My father hunted werewolves. The human beings he tracked down in Germany after World War II appeared ordinary. But under the right circumstances they proved themselves capable of monstrous deeds, of crimes against humanity.
In my files I have a story of children bound in ropes and shackled in leg irons, taken against their will to facilities where some were malnourished, where some were psychologically tortured, some physically tortured- -one until his ribs broke, another bleeding while he was hauled along pavement in handcuffs. In these same facilities children were subjected to dubious medical research, with results printed in scientific journals, whose staffs praised the determination of the experimenter, and ignored the plight of the experimental animals.
Those incidents, however, did not occur in Germany during World War II. They occurred in the United States during the drug war in the 1980s. The victims were teenagers who smoked marijuana.
How could such conditions come about? Why are they tolerated by the scientific community? To find answers to those questions, we must first examine the public record of conditions in the research facilities.
Research was conducted at several units of Straight, Inc. The following description of conditions is partly based upon federal litigation which found that Straight had falsely imprisoned a teenager named Fred Collins.1 I also rely upon the private investigation of Dr. Arnold Trebach, published in his book The Great Drug War.2 Dr. Trebach is one of the world*s foremost authorities on heroin, and is president of the Drug Policy Foundation in Washington, D.C. In addition, my description of conditions will draw from scientific journals reporting research performed upon teenagers at Straight.
As of March 1989 Straight. Inc. ran so-called drug treatment centers in
2. Arnold S. Trebach, the Great Drug War And Radical Proposals That Could Make America Safe Again (New York: Macmillan Fublishing Company, 1987).
Springfield, Virginia (near Washington, D.C.); Atlanta, Georgia; Stoughton, Massachusetts; Plymouth, Michigan; Dallas, Texas; Orlando and St. Petersburg, Florida, Straight also had a unit at Milford, Ohio (near Cincinnati) from 1981 to 1987.
Dr. Richard H. Schwartz, who served as Straight*s Research Director, says "any adolescent who is depressed, underachieving in school, or argumentative and belligerent" is showing symptoms of marijuana use.3 One sign of teen marijuana abuse noted by Dr. Schwartz is "shouting or cursing conflicts with their parents, often over trivial issues such as restrictions on use of the family car."4 Dr. Schwartz lists other warning signs of teen drug use:
"boredom," "restlessness," "impulsiveness," "disrespectful," "unable to delay immediate ratification," "anger toward loved ones, school, and society."5 In the words of Dr. Trebach, Straight "does not operate traditional psychiatric hospitals or professional drug-treatment facilities" and "often locked up children who used pot and beer occasionally- -or who were afflicted only with the normal though disturbing condition known as adolescence and who did not use any drugs."6 Dr. Trebach's characterization is supported by a report of research done on children at Straight. The report notes, without explanation, that children with no drug abuse problems are found in this "drug abuse" program.7 Straight*s Dr. Schwartz says that "for legal reasons, adolescents remain clients [rather than ‘patients*]."8
Dr. Schwartz describes the program as "unique."9 Here is how Dr. Trebach and court records describe the program.
Using Florida circuit court records, Dr. Trebach relates the story of a mother who paid private detectives to kidnap her teenaged son in New Mexico. They put him in leg irons and drove him overland 1,700 miles to the Straight
4. Richard H. Schwartz, Norman G. Hoffmann, and Richard Jones
"Behavioral, Psychosocial, and Academic Correlates of Marijuana Usage in Adolescence: A Study of a Cohort
Under Treatment, " ClinicaI Pediatrics
26 (1987): 266.
5. Richard H. Schwartz, "Psychoactive Drug Use During
Adolescence: The Pediatrician*s Role," American Journal of Diseases of
Children 138 (1984): 205. 6. Trebach, Great, 19, see also 37, 38. 7. Description of Group C in Richard H. Schwartz, et al.,
"Short-Term Memory Impairment in Cannabis-Dependent Adolescents," American
Journal of Diseases of Children 143 (1989): 1215. 8. Richard H. Schwartz, "Reply," Journal of
Pediatrics 111 (1987), 158. 9. Richard H. Schwartz, "Marijuana: A Crude Drug with a
Spectrum of Underappreciated Toxicity," Pediatrics 73 (1984): 455. Miller 3
5. Richard H. Schwartz, "Psychoactive Drug Use During Adolescence: The Pediatrician*s Role," American Journal of Diseases of Children 138 (1984): 205.
6. Trebach, Great, 19, see also 37, 38.
7. Description of Group C in Richard H. Schwartz, et al., "Short-Term Memory Impairment in Cannabis-Dependent Adolescents," American Journal of Diseases of Children 143 (1989): 1215.
8. Richard H. Schwartz, "Reply," Journal of Pediatrics 111 (1987), 158.
9. Richard H. Schwartz, "Marijuana: A Crude Drug with a Spectrum of Underappreciated Toxicity," Pediatrics 73 (1984): 455.
facility in St. Petersburg. A Florida judge found that the child was not a drug abuser and ordered the child*s release.10 Dr. Trebach tells of a teenaged girl, who was riding in a car with her mother when they stopped at a gas station. Her father and two other men entered the vehicle and forcibly restrained her while she was taken to a Straight facility. She was aware of her rights and managed to get legal aid to force her release.11 Dr. Trebach relates still another story of a teen who thought his parents were taking him to Disney World and wound up at Straight instead.12
Straights Dr. Schwartz blandly says most teenagers in the Straight system are "convinced by parental pressure to enter treatment."13 Does the phrase "parental pressure" adequately capture the admission procedures documented by Dr. Trebach and by court testimony?
