Science: UNDER THE MICROSCOPE: Full exposure

IS SELF-EXPERIMENTATION WISE?

EXPERIMENTS on humans that could lead to an improvement in medical care have a long tradition. An enormous amount of effort is devoted by ethics committees to see that patients rights are not being abused and that there is "informed consent". But Lawrence Altmann, a science writer on the New York Times, has asked a key question that is seldom put: Who goes first - the doctor, the scientist, or the patient? (Incidentally Altmann is just one of some 15 science and medicine reporters on the New York Times, providing them with the possibility to explore issues in a depth which few UK science journalists could have time to reach.)

Self-experimentation can provide an invaluable bond between experimenter and patient whose co-operation for further experiments is required. Sir Douglas Black, the inventor of beta-blockers and other major drugs, told Altmann: "It's much easier to get the volunteers' co-operation for a study if you sit by the bedside and say that you have done the same experiment on yourself, and are none the worse for it. And if you do do it on yourself first, it gives you a wonderful chance to iron out any bugs. Examples of paragons in this respect are the Nobel Laureate Werner Forssman who put a catheter into his own heart while developing the technique, and the Australian doctor Barry Marshall who showed that ulcers are caused by particular bacteria and swallowed some himself to show that it was true.

A less moral tale surrounds the discovery that mosquitoes transmit yellow fever. The standard story, often told to medical students, is that Walter Reed paid the ultimate price for his altruism by dying from yellow fever as he allowed himself to be the subject of the experiment. According to Altmann though, Reed pledged to experiment on himself along with three other members of his team, but did not do so. His colleagues did and found the link between mosquitoes and yellow fever. Reed died a few years later, from appendicitis.

One of the earliest, if not the earliest to experiment upon himself, was the Italian scientist Santorio of Padua. At the end of the 16th century, Santorio studied how his own body responded to the amounts of food and drink he took by measuring all that went in and all that went out and in doing so discovered insensible perspiration. All this was a completely safe procedure, but no less important or original.

British scientists J Scott Haldane and his legendary son the geneticist and polymath J B S Haldane, were also distinguished for self- experimentation. Both worked on the effect of various gases on humans. The father was interested in making coal mining safer and so went down pits. At his laboratory in his Oxford home he also experimented on the effect of high oxygen concentrations and showed that exposure to it caused a confusing euphoria. In these experiments he was helped by his son who was similarly exposed and who later went on to investigate, on himself, the effect of high pressures in relation to understanding a submarine disaster.

The moral dilemmas of self-experimentation are complex. Consider first cancer and chemotherapy. Chemotherapy has in many cases very unpleasant side effects even though it can save lives. Is it reasonable to ask doctors, free of the disease, who are trying to develop new therapies to try it out on themselves first? Again there must be a problem for those trying to find a vaccine for Aids. Is it really ethical to ask such scientists to try it out? I am glad that I am not faced with such a moral dilemma.