Politics on Trial: Five Famous Trials of the 20th Century
Arrested at the height of the red scare of , prosecutors targeted Italian anarchists Sacco and Vanzetti because of their politics. Their trial for robbery and murder marked one of the century's greatest miscarriages of justice. Sacco and Vanzetti were put to death in As in the Sacco and Vanzetti case, Kunstler's rendering of the Rosenberg trial shows without a doubt that they faced execution for their membership in the Communist Party, not for alleged crimes of Soviet espionage.
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Paltry evidence and perjured testimony doomed the defendants, Julius and Ethel, who maintained their innocence until their deaths in They refused to answer questions about their political beliefs and party affiliation, not allowing their politics be put on trial. The chapter on the "Scottsboro Nine"--nine Black young men and boys aged 13 to 20, sentenced to death in Alabama for allegedly raping two white women--is the best in the book.
The state-sponsored lynching that passed for a "trial" shows in no uncertain terms how far the racist courts will go to execute Klan-style justice. But as Michael Smith points out in the introduction to this chapter, "The mass campaign eventually saved their lives. African Americans and whites together, mostly members of the Communist Party This history, they declare, must serve as a warning of the lengths those in power will go to intimidate and suppress dissent.
Today, 'antiterrorism' has replaced anticommunism of the s and the anti-immigrant scare campaign He describes,' at length my oil lacked and I was constrained to apply in its place a digestive made of yolks of eggs, oil of roses and turpentine.
That night I could not sleep at any ease, fearing that by lack of cauterization I would find the wounded upon which I had not used the said oil dead from the poison. I raised myself early to visit them, when beyond my hope I found those to whom I had applied the digestive medicament feeling but little pain, their wounds neither swollen nor inflamed, and having slept through the night. The others to whom I had applied the boiling oil were feverish with much pain and swelling about their wounds. James Lind is considered the first physician to have conducted a controlled clinical trial of the modern era.
He planned a comparative trial of the most promising cure for scurvy. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of the knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet common to all, viz.
politics on trial; five famous trials of the 20th century - william kunstler
Two were ordered each a quart of cyder a day. Two others took twenty-five drops of elixir vitriol three times a day … Two others took two spoonfuls of vinegar three times a day … Two of the worst patients were put on a course of sea-water … Two others had each two oranges and one lemon given them every day … The two remaining patients, took … an electary recommended by a hospital surgeon … The consequence was, that the most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them, being at the end of six days fit for duty … The other was the best recovered of any in his condition; and … was appointed to attend the rest of the sick.
Although the results were clear, Lind hesitated to recommend the use of oranges and lemons because they were too expensive. Lind's Treatise of , was written while he was resident in Edinburgh and a Fellow of the Royal College of Physicians, contains not only his well known description of a controlled trial showing that oranges and lemons were dramatically better than the other treatments for the disease, but also a systematic review of previous literature on scurvy. The James Lind Library www.
The publicity and popularity of the James Lind Library has made 20 May to be designated International Clinical Trials Day, because James Lind's celebrated controlled trial began on that day in It took another century before the emergence of another important mile stone in the history of modern clinical trial: the placebo.
The word placebo first appeared in medical literature in the early s. He treated 13 patients suffering from rheumatism with an herbal extract which was advised instead of an established remedy. The favorable progress of the cases was such as to secure for the remedy generally the entire confidence of the patients. This nationwide study enrolled over a thousand British office and factory workers suffering from colds. This was quite a challenging endeavor in wartime,. The study was rigorously controlled by keeping the physician and the patient blinded to the treatment.
The treatment allocation was done using an alternation procedure. A nurse allocated the treatment in strict rotation in a separate room. The nurse filed the record counterfoil separately, and detached the code label for the appropriate bottle before asking the patient to visit the doctor.
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However, the outcome of the trial was disappointing as the analysis of trial data did not show any protective effect of patulin. The idea of randomization was introduced in However, the first randomized control trial of streptomycin in pulmonary tuberculosis was carried out in by MRC of the UK.
