ABSTRACT
Resumo No início do século XX, alguns médicos portugueses foram à África estudar a chamada doença do sono. Entre eles estava Ayres Kopke, membro da primeira missão médica à África Ocidental Portuguesa. De regresso a Lisboa, o professor da Escola de Medicina Tropical continuou suas pesquisas, inclusive por meio da observação de doentes trazidos para a metrópole. Desde 1903, as repartições de saúde nas colônias estavam incumbidas de enviar doentes com determinadas patologias exóticas para o Hospital Colonial de Lisboa. Com base em documentos desse hospital, incluindo fotografias dos doentes, então chamados de hipnóticos, o artigo aborda a importância das experiências com humanos na metrópole para o avanço da medicina tropical durante o colonialismo.
Abstract At the start of the twentieth century, some Portuguese physicians traveled to Africa to study sleeping sickness (African trypanosomiasis). One was Ayres Kopke, a member of the first medical mission to Portuguese West Africa and professor at the School of Tropical Medicine. After returning to Lisbon, Kopke continued his research, which included observation of patients brought to the metropolis. Starting in 1903, health departments in the colonies were responsible for sending patients with certain exotic diseases to the Colonial Hospital of Lisbon. Based on documents from this hospital including photographs of patients (who at that time were called "hypnotics"), this article discusses the importance of human experiments in Lisbon for advances in tropical medicine during the colonial period.
Subject(s)
Humans , Male , Female , History, 20th Century , Tropical Medicine/history , Trypanosomiasis, African/history , Colonialism/history , Medical Missions/history , Portugal , Africa, Western , Hospitals/history , Human Experimentation/historyABSTRACT
En Guatemala se llevaron a cabo experimentos por entidades de salud de Estados Unidos de Norte América, inoculando infecciones de transmisión sexual (gonorrea, sífilis y cancroide) a poblaciones vulnerables con el objetivo de generar un modelo humano para estudio de este tipo de enfermedades. Estos experimentos permanecieron ocultos durante 64 años, cuando la Dra. Susan Reverby los descubrió al revisar los archivos de quien fuera el investigador de los mismos, Dr. John C. Cutler. Fueron inoculados 1308 personas y reportadas fallecidas 83. Al hacerse pública esta nefasta noticia, se condenaron los hechos acontecidos entre 1946-1948 por múltiples organizaciones y el gobierno, nombrándose una Comisión Presidencial en Guatemala y por su parte el gobierno de Estados Unidos también conformó una Comisión Presidencial. Los informes y dictámenes de ambas Comisiones coinciden en que se violaron los principios éticos y morales, que la desigualdad social y racismo existente en esa época fueron condicionantes muy importantes, que lo acontecido puede ser catalogado como crímenes de lesa humanidad y que las personas que planificaron, aprobaron, condujeron, facilitaron y financiaron estos experimentos son moralmente culpables. A la fecha no se ha otorgado ningún resarcimiento a los afectados o familiares, ni compensación alguna a Guatemala...(AU)
In Guatemala, experiments were carried out by health entities in the United States of America, inoculating sexually transmitted infections (gonorrhea, syphilis and canker) into vulnerable populations with the aim of generating a human model for the study of this type of disease. These experiments remained hidden for 64 years, when Dr. Susan Reverby discovered them by reviewing the files of whoever was their researcher, Dr. John C. Cutler. 1308 people were inoculated and 83 were reported deceased. When this ominous news was made public, the events occurred between 1946-1948 by multiple organizations and the government were condemned, a Presidential Commission was appointed in Guatemala and for its part the government of the United States also formed a Presidential Commission. The reports and opinions of both Commissions agree that ethical and moral principles were violated, that the social inequality and racism that existed at that time were very important conditions, that what happened can be classified as crimes against humanity and that the people who planned , approved, conducted, facilitated and financed these experiments are morally culpable. To date no compensation has been granted to those affected or relatives, nor any compensation to Guatemala ... (AU)
Subject(s)
Adult , Syphilis/mortality , Sexually Transmitted Diseases/mortality , Research Subjects/history , Human Experimentation/history , Human Experimentation/ethics , United States , GuatemalaABSTRACT
Desde que el Rey Atalo III de Pérgamo, antes de la era cristiana, experimentase con veneno y antídoto en criminales condenados a muerte, la idea de probar fármacos en seres humanos siempre estuvo presente. Entre fines del Siglo XIX y principios del Siglo XX surgió una terapéutica basada fundamentalmente en evidencias experimentales, sin mayores recaudos éticos. El juicio de Nüremberg marca un antes y un después en la investigación médica con seres humanos. La Asociación Médica Mundial a través de la Declaración de Helsinski y sus posteriores enmiendas, al igual que otros importantes documentos deontológicos, procuran normatizar el desarrollo de estos protocolos de investigación, reafirmando que la participación del paciente debe ser voluntaria, libre y debidamente informada (consentimiento informado). Debido a que persisten las irregularidades en los procedimientos en sus distintas fases, es imprescindible una vigilancia ética que asegure los derechos de los participantes en estos ensayos clínicos controlados. Un hecho importante es la aparición de los comités independientes en investigación compuestos de manera multidisciplinaria(no solo por médicos) con facultades coercitivas. Hoy existe plena conciencia de que se impone el control público.
