Letters

A SERIOUS MISTAKE HUMAN SUBJECTS MACKLIN REPLIES Elisabeth Carpenter's article "Police Are Slow to Probe Attacks on Animal Labs" (December 14, 1987, p. 1), describes and il ustrates in vivid detail raids on laboratories by opponents of animal experimentation. We oppose destruction of property and have consistently sought to prevent mistreatment of animals through education and law enforcement. It is unfortunate that the article makes only a passing reference to the conditions that have led to these raids. It acknowledges a study showing that 23 percent of 186 major U.S. research institutions "had problems with veterinary care, caging, sanitation or ventilation." To get an idea of how serious such "problems" can be would require the same degree of specificity and photographic illustration that the article gave to the Animal Liberation Front raids. A viewing of the videotape taken by University of Pennsylvania scientists, and stolen in an early ALF action, would explain to readers why animal laboratories are invaded by people who are enraged by cruelty to animals. It has long been the contention of the Animal Welfare Institute that the best, indeed the only, effective protection against break-ins by activists is to eliminate cruelty and treat all animals in the institution well. I have worked for the past 36 years to get the best legislation regulating animal experimentation enacted and enforced. This has been and continues to be an uphill fight. Clearly, when such cruel abuse and failure to observe the most basic requirements for aseptic surgery on primates could be recorded on film by a research team at a leading university, our efforts have been unequal to the task. Not until every research institution takes humane treatment of animals seriously will they be protected against invasion by individuals determined to help the animals at any cost. Yet even now, hard-line boosters of unlimited animal experimentation are using every trick in the book to weaken, slow down or completely sink the well-drafted regulations contained in the Improved Standards for Laboratory Animals Amendments proposed by the Department of Agriculture on March 31, 1987. In my opinion, they are making a serious mistake. --Christine Stevens Animal Welfare Institute P0. Box 3650 Washington, DC 20007 I read with interest the Ex Libris article "Doing Research on People" (November 16, 1987, p. 23) by Ruth Macklin. I was very disappointed by the tone and approach she took. Perhaps some of this suffered from the space limitations in which she was forced to work, and I hope to one day read the book. However, the article is all that many people may get to see. Since she has a very important and visible role in a major medical college, herr attitudes undoubtedly will influence others. Thus, I think that the ambiguity and imprecision in the piece should be resolved. should not have to resort to the circumlocu tion of"hav(ing) an interest in the success of the research." Most research is not succes ful in coming to an unambiguous answer Requiring a personal interest in success as a condition for participation would greatly re strict research. Altruism, curiosity or just plain good will should be enough. To begin with, the title is offensive. If I first thought it was an editor's choice, I rapidly was convinced otherwise by the first two sentences, in which Macklin talks about the "use" of patients as research subjects and "experimenting on patients." Except in instances of diminished responsibility, where fully informed consent may not be possible, most human clinical research is done with patients rather than on patients. Although some may consider this a minor distinction, it represents the attitudinal difference between what is described in her horror-story examples and what should be taking place in medical research today. I fear that if Macklin is teaching the 'research on' metaphor to students, she is perpetuating the paternalism of an old-style medicine that is long gone. There is a participative aspect in clinical research and clinical care that goes beyond informed consent and extends into the realm of modern- day medical practice. "On" implies an imposition of a physician's will upon another person that just is not the norm today. In addition, MackIm's discussion of beneficence and Kantian imperatives in non-therapeutic research with persons fails to distinguish between healthy volunteers and patients. In addition, patients-people who have a therapeutic relationship with a physician--should be permitted to give consent to nontherapeutic research by another investigator. In that case, they stand in the same light as any other volunteer. I am concerned with therapeutic and non therapeutic medical research on a daily basis and I find MackIn's exposition less than helpful in creating a broader understanding of what it is all about. --Marvin E. Jaffe 2100 Packard Ave. Huntingdon Valley, PA 19006 I had no hand Whatever in making up the title of the Piece. The article was excerpted from my book Mortal Choices from a chapter entitled "Experimenting on Human Subjects" I can only presume Jaffe finds that title equally offensive since it uses the preposition "on." This appears to be a verbal quibble. Even when fully informed consent is obtained, the research is still done on human subjects, not with them. One does research with one's collaborators. The point of the chapter is to illustrate how carefully clinical research can be conducted by adhering to the precepts of voluntary informed consent. The "horror stories" are intended to show that it wasn't always that way in medicine. And, I suspect, in many centers there are significant lapses from the idea of properly informed consent. Jaffe's fear that I am teaching the "research on" metaphor to my students is unwarranted. First of all I don't teach metaphors, whatever that might mean. More important, I find myself defending clinical research that many students find horrifying when they first come on the wards or read about the research. They ask, "How can re search be conducted ethically, especially when acutely ill patients serve as subjects? Is it ethical to use placebos? Won't patients consent to any research maneuvers their own doctor asks them to undergo?" and so forth. Jaffe's charge that I am perpetuating the paternalism of an old-style medicine that is long gone is surprising. I find that paternalism everywhere, but I try to do little to perpetuate it. Jaffe must work in a very enlightened setting if that brand of paternalism is nowhere in evidence. I'm sorry Jaffe found my exposition less than helpful in creating a broader understanding of what medical research is all about. My aim was, indeed, to foster that understanding. It may well be that medical research is conducted differently in different places and by different people. I can recommend the publication IRB A Review of Human Subjects, published by the Hastings Center. A number of the issues Jaffe raises have been addressed in its pages over the years. THE SCIENTIST welcomes your letters. Please include your name, address, affiliation (if you like) and a telephone number. Letters must be signed. Letters selected for publication may be edited for length- Send letters to Feedback THE SCIENTIST 1101 15th St., N.W, Suite 605, Washington, DC 20005.

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