Food addiction among sexual minorities

Food addiction among sexual minorities. Jacob C. Rainey, Celina R. Furman, and Ashley N. Gearhardt. Appetite, https://doi.org/10.1016/j.appet.2017.08.019

Abstract: Although sexual minorities represent a small proportion of the general population, this group has been observed to be at an increased risk of developing various pathologies, including substance use and eating disorders. Research suggests that foods high in added fat and refined carbohydrates may trigger an addictive response, especially in at-risk individuals. Consequently, food addiction is associated with elevated risk for obesity, diet-related disease, and psychological distress. However, there is limited research on whether food addiction, like substance use, may be elevated among sexual minorities, and whether self-compassion may be a protective factor. Thus, the current study aims to test whether food addiction is elevated in sexual minorities (relative to heterosexuals) and if discrimination and self-compassion may be related to food addiction among sexual minorities. ***In a community sample of 356 participants (43.3% sexual minority), sexual minorities had almost twice the prevalence of food addiction (16.9%) as heterosexuals (8.9%). Also, sexual minorities on average experienced more food addiction symptoms*** (M = 2.73, SD = 1.76) than heterosexuals (M = 1.95, SD = 1.59). ***For sexual minorities, heterosexist harassment was associated with increased food addiction, while self-compassion appeared to be a protective factor***. Further research needs to examine between-group differences among sexual minorities for better treatment and interventions for food addiction.

The influence of reputational concerns on children's prosociality

The influence of reputational concerns on children's prosociality. Jan Engelmann, and Diotima Rapp. Current Opinion in Psychology, https://doi.org/10.1016/j.copsyc.2017.08.024

Highlights
•    At around age 5, young children show first signs of concern with reputation.
•    At around age 8, young children begin to reason about reputation explicitly and interpret others’ behavior in terms of self-presentational concerns.
•    Partner choice by peers and new theory of mind skills likely contribute to the development of reputation management.

Abtract: While it is well known that reputational concerns promote prosociality in adults, their ontogenetic origins remain poorly understood. Here we review evidence suggesting that the first prosocial acts of young children are not aimed at gaining reputational credit. However, at approximately 5 years of age, children come to be concerned about their reputations, and their prosocial behaviors show the signature of self-promotional strategies: increased prosociality in public compared to private settings. In middle childhood, at around 8 years of age, children acquire further abilities to control the image they project and start to reason explicitly about their reputation. We discuss potential social and cognitive factors – Partner Choice and Theory of Mind – that contribute to the developmental emergence of self-presentational behavior.

Women have greater inhibition even with no social component in the experiment

Sex Differences on the Go/No-Go Test of Inhibition. Espen A. Sjoberg and Geoff G. Cole. Archives of Sexual Behavior, https://link.springer.com/article/10.1007/s10508-017-1010-9

Abstract: Parental investment theory suggests that women, due to greater investment in child rearing, can be more choosy than men when considering a potential mate. A corollary to this is that women should possess greater inhibition abilities compared to men in contexts related to sex and reproduction. This notion has found support from the inhibition literature demonstrating that while women do indeed show greater inhibition on tasks that include a social aspect, no such effect is found on cognitive tasks that do not possess a social component. In the present experiment, participants (N = 66) performed a variant of a classic Go/No-Go task consisting of infrequent No-Go trials in which a response needed to be withheld. ***Importantly, the stimuli were geometric shapes possessing no social component. Results showed that women outperformed men on the No-Go trials, indicating greater inhibition***. No significant difference was found in reaction time on Go trials. Thus, the results cannot be explained in terms of a speed/accuracy trade-off. We discuss the findings in the context of the female-evolved inhibition hypothesis.

