Feb. 1, 1999
Volume 51, No. 18
New York Times' Altman delivers Future Makers lecture
Every miraculous breakthrough in medicine--and there have been more made during this century than in all the rest of recorded history--had its beginnings as an enigma, a yawning abyss, and someone had to be the first to step over the edge into the unknown. And many of these most important steps were made by the miracle workers themselves.
This is what Larry Altman, medical writer for The New York Times, addressed in his Jan. 25 lecture in the Health Sciences Center auditorium, "Who Goes First? The Story of Self-Experimentation in Medicine," lifted from the pages of his new book by the same name. Altman's speech was part of the Future Makers Lecture Series, sponsored by Executive Vice President for Health Affairs Michael Johns. Altman, who holds an MD from Tufts and medical licenses in Washington, California and New York, spent time in Atlanta in the '60s while working for the Centers for Disease Control and Prevention.
A proponent of self-experimentation, Altman posited that the practice is crucial to medical research and that the critics of self-experimentation operate under a "double standard," assuming that the lives of medical researchers are more valuable than other volunteers.
"Without self-experimentation, we might never have learned the true nature of [many] diseases," Altman said. "Drugs might not have been developed, and surgery would be infinitely more painful without anesthetic gases developed by doctors experimenting on themselves."
Official medical policy governing the use of self-experimentation dates back the Nuremberg trials following World War II, Altman said. Article 5 of the Nuremberg codes prohibits the use of human subjects for medical experiments when there is an a priori risk of death--except when the subject is the experimentor.
Altman had good and bad things to say about the U.S. policy of using institutional review boards (IRBs) to approve medical trials using human subjects. He said IRBs are "under scrutiny right now" and that one problem with their procedure is they "usually don't address the crucial question: who will be the volunteers?"
For example, Altman described the work of German doctor Werner Forssmann in 1929. Forssmann experimented on himself to test his theories of heart catheterization. "An IRB probably would have denied Forssmann permission [to conduct the experiment]," Altman said. "What would have happened if he still did it on himself anyway?"
No one knows how much self-experimentation is done in this country, Altman continued, because no records are kept of who the volunteers in a medical trial are. But the practice itself dates back to the Italian physician Santoria, living in Padua during the 17th century, who hooked himself up to an elaborate machine of his own construction to measure his physiological responses over extended periods of time.
Various scientists continued the practice over the years, often producing groundbreaking results. Indeed, Georgia's own Crawford Long experimented on himself in refining the use of ether as a surgical anesthetic. Nobel laureate Gerhard Domack injected cancer cells into his own body to prove it was not an infectious disease. And Joseph Goldberger used himself and his own family as subjects in the 1910s and '20s to prove pellagra was a nutritional disorder, not an infectious disease.
"If we as physicians accept the charge to find cures for heart disease, cancer, AIDS and other diseases," Altman said, "and we accept the logic of human experiments, we come back to the original question: Who goes first?
"Why call self-experimentation foolish when we climb mountains, become test pilots, build bridges and skyscrapers?" Altman asked. "In any experiment, the outcome is not known ahead of time. If the researcher claims there is no risk, why is the researcher unwilling to try it? Doctors' lives are no more valuable than those of the other members of society whom they ask to volunteer for their research."