Biographical Sketch: Dr. Everett Mendelsohn

A.B., Antioch College, 1953; Ph. D., Harvard University, 1960.

Member, Editorial Board of "Science" magazine, Editor, "Journal of the History of Biology".

Assistant Professor, History of Science, Harvard University, 1961-65; Associate Professor, History of Science, Harvard University, 1965; Research Associate, University Program on Technology and Society; Director of Research Groups on the Biomedical Sciences.

Senator HARRIS. Dr. Mendelsohn, you have a prepared statement. You may read it or proceed however you desire.

STATEMENT OF DR. EVERETT MENDELSOHN, ASSOCIATE PROFESSOR, HISTORY OF SCIENCE, HARVARD UNIVERSITY, CAMBRIDGE, MASS.

Dr. MENDELSOHN. Thank you, Mr. Chairman. I would like to support the establishment of a National Commission on Health, Science, and Society as proposed by Mr. Mondale in Senate Joint Resolution 145. I feel that there is a clear need for a much deeper understanding of the social implications of the advances currently being made and those in prospect for the biomedical sciences. It seems important that every effort be taken to anticipate the policy implications of new discoveries in the biomedical sciences, rather than to be forced to attempt remedial action after the fact.

As a historian of the biomedical sciences, I have come to recognize that the increasingly rapid rate of scientific discovery and the vastly increased amount of science available for human use and misuse have given to science a new relevance to the daily life of our society.

The process that society goes through in adjusting to scientific advance the socialization of science-has traditionally been a rather slow and rather leisurely process, indeed more often than not, an acci dental process.

Societies could afford to accept this haphazard manner of responding to scientific advance only so long as science remained in large measure irrelevant to the well-being of the citizens. I would contend that no society can any longer afford this leisurely process of adopting to scientific and technological advance, but that society must instead anticipate and plan for the social integration of new discoveries.

Procedures must be established so that the balance of risks and opportunities created by the advance of science may be examined and weighed prior to any unexpected or abnormal effects being felt. This, of course, is true for all of science but I believe it is especially necessary for the biomedical sciences. The biological life of individuals and of societies consists of so many irreversible processes that great care must be exercised in advance so as to avoid mistake. Many of the most exciting advances in the biomedical field have been brought about through the understanding gained in the scientific laboratory of the underlying or fundamental processes of living systems. One thinks immediately of the important work in molecular genetics and of the challenging advances in the area of modification and manipulation of behavior using chemical, electrical, and psychological means..

Many metabolic diseases have been identified and brought under control through the scientific understanding of basic metabolic

processes of the living body. Medicine has then developed a great debt to the basic sciences and there seems little doubt but that research in the future will increase that indebtedness even more.

But medicine has not, historically, always relied on fundamental scientific advances coming from the scientific laboratory. This is at fairly recent occurrence, dating from the mid-19th century, if not later, and this interaction between science and medicine, which has been so fruitful in many areas has also raised serious questions about the conduct of research in medicine.

Physicians have always carried out research of one sort or another, being continually on the lookout for new cures for diseases and new techniques for binding wounds. But experimentation, as we have come to know it in science, is not historically a natural outgrowth of medicine. The research that the physician carried out always had as its major goal the direct application of some therapeutic procedure to the patient upon whom the procedure was being tried out.

The physician regularly operated under the assumption that the only trials which you would ask a patient to undergo would be those which had some real probability of result in indirect and beneficial aid to the patient at hand. The therapeutic goal was therefore the governing one for medicine. The ideal of scientific research, however, although it may be aimed at securing some human benefit, has as its immediate task the finding of new knowledge.

This new knowledge may or may not have immediate further usefulness. The design of the scientific experiment would differ quite markedly then from the design that a physician would have used with his patient's benefit as the immediate concern. The subject of an experiment in science might not be the one to gain from the results of the research being carried out.

Indeed, scientific research procedures generally require that a control be established; that is, a group not receiving the new therapy or not having the new technique tried out upon them, for only in this way can it be determined whether those undergoing the tests are indeed being affected by the new substance or new process.

