The Moralist
An eminent physician did not hesitate to blast his colleagues for their ethical lapses. But was he in any position to criticize?
By John Lancaster and James P. Rathwell MD
In March 1965, Dr. Henry Knowles Beecher of Harvard Medical School traveled to Michigan for a scientific conference. At the airport in Boston, he bumped into a colleague who was heading to the same event, and took the opportunity to show him an unpublished paper that he planned to deliver as a speech.
The colleague, Thomas Chalmers, leafed through the document with a growing sense of alarm. He was stunned by what he read. Stunned and then angered.
“This is terrible,” he said.
What Beecher had shared with him was a searing — and, in Chalmers’ view, utterly wrong-headed — indictment of the research establishment that counted both men as prominent members. In twenty-seven typewritten pages, Beecher had accused his fellow scientists — researchers from the nation’s top medical schools and university hospitals as well as government institutes, military labs, and drug companies — of routinely risking the safety of human subjects enrolled in clinical studies. He buttressed his claim with eighteen examples, several involving children or other vulnerable groups. In one case, researchers at a military hospital had deliberately withheld penicillin from servicemen suffering from streptococcal infections, in order to test alternative (and less effective) treatments. Twenty-five of them subsequently developed rheumatic fever, which often causes severe heart damage.
No one told the men that they were part of a study, let alone sought their permission or warned them of any risks. Like others called out by Beecher — though not by name, since Beecher had chosen to withhold the identities of researchers and institutions — the doctors overseeing the experiment had failed to meet even minimal standards of “informed consent,” the supposedly bedrock principle of clinical research that arose from revelations of Nazi experiments on prisoners during World War II. “It is to be emphasized that what seem to be breaches of ethical conduct in experimentation are by no means rare, but are almost, one fears, universal,” Beecher charged.
Chalmers found that claim to be wildly overstated, and he worried about its potential to invite meddling from bureaucrats and politicians and thus gum up the works of scientific progress. Beecher, after all, was not just any whistleblower. At sixty-one, he was a star of academic medicine, holder of the world’s first endowed professorship in anesthesiology — he also chaired the anesthesia department at Massachusetts General Hospital — and the author of groundbreaking studies on the relationship between human physiology and the mind, especially as it relates to pain.
Just as Chalmers had feared, Beecher’s paper caused a sensation when he presented it to the scientists and reporters assembled at Brook Lodge, a conference facility in the rolling hills outside Kalamazoo that was owned by the Upjohn Corporation. His charges of ethical malfeasance were reported prominently in the national press (“Are Human Beings Used as Guinea Pigs Not Told?”, asked the front-page headline in the Boston Globe), along with Chalmers’ strident objections made publicly at the meeting (“a gross and irresponsible exaggeration”). Many researchers agreed with Chalmers, whose fury was compounded when, the following year, an updated version of Beecher’s paper ran in the New England Journal of Medicine, this time with even more examples.
But for government bureaucracies that oversaw the distribution of research funds, Beecher’s exposé was a swift kick in the pants. Fearful of lawsuits and Congressional scrutiny, they moved with unusual speed to mandate protections for human subjects in clinical studies. In the decades after his death in 1976, Beecher’s contribution would be recognized in a prestigious bioethics prize awarded annually in his name, in the endowment of a Beecher chair in anesthesiology at Harvard, and in glowing assessments by historians such as Columbia’s David Rothman, whose 1994 book on medical ethics, Strangers at the Bedside, compared the late Harvard doctor to “such noted muckrakers as Harriet Beecher Stowe, Upton Sinclair and Rachel Carson.”
“As has so often happened in the course of American history,” Rothman wrote, “a publication like Uncle Tom’s Cabin, The Jungle, or Silent Spring will expose a secret — whether it be the violation of the slave family, the contamination of food, or the poisoning of the environment — so compellingly as to transform public attitudes and policy. Beecher’s article fits in this tradition.”
But Beecher had secrets of his own. They were rooted in a murky chapter of the Cold War, when he was called upon by his government to use his skills in ways that fell well short of the ethical standards he later preached to his colleagues in Michigan, and that arguably had antecedents in Nazi Germany. As these secrets have slowly surfaced in the years since his death, they have tarnished Beecher’s halo, and led some to question whether he even deserves it. The answer is anything but simple.
In a photo taken when he was fifty-one, Beecher perches on the edge of a desk in a corridor at Mass General, one of Harvard’s main teaching hospitals. It was 1955 and Beecher was at the peak of his career. A handsome man with thick hair and a square, unlined face, he wears a white lab coat, gleaming wingtips and round horn-rimmed glasses — the very picture of the self-assured Boston Brahmin that most assumed him to be.
Lord knows he acted the part. Married to a slim, elegant obstetrician’s daughter from Massachusetts, he was a fixture of Boston society, fond of ballroom dancing, lobster, and fine Scotch, the latter often consumed in generous quantities at the Somerset Club, an exclusive WASP redoubt on Beacon Hill. His tweedy patrician style at times invited mockery. At Harvard Medical School, students nicknamed him “Beecher-Beecher,” for his habit of repeating himself. “I thought he was just a pompous ass, frankly,” recalls David Nathan, a member of the class of 1955. “I thought certainly he was a Groton graduate and must have belonged to the Porcellian Club at Harvard.”
Beecher was happy to feed that impression. Depending on his audience, he sometimes claimed kinship with the famous New England family that included Harriet Beecher Stowe and Henry Ward Beecher, the abolitionist preacher. But he also could be guarded about his heritage. Edward Lowenstein, an anesthesiologist who worked under Beecher in the early 1960s, recalls that when he once asked his boss about his ties to the celebrated clan, Beecher responded with “paroxysms of coughing” and a quick change of subject.
