In the early twentieth century, the United States Government commissioned Major Walter Reed to research yellow fever, particularly in the context of human infection [1]. Dr. Reed began a routine experiment with an experimental group to be infected by mosquitoes, and a control group to not. However, this quickly metamorphosed into a discussion on the ethics of human experimentation; more precisely, how is it just to purposefully infect humans with a disease they might otherwise never be diagnosed with?
In response to much criticism from the medical establishment about inflicting harm on others, a young doctor named Jesse Lazear working with Dr. Reed decided to qualm these criticisms: he would infect himself. Surely, they couldn’t be blamed for unethical treatment if they themselves were undergoing the test? Ultimately Dr. Lazear died soon thereafter, but Dr. Reed went on to publish convincing results. Today, Dr. Lazear is idolized and viewed as a brave trailblazer.
Dr. Barry Marshall, once a professor at UVA, used self-experimentation to win a Nobel Prize in 2005. Up until his time, it was believed that the bacteria Helicobacter pylori couldn’t be pathogenic. However, Dr. Marshall thought otherwise: “I had been arguing with skeptics for two years and had no animal model that could prove H. pylori was a pathogen”[2]. Because approval for human studies would have proved tricky, he brewed a dense suspension of H. pylori and subsequently drank the broth. Five days later, he described bloating, bad breath, and vomiting; subsequent testing demonstrated that because of the self-administered H. pylori, he now had gastritis, or inflammation of the stomach. Marshall subsequently took antibiotics and was cured several days later.
Is this really the best way to get research results? Fortunately Dr. Marshall’s illness could be cured easily, but what if he hadn’t had so much luck? What if the bacteria he drank turned out to be more harmful than hypothesized? In a 2012 literature review, Dr. Allen Weisse found that at least 140 studies that included self-experimentation were in the realm of infectious diseases: where’s the guarantee that researchers aren’t “putting their life on the line”? Doesn’t the Hippocratic Oath forbid self-inflicting harm when it says not to give “a deadly drug to anybody who asked for it”[3]?
On the other hand, Marshall and Reed produced concrete results that have without doubt saved lives. If, instead Marshall had capitulated his battle to prove ulcers weren’t caused by stress, some of the estimated 200,000 patients with ulcers might still suffer today. If Reed conceded to the chorus of outcry about infecting people, perhaps the United States would have more than the zero reported cases of yellow fever in 2015.
In an age where practiced medicine is no longer paternalistic, doesn’t self experimentation make sense? Should the oncologist with cancer treat one of his patients differently than he would treat himself? The dreaded question of many doctors, “what would you do if you were in my situation?” begets necessary discussion that goes beyond the risks and benefits of a treatment. While answering this question may be difficult when physicians try to display an objective summary of potential therapies, Dr. Marshall can easily tell his patients that antibiotics will likely work for their ulcers, precisely because they worked for him.
In the end, self-experimentation remains a gray area of medicine and science. Who is to police those that wish to put their lives and health on the line for the greater good? Yet how can we turn a blind-eye to those that willfully endanger themselves? What about the significant medical knowledge that has resulted from such experiments? Self-experimentation should be examined more closely to evaluate whether the realized benefit in medicine outweighs the potential for harm.
References
[1] Akhil Mehra, “Politics of Participation: Walter Reed’s Yellow-Fever Experiments,” Virtual Mentor 11, no. 4 (April 1, 2009): 326, doi:10.1001/virtualmentor.2009.11.4.mhst1-0904.
[2] Barry Marshall and Paul C Adams, “Helicobacter Pylori: A Nobel Pursuit?,” Canadian Journal of Gastroenterology 22, no. 11 (November 2008): 895–96.
[3] Ask a Librarian, “Guides: Bioethics: Hippocratic Oath,” accessed June 23, 2017, http://guides.library.jhu.edu/c.php?g=202502&p=1335752.