The Polio Crusade
Alan Colburn
Department of Science Education
California State University, Long Beach
Lesson Plan
Background You might be surprised to find the biggest news story in the summer of 1954 was neither Brown v. Board of Education, nor the Army-McCarthy hearings. No, the story that most captured the public’s attention was the largest experiment ever undertaken in the United States, testing Jonas Salk’s polio vaccine. As the basis for an ethics unit, it’s a story with lots of possibilities. For my classes on the nature of science (the scholarly examination of what science is and how science works) I chose to concentrate on the experimental trials themselves, focusing on the procedures used by the scientists. The issues raised are no different today when field testing a proposed vaccine, esp. if the vaccine is designed to protect a vulnerable population (like children) and is a fairly rare ailment (requiring large numbers of test subjects to get statistically significant data).
The classes in which I am and will be teaching this lesson are small and meet once per week (for three hours). They are discussion oriented, with lots of student participation. I rarely lecture or feel the need to present factual information via software like PowerPoint. That’s why I am providing this lesson description rather than slides.
Overview Speaking informally with students it was clear to me they--esp. those in the traditional undergraduate age range--know little about polio, the polio vaccine, or any of the people involved in its development and testing (including Jonas Salk). So my approach was to use the lesson’s Day1 to help students understand background information, followed by a reading assignment detailing the vaccine trials. We discussed the experiments on Day2, accenting not only ethical considerations but also relating details to the course’s content. Finally, students were also assigned to explore two web sites presenting ethical case studies related to science, and select one they or their future students might find engaging. The ethical issues in each case were obvious. We spent class time on Day3 discussing how the cases might simultaneously address content required in high school biology courses. I accented how high school students often find lessons with real-life scenarios more engaging than typical lessons.
Day1
I showed students the first 40 minutes of a program called The Polio Crusade, part of PBS’s American Experience series. The program provides background information on polio, polio treatments (including iron lungs), Franklin Roosevelt’s polio, Warm Springs, and the rise of The March of Dimes. I stopped the DVD here:
Narrator: O’Connor refused to wait. With another polio season looming, he would let nothing stop the trials. “This is one of the most important projects in medical history,” he wrote to parents across the country. “We feel sure you’ll want your child to take part.”
Kathryn Black, writer: As a parent today, it’s unimaginable that I would be one of those people pushing my child to the front of the line, saying, y’know, “Put the polio vaccine in my child first, and let’s see if it works.”
David M. Oshinsky, author, Polio: You are asking the parents of America to line up their kids for a vaccine that no one is sure how well it works, and no one is certain that it is perfectly safe. It has really not been tested that much on humans. This is an enormous leap of faith.
Narrator: On April 26th, 1954, The March of Dimes began field trials…. (40:04)
This is where I ended the lesson, turning students loose to learn details of the vaccine field trials via their assigned reading.
Day2
We discussed the reading assignment in class. Students generally liked it; a few loved it.
Ethical issues relate to the need the researchers had to test a massively large number of people, mostly children, because the actual disease rate was fairly low and no one knew how effective the vaccine would be, i.e., a statistically significant difference for a moderately effective vaccine and a relatively rare disease adds up to requiring really big sample sizes.
There was, on the one hand, risk from the vaccine itself. People in the experimental group might conceivably be sickened by the vaccine.
Jonas Salk and many other people--probably most--were more worried about the experiment’s control group, receiving a placebo injection, i.e., people not receiving the vaccine. Denied protection, they were at risk of coming down with polio--which could have been entirely prevented. Some of the researchers were racked with guilt at the possibility someone could receive a placebo injection and become paralyzed or die from polio.
In the end researchers essentially ran two experiments. We discussed the technical details of both in class; a randomized, double-blind study AND a prospective study (some people got the injections, and the researchers compared them with a bunch of “observed controls,” people who got no injections). The reading includes data from both groups, and I also have access to more detailed information (see link below).
Students in my classes learn about retrospective, prospective, and randomized experimental designs as ways scientists test potential cause-effect relationships. It’s impossible to do a retrospective study on something brand new, like an untested vaccine. We could, however, discuss randomized controlled tests vs. prospective designs, and the ethical implications of each design.
Finally, I asked students “As science teachers who want people to make informed, independent decisions about science related issues, what do you think a person needs to understand in this case (or the development and testing of any new vaccine)”?
Day3
I told students about two web sites (see links below) I selected with information about other science-related ethical case studies, and asked each student to look at one and then briefly summarize for classmates the case. I also asked students about science content they thought the cases addressed, making explicit that these interesting cases could still be part of standards-based instructional units.
Students found cases on topics including:
-issues surrounding a company developing a drug that will help people but not make any money
-clinical research studies done with just men or just women subjects (or decisions about limited research monies being spent on diseases affecting only men or only women)
-whether it was OK to publish microbiological research results which could potentially also be used for nefarious purposes (e.g., bioterrorism)
-when, if ever, is it OK ethically to kill a whale? (intersects with issues of international law)
-veterinarians being asked to euthanize moderately ill pets because of ultimate inconvenience or cost to owners