New Mexico News
| Research Beneficial To Everyone |
| Posted by () on Jun 10 2008 at 8:11 PM |
Medical research is a bit like a community center for recovering addicts: Most people think both are necessary, but don't want them in their backyards.
All of us benefit from the results of medical research, but many of us decline to participate. We may decline because it's too much bother or pain, or we may be concerned that the research will be conducted in a way that is deceitful, harmful to us personally or to someone we know, or will result in letting others know some of our most important secrets.
After all, some of us have heard of experiments that would now be considered entirely unethical, such as the experiments that Nazi concentration camp guards carried out on Jewish prisoners. In one of these, prisoners were exposed to extreme cold, and were watched until they died.
At the same time that these atrocities were occurring in Germany and Poland, unethical research was also being carried out in the United States.
Black men with syphilis were being observed in a 30-year study to see how syphilis progressed over time. The research continued long after it was determined that the disease could be cured with penicillin; subjects were not told that effective treatment was available.
Less prominent examples of research that needlessly or heedlessly endangered its subjects were catalogued in a remarkable article by Boston anesthesiologist Henry Beecher in 1966, making it clear that ethics still were being challenged 20 years after the end of World War II and the Nuremberg trials of the Nazi war criminals, including the Nazi doctors. Beecher documented 22 cases where improper research had recently been done.
His article at the time raised great interest, resulting in federal regulations as to how research could be done only where both ends and means were reviewed before the research began.
I've just completed University of New Mexico-required CITI training before I engage in research. CITI does not refer to the big New York bank, but to the Collaborative Institutional Training Initiative, which many universities use to train prospective researchers to make sure that research is carried out for the benefit of individuals and of society. It details the regulations surrounding research. It doesn't absolutely ensure that all research in the future will be ethical, but makes it clear that deviations from ethics will not be tolerated at UNM or at any other institution carrying out biomedical research.
I'm involved as a producer of research because I have a duty to do so, since I am a consumer of research. I “consume” research by using it every day to guide me in treating patients. You as a patient or you as a parent almost certainly have benefited from research done on other patients, including children. Let me give you a few examples of important research that has affected children.
n As an intern in the 1970s, I treated many premature infants born with immature lungs that just couldn't get in enough oxygen. Research carried out about that time at Johns Hopkins and elsewhere indicated that their lungs were unable to make a chemical compound called surfactant that kept the lungs from collapsing with each breath. Further research resulted in the ability to make this substance in a lab; now, infants at risk of premature lung disease are given the compound directly into their lungs right after birth, resulting in much less disability and fewer deaths.
Even better, obstetricians can often prevent the problem by giving mothers about to deliver too early a steroid shot — not the ones used or not used by Roger Clemens — that makes the lungs mature more rapidly, thanks to research done by New Zealanders G.C. Liggins and R.N. Howie, first on pregnant sheep and then on humans.
n As a new doctor in Gallup in the 1970s, I saw almost weekly cases of meningitis caused by a marauding bacterium called Haemophilus. Research carried out by many investigators, especially on the Navajo and Apache reservations where the disease was especially common, established the effectiveness of a vaccine. Now the disease is hardly seen — in Navajos, Apaches or any other group to whom the vaccine is given.
n Everyone in my medical school class “knew” that ulcers in children and adults were caused by stress and spicy foods. You used counseling, diet change, and if all else failed, surgery. But in the 1980s, research showed that ulcers are almost always the result of infection with a germ, Helicobacter pylori. Antibiotics work a lot better on bacteria than psychotherapy does.
We all benefit from medical research, so we need to support it — to pay for it, to conduct it, to participate in it as subjects. We can be virtually certain that it will now be carried out in sound, ethical ways that protect us as subjects and result in data that help to guide how we and others will be treated.
Lance Chilton, M.D., is a pediatrician at the Young Children's Health Center in Albuquerque, associated with the University of New Mexico. He is happy to hear from those with questions at 272-9242 or lancekathy@yahoo.com.>
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