1. Decades Later, Condemnation for a Skid Row Cancer Study GINA KOLATA October 17, 2013 http://www.nytimes.com/2013/10/18/health/medical-experiments-conducted-on-bowery-alcoholics- in-1950s.html?ref=health&target=comments&_r=0&#commentsContainer

2. Skid row alcoholics A medical researcher from Columbia University, Dr. Perry Hudson, made the skid row alcoholics in Lower Manhattan an offer: If they agreed to surgical biopsies of their prostates, they would get a clean bed and three square meals for a few days, plus free medical care and treatment if they had prostate cancer. It was the 1950s, and Dr. Hudson was trying to prove that prostate cancer could be caught early and cured. But he did not warn the men he was recruiting that the biopsies to search for cancer could cause impotence and rectal tears. Or that the treatment should cancer be found — surgery to remove their prostates and, often, their testicles — had not been proven to prolong life. But he said in a recent telephone interview that he believed the treatments did prolong life. “I told them the cure rate is extremely high,” he said.

3. Were these studies ethical? As more than 1,200 men living in flophouses on the Bowery signed up for Dr. Hudson’s study in the 1950s and ‘60s, neither his academic peers nor the federal officials overseeing his grants criticized his ethics, but times have changed. Two papers published on Thursday in the American Journal of Public Health and the Bulletin of the History of Medicine prompted medical historians to denounce this largely forgotten chapter in the history of government- financed medical research on vulnerable populations.American Journal of Public HealthBulletin of the History of Medicine They said the Bowery study was unethical, because of both the powerlessness of the people who participated in it and the things done to them.

4. Aronowitz charges Dr. Robert Aronowitz, an internist and medical historian at the University of Pennsylvania who wrote the new papers, stumbled upon the Bowery study — which was led by Dr. Hudson, a urologist trained at Johns Hopkins, and paid for by the National Institutes of Health, among others — and was so troubled by it that he became consumed with documenting what had happened. “Hudson used Bowery men because only desperate, poor, and unknowing men would participate,” Dr. Aronowitz wrote. “It was unimaginable that the average American man would volunteer.”

5. Hudson’s response Dr. Hudson himself makes no apologies for recruiting impoverished alcoholics. Now 96 and living in South Pasadena, Fla., he said in recent interviews that the men volunteered, they were not paid and they got “the best care in New York.” Doctors in private practice would never have allowed their patients to get biopsies since they assumed the disease was fatal, he said. Dr. Hudson was 33 and had just taken a position as head of urology at the Francis Delafield Hospital, a public cancer hospital in New York, when he and his colleagues began recruiting homeless men in 1951. He got the idea of going to the Bowery when he was caring for a man who had been a Princeton history professor but ended up a homeless alcoholic living there.

6. Not a good design Though the Bowery study had a laudable goal — to prove that prostate cancer could be caught early and cured — it yielded little credible data. Dr. Hudson did not set up a control group of Bowery men who did not get the biopsies and treatment. As a result, he had no way of comparing the men who got the interventions with those who did not or of documenting whether the men he treated lived longer.

7. The Economics We get to standard MB = MC analysis. Also, many in the field view efficacy ONLY in the sense of living longer. They don’t look at quality of life, although that’s really not relevant here. $ Quantity MBMC 0

8. Human subjects / Institutional review WSU Institutional Review Board at http://irb.wayne.edu/. http://irb.wayne.edu/ Let’s look at it.