WEBVTT - The Rise of the Guinea Pigs 0:00:15.356 --> 0:00:15.796 Pushkin. 0:00:20.276 --> 0:00:23.996 One of my favorite podcasts is called This Week in 0:00:24.116 --> 0:00:27.356 Virology TWIV, as it's known. 0:00:27.596 --> 0:00:32.716 This Week in Virology, the podcast about viruses, the kind 0:00:33.236 --> 0:00:34.516 that make you sick. 0:00:38.276 --> 0:00:42.876 On the show, a prominent virologist named Vincent Racaniello has 0:00:42.876 --> 0:00:46.276 a weekly chat with colleagues from around the country, updating 0:00:46.516 --> 0:00:49.236 their listeners on the latest news from around the world 0:00:49.956 --> 0:00:54.916 about microbes. TWIV is a very big deal. It's the 0:00:54.956 --> 0:00:58.636 tonight show only for virologists. For my birthday, my friend 0:00:58.716 --> 0:01:02.156 Charles got me a twift shirt, which I'm wearing right now. 0:01:02.756 --> 0:01:05.236 TWIF has taught me more about science than almost anything 0:01:05.276 --> 0:01:08.556 I can remember, and one of their most memorable episodes 0:01:08.676 --> 0:01:12.396 is called I Love the Smell of Vaccines in the Morning. 0:01:12.716 --> 0:01:17.516 Many people sent this to us asking our thoughts, and 0:01:17.636 --> 0:01:20.116 so there you go, We're going to give you our thoughts. 0:01:20.516 --> 0:01:22.676 I Love the Smell of Vaccines in the Morning came 0:01:22.716 --> 0:01:25.876 out in the winter of twenty twenty two. The Twivers 0:01:26.156 --> 0:01:28.276 wanted to talk about a study that had just been 0:01:28.276 --> 0:01:34.276 published entitled Safety, Tolerability and Viral Kinetics during tsar's COVID 0:01:34.316 --> 0:01:35.796 two Human Challenge. 0:01:36.116 --> 0:01:36.596 This is a. 0:01:36.556 --> 0:01:42.196 Study where you deliberately infect human volunteers under very carefully 0:01:42.236 --> 0:01:47.476 controlled conditions. They're under hospital care, they're isolated. Right, You've 0:01:47.516 --> 0:01:52.636 got anti virals and monoclonals at the ready should anything happen. 0:01:56.276 --> 0:02:00.876 The Human Challenge trial had thirty six unvaccinated subjects, all 0:02:00.916 --> 0:02:05.196 between the ages of eighteen and twenty nine, all volunteers 0:02:05.236 --> 0:02:08.436 who agree to be infected with COVID in a concentrated 0:02:08.476 --> 0:02:11.956 dose administered to the nasal cavity. The aim of the 0:02:11.996 --> 0:02:15.196 study was to figure out a crucial bit of information 0:02:15.516 --> 0:02:18.316 that was still unknown in the early days of the pandemic. 0:02:19.236 --> 0:02:21.556 How large a dose of covid do you have to 0:02:21.556 --> 0:02:24.156 be exposed to before you get infected. 0:02:26.316 --> 0:02:28.836 Sars kov two is not without risk. I mean it's 0:02:28.836 --> 0:02:32.836 not a bolah, right, but it's not common cold either. 0:02:33.436 --> 0:02:35.716 The TWIF crew went on for close to two hours 0:02:35.716 --> 0:02:39.956 about the study, comb through every detail, went on fascinating digressions, 0:02:40.156 --> 0:02:44.076 looked for insights and inconsistencies, and all came to the 0:02:44.116 --> 0:02:44.916 same conclusion. 0:02:45.796 --> 0:02:48.236 I would love to have been privy to the discussions 0:02:48.236 --> 0:02:50.316 that led up to the approval of this to see 0:02:50.356 --> 0:02:55.156 what they're thinking, right, Yeah, because I have to say 0:02:55.836 --> 0:02:57.876 I wouldn't be in favor of this because if one 0:02:57.916 --> 0:03:01.636 person dies, that's the end of it, and that person's 0:03:01.716 --> 0:03:03.596 family is pretty upset. 0:03:03.516 --> 0:03:07.796 Pretty upset, I would say, very upset. It's difficult because 0:03:07.836 --> 0:03:10.276 when you look at the paper and you see results, okay, 0:03:10.356 --> 0:03:13.956 and nobody died, nobody even got really sick, I mean 0:03:13.996 --> 0:03:17.036 really sick. Okay, when you look at it from that 0:03:17.076 --> 0:03:19.796 point of view, you go, oh wow, this is great. 