Albert Sabin and Bioethics: Testing at the Chillicothe Federal Reformatory

Dr. Albert Sabin (1906–1993) was born in Bialystok, Russia (now Poland). At age 15, he immigrated to the United States with his family. In 1930, he achieved U.S. citizenship and a year later was awarded a medical degree from New York University College of Medicine. Early in his career, Dr. Sabin developed an interest in poliomyelitis and along with other researchers, including Dr. Jonas Salk, joined the hunt for a vaccine against the virus, which he pursued from positions at the University of Cincinnati, College of Medicine and the Children's Hospital Research Foundation.

The poliomyelitis virus, a type of enterovirus that multiplies in the pharynx and gastrointestinal tract before entering the bloodstream and eventually attacking the nervous system, was first recorded in the United States in 1843. In the hundred years since its first identification on American soil, the number of attacks, their severity, and the ages of polio’s victims increased with devastating results. In 1952, according to data from the Center for Disease Control, over 21,000 cases of paralytic polio were reported in the U.S. (See also, Worksheet 3: Chillicothe Federal Reformatory Study Background Information).

In contrast to Dr. Jonas Salk, who worked with the inactive virus, Dr. Sabin worked with live polio strains, believing that injections from the living virus would afford greater immunity to the disease. In the mid-1950s, Sabin carried out his first experiment with injections of live, attenuated (weakened) oral vaccine on 30 adult male volunteer inmates of the Chillicothe Federal Reformatory.

As preparation (particularly for activities 2, 3, and the final assessment) the teacher may want to consult a short review of the history and use of the term “bioethics” from the Stanford Encyclopedia of Philosophy:

• The Bioethics Movement (s.v. Feminist Bioethics)
• Public Health Ethics (overview)

[Note: This lesson is a reformatted and edited version of a lesson under the same title that was created as part of an NEH grant and that resides on the website for the Hauck Center for the Albert B. Sabin Archives at the Winkler Center, University of Cincinnati.]

CCSS.ELA-Literacy.CCRA.SL.4 Present information, findings, and supporting evidence such that listeners can follow the line of reasoning and the organization, development, and style are appropriate to task, purpose, and audience.

CCSS.ELA-Literacy.RI.11-12.7 Integrate and evaluate multiple sources of information presented in different media or formats (e.g., visually, quantitatively) as well as in words in order to address a question or solve a problem.

CCSS.ELA-Literacy.RST.11-12.1 Cite specific textual evidence to support analysis of science and technical texts, attending to important distinctions the author makes and to any gaps or inconsistencies in the account

CCSS.ELA-Literacy.RST.11-12.6 Analyze the author’s purpose in providing an explanation, describing a

Activity 1. What Do I Know About Dr. Sabin and Polio?

In this introductory activity, students will gain competency in integrating and analyzing online secondary sources of information in a variety of formats in order to compare and contrast what they have learned about polio and Dr. Albert Sabin. After students have individually filled out part of Worksheet 1 with their prior knowledge of polio, Sabin, and what they want to know about each, they will conduct online multimedia research to find answers these questions and record them.

• It is suggested that students watch the short (2:31 minute) video from American Experience on FDR as a class to provide a mini introduction to both polio and to ethical issues in science. (It is also an example of bioethics and polio, with which students may already be familiar.) Lead a brief, whole class discussion on the ethical issues surrounding FDR’s concealing the extent of his polio such as the press’s role and why Americans may not have elected a president in a wheelchair.
• In order to build students’ knowledge of polio, divide them into small groups of 2–4 students and have each student in the group be responsible for researching one or two of the four remaining online resources) on Sabin and his role in creating an effective vaccine(see Preparation Instructions. Allow about 20 minutes for students to discover and list basic information about 1) Sabin; 2) polio; and 3) Sabin’s role in vaccine development.
• Instruct students within the groups to collaborate in filling in the final section of Worksheet 1. Encourage intra-group sharing of any interesting or important information students have discovered. Make sure to clarify any questions and offer further explanation on any points of confusion as they research and fill in their worksheets.

