The SRA Symposium - College of Medicine

Papers
observational and could do very little to really help patients. Now, however, medical science had
created situations requiring decision making. The patient becomes more involved; and medical
ethics, rather than focusing on the physician’s thoughts and actions, now must focus on the
patient’s wishes. Let us note that before the era of scientific research, medical ethics was really
healthcare ethics, which is quite distinct from research ethics; although, as we shall see, the distinction
easily becomes blurred.
Early Human Subjects Research
Possibly the first documented experiment with human subjects appears in the Book of Daniel
(1:3-15). In this chapter, whose historical setting is about 650 B.C.E., Daniel and his friends are
prisoners of Nebuchadnezzar, who wants to educate them to become advisors and orders a court
official to provide fare from his table: “8 Daniel resolved not to defile himself with the king’s food
or the wine he drank, so he sought permission of the chief officer not to defile himself.” The official
is worried the king will have his head, but he is kind and he and Daniel strike a deal: “12 ‘Please
test your servants for ten days, giving us legumes to eat and water to drink. 13 Then compare our
appearance with that of the youths who eat of the king’s food, and do with your servants as you see
fit.’ 14 He agreed to this plan of theirs, and tested them for ten days. 15 When the ten days were
over, they looked better and healthier than all the youths who were eating of the king’s food” (JPS
translation, 1985).
In the 3rd century B.C.E. the Alexandrian physicians, Herophilus of Chalcedon and Erasistratus,
performed systematic dissections of human cadavers and experimental vivisection on criminals.
Herophilus and Erasistratus accurately described the heart and heart valves, the liver, the female
reproductive organs, the eye, and the vascular system, among other discoveries. The Greek cultural
taboo against cutting the body effectively prohibited further such practices. Von Staden
offers a thorough explanation of how Greek concepts of death and pollution (extending even to
the house), skin, and cutting prevented medical experimentation. He suggests that the unique
confluence of Ptolemaic tyrants who offered generous patronage to intellectuals, Greek Stoicism
that placed the dead body into an “indifferent” moral category, and Aristotle’s rather crass attitude
concerning the human corpse combined to allow, for a brief period, contravention of traditional
Greek beliefs and practices. Systematic dissection would not occur again until the development of
early schools of medicine in the 12th and 13th centuries (von Staden, 1992).
The Babylonian Talmud (Niddah (30b)), begun about the year 550, reports what may be an
apocryphal story about Cleopatra, to settle an argument between two rabbis about the amount of
time it takes for a male and a female fetus to fully develop. Supposedly, Cleopatra had slave girls
impregnated, operated on at specified times, and killed to examine the development of the fetuses.
She was told that boys did indeed develop in the 40 days and girls took the full 80 days. Is this the
first instance of manipulating data to suit the sponsor?
Human experiments are mentioned at least two other times in the Talmud. In one instance, students
dissected a condemned prostitute to determine the number of joints in a human body (Berachot
(45)). In another instance, a rabbi used two handmaids to determine the validity of a test
for virginity (Ketubot (10b)). Interestingly enough, in the virginity experiment, which required
the test subject to sit on an open cask of wine, the rabbi did not think it appropriate to experiment
with Jewish women and so used non-Jewish handmaidens for the test.
The Talmud does not comment on the propriety of using these data to settle an argument. Nor
does it comment on the ethics of using people in experiments. Later commentaries (responsa) do
comment on human subject research and informed consent as well as on the ethics of using what
might be “tainted” data (in particular, data resulting from Nazi experiments).
196 2005 Symposium Proceedings Book