The fact is that Beecher was no blue blood. Born in Wichita, Kansas, in 1904, he was the son of Mary Julia and Henry Eugene Unangst, a onetime night watchman for the Coleman Lantern Company with a weakness for gambling and alcohol. Just weeks before entering Harvard Medical School in 1928, young Harry, as he was known at the time, changed his last name to Beecher. He borrowed the name from his maternal grandmother, whose connection to the New England Beechers was tenuous at best. Beecher later claimed that he did so because “Unangst” was hard to pronounce.
Beecher’s son, Jonathan, offers a different explanation, suggesting that Henry Beecher was eager to signal a break with his humble origins and especially his father. The two had been estranged for years, in part because the elder Unangst refused to help fund his son’s undergraduate education at the University of Kansas, where Beecher graduated with a chemistry degree in 1926. And of course, there was value in the Beecher name, especially in Boston. “It was important for him to be accepted in the snobby New England social world that my mother actually came from,” says Jonathan, a professor emeritus in history at the University of California at Santa Cruz.
Even without his new name, Beecher undoubtedly would have thrived. He was very bright, with a prodigious work ethic and an instinct for cultivating powerful mentors. He began his research career in his third year of medical school, when he embarked on a study of the physiology of breathing, conducted at Mass General. His work caught the eye of Edward Churchill, the hospital’s legendary chief of surgery, who selected Beecher for his residency program. After three years at Mass General, Beecher departed for Copenhagen and a research fellowship in the laboratory of physiologist and Nobel laureate August Krogh. When he returned to Boston in late 1935, he was squarely on track for a prestigious career as a surgeon.
But Churchill had other plans for his protégé. He wanted him to shift his focus to anesthesiology. At first blush, it sounded like a demotion. In a world where surgeons reigned supreme, the business of knocking patients out with ether or dulling their pain with morphine was considered a lowly support duty and often left to nurses. That had consequences — because of a lack of vigilance and sophistication on the part of anesthetists, patients often died during advanced procedures on the heart and lungs. Churchill believed that anesthesiology needed to keep pace with progress on the operating table. He wanted Beecher to take over the anesthesia service at Mass General and also to develop an academic program in the field. Beecher, seizing an opportunity, agreed.
Beecher would never be celebrated for his skills as an anesthesiologist — or “anesthetist,” as he preferred to be called, reflecting his belief that the specialty was not yet a science. He was at best competent; once a patient had gone under, Beecher would typically turn his attention to reading his mail or editing his latest scientific manuscript. Colleagues joked that when Beecher was on the job, “he’s half asleep and his patients are half awake,” recalls Paul Russell, a former chief of surgery at Mass General. Perhaps the best that could be said about Beecher’s clinical work was that it paid well, particularly since he made a habit of seeking out the wealthiest patients, sometimes pinning his bill to their pillows before they had even woken up.
Whatever his shortcomings in the operating room, Beecher had an eye for talent, eventually bringing in highly skilled anesthetists from all over the world. Surgical death rates plummeted. But his most important legacy was rooted in his research. From his newly established anesthesia lab at Mass General, he churned out a stream of well-received studies and wrote the first comprehensive textbook in the field; in 1941, he was rewarded with an endowed professorship at Harvard. Then he went to war. Commissioned as an Army major in July 1943, Beecher was sent first to North Africa and then to Italy, with a brief to study anesthesia under battlefield conditions. The work he did in both places sealed his reputation as a scientist and set him on the course that would define much of his postwar career.
It’s hard to think of a more hostile environment for medical research than the beachhead at Anzio, where Allied forces landed in January 1944, only to become trapped by German defenders who rushed to occupy nearby hills. For several months, amid ceaseless shelling and cold, driving rain, Beecher tended to the wounded in dugout field hospitals, meticulously recording observations in flimsy notebooks. Among other important discoveries, he found that multiple injections of morphine, when administered to injured soldiers to relieve pain in the battlefield, often had little effect, especially in cold weather. The opiate would pool in extremities instead of circulating. Then, when the soldiers warmed up in field hospitals, the drug would surge into the bloodstream, causing them to die of overdoses.
Beecher’s wartime research saved lives, and in 1945 he was awarded a Legion of Merit for “original observations … that never had been recorded in the history of warfare.” But Beecher’s most creative and original insight had implications far beyond the battlefield. It grew from his observations that gravely wounded soldiers often required far less pain medication than their injuries might have suggested (three-quarters of them refused morphine). On that basis, Beecher concluded that pain was not just a physiological phenomenon, but had a powerful emotional, or subjective, component — in this case, overwhelming relief at being off the battlefield and on the way home.
Beecher’s understanding of the relationship between mind and body would inform much of the work he resumed at Harvard and Mass General after the war. In particular, it fueled his interest in the so-called placebo effect, which culminated in a famous 1961 paper showing that patients who received “sham surgery” to cure angina were just as likely to report a reduction in chest pain as patients who got the real thing. Towards the end of his career, he led a committee at Harvard Medical School that proposed the first definition of irreversible coma, or brain death.
As he demonstrated on many occasions, Beecher delighted in pushing the traditional boundaries of his field and in challenging its conventional wisdom. In 1955, he and a colleague, Donald Todd, infuriated their fellow anesthesiologists with a study that accused them of accidentally killing patients at a rate high enough “to constitute a public health problem.” They based their claim on an exhaustive review of 600,000 cases in hospitals around the country. Their research showed that in cases where general-anesthesia drugs were supplemented with curare, then in widespread use as a muscle relaxant, the anesthesia death rate increased more than six-fold. “He must have been absolutely fearless,” says Lowenstein.