The trial began in As the amount of streptomycin available from US was limited, it was ethically acceptable for the control subjects to be untreated by the drug—a statistician's dream. Another significant feature of the trial was the use of objective measures such as interpretation of x-rays by experts who were blinded to the patient's treatment assignment. Sir Bradford Hill had formed his allocation ideas over several years with randomisation replacing alternation in order to better conceal the allocation schedule , but had only tried them out in disease prevention.
Dr Hill instituted randomization — a new statistical process which has been described in detail in the landmark BMJ paper of After acceptance of a patient by the panel, and before admission to the streptomycin centre, the appropriate numbered envelope was opened at the central office; the card inside told if the patient was to be an S or a C case, and this information was then given to the medical officer of the centre. Patients were not told before admission that they were to get special treatment. C patients did not know throughout their stay in hospital that they were control patients in a special study; they were in fact treated as they would have been in the past, the sole difference being that they had been admitted to the centre more rapidly than was normal.
Usually they were not in the same wards as S patients, but the same regime was maintained. Sir Bradford Hill had been anxious that physicians would be unwilling to give up the doctrine of anecdotal experience. However, the trial quickly became a model of design and implementation and gave a boost to Dr Hill's views and subsequent teaching, and resulted, after some years, in the present virtually universal use of randomised allocation in clinical trials.
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The ethical framework for human subject protection has its origins in the ancient Hippocratic Oath, which specified a prime duty of a physician — to avoid harming the patient. However, this oath was not much respected in human experimentation and most advances in protection for human subjects have been a response to human abuses e. World War II experiments. The first International Guidance on the ethics of medical research involving subjects — the Nuremberg Code was formulated in Although informed consent for participation in research was described in , the Nuremberg Code highlighted the essentiality of voluntariness of this consent.
In at Helsinki, the World Medical Association articulated general principles and specific guidelines on use of human subjects in medical research, known as the Helsinki Declaration.
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The Helsinki Declaration has been undergoing changes every few years the last one being in However, the use of placebo and post-trial access continue to be debatable issues. In particular, no one shall be subjected without his consent to medical or scientific treatment. Henry Beecher's study of abuses and the discovery of human exploitation of Tuskegee study in the s reinforced the call for tighter regulation of government funded human research.
In , International Conference on Harmonization published Good Clinical Practice, which has become the universal standard for ethical conduct of clinical trials. After that, legislation progressively demanded greater accountability for marketing food and drugs and the need for testing drugs in clinical trials increased. The regulatory and ethical milieu will continue to evolve as new scientific disciplines and technologies become part of drug development.
Evolution of Clinical Research: A History Before and Beyond James Lind
India has recently been recognized as an attractive country for clinical trials. But the country's journey in clinical research field has a long history.
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India has a rich heritage of traditional medicine — Ayurveda. The classic ayurvedic texts contain detailed observations on diseases and in-depth guidance on remedies. It is likely that these descriptions are based on direct observations made by the ancient ayurveda experts. However, there is no recorded documentation in the ancient texts of any clinical experiments. Hence, one has to fall back on current history of medical research in India.
The major historic milestones of the Indian Council of Medical Research reflect, in many ways, the growth and development of medical research in the country over the last nine decades. Between , several projects on beriberi, malaria, kala azar and indigenous drugs were initiated. Over next 60 years, ICMR established many national research centers in the fields of nutrition, tuberculosis, leprosy, viral disease, cholera, enteric disease, reproductive disorders, toxicology, cancer, traditional medicine, gas disaster, genetics, AIDS etc.
Venkatachaliah held its first meeting on September 10, Several subcommittees were constituted to consider ethical issues in specific areas e. The committee released Ethical Guidelines for Biomedical Research on Human Participants in which were revised in Schedule Y of Drugs and Cosmetics Act came into force in and established the regulatory guidelines for clinical trial CT permission.