Milgram is not Tuskegee

My IRB requires me to take a course on human subjects research every couple of years. The course, offered by the Collaborative Institutional Training Initiative (CITI), mostly deals with details of federal research regulations covering human subjects research.

However the first module is titled “History and Ethics” and purports to give an overview and background of why such regulations exist. It contains several historical inaccuracies and distortions, including attempts to equate the Milgram obedience studies with Nazi medical experiments and the Tuskegee syphilis study. I just sent the following letter to the CITI co-founders in the hopes that they will correct their presentation:

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Dear Dr. Braunschweiger and Ms. Hansen:

I just completed the CITI course, which is mandated by my IRB. I am writing to strongly object to the way the research of Stanley Milgram and others was presented in the “History and Ethics” module.

The module begins by stating that modern regulations “were driven by scandals in both biomedical and social/behavioral research.” It goes on to list events whose “aftermath” led to the formation of the modern IRB system. The subsection for biomedical research lists Nazi medical experiments and the PHS Tuskegee Syphilis study. The subsection for social/behavioral research lists what it calls “similar events,” including the Milgram obedience experiments, the Zimbardo/Stanford prison experiment, and several others.

The course makes no attempt to distinguish among the reasons why the various studies are relevant. They are all called “scandals,” described as “similar,” and presented in parallel. This is severely misleading.

Clearly, the Nazi experiments are morally abhorrent on their face. The Tuskegee study was also deeply unethical by modern standards and, most would argue, even by the standards of its day: it involved no informed consent, and after the discovery that penicillin was an effective treatment for syphilis, continuation of the experiment meant withholding a life-saving medical treatment.

But Milgram’s studies of obedience to authority are a much different case. His research predated the establishment of modern IRBs, but even by modern standards it was an ethical experiment, as the societal benefits from knowledge gained are a strong justification for the use of deception. Indeed, just this year a replication of Milgram’s study was published in the American Psychologist, the flagship journal of the American Psychological Association. The researcher, Jerry M. Burger of Santa Clara University, received permission from his IRB to conduct the replication. He made some adjustments to add further safeguards beyond what Milgram did — but these adjustments were only possible by knowing, in hindsight, the outcome of Milgram’s original experiments. (See: http://www.apa.org/journals/releases/amp641-1.pdf)

Thus, Tuskegee and Milgram are both relevant to modern thinking about research ethics, but for completely different reasons. Tuskegee is an example of a deeply flawed study that violated numerous ethical principles. By contrast, Milgram was an ethically sound study whose relevance to modern researchers is in the substance of its findings — to wit, that research subjects are more vulnerable than we might think to the influence of scientific and institutional authority. Yet in spite of these clear differences, the CITI course calls them all “scandals” and presents them in parallel, and alongside other ethically questionable studies, implying that they are all relevant in the same way.

(The parallelism implied with other studies on the list is problematic as well. Take for example the Stanford prison experiment. It would arguably not be approved by a modern IRB. But an important part of its modern relevance is that the researchers discontinued the study when they realized it was harming subjects — anticipating a central tenet of modern research ethics. This is in stark contrast to Tuskegee, where even after an effective treatment for syphilis was discovered, the researchers continued the study and never intervened on behalf of the subjects.)

In conclusion, I strongly urge you to revise your course. It appears that the module is trying to get across the point that biomedical research and social/behavioral research both require ethical standards and regulation — which is certainly true. But the histories, relevant issues, and ramifications are not the same. The attempt to create some sort of parallelism in the presentation (Tuskegee = Milgram? Nazis = Zimbardo?) is inaccurate and misguided, and does a disservice to the legacy of important social/behavioral research.

Sincerely,
Sanjay Srivastava

UPDATE: I got a response a day after I sent the letter. See this post: A very encouraging reply.

UPDATE 7/6/2011: Scratch that. Two years later, they haven’t changed a thing.