Self-experimentation in medicine
Self-experimentation refers to scientific experimentation in which the experimenter conducts the experiment on themself. Often this means that the designer, operator, subject, analyst, and user or reporter of the experiment are all the same. Self-experimentation has a long and well-documented history in medicine which continues to the present. Some of these experiments have been very valuable and shed new and often unexpected insights into different areas of medicine.
There are many motivations for self-experiment. These include the wish to get results quickly and avoid the need for a formal organisational structure, to take the ethical stance of taking the same risk as volunteers, or just a desire to do good for humanity. Other ethical issues include whether a researcher should self-experiment because another volunteer would not get the same benefit as the researcher will get, and the question of whether informed consent of a volunteer can truly be given by those outside a research program.
A number of distinguished scientists have undertaken self-experimentation, including at least five Nobel laureates; in several cases, the prize was awarded for findings the self-experimentation made possible. Many experiments were dangerous; various people exposed themselves to pathogenic, toxic or radioactive materials. Some self-experimenters, like
Definition
There is no formal definition of what constitutes self-experimentation. A strict definition might limit it to cases where there is a single-subject experiment and the experimenter performs the procedure on himself. A looser definition might include cases where the experimenters put themselves amongst the volunteers for the experiment. According to S. C. Gandevia of the University of New South Wales, who was looking at the question from the perspective of ethics, it is only self-experiment if the would-be self-experimenter would be named as an author on any subsequent published paper. That is, the person who would receive the academic credit for the experiment must also be the subject of it.[1]: 44
Motivations
There are many reasons experimenters decide to self-test, but amongst the most fundamental is the ethical principle that the experimenter should not subject the participants in the experiment to any procedure they would not be willing to undertake themselves. This idea was first codified in the
Critics of self-experimenters point to other less savoury motivations such as simple self-aggrandisement.[3]: xiii Some scientists have resorted to self-experiment to avoid the "red tape" of seeking permission from the relevant ethics committee of their institution. Werner Forssmann was so determined to proceed with his self-experiment that he continued with it even after permission had been denied. He was twice dismissed for this activity, but the importance of his work was eventually recognised in a Nobel Prize. Some researchers, apparently, even believe that self-experimentation is not permitted. However, this is not true, at least in the United States where the same rules apply regardless of who the subject of the experiment is.[3]: xv, xx
Self-experimentation is also criticised for the risk of over-enthusiastic researchers, eager to prove a point, not accurately noting the results. Against this it is argued by those supporting self-experiment that medically trained persons are in a better position to understand and record symptoms, and self-experiment is usually at the very early stage of a program before volunteers have been recruited.[3]: xiv
A wish to commit suicide is sometimes offered as a reason for self-experimentation. However, Lawrence K. Altman, author of Who Goes First?: The Story of Self-experimentation in Medicine, while acknowledging that this may sometimes occur, after extensive research could find only one verified case of attempted suicide by self-experimentation. This was Nobel Prize winner Élie Metchnikoff, who, in 1881, suffering from depression, injected himself with relapsing fever. This was his second suicide attempt, but according to his wife, Olga, he chose this method of death so that it would be of benefit to medicine. However, Metchnikoff survived and in 1892 also self-experimented with cholera, but this is not thought to have been a suicide attempt.[3]: 311–312
Perhaps the noblest motivation is the simple altruistic desire to do something of benefit to humanity regardless of the risks. There most certainly are risks, as
Even if I had deceived myself and the experiment endangered my life, I would have looked Death quietly in the eye for mine would have been no foolish or cowardly suicide; I would have died in the service of science like a soldier on the field of honor.[3]
According to Ian Kerridge, professor of bioethics at the University of Sydney, the most common reason for undertaking self-experimentation is not so much anything noble, but rather "an insatiable scientific curiosity and a need to participate closely in their own research".[4]
Ethics
