IF MEDICINE HAD A COURTROOM, WHO WOULD BE ON TRIAL?
Gayatri Brahmandam
Intern, Adichunchanagiri Institute of Medical Sciences
James Watson, the pioneer behind the discovery of the helical structure of DNA, passed earlier this month. This led me to revisit the details of the race to publish the results of Watson and Crick’s research.
It also refocused the spotlight on the importance of consent in research, and other landmark discoveries that have overlooked the humanity of the individuals behind them, such as Henrietta Lacks, whose cells were taken without consent, even as they went on to fuel some of the most transformative advances in biomedical science.
If medicine had a courtroom, the scorned defendants would be informed consent, ethics and autonomy in research.
Act I: Opening Statements
Medicine’s greatest breakthroughs are often quietly accompanied by its biggest ethical missteps. Every innovation that makes it to the news also overcomes ethical and moral conundrums in order to reach us.
Act II: Case One
The Double Helix Trial
The year is 1952, and two brilliant scientists are sprinting towards a Nobel-worthy finish line: discovering the structure of DNA and publishing their findings. The excitement in Cavendish Laboratory was palpable.
However, there was a missing piece left before their findings could add up. This infamous missing piece of the structural puzzle came from Rosalind Franklin’s lab over a hundred kilometres away. The piece was Photo 51, our Exhibit A – Material Evidence Obtained Without Permission.
Photo 51 is an X Ray diffraction image of DNA, a result of Franklin’s PhD student’s research, which, unbeknownst to her, was shown to Watson and Crick by her colleague, Maurice Wilkins. This image was conclusive evidence that DNA followed a double helical structure with a phosphate backbone.
The discovery, made in 1953, was celebrated, while key contributors were ignored. Franklin was not a footnote in the discovery; she was the scientist whose meticulous, methodical approach generated the data that made Watson and Crick’s model possible. Yet her contribution lived in the shadows for decades, obscured by the mythology surrounding scientific races and the heroes we choose to crown.
Watson and Crick are not the villains of this story; they were gifted scientists working within a system that rewarded speed and scientific leaps. Instead, this trial spotlights a scientific culture that viewed data ownership as fluid and disregarded the work of women in science.
If medicine had a courtroom, the prosecution’s argument here would be clear: scientific credit was mishandled, and autonomy over one’s work was an afterthought.
And the jury (modern researchers, physicians, and students) would likely agree that while the discovery changed the world, the process that led to it was far from ethically correct.
Act II: Case Two
The HeLa Trial
From the internal politics of laboratories and scientific discoveries, we shift our focus to something extremely relevant in today’s practice of medicine: informed consent and autonomy. These principles were not always awarded the same importance as they are today.
Around the same time that the final stretch of Watson and Crick’s research began in 1951, across the Atlantic Ocean, Henrietta Lacks walked into the clinic at Johns Hopkins, complaining of severe pelvic pain. A biopsy of her cervical tumor was taken for diagnosis and some of the cells obtained were silently diverted to research. Her cells, astonishing in their ability to divide indefinitely, became the world’s first immortal cell line.
They were instrumental in the development of Salk’s polio vaccine, discovering telomerase activity in cancer cells, providing the base for the Human Genome Project, quantifying the effects of ionizing radiation on human cells, and playing a major role in creating the HPV vaccine.
In short, HeLa cells launched vaccines, advanced oncology, cracked open virology, orbited the Earth and helped map genes. They changed medicine more profoundly than most other discoveries. Yet, Henrietta Lacks never knew about them.
Her family did not learn of her cells’ existence until nearly twenty years later. Her children did not understand why labs across the world held pieces of their mother. They certainly never shared in the profits generated by companies that commercialized HeLa cells.
In the courtroom of medicine, this case raises different charges: non-existent consent, racial inequity, and exploitation justified by scientific benefit. Unlike Franklin’s discovery, where a scientist’s intellectual autonomy was compromised, Lacks’ case challenges the very foundation of bodily autonomy. It forces us to confront the uncomfortable truth that some of medicine’s greatest advances were built on practices that would be unthinkable today.
HeLa’s legacy is scientifically immortal. But so is the ethical lesson it leaves behind.
Act III: The Verdict
The ethical shortcomings of crucial breakthroughs were analysed in Acts I and II. This forces us to ask if medical progress can ever be free from ethical dilemmas. The legacy of James Watson and Francis Crick is inseparable from Rosalind Franklin’s uncredited labour and the legacy of the HeLa cell line is inseparable from Henrietta Lacks’ unassuming contribution.
Today, the field of medicine certainly takes more accountability. Institutional Review Boards, data protection protocols, tissue-use governance, and increasing community engagement exist partly because of these past failures. Consent is no longer optional and autonomy is no longer viewed as an administrative inconvenience. Ethics committees which were once ceremonial, now wield real authority.
These two events, amongst many others, have taught us that progress need not come at the expense of dignity, autonomy, and morally correct judgement. With AI being an indispensable part of healthcare, we need to exercise more caution than ever about what constitutes patient confidentiality, safety and fairness.
Closing Remarks
The defendants can now speak for themselves, and medicine, the jury must decide whether we can learn from precedent or continue to face the same obstacles with new plotlines because we cannot promote a world of science where medical progresses coexist with serious ethical lapses.
References
- https://www.nature.com/articles/d41586-023-01313-5
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3516052/
