self-experimentation in medicine self-experimentation in medicine self-experimentation refers to scientific experimentation in which the experimenter conducts the experiment on themself. often this means that the designer, operator, subject, analyst, and user or reporter of the experiment are all the same. self-experimentation has a long and well-documented history in medicine which continues to the present. some of these experiments have been very valuable and shed new and often unexpected insights into different areas of medicine. norman thagard self-experimenting aboard the space shuttle. he conducted physiological experiments on personnel during the sts-7 mission. there are many motivations for self-experiment. these include the wish to get results quickly and avoid the need for a formal organisational structure, to take the ethical stance of taking the same risk as volunteers, or just a desire to do good for humanity. other ethical issues include whether a researcher should self-experiment because another volunteer would not get the same benefit as the researcher will get, and the question of whether informed consent of a volunteer can truly be given by those outside a research program. a number of distinguished scientists have undertaken self-experimentation, including at least five nobel laureates; in several cases, the prize was awarded for findings the self-experimentation made possible. many experiments were dangerous; various people exposed themselves to pathogenic, toxic or radioactive materials. some self-experimenters, like jesse lazear and daniel alcides carrión, died in the course of their research. notable examples of self-researchers occur in many fields; infectious disease (jesse lazear: yellow fever, max von pettenkofer: cholera), vaccine research and development (daniel zagury: aids, tim friede: snakebite), cancer (nicholas senn, jean-louis-marc alibert), blood (karl landsteiner, william j. harrington), and pharmacology (albert hofmann, and many many others). research has not been limited to disease and drugs. john stapp tested the limits of human deceleration, humphry davy breathed nitrous oxide, and nicholas senn pumped hydrogen into his gastrointestinal tract to test the utility of the method for diagnosing perforations. definition there is no formal definition of what constitutes self-experimentation. a strict definition might limit it to cases where there is a single-subject experiment and the experimenter performs the procedure on himself. a looser definition might include cases where the experimenters put themselves amongst the volunteers for the experiment. according to s. c. gandevia of the university of new south wales, who was looking at the question from the perspective of ethics, it is only self-experiment if the would-be self-experimenter would be named as an author on any subsequent published paper. that is, the person who would receive the academic credit for the experiment must also be the subject of it.: 44 motivations dr. herta oberheuser being sentenced at nuremberg there are many reasons experimenters decide to self-test, but amongst the most fundamental is the ethical principle that the experimenter should not subject the participants in the experiment to any procedure they would not be willing to undertake themselves. this idea was first codified in the nuremberg code in 1947, which was a result of the trials of nazi doctors at the nuremberg trials accused of murdering and torturing victims in valueless experiments. several of these doctors were hanged. point five of the nuremberg code requires that no experiment should be conducted that is dangerous to the subjects unless the experimenters themselves also take part. the nuremberg code has influenced medical experiment codes of practice around the world, as has the exposure of experiments that have since failed to follow it such as the notorious tuskegee syphilis experiment.: xv–xvii critics of self-experimenters point to other less savoury motivations such as simple self-aggrandisement.: xiii some scientists have resorted to self-experiment to avoid the "red tape" of seeking permission from the relevant ethics committee of their institution. werner forssmann was so determined to proceed with his self-experiment that he continued with it even after permission had been denied. he was twice dismissed for this activity, but the importance of his work was eventually recognised in a nobel prize. some researchers, apparently, even believe that self-experimentation is not permitted. however, this is not true, at least in the united states where the same rules apply regardless of who the subject of the experiment is.: xv, xx self-experimentation is also criticised for the risk of over-enthusiastic researchers, eager to prove a point, not accurately noting the results. against this it is argued by those supporting self-experiment that medically trained persons are in a better position to understand and record symptoms, and self-experiment is usually at the very early stage of a program before volunteers have been recruited.: xiv a wish to commit suicide is sometimes offered as a reason for self-experimentation. however, lawrence k. altman, author of who goes first?: the story of self-experimentation in medicine, while acknowledging that this may sometimes occur, after extensive research could find only one verified case of attempted suicide by self-experimentation. this was nobel prize winner élie metchnikoff, who, in 1881, suffering from depression, injected himself with relapsing fever. this was his second suicide attempt, but according to his wife, olga, he chose this method of death so that it would be of benefit to medicine. however, metchnikoff survived and in 1892 also self-experimented with cholera, but this is not thought to have been a suicide attempt.: 311–312 perhaps the noblest motivation is the simple altruistic desire to do something of benefit to humanity regardless of the risks. there most certainly are risks, as jesse lazear found to his cost when he died of yellow fever after deliberately infecting himself. max von pettenkofer, after ingesting cholera bacteria said:even if i had deceived myself and the experiment endangered my life, i would have looked death quietly in the eye for mine would have been no foolish or cowardly suicide; i would have died in the service of science like a soldier on the field of honor.: 25 — max von pettenkofer according to ian kerridge, professor of bioethics