Don’t trust posterity. The present is always merciless about the past

IT’S always puzzling that recruiters ask the question: “Where do you see yourself in five years’ time?”

Puzzling because the most realistic answer is the answer nobody ever gives: “I’m sorry. My degree is in accountancy/law/physics. Until I get around to a postgrad in prophecy, I can’t answer that one.”

Instead, the person going for the job warbles about their hopes, trying to negotiate the fine line between being properly ambitious without being repellently driven. It’s pointless and ridiculous and if anybody ever went back to find out how many of the interviewees ever found themselves where they had “seen” themselves five years earlier, the chances are that the predictive goals and the points reached are a country mile away from each other.

That disconnect, however, is in the ha’penny place compared to the disconnect between success, as defined by one generation in recent history, and the current generation’s view, which tends to be so huge as to suggest that anyone, whether they be in politics or any other area of life, should be wary before setting out to create a legacy. Today’s benign legacy often turns out to be tomorrow’s disgrace, as one 94-year-old American medic with a once-stellar reputation found out, this last week.

Back in the 1950s, Dr Perry Hudson appeared in Life magazine. Life was a heavily pictorial, highly prestigious publication whose editors repeatedly nailed the zeitgeist of their time. To appear in Life, therefore, was to be publicly validated. Not for merely being famous, the predominant current media reality as exemplified by the Kardashians, but for being a significant contributor to arts, literature, sport, exploration or science.

Dr Hudson was pictured in the glossy pages of the magazine along with other scientists in a big optimistic spread about emerging treatments for cancer. It was cutting-edge stuff. Life included the latest research, including material implicating cigarettes as a cause of cancer, which was pretty courageous of them, back in the days when full-page cigarette ads were a mainstay of magazine advertising.

The story about Dr Hudson presented him as a long way down the road to proving the worth of early prostate cancer diagnosis. He had done this partly by recruiting men from New York’s Bowery, the traditional place where the homeless and marginalised (then referred to as “bums’) spent most of their time. He asked them to let him take a biopsy from their prostate gland, offering them, by way of recompense, meals and shelter for a few day. In addition, he guaranteed them that, should the tests reveal that they were already suffering from prostate cancer, they would get free treatment for the disease. As duly happened when some of the alcoholic men involved proved to be sufferers. Dr Hudson told them that the cure rate for the treatment was extremely high. Life magazine thought this medical research venture was pretty damn splendid, as did Dr Hudson’s medical contemporaries and the scientific bodies who funded the research, which lasted into the 60s.

Roll forward 50-plus years, and, on Thursday of last week, a paper appeared in the American Journal of Public Health which took a very different view of Dr Hudson and his actions. The AJPH’s Dr Robert Aronowitz, who works at the Univerisity of Pennsylvania, had come across some references to the study which intrigued him enough to prompt him to do in-depth analysis. The paper which emerged at the end of that analysis was extremely sceptical about the way medics and lay people alike “came to believe in the efficacy of population screening followed by aggressive treatment without solid supporting scientific evidence”. But what made his paper catch the eye of scientists all over America, and of newspapers like the New York Times, was its contention, apropos the Bowery alcoholics, that “This poorly informed, vulnerable population was subjected to health risks that investigators knew others would not accept.”

MORE socially competent American men would either have instinctively rejected the opportunity to take part in the study or they would have asked questions about it. It is not clear, at this distance, that the alcoholics from skid row could or did ask questions about the research to inform their decision-making. What is abundantly clear, however, is that the researchers did not kill themselves proffering information to men whose lives were likely to be changed to a substantial, and in some cases grievous degree by what they committed to. They were not told, for example, that the taking of the biopsy itself could leave them impotent. (Biopsies, at the time, were considerably more invasive than at the present time.) Nor were they told that the free treatment they would be vouchsafed, were the research to reveal them to be suffering from prostate cancer, was not proven to have any material effect on the progress of the disease. On the contrary. As indicated earlier, Dr Hudson told them the cure rate was extremely high. He didn’t exactly lie to them with malice aforethought. He believed the cure rate was extremely high. Factually, it wasn’t.

The bottom line, therefore, was that more than 1,000 men who almost defined that over-used term “vulnerable” were persuaded to take part in a dangerous experiment that earned them a few meals and nights in a clean bed.

No doubt the same rationale applied to this study as applied to another piece of research, the Tuskegee study, which examined the sexually-transmitted disease syphilis in black men. The Tuskegee research was elegantly horrific in its simplicity. The cohort of men studied were simply left without treatment, even though the researchers, in common with most educated white people at the time (and for several previous centuries) knew that syphilis, untreated, followed a pattern of unbroken uniformity which ended in General Paralysis of the Insane, where the sufferer could neither move nor think. By the 1930s, when Tuskegee happened, some treatments were available, and while not perfect, they prevented the otherwise inevitable progress of the SDI. The doctors conducting the study, in the interests of science, withheld those treatments from the men, thereby condemning them to a long, painful and humiliating death. It can be assumed that they believed the greater good would be served by this unilateral action and, given the attitudes of the time, it can also be assumed they believed these illiterate black men were expendable in the good cause of developing better treatments.

Dr Hudson, who was photographed this week looking as a healthy 94-year-old might be expected to look, finds himself in an unenviable situation. Having set out with the laudable objective of proving that early detection of this cancer saved lives, his work failed to reach the objective, not least because he didn’t have a control group. Having been lauded for his work in publication after publication during the 1950s and 1960s, he now finds himself publicly condemned by medical historians for doing what almost nobody at the time would have found either exceptional or problematic. The problem is that nobody ever accepts the argument that “this is how it was at the time.” The present is always merciless about the past. Put not your trust in posterity.