Beecher’s social ambitions burned as brightly as his professional ones. Like a magpie chasing shiny objects, he perpetually sought to insert himself into the center of the action, to place himself in close proximity to important people and events. He was forever dashing off letters to one luminary or another, sometimes on matters that had little to do with his field (his personal papers include correspondence with Alfred Kinsey, B.F. Skinner, and a young Jack Kevorkian, among many others). In newly liberated Paris during the war, he made a point of tracking down Gertrude Stein, arriving unannounced at her home with gifts of military rations and bottles of Bordeaux, according to an essay by Bucknam McPeek, a former colleague, in the journal International Anesthesiology Clinics. Beecher and Stein were said to have remained lifelong friends.
With his hunger for excitement and historical drama, Beecher was not about to sit on the sidelines as the nation embarked on its next great crusade, this time against communism. After the war the Army had continued to consult with Beecher on anesthesia drugs. By mid-1950, though, he had been recruited for a new project. It was very different from his anesthesia work, yet also played directly to his deep interest in the intersection of psychology, drugs, and the brain.
The goal of the classified project — codenamed BLUEBIRD but later known as ARTICHOKE and finally as MKULTRA — was to find ways to influence human behavior, for a multitude of purposes. It was led by the CIA in close coordination, and sometimes competition, with the Army, Navy, and Air Force. The project lasted roughly twenty years and involved scores of researchers, some, like Beecher, with top-shelf academic credentials. Areas of interest included drugs, hypnosis, sensory deprivation, and electric shock. In his work for the Army, Beecher would focus on “narcoanalysis” drugs — or “truth sera,” as he sometimes called them — that could be useful in the interrogation of enemy prisoners.
The full scope of the program did not become publicly known until the Senate Select Committee on Intelligence reported on it in 1977, the year after Beecher’s death. By then the CIA had abandoned the effort as futile. Revelations of drug-testing on unwitting subjects, at least one of whom died, were widely covered in the media and became a major source of embarrassment for the agency.
Despite Beecher’s prominence as a researcher, his role received little attention at the time. He was only one among many, after all, and his involvement appears to have been relatively short, perhaps a year or two. The Senate committee’s report on MKULTRA barely mentions him. In The Search for the “Manchurian Candidate,” a bestselling book on the program by John Marks, which was published in 1979, Beecher’s participation is described in a single footnote. In the decades since, a much fuller picture has emerged from declassified MKULTRA files — including some obtained by Marks for his book and since made available to the public — and other sources, including several letters between Beecher and his Army handlers that survive among Beecher’s personal papers at Harvard.
One of those letters — from Beecher to Col. William Stone, the Army’s chief of medical research — indicates that Beecher was recruited to the program in May 1950, when Stone approached him at a meeting in a Washington. In his letter to Stone, written a few weeks later, Beecher assures him that he has “not been forgetful of the study you mentioned” and shares his thoughts on “a method of attack … to see which agents might make it possible to get at deliberately suppressed information.” He was hopeful about mescaline — a plant-based psychedelic that “the Russians are said to be using” — but worried about finding suitable volunteers. “It might be possible to…get the cooperation of some of the life-termers at Charlestown State Prison,” he wrote.
On the plus side, “wise advisors” had assured him that research subjects would not be harmed by the experiments, which could be carried out at Mass General or one of several nearby psychiatric facilities. “I believe we have an almost ideal setup here in Boston.”
Except perhaps in Hollywood, the idea of truth serum seems fanciful now. But the government had been exploring the concept since the early 1940s, when the Office of Strategic Services, the CIA’s wartime predecessor, established a “truth-drug committee” under Winfred Overholser, a psychiatrist in charge of St. Elizabeth’s Hospital in Washington. According to Marks’ book, the committee considered mescaline, barbiturates, and scopolamine before deciding that marijuana had the most potential, at one point testing the drug on a notorious New York gangster. (The test was judged a success. An agent on loan from the Federal Bureau of Narcotics invited the Mafioso to his apartment, then plied him with marijuana cigarettes until the “subject became high and extremely garrulous,” according to an OSS document uncovered by Marks.)
The quest gained new urgency with the start of the Cold War. Intelligence and military officials believed they were in a psychopharmacological arms race with the Eastern bloc. The communists were thought to have the edge not just in drugs for lubricating tongues, but also in methods for manipulating human behavior itself. These fears were fueled in part by the communist show trials of the late 1940s, with their glassy-eyed defendants and forced confessions, and by similar evidence of “brainwashing” of American POWs during the Korean War. “The Soviets are now using brain perversion techniques as one of their main weapons,” Allen Dulles, the CIA director, warned in a speech to Princeton alumni in 1953. “The target of this warfare is the minds of men.”
The agency and its military partners were particularly interested in psychedelics — especially d-Lysergic acid diethyl amide, or LSD-25, a synthetic version of a fungus called ergot that had been linked to outbreaks of “dancing madness” in medieval Europe. LSD’s mind-bending properties had been discovered in 1943, when its inventor, Dr. Albert Hoffman of the Swiss chemical firm Sandoz, accidentally absorbed a dose through his skin. In August of 1950, Dr. Arthur Turner, chief of the Army’s Medical Intelligence Branch, forwarded Beecher a report from Sandoz noting that when the drug was given to research subjects, some “were unable to allow their wills to function normally.”
Beecher was following a trail that had been blazed in Nazi Germany. After the war, a team of U.S. Navy investigators interviewed a former prisoner at Dachau who had been subjected to experiments with mescaline. The tests by SS-Hauptsturmführer Dr. Kurt Ploetner of the Luftwaffe’s medical research unit were designed “to eliminate the will of the person” under interrogation by the Gestapo, according to the prisoner’s account. Prisoners were given mescaline mixed with liquor or coffee, then questioned. “If the Messkalin had an effect on the mental state of the [prisoners], the examining person succeeded in every case in drawing even the most intimate secrets from the [prisoners] when the questions were cleverly put,” the prisoner reported.
