Skid Row Cancer Study
The Skid Row Cancer Study was a
At the beginning of the experiment, Hudson and his colleague selected 141 patients having symptoms and signs for urinary obstruction. However, as the experiment progressed, patients were selected randomly.
Background
Before securing a lead research position at
Consequences
The ultimate goal of Hudson's research included finding a viable way to use open perineal biopsy (OPB) to diagnose prostate cancer at an early stage. He wanted to see the biological history of the disease and prove that the best way to treat it was to attack any signs of the cancer before it became a serious issue.[2] However, the Bowery Series lacked a control group of patients who were not biopsied, so he was unable to compare data with his experimentation group.[6] He lacked any proof or evidence that the people treated were able to live longer, and were actually subjected to further health risks. Thus, the Bowery Series yielded little effective data, and the patients suffered from side effects of the OPB. Although he was unable to accomplish his goals, Hudson set the precedent for future studies in a push for the screen-and-treat movement. Before the Bowery Series, prostate cancer could only be detected at its latest stages when it was already too late to save the patient's life. However, recent advancements have enabled medical professionals to diagnose the cancer in earlier stages.[7]
Over the course of a decade starting in 1951, Hudson recruited over 1200 subjects from the Bowery flophouses in the "Skid Row" of New York.[2] Many of the recruits were 'down and out' men who suffered from alcoholism and mental illness. To motivate enrollment into the study food, bedding, and medical care were offered but the risks involved with the open perineal biopsy procedures were not fully explained to the patients, and many of them suffered long term health consequences. Hudson claimed that the procedure, involving excising a 2.5x1x.5 cm core of posterior prostate[3] caused no harm,[2] however an independent research team proved otherwise, reporting post-op incidence of impotence, rectal laceration, and a diminishing sexual function in 24 patients.[8] The assertion that the biopsies caused no harm was again refuted in an interview by one of his residents who claimed that impotence was a common result.[2] The results of the study were published periodically as case series. In the preliminary case series, the symptoms of a 100-person cohort that tested positive for cancer was described. Hudson implemented radical treatments to this cohort that were ambitiously beyond the standard of care with little scientific backing of efficacy. In addition to the surgical castration of these 100 men, he treated them with estrogen hormone therapy, which was later proven to be ineffective and detrimental. The hormone therapy put the patients at risk for heart disease and stroke and caused a loss in muscle tone and overall stamina.[2] In a summarizing study, Hudson reported that out of 686 patients tested, the mortality rate for men with negative biopsies was 20% and the mortality rate for men with positive biopsies followed by rigorous treatment was 30%. Hudson did not publish results for a control group or a group with biopsies done without hormone treatment so the value of these results are unclear.
Ethics
The ethical integrity of the tactics that Hudson used to recruit volunteers for his experiment has been questioned. Some of his methods exploited the fact that his volunteers were mostly homeless men. For example, Hudson would offer his volunteers compensation in the form of meal tickets and temporary shelter in a hospital room. Then, in order to ensure participation, authorities would only present the meal ticket to a volunteer once he showed up for the study.[9] Because they were homeless, the volunteers saw these rewards as very attractive.[2] Additionally, their lack of education made it more likely for the Bowery men to volunteer for Hudson's experiments, as they could not fully understand what they were signing up for. In particular, at the time of the experiment, the method of open perineal biopsy was new and largely untested, and it would have been unlikely for someone to voluntarily undergo the procedure.
Moreover, the volunteers were very ill-informed. They were not provided with clearly written papers about the dangers of the biopsies, such as rectal tearing. Even though the perineal biopsy approach seemed to have its benefits, its potential risk for rectal perforation was quite high.[2]
In an interview, Hudson defended his experiment's ethics. He said he felt no regret, saying the volunteers seemed to him to be fully aware of the aspects involved in the study. Also, they did not receive any monetary incentives from him to participate, which, otherwise, he thought, would "constitute coercion". Once becoming aware of Hudson's practices, an editor of the journal Cancer wrote him a letter asking what protection he had from the university's legal department. Hudson subsequently stopped publishing the results of his research.[2]
References
- PMID 13172685.
- ^ PMID 24134358.
- ^ PMID 13051702.
- PMID 13015376.
- PMID 30938779.
- ISSN 0362-4331. Retrieved 2016-11-12.
- ^ "Skid Row Cancer Study Has Implications for Treatment Today, Penn Researcher Says". news.upenn.edu. Retrieved 2016-11-12.
- PMID 13664538.
- ^ Bendiner, E. (1961). The Bowery Man. New York: Thomas Nelson & Sons. p. 169.