The Global Trade in Health
and Disease
HI176
Week 22
Nazis, Nuremberg & medical ethics
• Ravensbrueck Experiments on Sulfanilamide &
Other Drugs: no benefit to the experimental subject
• Ravensbrueck Experiments on Bone, Muscle, and
Nerve Regeneration and Bone Transplantation: no
benefit to the experimental subject
• Nuremberg Code sets out principle that
experimental subject must benefit at least as much
as ‘society’ from any experimental risks
AND
• That subjects must give fully informed consent to
the entire experiment
So what about the egg, womb
and organ trades, then?
The body as commodity:
is this new?
Body as medicinal substance
“The English Druggists, especially
those of London, sell the Heads or
Skulls of the Dead upon which
there is a little greenish Moss…”
Charas, Pharmacopée Royale
Galénique et Chymique 1676,
quoted in Pomet, A Compleat
History of Druggs 1725
‘Having been one summer
frequently subject to bleed at the
nose, and reduced to employ
several remedies to check that
disorder; that which I found most
effectual to staunch the blood was
some moss off of a dead man’s
skull….’ Robert Boyle, 1644
Portrait of John Tradescant (1608-1662)
gardener and proponent of corpse
medicines
Body as medicinal substance
“In Wilts., between Kinnett and
Overton … I approach’d workmen
digging … ‘making new boundaries
to enclose for French grasse or 5
foile’. Said the men, ‘we throw up
many bones here…; I quickly
perceiv’d they were humane, and
came the next day and dugg for
them and stored myself with many
bushells, of which I made a noble
medicine that relieved many of my
distressed neighbours.”
Letter, Dr. Toope to Mr. Aubrey, 1685, quoted
in William Long, ‘Abury Illustrated’ Wiltshire
Achaeological and Natural History Magazine
iv (1858), p.21 (Now known as West Kennet
Long Barrow)
‘Homo Man is not only the
Subject of Medicine, but
Contributes with his Body to the
Materia Medica. Officinal Simples
furnish’d from the Parts of the
human Body whilst alive are the
Hairs, Nails, Saliva, Ear Wax,
Sweat, Milk, Menses, Secundines,
Urine, Dung, Semen, Blood, the
Stones of the Bladder, … and the
Mebrane which covers the Head
of the Foetus.’
Robert James, Pharmacopoeia
Universalis, 1747
Selling and Owning (Living) Bodies: Slavery
'Inventory of Negroes, Cattle, Horses, etc on the
estate of Sir James Lowther Bart in Barbados taken
this 31st day of December 1766'
Congolese Slaves 1904
Selling and Owning (Living) Bodies:
‘Coverture’
• Feature of Anglo-American Law until mid-to late 19th century
(upheld by US Supreme Court as late as 1873), granting
fathers and husbands the right to control a woman’s property,
body, actions and labour. Only widows and unmarried adult
women could control their own possessions and actions.
Aspects of coverture continued even as late as 1972, when
US Supreme Court upheld state laws insisting that women
use their husbands’ names on their drivers’ licenses, held
their contracts not to be legally binding, etc.
• Based in Common Law, conceptions of coverture were
spelled out formally by Wm. Blackstone, : ‘By marriage, the
husband and wife are one person in law: that is, the very
being or legal existence of the woman is suspended during
the marriage, or at least is incorporated and consolidated into
that of the husband: under whose wing, protection, and cover,
she performs every thing…’
See also http://www.time.com/time/magazine/article/0,9171,942533,00.html
But also…
The body as
professional
medicine’s
raw material
Body as medical
raw material
Up the close and down the stair,
In the house with Burke and Hare.
Burke’s the butcher, Hare’s the thief
Knox, the man who buys the beef.
Children's Song
Burke’s Notebook (discovered 1829)?
This list was printed in an article by
FORBES and Co.Printers,
171,Cowgate
I. Sept.1826.--Went to lodge with
Hare, Tanner's Close, and assisted
with the cuddy.
Christmas 1827.—Sold the body of
Donald the pensioner, in Surgeon
Square, for L.7,10.
Paid William Hare, Tanner's Close,
L4,5.
For myself, L.3,5.
…
May 7 —Sold the old woman, who
came to lodge in Tanner's Close, and
the child, for £12.
Paid for drink, porterage, &c. 7s. Paid
William Hare L.5.
For myself L6, 13 .
…
Oct 5.-Sold the girl Paterson for LI0,
which was all paid to Harel, he being
hard up.
3I- Sold James wilson, or draft Jamie
for L15.
For myself L7, 10s
Body as medical raw
material …
Body as
medical raw
material
The Immortal Henrietta Lacks
Henrietta Lacks entered Johns Hopkins
Hospital with a vaginal discharge
February 1951. She was diagnosed
with cervical cancer, and despite the
best treatments then available, she died
in October the same year.
Her body lives on, in the form of the
best known, most widely used, and
most profitable cell line in medical
history, HeLA.
First used to develop Salk’s polio
vaccine in 1954, He La cells are now
the fundamental substrate for medical
research into cancer, AIDS, chemical
sensitivity, and a host of other problems.
The Lacks family were not informed, did
not consent, and have received none of
the profits made by ‘manufacturers’ of
the HeLA line.
As marketable bioproduct…
As ‘gift’
As entailing a social/ethical
responsibility…
Or as an entertainment?
And of course, the organ
trade… is health for sale?
Transplants and the commodification of
the body: medical timeline
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1902 Organ transplant proven possible by successful surgical joining of blood
vessels
1905 First corneal transplant
1918 Success of blood transfusions (facilitated by blood-tying and anticoagulants) during WWI makes this an everyday aspect of complex surgery
1920s fad for testicular transplants raises first expressions of concern about sale
of tissues.
1954 twin makes living donation of kidney to his brother (US; 1st UK 1960)
1962 First cadaver donor kidney transplant (immunosuppresive drugs)
1963 first lung, liver transplants
1967 first heart transplant
1968 National Tissue Typing and Reference Lab established in UK
1968 Harvard Med School publishes influential definition of ‘irreversible coma’
1968 US Uniform Anatomical Gift Act passed, making it legal to donate deceased
person’s organs/tissues for transplantation
1971 Organ Donor cards introduced for kidneys in UK
1972 Organ Matching Service established in UK
Medical timeline, cont.
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1979 UK transplant service established
1981 Presidential Commission in US adopts ‘whole brain’ inactivity as criteria for
‘brain death’ and Uniform Definition of Death Act
1981 UK kidney donor cards replaced with cards allowing donations of additional
tissues
1983 FDA approves Cyclosporin, anti-rejection drug
1984 National Organ Transplant Act, USA forbids sale of living tissues, organs
1986 United Network for Organ Sharing established in USA to ensure equitable
distribution of donated organs, set standards for transplant centres
1986 Bristol Eye Bank established (followed by Manchester, etc)
1987 Medicare US begins to pay for heart transplants
1990 Medicare US begins to pay for liver transplants (except in cases of liver
cancer)
1993 FDA regulates all tissue banks
1994 UK established national register for organ and tissue donation
1994 National Coalition on Donation partners with National Ad Council to develop
pro-donation ad campaign
1996 US Congress legislates to allow information on organ donor cards to be
included with US tax return materials
2005 UK transplant merges with NHS Blood Service
2007 First ‘stranger’ or ‘altruistic’ living donor donation allowed in UK
Imagining the Organ Trade…
Living with the Organ Trade