Exit ticket: Create a whole class activity for students using the filled-in worksheets. Ask student groups to offer a comparison of their new knowledge with their prior knowledge. Encourage students to add new questions that they now have about Sabin and polio that had not occurred to them before their research to their worksheets and the whole class discussion.

Activity 2. What is Bioethics?

This activity adapts a module from the National Institute of Health’s Department of Bioethics instructional series that will guide students in solving ethical problems using supporting evidence and logical reasoning.

• Before watching the brief PowerPoint, Dr. Albert Sabin and Bioethics, solicit students’ definition of bioethics. Encourage them to consider what the more general term “ethics” means both conversationally and as a discipline of study and how “bioethics” fits into this general definition. Ask them who might practice “bioethics”.
• Review the PowerPoint resource, which defines bioethics; describes key questions of bioethics; and provides examples of bioethical issues. Pay particular attention to the four key questions that will structure the students arguments in Activity 3.
• As instructed in the PowerPoint, have the whole class brainstorm and list other examples of bioethical issues and bioethical questions.

Exit ticket: After the discussions have been completed, divide the class into small groups of 2–4 students and let the groups choose one of the bioethical issues from the list that they have brainstormed. Have them submit this example to the four key questions from the PowerPoint and compose their answers in a narrative form of about 350 words. Have one or more groups present their conclusion to the class for argument and discussion.

Activity 3. Case Study: Albert Sabin and the Chillicothe Federal Reformatory

In this culminating activity, students answer the question: Was Albert Sabin justified in his use of rewards given to the inmates in return for their participation in the polio vaccination study? This exercise will help them determine the bioethical implications of the actions taken on the prisoners while giving them a better understanding of Sabin’s work in the Federal Reformatory. It will also help them come to their own conclusion of whether or not the studies were morally justifiable. 

• Distribute Worksheet 2. Polio Vaccine Studies and the Chillicothe Federal Reformatory, which is built around the Sabin bioethical question. Have the whole class read the 1969 Nashua Telegraph article, which was written by a medical doctor and comes from the New York Times News Service. It offers valuable insight on the ethical issues surrounding the use of prison populations for biomedical research. Have the class collaborate in filling in a summary of the important facts and the affected populations, as well as a list of relevant ethical considerations from their reading of the worksheet. 

Students will now directly put into practice their experience with the four key bioethical questions by applying this methodology to an actual case study that brings into play evidence-based reasoning based on primary source documents from the Sabin Archives.

• Arrange students again in small groups of 2–4 and as a case study, have them read Worksheet 3. Chillicothe Federal Reformatory Study Background Information, as well as the four letters from the Albert Sabin Archives, which cover the use of rewards for inmates’ participation in polio vaccine studies at the Chillicothe Federal Reformatory.
• As students read the documents instruct them to enter their notes that will help them to answer the remaining four key bioethical questions on Worksheet 3. Encourage group members to assist each other with analyzing the documents and to discuss the issues as they arise.

Exit ticket: Either in whole class discussion or in smaller group discussions, have students defend their position on whether or not the Chillicothe polio vaccine studies were ethical. During the discussion(s) remind students of the importance of applying the facts they have learned about polio and Sabin (and which have been summarized on the three worksheets) in support of their arguments. Guide them so that they work to answer and defend their position on the main bioethical question mentioned above. As the students talk, ask them to consider other related bioethical questions such as:

• Why were these inmates selected to participate in the study?
• Do you think they were volunteers or that they were forced to participate?
• Why would these images participate in a study where they could possibly get sick?
• Should the prisoners have been offered rewards to participate in the study?
• Was finding a vaccine for the polio epidemic more important than the health of these prisoners?
• Was it acceptable because no one died during the study?

Have students write individual defenses of their final opinion on the Sabin question in Activity 3, keeping the four bioethical questions they have learned firmly in mind. Remind them to cite the primary and secondary sources for their positions and note any objections that may have come up in the discussion as well as their defense against them. This exercise can be brief (a few well-developed paragraphs) or can be more detailed and extensive (possibly requiring outside research and additional information).