Since the King Atalo III of Pérgamo, before the Christian age, he who was experimented with poison and antidote on criminals condemned to death, the idea of to probe medication in human subjects has always been present. Between ends of the 19th century and beginning of the 20th century, therapeutic stocks arose fundamentally in experimental evidences, without major ethical objections. Nüremberg's judgment marks on earlier and a laterone in the medical research with human subjects. The Medical World Association across Helsinski's Declaration and its later amendments, as other important ethics documents, try to put in procedure place the development of these protocols of research, reaffirming that the participation of the patient must be voluntary, free and due informed (informed consent). Due to the fact that the irregularities persist in the procedures in its different phases, there is indispensable an ethical alertness thatassures the rights of the participants in these clinical controlled essays. An important fact is the appearance of the independent committees in research, compounds of a multidisciplinary way (not only for medical doctors), with coercive powers. Today exists full conscience of which the public control is imposed.
Subject(s)
Humans , Drugs, Investigational , Drug Evaluation/history , Drug Evaluation/trends , Ethics, Research , Bioethics , Informed Consent , Codes of Ethics , Controlled Clinical Trials as Topic , Human Experimentation/history , Human Experimentation/legislation & jurisprudence , Human Experimentation/ethicsABSTRACT
Clinical research is absolutely necessary for the development of medical knowledge. However, progress of Medicine has not always been obtained respecting human rights. From 1880 onwards, after Laveran's discovery of the protozoan nature of malaria, the increase in knowledge on paludism has been remarkable. Much of the knowledge gained up to the middle of the twentieth century was based although on highly questionable experiments according to modern ethical standards in the fields of biology and phisiopathology, and specially in therapeutic clinical triáis with antimalarial drugs.
La investigación científica en clínica es absolutamente necesaria para el desarrollo del saber médico. No obstante, no siempre el gran progreso alcanzado por la Medicina se ha obtenido respetando la persona humana. En particular, a partir de 1880, cuando Laveran constató por primera vez la naturaleza protozoaria de la malaria, el desarrollo del conocimiento sobre el paludismo ha sido muy notable, pero hasta la mitad del siglo XX estos logros fueron, en muchos casos, fruto de experimentos que hoy resultan en extremo discutibles desde el punto de vista ético, tanto los dedicados al estudio de la biología y de la fisiopatología, como especialmente los ensayos de carácter farmacológico efectuados en individuos sanos para probar moléculas con acción antimalárica real o presunta.
Subject(s)
Animals , History, 19th Century , History, 20th Century , Humans , Biomedical Research/history , Human Experimentation/history , Malaria/history , Antimalarials/history , Biomedical Research , Human ExperimentationABSTRACT
This paper aims to examine the spread of paragonimiasis and the Japanese colonial government's response to it. To consolidate colonial rule, the Japanese colonial government needed medications to cure paragonimiasis. When Dr. Ikeda Masakata invented acid emetine to cure paragonimiasis in Manchuria in 1915, emetine treatment carried the risk of emetine poisoning such as fatigue, inappetence, heart failure, and death. Nonetheless, Japanese authorities forced clinical trials on human patients in colonial Korea during the 1910s and 1920s. The emetine poisoning accident in Yeongheung and Haenam counties in 1927 occurred in this context. The Japanese government concentrated on terminating an intermediary host instead of injecting emetine to repress endemic disease in Japan. However, the Japanese colonial government pushed ahead with emetine injections for healthy men through the Preliminary Bureau of Land Research in colonial Korea in 1917. This clinical trial simultaneously presented the effects and the side effects of emetine injection. Because of the danger emetine injections posed, the colonial government investigated only the actual condition of paragonimiasis, delaying the use of emetine injection. Kobayashi Harujiro(1884-1969), a leading zoologist and researcher of endemic disease for three decades in the Government General Hospital and Keijo Imperial University in colonial Korea, had used emetine while researching paragonimiasis, but he did not play a leading role in clinical trials with emetine injections, perhaps because he mainly researched the intermediary host. Government General Hospital and Keijo Imperial University therefore faced limitations that kept them from leading the research on endemic disease. As the health administration shifted the central colonial government to local colonial government, the local colonial government pressed ahead with emetine injections for Korean patients. Emetine poisoning had something to do with medical power's localization. Nevertheless, the central colonial government still supported emetine injections with funds from the national treasury. The emetine poisoning accident that occurred simultaneously in two different regions resulted from the Japanese colonial government's support. This accident represented the Japanese colonial rule's atrocity, its suppression of hygiene policies, and its disdain for colonial inhabitants. The colonial government sought to accumulate medical knowledge not to cure endemic disease, but to expand the Japanese Empire.
