Originally published in Synapse on February 17, 1977.
Inmates of California’s prison system are currently being used as subjects for medical experimentation. Although the inmates participate in the experiments on a voluntary basis, critics charge that conditions existing inside the prisons lend a high degree of coerciveness to the inmates’ “free” choice.
The state Assembly Select Committee on Corrections recently held hearings on proposed guidelines on medical experimentation in prisons that would hopefully prevent exploitation of the inmates’ incarcerated position.
California is one of only seven states in the nation that conducts bio-medical experiments on prisoners. The Federal Bureau of Corrections halted all experimentation on inmates in federal prisons last year.
$30 per month
The majority of prison experimentation in California is currently done at Vacaville. The research now under way is largely “phase 1” cosmetic, dermatological and gastrointestinal.
“Phase 1” research consists of the first introduction of a new drug into humans for the purpose of determining human toxicity, metabolism, absorption, elimination, preferred route of administration, and safe dosage range.
Inmates at Vacaville are paid $30 per month to participate in the medical experiments. With approximately 2,800 prisoners and only 300 non-medical jobs at $10 per month, the medical experimentation roles are among the best jobs available at Vacaville and are apparently in great demand by inmates.
Testimony
At the hearings on guidelines, several prominent groups and individuals spoke out against medical experimentation as it is currently being practiced.
Jessica Mitford, author of Kind and Usual Punishment, testified that prisoners who participate in experiments are not treated with the same respect as volunteer subjects who are not imprisoned, and are paid only one tenth as much for their service.
Dr. Laurens White, a representative of the California Medical Association, stated at the hearings that conditions in the prisons were such that the prisoner’s freedom of choice is inherently compromised. Dr. White said that “informed consent” is not possible under prison conditions.
The Prisoners Union spoke out’ both against the way consent is obtained from prisoners and against the follow up treatment received by those who suffer adverse effects from their service.
The Prisoners Union cited a case at Vacaville now where a prisoner contracted polymyositis, an inflammatory disease of the muscles, while participating in an experiment and has as yet not received treatment.
At hearings, several persons spoke out against any restrictions on medical research. Dr. William Epstein, chairman of the Dermatology Department at UCSF, has been conducting experiments at Vacaville along with Dr. Maibach, and testified at the hearings in favor of continuing those experiments.
Earl Muff of the California Department of Corrections claimed that the inmates generally favor the continuation of medical experimentation and advocated that the research be allowed to proceed.
Minority groups have in the past been concerned that nonwhite inmates are made to bear a disproportionate share of the risks of research conducted in prisons. They point out that prison populations are disproportionately non-white.
Ironically, it seems that discrimination against nonwhites by prison authorities have sheltered minorities from much of the possible abuse of medical experimentation.
A recent federal investigation found that the relatively high paying experimentation “jobs” have been treated as privileges by prison authorities, who tend to bestow them on honor inmates.
The investigation found that experiment participants are generally better educated and more frequently employed at better jobs than the prison population as a whole.
Women are asked to be subjects for experiments less frequently than men. This may be due partly to hormonal differences and partly to sexual bias.
Kinds of research
Research conducted in prisons generally falls into four categories:
— research not related to the health and well being of the subject (Phase 1 testing of new drugs)
— research intended to improve the health and well being of the subject
— research into the causes, effects and process of incarceration
— research into the method of treatment or rehabilitation of prisoners.
Related to this last category are the “innovative” behavioral modification programs instituted in many prisons which include the use of electro-shock or drugs with unpleasant effects such as aversive conditioning, reinforcement techniques, etc.
Who does it?
Seven states are actually conducting bio-medical research, while five state conduct behavioral research. However, most states do not consider behavior modification research to be behavioral research and do not report it as such.
Very few of the bio-medical experiments are related to the health and well-being of the subjects. All involve primarily drug and cosmetic testing.
Research is conducted only in states, including California, that have specific legislation or departmental policies permitting and regulating it.
The federal Department of Health, Education and Welfare (HEW), the Public Health Service, and the Alcohol, Drug Abuse and Mental Health Administration all participate in using prisoners in research.