0:03:23.716 --> 0:03:26.756 My name is Malcolm Golbwell, you're listening to Revisionist History, 0:03:27.036 --> 0:03:32.636 my podcast about things overlooked and misunderstood. This is part 0:03:32.676 --> 0:03:37.836 two of our examination of the Minnesota starvation experiment. Part 0:03:37.876 --> 0:03:40.756 one was about what happened when ansel keyes invited a 0:03:40.756 --> 0:03:42.836 group of young men to spend a year in a 0:03:42.916 --> 0:03:51.876 dingy set of rooms under the University of Minnesota football stadium. 0:03:51.996 --> 0:03:55.356 This episode is about the strange way that so many 0:03:55.436 --> 0:04:01.396 scientists think about the morality of human experiments, like, for example, 0:04:01.916 --> 0:04:05.316 the experiment described in the twelve episode I Love the 0:04:05.356 --> 0:04:15.116 Smell of Vaccines in the morning. When the crew at 0:04:15.116 --> 0:04:18.956 This Week in Virology start talking about the experiment, they 0:04:18.996 --> 0:04:19.836 sound reasonable. 0:04:20.356 --> 0:04:24.396 There was very careful consideration given by the authors and 0:04:24.876 --> 0:04:28.556 a whole bunch of other people as to whether they 0:04:28.676 --> 0:04:32.756 turned it ethical. So no matter what we might think, okay, 0:04:32.996 --> 0:04:35.316 there are a whole bunch of people who thought that 0:04:35.836 --> 0:04:36.676 this was just fine. 0:04:36.876 --> 0:04:40.276 That's Rich Condent of the University of Florida, another of 0:04:40.356 --> 0:04:44.116 the twive mainstays. Medicine is typically in the business of 0:04:44.156 --> 0:04:47.196 trying to make sick people healthy, but there's no question 0:04:47.396 --> 0:04:49.916 that you can learn more by making healthy people sick. 0:04:50.996 --> 0:04:53.516 Making healthy people sick means you can study your disease 0:04:53.556 --> 0:04:56.316 from the very beginning, as opposed to the point where 0:04:56.316 --> 0:04:58.916 the patient shows up in your office. It means you 0:04:58.916 --> 0:05:01.796 can choose exactly the kind of disease you want to study, 0:05:02.156 --> 0:05:06.076 the precise strain of virus, the exact species of bacteria. 0:05:06.596 --> 0:05:09.316 You can choose who you want to study, young people, 0:05:09.396 --> 0:05:13.476 old people, world class marathoners, the thin, the overweight. You 0:05:13.516 --> 0:05:17.756 can compare different treatments easily and cheaply. But when you 0:05:17.796 --> 0:05:21.596 go from healthy to sick, you have a big ethical problem. 0:05:21.996 --> 0:05:26.276 The hippocratic oath all physicians take says first, do no harm. 0:05:26.596 --> 0:05:30.316 So how can you justify infecting healthy people with a 0:05:30.316 --> 0:05:31.836 potentially deadly virus. 0:05:32.036 --> 0:05:36.796 If I were confronted personally with whether or not to 0:05:36.876 --> 0:05:41.476 launch or support this study, I'm not sure I would 0:05:41.556 --> 0:05:41.796 do it. 0:05:42.116 --> 0:05:46.156 Then Brian Barker, a virologist at Drew University, chimed. 0:05:45.876 --> 0:05:48.116 In, Yeah, I was trying to imagine if I was 0:05:48.116 --> 0:05:51.636 in this age group, would I. 0:05:50.636 --> 0:05:52.356 Be interested in being in the study. 0:05:52.996 --> 0:05:54.956 And my answer was absolutely not. 0:05:56.636 --> 0:05:59.156 The more they talked about it, the more adamant the 0:05:59.236 --> 0:06:00.236 Twig crew became. 0:06:00.836 --> 0:06:02.836 I would not have approved this. If I were on 0:06:02.876 --> 0:06:05.356 the committee, I would have voted no. At some point, 0:06:05.436 --> 0:06:08.796 there's going to be a young person who seems perfectly healthy. 0:06:09.116 --> 0:06:11.436 There's got something we don't know about and is going 0:06:11.516 --> 0:06:14.396 to die here. And that's what I'm concerned about. And 0:06:14.436 --> 0:06:16.996 I don't know how. I'm sure these people don't know 0:06:17.036 --> 0:06:20.756 anything we don't know, all right. I don't know how 0:06:20.756 --> 0:06:22.756 they can sleep at night. 