From the late 1940s to the mid-1970s, inmates at Philadelphia's Holmesburg Prison and other correctional facilities across the country were treated as human guinea pigs in gruesome medical experiments. The prisoners were "volunteers" who received a few hundred dollars a month but weren't told they had signed up to be exposed to chemical warfare agents and radioactive, hallucinogenic and cancer-causing chemicals.
When this unconscionable exploitation was revealed, Congress passed a law in 1978 that limited testing on inmates to research involving only the most minimal risk.
Now the Institute of Medicine (IOM), a federal panel of medical advisers, wants the government to permit greater research with prisoners but under a tough new oversight regime that would prevent the abuses of the past and limit experiments to those that have a direct potential benefit to prisoners.
Why reopen such a delicate debate?
Because the current rules arbitrarily exclude prisoners from research that could be critical to improving their health and living conditions. Because such research could help control HIV, hepatitis C, tuberculosis, mental illness and substance abuse that are rampant in correctional centers. And because 95% of prisoners are eventually released, society as a whole would also benefit.
The IOM recommendations, which offer a safe and ethical framework, would:
• Set uniform guidelines for all research involving prisoners, regardless of its source of funding. The current restrictions apply only to a few federally funded programs, leaving much research largely unregulated.
• Urge Congress to mandate tough oversight at all federal, state and county facilities, and to expand protections to cover people on parole or probation.
• Limit prisoner research to only those studies where potential benefits to prisoners clearly outweigh risks and are in the least dangerous phases of clinical trials.
• Establish rigorous independent review of all research and a special prisoner advocate to make sure the studies are appropriate, inmates are fully informed of risks, and there is no coercion or undue inducement in getting them to give consent.
• Create a national database to track research involving prisoners. It's impossible now to know how many are involved in studies because no such database exists.
Many of these recommendations can be implemented by federal regulators; others require congressional approval. Given the sordid history of prison research, expansion of testing raises obvious and serious worries. Prison experiments are conducted in an inherently coercive environment with prisoners as a convenient source of subjects.
Even so, any research involves the balancing of risks and benefits. It's a mistake to so severely exclude this population from studies that could improve the quality of prisoners' lives and conditions unique to prisons. With stronger oversight, human dignity and medical progress needn't be incompatible.
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