In general, pharmaceutical companies do not like to conduct research in prisons because they fear that the widespread illicit drug use in jails would make it impossible to conduct controlled experiments.
Nevertheless, of 51 pharmaceutical companies polled by a federal commission, 16 confirmed that they use prisoners as subjects.
History
Countries other than the United States have not traditionally used prisoners for medical research. This was true for the United States before 1940. However, with World War II, prisoners were induced to participate in research programs designed to develop treatment for infectious diseases which afflicted the armed forces.
Participation by prisoners was considered to be heroic. After WWII, worldwide concern grew as a result of public acknowledgement of experiments conducted on prisoners in Nazi concentration camps.
This led to the establishment of the Nuremberg Code (1946-1949) which stated that “research using human subjects be conducted only when humans were so situated as to be able to exercise free power of choice.”
This was adopted by the World Medical Association in 1964, endorsed by the American Medical Association in 1966, and then was dropped by the AMA in 1975.
Since the 1965, questions have increasingly been raised concerning the ethics involved in using prisoners for research purposes. Eight states and the Federal Bureau of Prisons have moved to abandon research in prisons.
The US House Subcommittee on Courts, Civil Liberties, and Administrative Justice in 1975 concluded that “continued use of prisoners in any medical experimentation should not be permitted.”
Research in federal prisons is now gradually being phased out.
Recommendations
The National Commission of the Protection of Human Subjects of Biomedical and Behavioral Research has recently published guidelines in the Federal Register regarding the ethical conduct of research involving human subjects by HEW.
This commission has also created a list of recommendations to Congress concerning the protection of human subjects (in particular children, prisoners, and people in mental institutions) in research not subject to regulations by the HEW.
In making its recommendations, the Commission pointed out the severe conditions of lifestyle and health care in prisons. In addition, the Commission stated that, if prison living conditions were better, prisoners would probably not participate in research activities. The Committee’s recommendations include:
1) “that studies of the cause, processes and effects of incarceration or of prisoners as incarcerated persons be conducted only if they are of minimal or no risk; only if the competence of the investigators and adequacy of the research facilities have been established, and only if at least one human subjects review committee made up of sexually, racially and culturally diverse backgrounds has reviewed and approved the research taking into account risks, informed consent, selection of subjects and provisions for providing compensation for research related injury.”
2) “that research intended to improve the health and well being of the individual be conducted and supported as long as it meets provisions in (1).”
3) “that research on prisoners not be conducted unless a federal department or agency has determined that the research fulfills an important social and scientific need, and the reasons for involving prisoners in the type of research are compelling, that there be a high degree of voluntariness which would mean the ability to be voluntary, and at minimum have “adequate” living conditions, provision for effective redress of grievances, and separation of research participation from parole considerations.”
CMA guidelines
The California Medical Association’s Committee on Evolving Trends in Society Effecting Life has developed five proposals concerning experimentation on prisoners. The committee has recommended that experimentation not be allowed unless:
1) Informed consent is attained.
2) A thoroughly equipped medical staff is available to prisoners (this stipulation alone would eliminate all of the California state prisons).
3) There are 2 boards which judge the worth of proposed research — one board inside the prison and made up of prisoners, administrators and doctors, and another board outside the prison. (Presently, if a fulltime UC experimenter wants to do research, he or she must obtain approval from the UC board on Human Experimentation. However one is not subject to the UC Board ruling if personal insurance rather than UC insurance is used.)
4) Experimenters must have insurance to cover side effects and complications of research. (At present, 33 of 51 pharmaceutical companies polled have insurance policies which compensate subjects who are injured in research. There has however never been a determination made as to the extent to which such policies would provide compensation in the absence of legal liability).
5) That there be equivalent work opportunities within prisons so that a prisoner can choose another job at which he,, or she would make as much money as the research job. Assemblyman Richard Alatoree (Dem-LA), chairman of the California Select Committee which has just conducted the hearings, will study the CMA’s recommendation and the results of the recent hearings, and report them to the Legislature.