Waiting for the Second Treat: Developing Culture-Specific Modes of Self-Regulation

Lamm, B., Keller, H., Teiser, J., Gudi, H., Yovsi, R. D., Freitag, C., Poloczek, S., Fassbender, I., Suhrke, J., Teubert, M., Vöhringer, I., Knopf, M., Schwarzer, G. and Lohaus, A. (2017), Waiting for the Second Treat: Developing Culture-Specific Modes of Self-Regulation. Child Development, doi:10.1111/cdev.12847

Abstract: The development of self-regulation has been studied primarily in Western middle-class contexts and has, therefore, neglected what is known about culturally varying self-concepts and socialization strategies. The research reported here compared the self-regulatory competencies of German middle-class (N = 125) and rural Cameroonian Nso preschoolers (N = 76) using the Marshmallow test (Mischel, 2014). Study 1 revealed that 4-year-old Nso children showed better delay-of-gratification performance than their German peers. Study 2 revealed that culture-specific maternal socialization goals and interaction behaviors were related to delay-of-gratification performance. Nso mothers’ focus on hierarchical relational socialization goals and responsive control seems to support children's delay-of-gratification performance more than German middle-class mothers’ emphasis on psychological autonomous socialization goals and sensitive, child-centered parenting.

---
A higher percentage of Cameroonian Nso children (69.7%) than German middle-class children (28%) succeeded in waiting for the research assistant to return with the second treat. Furthermore, compared to only 28.9% of the Cameroonian Nso children, 49.6% of the German middle-class children ate or at least tasted the sweet before the research assistant returned. Only one Nso child left the room to terminate the delay period ahead of time, but 22.4% of the German middle-class children acted in this way. Finally, although eight Nso children (10.5%) fell asleep during the delay, no German child exhibited this behavior.

[...]

Subsequent univariate analyses revealed that German middle-class children exhibited more time in distraction behaviors in terms of turning away from the sweet and talking or singing. Furthermore, they spend more time in negative emotions than rural Nso children [desperate face, whining, crying, etc.].

[...]

waiting falls neatly into the hierarchically interrelated cultural model of the Nso farmer families, which has adapted to the community’s demands. In this context, the development of self-regulation constitutes an early and unconditional achievement that stems from children’s sense of belongingness and perceived responsibility (Keller, 2015). Accordingly, the children raised in these two cultural models also differed substantially in their delay strategies. Nso children displayed the lack of motion and emotion-neutral attitude expected of them as good behavior (Keller & Otto, 2009). They sat in front of the table with the sweet without engaging in much motor activity, and some downregulated themselves so effectively that they even fell asleep during the delay. Their emotional inexpressiveness is in line with the cultural ideal of an “easy child” who does not jeopardize social functioning with social or emotional demands. [...] German children, on the other hand, acted out their attitudes of self-selected behavioral choices with different kinds of motor strategies, such as moving their bodies, turning around, changing position, walking around in the room, and even leaving the room.

These different delay strategies further suggest that self-regulation is based on different underlying processes based on cultural environment.

An Investigation of Genetic and Environmental Influences Across the Distribution of Self-Control

An Investigation of Genetic and Environmental Influences Across the Distribution of Self-Control. Joseph A. Schwartz et al. Criminal Justice and Behavior, Vol 44, Issue 9, 2017, http://journals.sagepub.com/doi/abs/10.1177/0093854817709495

Abstract: Previous research illustrating a robust, negative association between self-control and various forms of delinquent and criminal behavior has resulted in a more concentrated focus on the etiological development of self-control. The current study aims to contribute to this literature using a sample of twin and sibling pairs from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine genetic and shared environmental influences across levels of self-control. The results of modified DeFries–Fulker (DF) equations revealed that genetic and shared environmental influences were distributed in a nonlinear pattern across levels of self-control. Subsequent biometric quantile regression models revealed that genetic influences on self-control were maximized in the 50th and 60th percentiles, and minimized in the tails of the distribution. Shared environmental influences were nonsignificant at all examined quantiles of self-control with only one exception. The theoretical importance of utilizing genetically informed modeling strategies is discussed in more detail.

My comment: intermediate levels of self-control are dominated by genetics, and the environment is dominant in those with high (more strict education???) and low (too lenient parents or non-structured families???) self-control.

