I hope you’re comfortable. It’s a long blog today!
When I heard the Berman Institute of Bioethics was hosting a lecture that featured “The Three Deans” (Dean Emeritus Donald Henderson, Dean Emeritus Al Sommer, and Dean Michael Klag), I knew I wanted to attend. With decades of public health experience in very different areas, I couldn’t even imagine some of the situations they faced.
Dean Emeritus D.A. Henderson’s experiences surrounded ethical questions regarding different vaccines. The one he focused on the most involved polio. As most people know, to take part in a clinical trial, participants must give informed consent to participate. But when the polio epidemics swept across Europe and North America, 2/3 of the population affected were children. Therefore, vaccine development focused on being successful in a child rather than an adult. Henderson was working for the CDC at that time and was part of a team that had two potential vaccines, one a dead virus that had been tested on mice and one a live virus tested on 20 children. The steps taken in the live virus were questionable and whichever vaccine the CDC decided to follow would not allow for the true meaning of informed consent as it must be tested on children. One of the largest medical experiments in history was the result of the group’s decision. As history shows, the dead vaccine trial was very successful and has led to almost eradicating polio across the world.
Alfred Sommer, also known as the “Vitamin A Guy”, had an entirely different ethical question on hand. In a randomized control trial in Indonesia, he and his team proved that a dose of Vitamin A could drastically reduce child mortality rates. The problem? Despite strong, statistically significant results, the scientific community did not accept Sommer’s trial. The skeptics won out over the science. Only the countries participating in the trials were willing to change their policies on Vitamin A. All four large scale trials gave the same results. Sommer explained he only conducted the fourth trial because he knew the children would benefit and the country’s policies would change. His problem? How to get all the countries to change their policies without doing more trials, and the larger ethical problem of how many randomized control trials are necessary to convince the scientific community? He pointed out the standards are clear on what is and isn’t statistically significant, but not on how many times must it be repeated. Unfortunately, there is still no answer within the scientific community.
Current Dean, Michael Klag, presented several ethical questions in his experience working as the Vice Dean for Clinical Investigation at The Johns Hopkins University School of Medicine from 2001-2005. In 2003, a patient in an asthma clinical trial died and all trials using human testing were stopped. The larger question was then what happens to the patients who are dependent on the treatment they are receiving in the trial? Klag’s own question was how to change a culture. At one point throughout the process, a doctor complained to him that the Internal Review Board (IRB) slowed down his progress. Indeed, this was the point. Although it seems illogical to slow down the progress of a trial, by slowing down, researchers have more time to absorb all possible results and outcomes as well as findings as they occur. Yes, they slow down the process, but the IRB can prevent unnecessary dangers and harmful outcomes. As would be expected with human testing, ethical questions still surround policies and procedures; but, by 2005 Klag’s leadership helped JHMI receive one of the highest ratings for their human testing policies.
As a whole, the Three Deans presented just a small portion of the ethical questions surrounding medicine and Public Health. And in reality, all three presented dilemmas that still have unanswered questions. But two weeks later, I’m still thinking about the problems these public health leaders faced in their careers thus far and how we can do better.