ethics in medical science

pdf: ETHICS in medical science

A chapter translated from the larger text “Des souris et des gènes” (“Of mice and genes”) by André Dréan, published in October 2019. Illustrations and afterword by SamFanto.

This text constantly uses the terms “bioethics” and “biomedicine”, terms which refer to mainstream, conventional medicine, usually of Western origin.

On the role of bioethics in medical research

“Ethics are only the mirror of the evolution of a society, it comes after, it is not the spearhead. If we put it before cold and amoral science, we would stop everything.”.ii Guy Vallancien

All current bioethics laws refer, to varying degrees, to the Nuremberg Code, dated 1947, a period when molecular biology was still in its infancy. The court established in 1947 was American, without the participation of the three other powers who had been a party to the first Nuremberg trials in 1945 against the Nazi dignitaries.

The code generalized the first control measures that had already existed in Europe for decades and which had been the occasion to formulate case law in specific cases, as Chamayou recalled in Les Corps vils [“Vile Bodies”]. For example, in the second half of the 19th century, when hospital researchers in Lyon used abandoned orphans as guinea pigs without any misgivings. The code was intended to prohibit the type of medical experiments that had taken place in the Nazi camps. At least the most unsupportable ones because many of them were an integral part, from the end of the 18th century at least, of experimental medicine, including in the territory of modern nation states, such as the United States, and in the colonial ones that they had constituted. With a few particularly infamous exceptions, they had never been banned and they had even on occasion been recommended by famous people such as Pasteur, Bernard, Yersin, etc. iii No more than for Nazi eugenics, there could be no question of the Nuremberg judges referring to the genealogy of Nazi medicine. They presented it as the infamous exception to the general rule of medical ethics, the famous oath attributed to Hippocrates. A falsification that misses out how defenders of the followers of Dr. Mengele at the trial occasionally reminded people of the experiments still being carried out at the time in the United States. Such as that on syphilis innoculated into thousands of guinea pigs chosen from among black sharecroppers, prisoners, psychiatric patients, prostitutes…

This is why, after condemning atrocities such as vivisection, at least vivisections carried out on human beings in the extermination camps, the Nuremberg Code stated that “some types of medical experiments on human beings, when they are inscribed within reasonably well-defined limits, conform to the ethics of the medical profession in general” iv. The judges justified their positions on the basis that such experiences produce results for the good of society, which are impossible to obtain by other methods or means of study”. In fact, for, anyone who knows the genealogy of medical experimentation since the Enlightenment, the decisions of the American judges in 1947 came purely and simply from Benthamite utilitarianism v, taking as their criteria the morality and legislation of “the happiness of the greatest number”, even if this means, in case of “necessity”, the misfortune inflicted on the “smallest number possible”. In addition, the code specified that such rules of ethics only applied to “the territory of the States concerned”. This amounted to authorizing the said States to continue to use the territories they controlled around the world, beginning with their colonies, as fields for medical experimentation.

From such rules of commercial morality, all that was left was to quantify, as closely as possible, the degree of suffering acceptable and accepted in the name of “the progress of the human condition”. This is why the judges accepted the very idea of human experimentation, not to mention prior animal experimentation which obviously did not pose any problem of conscience. They laid down “the fundamental principles” to be observed “in order to respond to moral, ethical and legal concepts”, namely: “The experiment must be based on the voluntary and enlightened consent of the human subject” ; “The experiment should be conducted in such a way that all unnecessary suffering and all physical and mental harm is avoided” ; “The level of risks to be taken should never exceed that of the humanitarian importance of the problem which the experiment should solve”, etc. As if, as a general rule, the common good is that of the state and capital, the Nuremberg Code left the door open to a lot of experiments, in laboratories and elsewhere, carried out by the wo/men in white coats and de facto contrary to the tables of bioethics law that it was supposed to sanction.