As already mentioned, it is an ethical principle that the researcher should not inflict on volunteers anything that the researcher would not be willing to do to him- or herself, but the researcher is not always a suitable, or even possible, subject for the experiment. For instance, the researcher may be the wrong gender if the research is into hormone treatment for women, or may be too old, or too young. The ethical question for the researchers is would they agree to the experiment if they were in the same position as the volunteers?[3]: 311
Another issue that can lead researchers not to take part is whether the researcher would stand to gain any benefit from taking part in the experiment. It is an ethical principle that volunteers must stand to gain some benefit from the research, even if that is only a remote future possibility of treatment being found for a disease that they only have a small chance of contracting. Tests on experimental drugs are sometimes conducted on sufferers of an untreatable condition. If the researcher does not have that condition then there can be no possible benefit to them personally. For instance, Ronald C. Desrosiers in responding to why he did not test an
The ethics of
Some researchers believe that experimental research is too complex for the general public ever to be able to give proper informed consent. One such researcher is Eugene G. Laforet, who believes that the researchers taking part in the experiment themselves is more valuable to the volunteers than a legal consent form. Another is 1977 Nobel Prize winner
The question of who should be first to try the procedure in a new experiment is an ethical one. However, according to Altman it is not a question that can successfully be legislated. A law requiring self-test would force researchers to take risks that may sometimes be inappropriate. A code forbidding it might inhibit valuable discoveries.[3]: 314
Self-experimentation has a role in medical education. Although no longer encouraged, in former times it was perfectly standard to expect medical students to try for themselves the drugs they were going to be prescribing. Charles-Édouard Brown-Séquard, whose own self-experiments led him to the concept of what are now called hormones, was a nineteenth century proponent of the practice:[3]: 314–315
I will suggest that you should study upon yourselves the effects of the most valuable remedies. I well believe that you will never know fully the action of certain remedies, if you have not ascertained, on your own person, what effects they produce on the brain, the eye, the ear, the nerves, the muscles, and the principal viscera.[5]
— Charles-Édouard Brown-Séquard
Value
Self-experimentation has value in rapidly obtaining the first results. In some cases, such as with Forssmann's experiments done in defiance of official permission, results may be obtained that would never otherwise have come to light. However, self-experiment lacks the statistical validity of a larger experiment. It is not possible to generalise from an experiment on a single person. For instance, a single successful blood transfusion does not indicate, as we now know from the work of
Such concerns do not apply so much if the self-experimenter is just one of many volunteers (as long as the self-experimenter is not also responsible for recording the results) but his or her presence still has value. As noted above, this can reassure the other participants. It also acts as a check on the experimenter when considering whether the experiment is ethical or dangerous.[3]: 314 [4]: 206
Notable examples
Anaesthesia
Dentist Horace Wells made multiple experiments with nitrous oxide, diethyl ether, and chloroform while trying to determine their uses as anaesthetics. The first, conducted in 1844, consisted of having his assistant John Riggs dose him with nitrous oxide and then extract one of his teeth.[6] His later self-experimentation of ether and chloroform took place in 1848, and he eventually became addicted to chloroform due to excessive use.[7] He inhaled chloroform as an anaesthetic shortly before committing suicide on January 24, 1848.[8]
Asthma
Blood
ABO blood group system
Dr. Karl Landsteiner's discovery of the ABO blood group system in 1900 was based on an analysis of blood samples from six members of his laboratory staff, including himself.[3]: 34–37
Thrombocytopenia
In the
Cancer
In 1901, Nicholas Senn investigated whether cancer was contagious. He surgically inserted under his skin a piece of cancerous lymph node from a patient with cancer of the lip. After two weeks, the transplant started to fade and Senn concluded that cancer is not contagious.[3]: 287 [12]: 203
Much earlier, in 1808,
Infectious diseases and vaccines
COVID-19
In February 2020, Huang Jinhai, an immunologist at Tianjin University, claimed that he had taken four doses of a COVID-19 vaccine developed in his lab even before it had been tested in animals.[13]
In March 2020, the Rapid Deployment Vaccine Collaborative (also known as RaDVaC) developed, produced, and published technical specifications for a modular, intranasal COVID-19 vaccine. Numerous scientists working directly and indirectly on the group's vaccine development also began self-experimentation using the project's multiple vaccine candidates.[14][15][16][17]
In March 2020, Hans-Georg Rammensee, professor of immunology at University of Tübingen and co-founder of CureVac began testing a COVID-19 vaccine on himself.[18][19]
