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Experiments and research with humans: Values in conflict
Fd Cormer. Toxicol. Vol. 15. pp. 151-152. Pergamon Press 1977. Printed in Great Britain
Review Section BOOK
REVIEWS
Experiments and Research with Humans: Values in Conflict. Academy Forum, Third of a Series (Editor
Development. Vol. 2. By L. Foulds. Academic Press,London, 1975. pp. xiv + 729. f16.80.
Neoplastic
B. S. Turvene). National Academy of Sciences,Washington, D.C., 1975. pp. vi + 234. $5.00. To those who seek a quick and ready answer to the question of when human experimentation may be justified, or to the somewhat different question of when it is legal, this volume will be of little interest. The book contains an almost verbatim report of the third of the meetings organized by the National Academy of Sciences, under the title ‘Academy Forum’, to provide an opportunity for subjects of great interest and concern to be debated in public. This particular debate was clearly on a high level, and covered a wide spectrum of situations in which scientific observations on man have been made, including the most controversial ones, such as the use of living tissues from viable and non-viable foetuses. ,Naturally, the proceedings were heavily loaded with examples of human experiments drawn from the field of medicine in which, indeed, the diagnosis and treatment of every individual patient constitutes a human experiment. In the realm of drugs and vaccines, there is no alternative to human observation. The Forum participants examined the principle of consent and the special difficulties that arise when consent is not possible owing to the age or medical condition of the experimental subject. As the President of the NAS commented in his closing remarks, there are dark aspects in the use of man as a guinea-pig. These range from the ferocious brutality often seen in war to experiments in which the risks involved obviously far outweigh any conceivable benefit. Those involved in the debate did not in any way shirk such issues,and the whole of this volume is characterized by its frankness of expression. One possible point of criticism is that only a sprinkling of ‘non-biomedical’ individuals participated. The few speakersfrom the fields of law, philosophy and divinity and those from organizations dealing with ‘citizens’ rights’ presented their views well, but their comments were rather diluted by the weight of medical opinion. Perhaps, in such a debate, this was inevitable, as it is the medical man who most frequently comes face to face with the problems that were under discussion. This volume can be highly recommended to any readers interested in human values, the methods of preserving them, the risks and sacrifices needed to establish them in practice, and the difficulties posed by questions such as ‘is the risk to the few justified in terms of the potential benefit to the many?’ Obtainable from the publishing office of the NAS for a mere 5 dollars, this is a document offering excellent value for money. 151
The author of this book has devoted most of his professional life to the study of the tissue changes that precede malignancy. A pathologist by trade, he was limited to microscopic observations, but his inventivenessand resourcefulnessenabled him to gather data that have provided a valuable insight into the nature of the lesions leading to the emergence of uncontrolled growth. The basic messageof this book, as of the previous volume reviewed some years ago (Cited in F.C.T. 1972, 10, 231), is that cancer is often, but not invariably, preceded by a series of histological changes in the affected or ‘target’ tissues. The author divides these changes into three principal groups, designated A, B and C. Many group A lesions (designated A,) are considered to be merely “exposure stigmata”, embracing a variety of histological changes commonly associatedwith the administration of chemical toxins. A further subgroup (AZ) forms a bridge between Ai and the lesions of group B, which are proliferative but not necessarilycancerous since some of them regresscompletely. It is difficult to distinguish histologically between lesions of types A and B. Group C lesions are cancerous and are divided into a number of grades according to their degree of malignancy. The author reviews both experimental and clinical data concerned with the changes that precede the development of cancer in various organs and attempts to classify them into group A or group B lesions. Some of these attempts are more successful than others, largely because some target organs, such as skin and mammary-gland tissue, are easily accessible and as a consequence have been studied intensively along appropriate lines. Nevertheless, despite the many gaps and deficiencies in the available evidence, the applicability of these principles to other target organs is clearly demonstrated in successivechapters of this book. The picture that emerges from this account is one of great importance to the pathologist engaged in cancer research. In practically every organ one can identify certain lesions that appear,to be the precursors of frankly malignant tumours. This is seen most clearly in experimentally induced lesions, but human material provides many instructive examples as well. One omission from this otherwise excellent account of the developmental stages of neoplasia is the absence of any attempt to distinguish and identify lesions that are clearly the result of repeated trauma and regeneration and that lead, in turn, to precancerous proliferative lesions and ultimately to cancer. The identification of such lesions is an essential step
Review Section BOOK
REVIEWS
Experiments and Research with Humans: Values in Conflict. Academy Forum, Third of a Series (Editor
Development. Vol. 2. By L. Foulds. Academic Press,London, 1975. pp. xiv + 729. f16.80.
