Human Guinea-pigs Experimentation in Man

THIS is a disappointing book. The reader gains the impression that the author has searched the world's medical literature to reveal procedures to which patients have been submitted that he thinks to be unpleasant, hazardous and unjustified. There is little evidence that anything more than a search of the literature has been undertaken. I would have been more impressed if the author had shown that he had investigated some of the alleged malpractices in greater depth. As it is, I am disconcerted to find that in three instances where I have personal knowledge of investigations that Dr. Pappaworth has criticized, I find his comments misleading and unreliable. For instance, he critizes investigations carried out under the direction of Dr. Stanley Bradley working at Boston and at the Presbyterian Hospital, New York (pages 88, 90 and 115). Dr. Pappworth clearly has little idea of the integrity of this investigator who would never allow anyone in his Department to carry out any procedure on any patient who did not have a full knowledge and understanding of what was being done. He also has little idea of the readiness with which patients will cooperate with procedures of this sort if they understand why they are being done, and he overestimates the discomfort of these procedures and implies hazards that were not present. Later in the book he criticizes (pages 149-152) the cardiac catheterization studies carried out in the Department of Medicine at the Queen Elizabeth Hospital, Birmingham, in the early 1950's on patients with mitral valvular disease. But he does not make it clear that at that time valvotomy was not an operation to be entered upon lightly. The main purpose of those cardiac catheterizations was to determine whether the pulmonary artery pressure was or was not abnormal, and this was considered a valuable indication as to whether surgery should or should not be offered to each individual patient. Dr. Pappworth quite rightly critizses the American practice of inviting prison inmates to volunteer for medical investigation. But he is less than just to Dr J. A. Shannon (pages 61-62) who was asked urgently to carry out studies of antimalarial drugs at a time of National Emergency in 1943-44 when the world's supply of quinine had been lost to the Japanese in the Dutch East Indies. In this instance, at any rate, each volunteer knew exactly what he was submitting himself to; they regarded …