Book Review

Subjected to Science: Human experimentation in America before the Second World War

N Engl J Med 1995; 332:1525June 1, 1995

Article

Subjected to Science: Human experimentation in America before the Second World War
By Susan E. Lederer. 192 pp. Baltimore, Johns Hopkins University Press, 1995. $32.95. ISBN: 0-8018-4820-2

The Nuremburg Trial and the annunciation of the Nuremburg Code in 1947 were watershed events in the history of the ethics of human experimentation. Although some of the judges who issued the judgment at Nuremburg were Americans, the period from the 1940s to the 1970s continued to reveal examples of the use and abuse of vulnerable human subjects in biomedical research in the United States. Experiments were often conducted under duress and without consent on military personnel, prisoners, children, the incompetent, the elderly, and the dying. Formal regulations protecting human subjects participating in biomedical and behavioral research were not promulgated in the United States until 1973.

What was the history of clinical research before World War II? In the first book to explore this question, Susan Lederer reviews the ethics of human experimentation in America between 1890 and 1940. The author is a well-known medical historian and an expert on the history of both human experimentation and the antivivisection movement. Dr. Lederer presents a meticulously detailed account of case after case of the exploitation of human subjects and the use of human subjects as a means to achieve scientific ends. This book is the first scholarly analysis of a critical phase in human experimentation that set the context for subsequent military atrocities carried out by physicians during World War II.

Undergirding this history is a valuable philosophical and sociological account of the changing views of the standing and authority of science and medicine. Medical research is alternately seen by the public as a good that benefits society and as an evil exploiting subjects. In parallel, the medical and scientific communities are seen as both heroes and egotistical opportunists.

The period around the end of the 19th century was characterized by a rapid increase in biomedical research. As science moved to the bedside, physicians had to reconcile their role as scientist in search of generalizable knowledge with that of clinician involved in a fiduciary relationship to benefit the patient. Organized medicine was equally ambivalent, since the American Medical Association defended clinical research yet failed to establish a specific code of ethics to protect human subjects.

Central to Lederer's account is the role of the American antivivisection movement in catalyzing concern for the protection of human subjects of medical research. The antivivisectionists tried to bolster their crusade to limit animal experimentation by claiming that unrestrained experimentation on animals would culminate in unrestrained experimentation on vulnerable human beings. It should be noted that the Society for the Prevention of Cruelty to Children was established in 1875, nine years after the Society for the Prevention of Cruelty to Animals. Increasing concern about the protection of human subjects also spurred a formal discussion of the evolving doctrine of informed consent.

By the 1930s medicine had gained unprecedented prestige as a result of the celebration of the advances of medical science. As the fruits of medical research entered clinical practice, the antivivisection movement became increasingly marginalized. Physicians gained further credibility by using themselves, as well as medical colleagues, in experiments.

Dr. Lederer's writing is crisp and clear, her historical documentation is exhaustive, and her social commentary persuasive. This book is an important addition to the growing literature on the history of human experimentation and medical research.

Michael A. Grodin, M.D.
Boston University School of Public Health, Boston, MA 02118