Dr. Trebach and court testimony describe what happens to children at Straight. Upon arrival they are physically restrained in a small room. A teen who attempts to leave will be stopped and perhaps beaten by so-called "peer counselors,"14 teens already in the Straight program. In this small room peer counselors subject newcomers to a barrage of questions about drugs and sex. Here is a sample addressed to a young man: "How does it feel masturbating inside a woman?"15 A teen who resists answering such questions is diagnosed as having a bad attitude, indicating treatment is needed. One who denies being a drug abuser is called a liar who needs treatment. A child who, after hours of pressure, finally "confesses" to drug abuse is found to need treatment. Such determination may be made by another teen in the Straight program.16
Straight*s Dr. Schwartz freely admits that the program is "supervised, in the main, by skilled non-physicians and recovering peer counselors .17
In the case of Fred Collins, he was forced to disrobe while "non-physicians and recovering peer counselors" probed his anus, mouth, and ears.18 A large peer counselor served as permanent guard over Collins. Collins said, "He
11. Ibid., 58.
12. Ibid., 29.
13. Schwartz, et al., "Short," 1215.
14. Collins vs Straight, Inc., 748 F.2d 916, 918 (1984); Trebach, Great,
15. Trebach, Great, 32.
16. Ibid., 32.
17. Schwartz, "Reply," 158.
would tell me things like, you know, if you try to leave, I'm gonna make your teeth eat the concrete, or something. He would poke his finger into my chest."19 The guard said that he himself had once tried to escape but had been captured, and raked barefoot and bloody across pavement while handcuffed.20 Dr. Trebach cites federal court testimony about an adult teenaged woman, Arletha Schauteet, who escaped from a Straight facility and hid at a friend*s house. The teen*s mother lured her outside near midnight, whereupon two men and a woman jumped the daughter, pulled her screaming into a car and sped off to a Straight facility.21 A Straight official warned her to say nothing, or else her mother would be imprisoned for kidnapping. Upon inquiry by a police detective, Straight released the girl.22 Straight has used sleep deprivation to weaken resistance to "treatment*; records show that one girl was harassed for 80 hours around the clock to keep her awake,23 and Fred Collins routinely got 4 hours or less sleep per night.24 Food deprivation is another technique that Straight has used. Fred Collins, who was 6 feet, 2 inches tall, weighed about 130 pounds when he escaped from Straight. Dr. Trebach said Collins "looked like a concentration camp survivor."25 Physical degradation is another technique. Straight has routinely forced large numbers of teens, of both sexes, to sit together for hours in a large room without bathroom access, until puddles of their urine accumulated in their chairs.26 While at such "therapy" sessions, some attenders mutilated themselves.27 In the words of Straight*s Dr. Schwartz and colleagues, this mutilation "caused the staff to feel angry and demoralized. In an attempt to stop the girls from carving themselves, countermeasures included public ridicule."28 "Public ridicule"--such was the therapy applied to people exhibiting a classic sign of despair and low self esteem.
Teens who resisted "therapy" were punched,29 thrown to the ground,30 yanked back and forth by their hair.31 "Peer counselors" broke seven ribs of
19. Quoted in ibid., 36-37.
20. I bid., 41.
21. Ibid., 57.
22. Ibid., 57-58. See also 41, 47-48.
23. Ibid., 41.
24. Ibid., 38.
25. Ibid., 38, 42.
26. Ibid., 38, 42.
27. Richard H. Schwartz, et al "Self-Harm Behavior (Carvinq) in Female Adolescent Drug Abusers," Clinical Pediatrics 28 (1989): 342, 344.
28. Schwartz, et al., "Self-harm," 344.
one teen at Straight.32 Court testimony named the male director of the St. Petersburg facility as personally applying such "therapy" to one teenage girl.33 Fred Collins said that at bedtime his guard would exclaim, "Love ya, Fred! "34
Therapy dogma is stated by Straight executive Christopher Yarnold:
"Anybody that is using a drug that is mood-altering has a problem. Okay. He has a problem. From now until eternity, . . . [he] will be chemically dependent."35 Straight*s Dr. Schwartz says that marijuana-using teens must be provided with "holistic care."36 Dr. Schwartz observes, "The lifestyle of these [Straight] patients changes abruptly; the adolescent is suddenly cut off from friends, sexual partners, family, entertainment, risk-taking behaviors, and privacy. Structure and responsibility are suddenly thrust upon the patients, perhaps for the first time. Such adolescents often enter a series of stages of loss and grief that may be misdiagnosed as depression."37
Having examined what the public record reveals about conditions at Straight, let us examine what the scientific record reveals about conditions under which medical research was performed on children there.
30. Ibid., 40.
32. Ibid., 39.
33. Ibid., 40.
34. Quoted in ibid., 37.
35. Quoted in ibid., 52.
36. Richard H. Schwartz, "Identifyinq and Helping Patients Who Use Marijuana," Postqraduate Medicine 86 (1989, no. 6):91.
37. Richard H. Schwartz, "Depression and Substance Abuse " Journal of the American Academy of Child and Adolescent Psychiatry 27 (19683: 515. Dr. Schwartz describes a classic brainwashing environment. Compare Israel Goldiamond: "In one form of brain-washing,* the person is deprived of the usual social support through isolation . . . by a special communal arrangement. Social sup port by the new group is then made contingent on individual behaviors which meet its requirements." (Israel Goldiamond, "On the Usefulness of Intent for Distinguishing Between Research and Practice, and Its Replacement by Social Contingency: Implications for Standard and Innovative Procedures, Coercion and Informed Consent, and Fiduciary and Contractual Relations," sect. 14, p. 41, in National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Rep ort: Ethical Principles and Guidelines for the Protection of Human Subjects of Research (1978) [SuDocs Y3.H88:2 B41/V.l and V.2]). Dr. Barry Beyerstein sees parallels between Straight activity and Chinese Communist brainwashing techniques used on U. S. prisoners during the Korean War (Trebach, Great, pp. 42n-43n). What the Chinese Communists did to prisoners was not considered therapy.
First, children subjected to research were at Straight involuntarily. This is clear in medical journal reports. From the American Journal of Diseases of Children: "A large majority . . . were convinced by parental pressure to enter treatment."38 From Journal of Pediatrics: "92% of the 220 adolescents in the facility were originally brought by their parents."39 From Clinical Pediatrics: "Approximately 90 percent of clients are brought into treatment by one or both parents."40 The remainder were civil commitments. Not a single teenager subjected to medical research was at Straight by his or her own volition.