Human Self as Information Agent: Functioning in a Social Environment Based on Shared Meanings

Human Self as Information Agent: Functioning in a Social Environment Based on Shared Meanings. Roy F. Baumeister, Heather M. Maranges, and Kathleen D. Vohs. Review of General Psychology, June 2017. DOI: 10.1037/gpr0000114

Abstract: A neglected aspect of human selfhood is that people are information agents. That is, much human social activity involves communicating and discussing information. This occurs in the context of incompletely shared information—but also a group’s store of collective knowledge and shared understanding. This article elucidates a preliminary theory of self as information agent, proposing that human evolution instilled both abilities and motivations for the various requisite functions. These basic functions include (a) seeking and acquiring information, (b) communicating one’s thoughts to others, (c) circulating information through the group, (d) operating on information to improve it, such as by correcting mistakes, and (e) constructing a shared understanding of reality. Sophisticated information agents exhibit additional features, such as sometimes selectively withholding information or disseminating false information for self-serving reasons, cultivating a reputation as a credible source of information, and cooperating with others to shape the shared worldview in a way that favors one’s subgroup. Meaningful information is thus more than a resource for individual action: It also provides the context, medium, and content within which the individual self interacts with its social environment.

---
One fascinating question about official falsehoods is whether the ruling elites who propagate such views believe them or not. We speculate that there are cases of both types. That is, some rulers may knowingly, even cynically, uphold a false worldview because it helps sustain them in power, whereas others sincerely believe their worldview. Probably many cases exist in the large gray area between those two, in which self-deceptive tactics are used to sustain preferred beliefs, and doubts are shrugged off as counterproductive. As an example close to home, psychology today is dominated by a political viewpoint that is progressively liberal, but it seems unlikely that many researchers knowingly assert falsehoods as scientific facts. They do however make publication of some findings much easier than others. The selective critique enables them to believe that the field’s body of knowledge supports their political views more than it does, because contrary facts and findings are suppressed (e.g., Duarte et al., 2015). In general, we suspect that far more elites use biased informational strategies to convince themselves of the truth of their preferred views than cynically assert positions they know to be false—though the latter happens too.

[...] Individuals should therefore first have some motivation to seek and obtain information. They may seek information to fill gaps in the group’s collective knowledge (as opposed to merely satisfying their own curiosity).

The group’s stock of information grows as people contribute different bits of information, but it is only a group resource insofar as the members share it. Hence resolving disputes and inconsistencies is helpful. There is thus some tension between adding diverse input and achieving agreement. A leader can encourage everyone to think the same thing, possibly at the expense of contrary and more accurate views. Leaders can also encourage diverse views and dissent, though that presumably makes it harder for the leader to lead.

Why might evolution have made people willing to sacrifice accuracy in favor of consensus, at least sometimes? Here we speculate that desire for consensus may derive from an innate social motive, whereas accuracy is an epistemic motive that would need to be acquired, and is therefore less deeply rooted and perhaps weaker [it is stronger the need to know what others think is true than to make sure you know the truth???]. Accuracy requires meaningful evaluation, as it is essentially a match between two ideas—and perhaps meaning cannot be transmitted by purely physical processes, such as birth. To put this another way, consensus is about you and me having the same thoughts, and nature can program us to want sameness in general, as is seen in preference for genetic kin. In contrast, accuracy is about abstract relationships between statements and circumstances, and thus it is a meaningful rather than a physical thing. There may not be an innate motive to evaluate the truthvalue of assertions or to appreciate the meaningful difference between truth and falsehood. Hence it may be necessary to learn from experience that accuracy is an informational virtue that confers benefits, whereas consensus may be more closely tied to innate motivations.

