March/April 2017 – Vol. 29 No. 6

Polio As a Case Study in Science Ethics

Posted: Tuesday, February 3rd, 2015

by Alan Colburn

Imagine for a moment the Ebola virus came to the United States. How do you think people would react? But now imagine scientists had developed a vaccine which they believed would be moderately effective at protecting people from the disease. Now how do you think people would react?

The situation is hypothetical, but the country confronted a similar situation in the 1950s when faced with polio – and a potential vaccine protecting against its spread.

Anyone alive in the 50’s remembers polio and the terror people felt at the possibility they or their children could catch the disease, which was also called infantile paralysis. Places people congregated, like swimming pools, theaters, and even churches, closed during the summer “polio season.” The March of Dimes was created to help fund a cure – ten cents at a time.

The payoff ultimately came when researchers like Jonas Salk and Albert Sabin developed vaccines that would prevent the disease from spreading, if they worked. Like all things scientific, first they needed to be tested. That essentially meant injecting a child, since children were the main victims, with a dead or weakened version of the dreaded polio virus. Today’s analogy would be injecting people with a dead or weakened version of the Ebola virus.

Testing vaccines against diseases such as polio or Ebola raises a panoply of ethical questions:

– Is it ethical to test a vaccine on primates if the only alternative is to do the research on human populations?

– Is it ethical to experiment on vulnerable populations (like children), if they are the group most susceptible to the illness?

– If you had a voice in how limited funds were to be spent, would you encourage rushing something moderately good to market, or use the money to invest in a better solution that would take longer?

– When should large-scale human trials of a vaccine begin, if people are dying and the vaccine might save lives?

For the K-12 science teacher interested in using and applying science practices, perhaps the most relevant questions are about the ethics of biomedical research (including vaccine testing) with placebo control groups. To be able to think about these issues in an informed way, teachers, students, and our entire populace, needs to understand something about different types of experimental designs and the factors researchers must consider when designing valid and reliable experiments. As K-12 science teachers you can help students understand the essential background information and the kinds of questions everyone needs to ask to help us make informed choices. This kind of practical value, in fact, was one of (several) factors considered by NGSS’s creators when deciding what content to include in the new standards.

With something as potentially lifesaving as a polio (or Ebola) vaccine, for example, pundits might make the case everyone should get the medicine. Why test with placebos? Why not experiment with the vaccine, see how many people in the test group were sickened by polio, and just compare the results with those seen during past summers?

The problem with this alternative experimental procedure was that the incidence of polio varied from one year to the next. No one knew why this was, and no one knew what the incidence was “supposed” to be when Salk’s vaccine was being tested. Researchers argued the only way the vaccine could be “fairly” tested would be by comparing its effectiveness against an untreated control group.

Biomedical researchers are confronted with the same dilemmas today. If your child was sick, and an experimental medicine might help, would you want your child to be part of a control group receiving a placebo?

In the case of the polio vaccine, the disease incidence in normal human populations was small enough that a statistically significant test would need to involve sample sizes involving hundreds of thousands of children. The test would need to be double blind, meaning that neither the clinician nor the subjects know who is receiving the vaccine and who the placebo. Assuming the vaccine was safe and effective, children in control groups receiving placebos continued to lack protection against the disease and were essentially being denied a potentially lifesaving treatment.

Ethical dilemmas, by definition, are mutually exclusive options, none of which appears to be completely satisfactory. Critical thinkers should recognize this, and be able to cogently explain the multiple sides of these often controversial issues. As science teachers we can help our students achieve these goals, while providing them with the scientific literacy we all need to make informed decisions, e.g., understanding what “statistical significance” and “double blind testing” means, as well as introducing concepts of antibodies and the immune response.

That said, what happened with the polio vaccine? It’s a rather amazing story. Testing the vaccine was (and is) the largest experiment ever undertaken, involving more than 500,000 research subjects. David Olshinsky tells it well in his Pulitzer Prize winning book Polio: An American Story. Or, if you prefer, The Polio Crusade, an episode of PBS’s American Experience TV series closely follows Olshinsky’s story. It’s available online.

For assistance in thinking through lessons on ethics, The Online Ethics Center for Engineering and Research, sponsored through the National Academies, is a good place to start. The site has a section devoted to ethics in the science classroom, which in turn has information about creating lessons.

Alan Colburn is a professor of science education at California State University, Long Beach, and is a member of CSTA.

Written by Guest Contributor

From time to time CSTA receives contributions from guest contributors. The opinions and views expressed by these contributors are not necessarily those of CSTA. By publishing these articles CSTA does not make any endorsements or statements of support of the author or their contribution, either explicit or implicit. All links to outside sources are subject to CSTA’s Disclaimer Policy: http://www.classroomscience.org/disclaimer.

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