 Let me welcome everybody to our afternoon meeting for our annual lecture series. I'm so delighted to be able to introduce a dear old colleague and friend of mine, Dr. Joel Howell, who will be giving today's talk. Joel Howell is an MD, PhD, a professor at the University of Michigan in the departments of internal medicine at the medical school in health management and policy at the Michigan School of Public Health and in the Department of History at the College of Literature Science and the Arts. Joel is also the Elizabeth Farron professor of the history of medicine. Joel received his MD here at the University of Chicago, stayed with us at the U of C for his internship in residency in internal medicine. He then went on to the University of Pennsylvania, but before I tell you about that, I do want to say that in the 1970s, I was one of the few, if not only medical ethicists here at the University of Chicago. And I was doing ethics consultations and also teaching students and residents about ethics. And in 1980, 81, I got an NIH award to go to the University of Virginia for the year, and I looked for who could replace me. Who could replace me as someone who could do ethics consultations and ethics teaching, and the best person was the senior resident, Dr. Joel Howell. And so in 1980, 81, or was it 81, 82, Joel? 81, 82. 81, 82. Joel took over for me for the year that I was away at Virginia and ran the ethics program here at the University. Then I came back and Joel went off to the University of Pennsylvania as a Robert Wood Johnson clinical scholar, and he got his PhD there at UPenn in the history and sociology of science. Joel Howell has been a faculty member at the University of Michigan since 1984. He's the senior associate director of the University of Michigan's National Clinician Scholars Program. He's written widely on the uses of medical technology, examining the social and contextual factors relevant to clinical application and diffusion, and analyzing why American medicine has become obsessed with the use of medical technology. Joel is a co-founder and director of the Medical Arts Program, a program founded by the Doris Duke Charitable Foundation to use the arts to help make medical students and residents become better docs. Dr. Howell's current research is an attempt to analyze the implication, the health policy, the factors that have been contributed to and slow the diffusion of medical technology into clinical practice using both the sociology of knowledge and a comparative approach. Joel's research has been recently supported by the Robert Wood Johnson Foundation Investigator Award in Health Policy Research and by the Burroughs Welcome Foundation Award in the history of medicine. Among Joel's many books along the way is an old book called Technology in American Medical Practice, 1880 to 1930, written in the late 1980s. A book called Medical Lives and Scientific Medicine at Michigan, 1891 to 1969, published by the University of Michigan Press. A book on technology in the hospital, transforming patient care in the early 20th century, published by Johns Hopkins University Press. A book about riding bikes, Washington or County bike rides, a guide to road rides in, and road rides in and around Ann Arbor, published in 2009. And his most recent book, The History of the University of Michigan Medical School at its Bicentennial, also published by the University of Michigan Press in 2017. Joel, it's a delight to welcome you back to the University of Chicago, even if it's only for a couple of hours. Well, it's a delight to be there and I wish I really was there. Thank you for that very kind introduction. I must continue to toot my horn by pointing out that the guide to road rides in and around Washtenaw County, the bicycling book, is the definitive guide to road riding in Washtenaw County. I can say that with some authority because it is the only guide to do road riding. Mark, just a personal note. Mark's been a trailblazer for all of us in so many ways. We could think about what it means to have a senior resident running the medical ethics program at the University of Chicago in 1981 and how far we have come since then. And Mark, on a very personal level, you've been a role model to me. I believe you are the first person to achieve a promotion and a tenured position in a major department of internal medicine with research that was explicitly in the humanities and social sciences. And in doing that, you really set the stage for many of us, including myself, who have come after you so that we don't have to... We have somebody we can point to that says you don't have to get NIHR-01 grants to deserve tenure in a department. So thank you for doing that. What I'm going to be talking about today is the human radiation experiments. And I'm going to do the traditional screen. Where are we? There we are. Okay. By radiation experiments, I mean human experiments having to do with radiation that took place during the Second World War and the Cold War. Unlike many, if not most, of the canonical historical examples of human experimentation that are more frequently remembered, these were a heterogeneous group of experiments done by various people in various places. They all had in common some attention to the curious phenomenon of radioactivity and the fact so dramatically demonstrated here over Japan in August of 1945, twice, that it can be used for military purposes. Now, to make sense of these experiments, we need to set the stage. We need to talk about science before and during World War II. We have to talk about the fact that World War II was a science-based war. We have to understand the development of big science, big federally supported science that was in a very direct way a precursor to the wonderful world of NIH funding that we all enjoy today. And the idea of research during war time when an apocalyptic ending to the world was a very real possibility. What I'm going to talk in doing this talk is start with by talking about technology in the first and the second World War. I'm going to talk about physical technology, biological technology. And then after a while, I'm going to pivot and sketch some of the experiments that were done and raise some questions we might want to think about. Now, it's really apropos in a strange and ironic and sad way to be giving this talk at the University of Chicago. It's ironic and sad because unsurprisingly, I'm actually in Ann Arbor, Michigan. And whether or not we're really at Chicago, I'll leave to the philosophers in the group. And you'll see that the University of Chicago plays a key role both in the overall history and in the human experiments we're going to be talking about in very, very many ways. Now, let's start early in the 20th century. The First World War had given us new and unprecedented ways of killing human beings and producing incredible harm with industrial efficiency, things like tanks and barbed wire, also a poison gas, the early use of airplanes and all of these things had to be invented by somebody. But after the war ended, there wasn't a lot of attention to doing really systematic research for military needs. The work that was done was small scale, it was unfunded, it was uncoordinated and the story of radar illustrates