In 1966, the publication of “Ethics and Clinical Research” by Dr. Henry K. Beecher created a popular sensation. For the first time, the general public was alerted to suspected ethical abuses in clinical research that were allegedly continuing, despite the Nuremberg Code of 1947.
But who was Henry K. Beecher, and did his early life and training give any hint of the ethical crusader to come?
Dr. Henry K. Beecher's Upbringing and Change of Name
Beecher was born Harry Unangst in 1904. His last name translates loosely to “without fear,” which is somewhat appropriate given his lifelong willingness to tackle controversial subjects. He earned a B.A. and an M.A. in Physical Chemistry from the University of Kansas. In 1928, he attended Harvard Medical School, where he studied respiratory physiology.
At some point during the 1920s, Unangst decided to change his last name to "Beecher." Although the reasons are unclear, he may have been inspired by the 19th-century abolitionist Henry Ward Beecher as well as Beecher's daughter, Harriet Beecher Stowe (the author of Uncle Tom’s Cabin). According to Moreno (1999), this decision was ironic, as Unangst was related to the Beecher family. In all likelihood, however, he did not know this at the time.
Beecher Receives Medical Training
After graduation from Harvard Medical School, Beecher underwent two years of surgical training at Massachusetts General Hospital (MGH). Upon completion of training in 1934, Beecher went to Denmark. There, he worked in a physiology laboratory under the guidance of August Krogh, who had won the Nobel Prize in Physiology or Medicine in 1920.
Beecher returned to the United States in 1936. He accepted a job as Anesthetist-in-Chief at MGH, and later became an Instructor in Anesthesia at Harvard Medical School. In 1941, Beecher became the first endowed chair in anesthesiology in the United States, even though he had never received any formal training in anesthesia before his appointment.
Beecher Witnesses the Placebo Effect
During World War II, Beecher served as a clinical pharmacologist in North Africa and Italy. Under combat conditions, he observed how critically wounded soldiers refused painkillers (such as morphine) because they were beyond all physical sensation, including pain.
This unique experience led Beecher to advocate the use of placebos (i.e., a fake medicine without any therapeutic value) in clinical trials. By using a placebo along with an active drug, Beecher believed that the role of the mind in general health could be explored. This phenomenon came to be known as the "placebo effect."
In 1945, Beecher was awarded the Legion of Merit for his services. He went to work for the Central Intelligence Agency (CIA), which at that time was interested in exploring new drugs as 'truth serums.' Some of the drugs being tested were mescaline (or peyote), hashish, and marijuana. Beecher allegedly interrogated CIA prisoners with mescaline, and some of the prisoners died from the psychotic effects induced by experimentation.
There is no record of what effect (if any) this experience had on Beecher's future as an ethicist.
The Impact of Nazi Medical Experimentation on Beecher
In 1946, the U.S. military began prosecuting select National Socialist (Nazi) physicians for medical experimentation abuses in concentration camps such as Auschwitz. The so-called Doctors’ Trial lasted ten months. The trial encouraged the military tribunal to propose the Nuremberg Code in 1947, which was intended to set limits on future human experimentation.
During this period, the U.S. Army asked Beecher to review records of Nazi medical experimentation – no doubt to assess the potential military usefulness of German scientific data. This review apparently had a profound impact on him. Beecher avidly studied the Doctors’ Trial and kept extensive notes of Nazi experiments in his personal files. His interest in the ethics of human experimentation probably began at this time.
Dr. Henry K. Beecher's Return to Civilian Life
According to Harkness et al. (2001), Beecher also was a deeply spiritual man. He was said to have read a portion of the Bible each day before going to bed. Perhaps his religious beliefs fueled his future ethical concerns.
After the war, Beecher returned to Harvard Medical School and his post as Instructor in Anesthesia. During the late 1950s, Beecher underwent a slow transformation from private academic to public critic. In 1959, he began publishing a series of articles on the ethics of human experimentation. Seven years later, his efforts would culminate with the landmark article for which he is best remembered.
References
Harkness J, Lederer SE, and Wikler D. 2001. Laying ethical foundations for clinical research. Bulletin of the World Health Organization. 79(4):365–366.
Kopp VJ. 1999. Henry K. Beecher, M.D.: contrarian (1904–1976). ASA Newsletter. 63(9):September.
Moreno J. 1999. Undue risk: Secret State Experiments on Humans. New York: W.H. Freeman.
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