Ulf Schmidt

Cold War at Porton Down: Informed Consent in Britain’s Biological and Chemical Warfare Experiments

By the end of the Second World War the advancing allied forces discovered a new nerve gas in Germany. It was called Tabun. Codenamed GA, it was found to be extremely toxic. British experts were immediately dispatched to examine the agent. On arrival, they discovered that German scientists had also developed even more toxic nerve agents, including Sarin, known as GB. The first organized testing of Sarin on humans began in October 1951 at Porton Down in Wiltshire, Britains biochemical warfare establishment since the First World War. In February 1953, volunteer number 562 experienced the first recorded serious adverse reaction. Testing continued. Two months later, on April 27, six subjects were given 300 milligrams of Sarin. One of the volunteers, a man named Kelly, suffered serious ill effects, fell into a coma, but then recovered. Although asked by their superiors to reduce the amount tested to the “lowest range of dosage”—which would have been somewhere in the region of 10–15 milligrams—Portons scientists continued their tests with a “lower” dosage, reducing it from 300 to 200 milligrams. I thank the two referees for their helpful and constructive suggestions. The paper was written as part of a Wellcome Trust-funded project on “Cold War at Porton Down: Medical Ethics and the Legal Dimension of Britains Biological and Chemical Warfare Programme, 1945–1989.” I thank the Wellcome Trust for its generous support.

The Nuremberg Code 70 Years Later

Seventy years ago, on August 20, 1947, the International Medical Tribunal in Nuremberg, Germany, delivered its verdict in the trial of 23 doctors and bureaucrats accused of war crimes and crimes against humanity for their roles in cruel and often lethal concentration camp medical experiments. As part of its judgment, the court articulated a 10-point set of rules for the conduct of human experiments that has come to be known as the Nuremberg Code. Among other requirements, the code called for the “voluntary consent” of the human research subject, an assessment of risks and benefits, and assurances of competent investigators. These concepts have become an important reference point for the ethical conduct of medical research. Yet, there has in the past been considerable debate among scholars about the code’s authorship, scope, and legal standing in both civilian and military science. Nonetheless, the Nuremberg Code has undoubtedly been a milestone in the history of biomedical research ethics.1-3 Writings on medical ethics, laws, and regulations in a number of jurisdictions and countries, including a detailed and sophisticated set of guidelines from the Reich Ministry of the Interior in 1931, set the stage for the code. The same focus on voluntariness and risk that characterizes the code also suffuses these guidelines. What distinguishes the code is its context. As lead prosecutor Telford Taylor emphasized, although the

Post-war Medical Ethics

He told me that he had worked on the creation of the Nuremberg Code for human experimentation and … there was still discussion to be brought up how to implement these rules in the Code, but that those were the basis … and that people needed to really pay attention to that, that these things should never ever ever happen again, that’s why he was in Nuremberg to see to it … He felt that he had sacrificed a year of his career to help bring about these changes and that it was very important to protect that … He felt that was, when he looked back on it, that that was the whole point, to create a new standard, not just to convict those people.1

The Nuremberg Code and Informed Consent for Research—Reply

these valid concerns.2 For example, the American Board of Internal Medicine (ABIM) recently reorganized its governance structure.3 This effort was undertaken in part to enhance program relevancy by increasing the number of practicing nonacademic physicians participating at all levels of governance. More than 70% of current ABIM governance members spend more than half their time in clinical care. Over the past 3 years, ABIM staff has changed examination blueprints in all disciplines based on critical review by thousands of physicians across the country.4 Earlier this year, in response to diplomate feedback, ABIM announced plans to roll out 2-year Knowledge Check-Ins taken at home or in the office as an option to the traditional MOC examination.5 To ensure full transparency, comprehensive ABIM financial information—including tax form 990 and the audited financial statement—is freely available online, along with a reader’s guide to help interested parties find the information of interest.6 Of note, ABIM carries a platinum rating for transparency from Guidestar, a designation attained by less than 0.1% of all nonprofit organizations. I believe these actions are indicative of the good faith efforts certifying boards are pursuing to address the specific concerns outlined by Cardenas and Freeman. Freeman suggests self-regulation is already weakened due to a misalignment between medical licensure and specialty competence. He is correct that state medical boards determine an individual’s legal ability to practice “medicine and surgery,” but physicians, through their specialty boards, define and curate the standards that define familiar disciplines (eg, ophthalmology or cardiology) and are widely used to create public confidence that physicians are actually trained to do what they do. In theory, without established specialty standards, any licensed physician would be free to perform a laser procedure or administer chemotherapy or perform a heart transplant. Such was the state of affairs at the beginning of the 20th century—at the very time when physicians opted to create specialty boards to establish the standards that defined the specialties practiced today. Laws designed to weaken board certification do not advance the medical profession.

Preparing for Poison Warfare: The Ethics and Politics of Britain’s Chemical Weapons Program, 1915–1945

Allied political and military leaders have frequently been credited both with considerable foresight and with strategic and moral leadership for avoiding chemical warfare during the Second World War. Scholars have not, however, fully acknowledged how close Allied forces came to launching a full-scale chemical onslaught in various theatres of war. The paper offers a thorough reconstruction of Allied chemical warfare planning which takes a close look at the development of Britain’s chemical weapons program since the First World War. The findings suggest that no “lack of preparedness,” as it existed in the initial stages of the conflict in 1939/1940, would have deterred the Allies from launching chemical warfare if the military situation had required it. Allied forces were planning to launch retaliatory chemical warfare ever since they had been attacked with chlorine gas in 1915. Just War theorists at first opposed the use of this new weapon and campaigned for an internationally enforced legal ban. The paper argues, however, that post-war military and political exigencies forced the advocates of the Just War tradition to construct new arguments and principles which would make this type of war morally and militarily acceptable. The paper explores the ways in which military strategists, scientists, and government officials attempted to justify the development, possession, and use of chemical weapons, and contextualizes Britain’s delicate balancing act between deterrence and disarmament in the interwar period.

