HC Deb 03 November 1971 vol 825 cc320-30

10.0 p.m.

Mr. William Molloy (Ealing, North)

This Adjournment debate concerns two issues that have shocked the nation. The first is the guinea-pigs issue—an allegation that National Health Service patients have been used as guinea-pigs for experiments. The second is the disgraceful reluctance of the Secretary of State for Social Services to hold an inquiry.

It is regrettable that the Secretary of State has not remained in the Chamber to answer the debate on a subject which is giving rise to great consternation throughout the country. Government Ministers who should answer debates on issues affecting the British people do not bother to stay in the House, although they have spent a great deal of time telling us how wonderful it will be for us to go into Europe. It seems that one Secretary of State has jettisoned the British people; he should have been here tonight. I respect the intelligence, ability and sincerity of the Under-Secretary of State who is to reply to the debate, and I am grateful that he at least is on the Front Bench.

The Secretary of State, in reply to a question put by one of his hon. Friends said: The House will be aware that such allegations as have been made to the contrary have been strongly denied by the hospitals concerned." [OFFICIAL REPORT, 19th October, 1971; Vol. 823, c. 97.] This matter is best related to the report of the Daily Mirror on 11th October and the Sun of the same date. The Daily Mirror report reads: Dr. Maurice Pappworth of Hampstead, London…discussed in a B.B.C. Radio interview American experiments in which terminal cancer patients were given massive radiation doses And he said, 'It is significant that most of these patients were "charity" patients and destitute. They were probably of low social class and of poor intelligence and, therefore. would not be aware of what was being done to them.' He added, 'But this is true also of Britain. Experiments on patients are never done in the private sector. They are done entirely on the National Health Service patients. Later, Dr. Pappworth said at his home. These experiments are being done without patients' know- ledge. They are going on in all teaching hospitals. I have documentary evidence. They are hazardous experiments which in no way improve the patients' chances of survival and are in no way in their interests'. The Sun quoted Dr. Pappworth as saying: I have seen elderly patients dying of cancer given experimental drugs—drugs being tried out for heart failure, for instance. This sort of thing happens daily in big teaching hospitals. There are hundreds of cases. I have stopped counting. The results of the experiments are often written up in medical journals. But how the patients were recruited is never disclosed. Dr. Pappworth goes on to say that these experiments could not possibly have helped. He also said on B.B.C. radio that the worst offenders were the Hammersmith Hospital at Wormwood Scrubs and the Royal Free Hospital at Holborn.

Since this issue became a national talking point I have received letters from all over the country—from men and women in medicine, from people who have themselves been in hospital, and from people whose relatives or friends have been in hospitals. One correspondent has written to no less a person that the Prime Minister—not that that will help him much— about a case, of which the Secretary of State knows, which is a very serious issue.

That is the case of a father who claims that his daughter suffered from experimental operations carried out by a research fellow, not a qualified orthopœdic surgeon, and that the results of those experiments left his daughter crippled. I submit to the House that, if only for the allegation contained in that one case, the Secretary of State should hold an inquiry. 1 submit to the Secretary of State and to any hon. Member listening to me that if it was his daughter he would want a public inquiry. If it were your daughter, Mr. Speaker, I am sure that you, too, would want a public inquiry.

So, if there is one British child who has been experimented on by unauthorised people and has been crippled for life, I say that the Secretary of State should hold a public inquiry. But there are many more instances. Quite a number of allegations have been submitted to me in reasonable, earnest and sincere terms, and I have submitted them all to the Secretary of State for his examination. Of course the nation is upset, and ordinary people and the medical profession are upset.

We have read in our newspapers—I heard the term, and had it referred to in correspondence—that there is some- thing awfully redolent of Nazi experiments in this whole distasteful allegation. I say immediately that that is a grotesque exaggeration, which I do not accept. But the fact that ordinary people feel compelled to make such a comparison surely makes it incumbent upon the Secretary of State to order a full inquiry.

One correspondent has sent me the 10 articles of the Nuremburg Code, to which we subscribe. It was drafted in Nuremburg because of the ghastly vulgarities of the Nazis. It was thought that this would do something to show that, in the town where the most awful evil was spawned, something good might be born. That code says that no human being shall be subject to any medical experiment against his will.