this point. After playing only a bit role in the First World War, air power was becoming increasingly important as a means of waging war. Planes fly high up in the sky, they go really fast, they can carry things, they kill people. And the biggest problem if people are flying planes against you is how to know that they're coming before they're right over your head and dropping bombs on them. So in 1930, people working in the British laboratory noticed that passing planes reflected back radio waves from the ground and figured out you could deduce the distance, you could do what you call radio detection and ranging or radar as a means of finding out when planes were heading at you. Now there was not much cooperation between the military services, the army only found out about this by accident when someone happened to visit the laboratory and there wasn't much in the way of resources to do anything with this new technology. In 1939, Nazi Germany invaded Poland and the Second World War started. France and the UK promptly declared war on Germany, the United States followed a couple of years later. Everybody knew at the beginning of this war that it was going to be a science-based war, much more so than other wars had been. People saw this coming. And how are we going to deal with that? How are we going to organize the science? Well, in the United States, a gentleman named Vannevere Busch, no relation to either of the President Busch's, was made the head of OSRD, the Office of Scientific Research and Development. The New York Times dubbed him the czar of research. And he thus became in charge of a civilian organization that was supposed to coordinate research activity that was government sponsored, primarily for the military. This was a fundamentally new idea that the government should get intimately involved in doing scientific research. It was a new idea in that suddenly there was a scale possible that you could say, I want all these people to work together. And we have resources to fund it. So if we go back to our old friend, Radar, it was not hard to figure out that Radar was going to be important. The question then arose, where should we put our laboratories? Where should we do the research? And previously these debates in Congress had come to an impasse. In the House of Representatives, Massachusetts has more votes than Montana. And so they'd say, let's put it in Massachusetts. In the Senate, Montana has exactly the same number of votes as Massachusetts. They would say, well, if the government is going to support research, it should distribute it evenly around the country. And the end result was the government didn't support a lot of research outside of its own labs. Along came the Second World War. And with respect to Montana, there wasn't a lot of science going on in Montana, but there was in Massachusetts. And the MIT or Massachusetts Institute of Technology set up the Radar Lab. They were extraordinarily successful. It had an enormous impact on the war. A couple of examples as you are may remember from your history lessons after the war started. Germany wanted to invade. Britain goering promised that the Luftwaffe, the German Air Force, could smash the British air defenses, he said in four days. Germany had a lot more planes than Britain did, but Britain had radar. And the radar could tell them when the German planes were taking off across the channel. And Britain survived, which surprised a hell of a lot of people, including many in the United States. It was also terribly effective and out of the Atlantic Ocean as well. The wartime effort depended upon shipping things across the Atlantic. Submarines could go under sea and were extraordinarily disruptive. They were hard to find. But with radar, you could see subs coming two to five miles away. How effective were they? Well, this chart gives you one example. I'll just say that between January and February of 1942, without radar, Allied forces managed to attack precisely four submarines in 8,000 hours of patrol. The first night out with the radar device, they were able to detect three U-boats and sink one. Its importance grew over the course of the war. And I think there's really great truth to say these are two lessons from radar that big organized wartime research could make a difference. And somebody else said the atomic bomb only ended the war. I think there's some truth to that. Lots of other research in the physical science is going on. Research in computing. Here you see early computing research going on, operations research, improved productivity. US merchant vessels that took 35 weeks to build before the war were being launched in 50 days by 1943. This is the 1944 Willow Run facility just down the road around sitting, produced 5,500 bombers per year. And this played an important part in winning the war because the Nazis were just not as fast in the high-volume manufacturing. So this led to the idea, again, wartime research is important and it deserves having a lot of resources thrown at it. Let's talk about biological research and human experimentation. Mustard gas was one of the most feared weapons of the First World War. There were fears that it would be widely used in the Second World War. Buster gas is species-specific, so you can't use animal models. And they did so-called man-break experiments to see what it would take to break a man. They would put people in the chambers with gas and not let them out until they passed out, even if they really asked to come out sooner and try different clothing and poison gas . This is an ethics talk. You may wonder if there were volunteers. They were encouraged to volunteer and as this quote says, occasionally there have been individuals who did not co-operate fully. A short explanatory talk and a slight verbal dressing down was always successful. But bear in mind that prisoners and conscientious objectors who are the subjects in many of these experiments were not allowed to go home. While many of their friends and relatives and colleagues were overseas, this was not a war where you rotated overseas. You stayed overseas until you died or the war ended. I'll also point out that mustard gas, of course, was an early chemotherapy occasion. Then there were experiments being done on it with some modest success. Epidemic diseases, always a big problem in time of war. There were experiments done in the 1930s but was not widely available. OSRD controlled access to penicillin for clinical trials and also controlled protocols and how it could be used. There were experiments done in this country. People talked about doing experiments of intentionally inoculating people with gonorrhea and then testing to see if you could treat it. Some of these were done here at the federal prison in Terre Haute, Indiana. The committee on medical research and research and research in 1942 said that volunteers should only be utilized as subjects and only after the risks have been fully explained and after signed statements have been obtained. This is a memo that he wrote but it was a top secret memo. I'll leave it to you to mull over whether or not an ethical dictum that is top secret is an ethical dictum. You've heard from Susan Revereby who did path-breaking research on the fact that after the