As medicine has come to depend more directly upon the basic sciences and as medical experimentation has come to take up many of the procedures of scientific experimentation serious questions have come to be raised about the role of the human being who becomes a subject in these experiments.

The problem of research and experimentation in the medical sciences becomes recognizable because of the enormous new scope of experi mentation caused by the increased willingness of our society to invest in research in the health fields. There is no doubt in my mind that medicine must continue to develop its experimental procedures and must continue to take advantage of all the benefits gained from fundamental scientific understanding of the human being, but it seems important that the design of medical experiments involving human beings be carefully scrutinized and indeed that procedures be established so that medical advance can be coupled with an increased awareness of the necessity to protect the subject in human experimentation. I should like to share with you some of the work we have done at Harvard during the past 2 years in a small group operating under the university program on technology and society. During the academic

year 1966-67 I served as director of that group and have been succeeded this current year by Prof. Seymour Kety.

Our aim has been to identify those advances now taking place and projected in biology and medicine which may confront our society with new problems and new potentialities. We have hoped that through our studies we might raise the level of discussion to a level beyond that which is generally characterized the inaugural address or the speech made at the dedication of a new laboratory.

To this end, we analyzed the existing literature in the field, surveyed expert opinion through interviewing scientists and others, and conducted five conferences aimed primarily at identifying the questions that most need asking as well as ascertaining the scientific state-ofthe-art in several fields.

The first conference, devoted to new medical technologies and the effect they had upon the organization and delivery of medical care, underscored the manner in which hospitals, originally established to care for the poor, have now become the centers for the distribution of a highly complex technical and scientific medicine. The new medical technologies have sharply undercut the traditional humane and psychological role of the family physician and while increasing the excellence of the medical attention being given, have raised questions about the overall quality of patient care. Are these questions significant ones or are they mere nostalgia and sentimentality?

The automated hospital of the near future seems sure to make medical treatment more impersonal and mechanical. The question remains however, as to how important a role human considerations and human interactions play in the healing process.

New technologies in medicine and information handling coupled with those advances made in the areas of medicine which affect the population at large everything from vaccines to contraceptiveshave projected the health professions into the position of having to consider public or community health. Is the medical profession ready to become active and assume responsibility in fields traditionally left to public authority, that is, preventive medicine for the general public, delivery of health care to the indigent and underprivileged, and for anticipating hazards to health which might arise from such causes as sonic boom or environmental pollution?

If medicine is to move its focus from the individual patient to the population as a whole, new modes of policy establishment and decisionmaking will need to be established so that the biomedical profession works in closer collaboration with technological innovators in other areas and with the decisionmakers and lawmakers at all levels of society and government.

A second conference dealt with biological and social aspects of aging. The biologists and medical men were unable to agree as to whether aging was a natural process of deterioration or whether it had to be viewed as a pathological process which could be arrested or reversed were the pathology to be understood.

Similarly, the social process of aging seemed in many ways to be dependent upon the attitudes of the public toward the nature of death and the functions which it is believed that the aged in a society can fulfill. The major contribution of science in this field to date has been to bring life expectancy closer to the biological normal life span.

This has been accomplished not through research upon the processes of aging but through the conquest of communicable and infectious diseases.

At this stage there seems little prospect that medical science is in position to extend the human life span for any significant number of people but the techniques now available for transplanting natural organs or implanting artificial organs thereby extending the life of individual patients already raise a taxing series of ethical, social and political questions.

The newspapers in recent days recording the successful and unsuccessful attempts at heart transplanting in human beings taken together with the longer history of kidney transplants and the implantation of artificial heart pumps and pacemakers face us now with such simple but really complex questions as who shall receive these new benefits of medicine shall they be reserved for the young or given to the aged? Who shall pay to receive the benefits of these new scientific capabilities shall they be reserved for the wealthy or shall society foot the bill?

