Tuesday, August 22, 2006

Guinea Pigs Behind Bars

Most psychiatrists know the story of how lithium was discovered, but for the rest of you here's the story:

Many years ago a fellow by the name of John Cade decided to give lithium to manic patients because he noticed that the substance seemed to calm agitated guinea pigs. (Don't ask me how he could tell the guinea pigs were agitated. As far as I can tell all guinea pigs do is squeak and munch alfalfa pellets, or occasionally chuckle while peeing on the visitor's lap but that's a story for another day.) Anyway, the lithium worked.

In the early '70's lithium was tried on another group of research subjects---prisoners with a history of violence. Researchers found that lithium cut the rate of violent infractions in half---even when the inmates didn't think the medication was working.

But the point of this post isn't specifically about lithium---we already have a nice post about that (Peace and Lithium). The topic of this post is clinical research on prisoners.

When this topic comes up most people have an immediate association to Josef Mengele and other horrors. However in the United States physicians had been doing research on prisoners for at least twenty years before that. In one study done in 1916 inmates on a prison farm were used to study pellagra, a disease caused by a nutritional deficiency of Vitamin B. In exchange for a full pardon they were placed on a four month diet entirely free of Vitamin B. By the end of the study half of them had developed dermatitis, weight loss, loss of strength and nervous system impairments.

By 1948 as a result of the Nuremberg trial America developed the earliest standards for human research on prisoners. Dr. Andrew Ivy, a prosecution expert at Nuremberg, proposed that medical research should be allowed if results were "unprocurable by other methods" and animal experimentation had already been performed. He also suggested that medical personel should serve as subjects along with volunteer prisoners. Although he recognized the potentially coercive influence of pardons or "good time" credit, he fell short of banning it outright as an incentive for participation.

At one time a central issue in correctional research was whether or not inmates truly had the capacity to give informed consent. The nature of the correctional environment was thought to be too coercive for completely voluntary consent given the lack of contact with advocates (including friends and family) or other counsel. Today this is not the prevailing opinion and inmates routinely give informed consent for treatment or research.

Presently correctional research is governed by the Code of Federal Regulations, Subpart C, entitled Additional Protections Pertaining to Biomedical and Behavioral Research Involving Prisoners As Subjects. These regulations permit research on prisoners if it falls within certain guidelines. The research must not give the subject advantages or opportunities within the prison to the extent that the offered reward would impair his ability to weigh the risks of the research. Subject selection must be impartial and free from influence by prison officials. Correctional research is allowed if it involves the study of the causes and effects of incarceration or criminal behavior, or conditions which affect prisoners as a class such as hepatitis or drug addiction. It is also allowed if it involves practices which have a reasonable probability of improving the health and well-being of the individual. All studies require that the research involve no more than minimal risk or inconvience to the inmate and that the decision to participate should not affect eligibility for parole or parole decisions. As with any human research, the study must be approved by an Institutional Review Board.

Now a New York Times article discusses a proposal to loosen Federal regulations for the use of prisoners in clinical drug trials. The proposal has the backing of a consortium of prison advocates, researchers, correctional staff and ex-offenders. Even the ACLU has signed on. But is this a good thing? Read the full story for the viewpoint of ex-research subject-prisoners. Be sure to watch the six minute video clip about the history of prisoner research in one Pennsylvania facility.

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You wouldn't believe how long it took to find this guinea pig picture. Along the way I found an unfortunate number of photos of guinea pigs as...umm...food. With apologies to our South American readers: yuck. Then I found this site with guinea pigs dressed in little costumes. How humiliating. Which would I prefer if I were a guinea pig?

Pass the parmesian.