At the time of his truth-sera research, Beecher was familiar with the prisoner’s account, which had been included in the Navy investigators’ report on Dachau. In 1947, Turner, the Army official, had mailed Beecher a copy of the report, suggesting that “it might be of interest to you.” Beecher read it carefully, making marginal notes and even correcting typos, before adding it to his files.
It was not the only time that Beecher would brush up against the legacy of Nazi science. In September 1951, he traveled to Europe to gather information on “‘ego-depressant’ drugs, usually called truth serum in the newspapers,” as he put it in a subsequent report to the Army surgeon general’s office. Beecher stopped first in the United Kingdom, where he made the rounds of defense officials and university researchers, then continued on to France and Germany. Not all of the U.S. military officials Beecher met on the continent shared his enthusiasm for the project. In Heidelberg, General Guy B. Denit, the Army’s top medical officer in Europe, “explained that as a physician under the Geneva Convention he could have nothing officially to do with the use of drugs for the purposes in mind and turned me over to G-II,” or military intelligence, Beecher said in his report.
Judging by the next stop on his itinerary, Beecher had no such reservations. Camp King was an American military installation in the town of Oberursel outside Frankfurt. During the war it had served as the Luftwaffe’s main interrogation center for captured Allied fliers. Now, as the historian Alfred McCoy has written, it was an early version of a CIA “black site” — a top-secret facility for interrogating Soviet-bloc defectors and suspected communist spies. It was jointly run by the agency and the U.S. military’s European Command. Many of the CIA’s most advanced interrogation methods — including drugs, hypnosis, and electric shock — were tested on prisoners there, often with help from former Nazis who had been hired for their expertise in the field.
One of the more prominent ex-Nazis at Camp King was its post physician, Walter Schreiber, the former chief medical officer of the German military command. Just a few weeks before Beecher’s arrival in Oberursel, Schreiber had departed Germany with his family for a new job with the School of Aviation Medicine at Randolph Air Force Base in Texas. Schreiber was an expert on chemical and biological warfare, and he also knew a thing or two about Communist interrogation techniques, having experienced them first-hand as a Soviet captive after the war. Interrogators at Camp King advised Beecher that Schreiber “would be a good man to see” when he returned to the United States, Beecher reported.
Beecher added that his hosts at Camp King had described the former Nazi as “intelligent and helpful. [Schreiber told them] that after one cigarette from the Russians he was quite unable to sleep for 48 hours.” Beecher speculated that the cigarette had been laced with mescaline.
Beecher’s report was discovered in declassified Army files at the National Archives in College Park, Md., in 2001 by Egmont Koch, a German investigative reporter who was researching the links between Nazi science and MKULTRA. As it happened, McCoy, of the University of Wisconsin-Madison, had been fishing the same waters. After Koch read some of his work, he proposed that the two cooperate, interviewing McCoy for a documentary and providing him with a copy of Beecher’s report. For McCoy, a dogged researcher with a slashing rhetorical style, that and other evidence he had gathered added up to a damning indictment. In a 2007 journal article and a subsequent book, Torture and Impunity, published in 2012, he drew a direct line from the Nazis’ mind-control research to Beecher’s LSD experiments on college students a decade later, accusing him of “drinking deep from Dachau’s poisoned well.”
That is something of a reach. As McCoy himself acknowledges, “we cannot be certain” that Beecher’s work was inspired by the mescaline research at Dachau. And if Beecher was open to working with ex-Nazis, he was only reflecting U.S. policy at the time. Schreiber was among hundreds of former Nazis, many of them scientists, who were recruited for sensitive national-security jobs in the early years of the Cold War (the now-infamous Operation Paperclip). In any case, it’s unlikely that Beecher ever got a chance to meet with Schreiber. Just months after he started work in Texas, Schrieber fled to Argentina when the Boston Globe exposed his complicity in war crimes.
The important question, in the end, is not whether Beecher’s truth-sera work was tainted by its association with Nazis. It’s what he actually did.
Beecher often threw parties at his home in the Boston suburb of Milton, where the liquor flowed freely and colleagues read ditties making fun of each other and their work. Beecher kept a few of his favorites, one of which was written by a psychologist who assisted with the truth-sera research. It reads in part:
We’uns work in Research
We probe the subject’s mine [sic].
We fit him into Latin squares
And give him Joy-Juice blind…
We ask the subject questions
From us there’s no reprieve
He’ll shake and sweat and shudder,
And ultimately heave…
We keep the subject in the dark,
Spout soothing words like founts —
He thinks we know just what we want —
Why not — That’s all that counts.
And as the poor slob totters home,
Deprived of food or weed
We put him on a ‘tab’ sheet.
Ah dark and evil deed…
At least at first, the “Joy-Juice” came in a variety of formulations. In a report to Stone, his Army handler, in July 1951, Beecher described 30 experiments in which 17 volunteers — college students over 21 — were dosed with benzedrine, scopolamine, morphine, ethyl alcohol, or “extract of cannabis indica” (a form of marijuana). The subjects were evaluated with Rorschach and other psychological exams and tested on their capacity for “volitional suppression” — their ability to keep secrets under questioning. “We have got a good start on the Narconalysis project,” Beecher assured Stone.
Beecher soon turned his attention to psychedelics, most notably LSD-25. We know this because at least some of his Army-funded experiments would be written up in a report titled, “Response of Normal Men to Lysergic Acid Derivatives,” according to a reference in declassified MKULTRA files obtained by John Marks. Beecher also described non-classified aspects of his LSD research in a journal article written with two of his colleagues, John M. Felsinger and Louis Lasagna, in 1956, several years after the experiments concluded.