In addition, the notion of “informed and voluntary consent of the subject”, posed in terms of formalistic legal terms, evades de facto that of the content. Firstly, even though the tests were, and remain, carried out by experimenters who underline its uncertain, even dangerous character, how can human guinea pigs grasp their modalities and consequences, if not in probabilistic terms and, ultimately, how can they not take medical knowledge at its word. Because where there are subjects, there are also masters. Moreover, it is clear that the fear of dying, for people on borrowed time, here plays the role of the decisive factor in the acceptance of the proposals of the experimenters and the rules of bioethics which are supposed to frame their actions. “Of all the passions, fear is the one that most assures submission to laws”, as Thomas Hobbes vi affirmed in Leviathan. Finally, the individuals tested by laboratories are, as a rule, paid, which in France is legal, at least outside the hospital setting. Which explains why they are from the poorest segments of the population.

The conventions that followed, such as that of Helsinki in 1964, only refined the Nuremberg Code further and insisted, at a formal level, on taking into account “exceptions”, in particular those concerning “voluntary consent” by introducing the idea that the experiment could be accepted by those legally responsible for the human guinea pigs, such as minors, sick or not, or those incapable of making decisions for themselves! So, for example, the current experiments in stem cell therapy on toddlers, or experiments presented as their prerequisites, with the sometimes enormous risks that they involve, are tolerated and even encouraged under such conditions.

The rise of molecular biology brought, in its wake, the formulation of additional rules concerning biomedicine, summarized in conventions such as Oviedo, from 1997, which was supposed, in particular, to frame interventions in human genomes, at least in Europe. Thus, according to Oviedo, they should only be undertaken for preventive, diagnostic and therapeutic ends and when they do not cause transmissible modifications to descendants. For this, the conventions postulate that cells can be classified into two categories, considered as independent of each other: the germen [the reproductive cells] and the soma [https://en.wikipedia.org/wiki/Soma_(biology)], and that, consequently, modifications induced on the latter cannot be passed on to the former. Which, as I have already pointed out, raises axioms which govern the activity of geneticists, without providing the slightest evidence.

But even such laws, which are not very restrictive, have no universal scope. Some European states have still not ratified Oviedo – Germany and the United Kingdom, the latter because it finds it far too restrictive. Which is hardly surprising when you know that in Great Britain, genetics, in particular human genetics, has long been the cutting edge of techno-science. Elsewhere, in the world, a case-by-case basis rules. In addition, biomedical research, like the rest of the research, has supranational sides. As a result, nothing prevents European researchers from participating elsewhere, in China, for example, in research that they consider to be under the control of their respective nation states. Not to mention, in a more general way, the many states that intend to draw annuities from the installation, even if temporary, of teams of people who play around with genomes in their country, especially in Africa.

In fact, the Oviedo Convention, and the various conventions which have completed it for twenty years, do not call anything essential into question, while their apologists claim the opposite. Not to mention that they leave the door open to innumerable exceptions in the name of medical emergency, which, like any article of constitutional law, are sanctioned by national or even supranational institutions. Exceptions which, little by little, become general rules and laws sanctioned by state power. The Oviedo convention, ratified by European states from 1999 on, in the midst of a period of the increasing power of human genome manipulation, proceeds from the same utilitarianism as the Nuremberg Code, but amalgamated with a few rules of morals of monotheistic origin, more exactly Christian origin, relating to the “defense of human life”. That’s why one of the main problems raised by bioethics in France, was that of whether or not to ban research on human embryos, those vast amounts of embryos frozen in their hundreds of thousands, created with a view to their in vitro fertilization. Until 2013, they were still unusable for research, with a few exceptions on the proviso that the parents authorised it

Quite a few well-known geneticists, above all René Frydman vii, demanded the lifting of the moratorium. The geneticist Jacques Testart, champion of so-called citizen science, was himself one of the initiators of in vitro fertilization (IVF), and also of the injection of sperm into the ova (ICSI) without even performing prior tests, which was protested against by those who play at criticism without questioning anything essential. Starting with his own work in animal genetics, then later in human genetics! For example, invited as an advisor to the prince by the Commission of bioethics of the National Assembly, in 2011, he argued: “If the legislator takes seriously the dignity of the human embryo, reaffirmed everywhere, the law should require that preliminary experiments on the embryos of animals should lead to indisputable advances, before moving on to experiments on the human embryo.” But in 2013, despite the frenzied opposition from defenders of “the dignity of the embryo”, namely the same priests and assimilated who defend “the dignity of the foetus”, and who are therefore hostile to voluntary termination of pregnancy (abortion), the law authorized research on vast quantities of embryos, and so on their still undifferentiated stem cells, in the name of the “necessary progress of cellular medicine in France”, within the limits of medical ethics”, of course!

