Foreword IN THIS ISSUE of the JOURNAL we are omitting the usual Medical Progress section to focus attention on one of the more important health issues of the m o m e n t - perhaps, from a long-range standpoint, the most important one. The question stated simply is: under what condition(s) and to what extent(s) is human experimentation for the furtherance of medical knowledge justified? The question applies solely to so-called nontherapeutic research, that which bears no relation to the illness of the individual who is being subjected to an investigational procedure and who is not expected to derive any direct objective benefit from it. There can be no doubt that answers to many medical questions can in the final analysis be derived only from definition of physiologic patterns and of their responses to foreign situations by direct investigation of human beings. No one should take issue with the policy that all possible information concerning a given problem should be obtained from carefully p l a n n e d i n a n i m a t e ("test tube") studies followed in turn by appropriate trials i n l a b o r a t o r y animals. But in the final analysis, for the solution of most problems that deal with human physiology, pathology, and therapy, the investigative model in man. The problem is compounded for pediatrics, because the subject is wholly or partially unable to understand the significance of the investigation or the risk to himself. For most thoughtful and responsible persons there should be no doubt that such research is vital to the continued improvement of medical care and to the quality of living itself. What are the answers? These will not come unless the issues and their significance are brought out in the open
with clarity and objectivity--not only for the medical profession but, even more importantly, for the nonmedical community. At a time when confidence in most of society's endeavors is at such low ebb, little can be hoped for except as this sense of distrust can be dispelled. The layman has the basic responsibility. He can respond appropriately only as he has complete confidence in the integrity of the medical profession. He must be confident that only those things in medical research will be done which are essential, which have the potential for improving health status, and which do not carry undue risks for the individual. Those of us whose interest and activities are devoted to improving the lot of children are in a peculiarly privileged position. Not only are we presumed to be the guides for the health supervision of children and hence in a position to inform and interpret for their parents the limitations of current medical practice, but we have an equally important opportunity to influence the child's development of a sense of responsibility for o t h e r s - - a sense of social consciousness. But the medical profession does need outside help; little hope may be had for real gains except as there is strong support from the clergy and from the legal profession. All of us must put our houses in order. It is not a hopeless task but within the current social milieu it looms as a Herculean one. It might even be one of the means to restore confidence in our social structure. W.E.N.
Vol. 84, No. 4, pp. 467-473