1: The "controversy machine" at work in this century

1916:	Udo J Wile, of the University of Michigan, reported that he had inoculated rabbits with treponema that cause syphilis, which he had obtained by trephining the skulls of six patients with neurosyphilis and taking a small sample of their brain. In response to controversy about this procedure, the American Medical Association recognised the need for ethical guidelines to cover research.
1947:	In the wake of World War II atrocities — not entirely on the Nazi side — the Nuremberg Military Tribunal formulated a 10-point code delimiting permissible medical experimentation on human subjects.5
1964:	The Nuremberg Code had a major impact on the formation of an international code by the World Medical Association in 1962, and which was adopted in 1964 as the Declaration of Helsinki.
1966:	Henry Beecher, of Harvard Medical School, produced 50 examples of ethically dubious research by skimming major journals. In response to this and other scandals, the National Institutes of Health moved from demanding adherence to codes to introducing committees: it required all recipients of NIH and Public Health Service (PHS) grants in the United States to have had their research proposal approved by an ethics committee at their institution.6
1972:	Revelations about the so-called Tuskegee study led to a further tightening; this study had involved secretly withholding treatment over a long period from 400 poor and uneducated syphilis patients in Alabama.7
1974:	The US Congress made institutional ethics committees mandatory in institutions receiving federal research grants and it established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The modern era of ethical review had arrived, at least in the United States.8

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