'From Skid Row to Main Street: The Bowery Series and the Transformation of Prostate Cancer, 1951–1966' [
PDF] by Robert Aronowitz in
Bulletin of the History of Medicine (forthcoming) comments that
Between 1951 and 1966, more than 1,200 homeless, alcoholic men from New York’s
skid row were subjected to invasive medical procedures, including open perineal biopsy of the
prostate gland. If positive for cancer, men typically underwent prostatectomy, surgical castration,
and estrogen treatments. The Bowery series was meant to answer important questions about
prostate cancer’s diagnosis, natural history, prevention, and treatment. While the Bowery series
had little ultimate impact on practice, in part due to ethical problems, its means and goals were
prescient. In the ensuing decades, technological tinkering catalyzed the transformation of
prostate cancer attitudes and interventions in directions that the Bowery series’ promoters had
anticipated. These largely forgotten set of practices are a window into how we have come to
believe that the screen and radical treatment paradigm in prostate cancer is efficacious and the
underlying logic of the twentieth century American quest to control cancer and our fears of
cancer.
Aronowitz notes that
Starting in 1951 and continuing for over a decade, Columbia University investigators recruited
more than 1,200 homeless, alcoholic men from New York City’s skid row, the Bowery, brought
them to a recently opened public cancer hospital, and subjected them to many invasive tests and
procedures, including open perineal biopsy of the prostate gland.1 If positive for cancer, men
typically underwent radical prostatectomy and surgical castration followed by a course of
hormonal treatment. Although some kind of consent may have been obtained, these studies were
conducted on poor, helpless men because investigators would and could not do these
experiments on people with more autonomy, power, and dignity, such as the paying private
patients at nearby Columbia Presbyterian Hospital.
Like other cases of unethical research practices such as those exposed by Henry
Beecher in 1966, the Bowery series was published in leading medical journals, cited frequently
in the medical literature, and was the subject of popular news coverage. These practices were
ultimately forgotten and had minimal direct impact on subsequent clinical developments. Yet
their history is significant because they provide a provocative and illuminating perspective with
which to view subsequent events. The Bowery series was a prescient attempt to combine a set of
existing practices for diagnosing and treating prostate cancer into a new early detection and
radical treatment paradigm. Very similar practices would gain acceptance decades later. The
difficulties of retrospective ethical judgments notwithstanding, we today respond to the invasive
procedures done to ill-informed men for uncertain benefit with some disgust and disbelief. Yet
very similar practices in the ensuing decades generally have not elicited similar reactions. Why?
Comparing and contrasting the Bowery series’ assumptions, goals, and limited impact to
subsequent developments provides some answers. This historical juxtaposition also makes visible some underappreciated ethical challenges posed by the ways that mass risk-reducing interventions have gained acceptance within modern medicine and society.
It is unsatisfying to simply observe that medical technologies and practices are accepted
because they are effective at saving lives and reducing morbidity. Not only is evidence of
scientific efficacy only one reason why medical and lay people accept new technologies and
practices, but scientific evidence is often absent or contested. Historians, especially since
Rosenberg’s influential 1977 essay, have researched the social and historical context within
which actors determine whether medical treatments work or not. This “social efficacy”
approach, which is also central to contemporary anthropological studies of medical practice,
focuses on the work done besides the direct impact on objective states of health.
Pressman noted that “a therapy’s usefulness is contingent upon a particular historical era.”
The corollary is also true. There may be a good deal of historical contingency to a therapy’s lack
of utility, i.e. its limited social efficacy. Looked at this way, the Bowery series is a crucial side
story illuminating what needed to happen in order for cancer risk to later get into men’s bodies
on a mass scale. Contrasting the failure of the Bowery practices to gain much traction with
similar practices deemed efficacious in later periods allows us to identify developments —
besides evidence of scientific efficacy — that changed the way these similar interventions were
later understood, legitimated, and diffused throughout American medicine and society.