The War Crimes Investigator

The city of Lubeck on the Baltic Sea, north-west Germany, was effectively cut off from the remainder of the Reich when the first reconnaissance troops of the British forces reached the city on the evening of 3 May 1945. For the Gauleiter of Hamburg, Karl Kaufmann, this was the signal to announce the capitulation of the city over the radio; shortly afterwards Hitler’s successor and head of state, Karl Donitz, decided to discontinue further fighting in the north. In England, Alexander followed the events on the BBC. On the evening of Friday, 4 May, at around 8.30 p.m., he could hardly believe what he heard on the radio, and immediately wrote to his wife: ‘The news is grand. I just heard the news of the surrender of Northwest Germany and Denmark and Holland to General Montgomery’s Army Group. VE day can’t be far off. Admissions have fallen off.’1 Yet while the people of Denmark, and indeed elsewhere, went on to the streets to celebrate, Alexander was continuing his research on combat personnel.2

The Road to Nuremberg

On 26 June 1945, after weeks of silence, Alexander wrote a long and impassioned letter to his wife in which he outlined his views on Nazi medicine and policy. Written the day before he was leaving for Paris to brief the American prosecution about medical war crimes, the letter conveys a sense of finite condemnation about the state of affairs of German medical research and practice: German medical science presented a grim spectacle. Grim for many reasons. First, because it remained essentially static and became comparatively incompetent, and second, because it was drawn into the maelstrom of depravity of which this country reeks — the smell of the concentration camps, the smell of violent death, torture and sufferings of muted victims will not rot of one’s nostrils. Their really depraved pseudoscientific curiosity went so far as to carry out vivisection and similar experiments involving extreme suffering, mutilation and death in human beings, large numbers of human beings, in concentration camps. The evidence is clear cut and admitted; and although one suspected the worst, the reality, as revealed, still surpasses the worst expectations.1

Constructing the Doctors’ Trial

In the weeks preceding the opening of the trial detailed discussions about the nature of German medical science and the principles of permissible and non-permissible experiments on humans emerged as a result of concerted efforts among the US prosecution to construct a legally viable prosecution case, and ultimately secure the conviction of as many of the accused as possible. The prosecution case was far from complete or satisfactory when Alexander and other senior members arrived at Nuremberg. The pressure for those on the ground at Nuremberg was enormous. To establish a trial with a shortage of qualified lawyers and staff, together with improvised organisational structures and communication facilities in an occupied zone where the population was more or less hostile towards the undertaking, was one thing; to constantly defend the rationale for the trials in a shifting political climate was quite another. While relations with the Soviet Union were deteriorating, support for war crimes trials was rapidly disappearing in Washington after the completion of the IMT. These factors contributed to a sense of emergency and need for improvisation among the prosecution team. Taylor and his staff knew that they had to ‘win’ the medical case if they wanted to hold further war crimes trials. They also knew that they were creating a precedent for future trials. Although the IMT offered them some guidance as far as the rules of procedure was concerned, the US prosecution found itself on quite unfamiliar legal territory in November 1946.

The Austrian Jew

Hitler and Alexander probably never met, though it could have been possible. For some time during the first two decades of the twentieth century, both lived in Vienna. The city was as influential in shaping the incipient prejudices and phobias of the former as it was in determining the religious and cultural identity of the latter. One can hardly over-estimate the influence that Alexander’s upbringing and childhood in the capital of the Austro-Hungarian Empire had on his social conscience, on his devotion to art and German culture, on his interest in music, theatre and science — in short, on his character. While not always noticeable, his Viennese back-ground was always present. In his speech and gestures, hobbies and professional interests, Alexander always remained firmly bound to his roots. Born into an Austrian-Jewish family, he was assimilated and educated, multinational and open-minded. Alexander and his siblings fit the stereotype of the hardworking Western Jew who began climbing the social and professional ladder after Emperor Franz Josef granted the Jews some legal protection in the late nineteenth century.1

The Nuremberg Code

At the beginning of January 1947 questions about the ethics and quality of German medical science led to a controversy as to whether one should publish the results of Nazi experiments. The debate was triggered in the British journal Lancet and followed up by the British Medical Journal.1 Although nothing had apparently been discovered which merited publication, the editors asked readers in January that if ‘facts of real value to medicine were still to emerge from the records of the experiments — should they be published or not?’2 In the ensuing debate some argued that publishers would become ‘accessories to the crime’ while others were adamant that scientists had a duty towards the victims to publish the results so ‘at least their suffering was of some benefit’. Experts from the British Medical Journal wanted to know whether if the Nazis had ‘discovered a cure for cancer would the rest of the world say that this information must be destroyed because of the manner in which it was obtained?’3 Others thought that the controversy was unnecessary. Ivy, for example, believed that German medical science had made no significant discoveries during the war and that there was probably nothing ‘worth publishing’.4