Second, teenagers upon whom medical experiments were performed at Straight were frightened The American Journal of Diseases of Children describes possible confounding effects on cognitive processing and concentration ability by emotional states of fear, anxiety, or depression possibly experienced by all adolescents."41
Third, published descriptions of some research fail to demonstrate informed consent by the teenaged subjects. Nor, in these descriptions, is there evidence of approval by human subject research committees of any hospitals or universities that researchers were affiliated with.42 Such lack of evidence is important. I quote from the book Clinical Trials: "One should not give the authors the benefit of the doubt and one*s suspicions should remain until proved otherwise. For instance, if the authors fail to mention randomization one should be inclined to assume that the study is non-randomized."43 Because some reports of research done at Straight do include explicit assertions of consent,44 lack of such statements in other reports heighten suspicion about circumstances of the research. In this regard I am struck by the words of Dr. Schwartz, who participated in all the cited medical research that lacked documentation of consent: "Because trust among patient, parent, and physician never existed in the first place, we believe that in cases such as the aforementioned our sincere concern for the
39. Richard H. Schwartz, George D. Comerci, and John B. Meeks "LSD Patterns of Use by Chemically Dependent Adolescents," Journal of Pediatrics 111 (1987): 936. See also Richard H. Schwartz, et al "Use of Phencyclidine Among Adolescents Attending a Suburban Drug Treatment Facility," Journal of Pediatrics 110 (1987): 322.
40. Richard H. Schwartz and Deborah B. Smith, "Hallucinogenic Mushrooms," Clinical Pediatrics 27 (2988): 71.
41. Schw artz, et al., "Short," 1215.
well-being of our patient justifies a breach of the privilege of informed consent."45 The context of that statement involves urine tests for illicit drug use in uncooperative teenagers, rather than research. If, however, a researcher believes, as does Dr. Schwartz, that consent is a "privilege" rather than a legal right of free citizen, a "privilege" that may be dispensed with when a medical professional has "sincere concern" for a patient, might such attitudes explain why proof of consent is lacking in some of his research upon teenagers at Straight?
Fourth, circumstances described above necessarily raise questions about moral and legal validity of consent given by subjects. The Declaration of Helsinki governs all medical research in the United States. I quote: "The right of the research subject to safeguard his or her integrity must always be respected. Every precaution should be taken to respect the privacy of the subject and to minimize the impact of the study on the subjects physical and mental integrity and on the personality of the subject."46 I quote further:
"The doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress."47 I also quote The
42. Deborah E. Smith, Richard H. Schwartz and David M. Martin, "Heavy Cocaine Use by Adolescents," Pediatrics 83 (½89): 540; Schwartz, Hoffmann, and Jones, "Behavioral," Schwartz et al., "Self-Harm," 341; Schwartz, et al., "Use of Phencyclidine," 322; Schwartz, Comerci, and Meeks, "LSD," 936; — Schwartz and Smith, "Hallucinogenic Mushrooms," 71; Richard H. Schwartz and Page Peary, "Abuse of Isobutyl Nitrite Inhalation (Rush )by Adolescents," Clinical Pediatrics 25 (1986): 308-9. A statement that teens volunteered to participate does not mean they gave informed consent. "Where indignities are required, consent may simply become another indignity required" (Goldiamond, "On the Usefulness of Intent," sect. 14, p. 39). Although hospital or university approval is lacking in Richard H. Schwartz, Gregory F. Hayden, and Mel Riddile, ‘Laboratory Detection of Marijuana Use: Experience With a Photometric Immunoassay to Measure Urinary Cannabinoids, ‘ American Journal of Diseases of Children 139 (1985): 1093, this medical experiment (in which Straight teens produced urine for the experimenters) was unusual in that the journal article said the teens gave written permission. The article did not say, however, that subjects were told they could withdraw from the experiment at any time- -a mandatory assurance in human subject research approved by a hospital or university.
43. Stuart J. Pocock, Clinical Trials: A Practical Approach (New York: John Wiley & Sons, 1983), 237.
44. Richard H. Schwartz, et al., "Nasal Symptoms Associated With Cocaine Abuse During Adolescence " Archives of Otolarvngology- -Head and Neck Surgery 115 (1989): 63; Todd W. Estroff Richard H. Schwartz, and Norman U. Hottmann, "Adolescent Cocaine Abuse: Addictive Potential, Behavioral, and Psychiatric Effects," Clinical Pediatrics 28 (1989): 551; Alan L. Berman and Richard H. Schwartz, "Suicide Attempts Among Adolescent Drug Users," American Journal of Diseases of Children 144 (1990): 310; Schwartz, et al., "Short," 1215. In the first three citations in this footnote, the only institution listed as approving the human subject research is Straight itself. In all research examined for this paper, only the "Short" article stated that research had been approved by an institution other than Straight.
45. Richard H. Schwartz and Vladimir Tsesis, "[Letter]." Pediatrics 85 (1990): 232.
Nuremberg Code of Ethics in Medical Research which requires that research subjects must "be able to exercise free power of choice without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion."48 The public record of conditions at Straight fails to show that these standards required by the Declaration of Helsinki and The Nuremberg Code of Ethics in Medical Research were met in research performed upon children there.
Dr. Schwartz*s tenure as Straight*s Medical Director and his subsequent continued involvement with teens held at Straight raise the possibility that a doctor-patient relationship existed between him and research subjects. This status is strongly implied by language such as, "Nine of our teenaged patients fulfilled DSM III diagnostic criteria for borderline personality disorder,"49 and, "The in-depth structured medical interview with the senior author [Schwartz] took approximately 30 minutes . . . . The senior author*s experience with 600 patients admitted to the facility has shown that answers to probing questions are more likely to be truthful after i week of treatment."50 Possible use of patients from Dr. Schwartz*s suburban pediatric practice is inferred by language such as, "An additional sample of 105 consecutive adolescent outpatients was secured from a suburban pediatric practice."51 Also, "three hundred fifty-five consecutive adolescents, ages 14-18 years (median age, 16 years), paying outpatient visits to a five-pediatrician group practice were surveyed for this study. . . . Each youth was asked by the office receptionist to complete the 30-item DAP Quick Screen questionnaire."52 And again, "Adolescents surveyed were patients of two group pediatric practices in Fairfax County, Virginia, a suburb of Washington, D.C. Adolescents from 13 to 17 years of age who were being seen for either a periodic health assessment or a variety of minor illnesses were
47. Ibid., I, 10.
48. The Nuremberg Code of Ethics in Medical Research, sect. 1. In a similar vein: "Undue social pressures should never be used to secure a child*s cooperation in research. Such pressures include coercion by parents, teachers or other adult authorities, and manipulation by the investigator of peer group influences" (Lucy Rau Ferguson, "The Competence and Freedom of Children to Make Choices Regarding Partcipation in Biomedical and Behavioral Research," sect. 4, p. 3, in National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, Research Involving Children: Report and Recommendations (1977): 131 [SuDocs . : Y3.H88:2C43/app.]) Ferguson notes a research must respect and enhance the freedom of choice of child subjects" (p. 4).
invited to participate in the study."53 Only in extraordinary circumstances can a physician ethically conduct research upon his or her patients. This general prohibition is due to the obvious conflict of interest in which a patient is asked to trust a therapeutic regimen ordered by a physician, and a research subject is expected to critically evaluate continued participation in a research project as it progresses. The Declaration of Helsinki allows a physician to conduct research on his or her patients "only to the extent that medical research is justified by its potential diagnostic or therapeutic value for the patient."54 Those requirements are not met by any of the published Straight research examined by me.
