A Brain (31 page)

“I've been under surveillance?” Martin was incredulous.

“We all have. Philips, let me tell you something. The results of this research are going to change the entire complexion of society. I'm not being dramatic. When we first started, it was a small project, but we had some very early results, which we patented. That caused the big computer companies to shower us with research money and help. They didn't care how we were making our discoveries. All they wanted was the results, and they competed with one another in giving us favors. But then the inevitable happened. The first major application for our fourth-generation computer was the Defense Department. It has revolutionized the whole concept of weaponry. Using a small artificial intelligence unit combined with a holographic molecular memory-storage system, we designed and built the first truly intelligent missile-guidance system. The army now has a prototype ‘intelligent missile.' It is the biggest defense breakthrough since the discovery of atomic power. And the government is even less interested in the origin of our discoveries than were the computer companies. Whether we liked
it or not, they blanketed us with the highest level of security they've ever amassed, even more than the Manhattan Project back when the atomic bomb was being created. Even the President couldn't have walked in here. So we've all been under surveillance. And those guys are a paranoid lot. Every day they thought that the Russians were about to storm the place. And last night they said you went berserk and were a security risk. But I can control them, to a point. A lot depends on you. You're going to have to make a decision.”

“What kind of decision?” Martin said tiredly.

“You're going to have to decide if you can live with this whole affair. I know it is a shock. I confess I was not going to tell you how we were making our breakthroughs. But since you learned enough to nearly be liquidated, you had to know. Listen, Martin. I am aware that the technique of experimenting on humans without their consent, especially when they must be sacrificed, is against any traditional concept of medical ethics. But I believe the results justify the methods. Seventeen young women have unknowingly sacrificed their lives. That is true. But it has been for the betterment of society and the future guarantee of the defense superiority of the United States. From the point of view of each subject, it is a great sacrifice. From the point of view of two hundred million Americans, it is a very small one. Think of how many young women willfully take their lives each year, or how many people kill themselves on the highways, and to what end? Here these seventeen women have added something to society, and they have been treated with compassion. They have been well cared for and have experienced no pain. On the contrary they have experienced pure pleasure.”

“I can't accept this. Why didn't you just let them kill me?” said Philips in a tired voice. “Then you wouldn't have had to worry about my decision.”

“I like you, Philips. We've worked together for four years. You're an intelligent man. Your contribution to the development of artificial intelligence was and can be enormous. The medical application, especially in the field of radiology, is the cover for this whole operation. We need you, Philips. It doesn't mean we can't do without you. None of us is indispensable, but we need you.”

“You don't need me,” said Philips.

“I'm not going to argue with you. The fact is, we do need you. Let me emphasize one other point. No more human subjects are needed. In fact this biological aspect of the project is soon to be closed down. We have obtained the information we needed and now it's time to refine the concepts electronically. The human experimentation is over.”

“How many researchers have been involved?” asked Philips.

“That,” said Michaels proudly, “is one of the beauties of the whole program. In relation to the magnitude of the protocol, the number of personnel has been very small. We have a team of physiologists, a team of computer people and several nurse practitioners.”

“No physicians?” asked Philips.

“No,” said Michaels with a smile. “Wait! That's not entirely correct. One of the neuroscience physiologists is an M.D.-Ph.D.”

There was a silence for a few moments as the two men eyed each other.

“One other thing,” said Michaels. “You, obviously and deservedly, will take full credit for the medical
advances that will be instantly realized with the application of this new computer technology.”

“Is that a bribe?” asked Philips.

“No. It's a fact. But it will make you one of the most celebrated medical researchers in the United States. You will be able to program the entire field of Radiology so that the computers will be able to do all the diagnostic work with one-hundred percent efficiency. That will be an enormous benefit to mankind. You yourself told me once that radiologists, even good ones, only function around seventy-five percent. And one last thing . . .” Michaels looked down and shifted his feet as if he was somewhat embarrassed. “As I said, I can only control the agents to a degree. If they think someone is a security risk, it's out of my hands. Unfortunately Denise Sanger is now involved. She doesn't know the specifics about this research, but she knows enough to jeopardize the project. In other words, if you choose not to accept this program, not only you, but Denise too, will be liquidated. I have no control over that.”

At the mention of a threat against Denise, another emotion overwhelmed Philips' sense of moral outrage. Hatred welled up inside of him. Only with great difficulty did he hold himself back from striking out in a fit of blind fury. He was exhausted and every nerve was drawn to its breaking point. It took every ounce of strength to force his mind back to rational thought. When he did, he was overcome by a feeling of futility in the face of the sheer power and momentum behind the project. Philips might have been able to sacrifice himself but he could not sacrifice Denise. A sad feeling of resignation settled over him like a smothering blanket.

Michaels put his hand on Philips' shoulder. “Well,
Martin? I think I've told you everything. What do you say?”

