Leigh Turner continues to question in the face of silence.
Last week, Kirstin Borgerson, a philosopher at Dalhousie University, published a thoughtful commentary on my colleague Carl Elliott’s persistent call for an investigation of Dan Markingson’s death and psychiatric research misconduct at the University of Minnesota. Dan Markingson was a young man from St. Paul who committed suicide by nearly decapitating himself while enrolled in a psychiatric drug study at the University of Minnesota Medical Center, Fairview.
In analyzing the audience’s response to Carl’s public lecture, alongside the typical response of her undergraduate students, Borgerson notes that there was no animated discussion of ethical issues in the Markingson case because “very simply, there is nothing to debate.” Borgerson adds,
Among serious scholars, there is no defense of the practice of: radically violating informed consent …; enrolling suicidal patients in the sort of risky trial that Markingson was enrolled in; having researchers disrespect and disregard concerns raised by family members about the well-being of research subjects during a trial; or creating conditions under which researchers are motivated to enroll subjects so as not to lose out on tens of thousands of dollars. My students and colleagues have it right: from an ethical perspective there isn’t anything to debate here.
Similarly, when I present this case in my research ethics course, the initial response is one of shocked silence. I suspect this is connected to the gruesome way in which Dan Markingson died; the many instances of serious research ethics violations; the obstructionist response of university officials; the suspicion that this could be a concerted institutional cover up; the painful realization that for almost a decade Dan Markingson’s loved ones have struggled to see justice be done; and the worry that there may be additional victims. After the silence, however, typically there are many questions related to Markingson’s decision-making capacity; financial conflicts-of-interest; and the failure to properly investigate alleged psychiatric research misconduct.
Leaving aside Borgerson’s analysis of the shocked silence among individuals who first learn about Markingson’s death, I want to comment on the collective silence of my colleagues at the University of Minnesota Center for Bioethics.
St. Paul Pioneer Press reporters Jeremy Olson and Paul Tosto first described Dan Markingson’s death in 2008. Carl Elliott’s article, “Making a Killing,” was published by Mother Jones magazine in 2010. Since then, Carl Elliott has made an extraordinary effort to help Dan Markingson’s mother, Mary Weiss, and her friend, Mike Howard, fight for justice. He has published many more articles and travelled to college campuses across Canada and the United States giving presentations and building public support for an investigation of psychiatric research misconduct at the university.
Acknowledging Elliott’s steadfast support for Mary Weiss and Mike Howard, scholars from Australia, Canada, Israel, Japan, New Zealand, Sweden, and other countries have supported his calls for an investigation of research misconduct at the University of Minnesota. And, last December, the University of Minnesota Faculty Senate passed the “Resolution on the matter of the Markingson case.”
At the University of Minnesota, Bill Gleason, a professor in the Department of Laboratory Medicine and Pathology, has written about Dan Markingson and pressed for an investigation of research misconduct. Kirk Allison, director of the university’s Program in Human Rights and Health, organized a campus screening of Off Label, a documentary featuring an interview with Mary Weiss. I have urged President Kaler, the Board of Regents, and Minnesota’s Attorney General to investigate. In addition, numerous faculty members signed a petition asking Governor Dayton to establish an independent panel to investigate Markingson’s death. University faculty – myself included – should have done more, however, to hold senior administrators accountable as they refused to investigate disturbing reports of possible research misconduct.
Meanwhile, the faculty members who should have been most vocal about research misconduct – faculty at the Center for Bioethics where Carl and I hold our faculty appointments – have been mostly silent. The only exception has been a single letter to the Board of Regents in November 2010 signed by eight faculty members asking for “an impartial panel of experts in research ethics and university governance of medical research to investigate the Markingson case, particularly any larger structural or financial conditions that might have played a role in his death and which may still be putting patients at risk.” Notably, however, then director of the Center for Bioethics, Jeffrey Kahn, did not sign the letter. Debra DeBruin, then associate director and now director of the Center for Bioethics, did not sign the letter. Susan Wolf and Steven Miles, two of the Center’s most senior and prominent bioethicists, did not sign the letter.
University officials have responded to Elliott’s efforts by attempting to frame him as a lone, self-promoting, rogue employee who twists facts and uses this “unfortunate tragedy” to advance his own interests. They malign him by claiming that he refuses to accept the conclusions of “indisputable” investigations by the FDA, Minnesota’s board of medical practice, Minnesota’s Attorney General, the university’s IRB, and the Office of the General Counsel.
Meanwhile, the faculty members best situated to counter this institutional script – faculty at the Center for Bioethics – have maintained their silence, allowing university administrators to isolate, insult, and attempt to intimidate Elliott. And sadly, in this instance there has been no exception to the collective silence, unless one counts the suggestion that Carl should resign his academic appointment.
When I reflect on these facts I ask myself: what if one day an investigation determines that serious research misconduct did occur at the University of Minnesota and that most faculty members at the Center for Bioethics remained silent? Contemporary bioethicists look at the Tuskegee research scandal and question why so many individuals remained silent in the face of wrongdoing. “It was a different time, a different place.” We look at the past and we think we are distinguishable from those who responded to injustice with silence and apparent indifference. But are we?
Update: Watch the YouTube video of Leigh Turner addressing the University of Minneosta Board of Regents on May 9, 2014 – http://www.youtube.com/watch?v=Sqcr-OOL-g8
Leigh Turner is an Associate Professor at the Center for Bioethics & School of Public Health at the University of Minnesota (@LeighGTurner). An extended version of this post will appear tomorrow on his blog, Health in the Global Village.