The dearth of lab notes or other detailed records of his truth-sera studies in Beecher’s papers — which contrasts sharply with the abundance of materials on his wartime research, down to the names of individual soldiers and descriptions of their wounds — strongly suggests that he was not particularly proud of the work. There were, perhaps, good reasons for this.
“It was laughable in retrospect,” Lasagna recalled in a 1994 interview with Suzan White-Junod and Jon Harkness, who were researching medical ethics on behalf of the Advisory Committee on Human Radiation Experiments. “The idea was that we were supposed to give hallucinogens or possible hallucinogens to healthy volunteers and see whether we could worm secret information out of them. And it went like this: A volunteer would be told, ‘Now we’re going to ask you a lot of questions. Under no circumstances tell me your mother’s maiden name or your Social Security number.’”
The interrogations were so “mindless,” Lasagna added, that he refused to participate in them, leaving that part of the experiments to a psychologist.
If nothing else, Beecher’s truth-sera research offered an early glimpse of the coming drug culture. “We had one student who came and said, `My roommate got LSD and was found on the Boston Commons in his nightshirt eating grass and I hope that happens to me, if I get that drug,’” Lasagna recalled.
Even at the time, however, Beecher and his colleagues must have had doubts about the safety of the experiments. In an article published in Science in 1954, Lasagna and Felsinger reported that on the basis of Rorschach results and interviews, the student volunteers suffered from “an unusually high incidence of severe psychological maladjustment,” and that three were probably psychotic (again, the article did not discuss the classified aspects of the research). And that, of course, was before they had taken any drugs.
Beecher himself appears to have been aware that LSD, in particular, could exacerbate the dangers of underlying psychiatric illness. In a memo that found its way to the CIA’s Technical Services Division, which oversaw MKULTRA, he dismissed as “overly positive” a suggestion that the drug posed no risk, describing the case of a Swiss doctor who had been suffering from depression and took the drug as part of an experiment. She killed herself three weeks later.
Beecher’s research subjects would be in their 80s now. A notice placed at our request in a recent issue of the Harvard alumni magazine yielded three responses. Two came from graduates who, it turned out, had volunteered not for the Beecher experiments but for CIA-sponsored drug tests at Boston Psychopathic Hospital.
Because that research had much in common with Beecher’s, it’s worth hearing from one of them. By telephone from his home in Alexandria, Va., Richard D. Simmons told us that he signed up for the tests at Boston Psychopathic as a 19-year-old junior in the spring of 1954, in response to an ad seeking volunteers for tests of a potential treatment for schizophrenia. Along with several other students, Simmons was given a written exam — he does not recall the questions — followed, a day later, by a vial of liquid that he was told contained a “recently discovered” drug called lysergic acid.
It was his first and only acid trip and he does not remember it fondly. “I spent several hours hiding under a table,” he said. Another student “managed somehow to escape from the building and was found walking down the adjacent main street half-dressed.”
After collecting $25 for his troubles, Simmons was sent on his way with a warning that he “might experience some short-term headache.” Simmons put the episode out of his mind until 1977, when he learned of the experiments’ true purpose from a story in The New York Times. That’s when he got angry. “They had taken a nineteen-year-old minor, lied to him about the purpose behind the test and … caused me to risk my life without sharing the real goals of the exercise,” said Simmons, a retired president of the Washington Post Co. “I was then — and am still now — convinced that I had a major tort case against the U.S. government.”
Another alumnus, Paul H. Bodden, recalled taking part in an LSD experiment during his senior year in the spring of 1952. He has forgotten the name of the doctor who supervised the experiment, and the hospital where it took place, but its timing and other details — including the researchers’ use of Rorschach tests — strongly suggest that he was one of Beecher’s volunteers.
Like Simmons, he remains troubled by the experience. He recalled that after the experiment was over, two of the researchers bundled him into a car and dropped him off in Harvard Square, even though he was still under the influence of the unfamiliar drug. Bodden woozily made his way back to his dorm, where he “spent about two hours in the damn shower” trying to regain his senses.
“I just felt a little used,” said Bodden, a retired executive vice president of the Terex Corporation, which manufactures heavy equipment. “I felt that I had been through some degree of risk.”
In December 1952, when his truth-sera project was in full swing, Beecher or his secretary typed a brief note for his files. Under the heading “Human Experimentation,” it read, “Nuremberg trials [sic], also defined what one can do in human experimentation.”
The reference, of course, was to the trials of Nazi war criminals before an Allied military tribunal in the German city of Nuremberg that began in late 1945. One of these examined the role of 23 Nazi officials, most of them physicians, in grotesque medical experiments that ended in the deaths of thousands of concentration-camp prisoners, including children. Some of these experiments — freezing prisoners to death in icy baths to study hypothermia, for example, or asphyxiating them in pressure chambers to probe the physiological effects of high altitude — were familiar to Beecher. They had been described in the same Navy investigators’ report that detailed the mescaline tests at Dachau.
The so-called doctors’ trial ended in the conviction of sixteen former Nazis, seven of whom were executed. It also produced the Nuremberg code, which is embedded in the final judgment and is now considered the second most important ethical code in medicine after the Hippocratic Oath. “The voluntary consent of the human subject is absolutely essential,” the judgment declared, adding that the subject “should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision.”
Beecher’s truth-sera research clearly fell short of this standard. In his 1994 interview, Lasagna, Beecher’s former colleague, recalled that when Beecher sent him an advance copy of the ethics speech he planned to deliver in Michigan, in the mid-60s, “I said, `Gee, Harry, when I was with you from 1952 to 1954, we never got consent on anybody.’” He added, “We got releases from some of our healthy volunteers because we had an Army contract and the Army wanted to say if anything bad happened to them, they wouldn’t sue the Army, but that was it.”