Subject(s)
Humans , Male , Clinical Trials as Topic/history , Colonialism/history , Emetine/history , Endemic Diseases/history , History, 20th Century , Human Experimentation/history , Japan , Korea , Paragonimiasis/drug therapyABSTRACT
The year 2000 marked the centennial of the discovery of the mode of transmission of yellow fever. Informed consent was systematically used for the first time in research. This process was the result of a complex social phenomenon involving the American Public Health Association, the US and Spanish Governments, American and Cuban scientists, the media, and civilian and military volunteers. The public health and medical communities face the AIDS pandemic at the beginning of the 21st Century, as they faced the yellow fever epidemic at the beginning of the 20th Century. Current medical research dilemmas have fueled the debate about the ethical conduct of research in human subjects. The AIDS pandemic is imposing enormous new ethical challenges on the conduct of medical research, especially in the developing world. Reflecting on the yellow fever experiments of 1900, lessons can be learned and applied to the current ethical challenges faced by the international public health research community.
Subject(s)
Humans , Yellow Fever , Informed Consent , Advisory Committees/history , Human Experimentation/history , Disease Outbreaks/history , United States , Yellow Fever , Cuba , Helsinki Declaration/historyABSTRACT
Las relaciones entre medicina y ética se pusieron de relieve en el pensamiento helénico de la Grecia antigua. Los antiguos códigos de las viejas civilizaciones dieron normas para mantener la salud y muchos preceptos religiosos tienen un fundamento higiénico. Fue la ética de los actos médicos y la relación con los enfermos, la que inspiró el primer código deontológico de la medicina: el juramento Hipócrates. Son las primeras normas que establecieron la relación entre el médico y el paciente, dando origen a la éticaq hipocrática, la cual expresó de modo insuperable los principios generales de decencia y responsabilidad que exige el ejercicio del arte de curar. En la actualidad, las normas del juramento de Hipócrates y la ética médica son, obviamente, insuficientes para poder resolver los dilemas relacionados con el desarrollo de la ciencia, la tecnología biomédica y los seres humanos. La ética médica se ha transformado en objeto de la más amplia preocupación pública. Cada una de las doctrinas esta siendo cuestinada y, al mismo tiempo reformulada...
Subject(s)
Bioethics , Ethics Committees/history , Ethics Committees , Human Experimentation/history , Human Experimentation/legislation & jurisprudenceABSTRACT
En este trabajo se hacen diferentes consideraciones acerca de las implicaciones éticas del estudio de humanos, a partir de su desarrollo histórico. Se señala la frecuencia con que ésto se han realizado desde que se impulsó el uso del método científico, orientado hacia la solución de problemas de salud de la población humana, así como las omisiones de carácter ético que, sobre el particular, dieron origen a una serie de códigos y declaraciones de hoy día, privilegian el estado de salud de los sujetos experimentales por encima de los intereses de la ciencia. También se menciona la importancia de ha tenido la Bioética para impulsar la reflexión ético-filosófica sobre la investigación además de promover la formación de comités de bioética en todas las instituciones donde se realiza, y de programar campañas sociales para la participación altruista en proyectos de investigación que redunden en beneficio de la salud humana
Subject(s)
Humans , Clinical Trials as Topic/history , Clinical Trials as Topic/legislation & jurisprudence , Ethics, Medical , Human Experimentation/historySubject(s)
Humans , Bioethics , Human Experimentation/history , Human Rights , Informed Consent , Research/trendsABSTRACT
A utilizaçäo de seres humanos em experimentos, necessária por ser parte intrínseca da medicina, cria problemas éticos cujas respostas säo de responsabilidade de todos e näo apenas dos cientistas, e só possíveis de serem obtidas através do diálogo e de concessöes mútuas. A fragmentaçäo do saber científico a partir do final do século XIX, de um lado favoreceu o progresso da ciência experimental e, de outro, tornou-a pouco reflexiva e sem controle sobre as consequências de suas açöes. Inicialmente, predominava o pesquisador com poucos recursos, pesquisando por diletantismo aquilo que lhe dava prazer. Atualmente, com o aumento em complexidade e custos, as pesquisas biomédicas säo realizadas por equipes de pesquisadores profissionais e financiadas principalmente pelo complexo