1.2 Scurvy trial: Ethical critical review
From an experimental design perspective, Lind did his best to ensure that his clinical trial was sound by ensuring that the subjects were physically similar as far as possible and also appeared to be affected by scurvy to a similar level. He also ensured that, with the exception of the experimental treatment, the sailors had the same diet and were kept in the same area of the ship. In addition, in the 1700s, all sailors would have been male so sex would not affect the results. With the knowledge available to him, Lind did a good job of attempting to choose similar subjects which means he controlled as many variables that may have affected the results as he could.
However, the sailors would have varied from each other in terms of their age, height, weight and level of scurvy symptoms and any of these factors could have had an impact on the result of the experiment. We can now also identify the fact that the sailors would have been genetically different, and it is not possible to rule out an individual’s genetic make-up as a factor influencing results. In addition, these sailors may have had other conditions or ailments that may have made them more vulnerable to sickness.
Nowadays Lind’s clinical trial would be considered unethical. One reason is that the participants were not volunteers and they had no choice but to be involved in the experiment. Another reason is that the outcome of the experiment in terms of the sailors’ health was unknown, which is unethical because it could have resulted in the sailors becoming even sicker or dying. In fact, some of the treatments may have been harmful rather than simply ineffective. For example, nowadays it would not be acceptable to give experimental subjects sulfuric acid on an empty stomach!
It is also hard to say how informed the sailors were of the risks of the experiment. In modern scientific studies involving humans, informed consent must always be acquired, and the participants can withdraw from the trial at any time. These rules are governed by ethics committees and ethical guidelines.
You will be relieved to know that the experiment conducted by James Lind would not be allowed today!