0:06:25.356 --> 0:06:27.636 Now, why are we spending so much time on the 0:06:27.676 --> 0:06:32.316 issue that Twivers had with this obscure COVID study, Because 0:06:32.396 --> 0:06:36.236 the Minnesota starvation experiment was exactly the same kind of 0:06:36.356 --> 0:06:41.916 human challenge trial ancil Keys took thirty six perfectly healthy 0:06:41.956 --> 0:06:45.996 young men and made them sick by starving them for months. 0:06:46.636 --> 0:06:50.836 A study like that should raise a million red flags, right. 0:06:54.476 --> 0:06:57.716 The Minnesota starvation experiment ran during the final year of 0:06:57.756 --> 0:07:01.076 the Second World War, and the subjects were all drawn 0:07:01.116 --> 0:07:04.076 from the pool of men who had refused military service 0:07:04.636 --> 0:07:10.396 conscientious objectors. They were about seventy two thousand and registered 0:07:10.676 --> 0:07:14.556 conscientious objectors in the United States during the Second World War. 0:07:15.396 --> 0:07:19.076 Some served in the military in non combat roles. Others 0:07:19.196 --> 0:07:22.876 chose alternative service and were put to work fighting forest 0:07:22.956 --> 0:07:24.836 fires or staffing hospitals. 0:07:27.316 --> 0:07:31.596 They did social work in the Deep South. They worked 0:07:31.596 --> 0:07:35.236 as orderlies in state mental health facilities. Many of them 0:07:35.276 --> 0:07:39.356 were digging ditches and grading roads and doing things that 0:07:39.596 --> 0:07:43.236 simply couldn't be defined as work of national importance. 0:07:43.516 --> 0:07:47.116 That's the historian Sarah Tracy who's been researching the Minnesota 0:07:47.116 --> 0:07:48.156 starvation experiment. 0:07:48.636 --> 0:07:52.916 Conscientious Objectors had been used as medical guinea pigs, and 0:07:53.476 --> 0:07:59.116 the US Civilian Public Service and Selective Service learn about this, 0:07:59.476 --> 0:08:03.916 and so there is this program that about seven hundred 0:08:03.996 --> 0:08:08.476 of the twelve thousand conscientious objectors who were doing work 0:08:08.476 --> 0:08:11.876 of national and importance, so called work of the national importance, 0:08:12.596 --> 0:08:16.996 about seven hundred of them enroll in medical experiments all 0:08:17.036 --> 0:08:17.916 around the country. 0:08:18.596 --> 0:08:22.436 Among the researchers who used human guinea pigs was ansel Keys. 0:08:22.796 --> 0:08:26.716 He's testing the effects of thiamine deficiency and needs willing 0:08:26.716 --> 0:08:29.476 to test subjects for a long term study in his lab. 0:08:30.116 --> 0:08:32.556 Why not these religious pacifists. 0:08:32.636 --> 0:08:36.196 He writes away, and he gets several about eleven to 0:08:36.916 --> 0:08:41.716 do vitamin experiments, and that goes very well. He's impressed 0:08:42.436 --> 0:08:48.236 by these conscientious objectors. They're dedicated, they're committed, they're excellent 0:08:48.836 --> 0:08:49.916 research subjects. 0:08:50.036 --> 0:08:53.476 It's from this pool of volunteers that Keys draws the 0:08:53.516 --> 0:08:58.236 first of the subjects for his starvation experiment. Now, if 0:08:58.276 --> 0:09:01.276 you want to make healthy people sick, you have to 0:09:01.276 --> 0:09:05.356 be completely sure that your subjects are acting autonomously, to 0:09:05.476 --> 0:09:09.236 use the word favored by ethicists, meaning did the subjects 0:09:09.476 --> 0:09:13.396 make their decision to join the experiment freely, without pressure 0:09:13.516 --> 0:09:17.556 or constraint. Were they informed of all the consequences? Did 0:09:17.556 --> 0:09:20.996 they fully understand what they were getting into? The NYU 0:09:21.036 --> 0:09:24.636 bioethicist Art Kaplan says, it's hard for scientists now to 0:09:24.716 --> 0:09:27.436 find an easy answer to those questions when it comes 0:09:27.436 --> 0:09:28.676 to the starvation experiment. 