Carte Blanche

Dear Reader,

Informed consent—a patient’s right to agree to a treatment before it is administered—is supposed to be an inviolable aspect of medical ethics. In Carte Blanche, the distinguished medical journalist Harriet Washington tells a shocking and heretofore unknown story about the severe erosion of informed consent over the past twenty-fi ve years. Through a combination of investigative reporting and moral passion, Washington will awaken the country to a terrible problem it hasn’t realized it had.

There is a long, bad history of Black Americans being used as unwitting experimental medical subjects. Today, as in the past, Black patients disproportionately bear the brunt of the weakening of medical consent. Washington gives a number of disturbing examples: the Army’s use of an experimental anthrax vaccine; the administration of an artificial blood substitute called PolyHeme to trauma victims in emergency rooms; the use of a surgical drug called ketamine to treat depression; the intentional induction of hypothermia to treat gunshot wounds. None of these medical interventions had been through the full testing and approval process. All of them produced harmful side effects.

Medical researchers have a strong incentive to present dramatic findings; they need official restraints against the temptation to experiment on human subjects. Back in 1996, two unnoticed changes in federal regulations severely loosened those restraints and ushered in a new era of weakened consent procedures. Today the country is in the middle of the worst public health crisis in a century, and also a profound racial awakening. Harriet Washington makes a fresh and important contribution to the national conversation at this moment by calling attention to an area where race and health care meet, with damaging results.

Best,

Nicholas Lemann
Director, Columbia Global Reports