at the university of sydney, the most common reason for undertaking self-experimentation is not so much anything noble, but rather "an insatiable scientific curiosity and a need to participate closely in their own research". ethics as already mentioned, it is an ethical principle that the researcher should not inflict on volunteers anything that the researcher would not be willing to do to him- or herself, but the researcher is not always a suitable, or even possible, subject for the experiment. for instance, the researcher may be the wrong gender if the research is into hormone treatment for women, or may be too old, or too young. the ethical question for the researchers is would they agree to the experiment if they were in the same position as the volunteers?: 311 another issue that can lead researchers not to take part is whether the researcher would stand to gain any benefit from taking part in the experiment. it is an ethical principle that volunteers must stand to gain some benefit from the research, even if that is only a remote future possibility of treatment being found for a disease that they only have a small chance of contracting. tests on experimental drugs are sometimes conducted on sufferers of an untreatable condition. if the researcher does not have that condition then there can be no possible benefit to them personally. for instance, ronald c. desrosiers in responding to why he did not test an aids vaccine he was developing on himself said that he was not at risk of aids so could not possibly benefit.: xx against that, the early stages of testing a new drug are usually focused merely on the safety of the substance, rather than any benefits it may have. healthy individuals are required for this stage, not volunteers suffering from the target condition, so if the researcher is healthy, he or she is a potential candidate for testing.: xiv an issue peculiar to aids vaccine research is that the test will leave hiv antibodies in the volunteers blood, causing the person to show hiv positive when tested even if they have never been in contact with an hiv carrier. this could cause a number of social problems for the volunteers (including any self-testers) such as issues with life insurance.: xix the ethics of informed consent is relevant to self-experimentation. informed consent is the principle that the volunteers in the experiment should fully understand the procedure that is going to take place, be aware of all the risks involved, and give their consent to taking part in the experiment beforehand. the principle of informed consent was first enacted in the u.s. army's research into yellow fever in cuba in 1901. however, there was no general or official guidance at this time.: 43 that remained the case until the yellow fever program was referenced in the drafting of the nuremberg code.: xvi, 157 this was further developed in the declaration of helsinki in 1964 by the world medical association which has since become the foundation for ethics committees' guidelines.: 43–44 rosalyn yalow at the bronx va hospital in 1977 some researchers believe that experimental research is too complex for the general public ever to be able to give proper informed consent. one such researcher is eugene g. laforet, who believes that the researchers taking part in the experiment themselves is more valuable to the volunteers than a legal consent form. another is 1977 nobel prize winner rosalyn s. yalow who said "in our laboratory we always used ourselves because we are the only ones who can give truly informed consent.": 313–314 on the other side of the coin, there is the possibility that members of a research team may be coerced into participating by peer pressure.: 46 the question of who should be first to try the procedure in a new experiment is an ethical one. however, according to altman it is not a question that can successfully be legislated. a law requiring self-test would force researchers to take risks that may sometimes be inappropriate. a code forbidding it might inhibit valuable discoveries.: 314 self-experimentation has a role in medical education. although no longer encouraged, in former times it was perfectly standard to expect medical students to try for themselves the drugs they were going to be prescribing. charles-édouard brown-séquard, whose own self-experiments led him to the concept of what are now called hormones, was a nineteenth century proponent of the practice:: 314–315 i will suggest that you should study upon yourselves the effects of the most valuable remedies. i well believe that you will never know fully the action of certain remedies, if you have not ascertained, on your own person, what effects they produce on the brain, the eye, the ear, the nerves, the muscles, and the principal viscera.— charles-édouard brown-séquard value self-experimentation has value in rapidly obtaining the first results. in some cases, such as with forssmann's experiments done in defiance of official permission, results may be obtained that would never otherwise have come to light. however, self-experiment lacks the statistical validity of a larger experiment. it is not possible to generalise from an experiment on a single person. for instance, a single successful blood transfusion does not indicate, as we now know from the work of karl landsteiner, that all such transfusions between any two random people will also be successful. likewise, a single failure does not absolutely prove that a procedure is worthless. psychological issues such as confirmation bias and the placebo effect are unavoidable in a single-person self-experiment where it is not possible to put scientific controls in place. such concerns do not apply so much if the self-experimenter is just one of many volunteers (as long as the self-experimenter is not also responsible for recording the results) but his or her presence still has value. as noted above, this can reassure the other participants. it also acts as a check on the experimenter when considering whether the experiment is ethical or dangerous.: 314 : 206 notable examples anaesthesia dentist horace wells made multiple experiments with nitrous oxide, diethyl ether, and chloroform while trying to determine their uses as anaesthetics. the first, conducted in 1844, consisted of having his assistant john riggs dose him with nitrous oxide and then extract one of his teeth. his later self-experimentation of ether and chloroform took place in 1848, and he eventually became addicted