This debate and the debate that the nation has had in the columns of our national newspapers were not inaugurated by nosey politicians or nosey journalists. I pay my compliments both to the Sun newspaper and the Daily Mirror for the remarkable job that they have done. This debate is taking place this evening —I hope that the Minister will confirm this—because of a big debate going on among eminent men in the medical profession. It is they who are making these serious allegations. Eminent men in the medical profession are making the denials. The medical profession is not above the law, nor is it above criticism; or should it be above an impartial inquiry, which should be ordered by the Secretary of State.

The nation is disturbed. There are many aspects to this question which, if true, is highly distasteful in addition to its horrendous aspects. If there were unofficial and unauthorised experiments on some of our fellow citizens in some hospitals, other members of medical staff, such as nurses, younger doctors, and anaesthetists, could well have been involved in something in which, if they knew that they were contributing to it, they would have refused to take part. This is another reason why there should be an inquiry, because other members of the medical profession are deeply concerned. That concern, and that gnawing fear that they might have participated in something vulgar, should be removed. The only way to remove it is by having a proper inquiry.

The House and the nation are justifiably proud of the National Health Service. I have said in the House and out- side that the Act establishing it was the finest piece of legislation placed on any statute book in the world. There is nothing to equal it, or even to compare with it. When the world imitates what we have done it will be a better world in which to live. I am therefore not only proud of the Service but jealous to defend it. In this connection, I acknowledge the great traditions of, and the magnificent service rendered by, all sectors of the British medical profession, because without their service our great National Health Service could not be the success that it is.

I sincerely believe that the charges which have been made cause no fear in the minds of the majority of those who serve so admirably in our medical profession. I also believe that these people would welcome a public inquiry. The public certainly wants a full, impartial inquiry. The Secretary of State should think again, and do his duty. If he does not, people will know that eminent men in the medical profession have made these serious charges and that equally eminent men have said. "What you are saying about unauthorised experiments used to take place but no longer take place". Other eminent medical men are saying, "They have never happened and never will happen".

The public is worried and apprehensive. If the Secretary of State does not order a full inquiry the next question everyone will ask is, "Why will not the Secretary of State hold an inquiry? Who is he shielding?" More consternation will be caused. The medical profession, all those employed in the National Health Service, and the general public, would welcome a full inquiry. It may well be that none of the things alleged happened. On the other hand, it may be that they did happen, but will not happen again. Whether or not they occurred, the issue has become of such primary importance to the National Health Service and the general public that the Secretary of State has no alternative but to accede to my request and order a full public inquiry.

10.15 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

The House will be glad that the hon. Member for Ealing, North (Mr. Molloy) has succeeded in raising a matter of considerable public concern. I must defend my right hon. Friend the Secretary of State. I think the hon. Gentleman knows that it is customary for Parliamentary Secretaries and Under-Secretaries to deal with Adjournment debates. My right hon. Friend has additional Government business to which he is attending elsewhere. I can assure the hon. Gentleman that my right hon. Friend not only has been aware that this matter was to be raised but will read very carefully everything that the hon. Gentleman has said.

It is right that we should all be concerned, when allegations are made that unauthorised experiments have been carried out on hospital patients, for such allegations, if substantiated, as the House will readily appreciate, would pose a threat to the very foundations of the practice of medicine namely, the relationship between patient and doctor based, on the one hand, upon trust and confidence and, on the other hand, upon responsibility.

The hon. Member has referred to incidents to which publicity has recently been given. The House will recall the public concern which was again aroused when reports were published in the Press that cancer patients in an American hospital at the University of Cincinnati Medical College had been exposed to radiation doses in excess of that ordinarily regarded as appropriate to their clinical condition. The reports alleged that this was carried out without the consent of the patients concerned—who were said to be mainly paupers or deprived citizens—and that the purpose was related to a research programme sponsored by the United States Department of Defense.

The House will not expect me to comment on this situation, which is a matter for the responsible authorities in the United States. It is, however, another matter when it is alleged, or the inference is drawn, that similar practices take place in hospitals in this country. I wish to make it perfectly clear that such a situation, whether true or not, as reported in the United States, is without parallel in the United Kingdom. The medical profession in this country has for generations been guided by a very strict code of ethical conduct in these matters. I am glad the hon. Gentleman has seen fit to pay tribute to the integrity of our medical profession. I will deal with this ethical code in more detail in a minute. Suffice it to say that there are significant differences in ethical practice here compared with the United States. An eminent American authority on ethics in clinical research, Professor Beecher of the Harvard Medical School, has argued in favour of British ethical practice, which, for example, does not permit—I stress this—research on mentally subnormal patients and children where true consent cannot be obtained.

