(00:00:00) Yeah, I have a couple things going on just quickly didn't comment on his military use of LSD annoying military personnel. I think that he's also had a personal experience which made me wonder just about the emphasis on the rational mind both of the you know, the feeling part of the human being in science. I had a tour of primate Center in Portland, Oregon many many years ago as a science student myself and I couldn't help it being affected. You know, when I saw these rhesus monkeys and all these different kinds of animals that that I mean you look in their faces, you know, we all are against cruelty to animals so forth, but we can you know, I'm not an animal active but I just saw his dead experience impacted me because what I saw was this he really had to be in a sense heartless, you know, and you had to be totally into your rational mind to really carry out these kinds of things. Father let's say I give Arthur Caplan a chance to (00:01:03) respond. All right get to interesting issues here. The first is a different series of abuses in the 1950s and early 1960s. The CIA actually did sponsor research on LSD and Other mind-altering Drugs partly to see if they could find a way to if you will break down the individuals Free Will and get them to talk freely or confess. The idea was to use it to break Secrets at this point in time. The CIA has been brought under interesting enough existing regulations. So they too were supposed to operate with informed consent and committee review. However, this puts me in mind of a very interesting issue that came up during the Gulf War. We had a number of military researchers who believe that they had vaccines and drugs that might benefit the troops if they were exposed to biological chemical weapons. However, they wanted to waive informed. Vent and wave the committee process because in fact they believe there wasn't time. It wasn't practical and some argued. It wasn't necessary. You should simply line up the troops give them their injection and if it worked fine if they were side effects, it was too bad. It's interesting. I think one of the legacies of the war will be to go back and should be to go back and ask do soldiers do members of the military in the armed forces lose the general framework of protections informed consent and committee review simply because they are in the military that of course smacks a little bit Echoes faintly of the old excuse of the Nazis that in some context you can waive the rights of the individual. If you're doing it to save the welfare security of the state and we heard a little bit of that language creeping into this debate about the the troops in the gulf and using untested and research substances on them on the other front the animal research front. I can answer that one. Simply, although it's a complex question the simple Try to make to the car as I don't believe that one has to become dehumanized or unemotional my experience of people who work with animals is not that they are somehow insensitive to the cost of what it takes to do work on animals. I think they are sensitive in the majority sensitive to pain and suffering and death. What they try to do is balance the need to do that work against the harm. It's going to cause the animal interestingly enough. We've built a parallel system now within the past two or three years to protect animal subjects clearly, you're not going to get them to consent but we do have now is the committee structure. So there is supposed to be a weighing of the cost and benefits where animals are involved in research. We'll see how that goes. There are some who think in principle it ought not be going on at all others think the trade-off might be worth (00:03:47) it other callers with questions for our guests Arthur Caplan who's director of the center for biomedical ethics at the University of Minnesota. Go ahead with yours. Yep. I have a question about biomedical ethics. I'm interested in the field wondering Where mr. Kaplan was educated and if the university offers a degree in biomedical ethics, I'll hang up and listen. (00:04:07) Well, that's a softball sort of a question always useful to promote the center the center that I run does not offer a degree in biomedical ethics per se and that's because at the present time if one was trying to go out and get a job there aren't that many people looking to hire Ephesus specifically specialist in biomedical ethics, but we do offer a track and you can come into the field in a number of ways some do it at this point in time by going to philosophy or theology getting a dream degree there and specializing in the area of bioethics. And in fact, that's what I did myself others come to us from medicine or law or nursing or public health. And what they try to do is concentrate on courses that are offered at the University in the bioethics area. I might mention as a curiosity of sorts for the first time. We at the center just got a medical student accepted into a very elite program only 20 schools around the nation have what's called a MD Ph.D. Program this student is going to be with us in the fall who's entering that program is going to do her PhD in philosophy and she wants to do bioethics and we had to bend over backwards both to get the university to let this through and to let the NIH the National Institutes of Health which funds this Elite program agree to let someone do ethics. So we're going to have the first person in the country coming up on that track. That's probably the kind of path that I think down in the long run. The field will turn toward is sort of the double degree. (00:05:41) What are some of the diseases are through that are currently the subject of medical experimentation to use that (00:05:47) precise. Well, I'd say probably the diseases that command the most attention and thinking about the ethics of research at this point of time are cancer. I'd say different forms of cancer command a lot of ethical concerns simply because for some forms of cancer we seem to have gotten cures and then there are large swaths of the disease. Pancreas cancer lung cancer certain forms of breast cancer where we don't seem to be able to do much and you are basically subjecting people to some pretty terrible drugs