Personal views: Lest we forgive
Authors: John Paul Leach
Journal: BMJ (1999)

As the century ends, the proliferation in medical literature has made it increasingly easy to become lazy about the quality and source of any data with which we are presented. This struck home as I was browsing through a CD Rom textbook (Neurobase, Arbor Inc, 1999). While skimming through theories on the aetiology of multiple sclerosis, my mind’s wandering was interrupted by a feeling of unease. I returned to the end of the preceding paragraph:


“Humans injected with multiple sclerosis brain extracts are not at an increased risk of multiple sclerosis.” 


We all have a duty to avoid recognising any work that is less than ethically rigorous



This was an arresting sentence: injection with diseased brain extract? Who could have carried out such a study? Could anyone have given informed consent? The study author was named as Dr Schaltenbrand, and my suspicions about the nature of the work increased when the German title of the book, published in Leipzig in 1943, was translated as “Human multiple sclerosis and the transmissibility of simian demyelinating diseases.” My first thought was to contact the American author to warn him that he may have unwittingly cited an unethical piece of research.

A few days later I got a reply to my email, the weary tone of which astonished me. I could almost imagine the sender sighing as she typed that the chapter’s author was “well aware” of the controversy surrounding Dr Schaltenbrand’s work. She added that “in the light of the concerns raised” (the implication being that I was unreasonably sensitive), Schaltenbrand’s work would be referred to indirectly as part of an article by M I Shevell and B K Evans in Neurology (1994;44:350-6), which discussed the contemporary use of Schaltenbrand’s data.

The editor in chief of the CD Rom was more concerned. In his reply he admitted that he had been disappointed and surprised at the inclusion of such studies in the textbook. Kindly, he sent further literature detailing the flawed horror of Schaltenbrandt’s experiments. This made instructive, if harrowing, reading. Schaltenbrand felt that the risks of this study, though low, were such that he could use only “verblodete menschen” (literally “demented individuals”). In all, 45 patients were subjected to intracisternal and intravenous injection of cerebrospinal fluid or serum taken from humans or monkeys. At least one of the subjects was a child with learning difficulties. Tellingly, the details presented in his writings are incomplete, and the results necessarily inconclusive. No useful implications can be drawn from the presented data.

I was appalled. It was bad enough that such studies were ever done, but dangerous and intolerable that they should be so nonchalantly—and knowingly—quoted a mere five decades later by a world authority. Even if we laid aside the moral qualms (which I find difficult), how can the scientific merit of such work be judged when ethical considerations have been so blatantly ignored? Verifiable scientific research demands a balance between care for the study subjects and detachment from the data. Not only are Schaltenbrand’s studies unrepeatable, but we cannot tell how much of his data interpretation was subject to the same bias. Any ethical flaws may not have been highlighted by the process of peer review. As detailed by E Ernst in the Journal of the Royal Society of Medicine (1994;87:246), many institutions had their members of the medical faculties replaced by politically acceptable appointees. In Nazi Germany, the referees may have been as tainted by Nazi association as the authors themselves, and for any doctor or scientist to ignore such considerations is lamentably indefensible.

Some mythology surrounds some of the experiments: that despite their barbaric nature, they hold enough potential for significant benefit to justify publication and continual recognition. Notably, however, 50 years after the Nuremberg trials, no medical experiments from that era have been universally accepted as having adequate scientific merit to justify contemporary citation. It seems that flawed researchers are inevitably drawn to produce flawed research.

As we enter the next millennium, medical literature continues to grow almost exponentially. Despite this it remains our duty to avoid recognising any work that is less than ethically rigorous. Despite receiving subsequent assurances that such data will never be cited again in the CD Rom, I am proud that my anger about the article has not abated: forgetting the origins of such studies affords the researchers a degree of respect which they simply do not merit. The scientific caution with which we should treat immoral data has rendered all such experiments useless, and “pragmatism” about the data cannot ignore the frailty of the science that it used.

As events in the Balkans should remind us, man’s inhumanity to man did not end 50 years ago. While it is necessary to keep a cynical eye on current medical research, we must remain equally vigilant in withholding any form of approval from the inexcusable immoralities of yesteryear. In this instance, forgetting is uncomfortably close to forgiving.