Wednesday, December 28, 2011

Holiday Special 2 - More Scandals

I have gotten a few emails noting new information about some older scandals. Nikita Kharlamov sent a really great analysis of the infamous Tuskegee experiments, and Rossella Traversa reminded me about what Ian Nicholson's has been digging out of the recently opened Milgram archives. Here is the quick background, and the highlights of the new information....

Tuskegee Experiments

While not a psychology scandal, these studies tremendously affected the course of psychological science because they are widely held up as the definitive proof that we need rigorous human subjects review boards. Thus, as I often explain the irrational behavior of review boards to my students with the half-joking comment that they are required to examine our totally innocuous psychological studies as if we might be giving people syphilis. The 30-second, popular culture version of the Tuskegee story goes something like this:
A bunch of white-coated white guys let a bunch of syphilitic black guys suffer terribly, without giving them treatment, just to satisfy their morally-detached scientific curiosity about how the disease progressed.
Longer pop-culture versions usually add that the study was started before there was effective therapy for syphilis, but still note that the researchers did not administer penicillin, even after it was established as an effective cure midway through the 40 year study.

However, in 2004, Richard Shweder, a cultural anthropologist/psychologist, wrote an essay for Spiked Essays (an online outlet that likes to attack narrow minded thinking), titled "Tuskegee re-examined." The essay is a bit repetitive, but it offers a great assessment of the standard version of the Tuskegee story, finds it wanting, and offers an alternative interpretation. Among the important revelations: Most people with syphilis at the time either never showed symptoms or spontaneously went into remission without treatment. The early "treatments" were so horrible, that few people finished them, and even amongst those who did, there was no good evidence the so-called "treatments" actually helped... because there was too little knowledge of the natural course of the disease. Even then, any patents in the Tuskegee experiment who needed treatment were offered it! Only patients who had had syphilis long enough for it to be in a latent, inactive, not-contagious phase were kept in the study. By the time penicillin was shown to be effective, most of the study participants had been infected for over twenty years, likely with no symptoms or complaints for at least 15 years, and there is no evidence that administration of antibiotics would have helped them in any way. Oh, and many of the doctors and key staff involved in the project were black.

Shweder offers a alternative narrative, with these three "main themes" and conclusion:
The first [theme] is that circa 1932 a reasonable, fully informed public health researcher who cared about the welfare of all human beings - black and white - might well have supported the Tuskegee syphilis study.
The second theme of the counter-narrative, is that we should not presume that the life-course morbidity and mortality profiles of the Tuskegee men were significantly influenced for the worse by participation in the study.
The third theme in the counter-narrative is a caution against hindsight moralising and the temptations of 'presentism' (the inclination to react to past actions as though they were occurring in the present and to judge them on the basis of the standards of our day). 
 According to the counter-narrative, the only real option available was this one: do the study or don't do the study. And it isn't hard to imagine that the Tuskegee research team reasoned that if the study was done the study subjects would at least be no worse off then if the study was not done; and that doing the study was better than not doing it, because of the possibility that baseline information about the natural course of the disease would facilitate the development of new and more effective treatments....
There is no doubt that the researchers were interested in the knowledge that might result from the study; but did they in fact sacrifice the health of the men for the sake of their study, or withhold medical care in disregard of their professional obligation to alleviate human suffering? According to the counter-narrative, by the late 1950s the PHS researchers would have certainly known that penicillin was effective at reducing or eliminating a syphilis infection - but they would have also (correctly) believed that the removal of a 20-plus-year-long (and by then largely self-limiting, self-correcting or asymptomatic) infection would make little difference for the health and life expectancy of the men in the study.
A bit before the conclusion, Shweder also notes that while the doctors in the study didn't go out of their way to tell the patients about the effectiveness of penicillin:
Of the 90 men from the original sample of infected men who were examined in 1963, 96 per cent had received some form of either arsenical or penicillin treatment from other sources.
And while Shweder doesn't push that point, I'm left with the astonishing question: If virtually everyone had received treatment... who are the scientists accused of failing to treat?!?

All in all, this is fascinating. It redoubles my objections to overly-intrusive IRB boards (well, not double, that would be hard).

Alas, I'm haunted by vague recollection of recent revelations (after Shweder's 2004 article) that at least one of the top dogs in the Tuskegee experiments went on to do much more obviously unethical things in Central America. I recall stories that he worked with prison wardens to supply prisoners with syphilitic prostitutes. Also as I recall, though the latter study is viewed as a huge ethical violation on the part of the few U.S. researchers who were involved, at the time the study had the support and cooperation of local health ministries. While this does not obviously affect discussion about the ethical value of the original experiment, it might reflect quite poorly on the individual(s) in question. A brief search indicates that a federal government report on the Guatemala experiments came out in September of this year, making this scandal a timely topic again.