Recognizing that each transplant operation is an expensive one benefiting a single individual, should medicine face the question of whether its efforts ought to be used in this area or should they be turned instead to other areas of biomedical research holding promise of help to a wider segment of the public?

Questions of this sort coming now with greater frequency and more urgency make us query whether the decisions are best made informally within the medical profession as has traditionally been the case, or whether broader and more formal procedures of decisionmaking are

necessary.

A third conference on the manipulation of behavior made amply clear that scientific investigation is now in progress in a wide number of fields which has as its aim the alteration and manipulation of human behavior, character and personality. The stuff of which "Brave New Worlds" are made is now the subject of serious investigation in scientific laboratories. The new advances are those making use of psychochemicals, electrodes implanted in the brain, and phychological conditioning. Some of the most striking results like those emerging from the laboratory of Prof. Jose Delgado at Yale University have been brought about by a combination of the very great experimental skill of Dr. Delgado and the availability of microminiature components which have come by way of other technological developments

Dr. Delgado has shown that an electrode introduced into the brain can with some high degree of probability be used to alter aggressive behavior via remote control signals. Incidentally, in human beings as well as in animals.

Others have demonstrated that psychochemical therapy can alter the behavior of a narcotics addict, or an alcoholic, while still other psychomimetic drugs have made it possible for schizophrenics to rejoin "normal" society.

One of our conferees from the legal profession queries us as to whether these new techniques of altering behavior might not be made available either voluntarily or nonvoluntarily so that the narcotics addict, the alcoholic, or the potential criminal might be aided in returning to normal life?

Should the law make use of these therapeutic procedures as an alternative to jail or enlarged police force? Is involuntary control of antisocial behavior through medical means more or less acceptable than the invocation of police power?

The scientific advances which have taken place in many of the areas just mentioned give clear indication that some decisions are already upon us, and that society delays at its peril the investigation, the deliberation, and the public education necessary to make sound decisions concerning both the risks and the benefits which these new scientific advances make possible.

The ability to control and manipulate human behavior has always been greeted with ambivalance, with many people being repelled at the prospect and thereby perhaps overlooking the immediacy of some questions and the alternative answers that can be given. It seems clear to me that the scientists alone is not in a position to deal with the social issues arising from the increasing ability to manipulate and control behavior. This seems one area which could fruitfully benefit from concerted examination by a combination of biomedical scientists, legal scholars, and students of social behavior.

I should be careful to indicate at this stage that I do not believe that we are on the edge of an era in which some scheming individual or dictator can, through the misuse of science, control the behavior of a whole society. This is not the prospect which I see in the immediate future. Instead, I am pointing to the more limited ability to alter and manipulate the behavior of single individuals or small groups of individuals through the use of new techniques now being developed by science. It goes without saying that there have always been means to coerce and manipulate behavior, but it seems to me that the ones upon which science is now working deserve renewed attention.

A fourth conference dealt directly with the ethics of experimentation and innovation in the biomedical field. Several of the points which seemed of great importance have been outlined above in my discussion of the changing nature of experimentation in medicine and I will not repeat those here.

I would also point out that in the recent past this question has received renewed attention from several sources. A very excellent conference conducted by the American Academy of Arts and Sciences during the fall of 1967 brought into sharp focus some of the aggravating problems as well as some of the steps taken to deal with the situation. The papers presented at that conference and the discussion are soon to be published in a special issue of Daedelus, the journal of the American Academy of Arts and Sciences.

In the fifth conference we examined the social response to biomedical discoveries and recognized that the manner in which society responds to new scientific discovery varies widely from the rational and logical to the irrational and illogical. One need only look at the public response to the scientific evidence concerning the harmful effects of cigarette smoking and of air and water pollution to recognize that scientific understanding is not the same as public acceptance and action. Are there means by which a society can organize itself and edu cate itself to make more fruitful use of the products of the scientific laboratory?

There is another response to scientific discovery which I would characterize as being "overlogical." It involves the rush to premature legis