Medical Harm, Ethical Failure, and the Need for Humility
The previous article in this series looked at the breakthroughs that saved lives and helped define the best of American medicine, but that is only half the story
To understand where medicine must go next, we also have to face where it went wrong.
Some of the darkest chapters in American history were shaped by medicine, research and public health policy when power overran conscience.
Patients were experimented on without true consent. Communities were harmed in the name of science.
Women, children, the poor, the disabled, and racial minorities were too often treated as problems to manage rather than human beings to protect.
Some of that harm came from ignorance. Physicians did not always know what we know now. They worked with limited tools, incomplete science, and theories that later proved to be wrong.
But some harm came from something more troubling.
It came from arrogance. It came from coercion. It came from institutions that placed research, ideology, profit, reputation, or public policy above the individual. It came from doctors and officials who believed their authority gave them permission to act without full consent.
That must not be forgotten.
IMA’s Medicine at 250 Years project is not only about honoring the breakthroughs. It is also about remembering the failures. If medicine is going to build a better future, it must be honest about where it lost its way.
The lesson is not that medicine should be rejected.
The lesson is that medicine must remain humble.
When Treatment Became Harm
For much of medical history, physicians used treatments that were accepted in their time but later proved ineffective or dangerous.
Bloodletting is one of the clearest examples. For centuries, doctors believed that illness could be treated by removing blood from the body to correct an imbalance. It was used for fevers, infections, pain, inflammation, and many conditions physicians did not fully understand.
To the doctors of the time, it often seemed reasonable. It fit the prevailing theory of disease, but in many cases, it weakened already sick patients.
This is one of the simplest lessons in medical humility. A treatment can be widely accepted and still be wrong. A practice can be defended by experts and still harm patients. A theory can dominate medicine for generations and still fail the patient at the bedside.
The same lesson has appeared again and again throughout history.
Mercury was used for syphilis and other illnesses, often causing poisoning. Early radiation treatments were sometimes used before long-term risks were understood. Drugs once promoted as safe were later withdrawn after more evidence emerged.
Surgical procedures once celebrated as breakthroughs were later questioned or abandoned.
Medicine does not become trustworthy by pretending it has never been wrong.
It becomes trustworthy by admitting error, studying outcomes, changing course, and placing patient safety above professional pride.
The Cruelty of “Progress” Without Consent
Some of medicine’s most disturbing failures occurred when human beings were treated as instruments of research rather than a human being with dignity.
The Nuremberg Code emerged after the world learned of horrific medical experiments conducted by Nazi physicians during World War II. The code made voluntary consent central to ethical research.
It affirmed that human beings must not be used as experimental subjects without their knowledge, freedom, and consent. The Belmont Report later recognized the Nuremberg Code as one of the defining responses to the abuse of human subjects in research.[1]
This should have changed everything, but even after Nuremberg, unethical research continued.
The U.S. Public Health Service Study of Untreated Syphilis at Tuskegee remains one of the most infamous examples in American medical history. The study began in 1932 and continued until 1972.
It involved 600 Black men in Alabama, 399 with syphilis and 201 without the disease. According to the CDC, the men’s informed consent was not collected, and researchers did not offer treatment even after it became widely available.[2]
This was not merely a failure of communication. It was a betrayal. Men were misled. Treatment was withheld. Families suffered. Trust was broken in ways that still echo across generations.
Tuskegee shows what happens when institutions convince themselves that data is more important than people. It shows what happens when patients are not treated as partners, but as material for study.
The moral injury did not end when the study ended. It became a dark part of the public memory of American medicine.
The Women Medicine Used and Failed to Hear
The history of medical progress includes stories of women whose suffering was ignored, minimized, or used for the benefit of others.
One of the most painful examples involves J. Marion Sims, often called the “father of modern gynecology.” In the 1840s, Sims performed experimental surgeries on enslaved Black women while developing techniques to repair vesicovaginal fistulas, a devastating childbirth injury.
The women most often named in historical accounts are Anarcha, Lucy, and Betsey. Their bodies were used in the pursuit of surgical innovation, but they did not have the freedom to give meaningful consent.[3]
The history is complicated by the fact that vesicovaginal fistula was a catastrophic condition, and the surgical repair Sims developed later helped many women, but that cannot erase the ethical failure.
Medical progress achieved through coercion or exploitation leaves a wound in the profession itself. It asks a question medicine must never avoid: Who bears the cost of discovery?
Women have also been harmed when their pain was dismissed, their symptoms minimized, or their fertility controlled by others. For too long, women were told that their suffering was emotional, exaggerated, or simply part of being female.
Many were not believed until disease was advanced, damage was done, or their voices could no longer be ignored.
A medicine that does not listen can become dangerous even when it believes it is helping.
Eugenics and the False Authority of “Better Science”
Few examples show the danger of scientific arrogance more clearly than eugenics, the discredited belief that society could be improved by controlling who was allowed to reproduce.
In the early 20th century, eugenics was promoted by many educated and influential people as a scientific effort to improve society. It claimed that poverty, disability, mental illness, criminality, and other human conditions could be controlled through heredity and selective reproduction.