and some pretty awful interventions in the faint. Hope that you're going to see benefit another area. That's that the listeners will understand right away zade's lots of research going on in the AIDS area clinical trials field trials so-called Community testing going on some challenges being put both to the doctrine of committee review and the need for informed consent. I've been at a number of conferences where people have said look I'm dying. I'm dying of an awful disease don't do me any favors with these ethical protections. I want entry into a clinical trial and if it's going to take a whole lot of bureaucracy to approve that trial before I can get in then I'd rather streamline that or wave it off entirely. So that's an area where there's a great deal of interest in ethics discussion about what's going on (00:07:04) back to the telephone with another question. Thank you for waiting. It's your Go ahead. Yeah. I like to know Dr. Kaplan what you think of what I call a promiscuous use of neuroleptic and often without informed consent and sometimes with people would have a different problem psychiatric. Mmm-hmm, you know. Don't take the drug anymore. You know, they they may suffer side effects. Yeah. (00:07:47) Sure, let's give our third chance response interesting. Most of the neuroleptics. The caller is talking about are not experimental their therapies. They have long been established as useful for different types of mental health problems. There's very little experimentation going on that I know of under the category of the neuroleptics, however, the issue of their abuse their overuse over-reliance on what to put it in English is basically maintaining patients by drugging them by instead of restraining them physically restraining them chemically, I think there is a problem there we've seen some studies at the University recently would show that the prescription patterns in nursing homes are not as bad as what people feared with respect to chemical restraint as it's sometimes called but it still is a difficult issue. It is clear that if we build our nursing homes mental institutions long-term care institutions to be more for want of a better term user-friendly we wouldn't have to rely on those drugs. Much and we'd be able to minimize side effects for the residents of those places (00:08:51) other callers waiting with questions and we'll go to the next one. Thanks for waiting. It's your turn. Go ahead, please. Yes, I have the sense to part and that is in industry along with the Armed Forces. You've discussed a little bit but in industry for instance in the nuclear industry. I remember Three Mile Island where they interviewed Macho blue-collar guys, that would go in and didn't seem to care saw some something in Macho Behavior about going in on the cleanup and where the medical people were then I've never heard that anything we fell these men or not. I don't know but then also in the cigarette, I know it's a controversy whether smoking does what it's supposed to do when the in the way of ruining People's Health and lives. But what is the medical ethics of the people who work for the tobacco industry. (00:09:43) Hmm. Well on the latter question, I don't think it's very controversial. Anymore, I think that the research here is not one involving human subjects to establish the dangers of cigarette smoking. It's basically what's called epidemiological research. You follow people over time see who smoke see who dies earlier. So he who suffers heart disease emphysema and so on and make the correlation interesting question for us in this state and indeed around the country should universities with medical schools and health science centers own. Tobacco stocks. There's been some movement to divest from a few schools. Johns Hopkins did it most recently about two weeks ago. Minnesota does have some Holdings in the air and I'd like to see us get rid of them. I think basically promoting substances that are known to be harmful that are known to be causes of death is not ethical so that while we have a lot of respect in our society for freedom of choice from the healthcare side from the educational side, the institutional connections should not be there. I think we should break that tie institutionally so to speak with respect. Ownership of tobacco on the first question that the listener raised about the radiation exposure. I'll tell you two stories. I won't so to speak solve this riddle. You reminded me of another Scandal one that I've been working on a little bit what we know for example about radiation and to some extent radon gas in our basements comes from the study of American Indians who acted as minors in the 50s and 60s in uranium mines the Public Health Service knew that these people were being exposed to high levels of radiation. Although they didn't know exactly what level of radiation was harmful. They studied them for a long time much as the Tuskegee study of the blacks with respect to syphilis found out that there was danger but didn't tell the miners and did run the study for over a period of a couple of decades. So there was another teskigi like study it did involve radiation. And in fact we use it today because what we know about radon gas, which is a derivative of uranium and also what we know about exposure. Places like Three Mile Island is built on the data. That was I would have to say immorally acquired from those American Indian (00:11:54) minors. Other callers waiting with questions for our guests Arthur Caplan director of the center for biomedical ethics at the University of Minnesota. Let's go to the next one. Thanks for waiting. Yes. Mr. Kaplan in the area of using material information for the good of mankind that has either been illegally acquired or without the the participants knowledge what I'll hang up and you can address this should we use the results of the Nazi experiments even though they are 50 years old or should we just ignore it totally at because it was so immoral. (00:12:30) Hmm. Well, this is a question that I've been thinking about quite a bit the issue of the use of what's known to have been acquired and morally is certainly one that has to be asked about the Nazi experiments. It's one that we have to ask to some extent in the