Internet Source: Instituto Venezolano de Investigaciones Cientificas
Source URL (Archive.org): http://www.ivic.ve/ivicspan/darknese.html
Egidio Romano MD, Ph.D.
Instituto Venezolano de Investigaciones Cientificas (IVIC)
Director
Professor Lamphere, thanks for allowing to say a few words in defense of IVIC´s scientists.
I do not dare to express any opinion on the controversial anthropological issues that Tierney´s book raises, I will comment only on some medical issues.
Were the Yanomami malnourished and immunocompromised in 1968?
Roche in a 1959 paper points out that the Yanomami although smaller and thinner than the neighboring makiritare, yet they were well nourished. He points out that the food consisted of dried mannioc, fish and whatever wild animal could occasionally be hunted. Again in 1962 Roche states that the Yanomami studied were adequately nourished and in good health. In 1968, Roche states, referring to the Yanomami living in the area of the Mavaca and Ocamo rivers, that the living conditions of the Indians had changed, although they remained very primitive. They no longer lived in the characteristic huts but rather in closed dwellings. They occasionally received food from the missions. They were in apparently good clinical nutritional state, of short stature, males 1.57 m. and 52 Kg., females 1.44 m. and 45 Kg. on the average, thus the relation height to weight seems to be around normal. Dr. L Llambi made similar observations when he did his BA thesis fieldwork among the Yanomami during 1967/1968. Thus, it seems to me that it is wrong to invoke malnutrition as a cause of a not yet proven immunodeficiency among Yanomami. Probably later on, in the 1980´s and 1990´s, because of changes in the living conditions had to a decrease in protein intake because of a much less hunting, being this the situation that Mr. Tierney found. There are reports of more recent studies, late 80´s, early 90´s, by R Holmes pointing to protein malnutrition among the Yanomami. There are also some studies in the 1980’s by Yarzabal´s group, which show a different immune cellular response against oncocerca parasites and by Botto reporting a higher incidence of spleen enlargement in Yanomami affected with malaria.
I will talk now on some medical research conducted among the Yanomami in the 1960’s. I will refer only to studies conducted by researchers from the Instituto Venezolano de Investigaciones Científicas, IVIC, and mainly to research done by Marcel Roche. He was instrumental in the organization of IVIC built on a previous institute founded by Humberto Fernandez Moran that was devoted mainly to neuroscience. Roche’s main interests were thyroid hormones and iodine metabolism and I will refer later to these studies. Besides him, there was a team of scientists studying the Venezuelan Indians. Cruxent, Wagner, Arvelo and others from the department of anthropology, and M. Layrisse, Z Layrisse, Martinez Torres, Hurtado and Arends, Gallango and others from the Department of Experimental Medicine. I was a graduate student in that department at that time. James Neel and N Chagnon were associated to our laboratory of pathophisiology. This association started in 1966 and the main purpose of the collaboration was to conduct a comprehensive population genetic survey, hematological parameters, frequency and types of blood groups antigens and antibodies, abnormal hemoglobins, serum protein markers like in transferrin, haptoglobins, immunoglobulins, lipoproteins, among many others. The results were then compared with those of similar studies in others populations and genetics, for instance mutation rates, and evolutionary conclusions were derived. So, this is the basis for saying that the Yanomami were a control group of the atomic bomb survivors. The Venezuelan researchers had also other specific interests. Layrisse in blood groups and nutritional anemia, hookworm anemia; Arends in abnormal hemoglobins, Roche in iodine deficiency and goiter, Z. Layrisse, Gallango, Hurtado and others in immunology. There were many others researchers from the USA and from Venezuela which for the sake of being brief, I will not mention.
Now, what is one of the big crimes against the Yanomami people so much criticized by Mr. Tierney? That the blood samples as well as the saliva and stool specimens were taken without an informed consent and the investigations in general were done without a previous approval of an ethical committee. This may be true. I am not sure. But is that a crime? Surely I regret very much that for many years, many medical research projects has not been pursued following today’s ethical standards. Without accepting what has happened in the past, let us try to do the exercise of looking at the kind of medical research in which blood, saliva or stool specimens are taken with consent of the individual but probably without a correct understanding of the purpose of the research. Let’s look at it but with the perspective of 30/ 40 years ago. Would have been different in the USA? Or in Europe where still in the 1980´s in many countries there was very little in terms of mandatory legal regulation rules to follow for medical research. Lets be sorry and regret what has been done wrong in the past, now, fortunately, medical research ethical regulations are much more adequate.
The review process needs the opinion of experts qualified in the matter, and certainly not of dogmatic and anti-scientific people.