In Dr. Schwartz*s work, language such as "because of our access to a large number of adolescents recovering from chemical dependency, we surveyed adolescent cocaine users"55 allows a reader to ask whether the children were selected for research because they were conveniently available to researchers. In its report and recommendations on children, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research warns, "There are manifest dangers that children living in orphanages or in special training facilities might be exploited for purposes of research. Given their dependent status and their diminished capacity to consent, it is important that children be protected against selection solely because of administrative convenience. "56
Ethical standards for research either on children or on institutionalized persons are so stringent that such research is rare.57 Yet repeated medical research has been conducted upon children institutionalized at Straight--a
50. Schwartz, H3flffiann, and Jones, "Behavioral," 265.
51. Berman and Schwartz, "Suicide,"310.
52. Richard H. Schwartz and Philip W. Wirtz, "Potential Substance Abuse Detection Among Adolescent Patients sing the Drug and Alcohol Problem (DAP) Quick Screen, A 30-Item Questionnaire," Clinical Pediatrics 29 (1990): 39. Of the research subjects, the article says, "They were provided with a ‘yes or no* written choice of keeping all information confidential. Regardless of their ‘yes or no* answer, they were promised confidentiality even if they did not choose it" (p. 39). On a er the research subjects could choose between two alternatives, but in reality the choice was made by the researchers.
53. Richard H. Schwartz, et al., "Drinking Patterns and Social Consequences: A Study of Middle Class Adolescents in Two Private Pediatric Practices," Pediatrics 77 (1986): 140. The report of this research on juveniles lacks any statement of consent by parents.
54. Declaration of Helsinki, II, 6.
55. Schwartz et al., "Nasal Symptoms," 63.
56. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, Research Involving Children: Report and Recommendations (1977), 131 (SuDocs Y3.H88:2C43].
population combining both children and institutionalized persons, a combination calling for extreme caution in seeking their consent to become research subjects. The public record demonstrates that Dr. Schwartz believed his research subjects to be mentally impaired by drug use, to be suffering from conduct or identity disorders, and from states of fear and depression strong enough to cloud their thinking.58 If a researcher believes that persons subjected to research are mentally impaired, it is difficult to understand how the same researcher can believe them capable of granting valid consent. The ethical peril of such research is well understood in the scientific community.59 Not only does the public record of research at Straight lack proof that extraordinary effort was made to compensate for mental impairment while seeking consent, the record indicates that consent procedures even failed to have the "cooling off period" recommended by authorities,60 in which unimpaired uninstitutionalized adults approached for consent have one or two days to decide.61
58. For example, see Schwartz and Peary, "Abuse of Isobutyl Nitrite," 308 and Schwartz, et al., "Short," 1214-15; Sc war z, et al., "Use of Phencyclidine," 323 Someone who reads "Suicide,,, (Berman and Schwartz, 310-14) may well ask if suicidal persons are capable of granting valid consent.
59. See Frank L. Iber, w. Anthony Riley, and Patricia 3. Murray, 1987), Conductinq Clinical Trials (New York: Plenum Medical Book Company 149-50 152-53; Robert J. Levine, "Appropriate Guidelines for the Selection of Human Subjects for Participation in Biomedical and Behavioral Research," sect. 4, pp. 29-38, in National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report (1978) [SuDocs B41/V.l and V.2].
60. Meinhart and Tonascia Clinical 155.
61. For example, see Schwartz, Comerci, and Meeks, "LSD," 936. Mother possible failing in consent procedures is indicated by comments such as these: Straight research subjects "were not permitted to receive mail, gifts, or visitors. Clients were under direct surveillance 24 hours a day seven days a week" (Schwartz, Hayden, and Riddile, "Laboratory Detection," i 1093). Dr Trebach indicates that surveillance includes prohibition of telephone calls (Trebach, Great, 44). A report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research recommends that anyone included in a survey be given the names, addresses, and telephone numbers of researchers and sponsors (Donald T. Campbell and Joe Shelby Cecil, "Protection of the Rights and Interests of Human Subjects in the Areas of Program Evaluation, Social Experimentation, Social Indicators, Survey Research, Secondary Analysis of Research Data, and Statistical Analysis of Data from Administrative Records" in National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Re ort (1978), section 12, p. 9 [SuDocs Y3.H88:2 B41/V.l and V. no now if Dr. Schwartz*s research followed that recommendation, but even if the letter of the recommendation were followed, the purpose would be nullified because
In some research, cited earlier, Dr. Schwartz asserts that children, and sometimes even their parents, granted formal written consent. Given what the public record reveals about parental conduct in admission procedures at Straight, we must ask whether parental consent for research on their offspring has any moral validity.62 Moreover, federal litigation in the Fred Collins case raises question about whether research subjects* formal written consent had any legal standing. I quote from the official summary of the U. S. Court of Appeals decision: "There was sufficient evidence for jury to have found that, if plaintiff [Collins] did consent to treatment, such consent was either not knowingly and voluntarily given, or, the scope of such consent was exceeded by the (Straight] facility."63 The consent referred to here was consent for medical treatment, and a federal appeals court found that Straight failed to meet requirements for consent to treatment. This finding is important because consent standards for research are higher yet. Given this federal appeals court decision, we can ask whether the consent asserted by Dr. Schwartz has any legal standing.