Thanks Nikita for pointing this out!

Stanley Milgram

Back to psychology, new revelations were published just this month in Theory and Psychology about Milgram's obedience studies. I'd enjoyed a talk by Ian Nicholson at Cheiron two years ago titled "The Conclusions Do Not Always Flatter: Stanley Milgram’s Private Assessment of the Obedience Experiments" and was excited to see the story in print. For those unfamiliar with Milgram's study, I recommend watching Derren Brown's startlingly exact recreation of the study as part of his TV show (it is a favorite of my Introductory Psychology students). This study was widely derided as proof that that Psychology needed human subjects protections as stringent as the medical profession.

Of course, the moral questions here are much deeper than you might think. (I, for one, don't think any of the participants should have been debriefed, or at least not any of those who went to the end.) Milgram often defended his own actions by claiming that, in fact, all subjects had agreed to participate in the study (i.e., he had consent), and that all had been debriefed and told the truth after the study, though such procedures were quite unusual at the time, and not in any way required. Further, the research had crucial scientific importance, and revealed deep truths about human nature, all without any real risk or harm to the participants. Nicholson provides an excellent analysis showing that publications (articles, trade books, and text books) seem to have bought Milgram's narrative, and have become much more positive over the past 50 years in their presentation of the obedience studies. However... recently, Milgram's archival papers were released, and they tell a different story. These records includes Milgram's diary, which contains detailed notes and reflections about the study as it progressed, as well as surveys and interviews with early participants.

Revelations from these diaries include:
  1. Not all participants were debriefed. Of those who were, especially in the early days, many were debriefed quite a while after the study took place. From the talk, I especially recall the quote from one participant who was a nervous wreck, and checked the local obituaries daily for two weeks in fear he might see the name of the confederate and find out that he was a murderer. Some didn't find out the whole story until they read the initial research reports.
  2. Interviews and surveys with the subjects revealed that the location of the study within the walls of Yale played a very important part in their going all the way to the end. They convinced themselves that nothing unethical would happen their. This draws into question whether Milgram's study found anything generalizable to the large question of how easily people are willing to do unethical things simply because they are ordered to do so.
  3. During the time of the study, Milgram himself doubted whether his study contained any scientific value and whether it was ethical. He even noted that it indicated something darker about him as a person, likely that he was doing it largely out of morbid fascination and for the complements it garnered from his immediate colleagues.
  4. He also did the debriefings, at least in a large part, for public impression management, rather than out of concern for the participants.
  5. Thus Milgram clearly lied in his many emphatic statements that there was absolutely no risk of harm, and that all subjects were told the complete story. These lies seem to be an intentional reaction to the fairly major controversy that mounted even before the study was published.
There is also a very good discussion about the scientific implications of the study, or lack there of, and how that should play into evaluating the ethical situation. I agree with Nicholson that there is no obvious scientific question being asked, and therefore no major scientific insight garnered. ("Will they do it?" is not a question of crucial importance to psychology.) But what of the social importance of the study? Surely, we are right to be fascinated by the study because the central question ("Will they do it?") has major implications for our view of ourselves and our fellow man.

Not so fast, Nicholson argues, the generalizability of Milgram's studies have been dramatically overblown. Nicholson seems to make two claims along these lines. The first, which I disagree with, is the claim that Milgram manipulated the participants into doing something "they would never ordinarily do." I'm not sure I buy the idea that there exists a "what they would ordinarily do", and I don't think the circumstances were that far from those one might experience on a regular basis in many parts of the world - figures of authority, in an official environment, over which they have purview, telling you to do something that seems ethically questionable. However, the second argument is very intruiging: Nicholson claims that participants knowledge of the college-based situation might well rule out any scientific or social importance because participants in effect did not believe that they would be allowed to hurt the learner to the extent the learner indicated. There is certainly evidence in the interviews that at least some participants did not fully believe the theatrics, though there is also evidence that most took the situation very seriously. How should we (ethically) interpret the behavior of participants who continued to the end, but correctly did not believe they were hurting anyone, and how should that alter our ethical evaluation of Milgram? Nicholson's eventual analogy, between Milgram's experiment and the mock-immoral situations routinely encountered in the course of a magic show (e.g., being asked to saw a woman in half) or police academy training (e.g., being asked to send attack dogs after someone during a training scenario), gave me pause.

Whether or not these revelations should darken our views on Milgram, they are very insightful, and worth promoting as an important part of psychology's history. The quotes from participants and from Milgram's own notes are very powerful, and well worth reading. I will be fascinated to hear about what else he finds in the archive.

Thanks Rossella for pointing this out!

So, there you have it. Two more scandals (only one of which is really about psychology) that came back onto the radar this past year.

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