It was wrong and also devastating.
The National Human Genome Research Institute describes eugenics as a scientifically erroneous and immoral theory of “racial improvement” and “planned breeding.” Eugenicists promoted involuntary sterilization, segregation, and social exclusion against people they deemed “unfit.” [4]
In the United States, eugenic ideas influenced state laws and public policy. Thousands of people were sterilized under laws that treated them as burdens rather than human beings.
The U.S. Supreme Court’s 1927 decision in Buck v. Bell upheld Virginia’s forced sterilization law, giving legal cover to one of the darkest chapters in American medical and public health history.
The eugenics movement is a warning about what can happen when medicine joins itself to ideology. It is also a warning about consensus.
Eugenics was not only promoted by fringe voices. It had supporters in universities, public health circles, courts, and respected institutions. It was cloaked in the language of science while violating the dignity of human beings.
That should humble every generation.
The fact that an idea is popular among experts does not make it morally sound. The fact that a policy is legal does not make it ethical. The fact that something is called “public health” does not mean it honors the person.
The Lobotomy and the Cost of Desperation
In the 20th century, lobotomy was promoted as a breakthrough for severe mental illness.
Families were desperate. Psychiatric hospitals were overcrowded. Physicians had few effective treatments for patients suffering from serious mental illness. Into that desperation came a procedure that promised relief.
The operation involved cutting or disrupting connections in the brain’s frontal lobes. In the United States, neurologist Walter Freeman became the most famous promoter of the procedure. He helped popularize the transorbital lobotomy, sometimes known as the “ice pick” lobotomy, which could be performed quickly through the eye socket.
The procedure could leave people emotionally blunted, cognitively impaired, passive, disabled, or permanently changed. At the time, some saw lobotomy as progress, but many patients paid a horrible price.
By the time the practice fell out of favor, an estimated 40,000 to 50,000 lobotomy or leukotomy operations had been performed in the United States between 1936 and 1959. Walter Freeman alone is estimated to have performed roughly 3,500 to 4,000 of them.[5] A
comprehensive survey of U.S. psychiatric facilities from 1949 to 1951 also found that most patients lobotomized by doctors were women.[6] That detail should stop us in our tracks.
Lobotomy was not only a story of medical desperation. It was also a story of who was considered difficult, disruptive, unstable or inconvenient enough to be surgically subdued.
Thalidomide and the Difference One Skeptical Physician Can Make
Not every story of medical harm ends in catastrophe for the United States.
Thalidomide is a powerful example of what can happen when one physician refuses to accept incomplete evidence.
In the late 1950s and early 1960s, thalidomide was sold in many countries as a sedative and was used by pregnant women for nausea. It was later linked to severe birth defects in thousands of babies worldwide.
In the United States, FDA medical officer Dr. Frances Oldham Kelsey resisted pressure to approve the drug because she was not satisfied with the safety data.[7]
Her caution helped prevent a much larger tragedy in America.
This story deserves to be included in this article about harm because it shows the other side of failure. The danger was real. The pressure was real. The product was already being used elsewhere. But one physician-scientist insisted on more evidence.
That is what medical humility looks like in practice. It does not mean rejecting innovation. It means refusing to rush past uncertainty when human lives are at stake.
When Warnings Were Ignored
One of the most tragic recent examples of medical harm in America is the opioid crisis.
Patients in pain deserved compassion. Physicians needed better tools. But that real need was exploited by companies that aggressively promoted powerful opioid medications while minimizing the risk of addiction.
Purdue Pharma’s OxyContin became the central example. Sales representatives were trained to tell physicians that the risk of addiction was “less than one percent,” even though federal investigators later noted that such claims were not substantiated.[8]
The consequences were devastating. The CDC reports that from 1999 to 2023, approximately 806,000 people died from an opioid overdose in the United States, including deaths involving both prescription and illegal opioids.[9]
Millions more have lived with addiction, family rupture, job loss, disability, incarceration, grief and the long shadow of trust betrayed. The harm also intersected with despair and suicide risk. One review found that people who use opioids are far more likely to die by suicide than the general population.[10]
There has been some legal accountability. In 2007, Purdue Frederick and three company executives pleaded guilty to criminal charges related to misbranding OxyContin and paid $634.5 million in fines.[11]
In 2020, Purdue Pharma pleaded guilty to federal fraud and kickback conspiracies, and in 2026 the Department of Justice announced that the company had been sentenced and ordered to pay more than $5 billion in criminal penalties for its role in fueling the opioid epidemic.[12]
But for many families, accountability has felt incomplete. A later settlement requires Purdue Pharma to dissolve and be replaced by a new company, with billions in settlement funds expected to come from members of the Sackler family and related parties.[13]
Still, many victims and families continue to question whether financial settlements can ever match the scale of lives lost, communities damaged and trust destroyed.
The opioid crisis is a warning about what happens when medicine allows marketing to outrun evidence, when pain becomes a market opportunity, and when institutions ignore warnings until the human cost is impossible to deny.
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Header image: Doctor’s Council