Featured article: Noortje Jacobs on postwar research ethics

Noortje Jacobs’s article, “A Moral Obligation to Proper Experimentation: Research Ethics as Epistemic Filter in the Aftermath of World War II” appears in the December issue of Isis. The article is free to all readers for a limited time.

In one of his last acts as our manuscript assistant before returning to his first love of teaching, Alexander Cagle interviewed Dr. Jacobs about her work on Dutch medical research ethics, a florid but curiously understudied moment in the larger history of bioethics.

CAGLE: Your essay focusses on Dutch medical research ethics in the decades immediately following World War Two. Could you briefly describe what drew you to this history and your process for finding relevant archival sources?

JACOBS: In the history of human experimentation in medicine, the decades immediately following World War II are often described as the “Gilded Age or Research”: a period that saw a vast increase in human experimentation, with little attention to the rights and safety of human research subjects. This fascinated me, as World War II is also often described as “the birth of modern medical research ethics”. And when I kept on reading that the Dutch were very early to raise international awareness of this issue, I started researching the documents this literature refers to. It turned out that very detailed minutes have been kept of many meetings that Dutch physicians had on this topic in the early 1950s. They did raise early awareness, because they were afraid that especially American and English researchers were starting to cross fundamental ethical lines in human experimentation. However, it turns out they were just as much—and perhaps even more—concerned with an ethical issue that we would not recognize as such today: i.e., the (poor) quality and quantity of most medical research. For me, as a historian of science, this was were it started to become really interesting, and so I followed my historical actors and sources into all sorts of domains and archives to further uncover this history.

A main throughline of your essay seems to be not only a discussion of medical ethics, but also a discussion of medical expertise and who could be considered an expert. Were you surprised by how much of the focus of the vivisectionists’ early ethical meetings seemed to not be about the patient at all but in fact on maintaining their medical authority and fending off the antivivisectionists? 

Yes, I was surprised by this initially, and was sometimes shocked to read how easily—on paper at least—they seemed to dismiss the interests of individual patients in favor of “the progress of good medical science”. But I became convinced, and I hoped this shows in my essay, that these physicians were not so much motivated out of self-interest (i.e., maintaining their authority or societal standing), but out of a very deep conviction that their definition of “good science” was little understood, under attack, and thus had to be protected and promoted for the benefit of human kind. As I write in my essay, they were often a bunch of frustrated elitists really.

At end of your article, you argue that the “use of ethics to further epistemic convictions” as a methodological tool has been undervalued. What are some other areas of research, whether it be in the history of medicine or beyond, that would benefit from the use of this framework?

For one thing, I see a lot of analogies between my historical actors and their arguments and the contemporary Open Science and Research Integrity Movements. I would argue that scholars like John Ioannidis et al. are at heart also therapeutic reformers, who make overt ethical claims to further their epistemic convictions. For another, I have benefited a lot in my work from historians of science such as Melinda Baldwin, Laura Stark, Alex Csiszar, Imogen Clarke, and Aileen Fyfe, who show how scientific journals and funding bodies in the modern period have become gatekeepers of “good science”. I think there are a lot of interesting connections to be made here with the historical functioning of research ethics committees—which is research that I am currently pursuing as well.

 As the questions for this interview are being written and answered, the first COVID-19 vaccines are being administered. How do you think your research applies to the current world health crisis as well as the current Dutch medical apparatus? 

Oef, that is a big question. I do wonder at times what my historical actors would have made of the big political push that we are currently seeing to get these vaccines out there as soon as possible—even if they have not yet gone through all of the stages that clinical trials usually go through to establish efficacy. As Austin Bradford Hill famously said: “In treating patients with unproven remedies we are, whether we like it or not, experimenting on human beings, and a good experiment well reported may be more ethical and entail less shirking of duty than a poor one.” But then again, these are exceptional times, that ask for a special type of trade-off between efficacy and expediency.

I do know though what my historical actors would have made of COVID-deniers! They would very much have convinced them that “good science” needs to be protected and promoted—and that this constitutes a moral obligation, even if this means that they are a bunch of frustrated elitists most of the time.