industrial farmacêutico. Como as tecnologias criadas pelo avanço científico modificam de maneira cada vez mais radical os seres humanos e os seus ambientes, o cientista tende hoje a servir a pelo menos dois deuses muitas vezes antagônicos, o da ética do conhecimento e o da ética cívica e humana. Devido à ampliaçäo do campo de açäo das conquistas científicas, näo é mais possível uma ética exclusiva da comunidade científica. Todos têm os mesmos direitos e igual responsabilidade para encontrar soluçöes para essas questöes. Sempre houve tentativas de regulamentaçäo dos experimentos que utilizam seres humanos. Entretanto, só no século XIX, com o início da medicina científica moderna com Claude Bernard, surgiu uma maior preocupaçäo com o tema. A partir de entäo, o aumento exponencial do número de experimentos, muitos financiados e incentivados pelos governos, näo foi acompanhado do estabelecimento de normas e diretrizes éticas adequadas. Apesar de algumas tentativas prévias de regulamentaçäo, foram as denúncias das experimentaçöes nazistas que motivaram a promulgaçäo das primeiras diretrizes éticas internacionais sobre pesquisas com seres humanos através do Código de Nuremberg. Posteriormente, outras diretrizes foram elaboradas por organismos internacionais. A mais conhecida é a Declaraçäo de Helsinque, cuja última versäo data de 1996. Hoje em praticamente todos os países há legislaçöes a respeito do tema. No Brasil vigora a resoluçäo 196/96 do Conselho Nacional de Saúde, que segue a mesma linha dessas outras diretrizes...
Subject(s)
Humans , Child , Bioethics/history , Ethics, Medical/history , Human Experimentation/history , Academic Dissertation , Child Advocacy/history , Child Advocacy/legislation & jurisprudence , Legislation/history , Research/historySubject(s)
History, 19th Century , Human Experimentation/history , Humans , Smallpox/history , Vaccination/historyABSTRACT
Hippocrates was the first physician to use the scientificn method to find rational and not religious or mythic causes, for the etiology of diseases. Hippocrates and Aristoteles did not dare to dissect the human body. Afterwards however, many scientists such as Heriphilus, Erasitrastus, Vesalus and Fallopio, performed experiments in human beings using vivisection. According to that age's ideas, there was no cruelty in performing vivisection in criminals, since useful knowledge for the progress of medicine and relief of diseases was obtained. Only during the 19th. century and with Claude Bernard (1865), the ethical principles of systematic scientific research in humans were defined. These principles were violated by nazi physicians during Hitler's dictatorship in Germany (1933-1945). As a response to these horrors, the Ethical Codes of Nuremberg (1947) and Geneva (1948), that restablished all the strength of Hippocratic principles, were dictated. The Nuremberg rules enact that a research subject must give a voluntary consent, that the experiment must be necessary and exempt of death risk, that the research must be qualified and that the experiment must be discontinued if there is a risk for the subject. The Geneva statement is a modernized hippocratic oath that protects patient's life above all. These classical rules, in force at the present time, are the essential guides that must be applied by physicians and researchers
Subject(s)
Humans , Biological Science Disciplines/standards , Ethics, Medical , Human Experimentation/history , Research/trends , Scientific Misconduct/history , Human Rights , Political Systems/history , Vivisection/standardsSubject(s)
Bioethics , Ethics, Medical , Human Experimentation/history , Physician-Patient Relations , ResearchABSTRACT
Se hace un breve recuento de las distintas etapas historicas de la experimentación en seres humanos, hasta el siglo XIX y comienzos del XX. En la decada de los años 30 y 40 del siglo actual, se desato una epoca de oscurantismo pseudocientifico, durante la cual numerosos criminales, con titulos de medico, sacrificaron en forma brutal, miles de vidas, en experimentos, frecuentemente mal enfocados, peor ejecutados e innecesarios. Al terminar la Segunda Guerra Mundial, surgieron varios codigos de etica, que prepararon un marco doctrinario para el desarrollo de la naciente investigación humana en gran escala, indispensable para el progreso de la Medicina, pero tambien respetuosa de la vida, salud y bienestar del paciente. Sin embargo, algunos errores, abusos y accidentes iatrogenicos observados, imponen la adopción de estrictas medidas de vigilancia gremial y estatal sobre esas actividades, exigiendo ademas, a nivel de la Universidad, una buena formación ética del joven medico