Dr. Schwartz*s experiments upon siblings of Straight teens64 raise additional ethical questions. Court testimony and private investigation have found that siblings who visit a brother or sister at Straight might find themselves held against their will and transformed into a Straight "client" just like the brother or sister. Fred Collins was one such victim.65 There were others.66 Dr. Schwartz says that siblings volunteered to have experiments performed upon them. Dr. Schwartz also says that they signified their willingness by a "show of hands."67 The phrase "show of hands" implies that the siblings were together in a group. One may reasonably assume that the most likely place that the siblings would all be together in a group would be inside a Straight facility- -what other reason would these strangers have for assembling together? Did they feel that volunteering for Dr. Schwartz*s experiments would show a cooperative attitude demonstrating that they did not need "treatment"? Given the fact that the experiments were all performed at
62. Even questions of legal validity may exist if a parent cannot be trusted to protect a child*s well being (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, Research Involving Children: Report and Recommendations (1977), 130 [SuDocs Y3.H88:2C43])
63. Collins v. Straight, Inc., 748 F.2d 916 (1984).
Straight, did siblings fear they would be refused permission to leave the facility if they withdrew from the experiment?
Some research, cited earlier, contains assertions from Dr. Schwartz that adolescents could decline to participate in his research or withdraw from it at any time without retribution. Even though he claims that a handful of teens refused to participate, several factors allow us to question his assertion that no pressure existed for teens to cooperate. First, the public record of Straight*s atmosphere provides evidence of 24-hour-a-day intimidation, whether inside a Straight facility or at sites off the Straight property. Second, much of the research was conducted at group therapy sessions, where teens could easily believe that refusal to participate would be considered resistance to therapy; we have seen what the public record says about consequences that befell teens who resisted therapy. Third, the public record reveals that Straight has violated terms of consent agreements. Straight promised Fred Collins that he could leave after 14 days; when he sought to leave he was held against his will and did not escape until 134 days after he entered the Straight program.68 Jeffrey McQuillen testified in federal court that he voluntarily entered Straight and was forcibly restrained when he decided to terminate therapy. Although tied with a rope, he leaped from a car while crossing the Woodrow Wilson Bridge in the Washington, DC, area, fought with a pursuer, and managed to escape.69 At the time Collins and McQuillen entered Straight they were 19 years old. They were teens, but adults. They were not civilly committed. They had a legal right to leave Straight at any time, but Straight personnel refused to let them leave. Hope Hyrons testified in federal court that when she protested that she had a legal right to leave Straight, the facility director said, "I don*t give a damn about your legal rights.70 Teens subjected to research by Dr. Schwartz had a legal right to leave the research at any time, but given the public record, can we be sure that Straight respected those rights?
65. Collins v. Straight, Inc., 748 F.2d 916, 917-18 (1984); Trebach, Great, 31-34.66. Trebach, Great, 57, 58.
67. Richard H. Schwartz to Richard Lawrence Miller, letter, author's files.
68. Collins v. Straight, inc., 748 F.2d 916, 918 (1984); Trebach, Great, 34, 39, 41, 44.
The question here is not only ethical but legal. Sometimes people can legally be forced to accept medical treatment against their will. We have seen, however, that Straight is not a hospital, and that, for legal reasons, adolescents sent there are called clients rather than patients. But even if an argument is made that Straight "clients* were indeed receiving medical therapy, that argument ignores the issue I raise. The question is not whether Straight teens have received medical therapy against their will. The question is whether they have been subjected to medical experiments and other medical research against their will. If that has happened, the teens have been forced into involuntary servitude. The question is whether research done on teens at Straight has violated anti-slavery laws.71 Federal litigation has determined that Straight has engaged in false imprisonment.72 Perhaps federal authorities should determine whether Straight has engaged in slavery.
One more ethical question is raised by Dr. Schwartz*s research upon teens at Straight. I quote from the book Clinical Trials: "It is unethical to conduct research which is badly planned or poorly executed."73 And again:
"Avoidance of bias is . . . an ethical as well as a scientific issue."74 There is a "strong connection between ethics and good science."75
Here we have a crucial question for the scientific community. Legality aside, morality aside, can research conducted upon human subjects produce good science if ethical questions arise about the research? Might researchers who disregard rules about ethics also disregard rules that govern science? In the Straight research, is there evidence of poor planning, poor execution, or bias?
The bulk of Dr. Schwartz*s research upon teens at Straight includes
70. Quoted in ibid., 58.
71. Research on prisoners who volunteer for study may be illegal for that very reason, because in terms of law the prisoners may have been put into slavery (H. Tristram Engelhardt, Jr., "Basic Ethical Principles in the Conduct of Biomedical and Behavioral Research Involving Human Subjects," section 8, p. 7 in National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report (1978) [SuDocs Y3.H88:2 B41/V.1 and V.2]).
72. Collins v. Straight, Inc., 748 F.2d 916 (1984)
73. Pocock Clinical p. 103. Similar sentiments are in LeRoy Walters, "Some Ethical issues in Research Involving Human Subjects," sect. 11, p. 7, in National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report (1978) [SuDocs Y3.H88:2 B41/V.1 and V.2].
74. Pocock, Clinical, p. 103.
75. Ibid., 104.
reliance upon questionnaires administered to teens inside Straight facilities.76 If the veracity of answers can be challenged, so can the bulk of Dr. Schwartz*s findings and conclusions.
When Dr. Arnold Trebach investigated Straight, he documented that teens are instructed to answer questions in such a way as to exaggerate their drug use. Research reported by Straight*s Dr. Schwartz relies upon a questionnaire answered "at the time of admission."77 In speaking of his initial Straight interview Fred Collins said, "When I asked how I should answer the question ‘How long have you been doing drugs?* he [a peer counselor] said say five years, since I had first tried pot back then, I was apprehensive because it was very misleading, it looked like I had done them every day, but I wrote down what he said."78 Similar exaggeration can be seen in research reported by Dr. Schwartz, for example, a single experimental use of cocaine in a teen*s lifetime causes Dr. Schwartz to describe that teen as belonging to a group of recovering cocaine users."79 Fred Collins noted, "Also, when I said ‘caffeine pills* he [a peer counselor] wrote down ‘speed* and said it was the same thing."80 Collins had to write a daily "Moral Inventory" in which he described his drug use and other matters of interest to Straight. If he did not admit enough drug use, his food rations might be cut in half.81
Implicit evidence exists for similar exaggeration in replies to Dr. Schwartz*s questionnaires. Questionnaires were typically distributed and filled out during "group therapy" sessions.82 Dr. Trebach describes the atmosphere of such sessions: "For at least twelve hours on weekdays, and
77. Schwartz, Hayden; and Riddile, "Laboratory Detection," 1093.
78. Quoted in Trebach, Great, 32. This interview was not part of Dr. Schwartz*s research, but is relevant because it captures the atmosphere of what teens are encouraged to say upon arrival, the time when Dr. Schwartz*s questionnaires were answered.