Disclosing information about the self is intrinsically rewarding -- individuals were willing to forgo money to disclose about the self

Disclosing information about the self is intrinsically rewarding. Diana I. Tamir and Jason P. Mitchell. Proc Natl Acad Sci, 109(21): 8038–8043, May 22 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361411/

Abstract: Humans devote 30–40% of speech output solely to informing others of their own subjective experiences. What drives this propensity for disclosure? Here, we test recent theories that individuals place high subjective value on opportunities to communicate their thoughts and feelings to others and that doing so engages neural and cognitive mechanisms associated with reward. Five studies provided support for this hypothesis. Self-disclosure was strongly associated with increased activation in brain regions that form the mesolimbic dopamine system, including the nucleus accumbens and ventral tegmental area. ***Moreover, individuals were willing to forgo money to disclose about the self***. Two additional studies demonstrated that these effects stemmed from the independent value that individuals placed on self-referential thought and on simply sharing information with others. Together, these findings suggest that the human tendency to convey information about personal experience may arise from the intrinsic value associated with self-disclosure.

Keywords: self-reference, social cognition, reward, functional MRI

Helping populism win? Social media use, filter bubbles, and support for populist presidential candidates in the 2016 US election campaign

Helping populism win? Social media use, filter bubbles, and support for populist presidential candidates in the 2016 US election campaign. Jacob Groshek and Karolina Koc-Michalska.  Information, Communication & Society, Volume 20, 2017 - Issue 9, Pages 1389-1407. http://dx.doi.org/10.1080/1369118X.2017.1329334

ABSTRACT: Undoubtedly, populist political candidates from the right and the left, including Donald Trump and Bernie Sanders, changed the tenor and direction of the 2016 presidential contest in the US. Much like Barack Obama’s electoral successes that were credited at least in part to his savvy social media campaigning in 2008 and 2012, since Trump’s victory, the notion that social media ‘helped him win’ has been revitalized, even by Trump himself [McCormick, R. (2016a). Donald Trump says Facebook and Twitter ‘helped him win’. The Verge. Retrieved from http://www.theverge.com/2016/11/13/13619148/trump-facebook-twitter-helped-win]. This study therefore explores citizen support for populist and establishment candidates across the ideological spectrum in the US to specifically examine if using social media was related to an increased likelihood of supporting populist presidential political candidates, including Trump. Differing forms of active, passive, and uncivil social media were taken into account and the findings suggest active social media use for politics was actually related to less support for Republican populists, such as Trump, but that forms of both passive or uncivil social media use were linked to an increase in the likelihood of support to a level roughly equivalent to that of the traditional television viewing. These patterns are almost the inverse of support for Democratic populists, in this case namely Sanders.

KEYWORDS: Populism, social media, elections, president, campaigns, Trump

Concerned that DSM-5 tend to over-pathologize ordinary quirks and eccentricities

Misophonia: A new mental disorder? Steven Taylor. Medical Hypotheses, Volume 103, June 2017, Pages 109-117, https://doi.org/10.1016/j.mehy.2017.05.003

Abstract: Misophonia, a phenomenon first described in the audiology literature, is characterized by intense emotional reactions (e.g., anger, rage, anxiety, disgust) in response to highly specific sounds, particularly sounds of human origin such as oral or nasal noises made by other people (e.g., chewing, sniffing, slurping, lip smacking). Misophonia is not listed in any of the contemporary psychiatric classification systems. Some investigators have argued that misophonia should be regarded as a new mental disorder, falling within the spectrum of obsessive-compulsive related disorders. Other researchers have disputed this claim. The purpose of this article is to critically examine the proposition that misophonia should be classified as a new mental disorder. The clinical and research literature on misophonia was examined and considered in the context of the broader literature on what constitutes a mental disorder. ***There have been growing concerns that diagnostic systems such as DSM-5 tend to over-pathologize ordinary quirks and eccentricities. Accordingly, solid evidence is required for proposing a new psychiatric disorder.*** The available evidence suggests that (a) misophonia meets many of the general criteria for a mental disorder and has some evidence of clinical utility as a diagnostic construct, but (b) the nature and boundaries of the syndrome are unclear; for example, in some cases misophonia might be simply one feature of a broader pattern of sensory intolerance, and (c) considerably more research is required, particularly work concerning diagnostic validity, before misophonia, defined as either as a disorder or as a key feature of some broader syndrome of sensory intolerance, should be considered as a diagnostic construct in the psychiatric nomenclature. A research roadmap is proposed for the systematic evaluation as to whether misophonia should be considered for future editions of DSM or ICD.