war the same people who wanted to do this in Terre Haute went down to Guatemala and did similar kinds of research. Other biological research was important, malaria, huge problem in the war, North Africans, Sicily and the Pacific Theater. Some people called it the biggest medical problem of the war and it raised interesting medical issues, not least because a lot of the work was done on prisoners. This image is from a malaria ward at Stateville Penitentiary in Illinois just south of Chicago. They delayed doing these experiments so that a life magazine photographer could be on hand when this prisoner was allowed to be bitten by mosquitoes carrying malaria. And this image and the point came back up again at the Nuremberg trials on the question of whether or not prisoners could in fact give informed consent to experimentation. One of those prisoners has a very famous connection with the University of Chicago. Nathan Leopold was a University of Chicago student who together with his buddy Lo decided to murder a 14-year-old child in Hyde Park just because they were curious to see what it was like to see somebody die. But that's another University of Chicago story for another time. As important as medical research was, it was not the centerpiece of World War II research. The centerpiece was physics and physicists. And this is a statue that stands, as I hope many of you recognize it, it stands not far from where we would be gathered, where we gathering in person in Hyde Park. Physicists became the elite scientists. Daniel Cavalos has a wonderful book called The Physicists that talks about this. They benefited from the kind of large-scale research that was being, that I mentioned earlier, and doubtless the most famous impactful event was the invention of the atomic bomb. Now in the 1930s, there was a lot of interest in nuclear physics. And in fact, the most dramatic scientific event of 1939 was the splitting of the uranium nucleus. This was done in Germany. Germany arguably had the very best physicists in the universe in Germany. And people started mulling about whether or not the energy that was released could be used to make a bomb. Nobody knew. It wasn't clear. Einstein, of course, who had theorized E equals MC squared, which talks about the amount of energy that could be released, was alarmed about the possibilities of building a bomb. And then he went to President Roosevelt, who started the Manhattan project, which we'll talk about in a second. But nobody knew if it could be done, where it could be done, how you could separate the events. There's a wonderful play called Copenhagen by Michael Frane, F-R-A-Y-N, which explores Heisenberg, arguably the most brilliant physicist of the 20th century, visiting with Niels Bohr in Copenhagen discussing whether or not one could build an atomic bomb. He then went back to Germany and told Hitler that it wasn't possible to build an atomic bomb, that the physics just wouldn't work. And we do not know to this day whether he made a mistake. Even the best physicists in the world can make a mistake. Or if he foresaw what would happen if Nazi Germany got an atomic bomb. Many historians have tried to figure this out. I think so far, unsuccessfully. It's a wonderful, wonderful play. I highly recommend it to you. But the play is one thing, reality is another, and now we must turn once again to the University of Chicago and to Stagg Field, being built here in 1927. The University of Chicago football has a gloried and storied, if not terribly long, history. We who don't know the very first Heisman trophy winner played for the University of Chicago. The University of Chicago was a founding member of the Big Ten. It left in 1946. Michigan State was added in 1949 to make it a Big Ten, and we now have 12 members, and I'll leave to another day how come the Big Ten has 12 people, but that's life. The University of Chicago presidency was not known for being that excited about the importance of exercise. He once commented that when I feel like exercising, I lie down until the feeling goes away. Stagg Field eventually fell into disrepair, and you all know the area of Stagg Field because this is the Regenstein Library sketch on top of where Stagg Field was, and the Moore sculpture sits over here. However, when it was still a stadium, a major stadium, it was the site for arguably one of the most significant events of the 20th century in any field bar done, and that's a strong statement, but I think it's defensible. People decided that if we were going to study nuclear, whether or not you could build a bomb, the work should be done at the end of the 20th century, and it would be done at the end of the 20th century, and it would be done at the end of the 20th century because of the excellent academics and facilities, in part because it wasn't on the coast and was a little safer from attack by enemy forces. In 1942, people gathered at one of the old squash courts under Stagg Field to examine a pile of things like the fact that this was a squash court they worked on. Some of you may know that Mark Siegler was an excellent squash player in his day. I played against him many times. Mark, you were a very irritating player to play against, and when your opponent says you're irritating, that usually means it's because I couldn't figure out how to beat you, which I found very irritating. Mark's a left-handed guy who he only had two shots, lobs and drop shots, which basically meant you were spending the entire time running to the front and back of the court and eventually got tired and gave up, but that's, again, another story. Here are the squash courts of the University of Chicago, Stagg Field, again, not far from where you're sitting, so those of you who are in Hyde Park. People try to see if you could actually create a self-sustaining nuclear reaction. If the laws of physics permitted the creation of energy that would keep going for my nuclear reaction. Of course, the other question is once you start this chain reaction going, can you stop it? I'm going to come back to this apocalyptic fear a couple of times, but people were genuinely scared. This was a new world they'd never been there before, and one of the leading physicists who loved to eat and loved dining once commented when he was asked why he had dinner twice the night before this experiment he said, we have an experiment we're going to run tomorrow, chances are it won't work but there's a remote chance it'll work too well and that's why I'm having a second dinner tonight. And I don't think he was totally joking about that. December the 2nd, 1942 cold day in Chicago, 10 degrees there was no photographer present this is a sketch of what somebody thought it looked like they gradually withdrew the control rods and the counter neutron counter started to increase they sounded like crickets and the power went critical meaning it started a reaction that would have been self-sustaining they then put the rods back in and somebody handed Fermi a bottle of chiante a paper bag he sent a coded message out saying the Italian navigator has just landed in the new world the question came back Howard the natives and he said very friendly I haven't emphasized I should have how super secret this was let's just bear in mind