So associations like Citizen Sciences try to play the role of advisors to ethics committees, even if it means sometimes fooling around with theologian “defenders of the integrity of human life”, but do not question anything, and even close their mouths when state power amends essential articles of law, such as those relating to the use of large numbers of embryos in 2013, a state power that does not even ask them their opinion, nor that of the citizens they believe they represent. Which, by the way, given the hopes they place in biomedical research, are mostly rather favorable. But the bioethical committees, recognized by state power, are composed, for the most part, of geneticists who play the role of both judge and civil party. It could not be otherwise given Bacon’s precept: Knowledge is power”. Since science was defined as experimental science, roughly since the end of the Renaissance, the innovations that it generates, or in which it participates, are imposed, via state power, by so many forceful blows which are then legalized a posteriori, which then encounter, on occasion, more or less substantial resistance according to which the same state power establishes committees of control, surveillance, etc. For example, during the 19th century, after recurring riots directed against forced variolationviii in England, and, sometimes, as in France, after the forced use of toddlers placed in hospices as guinea pigs or, as Jean-Baptiste Fressoz demonstrates in The Joyful Apocalypse ix after the catastrophes caused by the carbonization, then by the nuclearisation, of industrial and statist activities. In this way, in the face of faits accomplis, ethical questions were and are asked, without any real success, with one essential aim only – to regulate and supervise the race for power imposed by the state. Bioethics and committees of the same name are no exception. Hence their derisory activity in the face of the repeated and accelerated forceful blows that characterize today’s biomedicine which, operating at full capacity, is nevertheless harmful because at the end of the day, the role of bioethics remains to make people accept the unacceptable.

Recommended: An illustrated history of human guinea pigs (though it ends on an excessively optimistic note on the basis of apparent recent “ethical” requirements made on the pharmaceutical industry that are almost certainly just window-dressing)

FOOTNOTES

Unless otherwise stated, footnotes are by the author, André Dréan.

ii Professor at the Descartes University, Paris, Vallancien is a member of the Society of Predictive and Personalised Medicine. Declared at a congress in 2016, Montpellier.

iii Discoverer of the bacillus plague, Alexandre Yersin, one of the heads of the Pasteur Institute in French Indochina, inoculated it into Cochin-Chinese prisoners.

iv Translator’s note: translated from the French translation back into English, so it may not be the precise wording. This was put on the Inserm site, Inserm being France’s state organisation that tests and then allows or disallows medical products to be used by the general public.

v Jeremy Bentham took up the utilitarianism of Helvétius, amalgamated with the sensualism of Hume. He claimed to be able to calculate the ratio between joys and penalties from the perspective of statisticians like Petty, the combination of individual interests resulting in the common interest of society, and therefore that of the State.

vi Leviathan or The Matter, Form and Power of a Commonwealth Ecclesiastical and Civil. 1651. Hostile to the English revolution which was liquidated the year the book came out, Hobbes defined the bases of the sovereignty of the modern state, born out of the counter-revolution. Folio. 2004.

vii In collaboration with Jacques Testart, René Frydman was the designer of Amandine, the first “test tube baby” in France. Later, the apologist for the birth of “medical babies“, made by the same selection process as “test tube babies”, intended to be donors compatible with their critically ill older siblings.

viii Translator’s note: A method of immunizing against smallpox comprising inoculating healthy subjects with a mild form of smallpox.

ix The Joyful Apocalypse, a story of technological risk. Despite the sometimes post-modernist approach, the book is useful. Jean-Baptiste Fressoz. Le Seuil. 2012.