79. Schwartz, et al., "Nasal Symptoms," 63.
80. Quoted in Trebach, Great, p. 32.
81. Trebach, Great, p. 38.
often half that time on weekend days, the residents went through a series of group sessions, or raps. . . . A major feature of each rap was ‘motivating’. The residents flailed their arms wildly about, moving their bodies frantically in their chairs, in order to get recognized by the group leader. The chosen person would stand and make confessions and ‘renouncements’, often crying as he or she did so. These public confessions were usually about their ‘druggie pasts.’ It was common for residents to exaggerate their drug involvement so as to demonstrate the great progress they were making."83 These are the sessions at which teens were denied bathroom privileges until they sat in puddles of their urine.84 These are the sessions at which Dr. Schwartz reported that his research subjects engaged in self-mutilation.85 And it was at "group therapy" sessions that teens answered Dr. Schwartz*s questionnaires about drug use.
In addition to implicit evidence, explicit evidence exists that Dr. Schwartz*s subjects exaggerated their drug use. In reporting a series of medical experiments allegedly measuring memory deficits among teens who smoked marijuana, Dr. Schwartz rated one group of subjects as "cannabis dependent" on basis of their admission of daily smoking. But 20% of these "daily smokers" had no cannabis metabolites in their urine upon arrival at Straight,86 and Dr. Schwartz claimed that the urine test could detect metabolites up to 9 days after marijuana use.87 Moreover, Dr. Schwartz used the EMIT urine test but reported no double check of positive results through another type of test. Because EMIT can produce false positives for marijuana, use among the so-called "cannabis dependent" teens may have been lower yet. Dr. Schwartz explained the discrepancy between teen confessions and urine test exonerations by saying the test was not sensitive enough. An alternative explanation is that teens told Dr. Schwartz what they thought he wanted to hear.88 Indeed, a report on Dr. Schwartz*s cocaine research explicitly says that one-third of surveyed teens claimed to be giving false answers on his questionnaire. 89
83. Trebach, Great, A8.
85.Schwartz, et al., "Self-Harm," 342.
86.Schwartz, et al., "Short," 1216.
Given the public record of Straight*s coerced confessions of exaggerated drug use and deceptive classifications of drug use (for example saying that caffeine and amphetamines are the same drug), given the discrepancy between confessions reported by Dr. Schwartz and exonerations reported by laboratory tests, and given claims by some research subjects that they put false answers on the questionnaires, we cannot assume accuracy in any data generated by Dr. Schwartz*s questionnaires. If those data are inaccurate, much of his research is meaningless. This problem was easily forseeable when designing the research.
Subject veracity was also crucial to Dr. Schwartz*s experiments measuring memory deficits in marijuana smokers.90 In theory, subjects could have performed at levels below their capability, particularly if they believed that Straight expected them to show improvement or deterioration over time. The plausibility of that theory is strengthened by the public record of conditions at Straight. Unless we can be assured that teens at Straight felt no such pressure while receiving "therapy" during the weeks covered by Dr. Schwartz*s experiments, his claim of memory deficit among marijuana smokers has no validity. This problem was easily forseeable when designing the experiments.
In addition to possible problems in design and execution of research, published reports of Dr. Schwartz*s work contain flaws in reasoning and interpretation. In a study of Straight teens who said their drugs of choice were alcohol or marijuana, we read "among the untoward effects of substance use in adolescence is a manifest depression and the possibility of consequent suicide."91 Yet the role of marijuana in teen suicide can be questioned from other data in the article, such as "about one fourth of these [suicide] attempters recalled that both the wish to hurt themselves and a suicide attempt occurred prior to their involvement with drugs."92 Suicidal marijuana users also stated they had experienced chronic depression in childhood and came from families where parents suffered from chronic depression or alcoholism.93 Elsewhere Dr. Schwartz reported, "a notably high level of
89. Smith, Schwartz, and Martin, "Heavy Cocaine Use," 540.
90. Schwartz, et al., "Short," 1214-19; Schwartz, Gruenewald, and Klitzner, "Effects," 404.
dysfunction in the families of these cannabis-dependent adolescents before they became harmfully involved with drugs."94 Might such factors have more to do with a suicidal personality than marijuana does?
(Still another factor with this particular population is Straight itself. Fred Collins, the teen falsely imprisoned by Straight, said he considered suicide while being held there, and professional examination after his escape concluded that Straight "therapy" had given him neurotic symptoms.95 Straight*s Dr. Schwartz himself admits, "Admission to a drug-treatment facility, particularly one that separates adolescents from their friends, family, and social milieu, is in itself a major cause of and confounding variable for depressive affect."96)
The suicide article misinterprets an important point. "Although signs and symptoms of depression were reported as quite prevalent in childhood and prior to the onset of drug use, suicide ideation and behavior increased significantly during the years of drug use. If substance use is intended as a self-medication of an underlying depression, it evidently fails miserably in accomplishing this purpose; instead, it appears to potentiate suicidality."97 Wrong. Stress may promote suicidal behavior among persons already so inclined, and adolescence is a time of stress. In our examination of "parental pressure" used to put teens into Straight facilities, we glimpse the extraordinary levels of stress confronted by Straight teens in home life. The quality of loving concern in those households can be inferred from the claim that among families where teens attempted suicide, one-fourth of the households continued to keep guns and ammunition in the residence.98 Adolescent use of marijuana did not make those parents provide ready means of self-destruction to their children following a suicide attempt. If levels of stress and levels of marijuana used to cope with that stress rise together, that does not mean marijuana encourages suicide. Dr. Schwartz confuses a correlation with a cause/effect relationship, a confusion also seen in his claim that marijuana is a so-called "gateway" drug99--that marijuana causes people to use drugs such as cocaine. In addition Dr. Schwartz seems to
94.Schwartz, Hoffmann, and Jones, "Behavioral," 265
95.Trebach, Great, 43, 56.