0:09:29.076 --> 0:09:33.236 Bioethicists like me have tended not to comment much on 0:09:33.316 --> 0:09:37.356 this study. It's interesting, this is such a difficult case 0:09:37.436 --> 0:09:40.396 that I think people they've steered away from it a 0:09:40.436 --> 0:09:40.836 little bit. 0:09:42.916 --> 0:09:45.556 What makes the case so difficult is a keys of 0:09:45.596 --> 0:09:48.356 study was conducted in the middle of a world war. 0:09:49.196 --> 0:09:51.956 His subjects were all men who would refuse to fight 0:09:52.036 --> 0:09:55.156 Nazis in Europe, and because of that they were subject 0:09:55.196 --> 0:10:00.676 to intense social pressure. People called them cowards, shirkers, morally bankrupt. 0:10:00.956 --> 0:10:04.116 Doors were slammed in their faces. And so along comes 0:10:04.196 --> 0:10:08.476 Ansel Keys, charismatic ansel Keys, Ansel Keys with a two 0:10:08.556 --> 0:10:11.636 hundred point IQ score, and he says, would you like 0:10:11.716 --> 0:10:14.196 to be part of a medical experiment that makes a 0:10:14.236 --> 0:10:19.596 difference that erases the sin of your absence from the war? Well, 0:10:19.676 --> 0:10:22.716 of course they're going to say yes. So is that 0:10:22.756 --> 0:10:31.676 an autonomous decision or is that a coerce decision? In 0:10:31.716 --> 0:10:34.796 the previous episode, we heard how one of the volunteers, 0:10:35.036 --> 0:10:37.796 Sam Legg, chopped off some of his fingers with an 0:10:37.836 --> 0:10:41.676 axe in the delirium of his starvation. And then as 0:10:41.716 --> 0:10:45.276 he lay in his hospital bed, leg begged Ansel Keys 0:10:45.516 --> 0:10:50.876 to let him stay in study. Remember what he told Keys, doctor, 0:10:51.316 --> 0:10:53.596 for the rest of my life people are going to 0:10:53.636 --> 0:10:56.996 ask me what I did during the war. This experiment 0:10:57.076 --> 0:10:59.996 is my chance to give an honorable answer to that. Question. 0:11:01.436 --> 0:11:05.276 That does not sound like a rational, autonomous decision. That 0:11:05.356 --> 0:11:07.836 sounds like someone who's terrified to go back to his 0:11:07.916 --> 0:11:12.436 hometown and tell I'm sorry, I've now failed my country twice. 0:11:14.116 --> 0:11:17.076 As for the second test of autonomy, did the subjects 0:11:17.076 --> 0:11:19.916 know what they were getting into? Did they fully understand 0:11:19.956 --> 0:11:24.516 the consequences of their participation? Of course not. That's the 0:11:24.556 --> 0:11:27.556 whole lesson of the testimony from the eighteen volunteers in 0:11:27.596 --> 0:11:30.556 the Library of Congress. They thought they would be hungry. 0:11:30.836 --> 0:11:33.516 They didn't understand that starvation could cause him to start 0:11:33.516 --> 0:11:38.036 losing their moral bearings. Sam Legg remembered one day when 0:11:38.036 --> 0:11:40.316 he was out walking and saw a boy whiz by 0:11:40.396 --> 0:11:41.156 on his bicycle. 0:11:41.836 --> 0:11:45.076 How very brief I hope it was brief moment I 0:11:45.116 --> 0:11:51.636 suddenly hated that that boy, and that I hate at 0:11:51.676 --> 0:11:56.276 this point to tell you this, because it doesn't speak 0:11:56.356 --> 0:11:56.996 very well for me. 0:11:58.116 --> 0:12:02.076 Legg was a committed pacifist, a deeply spiritual man. Did 0:12:02.156 --> 0:12:04.956 he consent to that feeling when he signed up? He's 0:12:04.956 --> 0:12:06.676 still ashamed of it half a century later. 0:12:18.516 --> 0:12:25.476 Frankly, I was amazed or shocked by the study. 0:12:26.196 --> 0:12:29.316 That's so hard. Letterman, a bioethicist who teaches at the 0:12:29.436 --> 0:12:32.276 Rohmbam Medical Campus in Israel, and it's one of the 0:12:32.316 --> 0:12:34.596 few people in his field to have written about the 0:12:34.636 --> 0:12:38.676 Minnesota starvation experiment. Letterman's big problem is with the notion 0:12:38.836 --> 0:12:42.276 that the subjects quote unquote volunteered. 0:12:41.996 --> 0:12:44.756 We served is ready serving the army as well. And 0:12:44.876 --> 0:12:48.636 we have a joke about volunteering for something. You don't 0:12:48.716 --> 0:12:52.476 volunteer in the army, you get volunteered, right, And we 0:12:52.516 --> 0:12:54.796 even have a special ward for it in Himbrew. 