“I said, `How about that, `Let him who is without sin cast the first stone’”?
At the time of the experiments, Lasagna was young and just beginning an illustrious career in pharmacology. He also would make a name for himself as an expert on medical ethics. Four decades after leaving Boston for Johns Hopkins (he later moved to the University of Rochester), he seemed embarrassed by the work he had done in Beecher’s lab. “I would say my ethical conscience wasn’t implanted during those two years I was with Harry Beecher,” he said, “because we never discussed ethics at that time.”
Beecher was not oblivious to ethical concerns. In fact, there is evidence that even as he was supervising the truth-sera research, he was troubled by its moral implications. In a letter to a Cambridge University scholar in late 1951, he wrote, “I have recently become very interested in some moral problems concerning human experimentation since we are working in an increasingly delicate field, the central nervous system depressants … and especially on the group of agents used in narcoanalysis.”
Over the next few months, according to letters in his files, he sought advice on research ethics from several other authorities, including the dean of the Harvard Divinity School, Willard K. Sperry, and — indirectly — Pope Pius XII, writing the Archbishop of Boston to request a papal document on human experimentation.
But if Beecher was bothered by his conscience, he wasn’t bothered enough to stop what he was doing in his lab. If anything, he wanted to broaden his classified portfolio by working more closely with the CIA, whose elite, Ivy League cachet must have appealed to the ambitious Midwesterner. In his July 1951 letter to Stone, Beecher expressed frustration at “our failure so far to get clearance from the Central Intelligence Agency” to examine wartime records on truth sera research, while declaring that “we would be glad to cooperate” with the agency on its efforts in the field.
With his usual flair for self-promotion, Beecher approached his Cold War mission not just as a scientist, but as a counter-espionage strategist and purveyor of dark, apocalyptic warnings. Reporting on his trip to Europe in the fall of 1951, for example, he fretted about the possibility that surreptitiously administered drugs could cause scientists in the nation’s nuclear-weapons complex to “lose their integrity” and spill secrets to the enemy. After visiting Europe again the following year, he warned that LSD could be used to contaminate water supplies, wreaking havoc in cities or the military. “The lysergic acid derivatives can produce a temporary state of severe imbalance, hysteria, insanity,” he wrote in his report on the trip. “It takes little imagination to realize what the consequences might be if a battleship were so affected.”
The Army eventually yielded to Beecher’s entreaties and awarded him a “top secret” security clearance. But the CIA proved to be the one exclusive club that didn’t want him as a member, according to declassified agency memos that appear to refer to Beecher (the names have been redacted). “It would be well to consult with him,” said a May 1951 memo from a CIA security officer to the agency’s Office of Scientific Intelligence. “It is not felt, however, that he should be brought fully into the picture.” In September of the following year, CIA officials affirmed that decision, in part “because of his propensity to talk.”
In some respects, Beecher’s willingness to set aside his ethical qualms in the cause of national security was typical of an era permeated by fear of the Soviet Union, which detonated its first nuclear bomb in 1949. But there’s more to his story than Cold War paranoia. For the truth is that even in his non-classified research, Beecher often kept his research subjects in the dark. “I have no memory of any discussion of the need for informed consent,” the late John Bunker, an anesthesiologist who worked for Beecher in the 50s, recalled in an essay published in 2001. Perhaps there should have been. In one of Beecher’s clinical studies, patients were given methadone after surgery to determine whether the relatively new drug was a more effective pain-reliever than standard analgesics. Three of the patients “proceeded to sink into a coma lasting several days,” Bunker wrote.
Beecher’s behavior seems reckless now, but any fair-minded appraisal of his record has to acknowledge that it was far from unusual at the time. The Nuremberg principle of informed consent was aspirational at best. As David Rothman has written, researchers saw little connection between their work and the experiments described in testimony before the military tribunal, which after all “had been the work of Nazis, not doctors.” Ethics rules were ad hoc and for the most part not even written down. Physicians simply trusted themselves — and their colleagues — to do the right thing.
“My idea…of informed consent was, ‘You are the patient. I am Dr. Nathan. Lie down,’” recalls David Nathan, who had gone on to a dazzling career as a researcher specializing in blood diseases after crossing paths with Beecher as a medical student at Harvard. “In no way was there a document. There were no witnesses. But the worst thing was I never had to present the whole idea to anybody else.”
Like many of his peers, Nathan often assessed the ethics of a particular experiment on the basis of whether he would be willing to subject himself to the same test — which in many cases he was, coming home to his appalled wife with his arms bandaged after giving himself injections or drawing blood or even bone marrow. “It was a closed society,” says Nathan, now the president emeritus of the Dana-Farber Cancer Institute and physician-in-chief emeritus of Boston Children’s Hospital. “We did what we thought was best but we didn’t ask any outsiders what they thought.”
The freewheeling approach reflected the heady atmosphere of postwar medical research. It was a time of major advances such as the polio vaccine, developed by Jonas Salk in 1955. Such breakthroughs had combined with a flood of federal research money to generate excitement and a sense of urgency, a feeling that anything was possible and that delays would be measured in human lives.
“It was productive, massively productive,” Nathan recalls of his own research during that era — some of which, he acknowledges, would never be permitted under today’s rules. One of his most important studies, in the early 60s, sought to determine whether the spleen should be removed as a treatment for a type of anemia. As part of the experiment, Nathan injected himself with red blood cells harvested from a child who had the disease. The study confirmed that the spleen should, in fact, be removed — a lifesaving advance in scientific knowledge. Only years later did Nathan learn that he had given himself hepatitis.
