My battle against gonorrhea.

The familiar white urinals, puce-colored walls, and the queasy odor of disinfectant in M207—the men’s room on the mezzanine floor of the University of Pittsburgh’s medical school. I remember standing in a ragged line of seven young men across from the toilet stalls, pants stripped to my ankles. This was the moment, the crux of the clinical trial, the procedure that had seemed so trivial a few weeks earlier when I had agreed to participate. Two men wearing long lab coats busied themselves arranging a sequence of labeled catheters on a metal cart near the sinks. The short one looked like a Marine drill sergeant; the other, older one reminded me of Marcus Welby, television’s kindly general practitioner. But this time Welby wasn’t curing the sick. He snapped on a pair of latex gloves as the drill sergeant turned toward me and the other half-naked subjects and barked, “Okay, gentlemen, we’re ready to inoculate.” I looked from side to side. My colleagues’ faces were mostly indeterminate. One guy, a graduate student from some department across the campus managed a macho smile. My pediatrician friend had turned green. I told myself there was absolutely nothing to be afraid of—a sharp stab in the urethra, yes, but no danger, no side effects, and, best of all, a walloping reward. One thousand dollars! For a newly minted junior faculty member in 1975, this amount was nothing short of miraculous. My participation in the experiment had begun when my department chairman, Ken Rogers, invited me one morning to meet with his colleague, Charlie Brinton, whom I remembered as a fatherly but somewhat boring microbiology lecturer. Dr. Brinton was actually a topnotch scientist who had discovered that protein filaments called pili, which cover Neisseria gonorrhea’s cell wall, are responsible for attaching the organism to human mucosal cells. The pili also inhibit leukocytes’ ability to ingest the bacterium, thus contributing to its pathogenicity. Moreover, Brinton’s laboratory had recently created an antipilus vaccine that produced significant antibody responses in rats, as well as in two human volunteers. In the grand tradition of medical self-experimentation, the two volunteers were Brinton himself and my boss, who was an old hand at vaccine trials, having worked on polio with Dr. Jonas Salk at the old Municipal Hospital for Contagious Diseases. The Army had awarded Dr. Brinton a contract to pursue further work on his vaccine. This was a highpriority project for the military. Gonorrhea infected many thousands of personnel every year and lowered their productivity and morale. An effective N. gonorrhea vaccine had the potential to prevent all that if given to recruits during basic training. The next step was for Brinton and his coworkers to embark on a small pilot study of vaccine efficacy in healthy adult men, which was precisely where I came in—they needed a seventh and final subject. The protocol was straightforward. Each volunteer would first receive a parenteral vaccine injection. The subjects’ antibody responses would then be monitored over the ensuing several weeks. The project definitely did not involve going out and contracting gonorrhea in the traditional way. Rather, each subject would be given an intraurethral inoculation. Four subjects were randomly assigned to receive a pathogenic dose of Neisseria gonorrhea; the other three, a saline solution. Subjects would keep track of symptoms, if any, and undergo a daily examination. Subjects who became ill with gonorrhea would be treated immediately; their nonsymptomatic colleagues would receive antibiotics at the end of the study as a cautionary measure. The inducement was a check for $1000. This sounded like the key to a new car to me. We had been nursing along our romantic but utterly undependable Jeep Cherokee for weeks. We desperately needed a new family car. Having recently arrived in Pittsburgh with two small children and two mortgages— our house in North Carolina was still on the market—we had only one salary of $26,000 per year. “Gonorrhea!” My wife exploded later that night when I described the study to her. “You must be out of your mind!” “No,” I assured her. “This makes a lot of sense. It’ll prove I’m a team player. What will Ken and the others say if I turn it down? They’ll think I’m not committed.” “But isn’t it dangerous?” she asked. “Absolutely not,” I insisted. “If I develop an infection, they’ll give me penicillin right away. You, too. There’ll be no problem. Really, it’s perfectly safe.” In the end we agreed that I’d sleep on the sofa until the study was safely over. I don’t remember the consent form, but it was certainly a far cry from today’s complex and highly regulated legal documents. In the mid-1970s, the modern era of ethics in human research had hardly begun. As a result of public outrage over revelations about the Tuskegee Syphilis Study, Congress had passed the National Research Act in 1974, which authorized the creation of a National Commission for the Protection of Human Subjects in Biomedical and Behavioral Research. Ethical requirements for human research, including informed consent procedures and evaluation by institutional review boards, would not be fully established until several years later when the Commission issued its final recommendations, in the Belmont Report, in 1979. Annals of Internal Medicine On Being a Doctor