0:12:54.836 --> 0:12:57.916 Only in Israel is there a special word to describe 0:12:58.196 --> 0:13:02.996 the condition of volunteering without actually volunteering being volunteered. 0:13:03.236 --> 0:13:07.396 So I suspect that in that environment. And again I'm not, 0:13:07.956 --> 0:13:10.636 you know, not an historian. They don't know what it 0:13:10.756 --> 0:13:13.956 was like during that time in the early forties in 0:13:13.996 --> 0:13:17.596 the US. But I think we need to be worthy 0:13:17.876 --> 0:13:22.596 of any assumption of voluntariness in that context. 0:13:23.156 --> 0:13:27.276 Letterman's point is, if an experiment isn't truly voluntary, how 0:13:27.316 --> 0:13:29.476 do we justify making the subjects suffer? 0:13:29.916 --> 0:13:33.636 If it's minimal harm, you give them diarrhea. I mean, 0:13:34.076 --> 0:13:36.756 you can say, okay, that's fine, that's nothing, But if 0:13:36.756 --> 0:13:42.676 that means that they start chewing gums, showing a bubble 0:13:42.716 --> 0:13:46.836 gum all day long, or cutting off their fingers, or 0:13:46.876 --> 0:13:51.316 developing neurosis or developing kidney failure, or two people developed 0:13:51.396 --> 0:13:54.236 kidney failure because of the study. I think at that 0:13:54.436 --> 0:13:59.036 point you should say, no, that's enough. Regardless of the 0:13:59.076 --> 0:14:02.356 potential benefits. There are some things we cannot do. 0:14:03.796 --> 0:14:07.676 There are some things we cannot do. This is exactly 0:14:07.716 --> 0:14:10.276 where the Twitters ended up as well in their discussion 0:14:10.356 --> 0:14:14.836 of the COVID infection study. Remember what Vincent Racanello said. 0:14:15.076 --> 0:14:17.396 I'm sure these people don't know anything. We don't know, 0:14:18.076 --> 0:14:23.796 all right. I don't know how they can sleep at night. 0:14:24.996 --> 0:14:25.236 Now. 0:14:25.356 --> 0:14:27.996 Am I happy that scientists cared deeply about the ethical 0:14:28.036 --> 0:14:31.596 implications of their field, of course, But there's something I 0:14:31.636 --> 0:14:34.996 don't quite understand about the arguments used by those who 0:14:35.036 --> 0:14:39.036 worry about human jallenge trials. Listen to this exchange, for example, 0:14:39.316 --> 0:14:42.196 the twive crew are digging deeper and deeper into the 0:14:42.196 --> 0:14:46.516 details of the COVID infection experiment and which condit starts, 0:14:46.676 --> 0:14:49.356 reading to the fine print on the studies design. 0:14:50.716 --> 0:14:53.556 I thought it was interesting that they apparently started out 0:14:53.596 --> 0:15:01.236 by soliciting volunteers with an online application and got twenty 0:15:01.236 --> 0:15:02.596 seven thousand responses. 0:15:03.596 --> 0:15:07.076 Wait, the people who ran that study didn't have to 0:15:07.156 --> 0:15:10.116 trick people to get them to side, or go to 0:15:10.196 --> 0:15:13.036 some out of the way prison and use inmates as 0:15:13.076 --> 0:15:18.156 guinea pigs. No, twenty seven thousand people looked around them 0:15:18.236 --> 0:15:21.076 at the millions of people dying from COVID and said, 0:15:21.636 --> 0:15:24.436 I'm willing to take that risk, to make that sacrifice 0:15:24.516 --> 0:15:27.476 for society. There was a line out the door, down 0:15:27.516 --> 0:15:29.476 the block and clear across town. 0:15:29.916 --> 0:15:32.156 They were coming to us saying, we're in the middle 0:15:32.156 --> 0:15:32.876 of a pandemic. 0:15:33.316 --> 0:15:37.036 I called up Andrew Catchpull, the British virologist who led 0:15:37.076 --> 0:15:38.396 the COVID infection study. 0:15:38.716 --> 0:15:41.196 They came to us with phrases like they just wanted 0:15:41.236 --> 0:15:43.436 to do their bit for the pandemic. They felt that 0:15:43.476 --> 0:15:47.196 this was something that they could do to help. So 0:15:47.276 --> 0:15:49.276 it was really heart warming actually to see that. 0:15:50.116 --> 0:15:52.636 Now, you would think that if you were a virologist 0:15:52.796 --> 0:15:55.676 on the biggest virology podcast in the world trying to 0:15:55.716 --> 0:15:59.316 figure out the ethics of a particular study, then this 0:15:59.476 --> 0:16:03.236 kind of information would matter. That if you're worrying about consent, 0:16:04.036 --> 0:16:07.916 then that kind of overwhelming enthusiasm should maybe make you 0:16:08.076 --> 0:16:11.796 a little less worried. So, like any loyal Twive listener, 0:16:12.236 --> 0:16:14.436 I waited for the rest of the crew to start 0:16:14.476 --> 0:16:18.236 talking about the implications of the twenty seven thousand volunteers. 