96.Berman and Schwartz "Suicide," 312.
confuse pharmacological effect with effect of setting: "As [cocaine] addiction progresses, so does psychological dysfunction and criminal behavior. Stealing automobiles, selling drugs to obtain money, and trading sexual favors for cocaine become more common among those more heavily addicted."100 Is such behavior caused by cocaine*s pharmacology, or by its illegality and expense? Another example of questionable reasoning is found in Dr. Schwartz*s article "Nitrous Oxide: A Potentially Lethal Euphoriant Inhalant," where he gives the example of a man "found unconscious with his head enclosed by a plastic bag, used as a reservoir for the gas."101 I submit that a man could stick his head in a plastic bag used as a reservoir for oxygen and pass out, that the described hazard is not caused by the gas but by the means used to inhale it. Dr. Schwartz*s work repeatedly demonstrates questionable reasoning.
One final quotation from the suicide article exhibits yet another flaw in Dr. Schwartz*s work. "Satanic music is believed to be associated with adolescent suicide because of the nihilistic lyrics repetitively suggesting that suicide is a viable option to put an end to unbearable emotional pain during adolescence."102 Believed by whom? Scientific evidence for a cause/effect relationship between rock and roll music and suicide is zero. Zero. In highly publicized litigation, parents of two teens who shot themselves claimed the teens did it because they heard music by the rock group Judas Priest. The magazine Rolling Stone revealed things that may have influenced the teens* action as much as rock and roll did:
The judge in this litigation was friendly to the notion that rock and roll kills, but even he found no evidence that music killed these teenagers, and
98.Ibid., 310, 311.
100.Estroff, Schwartz, and Hoffmann, "Adolescent Cocaine Abuse: Addictive Potential," 552.
101.Richard H. Schwartz and Martha Calihan, American Family Physician 30 (1984): 171.
standards of evidence in law are much looser than standards in science.
The flaw in Dr. Schwartz*s claim about "Satanic music" is that no evidence supports his claim. He states in the same suicide article, "It is generally agreed that there is a progressive increase in depressed mood from abstainer to substance user and a corresponding increase in suicide attempts among adolescents."104 Wrong. There is no general agreement that a teen who uses beer or marijuana is more depressed or suicidal than one who does not. When Dr. Schwartz cited eight journal articles supporting his contention that marijuana has "a major negative impact on adolescent development and psychosocial functioning," examination revealed that he wrote four of the articles himself, a research associate of his apparently wrote one, and a paid consultant to Straight wrote two.105 Citing yourself as an authority may be legitimate but does not establish that the scientific community supports your views. The Journal of the American Medical Association106 has printed correspondence criticizing Dr. Schwartz for presenting his personal assumptions as fact. Journal of Pediatrics has printed correspondence noting that Dr. Schwartz failed to comprehend a statement he condemned.107
The need to search for possible bias in Dr. Schwartz*s research is emphasized by passages such as "improbable or untruthful responses were deleted" from a data base.108 Because Dr. Schwartz asserts that teenagers use more drugs than they willingly admit,109 it is possible that he adjusted his research data to show a higher use than is claimed by the teens. Conceivably such adjustment could be proper, but any researcher who drops data must justify such action, and criteria for determining "improbable" data do not appear In the research just cited.
103. Mary Billard, "Heavy Metal Goes on Trial," Rolling Stone, July 12,1990, p. 84.
104. Berman and Schwartz, "Suicide," 310. See also the marijuana suicide claim in Schwartz, "Marijuana: An Overview," 315.
105. The paid consultant was Dr. Robert L. DuPont (Trebach, Great, 52) who, according to court records, diagnosed Fred Collins without ever examining him (ibid 53).
106. Roland E. Herrington, "In Reply," Journal of the American Medical Association 260 (1988): 3592.
107. Nancy M. P. King and Alan W. Cross, "Reply," Journal of Pediatrics 112 (1988): 330.
108. Schwartz, et al., "Nasal Symptoms," 63; Estroff, Schwartz, and
Little doubt exists that Dr. Schwartz has strong feelings about teens and marijuana. He has proclaimed, "It seems appropriate that veterinarians be aware of the possibility of marijuana intoxication as the cause of a glazed look in the eyes and/or ataxia in an animal living in the home with a teenager.110 He has urged veterinarians to give such animals urine tests for marijuana use.111 He has complained that veterinarians have not heeded his advice.112
Two themes run through the published work of Dr. Schwartz: teenagers cannot be trusted, and marijuana ruins teenagers. I have no explanation for those themes. Certainly his published research fails to support the propositions.113 That sort of failing is a classic sign of bias. In this regard, let me share some things Dr. Schwartz has revealed about his personal life.
In 1983 he wrote,
109. Schwartz, "Identifying and Helping," 94; Schwartz, "Psychoactive Drug Use During Adolescence, 205
110. Richard H. Schwartz and Mel Riddile, "Marijuana Intoxication in Pets," Journal of the American Veterinary Medical Association 187 (1985): 206. The warning said that pets were becoming intoxicated from marijuana smoke exhaled by teenagers.
112. Richard H. Schwartz, "Comments on Cannabis Intoxication in Pets," Veterinary and Human Toxicology 31 (1989): 262. His complaint was prompted by an instance in which a "respectable-looking owner" (R. A. Smith, "Coma in a Ferret After Ingestion of Cannabis," Veterinary and Human Toxicology 30 (1988): 486) presented a ferret that had apparently eaten marijuana. The owner did not reveal this fact during examination, and the animal was misdiagnosed as brain damaged and, in the terminology of Dr. Schwartz, "sacrificed." (Actually the animal was euthanized; Tr. Schwartz*s term implied he viewed the patient as a research subject.) Dr. Schwartz*s complaint is curious because the case did not fit the criteria he had warned veterinarians to watch for; nothing in the case report indicates that a teenager lived in the home, and nothing indicates that the animal became intoxicated from smoke exhaled by a marijuana user.
113. He cites numerous correlations of deviant behavior with drug use but fails to demonstrate that drugs cause the deviant behavior. He ascribes the same kinds of behavior to users of cocaine (Smith, Schwartz, and Martin, "Heavy Cocaine Use," 540) and marijuana (Schwartz, "Frequent Marijuana Use," 203-4), two drugs with such different characteristics that we can hardly believe they could have the same effects. An additional reason to doubt Dr. Schwartz*s claims that marijuana causes gross changes in behavior is his admission that a person on a marijuana "high" can behave and perform normally, that a user can easily overcome the mild pharmacological effects at will (Schwartz, "Marijuana: A Crude Drug," 456; Schwartz, "Marijuana: An Overview," 307).