Now let me elaborate very briefly on Marcel Roche’s research. Roche is a Venezuelan medical doctor with postgraduate studies at Harvard Medical School in Boston. He and another distinguished Venezuelan doctor, Francisco de Venanzi started in 1952 a laboratory that for the first time in the country was equipped for medical radioanalisis. They started to study radioiodine uptake by the thyroid gland. In 1954, with financial support of his father, a wealthy land developer, Roche and colleagues initiated a medical research Institute. The main lines of research were nutritional anemia, endemic goiter, diabetes and parasitic diseases. Thus Roche and colleagues for the first time in Venezuela used radioisotopes for medical purposes. Specifically they used 55Cr to study red cell survival, 55Fe and 59Fe to study anemia due to iron deficiency and 131I for endemic goiter. Following important studies by Skanse in Boston and by Stanbury in Mendoza in the Argentinean Andes, Roche decided to study iodine deficiency, the most common cause of endemic goiter, in Venezuela. Firstly, he studied the uptake of radioiodine in the normal, euthyroid, population in Caracas, and in 1954/1955 he did a large study in the Venezuelan Andes where there were many towns in which goiter was the rule and not the exception, for instance in Bailadores the incidence of goiter was 84.5 % in adults and 83% in children. Roche went on to study Iodine metabolism in others regions of Venezuela. Because of the remoteness and isolation of the Amazonian region, it was logical to do similar studies among the Indians. In 1959, he did a first study in Maquiritare and Guajaribo (Saname Yanomami ) tribes in the Alto Ventuari. He found a high iodine uptake without clinical goiter. Continuing this study, 2 years later he studied the urinary excretion of stable iodine and the content of iodine in drinking water, confirming an iodine deficiency without associated goiter suggesting that even if iodine deficiency is necessary for goiter, other factors may be involved. Very little iodine was found in the river´s water. This study was extended in 1962 in the region of the Mavaca River obtaining similar results. Roche in 1968, as part of the same expedition in which Neel, Chagnon and Lizot took part, extended the study of iodine uptake and excretion to the Yanomami of the Ocamo region. In all these studies he used 5 to 30 microcuries for determination of iodine uptake and in some cases 100 microcuries for kinetics studies.
Having said this, now I would like to stress several points. Firstly, iodine deficiency and hypothyroidism leading to cretinism in children is a very serious condition. In the recent past, it has been reported that 1 out of every 4 children in the Venezuelan Andes had a variable degree of cretinism. Even today, being the table salt for human consumption fortified with iodine, cretinism and goiter is a relatively common find. Secondly, precisely Roche’s studies helped to set a national program for goiter prevention by iodine supplementation of table salt. Similarly, Layrisse’s studies on iron absorption from food using radioiron has helped to set a national program of iron supplementation to prevent iron deficiency anemia. Thirdly, similar studies were conducted during the same years by many researchers, using the same methodology in many countries in the world. For example, this type of studies were done in the USA, Argentina, Italy, Finland, Holland, Yugoslavia, Taiwan, India, Philippines, Congo Republic, just to mention the most important. It is being now said that the studies were unethical because violated the principle of informed consent and because did not benefit the patient. Please look at this with the perspective of 40 years ago. The derived new knowledge was and it is important. Precisely, it shows, on the contrary of what is been said that the study was not important for the Yanomami because they did not suffer of goiter, it is very valuable because it suggest the possibility of hypothyroidism in the absence of goiter, which even nowadays is still to be determined for that population. In the 1960’s there were no sensitive immunoassays to determine the thyroid hormones T3, T4, Thyroglobulin and the Thyroid Stimulating Hormone (TSH) and other means that are available today for studying thyroid function. So, was it a crime to use radioiodine? Still it is done. Is it correct to say that theYanomami were used as guinea pigs as was Mr. Tierney´s quoted in a Venezuelan newspaper? Is it a reason to cast doubts on the honorability of a good, humanitarian, man suggesting that he could have been involved in unethical experiments using radioisotopes in humans just to observe the effect in the human body? I leave to the audience the conclusion. In one of the Venezuelan leading newspapers, on Nov. 11th in a headline Mr. Tierney was quoted as saying that ...the Yanomami were used as a control group of the atomic bomb...I leave to your imagination how misleading could be that statement to the public opinion.
In the last part of this brief talk, I am going to refer to what is for me the most difficult part, the measles outbreak. I assume that most of you are familiar with Mr. Tierney’s interpretation. Briefly, he states that: 1. The Edmonston B vaccine was no good, especially for the Yanomami, and that it should have been administered with specific anti measles immunoglobulin. 2. That it was given without permission from the Venezuelan health authorities. 3.that the epidemic followed Neel’s group movement. 4. That no quarantine was imposed so it spread quickly. 5. Tierney cast doubts on the possibility that the disease was brought by Brazilian visitors. As a consequence, Tierney suggest that the measles outbreak could have been originated by the vaccine itself and implies that Neel, Chagnon and Roche were responsible for the death of hundreds or thousands of Yanomami.
