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NO BURNING SECRETS

By Eugene P. TraniJuly 3, 1994
Source: The Washington Post

On June 19, The Post’s Outlook section carried an essay titled “Burning Secrets” by Cliff Honicker, director of the American Environmental Health Studies Project of the Commission on Religion in Appalachia. The article claims that secret and unethical Cold War experiments were conducted in the 1950s at the Medical College of Virginia, now a part of Virginia Commonwealth University.

In an inaccurate portrayal of the archival records, the article falsely alleges that Dr. Everett Idris Evans and a scientific team working in MCV’s burn unit — the first civilian burn unit in the country — took advantage of “unaware human subjects, most of them poor and African American” in burning and radiation studies.

In fact, these not-so-secret studies resulted, during the course of the research project (1949-59), in the publication of 27 articles in nationally recognized scientific journals, a number of presentations before the most prestigious medical and surgical organizations in the world, and local Richmond newspaper coverage.

Funded by grants from the U.S. Army Medical Research and Development Command, Dr. Evans and his team conducted a series of studies involving animal and human subjects to examine the impact of the effects of an atomic blast. The animal study involved whole-body X-ray radiation. Its purposes were to determine the fluid and blood replacement needs following severe burns and to devise approaches to coping with large-scale burn trauma. No such studies were done on humans.

A second, very different study sought to determine the effects of heat radiation and different degrees of thermal injury on healthy human subjects. This study used paid volunteers. They included 44 white MCV students and 22 African American Virginia Union University students. The research team, including two women investigators, also subjected themselves to burns. In this study, subjects received dime-sized “flash” burns of varying degrees on their arms from a 24-inch field Army light — the “intensely hot Army searchlight in a secret lab” noted in the article.

Among the researchers’ conclusions reported in the Richmond newspapers in 1953 and 1954 was that damage from an atomic blast would occur in less than a second, contrary to earlier theory suggesting a longer time lapse. They also learned for the first time that women and African Americans burn more easily than white men. It is interesting to note that the MCV scientists recognized the merit of using women as well as men, African American as well as white, subjects — a major interest of federally funded research today.

The study team also conducted a third study involving burn patients at MCV that was both investigative and therapeutic. It is this aspect of the project that the article attacks most, suggesting these patients were “unwitting” subjects of dangerous radiation.

This study incorporated batteries of diagnostic tests not unlike those conducted nowadays on seriously ill patients in intensive care units. Over the 10-year period of the study, more than 770 patients were treated in MCV’s burn unit, of whom approximately 460 were African American. This study investigated complications resulting from severe burns, particularly fluid loss and anemia.

One test — called the most “chilling part of the experiments” in the article — involved measuring blood volume, red blood cell volume and red blood cell survival. This test involves taking a small sample of the patient’s blood and mixing it with a tiny amount of a labeling agent to tag the red blood cells. This sample is then reinjected into the patient. The labeled cells are identified by subsequent sampling, allowing the calculation of blood volume and red blood cell survival.

Two types of labels were used: phosphorous-32 and glycine containing nitrogen-15. Nitrogen-15 is a stable isotope of nitrogen and is not radioactive. Phosphorous-32, which is radioactive, is on the order of the background radiation to which an individual living in North America would be exposed in a given year. Patients who today undergo a thallium stress test to diagnose coronary artery disease receive six times as much radiation.

It is important to realize that since the work of Nobel laureate George Charles de Hevesy in the early 1940s, phosphorous-32 had already been in use as a diagnostic tool to measure red blood cell volume. The technique of tagging red blood cells with a radioactive isotope is a standard clinical tool used in hospitals around the world.

The net results of the entire MCV project led to several important advances. These included, among others, the most effective use of antibiotics, the development of fluid and nutritional requirements following thermal injury, a universal dressing for burns, and the causes and treatment of anemia — all of which formed the basis for procedures used today to treat burn victims.

Among the major problems of Honicker’s article is that it inappropriately links the whole-body radiation in the experimental animal study to the clinical blood cell studies performed during the treatment of the burn patients. Comparing the former to the blood cell test, however, suggests a gross misunderstanding of the science.

Another grave concern is that the article questions whether the patients who died during this time did so as a result of the tests. It is important to recognize that these were severely ill patients. The top priority of the physicians involved in the study was to try to save their lives, and those who did not survive almost surely died from their condition.

The article also raises the matter of informed consent, implying that patients were victims of self-serving scientific ends. Again, radiation experiments were not conducted on patients. All studies conducted on patients were administered only for the appropriate diagnostic and therapeutic reasons, and they were covered under a general consent for hospital procedures. The volunteers gave verbal consent, the medical and scientific standard being practiced at the time of the project.

In addition, the Atomic Energy Commission served as the oversight body reviewing radiation studies. In fact, the MCV project was approved by an internal faculty committee established under the auspices of the Atomic Energy Commission. It was not until 1971 that federal regulations governing research protocols, including documentation of informed consent, were established through the Department of Health, Education and Welfare.

Finally, the article questions Dr. Evans’s reasons for writing the Atomic Energy Commission requesting information on malpractice and other exigencies of radiation in studies. It would have been natural for Dr. Evans to be concerned about the liability of the institution in studies involving human subjects. Lacking the federal safety net that would come later, Dr. Evans could have been seeking information to help him govern his own study.

This was not the stuff of a top-secret lab nor the work of unethical scientists on a project that lacked therapeutic purposes. Rather, the team embodied the ethic of the basic researcher — that investigative medical studies ultimately should produce new treatments for patients and a better understanding of prevention. Judging by an editorial on the surgeon’s ethics that Dr. Evans published in 1950 in the Annals of Surgery, it also is clear that he was himself a staunch proponent of appropriate medical ethics.

In all, The Post article’s “investigation” of the Medical College of Virginia’s burn unit misreads the record, misrepresents the work of the scientists and moralizes about past research practices.

In attempting to understand the events of yesterday, it is vitally important for journalists, editors and authors to get the facts and their interpretation straight. It is all the more critical when the reputations of individuals and institutions are at stake and when the danger exists that former patients and their families will be misled about their treatment.

The work of MCV’s investigators, the times in which they made their groundbreaking discoveries and the former patients of MCV deserve better.

The writer is president and professor of history of Virginia Commonwealth University.

What other stories of unethical medical experiments are apart of our history? What are the unethical experiments of today? What would you like to see happen with regard to unethical medical experiments?

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