“I don't think I have a choice,” said Martin slowly.

“Yes you do,” said Michaels. “But it's a narrow one. Obviously both you and Denise will stay under close surveillance. You will be given no chance to give the story to either Congress or the press. There are contingency plans for any eventuality. Your choice is merely between life for you and Denise or purposeless instant death. I hate to be so blunt. If you decide the way I hope you will, Denise will only be told that our research has had Defense Department application that you did not know about and that you became a mistaken security risk. She will be sworn to secrecy and that will be the end of it. It will be your responsibility to keep her from knowing the biological origins.”

Philips took a deep breath, turning himself away from the row of glass cylinders. “Where is Denise?”

Michaels smiled. “Follow me.”

Retracing their steps back through the double vault-like doors and past the amphitheaters, the two men walked down the rubble strewn corridor, turning into the old medical-school administrative office.

“Martin!” shouted Denise. She jumped up from a folding chair and rushed between two agents. Throwing her arms around Philips she burst into tears. “What has been happening?” she sobbed.

Martin couldn't speak. His pent-up emotions overflowed with joy at seeing Denise. She was alive and safe! How could he take responsibility for her death?

“The FBI tried to convince me you had become a dangerous traitor,” said Denise. “I didn't believe it for an instant, but tell me it isn't true. Tell me this is all a bad dream.”

Philips closed his eyes. When he opened them he found his voice. He spoke slowly, choosing his words with great care, because he knew Denise's life was in his hands; they had him shackled for the moment, but he would find a way to break their hold someday, even if it took years. “Yes,” said Philips. “It's all a bad dream. It's all a terrible mistake. But it's over now.”

Martin tilted Denise's face up and kissed her mouth. She kissed him back, secure that her feeling about him had been correct, that as long as she trusted him she would be safe. For a moment he buried his face in her hair. If individual life was important, then so was hers. For him more than anyone.

“It's over now,” she repeated.

Philips glanced at Michaels over Denise's shoulder and the computer expert nodded approval. But Martin knew it could never be over . . .

THE NEW YORK TIMES

SCIENTIST SHOCKS
SCIENTIFIC
COMMUNITY; SEEKS
POLITICAL ASYLUM
IN SWEDEN

 

STOCKHOLM (AP)—

Dr. Martin Philips, the physician whose research has recently propelled him into international celebrity status, disappeared yesterday afternoon under mysterious circumstances in Sweden. Scheduled for a lecture at 1
P
.
M
. at the famed Carolinska Institute, the neuroradiologist failed to appear in front of a packed audience. Along with the celebrated scientist, his wife of four months, Dr. Denise Sanger, also disappeared.

Initial speculation suggested the couple sought seclusion from the attention that has been showered on them since Dr. Philips began unveiling his series of startling medical discoveries and innovations six months ago.
That idea was abandoned, however, when it was learned that the couple had had surprisingly massive Secret Service protection and that their disappearance definitely depended on Swedish authorities' cooperation.

Inquiries to the State Department have been met with strained silence, which has been made more curious when it was learned that the affair had unleashed feverish activity on many U.S. government levels, seemingly out of proportion to the event. International curiosity, already peaked, was honed to a razor's edge by the following prepared statement released late last night by the Swedish authorities:

 

Dr. Martin Philips has asked for and has been granted political asylum in Sweden. He and his wife have been placed in political seclusion. Within twenty-four hours a document written by Dr. Philips will be released for the international community outlining a gross abrogation of human rights perpetrated under the aegis of medical experimentation. Until now, Dr. Martin Philips has been constrained from voicing his opinions by a consortium of vested interests including the United States government. After the document has been released, Dr. Philips
will hold a press conference by video under the auspices of Swedish TV.

-----------------

Exactly what the “gross abrogation of human rights” involves is not known, although the strange sequence of events surrounding Dr. Philips' disappearance has stimulated serious speculation. Dr. Philips' area of expertise involves computer interpretation of medical images, which hardly seems open to gross violation of experimental ethics. However, the reputation of Dr. Philips (his winning this year's Nobel Prize in Medicine is considered inevitable by most reputable researchers) guarantees him a large and attentive audience. Obviously the affair had to deeply offend Dr. Philips' sense of morality for him to jeopardize his career by taking this drastic and dramatic step. It also suggests that the field of medicine is not immune to having its own Watergate.

Human experimentation since World War II has created some difficult problems with the increasing employment of patients as experimental subjects when it must be apparent that they would not have been available if they had been truly aware of the uses that would be made of them.
¹

That comment was made by an esteemed Professor of Research in Anaesthesia, Harvard Medical School, at the outset of an article describing twenty-two examples of experiments which he felt violated medical ethics. He chose these examples from a group of fifty, and he cited a Professor in England, Dr. M. H. Pappworth, who had amassed a list of five hundred.
²
The problem is not an isolated, infrequent episode. It is endemic, spreading from the basic value system inherent in the physician/experimentor image spawned by the current research-oriented medical community.