My comment: Hahahahahahahaha. How could they think so... Why the concern? Hahahahahahahaha.

They distanced themselves from the negative images of consumption associated with the wealthy... ostentation, materialism, and excess -- all markers of moral unworthiness

Uneasy Street: The Anxieties of Affluence. Rachel Sherman. Princeton, NJ: Princeton University Press, 2017, http://press.princeton.edu/titles/11096.html

...they described their desires and needs as basic and their spending as disciplined and family-oriented.  They asserted that they "could live without" their advantages if they had to, denying that they were dependent on their comfortable lifestyles.  They distanced themselves from the negative images of consumption often associated with the wealthy, such as ostentation, materialism, and excess -- all markers of moral unworthiness.  These interpretations allowed them to believe that they deserved what they had and at the same time to cast themselves as "normal" people rather than "rich" ones.


See also: This Hamptons trailer park is a billionaire hotspot. By Jennifer Gould Keil. NY Post, Jul 26, 2017. https://nypost.com/2017/07/26/this-hamptons-trailer-park-is-a-billionaire-hotspot/

And: The Perils of Proclaiming an Authentic Organizational Identity. By Balázs Kovács, Glenn Carroll & David Lehman. Sociological Science, January 2017, https://www.gsb.stanford.edu/faculty-research/publications/perils-proclaiming-authentic-organizational-identity

And: Why Elites Love Authentic Lowbrow Culture: Overcoming High-Status Denigration with Outsider Art. By Oliver Hahl, Ezra W. Zuckerman, Minjae Kim
American Sociological Review, http://journals.sagepub.com/doi/abs/10.1177/0003122417710642

Anomie, Mistrust, and the Impact of Race, SES, and Gender

"It's Hardly Fair to Bring a Child Into the World With the Way Things Look.": Anomie, Mistrust, and the Impact of Race, SES, and Gender. Melvin Thomas. Sociological Inquiry, http://onlinelibrary.wiley.com/doi/10.1111/soin.12191/abstract

Abstract: This article examines the impact of race, socioeconomic status (SES), and gender on subjective outlook using anomie and general mistrust as indicators. Specifically, this study addresses the following questions: (1) How do African Americans and whites compare with respect to anomie and mistrust? (2) Do racial differences in anomie and mistrust vary by SES? (3) Do African American women have higher levels of anomie and mistrust than whites and African American men? and (4) Are African Americans becoming more or less trusting and anomic over time? Using data from the General Social Survey (GSS) (1972-2014), the analysis reveals significant racial differences in social outlook as measured by anomie and mistrust. African Americans indicate higher levels of both anomie and mistrust than whites even after controls for SES and the other variables. The racial gap in anomie and mistrust increases with increases in SES. Being African American and female is associated with higher levels of anomie but not mistrust. African American mistrust decreases relative to whites over time. More affluent African Americans' anomie levels slightly increase relative to similar whites over time. Explanations using the "rage of a privileged class" and "intersectionality" ideas are evaluated.


My comments:

1  the result of this research is unfavourable to the group studied, so the author use a justification in the title. The truth could be this: if one is poor, one is more ethical and respects rules and laws (at least those of your own group, we don't know), and is more trustful of others (we don't know who are the others, see below comment #2 on mistrust). When people in this group increases their socioeconomic status (SES), they find reasons to throw that love of law and ethical behavior overboard (which we assume have a negative impact on community life, cooperation and solidarity), and rationalize it _afterwards_ with how harsh and unjust is the real world. Same with mistrust, which also increases with SES. Of course, other groups with a long history of discrimination, including obstacles to access higher education today, are not in anomie or mistrust levels as we see here. This makes the group studied look bad, and they compensate with a poor-me-how-harsh-is-life title.

