Subjects or objects? Prisoners and human experimentation.

D the 1950s, inmates at what was then called Holmesburg Prison, in Philadelphia, were inoculated with condyloma acuminatum, cutaneous moniliasis, and viruses causing warts, herpes simplex, and herpes zoster.1 For participating in this research, and in studies exposing them to dioxin and agents of chemical warfare, they were paid up to $1,500 a month. Between 1963 and 1971, researchers in Oregon and Washington irradiated and repeatedly took biopsy specimens from the testicles of healthy prisoners; the men subsequently reported rashes, peeling, and blisters on the scrotum as well as sexual difficulties.2 Hundreds of such experiments induced the federal government to essentially ban research involving prisoners in 1978. The message: such research is fundamentally exploitative and thus unethical. Yet a recent report by the Institute of Medicine (IOM) has opened the closed door, arguing not only that such research can be performed appropriately but that prisoners deserve to be included in investigative studies — at least those who might benefit directly. Examination of the explanations behind U.S. restrictions on prison research and their current applicability can provide guidance for today’s policy debates. The vulnerability of prisoners to exploitation has long been known. As early as 1906, for instance, critics noted how difficult it would have been for prisoners to refuse to participate in a cholera experiment that ultimately killed 13 men.3 Still, investigators periodically sought out “volunteers” among such captive populations, whose institutionalization offered researchers accessible subjects unlikely to be lost to follow-up. Most such research did not seek to benefit participants. In 1915, for example, Public Health Service researcher Joseph Goldberger induced pellagra in healthy Mississippi prisoners, who were offered