In May 2020, Alexander Gintsburg, director of the Gamaleya Research Institute of Epidemiology and Microbiology announced that several vaccine specialists had begun self-experimentation with the Sputnik V COVID-19 vaccine.[20]
AIDS vaccine
Daniel Zagury, in 1986, was the first to test his proposed AIDS vaccine.[3]: 26 [21][22]
Bartonellosis
Cholera
Dysentery
S.O. Levinson with H.J. Shaugnessy – and others between 1942 and 1947 – injected themselves with a vaccine against dysentery. The vaccine had previously been tested on mice, which had all died within minutes, and the effect on humans was completely unknown. The experimenters survived but suffered strong side effects.[12]: 139
Gastritis and peptic ulcers
Helicobacter pylori
In 1984 a Western Australian scientist, Dr
Marshall's experiment debunked the long-held belief of the medical profession that
Campylobacter jejuni
Marshall's investigation was preceded by David A. Robinson who, in 1980, ingested Campylobacter jejuni, a bacterium found in cow's milk, to investigate whether gastritis could be caused by drinking milk infected with C. jejuni. Robinson became sick as a result. Robinson needed to do a human experiment because the alternative, testing on cows, was not viable as infected cows frequently do not become ill.[3]: 33
Malaria
Tu YouYou and two colleagues tested qinghaosu on themselves before offering the treatment to patients.[25][26]
Staphylococcus
Syphilis
Constantin Levaditi (1874–1953) injected himself with spirochaete from rabbits suffering from syphilis but did not contract the disease himself.[12]: 138–139
Yellow fever
In Cuba, U.S. Army doctors from Walter Reed's research team infected themselves with yellow fever including James Carroll, Aristides Agramonte, and, most notably, Jesse Lazear, who died from yellow fever complications in 1900. These efforts ultimately resulted in proof of the mosquito-borne nature of yellow fever transmission and saved countless lives. Stubbins Ffirth had investigated the contagious nature of the disease at the end of the 18th century.[12]: 137
There was an unsuccessful campaign to award a Nobel Prize to Reed's team. Lazear, in any event, could not be awarded the prize because it is never given posthumously. However, a Nobel Prize was awarded to a later yellow fever researcher and self-experimenter, Max Theiler who, in 1951, developed the first yellow fever vaccine and was the first to try it.[12]: 156–157
Trachoma
Anatolii Al'bertovich Shatkin, in 1961, injected
Schistosomiasis
In July 1944, physician researcher Claude Barlow ingested over 200
Non-infectious diseases
Anaemia
Hyperthyroidism
Scurvy
In London in June 1769, William Stark aimed to find the cause of scurvy with a series of dietary experiments on himself. He devised a series of 24 dietary experiments and kept accurate measures of temperature and weather conditions, the weights of all food and water he consumed, and the weight of all daily excretions. He started with a basic diet of bread and water and became 'dull and listless'. When he recovered, he resumed experimenting by adding various foods, one at a time - olive oil, milk, roast goose, and others. After two months, he had symptoms of scurvy. By November 1769 he was living on nothing but honey puddings and Cheshire cheese. He considered testing fresh fruits and vegetables when he died in February 1770.[31][32]
Drugs
Cocaine
In 1936, Edwin Katskee took a very large dose of cocaine. He attempted to write notes on his office wall, but these became increasingly illegible as the experiment proceeded. Katskee was found dead the next morning.[33]: 313–325
Disulfiram
In 1945, during the
Furan
Chauncey D. Leake, in 1930, took furan as a possible substitute for aspirin but it just gave him a splitting headache and painful urination that lasted three days.[12]: 137–138
Grapefruit juice
David G. Bailey, in 1989, was researching the effects of drinking alcohol while taking the then experimental drug felodipine. It was usual in this kind of research to mix the alcohol with orange juice but Bailey did not like the taste of this drink so used grapefruit juice instead. Bailey found that there was three times more felodipine in his, and fellow researchers', blood than had been reported by other scientists using orange juice. It was later found that grapefruit juice suppresses an enzyme responsible for breaking down a large number of different drugs.[3]: x–xi [36]
Ibuprofen
As part of the team who developed ibuprofen in the 1960s, Stewart Adams initially tested it on a hangover.[citation needed]
Psychoactive drugs
Friedrich Sertürner isolated morphine from opium in 1804. Morphine was the first-ever alkaloid isolated from any plant. Sertürner wanted to prove his findings to his colleague with a public experiment on himself and three other friends.[37]
Psychopharmacologist Arthur Heffter isolated mescaline from the peyote cactus in 1897 and conducted experiments on its effects by comparing the effects of peyote and mescaline on himself.[38]
Albert Hofmann discovered the psychedelic properties of LSD in 1943 by accidentally absorbing it and later intentionally ingesting it to verify that the effects were caused by LSD. He was also the first to isolate psilocybin from psilocybin mushrooms and self-experimented with it to prove it to be the active principle of psilocybin mushroom's psychoactive effects.