There is no mention of other groups: "asia" (Asian, Asiatic), "hispan" (Hispanic, Hispanos, Hispanas), "latin" (Latino, Latina). So, of course, we cannot know if the community is that of your ethnic background, or one including the whites, or only that of whites, or maybe whites + other minorities.

This not knowing which laws/customs/mores do they respect makes useless this half of the study, IMHO.

BTW, the explanation for their abandoning love of law is that the guys increasing their SES are more conscious of the discrimination they suffer. Which, again, other groups do not do to the same extent.Of course, it can be a catch-22 situation... More criminality in this group makes the others fearful of young members of the group and those who are not criminal (the overwhelming majority) get offended for the assessment.


2  about the mistrust part... we do not know what the subjects mean when they answer to "most of the time people" or "most people" questions, and the authors recognize it, although they bury the problem in the text:

One problem interpreting these findings is that it is hard to know who “most people” are imagined to be in the trust items. [...] Unfortunately, not knowing exactly whom the respondents have in mind is a limitation of this study.

They are good scholars because they say this? Are you serious? Right in front of my salad? Wrong. This limitation makes this half of the study useless.

To me it is clear that there is a mix here of effects. Some subjects (most likely men) are talking about whites, and some about whites + hispanics + asiatics + others, but don't know the proportions. But some women probably are complaining about black men (husbands, sex partners). As a consequence of the defects in the questionnaire, we don't know the proportions or men and women who equate "most people" with blacks, or whites, or whites + others.

The Gun-Slave Hypothesis And The 18th Century British Slave Trade

The Gun-Slave Hypothesis And The 18th Century British Slave Trade. Warren Whatley. Explorations in Economic History, https://doi.org/10.1016/j.eeh.2017.07.001

Abstract: The Gun-Slave Hypothesis is the long-standing idea that European gunpowder technology played a key role in growing the transatlantic slave trade. I combine annual data from the Transatlantic Slave Trade Database and the Anglo-African Trade Statistics to estimate a Vector Error Correction Model of the 18th century British slave trade that captures four versions of the Gun-Slave Hypothesis: guns-for-slaves-in-exchange, guns-for-slaves-in-production, slaves-for-guns-derived and the gun-slave cycle. Three econometric results emerge. (1) Gunpowder imports and slave exports were co-integrated in a long-run equilibrium relationship. (2) Positive deviations from equilibrium gunpowder "produced" additional slave exports. This guns-for-slaves-in-production result survives 17 placebo tests that replace gunpowder with non-lethal commodities imports. It is also confirmed by an instrumental variables estimation that uses excess capacity in the British gunpowder industry as an instrument for gunpowder. (3) Additional slave exports attracted additional gunpowder imports for 2-3 more years. Together these dynamics formed a gun-slave cycle. Impulse-response functions generate large increases in slave export in response to increases in gunpowder imports. I use these results to explain the growth of slave exports along the Guinea Coast of Africa in the 18th century.

The Nuremberg Code 70 Years Later

JAMA Viewpoint
The Nuremberg Code 70 Years Later. By Jonathan D. Moreno, PhD; Ulf Schmidt, PhD; Steve Joffe, MD, MPH

JAMA. Published online August 17, 2017. doi:10.1001/jama.2017.10265

Seventy years ago, on August 20, 1947, the International Medical Tribunal in Nuremberg, Germany, delivered its verdict in the trial of 23 doctors and bureaucrats accused of war crimes and crimes against humanity for their roles in cruel and often lethal concentration camp medical experiments. As part of its judgment, the court articulated a 10-point set of rules for the conduct of human experiments that has come to be known as the Nuremberg Code. Among other requirements, the code called for the “voluntary consent” of the human research subject, an assessment of risks and benefits, and assurances of competent investigators. These concepts have become an important reference point for the ethical conduct of medical research. Yet, there has in the past been considerable debate among scholars about the code’s authorship, scope, and legal standing in both civilian and military science. Nonetheless, the Nuremberg Code has undoubtedly been a milestone in the history of biomedical research ethics.1- 3