context of American Medicine after all what we know for example about the treatment of yellow fever what we know about the treatment of a number of other tropical Diseases came from experiments that were done on subjects who did not consent and indeed were too ignorant to know what was being done to them and we have the examples. I've just given of the uranium exposures and the Tuskegee study in our own country. So what should we do? When we know that something has come immorally part of the answer this question is what have we done in the answers. We've used it. We've Justified it on grounds that since it is information that exists. It won't do us any good to turn away from it. So I would say to the caller practically speaking. We've answered the question and this has been true for the Nazi data to by using it. Should we do it is it right to continue to do it? I think my own answer to that is to say yes with a but I think you have to be persuaded that you have no other source of information and you have to constantly acknowledge how the information was obtained. If you can meet the conditions that you have no choice that is a high-stakes issue. That is life or death may hang in the balance. With respect to the information and that you constantly acknowledge that you're using tainted data or data illegally and immorally acquired then I would say I would tolerate some use (00:14:06) what's the picture overseas where we may or may not find I are bees or well informed consent specifically, what are the issues being look at? What are the countries involved in research and experimentation that concerns (00:14:20) you well, it's interesting. One of the things that you see is as you ratchet up the standards with respect to research ethics. There is a certain amount of flight to countries that are less concerned about these matters. Someone sent me about six months ago and informed consent form from one of the mid African nations, and it said something like this you will be exposed to 500 milligrams of radiation following which certain chemotherapy will be given to you and then you will be put into a double-blind randomized trial in order to assess the efficacy of an agent and on the bottom was an ex. That was the signature so we can presume That not everyone is getting informed consent to the same degree that we might hope occurs in this country. There is a certain amount of flight across borders that does concern me. We do have international pharmaceutical firms. We do have international ties among researchers that lead them to do things. In other countries that they could not do here. There's certain amount of AIDS research. For example that is going on in Africa that simply wouldn't get wouldn't pass muster in terms of ethical requirements here not adequate consent on a literate people without really being informed about what the side effects and dangers are of what's going on. So, I think I worry about that the other issue that worries me is when you go to countries where say women are not treated in the same with the same moral standing as a afforded to men. I think there are certain things that are done in some Nations that involve the exploitation of women simply because they're not viewed as morally equal to (00:15:52) men. I raised that question for several reasons our third. Not the least of which is the very large amount of money at stake in the organ transplantation. ER human tissue transplantation business with you will are trafficking. Yeah, the Wall Street Journal and others have (00:16:05) heard of commented on yet. I think on that score what people are concerned about is do we find people engaged in a trade in the third world? It doesn't meet what I would call experimental work because usually the organs that are being pursued things like kidneys are four procedures that have been established as efficacious. However, it's the ree the listeners might be interested to know than at least in four or five nations India among them Brazil among them. It is legal to trade in body parts so that if I were to be an Indian, I wanted to sell my kidney to some American or British firm that was going to ship it back I could do so within the bounds of the law. I've had a few discussions with some Indian colleagues about this and what they say is look you have the Cherie of taking a high moral stance of invoking the idea that someone ought not commodify themselves. Let someone ought not have to prostitute their bodies by selling a kidney from our point of view in India. We have no transplant capacity. We don't even have renal dialysis the kidney machine to help people if there's going to be any kidneys available. They're going to have to come from sale. And why should we prevent someone from taking not only himself but his family and maybe generations of his family out of utter poverty by selling a kidney that he can live well without (00:17:32) Other questions for our guests Arthur Caplan director of the center for biomedical ethics at the University of Minnesota. Thanks for waiting. It's your turn. Hello. Yep. Go ahead. Yeah, first a question and then a little comment question has to do with whether we could have a quick update about fetal tissue research and using the United States vis-à-vis the federal government and maybe medical practices to date and that and second and talk about Ethics in all of these issues and I think in particular fatal fetal research and is fatal as well. Isn't it kind of Ethics aren't ethics as used or applied always relative unless someone has some moral absolute to go by such as respect for all human life including the preborn. Thank you. (00:18:18) I think there are certain absolutes that exist in the area of let's say research ethics. I thank you do for example when you're dealing with competent adults want to advance the principle that they should have the right to give permission to for participation in research. They may waive it. They may not want to exercise it. That's fine by me but they ought to have the option of saying yes or no when you move on to the incompetent, I think no research should be done unless it basically is done for the benefit of that subject the hope for benefit of that subject. So be it a fetus or mentally