this is 1942 we're in the middle of a world war it's unclear who's going to win the war we're afraid that Germany has the best physicists in the world they could be working on a bomb as well the last thing you know if we're successful and they know we're successful then they'll know they can go ahead and push forward this was all done ultra super secret world at the University of Chicago people interested in the bomb got together informed with the metrolurgical laboratory or METLAB that was a coded name as many as 2,000 people spread across campus it eventually became the first federal laboratory Argonne National Laboratory this shows people who are present here at the chain reaction gather together outside Eckhart Hall at the University of Chicago which was one of the sites for the METLAB and is now the location of the Department of Mathematics there were people in this group Robert Stone from the medical school I don't know who he is in this picture was involved and we'll get back to him with the radiation experiments but the action now moved to Los Alamos north of Albuquerque 7,500 feet up and this is where people got together to build the bomb there were as many as eight Nobel laureates sitting around having dinner together they cooked on electric hot plates because wood burning stoves didn't work scientists in the military had to learn how to work with each other something was new they had basically any resources they wanted so this is big science ultra-secret science and at Almagard on New Mexico on July 16th, 1945 the first nuclear bomb was exploded there was serious concern that this was going to cause a rift in the physics of the universe that it would spread uncontrollably around the world and that would basically be the end of the world nobody nobody had any idea what was going to happen when you actually exploded an atomic bomb it obviously did not cause the end of the world literally in that sense and the question was then what to do with it the war was working its way across the Pacific Ocean Iwo Jima took the United States four weeks to win the war 30,000 U.S. servicemen died Okinawa took 12 weeks 50,000 U.S. servicemen died 100,000 Japanese troops died 100,000 civilians died those are horrible numbers and people thought this was a dress rehearsal for the invasion of Japan which was just going to be a whole lot worse I'm mentioning this because there's a lot of debate now about whether or not to drop the bomb whether we should have dropped the bomb or done a demonstration over at Pacific Island the problem with that is we weren't sure if the bomb would work we'd only done this once and those are the seconds going to work at the time it was not that much of a debate President Roosevelt had died in April of 1945 President Truman had seen the wages of war first hand in World War I he wanted unconditional surrender it's telling about the secrecy that President Truman the Vice President Truman when he was Vice President it had been kept secret from the Vice President to the United States but when he found about it he appointed a committee and said use it as fast as possible and without any advance warning whatsoever on August the 6th 1945 the Enola Gay an airplane dropped the bomb over Hiroshima 350,000 people lived in Hiroshima before the Enola Gay flew over at 140,000 of them died this is what Hiroshima looked like after the explosion this is Nagasaki the second bomb the top shows before the bomb hit the bottom shows after the bomb hit these numbers are horrific I should point out by the way that not totally unprecedented Tokyo had been bombed with conventional weapons in 80 to 130,000 people had died Dresden was fire bombed and about 100,000 people died the Vonnegut by the way has a wonderful book called Slaughterhouse 5 it's not wonderful it's a powerful book about being in Dresden during the fire bombing World War II was different in that civilians were targeted more and during the First World War 90% of the people who died were military during the Second World War 60% were military and 40% were civilians so the war comes to an end and the question is now what do we do many scientists said we need to make the information public they said the laws the monopoly is not going to last and the laws of nature are available to anyone the United States and the Soviet Union had won the war as allies we often forget that we were allies during the Second World War they formed a commission as to what we should do about nuclear weapons the United States said we should have a comprehensive evaluation should have on-site inspections and then we would relinquish our arsenal of nuclear arms and scientific information the Soviet Union said they wanted an immediate ban on manufacture and use of atomic weapons the United States said the Soviets were asking the United States to give up its monopoly for a promise the Soviets said the United States was asking them to reveal the state of their research before we gave up our weapons and the commission came to nothing thus ended one war and started another the Cold War we'll spend a few minutes giving the setting of the Cold War before we shift to the experiments that went on the Soviet Union of course got an atomic bomb 1949 we got a hydrogen bomb in 1952 the Soviets got one in 1953 and in this competition which was again science-based the Soviets appeared to jump ahead with Sputnik I in 1957 a huge prestige jump for what had previously been seen as a backward state they claimed this meant that they were the best system because they were able to put satellites in orbit around the earth next they sent up Sputnik II this time they had a dog the dog didn't come back by the way but the point is if they could send up a dog around the world they could send up anything including a bomb this state said we could do it too and on December 6th we tried to launch a missile from Cape Canaveral and it failed miserably so things were not going well in the Cold War the Cuban Missile Crisis came in 1962 the Soviets put missiles in Cuba 42 medium-range missiles placing most of the United States under direct threat they could have hit the United States in six minutes coming across 234 miles to Miami very very close to an all-out war on a personal level I was living in Columbus Mississippi outside of a strategic air command base maybe the combination is this Titan II missile every warhead this missile had was 600 times as powerful as the one that landed on Hiroshima they were around Wichita, Little Rock and Tucson each Titan warhead had 18 warheads excuse me they had 6 warheads and there were 18 of them they could be launched from inside of a silo people turned the keys the people who launched them didn't know where they were going but the level of destruction was nearly unimaginable the Soviet Union tested a bomb in 1961 that could have a yield of 100 million tons 100 megatons of TNT that is 3300 times as powerful as the bomb that killed 100,000 people in Hiroshima this constant attempt to build more and more powerful weapons was reflected in a number of ways one of which was in popular media if you haven't seen Dr. Strangelove you should because it's a wonderful way to evoke the meaning of the Cold War when I teach this to my I talk about the radiation