Writings on medical ethics, laws, and regulations in a number of jurisdictions and countries, including a detailed and sophisticated set of guidelines from the Reich Ministry of the Interior in 1931, set the stage for the code. The same focus on voluntariness and risk that characterizes the code also suffuses these guidelines. What distinguishes the code is its context. As lead prosecutor Telford Taylor emphasized, although the Doctors’ Trial was at its heart a murder trial, it clearly implicated the ethical practices of medical experimenters and, by extension, the medical profession’s relationship to the state understood as an organized community living under a particular political structure. The embrace of Nazi ideology by German physicians, and the subsequent participation of some of their most distinguished leaders in the camp experiments, demonstrates the importance of professional independence from and resistance to the ideological and geopolitical ambitions of the authoritarian state.

The circumstances in which the code was promulgated thus signified a tension between professional standards and duties to the state. There had long been an intense debate within the medical profession about its ethical obligations in the course of human experiments, dating back to 18th- and 19th-century objections against objectifying human beings for scientific purposes. The increased demands placed on modern states to promote the health and welfare of citizens in the 20th century required state agencies to respond to public pressure to protect participants in clinical trials. These debates were often stimulated by medical ethics transgressions or medical errors that attracted the wider attention of state agencies and the public at large, or by concerned physicians who regarded themselves as reformers and wished to improve their colleagues’ practices. At the center of that debate is the question of how to balance participants’ rights and welfare with the progress of medical science, for example, through professional guidelines and ethics codes or through greater state intervention, laws, and regulations. That the Nazi doctors’ crimes occurred despite the vigorous and sophisticated ethical debates of the time and place should serve as a cautionary tale for physicians today.

Exactly a century ago, for example, Heiman unleashed substantial criticism against what he regarded as his colleagues’ irresponsible experimental practices in his book Etyka Lekarska (“Medical Ethics”).4 He vigorously criticized the reduction of human beings to experimental material, insisted on consent, and warned against taking advantage of desperate patients who may fear their physician will abandon them if they do not cooperate. This tradition in Eastern European medicine, which has persisted over the generations even amid catastrophic wars and massive political turmoil, demonstrates the importance of professional self-governance and advocacy in the face of an undemocratic and in many ways authoritarian state with little respect for individual rights. In 1967, 50 years after the publication of Heiman’s book and 20 years after publication of the code, the Polish Medical Association published strict “Deontological Ethical Rules” (Deontologiczno-Etyczne Zasady) about consent, voluntariness, risks and benefits, publication, and qualified investigators.5 Those rules were expanded 10 years later. Although rules do not necessarily translate into practices, it is notable that even at the height of the Cold War in a socialist government, the association sent a copy of these rules to every physician in Poland. Whether this was effective in protecting patients who participated in research is unknown.

More recent scholarship has found a similar preoccupation with “medical deontology” (medical ethics) in other countries in that region, perhaps partly owing to their proximity to the concentration camps, the collective experiences of the Second World War, and the need to assert professional ethics against a background of authoritarian rule. For example, in East Germany, medical ethicists collaborated with state commissions, such as the Central Expert Committee for Drug Commerce (Zentraler Gutachterausschuss für Arzneimittelverkehr) to monitor the safety and ethical conduct of pharmacological experiments on thousands of patients. Rather than working in an entirely different ethical universe behind the so-called Iron Curtain, these experts, though seemingly removed from the fundamental ethical principles of the code, applied their detailed knowledge of modern research ethics to the practical challenges of experimental medical science in undemocratic societies. The infamous state-sponsored “doping” of world class athletes, in which physicians were involved, was not necessarily typical of medical and ethical practices.

