Mark Attiah | The fruits of forbidden knowledge

During World War II, German scientists conducted a series of horrific experiments on prisoners in concentration camps designed to find out how well the human body can tolerate extreme cold. Naked prisoners were immersed in ice water. Many died agonizing deaths, but not before the scientists found that individuals died much faster when their necks were submerged in the frigid water. As a result, the scientists developed a flotation device, worn like a vest, that keeps the wearer’s neck above water. Sound familiar? It should — if you’ve ever been kayaking, canoeing, jetskiing or the like, there is a good chance that you owe your life to Nazi science.

You aren’t supposed to be elated about this. So-called “forbidden knowledge” is a dilemma that has troubled researchers and ethicists for years. If knowledge is obtained in an unethical way, what should we do with it? Is it to be kept under lock and key, emblazoned with a skull and crossbones and hidden away in a dark underground vault as fodder for conspiracy theories and Dan Brown novels? Some would say yes, but recent history sees things differently. Medical textbooks and journals are rife with information based on unethical experiments. Your life jacket is proof.

So who decides what is on- and off-limits? Are there really some things that ethics dictate we’ll just never know?

Earlier this month, the Presidential Commission for the Study of Bioethical Issues — headed by Penn President Amy Gutmann — published a report detailing how American researchers deliberately infected Guatemalan prisoners with syphilis in the 1940s. What if her report had included the tidbit that a good deal of what we know about the progression of syphilis is thanks to this study? That would be beside the point. A situation like this demands an unconditional apology, and that apology should not include an expression of gratitude for any benefit that may have come from the ordeal.

But, as it seems, the government’s tacit stance on the issue is a utilitarian one — if the information benefits a large number of U.S. citizens, then we should use it. Consider the story that The Guardian uncovered last month. In the run-up to the operation that killed Osama bin Laden, the Central Intelligence Agency conducted a false vaccination drive in Abbotabad, Pakistan, where he was ultimately found. The drive enlisted the help of a local doctor and nurses with the ultimate goal of gathering DNA from bin Laden’s family members. Nurses delivered Hepatitis B vaccinations to the populace while aiming to gather evidence that bin Laden’s family was in the area. Of course, deception and secrecy would have been key to the operation’s success. Like the use of “enhanced interrogation techniques” on enemy combatants in secret prisons, measures with dubious ethics are necessitated by the circumstances. According to the government, the ends here justify the means. We got bin Laden, didn’t we?

The means, though, come with a real cost, apart from just losing moral capital. If the well-being of that region is of any importance, then so is its health. Trust in Western medicine in developing countries like Pakistan is hard to come by. By tricking the people in this way, the CIA has undermined the public’s trust in any legitimate public health initiatives in the near future. If there is another vaccination drive in the area, how many people might not participate for fear of the whole thing being another conspiracy by the American government? For community health initiatives like this to work, there needs to be a fundamental belief that healthcare providers are looking out for the people’s best interest. Instead, the doctor who was in league with the CIA is now under arrest.

It may sound like blasphemy to a reader affiliated with an institution like Penn to hear that there are some things that we just shouldn’t know. But if the methods for getting that information lead to a counterproductive compromise of trust in healthcare providers, then — as much as it hurts me to say it — staying painfully ignorant is the better option.

Mark Attiah is a second-year medical student from Dallas, Texas. His email address is mattiah@mail.med.upenn.edu. Truth Be Told appears every other Thursday.

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