Military medical research ethics: Investigational drugs, clinical trials, and enhancement

Military medicine presents unique challenges for medical research. Landing in Iraq, Coalition forces required investigational drugs to combat the threat of poison gas. As the fighting progressed, battlefield conditions necessitated rapid innovation to control bleeding, manage fluid resuscitation and transfusion, conduct field surgery, treat traumatic brain injury, develop limb prosthetics, and enhance performance. While clinicians delivered high-quality retrospective and survey studies, conditions unique to the military made it difficult to obtain informed consent and conduct controlled clinical trials of emerging therapies and medical devices. The result was a dearth of sufficient studies. Remedying the situation requires reformulating the rules of informed consent for military medical research and enlisting civilian subjects while protecting the rights and privileges of each group.