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Lecture 5

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ANTH 227
Dan Small

Anthropology 227 – Medical Anthropology February 5 , 2013 Continuation of “Miss Evers’ Boys” and Ethics of Research - 1970s: Stanford Study A study conducted to see if the position people are assigned, if that would change how they act. They took college students and assigned them roles in a prison (prisoners or guards) and dehumanizing (taking their identity away from them). Meant to run 2 weeks. Got very out of control and abusive very fast and the study was shut down after 4-5 years. - Miss Evers’ Boys (continued Part 2)  = forbidden experiment, the means does not justify the ends  Proposed study: study 400 men with syphilis, 200 as a control group  study them without any form of treatment, even though treatment is available  The subjects will be told that they are being treated for syphilis, but they are not. They are kept healthy in every other respect in order to see the changes to health by only syphilis.  “412 men with syphilis taken” and they are told that nothing has changed from the beginning. They are convinced that any new procedures are just the same as previous treatment  The idea was that treatment would come in 6 months, but it ended up being a total of 40 years without treatment even though a cure (penicillin) had been found (1942) halfway through the experiment  Hertzimer reaction = penicillin can cure syphilis, but it may also kill them through an allergic reaction with cases as severe as the men have  The end point of the study is considered to be after autopsy of the men  there was never going to be treatment  One of the motives: through scientific proof it can be shown that there is no difference in how disease effects different races, for once and for all showing that we are all equal  The syphilis began to get worse, taking over both physical and mental capacities (ex. Weak legs, eyesight loss, paranoia)  The subjects truly believe they were patients = fundamental flaw, there was no cultural accounting between researchers and patients Ethical issues with the Tuskegee Study - Blacklisted from being able to get treatment from any where even if they wanted to or had the means - **Withholding information about the care (or lack of) that they were being given (with holding treatment and cure when it was found) - Tried to make it seem that they were doing good by using race as a reason - Even once a cure was found, they continued the study until autopsy could be taken  because they was no reason, study men taken as disposable  The people that were a part of the study may have thought they were doing the wrong thing. Until this study was exposed through the media (where after the president apologized and it was exposed for what it was), the men continued life as if they did not have syphilis they passed on syphilis to their families as well  Originally was not meant to be ethnocentric, was not intended to be a punishment for a certain race – those involved thought that they would be given the chance to bring truth to people.  The doctor initially gave treatment, stopped and gave even “fake” treatments, hoping to get money for the cure/treatment BUT even once it was apparent that would not be the case, continued the study Doing academic research is sometimes solely academic, does not make a difference in peoples lives  Those who initiated the study appeared to be genuine (weren’t Nazi doctors) -But there was never proper consent Power roles behind the Tuskegee Study  Doctor, Nurse – knowingly used their power to convince the men to participate in the study “Doctor knows best” The Board > Doctor > Nurse, but the Nurse had more direct influence/doctor over the patients  The Board used social leverage “You can prove what black doctors can do”  Sometimes a key informant (ex. Nurse) = double agent, have influence so can recruit people into the study for the benefit of the study In the Tuskegee Study – used influence Miss Evers to make people comply Thinking about giving people payment for participating in your study - Ex. Giving someone $50.00 for participating in the Tuskegee Study - You have do a cultural assessment IDEAS: Is there ever a justifiable reason for withholding treatment? - Might say money ex. Someone needs a treatment that is too costly that the person cannot afford - Answer: n0 The “Gift” - Clinical trial for a disease in marginalized populations that would otherwise not receive any health care at all? Are they choosing this intervention under implicit duress because it is the only option available? Is the study really a benefit? Is healthcare universally available? Ex. Tuskegee: food, ride in case, medical care? The goal at the end of research is to get a peer reviewed paper, not really to health the subjects  just an academic question and we leave it to others to apply But when we are doing this kind of research, we have an obligation to the subjects What is a right? Health care may not be an explicit right, but it is an implicit one in Canada Differing cultures in Medical ethics - Two separate hospitals, one where doctors stopped treatment once
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