I would like to offer my point of views. Firstly, during November and December 1967, there was an outbreak of measles in the neighboring Yanomamo villages in Brazil. Also, and this is very important, according to one of us, Dr. Nelly Arvelo who is attending this meeting, she traveled to the Alto Ventuari region of Amazonas the day after Neel, Chagnon, Roche and Lizot arrived in La Esmeralda. The airforce plane left Arvelo in a Yekuana region neighboring north of the Yanomami region and on her way up the Alto Ventuari River she met several Piaroas and Yekuanas Indians coming from villages upriver, who had measles and were traveling to the Kamani settlement to seek medical help. This testimony clearly shows that by Jan 22, 23 of 1968, there was already an ongoing measles epidemic in the region. There are also several written testimonies by Jacques Lizot that states that there was already measles when they arrived. So, measles vaccination was correctly indicated from a medical standpoint. Was it the Edmonston B strain a good vaccine? This is not up to me to clarify, however at that time it was still currently being used every where in world. Mr. Tierney says that in the same year 1968 in Venezuela the further attenuated Schwarz vaccine was used. This is not the information that I was given. Officials from the Direccion de Epidemiologia told me, that in 1968, after a short trial in 1967, the Edmonston vaccine was administered to children between 9 and 35 months of age. It was used at a dilution of 1 to 3 because it was too expensive and in this way more children could be vaccinated, procedure, which had been already used elsewhere. I most say that the officials are not sure if it was the original Edmonston B strain or a further attenuated derivative, but the information says Edmonston . In 1972, an epidemic of measles of great dimension occurred in Venezuela and so in 1973 a full scale vaccination was done although it was not informed if it was the Edmonston B or a further attenuated vaccine. Why was the Edmonston B vaccine used? Simply, I believe, because was the vaccine that was donated to Neel by Roxane and Lederle Laboratories. Was it administered with or without permission of the Venezuelan health authorities? Mr. Tierney cites Dr. Adelfa Betancourt as saying that no permission was asked. Recently, many of us have asked officials from the Ministry of health about that and the response is that they have not being able to locate the information yet. Certainly, Venezuelan health employees also helped with the vaccination team. Mr. Tierney says that in an interview with Roche in 1996, Roche did not recall to have diagnosed measles to a Brazilian indicated by Neel as the possible initiator of the outbreak. This argument is very thin. Roche was already sick in 1996, he is suffering of a very advanced stage of Alzheimer disease, so it is irrelevant if he recalls it or not. Anyway, there were several possible contacts with people convalescent or carrier of measles virus visiting Yanomami villages. That the outbreak followed Neel’s movement is not a good argument to imply that the epidemic was caused by the vaccination. Neel and collaborators tells another story in the article published in the American J. of Epidemiology, vol 91, 418, 1970. They say that they were trying to get ahead of the spreading of the disease and try to vaccinate people before contact.
Mr. Tierney implies that the Edmonston B vaccine itself was contagious and therefore originated or aggravated the measles outbreak, I find it difficult to support. In the opinion of Dr William Bellini, an expert in measles working at the CDC in Atlanta, this is very unlikely. I quote Dr. Bellini...While Edmonston B vaccine to measles was known to be reactogenic, the vaccine was never shown to be transmissible from person to person. What evidence is there that these Amerindians are or were immunocompromised? I am not aware of this. The Edmonston B vaccine in my opinion could not have caused an epidemic...end of quotation. In all this, Mr. Tierney could be right in one point. The Yanomami reacted much more strongly to the vaccine in terms of fever and respiratory complications than Caucasians and other ethnic Indians. Even so, according to Neel´s data, among vaccinated Yanomami the mortality rate was about 8% while it was 15/20% among the non vaccinated. What had Roche to do with the measles outbreak? He was only helping, his project was related to iodine metabolism, as it is proven by the fact that he was not a co-author of Neel and colleagues paper on the measles vaccine.
Egidio Romano.
Egidio Romano MD, Ph.D.
HIPERVÍNCULO Eromano@ivic.ve
Tel (582) 504 1122
Fax (582) 504 1428
I forgot one small point. Tierney suggest that Roche collaborated with the AEC in unethical studies involving uniformed exposure of humans to radioisotopes and sending human bones from Venezuelan people autopsied in the Instituto Roche. According to the testimony of Dr. L M Carbonell, a pathologist, and former researcher at that institute, autopsies were made to mice, rats and occasionally on rabbits.
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