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Beecher: The Ethical Investigator

In 1966, the anaesthetist-in-chief of Massachusetts General Hospital published a paper that would yield greater protection for clinical trial subjects.

Summer 2011
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Henry Knowles Beecher wasn’t the first to draw attention to research abuses when, 45 years ago, he published a paper in The New England Journal of Medicine detailing 22 cases of researchers jeopardizing the health or life of their subjects without informing them of the risks or obtaining their consent. Among the abuses were withholding treatment from soldiers with rheumatic fever and performing extensive, experimental X-rays on newborns. But “Ethics and Clinical Research” was to become a landmark publication, for, as Columbia University medical ethicist David Rothman later wrote, Beecher’s “most important and controversial conclusion” was that such practices “represented the mainstream of science.”

Beecher

Yale Joel/Time & Life Pictures/Getty Images

By 1966, Beecher (who changed his name from Unangst to evoke the 19th-century abolitionist Beecher family) had been anaesthetist-in-chief at Massachusetts General Hospital for more than 30 years. A former army physician, he had learned the power of placebo injections in treating soldiers in pain—lessons that Rothman concluded had helped forge Beecher’s belief that randomized, controlled trials were the only antidote to sham therapy.

Beecher’s views on medical ethics, like those of many of his colleagues, were shaped by revelations of Nazi atrocities and the subsequent Nuremberg Code, which insisted on voluntary consent. Yet Beecher believed that the medical establishment had failed to fully absorb the lessons of Nuremberg at a time when massive increases in government funding were producing an unprecedented expansion of medical research. More money for science meant more subjects to conduct science on—and “science for the sake of science” became a dangerous guiding principle.

Thanks in no small measure to Beecher’s article, medical ethics has shifted radically. International declarations, institutional review boards and watchdog agencies provide research subjects with more protection than ever.

Still, Beecher, who died in 1976, might not be satisfied. Jay Katz, a Yale University medical ethicist and a friend of Beecher’s, wrote that he felt Beecher’s reliance on the good intentions of researchers was insufficient protection.

In a 1958 paper, Beecher said most breaches of ethical behavior stemmed from “ignorance or thoughtlessness,” not malice. Beecher, Katz wrote, “wanted to teach, not to indict.” Yet that sentiment also underscores why his 1966 vision remains unfulfilled.

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