RUNNING HEAD: ETHICAL IMPLICATIONS FOR SKID ROW STUDY

The Ethical Implications for The Skid Row Study

University of the Southern Caribbean

THE SKID ROW STUDY 2

Abstract

This paper takes an expansive look into the research conducted during the 1950s and 60s, by

Dr. Perry Hudson of the John Hopkins University. This study, labeled ‘The Skid Row Study’,

involved over one thousand and two hundred homeless men, who were mainly alcoholics,

mentally insane or physically ill. These men were selected as the ‘guinea pigs’ for cancer

research, which, under the estimation of Dr. Hudson and his associates, would have provided

a break through in the area of prostate cancer treatment in men. However, this research

proved inconclusive and infringed on many of the rights of the participants and gained much

scrutiny as it was deemed as a flawed study underpinned with much unethical processes.

Many researchers and institutions have ridiculed this study and the methods by which the test

subjects were acquired and have sought to enforce the policies that guide research. This paper

captures the deviations from such policies in The Skid Row Study and seeks to reinforce the

importance of transparency in conducting research and experiments that involve living

subjects, especially when those subjects are human beings.

THE SKID ROW STUDY 3

Ethics is derived from the Greek word etikos or ethos, meaning habit, custom, character or

disposition (Dictionary.com). As a branch of philosophy, this code of thinking and behavior

is governed by a combination of personal, moral, legal, and social standards of what is right

(Internet Encyclopedia of Philosophy). Although what is deemed appropriate varies

significantly among cultures and even according to situations, ethics, in the context of a

society, is guided by tenets of religions, philosophies and cultures. The goals of ethical

principles include beneficence, non-maleficence, respect for autonomy, fairness, truthfulness

and justice. Hence, an ethical issue arises when an individual or organization is compelled to

choose that which is morally acceptable or that which is wrong (Businessdictionary.com).

Such controversial issues include euthanasia, abortion, capital punishment, ethics of war,

animal ethics, torture and medical research.

The origin of modern research ethics began with an intention to protect human

subjects involved in research projects. The first attempt to formulate regulations began during

the Doctors Trial of 1946-1947. To prosecute the accused Nazi doctors for the atrocities they

committed during World War II, a list of ethical guidelines for the conduct of research – the

Nuremberg Code– were developed. Out of the Nuremberg Code came the Helsinki

Declaration, which was developed by the World Medical Association and has been revised

and updated periodically since 1964, with the last update occurring in 2000 (Claremont

Graduate University).

The Skid Row Cancer Study is one such case of unethical medical research. Dr. Perry

Hudson, a trained urologist at John Hopkins University and a medical researcher at Columbia

University, spearheaded this research during the 1950s and ‘60s. Hudson, then 33 years old,

was also the head of urology at The Delafield Hospital—a public facility for cancer patients

in New York. During this epoch, prostate cancer was usually detected in its final stages and

was almost always fatal. Hudson opined that the early detection and treatment of this disease
THE SKID ROW STUDY 4

would definitely save lives. This was certainly an ambitious undertaking. At that time, one of

his patients- a former Princeton history professor- was an alcoholic, living on the streets of

the Bowery community in Lower Manhattan, New York. This made it easy for Hudson to

gain access to the homeless males in that area. He used over 1, 200 ‘skid row’ alcoholics for

to conduct his study (Glasshospital.com- The Long Arm of Medical Ethics- Skid Row

Study). Hudson’s approach, however, was deemed unethical on several grounds.

It is imperative that researchers consider the ethical implications and psychological

consequences for the participants in their research. The essential tenet is that the investigation

should be viewed from the stance of all participants; predictable threats to their psychological

well-being, health, values or dignity should altogether be eliminated. Hudson erred by

choosing a vulnerable population. Allan Brandt, a Harvard medical historian who wrote

extensively on the Tuskegee experiment, avers, “The invasiveness of this particular research

was really horrendous.” (New York Times, 2013) Dr. Robert Aronowitz posits, “Hudson

used Bowery men because only desperate, poor, and unknowing men would participate… It

was unimaginable that the average American man would volunteer.” (Ibid)

The participants who agreed to the biopsies were offered clean beds, three square

meals and free medical attention, if they were indeed diagnosed with prostate cancer. There

was an element of bribery, however; as Elmer Bendiner, author of The Bowery Man notes,

“Once a man chosen for the study was persuaded to volunteer, the authorities lifted his meal

ticket and returned it only when he had kept his appointment.”(New York Times, 2013)

Hudson insisted that he informed the subjects about the risk of infection from the

surgical procedure performed; however, the participants were not informed of all the possible

dangers (Glasshospital.com, 2013). In addition, investigators are supposed to ensure that

participants receive any necessary debriefing in the form of active intervention before they

leave the research setting. Hudson, along with his team of researchers, took wedge-shaped
THE SKID ROW STUDY 5

biopsies of the men’s prostate glands by making incisions in their rectums. These subjects,

however, were not fully informed of the side effects of this procedure. These included life-

threatening infections from rectal tears, impotence, loss of muscle tone and stamina, as well

as incontinence.

