'Experimental Rage': The Development of Medical Ethics and the Genesis of Scientific Facts. Ludwik Fleck: An Answer to the Crisis of Modern Medicine in Interwar Germany?: Society for the Social History of Medicine Millennium Prize Essay 2000

Abstract

In 1930, the large-scale introduction of the BCG vaccination in the city of Lübeck in northern Germany led to a major scandal that focused public attention on medical experimentation with human beings as well as reviving criticism of the medical profession that had been voiced before. The trial following the catastrophe raised the first clearly identifiable public discussions on medical ethics in Europe, and led to the establishment of the first regulations for medical research on human beings in the western hemisphere; the German 'Richtlinien' of 1931. In 1935, Ludwik Fleck (1896-1961) published a now classic monograph entitled Genesis and Development of a Scientific Fact. The central hypothesis of this article is that, when Fleck published his book four years after the Lübeck trial, he was proposing answers to questions raised, at least partially, by the Lübeck case, although he never explicitly mentions it. Most interestingly, Fleck proposed a different approach to the fundamental dilemma of modern experimental medicine, the potential opposition between an individual's well-being, and the production and application of scientific knowledge in medicine. Where the standard answer to these questions has, since the 1930s, become moral reasoning and ethical regulation, known today as bioethics, Fleck portrays a different approach that could be characterized as the attempt to foster a deeper and more democratic understanding of science through an examination of its intimate functioning.

The Philosophical Works of Ludwik Fleck and Their Potential Meaning for Teaching and Learning Science

“…Fleck suggested an explanation of both how changes in scientific knowledge occur and how the scientific community behaves (Bonah 2002). Fleck's monograph discusses the medical understanding of syphilis as well as the development of a standardized test for its detection (the Wassermann reaction) as examples to elaborate his epistemological concept.…”

“…Because the acknowledgement of his insights came so late, Fleck has also been called the 'Gregor Mendel of the history and philosophy of science' (Bonah 2002, p. 187). At the same time, Fleck was also listed among the 'classical' figures of both epistemology and the social history of science, a position comparable to Karl Popper or Robert K. Merton (Bonah 2002;Howard 2009). …”

Medical Science in the Light of the Holocaust

“…Fleck's moral commitment to these political activities is certainly noteworthy, but his intellectual position was much more refined (Bonah, 2002) and transcended the dual logic of scientific freedom and code of conduct that resulted from the Nuremberg trial against physicians in form of the Nuremberg Code of medical ethics. Based on the above discussion, the issue appears to be more complex (also see Hedfors, 2007c).…”

Testing vaccines in pediatric research subjects

“…The history of modern research regulation dates back to at least the 1930s and the Lübeck vaccine disaster [1]. Back then, in Europe, tuberculosis remained rampant.…”

“…This tragedy actually led to the first published discussion on medical research using human subjects, approximately two decades before the Nuremberg Trial and the Code of Nuremberg [1]. Julius Moses, a Member of German Parliament, called for a public accounting of medical science.…”