The House will be aware—the hon. Gentleman has properly referred to it— of the allegations made by Dr. Maurice Pappworth in a B.B.C. broadcast when commenting on these very American incidents, that patients suffering from cancer in the Hammersmith and Royal Free Hospitals had been subjected without consent to experimental tests for liver disorders. As my right hon. Friend the Secretary of State for Social Services has already pointed out in answer to hon. Members' questions, these allegations were promptly and vigorously denied by the hospital authorities concerned. Moreover, the author of the allegations, whose sincerity I obviously do not question, has, I understand, not been prepared to support them with specific evidence. Certainly I can say that my Department has not been supplied with any such evidence. Other allegations have been made and denied, but again no evidence has been forthcoming.

Thus as matters now stand, public concern has been aroused, first, as a result of events which took place in the United States and which, as I have said, are not paralleled here, and, secondly, by allegations of similar practices in this country which are as yet both unsubstantiated and vigorously denied. In spite of this situation, the concern which the hon. Member has expressed is, I assure the House, shared by my right hon. Friend the Secretary of State, by myself, by my Department and by the whole medical profession.

My Department has always held the view that the treatment of patients in hospital is primarily the concern of the doctor responsible for the patients' care and that he must be free to exercise his clinical judgment in the best interests of his patient. He is, of course, able to call upon further specialist advice where the circumstances require it. The House will recognise that clinical practice is not in a static situation—goodness knows where we should be today if it were— and that without experimentation and trial of new therapeutic procedures and substances the frontiers of knowledge would not have advanced as rapidly as they have and thousands upon thousands of patients would not have recovered their health or benefited from an improvement in the quality of their life. There are, therefore, occasions when new therapeutic procedures and investigations are used. The important issue is that their use should at all times be subject to a proper regard to the ethical issues and to the rights of the individual patient.

Furthermore, it is not enough to claim that ethical considerations can subsequently be justified by a favourable result. As an authority no less than Lord Cohen of Birkenhead, President of the General Medical Council, puts it: … the fact that there is a post hoc justification for an experiment does not justify it. An experiment is ethical, or not, at its inception, and the end cannot justify the means. In considering these important ethical questions it is necessary to draw a distinction between procedures which are undertaken for the benefit of the individual patient and those which are undertaken on patients or healthy subjects for the purposes of contributing to medical knowledge and which may not necessarily be designed for the benefit of the individuals concerned.

The first instance falls within the accepted relationship between doctor and patient. Implicit in that relationship is the willingness of the patient to be guided by his doctor. In exercising his judgment, the doctor must, of course, be quite satisfied that there are reasonable grounds for believing that his patient will benefit from the procedure he proposes. Where that procedure is novel, doctors are enjoined to exercise special care, and it is regarded as consistent with good medical practice that the patient's consent should be obtained before such procedures are used.

In the second case the ethical considerations are difficult and even more important and have been recognised as such by the professional bodies who have issued comprehensive advice and guidance to members of the profession. The main principle underlying this guidance is that the subjects of such investigations must be volunteers in every sense; that is to say, they must freely consent with a proper understanding of the nature and consequence of what is proposed.

The profession's attitude to ethical matters has, in my view, been responsible in every way. The doctrine is contained in two reports, one published by the Medical Research Council in 1963, "Responsibility in Investigation on Human Subjects", and the other in 1967 by the Royal College of Physicians in London," Supervision of the Ethics of Clinical Investigation in Institutions." My Department has circulated copies of both these reports to all hospital authorities in England and Wales, which were asked to ensure that they were brought to the attention of all hospital doctors.

The second report recommended that in hospitals where clinical investigations were carried out, committees including doctors with experience of clinical investigation should be set up to ensure that all such investigations were ethical and conducted with the optimum technical skill and precautions for safety. Hospital authorities were asked by the then Secretary of State to take steps to ensure that this recommendation was put into effect.