experiments to my undergraduates I have them watch Dr. Strangelove and here you see the guy riding the bomb down they offered this role to John Wayne who turned it down how to survive a nuclear attack became part of common parlance this is a brochure that was sent out for how to survive an atomic attack don't rush right outside right after bombing that sounds like a good sense idea meanwhile jump into a trench are any other convenient depression in the ground if you're in a yard when the bomb explodes this was what I was taught in elementary school this is the world we lived in people built fallout shelters air filters air exhaust plumbing so when the whole world is going to hell on top of you you could survive and people built these things and they stopped these things and one of the ethical questions was if you got room for your four family members to exist for six weeks and your neighbor comes and knocks on the door you let him in the point was during the cold war the threat of nuclear annihilation was always there and in that context let's turn and talk about the human radiation experience we're going to go back up to the mountains of Los Alamos people were working with a new element called plutonium is named after plutonium should have been called plutonium but Glenn Seaborg who named it like the way plutonium sounded so that's what it was called he later got the Nobel Prize in chemistry and worked against nuclear bombs we didn't know about the health effects what did this do to people we knew a little bit from radium we used to have watches that would glow in the dark because of the radium on there and there were women who took little things and licked the paintbrushes and painted the radium on the dials and they unfortunately came down with some fairly nasty diseases of radiation so people knew that radiation exposure caused disease they didn't know what plutonium could do they needed to find out because on August the 1st 1944 this guy a 23 year old chemist named Don Mastic a promising young graduate of the University of California Berkeley was working at Los Alamos for the entire supply of plutonium it was rare, it was hard to make it was unbelievably valued it was super secret the word plutonium was secret he was doing mouth pipetting laboratory scientists out there never do mouth pipetting this is only one good read he was doing mouth pipetting and suddenly wound up with a bunch of plutonium in his mouth he could taste the acid he spit it out he wished his mouth with a combination of chemicals designed to extract the plutonium they pumped his stomach they extracted as much as possible and for weeks he could make a radiation meter go nuts by just walking into a room and blowing out we wanted to build bombs we wanted to make more and more bombs but we didn't know what happened to people when they ingested plutonium they did work trying to find out at Los Alamos by measuring the amount that was excreted in the urine and still but we didn't know how much they were taking in so we didn't know what the kinetics were and we needed to find out this is one set of radiation experiments this is the set we're going to spend the most time on so we decided to go to places that had better hospital facilities I keep saying we because this is the United States government that's doing this places like Oak Ridge, Rochester and the University of Chicago they didn't expect acute short-term effects low doses they had some experience but they weren't sure about the long-term effects if you want to do the and they wanted to know what happened in people so ethicists out there this question over as we go along if you wanted to find out what happened to plutonium when people are exposed to it who should be your subjects and what should they be told bear in mind that the word plutonium is super secret and we are living in the world I've described to you in which an all-out war with nuclear weapons seems like a very real possibility people went to Oak Ridge where a 53 year old quote-unquote color man that's how he was described a cement worker named Ed Cabe was in the hospital after a motor vehicle accident he was injected with plutonium he wasn't told that he was being injected the very word plutonium was classified it was kind of a comedy of errors they mixed up the before and after urine samples so that didn't work they took his bone and teeth and found out that it had gone into the bone in Rochester they had a cyclotron which made it easier to work with and they gave people uranium at increasing doses until they got kidney damage here metaphorically at the University of Chicago they set up a series of questions they wanted to answer and Robert Stone who headed up the Biological Sciences Division of the UC Met Lab wanted to know the answers to these questions what are the first changes produced is where for a blood and accurate measure can you recover completely are there ways to aid recovery how much radiation does it take to kill somebody University of Chicago went on and did work on a number of people was a 68 year old man with cancer in the mouth and long by the name of Arthur Hubbard a businessman from the University from Austin, Texas he was the first person injected 6.5 micrograms codelabel CH1 Chicago first patient they collected his urine and stool did similar work on a 55 year old woman with breast cancer and also on a young man with Hopkins with Hodgkins those last two got 95 micrograms and what they learned was that the fecal excretion rate was lower for humans than it was for animals and that's useful information and in the early 1960s George Leroy named it might be known to some of you this did some work on what happens when you ingest fallout for this one thing they said they did get informed consent and they actually swept up nuclear fallout from Nevada from atomic testing and fed it to University of Chicago students and residents and then studied to see how the radiation came through other work was done in places like UCSF and others I'm going to talk a little bit about the work that was done at Cincinnati because it's particularly relevant that's general also did some similar work Cincinnati was involved in total body radiation because people who were on the army had logical questions what happens to people who are exposed to lots of radiation 5,000 troops have received 100 rads of radiation is it alright to reassemble these men and take them into combat I don't know they wanted to assess combat effectiveness could you still land a plane how much exposure did it take to get you sick because if you knew how much exposure it took shielding would need to go on the plane that would affect how far the plane could fly how much bombs payload it could carry or if you were going to build a nuclear power plane which people were thinking about what would the effects of radiation be so what does it do to people when they get a radiating when do you get nausea and vomiting how long before it shows up in the bone marrow does it impair your ability to think does it impair your ability to do things can we take medication ahead of time what about it being exposed to small repeated doses and in Cincinnati there were a number of experiments done using whole body radiation under