0:16:18.996 --> 0:16:22.596 I waited and waited for the Twivers to make sense 0:16:22.636 --> 0:16:28.356 of this and crickets. The conversation just moved on. 0:16:29.396 --> 0:16:29.796 All right. 0:16:30.396 --> 0:16:34.996 So after the screening, they're admitted to individual negative pressure 0:16:35.036 --> 0:16:39.516 rooms in a quarantine unit twenty four hour monitoring their 0:16:39.556 --> 0:16:42.396 screen for other respiratory infections using what's bulderbio. 0:16:42.556 --> 0:16:45.356 Vincent Racanello might as well admit a big w with 0:16:45.396 --> 0:16:50.956 his fingers. Whatever, the fact that twenty seven thousand people 0:16:51.276 --> 0:16:54.636 signed up to get infected with COVID has apparently made 0:16:55.116 --> 0:17:00.116 no impression at all on these virologists. Human challenge trials 0:17:00.356 --> 0:17:10.756 are a problem to scientists. Let me read to you 0:17:10.796 --> 0:17:13.796 from a paper that appeared early in the pandemic in 0:17:13.956 --> 0:17:17.796 p and As Proceedings of the National Academy of Sciences, 0:17:18.076 --> 0:17:21.756 which is about as prestigious as scientific journals get. The 0:17:21.796 --> 0:17:25.796 paper was written by a group of America's leading medical ethicists. 0:17:26.276 --> 0:17:29.396 They're talking about the same general question that was discussed 0:17:29.436 --> 0:17:34.036 on the TWIB episode. Should people be allowed to volunteer 0:17:34.156 --> 0:17:37.716 to be deliberately infected with COVID. In this case, they're 0:17:37.716 --> 0:17:42.676 talking about deliberate infection for testing potential COVID vaccines. They 0:17:42.716 --> 0:17:45.436 give you the experimental vaccine, then they expose you to 0:17:45.476 --> 0:17:47.676 COVID to see if it works, and the risk, of 0:17:47.716 --> 0:17:51.476 course is that if it doesn't work, you'll get sick. Now, 0:17:51.556 --> 0:17:54.116 if you volunteer to be a COVID guinea pig in 0:17:54.156 --> 0:17:57.596 an experiment like that, I'm assuming you understand what you're 0:17:57.596 --> 0:18:01.716 getting into. But the famous ethicists, in their paper in 0:18:01.796 --> 0:18:05.436 the Proceedings of the National Academy of Sciences begged to differ. 0:18:06.276 --> 0:18:11.196 Here's what they wrote. Despite acknowledge in consent forms that 0:18:11.236 --> 0:18:15.956 participants may not experience direct benefits from the experimental intervention, 0:18:16.516 --> 0:18:20.516 it is entirely possible that volunteers may labor under a 0:18:20.596 --> 0:18:25.036 quote preventive misconception that they will receive some protection from 0:18:25.076 --> 0:18:30.596 infection by their participation. That's a lot of gobbletgook. So 0:18:30.716 --> 0:18:33.916 let me translate for you. You can tell the guinea 0:18:33.916 --> 0:18:37.996 pig that this vaccine is experimental, that it hasn't been tested, 0:18:38.356 --> 0:18:40.916 that we don't know yet whether it works, but there 0:18:40.956 --> 0:18:44.036 is at least a theoretical possibility that one of those 0:18:44.076 --> 0:18:47.636 guinea pigs are going to misunderstand what's going on, And 0:18:47.716 --> 0:18:51.476 the possibility of that misapprehension means that you should never 0:18:52.156 --> 0:18:58.156 ever try an experiment like that. I'll be honest. When 0:18:58.196 --> 0:19:01.836 I read that paper, I got a little puzzled. I mean, 0:19:02.036 --> 0:19:05.756 what would it take to make these bioethesists happy? What 0:19:05.916 --> 0:19:08.676 if we screened and vetted and sifted and sorted through 0:19:08.756 --> 0:19:12.436 every one of the people who volunteered, picking out only 0:19:12.476 --> 0:19:15.916 the select few who we thought really and truly understood 0:19:15.996 --> 0:19:19.236 what was going on? Would that make them happy? What 0:19:19.276 --> 0:19:22.116 if we only pick people with graduate degrees, or ones 0:19:22.116 --> 0:19:24.396 with IQs over one hundred and fifty, or ones willing 0:19:24.436 --> 0:19:27.476 to run a ten thousand word essay describing exactly what 0:19:27.556 --> 0:19:30.596 they think they're getting into. Would that make them happy? 