Dark Medicine: Rationalizing Unethical Medical Research

For those interested in medical research ethics, this is an important book. With so much of the day-to-day discussions in bioethics focused on the wording of consent forms and other details, this volume raises some of the most profound issues in the history of medical research. It also raises some difficult issues in today's medical research.

The historical material in this volume is divided into three parts: Germany and the Nazis, World War II Japanese experiments, and Cold War American experiments. The primary focus of the five essays on Nazi medical experiments is the way in which mainstream German medicine was complicit with the abusive medical research. Psychiatrists, in particular, played important roles in developing genocidal methods in the killing of large numbers of people with serious mental illnesses and cognitive disabilities. Psychiatrists were not alone, however. Some prominent scientists played a role in justifying and even planning the mass killings by the SS. It is also important to recognize that much of the research done in these medical experiments, gruesome and awful as it was, was directed at real scientific questions.

Although most of us know something about the Nazi medical experiments, the Japanese abuse of human subjects is less discussed. Although the history is complex, many of the abuses were part of the Japanese military's attempt to develop effective biological warfare agents. Part of the reason that they are not better known is that American occupation forces decided to keep the experiments secret as part of our own use of the information collected. Frederick R. Dickinson's interesting essay shows that, despite claims that the Japanese have downplayed World War II crimes, there has been much public discussion and media coverage of these unethical experiments in Japan.

Although one must wonder why it is in a book about medical research, a startling chapter concerns the possible use of biological warfare by the American army during the Korean War. Although the evidence is not conclusive, it is worthy of more serious investigation. That essay and two others make clear that, in the name of national security, the United States has not been ethically pure.

Perhaps the most interesting essay in this volume, however, is not historical. Renée C. Fox's essay about iatrogenesis and the ways in which it is woven into conventional medicine is eye opening. Her thesis is that the practice of medicine routinely involves doing harm, as well as benefit, to patients. Think of the damage that chemotherapy does to healthy cells as well as to cancer cells or the side effects of antipsychotic medication. This is not to say that our approach to medical care is wrong but that negative effects are not incidental, but built in, to our approaches to treatment.

Although the quality of the essays in this volume is uneven, important issues are raised that should be considered by everyone who is interested in the history and ethics of medicine and medical research.

The reviewer reports no competing interests.