contract with the department of defense this could be argued as part of therapy for cancer although people knew that it probably wasn't going to work ironically if you were going to use whole body irradiation on people who had cancer you got better experimental results if you treated people whose tumors you knew were not going to be affected by the radiation because the army was really interested in what the effects of radiation were on normal tissue not on cancerous tissue people involved in these experiments were not given medications like anti-medics this would diminish the value of the experiments nor were they warned about any side effects because they didn't want to suggest them 21 out of 90 people died in one month the problem with these experiments of course is that young healthy soldiers and sick patients with cancer don't respond in the same way to radiation or to much of anything else this eventually wound up in a lawsuit in the hospital denoting this with data that we still use today these are some of the radiation experiments I'm going to touch very lightly on a few more and then come back to some general conclusions for now state school in Massachusetts children with developmental difficulties they were fed radiation in their oatmeal in order to see what the effects would be of ingesting radiation prisoners were used for a number of very important experiments we're going to send people up into space what are the effects of radiation they wanted to know they were particularly interested in the effects on testicular tissue this was studied at the Oregon state penitentiary as well as in Washington state there are the so-called green run experiments also out of Washington state in which radiation was released into the atmosphere we wanted to know what happens when radiation floats across the countryside no better way to figure it out than to release the radiation ourselves and see what happens I'm being I'll give you sources in a second I know I'm being very brief the point is that during this period there was a lot of interest in radiation and a lot of different kinds of experiments being done all done under secrecy this is from the Washington site protection for all don't talk silence means security there was a chain reaction for espionage now for years there were rumors about Americans being injected with plutonium 1986 congressional report on America's nuclear guinea pigs got a little bit of attention but really the person who deserves the most credit I think for breaking the story as a woman named Eileen Welleson she was a reporter for the Albuquerque Tribune she put names and faces to the story and this is a book that I think has a lot of the essential information in addition there was a commission that was formed the president's commission on human radiation experiments formed in January of 1994 by Bill Clinton who instructed government agencies to cooperate with them in studying the experiments they were asked to decide who should receive monetary damages and so doing they addressed the question of retrospective ethical judgment and I refer you to their chapter on retrospective ethical judgment because I think it's superb the report was released on October the 3rd 1995 those of you who are really really good know that October the 3rd 1995 was also the day that the OJ Simpson verdict came down as a result the OJ Simpson verdict got a whole lot more attention than the release of this report these reports all suffer from the inevitable problems of historical research which is we need the data we need the information a lot of the questions you want to know the answers to just aren't there the records weren't kept or if they were kept they weren't saved so where do we what is all this mean I think we need to think about human experimentation and particularly the ethics of human experimentation as it confronted a whole new context this was a context that simply did not exist prior to the Second World War for one thing this was a world war that affected everybody it was a science based war in a sense that other wars had not been it was science based in that everybody knew when the war started that the people who had the best science were probably going to win the war I have only scratched the surface of telling you about all the scientific work done in the Second World War there was a lot more that we didn't even mention this then carried over into the Cold War a potentially apocalyptic war in which there were realistic concerns that the entire nation could be destroyed in a matter of a few minutes or an hour or so in which secrecy was seen as a paramount virtue because we were attempting to conceal knowledge from the other side that would enable them this was a situation that was called mad for mutually assured destruction the only reason it was thought and it may be true that we didn't blow the other side to smithereens if we did they would blow us to smithereens and so we were each standing with a loaded gun on our finger on the trigger but neither one was going to pull the trigger and the research that was done was seen as essential to maintaining that balance the other new things that happened here this is big science we now think that it's natural and inevitable that the federal government should support scientific research in non-federal facilities we call it the NSF we call it the National Institutes of Health the University of Chicago the University of Michigan and many many others around the country rely to a great extent on federal research dollars this was not standard before the Second World War it came directly out of this kind of of large scale research finally it was going on at multiple sites unlike the one of a lot of historical medical experiments we talk about which are relatively limited number of sites and finally the fact that it was done by such a heterogeneous group of players suggests that at some level the ethical norms permitted such research to be done and we can talk about whether or not it was ethical and what that means the details remain fuzzy for a lot of what happened what's not fuzzy is the key role of the University of Chicago in so many of these steps it's also not fuzzy the way in which these experiments pressage much to this to come so finally medicine the quest for knowledge, human experimentation always has to be looked at in a specific social, political and economic context I've tried to sketch out the context in which the human radiation experiments were done I thank you for your attention and I would be happy to entertain questions Did I see Debra Net raising a question No I was just clapping that was an awesome talk Thank you Dahl for bringing that whole history to us and especially bringing some of the history of University of Chicago to the fore it's just an excellent talk Thank you I don't think there's hyperbole to say that for those of you that are in Hyde Park right now that at that site that changed the world for everybody in ways that are very and it did so at a particular moment in time there's not a whole lot else that you know were historians we love to say that it's more complicated well there's a lot of context but it's in the 20th century Chris Daugherty seems to have his hand up I don't Am I supposed