It is essential, however, to distinguish the inherent structural problems of nondemocratic and authoritarian government systems from legitimate government regulation for the protection of patient-participants. The two are not the same. For example, in the late 1940s and early 1950s, critics of the newly founded postwar British National Health Service (NHS), which does support clinical research, alleged that greater government direction of medicine and medical science may inevitably lead to a Nazi or Soviet style of government. Organizations such as the Society for Freedom in Science likewise denounced as totalitarian almost any government program that promoted a greater degree of central or state planning of clinical care and medical research.2 These tensions regarding professional vs governmental control over medical science are pervasive and longstanding.

In a symbolic sense, the Nuremberg Code is part of the infrastructure of the democratic international system that emerged after World War II, with its focus on respect for human rights, individual autonomy, and informed consent. But even that symbolic role is intangible at best. In the field of human research ethics the code was eclipsed by the World Medical Association Declaration of Helsinki in 1964. While the code may have created greater awareness of the importance of human rights in medical science among wide sections of the medical profession, its specific role in international human rights law is modest compared with the 1948 Universal Declaration of Human Rights, created by the United Nations General Assembly in light of 2 world wars. In 1987, 40 years after the code was written, the US Supreme Court ruled that it did not apply in the case of a retired Army sergeant who claimed to have been injured in an LSD experiment. Likewise, in 2004, an inquest into the death of a British serviceman from a Cold War sarin nerve agent experiment ruled that the code—despite its importance as a reference point in medical ethics—did not apply to UK domestic law. Indeed, the code has not been adopted by any government, with the partial exception of the US Department of Defense in 1953 regarding defensive experiments concerning atomic, biological, and chemical agents.1

The story of the Nuremberg Code is not one of ethical norms taking on the force of law. Rather, its legacy shows the fundamental importance of a robust organized medical profession that protects its independence from political interests and its ability to chart its own moral course, yet is at the same time open to the essential role of nations and government agencies that respect broadly defined and agreed-upon rules to protect the rights and well-being of human research participants. Renewed allegations in 2017 that psychologists working with the Central Intelligence Agency on detainee interrogations engaged in unethical human experimentation demonstrate that these matters are not merely of historical interest.6 It is therefore worth asking, 70 years after the judgment at Nuremberg and in the face of increasing authoritarianism worldwide, whether contemporary physicians can claim membership in a profession that reflects the spirit of the code.

Corresponding Author: Jonathan D. Moreno, PhD, Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, BH1415, Philadelphia, PA 19104.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Schmidt and Moreno report grants from Wellcome Trust during the conduct of the study. No other disclosures were reported.

Funding/Support: Drs Schmidt and Moreno acknowledge the support of a Wellcome Trust Seed Award 2016, “Cold War Bioethics: Human Research Ethics in Central Eastern Europe, 1945-present” (WT: 201441/Z/16/Z).

Role of the Funder/Sponsor: Wellcome Trust had no role in the preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

References
1.  Moreno  JD.  Undue Risk: Secret State Experiments on Humans. New York, NY: Routledge; 2001.
2.  Schmidt  U.  Justice at Nuremberg: Leo Alexander and the Nazi Doctors’ Trial. New York, NY: Palgrave Macmillan; 2004.
3.  Schmidt  U.  Secret Science: a Century of Poison Warfare and Human Experiments: New Product Edition. New York, NY: Oxford University Press; 2015.
4.  Heiman  T. Etyka lekarska i obowiązki lekarza: (deontologia). Warszawa, Poland: skł. gł. Gebethner i Wolff; 1917.
5.  Polish Medical Association.  Deontologiczno-etyczne zasady.  Służba Zdrowia. 1967;26:3.
6.  Dougherty  S, Allen  SA. Nuremberg Betrayed: Human Experimentation and the CIA Torture Program. June 2017. http://physiciansforhumanrights.org/assets/multimedia/phr_humanexperimentation_report.pdf. Accessed June 22, 2017.