Carbon monoxide story 1.5: Human Ethics
Request permission to expose humans to CO, please”(1.5)
It was agonizing to write the request for permission from the Ethics Review Board (ERB), to expose humans to CO.
The argument ran along these lines: Humans expose themselves to CO frequently. For example, smoking tobacco, and driving a car. Imagine driving in stop and go traffic on the Santa Monica Freeway inhaling gas from thousands of tailpipes. Studies have shown that even non-smokers can have CO levels up to about 6-10 % of their hemoglobin occupied by carbon monoxide instead of oxygen. This combination of hemoglobin and carbon monoxide is called carboxyhemoglobin (COHB). Now add some chain smoking with the windows up. This describes thousands and thousands of people every day, year after year. In comparison, we proposed to expose people to bring their blood to 10-12% COHB, but in a much safer manner. Whereas the Santa Monica folks continued to carry the CO in their blood after they got to where they were going, our subjects would it have all cleared before they went home. The rapid rise and fall of the CO, the argument went, is much safer than poisoning over hours on the Santa Monica Freeway. Why? Well, the CO is taken up by the blood and sticks strongly to the blood for some time. Over time it seeps into the cells of the body and starts poisoning some of the cell components such as cytochromes and myoglobin. In our subjects, the rise of CO in the blood would take about 10-15 minutes and would be cleared from the blood before any substantial amounts would get into the cells. The sweetner to the ERB group was telling them that we would concentrate on recruiting subjects from among the hospital medical staff, particularly the anesthesiologists so there would be no question about how informed the consent was.
I was trying my best to get permission, but at the same time, I was hoping they would deny permission for the study. My stomach was in knots. I was waking up early and couldn’t fall back asleep with anxiety. I just didn’t want to do it. Well, yes I did want to do it, sort of, but actually was hoping they would say ‘no’ so it wouldn’t be my choice. Talk about being conflicted internally.
After the first airing of my application, the ERB decided to invite me to answer some questions. One issue to address was why we needed to study humans when we already showed the efficacy in animals. The answer was: Before it can be used to treat a human, it must be tested on a human. We needed to show that the rates of CO elimination we saw in the dogs are similar in humans. After all, the dogs were hyperventilated by being attached to a ventilator. The humans will be breathing on their own. We don’t know how much they are going to breathe. If they don’t increase their breathing, then maybe the rate of CO removal won’t be any different than just breathing through a regular oxygen mask. And even if they are coached to hyperventilate, how much hyperventilation, and what duration of hyperventilation, can we realistically expect, and what will it add to the rate of CO elimination?
I began to feel that this study will be a “theoretical”, but practically futile, exercise. I don’t know how much of this was visible on my face, voice and demeanor, to the committee. My own words and unspoken thoughts further demoralized me and I actually wanted to forget the whole thing. To help them decline the study, and give me further comfort in doing the study, I told them not to approve it if they would refuse to be a subject themselves or allow their spouse or children to be subjects. The room was dead silent for an extended time. I rose and left.
The next day I got a letter saying the IRB approved the study.
Shit.
Go to 1.6: A cosmic coincidence