Even before that diagnosis, Nathan had begun to question some of the risks that he and his colleagues were taking, which is why, when Beecher’s article appeared in 1966, he was more receptive to its message than many of his peers. “I thought it was a terribly important statement,” Nathan recalls. “I quickly revised my view of Beecher. I thought, underneath this Brahmin appearance is a very thoughtful guy who’s telling it as it is. I agreed with him.”
To be sure, Beecher had shed none of his pretensions. Lowenstein, the anesthesiologist who worked under him in the early 1960s, recalls the night Beecher spotted him in a hallway after work and peremptorily declared, “We must have dinner together.” Outside, a blizzard raged, and the city was all but paralyzed. The two trudged through blinding snow to the Ritz Carlton, where the dining room was deserted except for a handful of bored waiters.
“My name is Henry K. Beecher,” he announced, as his dinner companion fervently wished he could make himself invisible. “I am the Henry Isaiah Dorr Professor of Anesthesia at Harvard Medical School. Can you find me a table?”
A man of such impeccable establishment credentials made for an unlikely revolutionary — and a reluctant one as well, at least for a time. In 1959, nearly a decade after his first inquiries on the “moral problems” of research, Beecher published a lengthy monograph titled simply, “Human Experimentation in Man.” It set out some obvious limits — for example, prisoners of war should not be used in research. But its most striking quality was its caution. Beecher steered clear of any recommendations that would have seriously disrupted the status quo. “In most cases, the problems of human experimentation do not lend themselves to a set of rigid rules,” he wrote. He even questioned whether informed consent was possible in most cases. After all, he argued, “lay subjects, sick or well, are not likely to understand the full implications of complicated procedures even after careful explanation.”
Beecher adopted a similar line of reasoning when, in 1961, the Army Surgeon General’s office proposed new rules for Army-funded research on human subjects based on the Nuremberg code. Beecher helped lead a rebellion against the change, arguing that “such a vast code would be restricting and crippling to experimentation in man,” according to minutes from a meeting of the Harvard Medical School Administrative Board on Oct. 6, 1961. In a formal response to the Army some months later, he argued self-servingly that the “best protection” for human subjects was the researcher’s “character, wisdom, experience, honesty, imaginativeness and sense of responsibility.”
Beecher’s argument — in effect, “trust us” — carried the day. The Army agreed that the ethics principles spelled out in its research contracts should be interpreted as “guidelines” rather than strict rules.
Despite his resistance to the Army’s proposed rules, Beecher continued to hold himself up as a paragon of ethics — as in 1963, for example, when he publicly condemned his Harvard colleagues Timothy Leary and Richard Alpert for testing hallucinogens on prisoners and graduate students as well as on themselves. “This reminds me of De Quincy’s Confessions of an English Opium Eater of a century and a half ago rather than of a present-day scientific study of subjective responses to drugs,” he wrote in an editorial for the Harvard Alumni Bulletin. Beecher’s finger-pointing took a lot of brass, given his own history in the same field. But it was entirely consistent with his public persona and his belief that if researchers didn’t police themselves, then someone else would.
One of the enduring mysteries about Beecher is why he changed his tune so abruptly. Why did he vigorously defend the status quo in the early 1960s, only to upend it a few years later in Michigan, with his broadside against his fellow researchers? Similar questions could be asked of many whistleblowers, whose proliferation across government and industry in recent decades has spawned a cottage industry of social-science research. In a 2001 book, C. Fred Alford of the University of Maryland argues that whistleblowers tend to be motivated by a rare combination of vanity, ambition, and high ideals that he calls “narcissism moralized.”
It’s not hard to find Beecher in that description.
To begin with, he was nothing if not a moralist, a devout Christian who had read the Old Testament several times in its entirety, recording the dates that he finished inside the cover of the family Bible, according to Jonathan Beecher. He insisted that his son (though not his two daughters) read a chapter of the same volume each day. “We went to the Episcopal Church when I was growing up,” Jonathan recalls. “Dad took organized Christianity very seriously.”
With that background in mind, Beecher’s decision to hold the research establishment to account can reasonably be seen as an expression of Christian duty — exacerbated, perhaps, by a need to atone for his own past sins. “Lest I seem to stand aside from these matters,” he said in his Michigan speech. “I am obliged to say that in years gone by work in my laboratory could have been criticized.”
Beecher, however, never offered any details of his own dubious experiments, and as public mea culpas go, his was pretty weak. Of course, he was hardly the type to wallow in public displays of contrition. Like Alford’s narcissistic moralizers, he was a man of considerable self-regard and ambition. He also had a well-known thirst for the limelight and a keen sense of which way the wind was blowing. And even before he flew out to Kalamazoo to deliver his famous speech, it was clear that the wind had begun to shift.
Stories of misbegotten experiments on “human guinea pigs” increasingly were finding their way into the public eye. In 1964, for example, newspapers reported on a researcher at New York’s Sloan-Kettering Institute for Cancer Research who had injected elderly patients with live cancer cells — without telling them — in an experiment to determine whether the immune system could suppress the disease. A few physicians had begun to quietly agitate for reforms. The most important of these was James Shannon, the director of the National Institutes of Health, who feared that the surge of bad publicity would undermine public support for federal research funding (in particular, Shannon was worried about the potential fallout from an experimental, NIH-funded transplant of a chimpanzee heart into a human).
With changes already stirring in the research establishment, Beecher’s decision to go public with his charges smacks at least partly of opportunism. The unveiling of his exposé in Michigan was deftly orchestrated. According to an account by historian Lara Freidenfelds, Beecher handed out copies of his manuscript to reporters, yet refused to give press interviews, to avoid the appearance of grandstanding that might have undercut his influence with fellow researchers. Beecher’s next step — placing his expose in a medical journal — proved difficult, in part because its charges were so incendiary. But he finally succeeded with the New England Journal of Medicine, which published the article in June of 1966.