0:19:30.956 --> 0:19:33.276 Or would they still be like? I don't know. I 0:19:33.316 --> 0:19:36.476 think it's entirely possible that volunteers may labor under a 0:19:36.476 --> 0:19:40.836 preventative misconception. So even as this pandemic rages all around us, 0:19:41.356 --> 0:19:44.596 let's not do anything at all. Now, how are they 0:19:44.636 --> 0:19:47.356 so sure of this? Did they debrief anyone who've been 0:19:47.396 --> 0:19:51.156 part of a vacting challenge trial. No, they didn't. I 0:19:51.196 --> 0:19:53.436 want to talk a little bit more about the men 0:19:53.516 --> 0:19:56.756 who volunteer and their motivations and how we judge them 0:19:56.836 --> 0:20:00.316 in retrospect. I brought this issue up with the bioethicist 0:20:00.396 --> 0:20:04.316 Zohar Letterman when we were discussing the Minnesota Starvation Experiment, 0:20:04.636 --> 0:20:07.516 and I'm wondering, when it comes to assessing the risks 0:20:07.516 --> 0:20:11.516 and benefits of a study like this, shouldn't what the 0:20:11.556 --> 0:20:16.116 subjects think matter? You're not interested in subjects. 0:20:15.676 --> 0:20:15.916 I think. 0:20:16.916 --> 0:20:21.836 I think in research ethics, as BIOasis, as policy makers, 0:20:23.516 --> 0:20:27.676 we can only listen to what people want up to 0:20:27.716 --> 0:20:34.916 a certain point when it comes to unnecessary harms. When 0:20:34.916 --> 0:20:40.316 it comes to the ethics per se of a certain 0:20:40.876 --> 0:20:45.676 policy or certain study, there comes a point when you 0:20:45.876 --> 0:20:48.476 no longer need to listen to the voices, but you 0:20:48.756 --> 0:20:51.036 just have to go on the ethics of it. 0:20:52.316 --> 0:21:16.556 Actually, no, I think we should listen to the voces. 0:21:17.996 --> 0:21:22.436 Eighteen of the surviving members of the starvation experiment left 0:21:22.636 --> 0:21:27.716 oral histories behind about their experience. On first listen, what's 0:21:27.716 --> 0:21:31.036 striking about them is what the men went through their pain. 0:21:31.556 --> 0:21:34.796 But if you listen more closely, you hear something else. 0:21:36.196 --> 0:21:38.316 Why were you a craciential subjector. 0:21:40.036 --> 0:21:43.516 Well, because in when I was in high school, I 0:21:43.676 --> 0:21:47.676 became acquainted with a fellow by the name of Jesus 0:21:47.676 --> 0:21:51.796 of Nazareth, and I thought he was a pretty good guy, 0:21:53.676 --> 0:21:58.956 and I liked what he said, and I liked the 0:21:58.956 --> 0:22:03.156 way he lived and the way he handled situations with 0:22:03.236 --> 0:22:04.156 other human beings. 0:22:05.956 --> 0:22:12.556 I couldn't imagine Jesus. I couldn't visualize him in the 0:22:12.676 --> 0:22:16.716 uniform of a US army or any kind of an army. 0:22:17.516 --> 0:22:23.036 It just didn't fit. And so I basically said, well, 0:22:23.036 --> 0:22:24.396 if he couldn't do what, I can't do it. 0:22:25.356 --> 0:22:29.716 The interviewer asked everyone the same question, why wouldn't you fight? 0:22:30.356 --> 0:22:32.916 And each man gives a version of the same answer. 0:22:33.036 --> 0:22:35.196 Why were you a conscientious objector? 0:22:35.956 --> 0:22:37.836 I'm not going to kill anybody, and I don't want 0:22:37.836 --> 0:22:38.676 anyone to kill me. 0:22:39.716 --> 0:22:41.316 God put us on his earth. 