Furthermore, Hudson never informed his subjects that the surgery for prostate cancer,

which involved the removal of the prostate gland and often the testicles, was not guaranteed

to lengthen their life span. Approximately one hundred men were diagnosed with prostate

cancer and were treated with estrogen. This augmented their risks of heart attacks and

strokes. After the study was completed, Hudson and his team failed to debrief these

participants. Indubitably, this shows that there was a gross level of deception in conducting

this research.

In terms of moral responsibility, investigators must ensure the ethical treatment of

research participants with their collaborators, assistants, students and employees. In this

study, neither Hudson’s academic peers nor the federal officials overseeing his grants

criticized his ethics although they knew about the nature of his research. Like the Tuskegee

Syphilis experiment, the highest medical officials in the United States government endorsed

this. Dr. William Parry, urologist at the University of Rochester during that period, notes that

Dr. Hudson’s colleagues did not question his use of destitute men with alcoholism, some of

them mentally ill, or his failure to carefully inform them of the potential risks of his research.

(New York Times, 2013)

The design of Hudson’s study is also questionable. Hudson failed to establish a

control group with males who did not receive biopsies and treatment. Hence, there was no

means of truly determining whether the men who underwent surgery and treatment actually

lived longer. Although the goal of Hudson’s study was ambitious, the results obtained are not

reliable.
THE SKID ROW STUDY 6

Despite this botched experiment, there is a greater level of awareness of prostate

cancer among today’s men. The need for screening is also emphasized. As unfortunate as this

study turned out, it underscored the risks involved in screening. In light of Hudson’s study,

The Times notes:

A federal panel of experts recommended in 2011 that men no longer get the P.S.A.
blood test to screen for prostate cancer because clinical trials had found that the test’s
benefits are uncertain and its risks — treatments that needlessly cause incontinence
and impotence — are severe….But many urologists believe screening saves lives, and
the American Urological Association recommends that men consider starting it at age
55…Ethical tragedies are difficult to recognize in the present…Future observers may
view the massive evidence-challenged expansion of our screen-and-treat paradigm in
prostate cancer in the same way as we now view the Bowery series practices.
(Glasshopital.com, 2013)

Despite Hudson’s unethical approach, many American men now get screened for

prostate cancer annually and thousands of them still undergo biopsies. This early detection

has saved thousands of lives and will continue to do so in the future. Does this mean that the

unethical approach is justified? The answer repeats as a resounding no! If Dr. Hudson had

followed the code of ethics and possessed an element of morality, his motives would have not

been questioned and the results of his study would have possibly provided quicker aid to

many men who suffered with this fatal condition after the 1950s. Dr. Hudson fell short in tow

main areas. Firstly, he was not transparent with the victims and did not provide all the

information, including long-term effects of the study, so that the consent given was one given

based on complete awareness. Secondly, although this research, proved to be of benefit to

many years later, the aspect of no maleficence was clearly not considered, as the doctor knew

without a doubt of the harm it would cause to the test subjects. And when this harm was

caused, there was no follow up care provided to the subjects after the study. It seemed that

the ends justified the means for Dr. Hudson.

THE SKID ROW STUDY 7

Today, there are many studies coming to the light that proved unethical. As recent as

February 2015, the study involving Guatemalans being injected with STDs in the 1950s was

unraveled and made public. The institutions involved are denying accountability and are

ready to fight these accusations in the courts. When will human life be valued above the quest

for knowledge or should we be satisfied to sacrifice a few for the benefit of the wider

population? As our world is becoming more ill, what unethical studies are being carried out

now on us, especially those that are considered to be irrelevant and insignificant? As we

continue to thirst for knowledge and as we grow hungrier for answers and as survival

becomes more a daily challenge, will our ethical code be forced to change? Will our morality

be even more tested? And ultimately who determines the code of ethic and morality for a

world that has more questions than answers?

I propose one easy solution, the golden rule, which proves itself to be timeless – ‘do

unto others, as you would have them do unto you’. This, to me, encapsulates the question of

ethics, morality and humanity. Let’s continue to find solutions to our problems, but let’s do it

together being fully accountable to and for each other.

THE SKID ROW STUDY 8

References

Dictionary.com (2015) Ethics. Retrieved from http://dictionary.reference.com/browse/ethics?

s=t

Fieser J. (n.d.). Ethics. Retrieved from http://www.iep.utm.edu/ethics/

Kolata, G. (2013). Decades later, condemnation for a skid row cancer study. Retrieved from

http://www.nytimes.com/2013/10/18/health/medical-experiments-conducted-on-

bowery-alcoholics-in-1950s.html?_r=1

Glasshospital (2013). The long arm of medical ethics. Retrieved from

http://glasshospital.com/2013/10/27/the-long-arm-of-medical-ethics/

Claremont Graduate University (2015). History of ethics. Retrieved from

http://www.cgu.edu/pages/1722.asp