Neoplastic
B. S. Turvene). National Academy of Sciences,Washington, D.C., 1975. pp. vi + 234. $5.00. To those who seek a quick and ready answer to the question of when human experimentation may be justified, or to the somewhat different question of when it is legal, this volume will be of little interest. The book contains an almost verbatim report of the third of the meetings organized by the National Academy of Sciences, under the title ‘Academy Forum’, to provide an opportunity for subjects of great interest and concern to be debated in public. This particular debate was clearly on a high level, and covered a wide spectrum of situations in which scientific observations on man have been made, including the most controversial ones, such as the use of living tissues from viable and non-viable foetuses. ,Naturally, the proceedings were heavily loaded with examples of human experiments drawn from the field of medicine in which, indeed, the diagnosis and treatment of every individual patient constitutes a human experiment. In the realm of drugs and vaccines, there is no alternative to human observation. The Forum participants examined the principle of consent and the special difficulties that arise when consent is not possible owing to the age or medical condition of the experimental subject. As the President of the NAS commented in his closing remarks, there are dark aspects in the use of man as a guinea-pig. These range from the ferocious brutality often seen in war to experiments in which the risks involved obviously far outweigh any conceivable benefit. Those involved in the debate did not in any way shirk such issues,and the whole of this volume is characterized by its frankness of expression. One possible point of criticism is that only a sprinkling of ‘non-biomedical’ individuals participated. The few speakersfrom the fields of law, philosophy and divinity and those from organizations dealing with ‘citizens’ rights’ presented their views well, but their comments were rather diluted by the weight of medical opinion. Perhaps, in such a debate, this was inevitable, as it is the medical man who most frequently comes face to face with the problems that were under discussion. This volume can be highly recommended to any readers interested in human values, the methods of preserving them, the risks and sacrifices needed to establish them in practice, and the difficulties posed by questions such as ‘is the risk to the few justified in terms of the potential benefit to the many?’ Obtainable from the publishing office of the NAS for a mere 5 dollars, this is a document offering excellent value for money. 151
The author of this book has devoted most of his professional life to the study of the tissue changes that precede malignancy. A pathologist by trade, he was limited to microscopic observations, but his inventivenessand resourcefulnessenabled him to gather data that have provided a valuable insight into the nature of the lesions leading to the emergence of uncontrolled growth. The basic messageof this book, as of the previous volume reviewed some years ago (Cited in F.C.T. 1972, 10, 231), is that cancer is often, but not invariably, preceded by a series of histological changes in the affected or ‘target’ tissues. The author divides these changes into three principal groups, designated A, B and C. Many group A lesions (designated A,) are considered to be merely “exposure stigmata”, embracing a variety of histological changes commonly associatedwith the administration of chemical toxins. A further subgroup (AZ) forms a bridge between Ai and the lesions of group B, which are proliferative but not necessarilycancerous since some of them regresscompletely. It is difficult to distinguish histologically between lesions of types A and B. Group C lesions are cancerous and are divided into a number of grades according to their degree of malignancy. The author reviews both experimental and clinical data concerned with the changes that precede the development of cancer in various organs and attempts to classify them into group A or group B lesions. Some of these attempts are more successful than others, largely because some target organs, such as skin and mammary-gland tissue, are easily accessible and as a consequence have been studied intensively along appropriate lines. Nevertheless, despite the many gaps and deficiencies in the available evidence, the applicability of these principles to other target organs is clearly demonstrated in successivechapters of this book. The picture that emerges from this account is one of great importance to the pathologist engaged in cancer research. In practically every organ one can identify certain lesions that appear,to be the precursors of frankly malignant tumours. This is seen most clearly in experimentally induced lesions, but human material provides many instructive examples as well. One omission from this otherwise excellent account of the developmental stages of neoplasia is the absence of any attempt to distinguish and identify lesions that are clearly the result of repeated trauma and regeneration and that lead, in turn, to precancerous proliferative lesions and ultimately to cancer. The identification of such lesions is an essential step