Timothy Leary took LSD and was a well-known proponent of the social use of the drug in the 1960s.[12]: 138
Alexander Shulgin synthesized and self-experimented with a variety of psychoactive drugs, notably MDMA.[39] He developed a system known as the Shulgin Rating Scale for his research group to use during the self-experimentation of psychedelics.[40]
Gases
Hydrogen
Around 1886,
Reports that Senn used helium in this experiment[12]: 203 are almost certainly erroneous. Helium was first detected on Earth in 1882,[43] but not isolated until 1895,[44] and extractable reserves not found until 1903.[45]
Synthetic gases
Humphry Davy self-experimented with breathing of several different gases, most notably nitrous oxide.[citation needed]
Genes
Self-experimentation with gene therapies have been reported.[46][47][48][49][50] Every gene therapy has a unique risk of harm, including the risk associated with the gene delivery method (i.e., the particular viral vector or form of transfection) that is used and the risk associated with a specific genetic modification.[medical citation needed] Examples of potential risks for some gene therapies include tissue damage and an immune response to foreign DNA,[49] among many others.
Pain
In 1983, entomologist Justin O. Schmidt released a paper detailing what he called the Schmidt sting pain index based on his own personal reactions to the stings of various insects of the Hymenoptera order, rating them on a range from 0 to 4.[51] His 1990 revised paper covered 78 such species.[52]
Physical experiments
Hanging
In the early 1900s Nicolae Minovici, a professor of forensic science in Bucharest, undertook a series of experiments into hanging. At first he put the noose around his neck while lying down and had an assistant put tension on the rope. He then moved on to full suspension by the neck. Finally, he attempted suspension with a slipping hangman's knot, but the pain was too great for him to continue. He could not swallow for a month. Minovici was determined to surpass a record set by Dr. Fleichmann of Erlangen, who in 1832, self-asphyxiated for two minutes.[53] However, Minovici could not get close to this and disbelieved Fleichmann.[33]: 318–320
Minovici and Fleichmann are not the only ones to self-experiment with strangulation. Graeme Hammond, a doctor in New York, tried it in 1882. Francis Bacon described an even earlier occasion in 1623 when the self-experimenter stepped off a stool with a rope around his neck, but was unable to regain his footing on the stool without assistance.[33]: 316–317
Rapid acceleration
These tests were carried out for the
Weight balance
Poisons
Black widow spider venom
Hydrogen cyanide
- For other self-experiments by Barcroft, see § Temperature and pressure
Snake venom
Tim Friede created his own
Tetrachloroethylene and carbon tetrachloride
In 1921, Maurice Crowther Hall ingested carbon tetrachloride to test its safety with a view to its possible use as a treatment for hookworm. Hall reported mild side effects. Carbon tetrachloride has since been found to cause acute liver failure.[62] In 1925, Hall ingested tetrachloroethylene (the most common dry cleaning fluid) for the same purpose.[12]: 102
Radioactive materials and isotopes
Gary Earl Leinbach, in 1972, swallowed
Kenneth Gordon Scott, in 1949, inhaled aerosols of plutonium and uranium.[12]: 203
Heavy water
In 1935, pharmacologist Klaus Hansen drank heavy water to determine its effects on living beings. After his first dose yielded no ill effects, he began taking increasing doses on a daily basis. A follow-up report released a year later confirmed that he was in good health, and he lived to the age of 75.[63] [64]
Surgical and psychological procedures
Cardiac catheterization
Clinical application of
Self-surgery
There have been several cases of surgeons operating on themselves, but most often it has been in the nature of an emergency rather than experiment. Such a case was
Sensory deprivation
John C. Lilly developed the first sensory deprivation tanks and self-experimented them with the intention to study the origin of consciousness and its relation to the brain by creating an environment which isolates an individual from external stimulation.[citation needed]
Temperature and pressure
In 1931, Barcroft subjected himself to freezing temperatures while naked. Towards the end of the experiment he showed signs of the final stages of hypothermia. He was thought to be close to death and had to be rescued by colleagues.[33]: 321–322
Neural implant
Kevin Warwick had an array of 100 electrodes fired into the median nerve fibres of his left arm. With this in place, over a 3-month period, he conducted a number of experiments linking his nervous system with the internet.[73]
Neural adaption to immobilization
Nico Dosenbach wore a pink cast over his (unbroken) right arm for two weeks in order to examine how brain circuits controlling movement are impacted by immobilizing illnesses or injuries. He did a 30-minute resting state fMRI study daily and identified an undiscovered pattern of pulses of rs-fMRI signal in motor regions controlling the disused anatomy.[74][75]
See also
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Further reading
- ISBN 978-0765807151.
- PMID 20580874.
- Dagi, T. Forcht; Dagi, Linda Rabinowitz (1988). "Physicians Experimenting on Themselves: Some Ethical and Philosophical Considerations". In Spicker, S. F.; Alon, I.; de Vries, A.; Engelhardt, Jr, H. Tristram (eds.). The Use of Human Beings in Research: With Special Reference to Clinical Trials. Springer Science+Business Media. pp. 249–260. ISBN 9789400927056.