Enduring Contributions of Henry K. Beecher to Medicine, Science, and Society (Vol. 45, No. 4 and Vol. 46, No. 1 of International Anesthesiology Clinics). Edited by Edward Lowenstein, M.D., F.R.C.A., and Bucknam McPeek, M.D. Baltimore, Lippincott Williams & Wilkins, 2007. Pages: 249. Price: $131.00 per part.
In my short career as an academic anesthesiologist, no unpleasantness has quite matched the deep revulsion elicited when I learned it was time for my yearly recertification with the institutional review board. The first time I muddled through the web-based program took hours and I thought, “surely I did that not even 6 months ago!” I painfully logged on once again for the moderately shortened recertification version and “point-clicked” my way as quickly as possible through the material. However, this time, just like the first, I paused momentarily when I came across the name “Henry Knowles Beecher.” What caught my attention and surprised me for the second time was that this whistle-blower, this champion for informed consent, was an anesthesiologist. This bit of trivia intrigued me, and I skimmed the summarized account of his 1966 landmark paper Ethics and Clinical Research on the computer. In my eagerness to put this computer tutorial out of my misery, it is very likely that I did not comprehend the importance of his work, nor the impact it had on the practice of medicine and medical research. Thus, the tenacious Dr. Beecher and his paper did not cross my mind again until very recently, when I was invited to review Enduring Contributions of Henry K. Beecher to Medicine, Science, and Society , edited by Lowenstein and McPeek. Suffice it to say that my appreciation for Beecher's life and work has changed drastically.
This book is a well-organized compilation of Dr. Beecher's papers and archival and intimate biographical materials. His original papers, including 1966's Ethics and Clinical Research are accompanied by excellent commentaries that elaborate on the controversial work of Dr. Beecher and its relevance to the practice of modern medicine. This organization allows the reader to experience Dr. Beecher in his own words, to assess his ideas, and then engage in a discussion of these ideas through the commentaries.
Besides his crusade for informed consent and reform in human medical research, Dr. Beecher's diverse volume of work also includes studies of pain and its perception, anesthesia-related mortality, the placebo effect, bias in clinical research, and even hallucinogens for use by the military. The most enduring of his “Enduring Contributions” is, in fact, the paper Ethics and Clinical Research mentioned previously. Having been cited over 500 times in medical literature alone, this exposé of over 20 examples of unethical research in poorly informed or uninformed human subjects sent shockwaves through the medical research community. Considering the specific studies Dr. Beecher cited, it is especially chilling that he asserted that “such breaches of ethical conduct in experimentation are by no means rare but are almost… universal.”1This paper is credited with spurring the National Institutes of Health to empower local institutional review boards to critique all human research proposals. The most fascinating paradox is that Dr. Beecher himself was fully established in the medical research community whose corruption he condemned. His firm belief was that the end never justified the means if a single patient could possibly be harmed. To his fellow researchers, however, he was ultimately faithful; he never exposed by name any of the individuals whose actions he used to kindle a firestorm.
This selection will be enjoyed by enthusiasts of anesthesia and medical history alike, because Dr. Henry K. Beecher transcended anesthesiology. He was one of a rare number of clinicians who first excelled in their specialty and then rose through research to affect the practice of medicine globally.
University of Alabama School of Medicine, Birmingham, Alabama. firstname.lastname@example.org