Consider some examples . . .

One experiment which has been in the news in
recent years and a subject of a television video essay by Sixty Minutes involved various U. S. Government agencies experimenting on unknowing servicemen in an attempt to determine the effects of hallucinatory drugs. Perhaps more disturbing and closer to the story line of Brain was an experiment in which live cancer cells were injected into elderly patients without their informed consent.
³
At the time of the study the researchers did not know if the cancers would take or not. Apparently they took it upon themselves to decide that the patients were already so old that it didn't matter!

There are numerous examples of radioactive materials being injected into unknowing, unsuspecting people, primarily institutionalized mental defectives, but even new-born babies have not been immune.
⁴
There is no way that these studies can be justified for the therapeutic benefit of the individuals and there is no doubt that these unknowing people were subjected to the risk of injury and disease, not to mention discomfort and pain. On top of that, the results of studies of this kind are often of little consequence, serving more to augment the bibliographies of the involved researchers than advance medical science. Many of these studies were knowingly supported by the U.S. Government agencies.

Another experiment involved the purposeful injection of seven to eight hundred mentally retarded children with infected serum in order to produce hepatitis.
⁵
This study apparently was approved and supported by the Armed Forces Epidemiological Board, among others. Consent was mentioned to have been obtained from the parents but the circumstances lead one to wonder how the consent was obtained and the degree to which it was “informed consent”;
and, even so, did this consent by the parent protect the rights of the subjects? The question remains: would any of the researchers have allowed a mentally retarded member of their own family to participate, or in the other experiments mentioned, would the researchers have allowed a family member or themselves to be involved as subjects? I sincerely doubt it. The intellectual elitism that medicine and medical research fosters creates a sense of omnipotence and with it, a double standard.

It would be irresponsible to suggest that the majority of research involving humans in the United States is based on unethical standards, because it is definitely not true. However, the fact that there is a significant minority is frightening and demands attention from the public. The pressure for research within our academic medical centers is as strong as ever and the ensuing investigative enthusiasm and air of professional competition can cause people to lose sight of the negative consequences for patients. Besides, the confusion of values between patient/subject risk and possible societal benefit has not been unequivocally settled.
⁶
And the idea that patient consent will obviate abuses has proved to be false. Take for instance the case of fifty-one women used as subjects for a study of an experimental labor-inducing drug. They all signed consent forms but apparently under less than ideal conditions. An investigation of the study reported that many gave their consent during the duress of the admitting procedures or in the delivery room itself.
⁷
After the fact, the patients were interviewed and almost forty percent had no idea they'd been the subject of research even though they had purportedly given “informed consent.” One of the subtle ways consent was obtained was by saying the
study involved a “new” drug, not an “experimental” drug, the researcher knowing full well that the adjective “new” would imply that the experimental drug was better than the “old” drug.

Subterfuge need not be necessary to obtain consent. Subtle innuendos suggesting that the care of the individual will be less than maximum if the person does not “cooperate” is the most frequent ploy. Next in frequency is for the researcher to cleverly imply that the experimental procedure might benefit the individual even if that possibility is negligible. Finally there is the method by which the researcher fails to inform the potential subject that there are alternative and, frequently, established modes of therapy.

All this is not new. Lip service has been given to violations of medical ethics involving human experimentation for more than twenty years in the medical journals. The fact that it still exists to the extent that it does is a tragedy of major proportions. And now that the decade of the eighties has arrived with medicine beginning a new love affair with physics, the opportunities for abuse reach a new and horrifying potential. The center stage for the marriage of medicine and physics is neuroscience, and the chief actor will be the human brain, considered by many to be the most mysterious and amazing creation in the universe. The ethical and moral issues involving human experimentation have to be solved before . . .

 . . . before fiction and fantasy become fact.

ROBIN COOK, M.D.

1.
 Beecher, H. K., “Ethics and Clinical Research,” New England Journal of Medicine, vol. 274, 1966, pp. 1354-60.

2.
 Pappworth, M. H., Human Guinea Pigs: Experimentation on Man, Beacon Press, Boston, 1967.

3.
 Barber, B., “The Ethics of Experimentation With Human Subjects,” Scientific American, vol. 234, no. 2, February 1976, pp. 25-31.

4.
 Pappworth, M. H., op. cit.

5.
 Veatch, R. M., Case Studies in Medical Ethics, Harvard University Press, 1977, pp. 274-77.

6.
 Jonas, H., “Philosophical Reflections on Experimenting with Human Subjects,” Experimentation with Human Subjects, P. A. Freud, ed., George Braziller, 1969.

7.
 Barber, B., op. cit.