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AFTERWORD by Sam Fanto

A brief note on Dr.Mengele:

In January 1937, the same year he joined the Nazi party, Mengele joined the Institute for Hereditary Biology and Racial Hygiene in Frankfurt, where he worked for Dr. Otmar Freiherr von Verschuer, a German geneticist with a particular interest in researching twins. Mengele focused on the genetic factors that result in a cleft lip and palate, or a cleft chin. His thesis on the subject earned him a cum laude doctorate in medicine (MD) from the University of Frankfurt in 1938, the same year he joined the SS.  It’s generally thought, in the scientific world, that Mengele’s published works were in keeping with the scientific mainstream of the time, and would probably have been viewed as valid scientific efforts even outside Nazi Germany. Why mention this? Because there are some people who think that  accuracy and correct evidence-based papers are the essential criteria for judging science, and the practical uses of such ideas are something separate.

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The following extracts from a paper written by K, is also relevant given the  context of a critique of the separation between ethics and science, even though this does not refer to medical science:

“By the late 1800’s, declining soil fertility in Europe drove both scientific research and imperialist land grabs. The search for a means of chemically fixing atmospheric Nitrogen, the main component of what would become Ammonia based fertilizer, was the holy grail of modern Chemistry. The process which broke the deadlock, and which is still in use today, was named the Haber-Bosch process after the two men who created and refined it. The former, Frtiz Haber, invented the laboratory-based method and the latter, Carl Bosch, was responsible for its engineering on an industrial scale. Both men were employees of the German chemicals company Badische Anilin und Soda Fabrik, or BASF.

Within the first two years of the longer-than-expected war with France and Russia, the Deutches Heer was in desperate need of both food and munitions due to the Entente’s naval blockade of German ports. By increasing the productivity of domestic German agriculture and supplying a ready source of the Nitric Acid used in explosives, the Haber-Bosch process provided for both necessities and considerably prolonged the war. In 1932, Carl Bosch reflected, “I have often asked myself whether it would have been better if we had not succeeded. The war perhaps would have ended sooner with less misery and on better terms. Gentlemen, these questions are all useless. Progress in science and technology cannot be stopped” (Hayes 356). Not only was Bosch’s work directly responsible for the massive death toll, the shell shocked and amputated generation which resulted from the first war, but for Bosch these outcomes were of secondary importance to the progress of technology. Bosch’s motivations and intentions can be described solely in terms of scientific development, industrial and commercial efficiency, and managerial efficacy. …

Bosch’s complicity in the horror of war does not end there. Due to his success with Ammonia synthesis Bosch was promoted to chairman of BASF. His ambitions in the service of progress would lead him to play an instrumental role in the creation of the world’s first iteration of the military-industrial complex, and the largest chemical company of its time, the German conglomerate IG Farben. Under Bosch’s leadership, IG Farben developed Coal Hydrogenation, a chemical process for synthesizing gasoline similar in nature to Ammonia synthesis, as well as the means of producing synthetic rubber. …

Before the armament of the German war machine, before the industrial planning behind occupations in the Ukraine and France, before the development, production and sale of Zyklon B to the Schutzstaffel or the construction of a synthetic rubber factory next to Auschwitz, IG Farben executives Carl Bosch and his protégé Carl Krauch were intimately familiar with death and destruction. In 1921, an explosion of the BASF/IG Farben chemicals plant at Oppau killed 561, wounded 2000, and left 7,000 homeless (Hayes 358). Under the direction of Krauch, the plant was restored to full production capacity in three months’ time. This prefigurative insensitivity to the human costs of industry pales in comparison to the efficient slaughter of the holocaust. Additionally, after the incident at Oppau there was no equivalent of the Nuremburg trials to assign blame and hang the judged. And yet, this more socially acceptable collateral damage of progress exposes the moral vapidity of Bosch’s justifications precisely because of its inherency to industrial production. If progress cannot be stopped, then the pile of bodies in front of and behind it must not be accounted for.

After the conclusion of the second war, IG Farben was broken up into its constituent parts including BASF and its pharmaceutical equivalent, Bayer. The global center of Ammonia synthesis moved from Germany to a former forced subsidiary of IG Farben, the Norwegian company and BASF competitor Norsk Hydro. Today, Norsk Hydro is known to the world as YARA and its North American operations produce more synthetic ammonia than any other company on the planet. Bayer, the former chemical weapons manufacturer, heroin distributor, and co-founder of IG Farben, currently owns Monsanto and is one of the world’s largest pharmaceutical and agribusiness companies. The scientific, industrial, and even corporate legacy of the Haber-Bosch process lives on.

