Here To Help?

She Came In For Treatment

On Jan. 14, 1983, Shalmah Prince went to the emergency room at University Hospital in Cincinnati. Prince, who had been suffering from manic depression for two years, felt as if she was losing control. She went to there because she didn't have any health insurance.

Prince was not admitted as a patient, but as a test subject for psychiatric research. She was put in a locked unit known as "Two-West." Correspondent Erin Moriarty reports on how that experience changed her life.


Prince had no idea that she was going to be part of a research trial, she says. Although she willingly signed the consent form, she didn't read it, she adds.

The form said that she agreed to take part in a study of manic depression. The doctors there didn't try to call her family, doctor or the psychiatrist who was treating her, Prince says. Nor did they tell her about any potential risks, she says.

"We would not even tolerate it had we known that it was research," says her mother, Jenelle Cogsdell. "We just thought she was being treated."

What neither Prince nor her parents were told was that she wasn't being treated for manic depression; in fact, she wasn't being treated at all. She was in a study of psychosis: According to hospital's own records, Prince wasn't psychotic when she came into the emergency room. Five days later, she was.

Medical records show that when Prince was taken off of her regular medicine, she began to act bizarrely. Then she got worse. "I remember laying on my bed thinking that if I shut my eyes, I could transmit myself to South America," Prince recalls.

Researchers, who wanted to compare her brain chemistry to that of schizophrenics, had injected Prince with a drug called apomorphine. It made her delusional, she says.

"It hits you at the deepest level," she says. "You feel you're coming internally undone, you know, and falling apart inside." At that point, Prince became so paranoid and out of control that she was put in restraints for three days. She had never acted like that before and has never acted like that since, her mother says.

"It was the result of what was injected into her at the time that she was there," Cogsdell says. She turned into someone even her mother has trouble recognizing, Prince says. Once a bubbly cheerleader and promising painter, she now spends much of day alone in her car, driving the same streets in her hometown of Cincinnati, over and over.

"She was being used as a guinea pig, because she went there for treatment," says Dr. Adil Shamoo, a bioethicist at the University of Maryland. "And apomorphine is not treatment." He believes that all nontherapeutic research on humans should be banned.

"We as a society have elected not to cause needless pain and suffering to animals," he says. "So why should we cause needless pain and suffering to patients when this medicine has no...medical benefits?"

Th doctor who ran the research unit at University Hospital, Dr. Jack Hirschowitz, no longer works there and refuses to respond to Prince's claims. But in court documents filed after she sued him, Dr. Hirschowitz insists that she entered the study willingly and that she was dropped from it and given treatment when she became ill.

Dr. Shamoo says that cases like Prince's happen all the time: Mentally ill patients who come to emergency rooms for treatment are still regularly recruited for research.

Some doctors say this practice is not wrong. Among them are Drs. Stephen Strakowski and Paul Keck, researchers at the University of Cincinnati. The pair, who were not involved in Prince's treatment, say that many mentally ill patients can give informed consent.

Strakowski and Keck recently were criticized by advocates for the mentally ill for paying psychotic patients to undergo research before they were given treatment. For their study, they recruited patients who were delusional and hallucinating. They asked these people for informed consent.

"Just because someone has those symptoms does not mean they're not capable of making life decisions," Strakowski says. "Patients will say, 'I don't want anyone else to have to go through this.' Or 'If this is something that might help me in the future, then I will do it.'"

Today Prince lives with her husband Richard and works part time as a portrait painter. She lost the suit she filed against the doctors alleging she was tricked into being a test subject. The judge ruled that she waited too long to sue.

The study that Prince participated in was partially funded by the government. Steven Hyman, who heads the National Institute of Mental Health, the government office that funds most psychiatric research, admits that too many studies have put people at risk.

"I think the issue really is to understand whether that patient in that circumstance really can understand and make a reasoned judgment," he says.

To make sure that this is happening, Hyman in 1998 changed the funding rules at NIMH, raising the standards for doing studies with human subjects.

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