to be calling on paper Mark? Yeah Hi Joel, yes it's Chris Hi You know some of us who've been here a long time have heard kind of intimate stories about a couple of folks that were here and even here deep into the 20th century and one of those folks was Leon Jacobson Leon was head of Hemak and then chair of medicine and then the dean and we've been taught these stories about how Jacobson was pulled off the floor as an intern and taken into a room and told that he would be responsible he would be under direction from Dr. Stone and be responsible for examining physicists and technicians and the presumption was that he had access to the isotopes to the plutonium and he was one of the ones that was actually injecting patients doing some of those radiation experiments but that was never kind of revealed our earliest history of Jacobson is about the discovery and administration of nitrogen mustard for cancer including Hodgkin's disease that's where his story starts and then there was the advisory committee's report back in the 90s about the human radiation experiments and the ethical issues about could those data be used and do we use the same standards of informed consent today as we should have been do you have any knowledge about some of the individual players opposed to the institutions themselves you know to get to drill down to that the advisory committee has a wonderful website in which they have a ton of archival materials that's where I would go if you were to see what you know precisely what role Jacobson played there are also the archives over in special collections in Regenstein that would probably have a lot of that of that information yeah I do not I do not know apparently stones archives are there such as they are but I was told quite honestly by public relation years ago that when it was announced that there was going to be this investigation a lot of Jacobs archives were actually picked up and moved to some some more confidential site that wouldn't surprise me when the reports came out a lot of institutions including the University of Michigan look specifically at what happened at their place and that's certainly one approach to do in the history I think it's I was trying to give a sense more that said this stuff what's going on I would also say as a historian and I know there's at least one or two other historians on this call or were earlier when somebody tells you this is I was there this is what happened you say thank you very much I understand that's your memory of what happened and that's very useful information I don't want to take the time but there are innumerable examples of people who just remember things differently than solid archival I mean over the passage of time we all rework our memories the way you treated your siblings growing up I'm sure that you don't they would remember it differently beware of I remembered this I want to see the archives yeah yeah thank you I just want to say one thing to piggyback on that Deb Warner put a link Deb Warner who's our biomedical librarian and super sleuth extraordinaire put a link to the Jacobson papers at the U of C Special Collections and I remember reading in an article either it's something about him he wrote this great book from Adam to Eve ATOM to Eve about his experience it'd be interesting to sleuth that because I think that's absolutely fascinating and you know as you were saying Joel the whole you know the first cancer center at the U of C was actually a partnership you know with the Atomic Energy Commission and there's great pictures in the special collections of all the you know radio isotopes in the floor and pictures of you know Leon Jacobson and who was the other guy whose name is Robert Stone yeah and Stone and all these guys there's great pictures actually the Special Collections is a real treasure trove it'd be fun to plumb that and see I'm just looking at the refining right now I see there are 98 boxes and so well a lot depends upon you know how accurately it's organized and knowing the Special Collections of Regenstein I've worked there it's probably very well organized and how much material is still there but that's worth a look for those of you who are there hey you know if you're even minimally interested don't take a look I mean the bug it is really fascinating to look through the original archival material all you got to do is let them know you're coming and say you want to look at these three folders and they'll pull them out I mean obviously I love it it's what I do for a little bit I would suggest that anybody who thinks they might love it should give it a shot can I jump in Hi there thank you so much for that talk I'm curious maybe to hear you say a little bit more about this retrospective ethical judgment that came up in the president's commission if you wouldn't mind you know elaborating on that but I think the question maybe relative to that for me is really how you're thinking about a history like this which is so sort of horrific and extreme in relation to like normative judgment I mean how does a commission look at a history like this and really sort of move forward in some productive way toward you know a normative set of you know policies or recommendations I'd love to hear you reflect on that I have two or three weeks to get started that's obviously it's a really good question it's the key question and I'm going to be provocative here and probably irritate two thirds of the people on the call and suggest that by and large most norms are cultural and social and ethical and that is to say that it's really hard to come up with standards that cross all cultures and all time periods and that's what the President's commission tried to do you run into what people sometimes you refer to relativistic medical ethics I mean it's bad to kill people actually there's a trial going on just north of you right now about whether or not you're justified in killing people and I will restrain myself I have very strong opinions about that particular series of events on the other hand you don't want to go say anything goes and so one of the things the President's commission looked to and said are there written standards or accepted standards if everybody agreed you shouldn't do something and you did it then you're transgressing an ethical norm and that's what the coded comment I made about the memo that said you need to get consent from volunteers to do it but if it's a secret memo how do you think about that they did say that using people purely as a means to an end they viewed as being unethical at all levels you know I think it's an interesting question and it's so good I'm not trying to duck it unless you want to believe that we're being unethical and we don't have access to some set of ethical norms that transcends all cultures times and beings and you'll tell us what it is and if we don't abide by it then we're being unethical that is an approach that one could take I would not support such an approach that's helpful thank you so the retrospective aspect of that commission or should have been present at that time as opposed to sort of saying well after the fact we're going to decide that that was wrong or something they were specifically aimed at who deserve money who should be paid