Case Study 2: Arkansas Ivermectin Experiment

Case Study 2: Arkansas Ivermectin Experiment Like many inherently racist studies conducted by the United States, the study conducted in Arkansas to test ivermectin on inmates in 2021, suggests that America follows its past in prioritizing medical research over any ethical basis. Ivermectin is an antiparasitic agent that is used to treat organisms like nematodes or parasitic bacteria in primarily livestock (Ivermectin). The correlation to ivermectin and COVID-19 was made by Dr. Robert Karas, who alongside many right wing activists, were convinced it could be a treatment for COVID-19. With that being said, it should be noted that the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) both advised not to use the drug as it has been tested for a COVID-19 treatment and has proved to be ineffective (Yang 2022). Additionally, the FDA has stated that side effects of ivermectin may include diarrhea, nausea, or allergic reactions (Yang 2022). Nonetheless, Dr.Karas proceeded with his experimental desires, with the rightwing community to defend his actions, and proceeded to neglect any ethical consideration and essentially poision the inmates. In this study, the subjects were 4 inmates, Dayman Blackburn, Julio Gonzales, Jeremiah Little and Edrick Floreal-Wootenwho, who were all people of color. Because they all contracted COVID-19 they were told they would receive a combination of vitamins, steroids, and antibiotics that would allegedly help treat the virus (Aleem 2021). However, Dr.Karas administered Ivermectin, in astonishing doses, to the inmates instead of the promised treatment. Records indicate that one inmate who was 71.6 kg and 6ft and 1 inch, received 48 mg over the course of four days, which is 3.4 more times than the approved amount. Another inmate, who was 6 feet and 1 inch and weighed 86.6kg received a total of 108 mg which is 6.3 times the approved dosage (Yang 2022). Essentially, all of the inmates were given dangerously high dosages which were never approved. After the inmates had begun the ivermectin doses, it was soon after when their side effects began which were vision problems, bloody stool, and diarrhea (Medina 2021). The inmates found out about their ingestion of ivermectin through the news as it was reported, but not a single authority at the prison informed them of what was occuring (Aleem 2021). The authorities at the prison, including the sheriff, were aware of the experiment but chose to allow it, perpetuating the unethicality of the experiment. Additionally, the inmates expressed how they felt dehumanized, treated like livestock, and were not informed of what was being done to them (Yang 2022). It should be noted that the information released about dosage of the two inmates did not include further information about the other two inmates, nor their names. More specifically, further details about methodology and procedure have not been released. On behalf of the inmates, the Arkansas chapter of the American Civil Liberties Union filed a lawsuit against Washington county jail, Tim Helder, who is the county sheriff, and Dr. Robert Karas. The lawsuit is still ongoing and both the inmates and Dr.Karas await for the judge’s ruling. This study violated crucial components of research, which is informed consent, and specifically targeted inmates who were of color, perhaps due to the institutional racism that is present in America, allowing them to be a vulnerable subject for the cause. Vulnerability: The inmates in this study are the vulnerable population for an array of reasons. First, inmates in general lack authority and many rights. However, inmates who are not white are at more risk for cruel and unusual punishment because of America’s dark history in racism. People of color, especially African Americans, have faced copious amounts of injustice because of discrimination and the perspective that they are simply an inferior population. With that being said, many studies have been conducted with this discriminatory mindset- like the Tuskgee Syphillis experiment- and it is still prevalent today as shown by this experiment. A prison in Arkansas consists of predominantly white inmates, meaning these 4 inmates were specifically chosen because of the color of their skin, as it cannot be because of chance or any other confounding factor. More specifically, the variables for the subject in the prison remain the same, all of the subjects were male and inmates, meaning the only other variable was race. Moreover, these subjects did have COVID-19 which is why the drug was administered, but this experiment occurred when COVID-19 was at a peak in America, meaning it is very unlikely that the only subjects that were feasible for the experiment were only the inmates of color. It can be concluded that there is a racial motivation in the selection of the subjects as people of color have suffered tremendous amounts because of idea that they do not deserve equal treatment because of race, which is inherently discriminatory. Inmates do not have many rights, making them a vulnerable population in this experiment because their lack of rights make them more susceptible to experiments and being taken advantage of as they are seen as an easier population to target. More specifically, they are under constraining conditions, which can affect their mental and physical health, which will then factor into their decision making process. Inmates can make decisions that are not truly representative of what they want because of the conditions they are in, making them easier to coerce and manipulate. Moreover, many inmates may lack knowledge or not even question experimentation, meaning they are less likely to advocate for their beliefs or doubts. In this experiment, the subjects were both inmates and not white, making them extremely vulnerable. The subjects already have a limited amount of rights because they are incarcerated, but they are also not white which makes them susceptible to racism and being taken advantage of. Being in a prison, and having COVID-19, are extremely unfavorable conditions, which could make them desperate for