retarded person or someone in a coma. I don't think you want to use them simply to benefit others. The only kind of research I think is tolerable is that which is intended to benefit them on the fetal tissue matter, of course, what we're talking about here is fetuses that are dead. So their benefit is not possible and the moral question really devolves around the question. Should we allow this tissue to be used? It's Matter of consent it's not a matter. Even of respect for the fetus. What you're talking about is can you take the remains of fetuses and use them in scientific studies in the American context? We don't have any federal money going toward this there is no federally sponsored fetal tissue research being done. There's some private money one of the interesting aspects of American Research is that if you can't get it from the federal government the private sector can move along they are not bound by the protections that Dan we've been talking about a little bit in that if they want to use informed consent and they want to use the committee's they can and most do but they don't have to they do not have to they don't have to because the federal government's lever of enforcement of those twin protections is funding to take it away or make it (00:20:04) available. I am assuming Arthur that the public pot of money federally funded medical experimentation research is much larger than the private (00:20:11) sector it is, but the balance is Shifting one of the things my colleagues at the University would be quick. Leap up and point out at this juncture is to say look if you want to have high standards of ethics and good protections for subjects. Then you have to realize that we have an asymmetry and if the federal government begins to pull money back from basic research and clinical research and that's slack is picked up by the private sector. There is more leeway accorded the private sector as to how they conduct themselves. I don't want to suggest it just because it's private research it's worse and because it's done at the University it's better but at least technically and legally compliance is more voluntary when it's done in the private sector. So to come back to the caller's question. There is some research being done on fetal tissue by certain companies by certain organizations. Some of it using tissue from elective aboard us' I think the the the the matter they're really then gets to the question of do we want to accept this for fear either that it will encourage elective abortion or because somehow or another we think that it dignifies or legitimates that practice I'm not sure I find either of those arguments persuasive, but I think that Of the moral issues in a sense. We have to settle to understand the ethics of that research (00:21:23) time for another telephone question for our guest Arthur Caplan and let's hear yours now. Go ahead please my question is my husband was mildly diabetic and he went to to get to laser treatments and a doctor recommended these laser treatments have been for his eye for his died. Yes, and after my husband took several lace went to the hospital for several laser treatments. He was blinded by a doctor. My question is he's had two heart attacks since then he passed away in 82. My question is who do they experiment on for these laser treatments before they experiment on the human beings? (00:22:09) Well, the laser treatment of the circulatory disorders that are common with diabetes. He's is actually at this point in time a boon to diabetics. I think their Vision can be helped and preserved. It can't the diabetes can't be reversed. But the laser has been a wonderful instrument in the field of Ophthalmology where diabetes is concerned the answer your question is how would they tested? Well, I'd say predominantly in animals and then the system that is now used the consent and committee review process requires that you try the experiment first on either healthy volunteers or people whose vision is so bad that they can't have any other alternative form of therapy. I doubt lasers were used on the healthy volunteers. So my hunch is the first subjects to be exposed to laser treatment were probably people whose Vision was so bad because of the diabetes that it was thought that they couldn't be (00:23:06) hurt time for one short question and fairly brief response. Go ahead. It's yours. Hi. Mr. Kaplan. I'm wondering what's what's happening in the area of being allowed to die. Ethically. There's a lot of safeguards for treatment so that a person is treated so their condition can improve but what about when they decide it's really time to stop there doesn't seem to be a way to die gracefully. (00:23:30) Right? Well two quick answers on the side of therapies. The big push has been to advance the idea of living wills or Advanced directives. That's been the Minnesota response. We have the right now to fill out documents that assumedly will be paid attention to that guide how we die interestingly in the experimentation setting what happens frequently is they are it may be tougher to stop I'll leave you with the image of Barney Clark with his artificial heart saying, please turn this off and indeed. Dr. Clark had a very difficult time getting the researchers to listen. (00:24:03) All right Arthur Caplan director of the center for biomedical ethics at the University of Minnesota. Thank you for coming by in June another conference (00:24:12) the conference in June. We're going to take a look at the Tuskegee experiment in fact and try and ask ourselves. What is the Vince of race in healthcare will do it in cooperation with the illusion theater and the urban Coalition of Minneapolis. We (00:24:26) should note that some of the material for the documentary reports the three of them who's in charge in the 90s came from a conference. You helped organize (00:24:34) it that came from last year's conference that looked at the Nazi data (00:24:37) question. All right. Thank you again for coming by and for those of you calling in with questions, thank you for your participation to now the reminder is that tomorrow during the noon hour as part of. Midday. You'll hear the other two parts of the three-part series on biomedical ethics who's in charge in the 90s.