to judge it and for the finale group came up they thought they deserved some financial recompense I forget exactly who got it there weren't a whole lot of people who they thought they deserved thank you Joe I have a very strange question to ask a strange answer with regard to that December of 1942 self-sustaining nuclear reaction that was done in the squash court I've often been concerned about how much knowledge they had on whether there was an ability to stop nuclear reaction from continuing and extending I mean destroying the community and the university was there any work in advance of that procedure that gave them an idea that it would be that it would have the ability to stop it they thought really hard they wrote a bunch of equations but they didn't know and in terms of informing the community again we're in the middle of a world war and Germany is busy bombing central London every chance they get and I don't think anybody doubts that if they had a nuclear bomb they would have dropped it in the middle of central London and if they knew what we were finding then they would be more inclined to keep working because they would believe that it was possible so the quote that I gave you which I love I didn't tell you it's a Hungarian physicist who was very involved in the work you know he was not sure if that was going to be the end of everything and again when they actually had the first atomic bomb they didn't know what it would do to the space time continuum and would spread all around the world and a not so theoretical way during the Cold War we had somebody we were running out of targets in the Soviet Union and they were running out of targets in the United States and the joke wasn't a joke but the line was that the bombs were just going to make the rubble bounce up and down and this is something that could have gone on a hair trigger because with mutually shared destruction if you think they're about a bunch of missiles at you you've got to launch your missiles or you lose the ability to respond but specifically I don't think they did any I don't think anybody ever thought of warning the community I don't think that was even on their radar screen they were trying to run the war thank you there's a hand up and I don't know how to pronounce a seal thank you my question is with respect to the presidential commission does it only was it established with the purpose of investigating I'm looking into previous war cases or is it geared towards past and possibly current war situations and I would like to specifically know if there has been any studies into the Gulf War syndrome that veterans suffered from during the 1991 war and if the monetary compensation that was set aside by the commission covers both compensation to the veterans as well as subsequent or future research to investigate this disease thank you the purpose of the commission was specifically the human radiation experiment and I do not know about other commissions set up to explore experiments or issues related to the Gulf War I know there were investigations like the Vietnam War but this particular commission was focused on the human radiation experiments again coming out of the work done by Eileen Wilson and also either Senator or Representative Markey of Congress who shared a committee that also looked into the same the same questions did you want to go? sure thank you thank you for this talk there is a really interesting history that you have outlined here I am thinking in the context of our current time we are not in the Cold War anymore but the most pressing foreign policy that is our national security issue is the war on terror where there is a similar of there is often a similar kind of angst and even perhaps willingness to override particular rights of human beings soldiers, prisoners of war what have you for this admittedly diffuse sense of the nation's security and some of that is not direct I am not aware of any sort of relations to that with medical research so I would not have been aware of much of this if we were going if this was we were talking about this in 1950 but I am curious how do you feel confident that given the sort of regulations that are in place now that this sort of thing this kind of that similar sort of experiments wouldn't be replicated in sort of our current time or something similar absolutely absolutely not you know let's take a look at some of the regulations IRBs as you may know came directly out of the Tuskegee experiments right the Tuskegee experiments started in 1932 run by a bunch of scientists in the public health service if they if you had convened in IRB in 1932 do you really believe they would have not allowed the Tuskegee experiments to go forward there there was the people who were running them were the same people that were doing the experiments similarly these days I think very very weak constraints on the unethical promulgation of experiments and I think national security could very easily be used to justify well I mean look it's already been used to justify all kinds of stuff I mean look at the unless you think torture is the valid way of us performing our tasks which I do not believe that it would never happen again that's fine but I don't have that some kind of confidence does that answer your question am I confident it will never happen again no yeah I guess my sort of follow up is you know thinking about one of the sort of one of these sort of I would think one of the sort of levers as far as like policies is the sort of like secrecy sort of overriding as sort of under which these experiments took place and obviously as you as you mentioned you know we're not the current our current environment might not might not involve sort of medical experiments under secrecy but you know black sites sort of where all manner of things take place underneath them it's still very much used and so the hope that this wouldn't happen again is probably not a very is a hope it's not exactly a confidence the one thing that is different and I think I'm right on this I think there was more of an apocalyptic fear about existential threats to widespread existence during the Cold War I mean people really did have fallout shelters and you know the Cuban Missile Crisis brought us very very close to entering into an exchange of nuclear weapons there's Abel Archer I just talked to anybody Abel Archer is the name of a exercise that we ran I believe it was in 1923 across the ocean with Russians in which they sincerely believed we were getting ready to launch a surprise attack on them and they were getting ready to preemptively launch an attack on us there's a fair amount of literature on this I've written one paper about it so we've come very very close and you know if we get into a nuclear war with even today with Russia it's I mean the world is done and their world is done and most of the world is done but there was very much there was much more of something that was on people's minds and that you thought about when you went to school I mean can you imagine being taught in elementary school you know if you see the flash of an atomic weapon what you should do is drop down into a culvert and look away I mean this was real this is what we were being taught we're not quite there now