Later, saying he was "very upset by the opinionated editorial" that appeared in a medical journal, he wrote to the editor,
When his sons troubled childhood was succeeded by a troubled adolescence, Dr. Schwartz decided the explanation had to lie in some agency outside the son or family, and the outside agency was marijuana. After 17 months in the Straight system, his teenaged son exhibited "resentment" and "anger." And the son then resumed smoking marijuana, conduct that would hurt his father.
I do not presume to dissect the nuance of intimate family relations on the basis of two brief comments in medical journals. I do suggest, however, that Dr. Schwartz experience with his son has affected his research, both in its direction and its intensity, activity that the journal Clinical Pediatrics praised as "almost a compulsion."116
Medical research performed at Straight by Dr. Schwartz involves questionable ethics, questionable design, questionable execution, questionable results, and questionable interpretation. His work illustrates the linkage of questionable ethics with questionable science. Ethics is not just a matter
1984, the article was received by the journal in 1983. Dr. Schwartz wonders if, without marijuana his teenaged son might have matured into a responsible adult. Note that the son was 15 or 16 years old when Dr. Schwartz concluded that he was inca p able of adult behavior.
115. Richard H. Schwartz, "Screening for Drug Use in Adolescents: The Other Side of the Coin," Journal of Pediatrics 112 (1988): 328.
116. "Richard H. Schwarz, : Practioner-Researcher," Clinical Pediatrics 28 (Dec. 1989).
for philosophers, or a mere paperwork chore for researchers. The kind of thinking that pushes aside doubts about ethics will also push aside doubts about data. Good ethics is crucial to the production of good science.
Anyone familiar with the history leading to the current consent system, a history involving research upon subjects held against their will, cannot help but be disturbed that medical research has been conducted upon teens held at Straight. Possibly investigation might determine that nothing is amiss. But the public record raises a possibility that the consent system has failed to protect the rights of research subjects at Straight. If such be the case, we would then have to ask whether we are seeing a freak occurrence or merely one example of many instances in which the consent system is breaking down.
The possibility of a wider problem is suggested by what happened when I wrote to the editors of two journals that have either published the Straight research or reported about its findings. In my letters I briefly outlined the public record of conditions at Straight and noted aspects of Dr. Schwartz*s research consistent with such conditions.
The editor of Science News sent no reply. The reply of Vincent A. Fulginiti, editor of American Journal of Diseases of Children,117 gave insight into the workings of both the consent system and the peer review system. "It is not the editorial policy of AJDC to make judgements concerning the programs that are detailed in studies submitted to our journal." In other words, this medical journal does not care about what happened at Straight. "You appear to have the view that the authors* description of the facility that cared for the study subjects conforms to Straight, inc." The reason I have that view is because the authors said the facility was Straight, Inc.118 Dr. Fulginiti says I apparently feel "based on a book by Trebach, the inclusion of that facility raises ethical questions. I cannot comment on your viewpoint, or on the book by Trebach, which I have not read." Having refused to consider the questions I raised, Dr. Fulginiti concludes that because the proper legal forms were followed and because the published article claimed nothing was amiss, the research in question was ethical.
Dr. Fulginiti says the consent system's requirements were followed with
118. Schwartz, et al., "Short," 1215.
the experiment in question. But I did not contend otherwise. Instead I asked whether the consent system may be flawed and may have allowed abuse of subjects in medical research at Straight. Dr. Fulginiti and I address two different issues. He did not answer the questions I raised; indeed he explicitly refused to do so.
Dr. Fulginiti forwarded my letter to Dr, Schwartz so he could reply if he chose to do so. He did not. Dr. Fulginiti also sent my letter to his journal/s editorial board and to assorted American Medical Association staff members. None of them sent me a response.
Why does the medical community demonstrate such indifference to the issue of using Straight teens for medical research? I wonder if no one would be curious about juvenile asthma sufferers who received "unique" therapy that deprived them of sleep and broke their ribs. I wonder if no one would be curious about juvenile cardiac patients who received "unique" therapy requiring them to sit in pools of their urine while they mutilated themselves. Somehow I think such conditions would prompt investigation.
I suspect the reason for the scientific community's indifference about Straight, Inc., is both simple and disturbing. I suspect the reason for indifference is that teenagers at Straight smoked marijuana. I believe many scientists and medical practitioners view such teenagers as depraved. I believe that depraved persons are often considered worthy of punishment. I believe that despite the best work of persons such as Karl Menninger, who sought to close the snake pits into which mental patients were thrown, many medical practitioners think that teenagers at Straight are getting what they deserve. If there were no bigotry against marijuana users, I cannot imagine that the scientific community would be unperturbed by the public record of conditions at Straight, Inc.
I conclude now, with a warning.
I have used Straight, Inc. simply as a case study. I do not see anything extraordinary about the researchers there, or about the committees that approved the work, or about the journals that published the results. We have seen a case study of how the consent system and peer review system work routinely. There is no indication that the research at Straight received inspection that differs in any way from the inspection given to research any
place else in the United States.
Therefore if the normal routine has allowed a problem to exist at Straight, quite possibly similar problems exist elsewhere. I found the public record of conditions at Straight to be shocking, but I do not believe any of these things were done by psychotics. I believe the things were done by persons who are ordinary in every way and who may even be admired by neighbors and professional colleagues. I believe examination would simply find these ordinary people to have a strong belief in the necessity to do something and a lack of concern about side effects of getting the job done.
We can see such people all around us. If we look closely enough we may even see them when we look into a mirror. Few of us are monsters, but many of us are werewolves, willing to brush ethics aside when faced by certain situations, willing to engage in monstrous behavior that may receive approval from society and from our own consciences.
If you are disturbed by the public record of Straight, I urge you not to feel morally superior. Most of us have the ability to make someone cry out in pain, and feel righteous about it. That is why the consent system for medical research was developed, to be sure that a check would exist upon investigators who were so carried away by the importance of their research that they ignored its effects. Few of us are so saintly that we do not need occasional peer review of our actions, And I hope the case study I have presented illustrates the importance of not losing sight of the purpose of such review. Exact compliance with the ritual of consent is important, but we must not forget that the resulting paperwork is indeed just ritual, a means and not an end, and can be empty of content unless we always remember the purpose it stands for. That purpose is not only to protect research subjects, but to protect us from our own folly.
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