Like his speech, the article derived much of its power from its sensational — if anonymous — examples of ethically flawed studies, culled from major medical journals. Beecher later claimed that he chose not to name names because to do so might have made some researchers vulnerable to lawsuits. This was a bit disingenuous. Identities could easily be gleaned from other details in the examples, many of which — such as the Sloan-Kettering cancer study, which he had included in his bill of indictment — involved prominent scientists at major research centers. A more plausible explanation is that leaving out names gave cover to potential publishers wary of scapegoating individual scientists. And of course, the decision meant that Beecher could exploit the scientists’ alleged lapses for maximum effect while avoiding the tedious business of actually calling them up to get their side of the story.
Had he done so, their explanations might have clouded the picture. Several of the studies he criticized had been coauthored by Eugene Braunwald, who was then at the National Institutes of Health and headed for international renown as a cardiologist. After Beecher’s article appeared, Braunwald prepared a lengthy rebuttal, arguing that the subjects in his studies were not healthy volunteers but patients who stood to benefit from the procedures being tested, and that many in fact did benefit. And he disputed Beecher’s contention that his research subjects had not been fully informed.
In the end, Braunwald decided not to send his rebuttal to the journal, concluding that it would only embroil him in an argument he could not win. But almost half a century later, Braunwald, now 86, is still angry at Beecher. “It was an accusation — a serious accusation — published in a widely available medical journal, about my ethics, without having the information,” Braunwald told us recently in his office at Brigham and Women’s Hospital in Boston. “All he had to do was ask or request the charts.”
For all the stir it created, Beecher’s article offered few concrete recommendations. In that sense it echoed his 1959 monograph, not only in its cautious approach to informed consent, but also in its faith in “the more reliable safeguard of an intelligent, informed, conscientious, compassionate, responsible investigator.”
But as Freidenfelds writes, if Beecher had hoped “simply to do some consciousness raising” among his peers, he surely would have chosen a more discreet way to go about it. The sensational and highly public nature of his charges placed enormous pressure on the research establishment. It cannot have been mere coincidence that within months of Beecher’s Michigan speech, NIH had written an entirely new set of rules for the research it funded. Not only did the rules mandate informed consent, but they also required researchers to get approval for their experiments from panels of colleagues not involved in them — an unprecedented step. Such “institutional review boards,” or IRBs, have since become part of the landscape of American medical research.
At least in the short term, Beecher was the rare whistleblower whose career actually benefited from his heresy. From his spacious office at Mass General, with its well-stocked liquor cabinet and steady stream of visitors, he continued to run the anesthesia department, which had become independent of the surgery department in 1963 and was now a powerful and respected fiefdom in its own right. Besides his pivotal role in defining brain death, in 1967, Beecher also served as chairman of Harvard’s first IRB and embraced the role of gray eminence, opining regularly on the subject of human experimentation in medical journals and the press.
By the end of the decade, though, some of Beecher’s colleagues had grown weary of the diva in their midst. The episode that ended his career, strangely enough, turned on a matter of research ethics. While Beecher was chairing the review board, two prominent neurosurgeons had sought approval for experimental lobotomies on prisoners suffering from temporal lobe epilepsy, to determine whether the procedure would curb their violent behavior. The proposed experiment raised a host of ethical concerns, and Beecher proved incapable of leading the panel to a decision. His dithering on the matter prompted complaints from the surgeons and ultimately led to Beecher’s forced departure from the anesthesiology department in 1969.
Embittered and hurt, Beecher moved to a tiny office at Harvard’s Countway Library of Medicine across town, where he spent several years organizing his papers and occasionally fielding inquiries from the media (including NBC News, which in 1972 agreed to pay him $500 in exchange for “names and locations of medical experiments which you consider to be unethical,” according to a letter in his files). On July 25, 1976, he died of pancreatic cancer at the age of 72. A statement from Harvard’s faculty of medicine acknowledged his many scientific accomplishments but described his influence on research ethics as his “greatest contribution.”
In light of what we know now, does Beecher deserve his place in medicine’s pantheon of heroes? Alfred McCoy, for one, doesn’t seem to think so. “Apart from Beecher’s own oblique references to his lab’s ethical lapses, the literature seems ignorant of his darker side,” he writes. “Today, every academic researcher in America and Canada lives under Dr. Beecher’s long shadow, forced to submit all research protocols to institutional review boards that would certainly ban the experiments done, … ironically, by Beecher himself.”
McCoy has a point: Beecher was nothing if not hypocritical. But then again, so what? Just because he was less than fully forthcoming about his own culpability didn’t make his central point — that researchers were risking lives in the name of scientific progress — any less important or timely. Heroes come in many guises — though Beecher’s was perhaps more complicated than most.
An oil portrait that Beecher sat for in Paris, in 1962, hints at the ego, imaginativeness, and eclecticism that defined his career. Paid for by colleagues in the anesthesiology department, it is a surrealist work by Jean Pierre Alaux, a young artist whom Beecher had befriended during a previous trip to Europe and personally selected for the job, according to his daughter, Mary Beecher Price. The portrait depicts its subject in a business suit with his trademark horn-rimmed glasses, one hand resting on an open lab notebook, an image of the Bullfinch building — the original home of Harvard Medical School and the site of the Ether Dome, where general anesthesia was first demonstrated publicly in 1846 — floating behind his head. There are other disembodied images: A wavy line, as if from an electroencephalogram used to detect brain activity, connects to a death mask, presumably to suggest Beecher’s interest in defining brain death. A flowering poppy symbolizes morphine and Beecher’s work on understanding pain.
For whatever reason, Beecher never liked the portrait, which is, it must be said, a little odd. But eventually the painting found a prominent home in a busy corridor of the hospital where Beecher spent his career. It hangs there still.