0:22:42.716 --> 0:22:44.596 And as the only one that has a right to 0:22:44.636 --> 0:22:45.276 take us away. 0:22:45.956 --> 0:22:48.436 These were not people who dodged the draft out of 0:22:48.516 --> 0:22:53.676 cowardice or indifference. These were deeply moral people from religious 0:22:53.716 --> 0:22:56.676 traditions like the Quakers or the Mennonites or the Brethren, 0:22:56.916 --> 0:23:00.756 that had principled theological objections to war that go back 0:23:00.876 --> 0:23:01.796 hundreds of years. 0:23:02.316 --> 0:23:05.516 So you know, on the most basic level, why were 0:23:05.516 --> 0:23:06.716 you a conscientious objector? 0:23:07.476 --> 0:23:10.676 Well, I don't believe in killing people under any circumstances. 0:23:11.676 --> 0:23:14.636 Conscientious objectors had many ways to serve during the war, 0:23:15.076 --> 0:23:17.916 but it becomes clear listening to their accounts that the 0:23:17.956 --> 0:23:20.636 issue for them was not what is the easiest or 0:23:20.676 --> 0:23:24.596 most convenient way to fulfill my wartime obligation. It was 0:23:24.996 --> 0:23:27.276 what is the most useful way for me to help 0:23:27.316 --> 0:23:30.836 alleviate human suffering. That's why some of them volunteer to 0:23:30.876 --> 0:23:34.516 work as research subjects in ansel Keys's lab. They want 0:23:34.556 --> 0:23:37.796 to do more than dig ditches or work as hospital orderlies. 0:23:38.796 --> 0:23:42.716 So did they suffer during the starvation experiment? Of course 0:23:42.756 --> 0:23:46.716 they did, but that doesn't make the experiment immoral. Listen 0:23:46.756 --> 0:23:48.996 to Sam leg again, the man who chopped off his 0:23:49.036 --> 0:23:53.156 own fingers in the delirium of malnourishment. Many decades later, 0:23:53.556 --> 0:23:54.756 this is what he has to say. 0:23:55.476 --> 0:23:57.876 Everybody else around us is pulling down the world. We 0:23:57.916 --> 0:24:00.156 want to build it up. We want to be of service. 0:24:00.476 --> 0:24:03.316 Here was an obvious opportunity for us to be of service. 0:24:03.756 --> 0:24:06.876 You cannot form a legitimate opinion on the ethics of 0:24:06.916 --> 0:24:10.956 what happened in Minnesota. Unless you willing to listen to Sandleg. 0:24:10.796 --> 0:24:15.516 Now immediately you'll say, oh, come on, you are a 0:24:15.596 --> 0:24:19.636 Jesus freak, which I will agree to. And so you 0:24:19.676 --> 0:24:22.676 were going to emulate Jesus. How well have you done it? 0:24:22.716 --> 0:24:24.956 And I say, that's none of your business on this 0:24:25.036 --> 0:24:28.556 one issue of this aspect of Jesus, I've done it. 0:24:29.556 --> 0:24:32.836 Never mind the rest, but that stock that was important 0:24:32.836 --> 0:24:33.036 to me. 0:24:36.036 --> 0:24:38.916 When ensel Keys retired, he was interviewed by a colleague 0:24:38.956 --> 0:24:41.716 of his at the University of Minnesota. At one point 0:24:42.076 --> 0:24:43.916 they talk about the starvation experiment. 0:24:44.396 --> 0:24:47.636 There's evidence coming all around. At the end of the war, 0:24:47.716 --> 0:24:50.636 would see a lot of problems and people have been 0:24:50.636 --> 0:24:55.516 semi starved, especially in northern countries. So I went to 0:24:55.556 --> 0:25:01.156 the certain general's office and mentioned this, said we ought 0:25:01.156 --> 0:25:05.196 to get some evidence on it and what happens when 0:25:05.196 --> 0:25:10.316 people are starved. And then so the network others of him, 0:25:10.356 --> 0:25:14.436 being an experimentalist, proposed to carry out an experiment, and 0:25:15.796 --> 0:25:20.076 we've got the authorization to have conscientious objectors. 0:25:20.956 --> 0:25:23.396 The net result is that I propose that we carry 0:25:23.396 --> 0:25:26.996 out an experiment, and we got the authorization to have 0:25:27.076 --> 0:25:32.036 conscientious objectors. Ansel Keys, the Great Genius, wanted the world 0:25:32.076 --> 0:25:37.116 to know that the starvation experiment was his idea, But 0:25:37.356 --> 0:25:40.236 like so many other things about that study, the truth 0:25:40.636 --> 0:25:44.756 is more complicated. It goes back to Ansel Keys's earlier 0:25:44.836 --> 0:25:48.996