincingly builds his analysis around a juxtaposition of Beecher as "the quintessential `insider'" and Pappworth as the "very definite `outsider.'" Edelson, however, misses an interesting layer of complexity with respect to Beecher's status as an insider. Henry Beecher was born Henry Unangst. Young Henry changed his surname to Beecher when he left Kansas for Harvard Medical School, correctly calculating that Boston would be more impressed with a moniker that matched the prominent abolitionist clan (to which he was distantly related through his maternal grandmother). Edelson concludes his essay with perhaps the most interesting general point in the book. He asserts (drawing on the work of Robert A. Nye) that we can properly understand the reaction of physicians to the regulation of human experimentation only by taking into account the "culture of honor" — the central concept from which professions (of medicine or anything else) arose.
Much of this book, however, fails to live up to the standards and expectations set out by the editors. Many of the essays are so poorly organized that the basic points are difficult to discern. Some of the authors fall into the unenlightening trap of presentism. One contributor tosses out the statement that "the process of establishing modern experimental medicine . . . was often, but not exclusively[,] based on unethical experimentation." Simply to label experimentation of the past as "unethical" is to close off some of the most interesting lines of historical inquiry. And, given the editors' call for careful historical scholarship, their choice of citation style is a frustrating mystery. The particular combination of footnotes and reference lists they use is awkward for published works and all but unworkable for archival sources.
The editors are to be commended for rendering all of the contributions into one language, and I am grateful they chose English. The copyediting challenges inherent in working with authors who are not writing in their native tongue are often considerable. In this case, the final results fall well short of any reasonable standard. The text has dozens of clunkers such as the following: "It was quite usual to use hospital patients for experiments." And trite expression seems to have gone largely unchallenged. For example, we are offered the following worn (not to mention inaccurate) metaphor that racism "was the 2000-pound elephant sitting unremarked-upon in the center of the laboratory." (A ton is more like the weight of a water buffalo; a standard elephant weighs about 12,000 pounds.)
Jon M. Harkness, Ph.D.
University of Minnesota
Minneapolis, MN 55455
harkn008@umn.edu(Volker Roelcke and Giovan)