While some scholars argue for the impossibility of feeding the world’s current and projected population without the chemical synthesis of Ammonia (Smil), others warn of its compounding detrimental effects which contribute to the existential crisis of an economy and way of life based on industry and petrochemicals. The continued concentration of Nitrogen in our soil and water creates toxic, abiotic conditions, and the release of Nitrous Oxide through the denitrification of Ammonia contributes to the greenhouse effect (Duke), to say nothing of the carbon dioxide produced during the synthesis process. In addition, the improper application of anhydrous ammonia, a common form of ammonia fertilizer, can result in evaporation leading to more pollution, seed destruction, skin blistering and lung tissue damage. In light of these facts, not even the increased food production associated with Bosch’s work can be judged as historically neutral. Here we have yet another outcome, the weight of which buries the intentions of its authors and traps our imaginations between mass starvation and inevitable environmental collapse. A dissection of the arguments around the false choices of petrochemical based industrial agriculture is the subject of its own essay, but the partisan role of corporate propagandists in the public conversation is central to this one.

…Monsanto promotes itself, not as a complicit harbinger of the end of the world, but as a source of life-giving nourishment whose products are necessary in a world with an ever-increasing human population. Contrary to this public relations presentation, in 2019, Monsanto was sued in civil court for, among other things, manipulating the scientific publishing process, colluding with government regulators, and infiltrating media outlets. In an incident which calls to mind Bernays’s infamous subversion of the suffragist movement with his “torches of freedom” media stunt (Century), Monsanto paid fake reporters to spread misinformation to real reporters and thus conscript legitimate media outlets in their propaganda war (Gillam). Never mind that Monsanto products, just like cigarettes, cause cancer. … a scientific pursuit which enabled war and genocide in the last century threatens the basis of life itself in the next.

The Nuremburg trials did not ultimately convict the German executives of IG Farben for their role in the holocaust. The massive quantities of an odorless particulate marketed as pesticide and sold to the Nazi bureaucracy were insufficient to justify a hanging (Jessbenger). The purported use for the pesticide was the maintenance of Jewish ghettos with their cramped conditions. At Nuremburg, this intention was judged as somehow less intrinsic to the outcome of the genocidal process than the gassing itself. It would seem that the authors of Allied military justice agreed with Bernays, unsurprisingly, more than Marx. In yet another noteworthy contortion of history, the patent for Zyklon B was held by Deutsche Gesellschaft für Schädlingsbekämpfung mbH (“German Corporation for Pest Control”), or Degesch for short. Degesch being controlled by IG Farben and its parent company Degussa, which in turn was chaired by none other than Nobel laureate and German nationalist Jew, Fritz Haber. Haber notoriously attempted to create gold from seawater in order to pay German reparations form the first war. This modern alchemy was an ultimately unworkable proposition, the improbability of which is tempered by Haber’s equally ambitious success in creating explosives from thin air. Haber’s former collaborator Carl Bosch escaped the judgment of tribunals altogether, dying in obscurity of alcoholism and ill health in 1940. One of Bosch’s contemporaries and fellow IG Farben board members, NSDP party member Fritz ter Meer (https://en.wikipedia.org/wiki/Fritz_ter_Meer), was sentenced to a mere seven year’s imprisonment and upon his release was re-elected as chairman of Bayer.

Nuremberg raised the question of individual responsibility for social crimes and its utilitarian answers favored the likes of Meer and NASA’s Wernher von Braun. Significant numbers of its trials ended in acquittal and shockingly brief sentences. The rising authoritarianism, mass dislocation, hunger, disease and global conflict suggested by our continued non-responsive orientation to the degradation and collapse of our biosphere provides a parallel that meets the epic tragedies of the world wars in terms of scale if not in terms of historical judgement. Will future generations convene their own tribunals? Will they find any use for the technocrats and organizers of industrial death? Or will they decide to finally halt our steady forward march over the edge of a cliff? Only time will tell, but the isolation of intention from outcome demonstrated by previous generations has surely met its expiration date as a useful measurement of responsibility and value. Indeed, the critical examination of what we produce and how we produce it is a task to be undertaken with utmost urgency.”

 

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