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89   It's Better to Prevent Abuses
     In Transplant Experiments
     The Washington Post  Saturday, March 16, 1968

     Dr. Christian Barnard, Prof. Arthur Kornberg and I were here
last week for a senate hearing on a bill to establish a national 
commission on the social impact of biology.  We agreed that such a 
commission might be beneficial  or harmful, depending on its terms 
of reference.

     A hurried formulation of far-reaching prescriptions would almost
certainly be regressive.  Biology and medicine are moving very rapidly
and have enormous potential benefits to offer in the prevention and 
treatment of disease and suffering.  Sounder public understanding of
this scientific revolution, and realistic insight into how it can
influence human life, are essential bases for developing public
policy.

     Inasmuch as the teaching of evolution and information about 
contraception are still subject to legal harassment in parts of the
United States, we still have far to go before rigidifying prevalent 
anxieties and attitudes.  The development of reliable channels for 
improving public understanding would be a major task for the commission.

     We were unanimous about the desirability of an educational,
rather than a regulatory, commission.  However (in the privacy of a TV
studio), Dr. Barnard and I did debate the end for some local 
surveillance of organ transplants.

     Taking to Dr. Barnard about this was like asking an honest man to
prove his credentials before cashing his check.  The proposal is not
a hostile criticism of pioneers like Dr. Barnard or Dr. Norman Shumway.
It is intended to protect the investigator by establishing a firm
commitment by his colleagues on the integrity of his purposes, the
utility of his investigations and the adequacy of his procedures in
securing the voluntary consent of the patients and subjects.  These
rules are, in fact, virtually the same as those already established
for research projects supported by the NIH where they involve 
experimentation on human subjects.

     Dr. Barnard believes that doctors are already entrusted with
grave responsibilities and that their ethical code is a sufficient
warranty of the public's interest in experimental procedures.  This
is undoubtedly true for him and for the majority of reputable 
physicians.  However, some physicians have, on their own initiative, 
acted less prudently.

     Any irresponsible worker could easily evoke violent public 
reaction against medical experimentation in general. After abuses are   
publicized, ever more intrusive  machinery would be invoked if a 
tradition of effective professional surveillance were not previously
established.  

     The existing system of medical ethics is effective, but not 
perfect. Patients can still be exploited by surgeons who urge 
unnecessary tonsillectomies and appendectomies.  Flagrant abuses are 
becoming rarer and cases like these are not so outrageous that we need 
an elaborate system to police them before the fact.  However, in the  
field of organ transplantation, and other sensitive, major medical 
experiments, we need to maintain a consistent effort to prevent abuses 
before they happen and excite public ire.

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