almost any form of relief. Therefore, when a treatment was presented to them for COVID-19, they could have agreed to the experiment for sheer relief from the conditions they were experiencing. However, they were never informed of what they were actually receiving as a “treatment”, making them victims of this experiment, possibly because of how vulnerable they are. Ethics: This experiment is inherently unethical for many reasons, including lack of informed consent and racial motivation. Using both the justice and rights lens, I argue that the inmates were treated unethically by Dr.Robert Karas. Rights Lens: The inmates, although they may have limited constitutional rights, still have the right to good health which includes informed consent when receiving health care. The experiment involved Dr.Karas stating that he will administer a combination of vitamins, steroids, and antibiotics,for COVID-19 treatment, while in reality he administered ivermectin. Additionally, they also have a right to know exactly how much of the treatment they will be taking and for how long, which is also a part of informed consent. Dr.Karas administered doses that were incredibly high in comparison to the approved amount, which is extremely dangerous in medicine. Furthermore, the inmates have the right to be treated by effective medicine. Ivermectin has been proven ineffective for treating COVID-19, but it was still used on the inmates, to which they could have refused if informed consent was given. The inmates also have the right to seek justice for the unethical medical treatment they received. After the inmates realized they have been administered ivermectin, a lawsuit was filed in the U.S District Court for the Western District of Arkansas because of the administration of ivermectin instead of the promised treatment Dr.Karas had told them (NY times citation). Justice Lens: It is very evident that the prisoners were treated unjustly because they were never informed of what they were actually receiving as treatment. Using the justice lens, the inmates were treated unfairly for the following reasons: Aforementioned, the inmates are vulnerable because they are prisoners and lack rights in comparison to others and because they are not white. Because of these differences from the general population in Arkansas, they are deemed as easy to manipulate, or coerce. This perspective, set by Dr.Karas, leads to the discrimination that they face because they are viewed as a population that is acceptable in being discriminate against because they are in a ‘correctional center’, meaning this could be a way of “justice” for the actions they have committed. Moreover, Dr.Karas was able to choose his subjects for experimentation, and he deliberately chose inmates, suggesting he created a correlation between socioeconomic status and experimentational attainability. Additionally, in a predominantly white prison, the subjects that were chosen were all of color, suggesting there is a racial motivation behind the selection of subjects. There were no white subjects, although the prison was majority white. To conclude, it is a combination of the lack of respect prisoners get due to their social status and not being white, for the reason these inmates were treated unethically by Dr.Karas. Informed consent laws: There are laws that have been placed before this experiment was conducted so that the patient’s understanding, safety, and comfortability are prioritized. To reiterate, the following laws have been established in the past, but this experiment did not follow the regulations that were established. 1) Right to Try Act (2018) This act states that an investigational drug must only be administered to a subject when a life threatening condition has taken place and there has been a signed consent form from the subject. 2) Section 1557 of the Patient Protection and Affordable Care Act (2010) This act states that there will be no discrimination in patient care in terms of race, sexual orientation, sex, age, gender identity, age, or national origin. 3) Belmont Report (1979) - The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research This report states that there are three ethical principles that must be followed when conducting human experimentation: respect for persons, beneficence and justice. 4) Nuremberg Code (1947) This code is meant to justify a human experiment stating that an experiment conducted is only ethical by the many principles within the code. The principles state that informed consent is mandatory, the experiment should have previous knowledge and knowledge from animal experimentation, the benefit should be greater than any cost, and most importantly the autonomy and safety of the subject should be prioritized. Works Cited: (Ivermectin) - Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/050742s026lbl.pdf. (OCR), Office for Civil Rights. “Laws & Regulations Enforced by OCR.” HHS.gov, 22 Nov. 2021, https://www.hhs.gov/civil-rights/for-providers/laws-regulationsguidance/laws/index.html. Aleem, Zeeshan. “Covid Patients Were Unknowingly given Ivermectin in an Arkansas Jail.” MSNBC, NBCUniversal News Group, 8 Sept. 2021, https://www.msnbc.com/opinion/covid-patients-were-unknowingly-given-ivermectinarkansas-jail-n1278729. Commissioner, Office of the. “Right to Try.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatmentoptions/right-try. Medina, Eduardo. “Detainees Sue Arkansas Jail That Gave Them Ivermectin to Treat Covid.” The New York Times, The New York Times, 18 Jan. 2022, https://www.nytimes.com/2022/01/17/us/ivermectin-covid-arkansas-jail.html. “Nuremberg Code.” UNC Research, 1 May 2017, https://research.unc.edu/human-researchethics/resources/ccm3_019064/. Office for Human Research Protections (OHRP). “The Belmont Report.” HHS.gov, 16 June 2021, https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html. Yang, Maya. “Arkansas Jail's Ivermectin Experiments Recall Historical Medical Abuse of Imprisoned Minorities.” The Guardian, Guardian News and Media, 14 Feb. 2022, https://www.theguardian.com/us-news/2022/feb/14/arkansas-prison-covid-19-ivermectinexperiment-minorities-medical-abuse.