The Royal College of Physicians itself last year conducted a follow-up survey, the results of which indicated that nearly all teaching hospitals, where the bulk of clinical investigation takes place, had established active and functioning ethical committees. The information obtained was, however, not complete and my Department is therefore making its own inquiries of hospital authorities in England—the results of which I shall be happy to make known to the hon. Member as soon as they are available—about progress in establishing these ethical committees.

From what I have said, I hope the hon. Member and the House will be assured that the interests of patients are safeguarded by the code of conduct which the professional bodies have themselves evolved in keeping with their traditions and which both they and my Department keep under review. Codes of conduct are, however, by no means the only constraint operating upon professionals working in the research field. In the first place, such codes do not infringe upon or alter the protection which the law affords to the individual citizen. Also, the disciplinary machinery of the General Medical Council can be invoked where evidence is available which might substantiate a charge of serious professional misconduct.

The Medical Research Council, which sponsors and funds a major part of clinical research, does everything in its power to ensure that the projects it supports are ethically properly conceived and that the practice of those engaged on a sponsored project" is unexceptionable and known to be so."

Mr. Molloy

I am not complaining that the codes of conduct are failing; my complaint is that they have possibly been abused.

Mr. Alison

I return to the point I made earlier, that allegations must be substantiated. I am sure that the hon. Gentleman will agree that the capacity simply to make an unsubstantiated allegation cannot be a ground upon which all the apparatus of public scrutiny and investigation is brought into play, very often to the grave detriment of the standing of an innocent party who is made the subject of groundless and baseless allegations. They must be substantiated on the ground of sound evidence, which has been lacking in the cases brought to our attention so far.

A further responsibility is laid upon the editors of medical journals in this country to ensure that in publications on clinical research it must remain unmistakably clear that the proprieties have been observed. I think that the hon. Gentleman will find that in most of the professional medical journals this is carried out.

The House will no doubt appreciate that medical science, like other sciences, cannot be precise when the frontiers of human knowledge are being explored. Whatever safeguards are enshrined in codes of ethical conduct, cases are bound to come to light from time to time which leave room for doubt whether the conduct of a particular case has been ethically correct. There may also be room for differences of opinion amongst professional men as to whether a procedure is justified in the particular case, and the hon. Gentleman has certainly drawn attention to this. Many of the allegations made are based upon a disagreement among the professionals as to whether it is in the interest of a particular patient that an experiment be made.

There can be no room for doubt. however, that the informed consent of patients must be properly obtained whenever the procedure is not directly for the benefit of the patient concerned and, even when it is, doctors are generally expected, as I have said, to obtain similar consent where the procedure proposed is not in accordance with regular therapeutic practice. I can readily assure the hon. Member and the House that my right hon. Friend the Secretary of State would undertake to investigate specific cases in which there is prima facie evidence of a failure to observe the ethical requirements I have mentioned. To undertake a general inquiry into ethical matters would not, however, in our view, be appropriate in the absence of any evidence to support the view that the mechanisms evolved by the profession and commended by my Department are not working satisfactorily.

The hon. Gentleman made a very powerful plea for a general inquiry. As I have said, it would not be proper in the circumstances to initiate any such inquiry. We remain firmly satisfied that the allegations made, as rebutted by the hospitals concerned, are not based upon sound evidence. We remain willing and anxious, indeed, to carry out specific investigations into any cases in which hard evidence is adduced of misconduct or of a breach of the established ethical codes, but so far none of these points has been raised.

Dr. Tom Stuttaford (Norwich, South)

Would my hon. Friend agree that many of these allegations date from stories and rumours which are now out of date by a very long way? Many of these stories originated in the late 1950s and early 1960s and the code of ethical practice has eradicated practices which may be suspect.

Mr. Alison

My hon. Friend has made an important point. Dr. Pappworth's substantial work in this connection cites a large number of cases which date back a good deal earlier than 1963, when the Medical Research Council's evidence was first produced.

Mr. Molloy

With respect, one eminent man in the medical profession admitted that this used to happen but said that it has stopped now.

Mr. Alison

The hon. Gentleman must bear in mind that the Medical Research Council has established this guiding line on the ethical code from 1963 onwards and that it is the present and the recent past about which we can have considerable equanimity.

Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.