History Lessons

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The history of medical research is filled with studies of dubious ethical merit. In fact, some past studies were based on protocols that would be considered abhorrent today. Studies based on animal experiments are still performed today, as are studies on disease cures that use control subjects. By that I mean that volunteers with the same disease are separated into two groups—one group is given the experimental cure and the other group is given a placebo. This type of study is usually double-blinded, meaning that neither the subject nor the researcher knows whether the subject is given the cure or the placebo.

Recently, the American Urological Association’s Didusch Center for Urologic History in Baltimore publicly exhibited detailed charcoal and pencil sketches used in two textbooks of prostate surgery written by Perry B. Hudson, M.D., who was chief of urology at Columbia University’s Francis Delafield cancer Hospital in the 1950s. The drawings, done by Tod Dee Craig, who was a staff artist at Delafield Hospital, were notable for their technical detail and their role in the history of urologic surgery. Men were recruited by Dr. Hudson to undergo open biopsies and prostatectomies to verify his belief that prostate cancer could be detected and treated at an early age. The men were homeless alcoholics living on the streets and flophouses of the Bowery. Many were veterans unable to readjust to society after the war. Dr. Hudson and his colleagues recruited hundreds of these men through offers of hospitalization, which the men freely accepted because it enabled them to trade their dingy environment for a hospital’s clean sheets, three hot meals a day, and maybe even a little respect.

Historical evidence, however, reveals that many, if not most, of the men were unaware of the risks of what they were agreeing to, an assertation later vehemently denied by Dr. Hudson. These mostly asymptomatic men underwent open prostate biopsy, and if cancer was found on frozen section, they simultaneously underwent radical prostatectomy, surgical castration, and postoperative administration of estrogen. Dr. Hudson reported prostate cancer in about 10 percent of the men with a six-year mortality rate of 30 percent. Since there was no control group, the study did not produce any meaningful conclusions about the survival benefits of treatment and surgical complications such as perforation and erectile dysfunction occurred at a significant rate. The results of the study were published in well-known medical journals and Life magazine. The study concluded in 1966 after Dr. Hudson left Delafield Hospital under a cloud of legal and ethical concerns arising from his work.

Dr. Hudson, who was accustomed to criticism of his work, defended himself by stating that it would have met the tenets of the Nuremberg Code, which had been formulated just four years before his Bowery study commenced. Ms. Craig, the artist, was a socialite until life’s darker forces overcame her. She committed suicide in her mid-40s. Dr. Hudson bounced from location to location, at one time being the dean of a Caribbean medical school. He died in 2017, just shy of his 100th birthday, in Florida. One hundred and eighty-four drawings were rescued from his home and the rapidly approaching Hurricane Irene and were sent to the Didusch museum. Today, all hospitals have Institutional Review Boards to prevent ethically challenged studies from ever getting started.

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