A Brief History of Medical Experiments and Its Importance Today
The Nuremberg trials: a series of 13 trials conducted in Nuremberg, Germany, held to bring Nazi war criminals to justice.
By Mayra E. Salgado
The 1940s brought forth a series of the most inhumane actions in history, like The Holocaust, various wars, starvation, disease, and genocide. Among the heinous activities in concentration camps, the Nazis would use the camp inmates for medical experiments without their consent and force them into questionable and dangerous situations. After the war ended and the camps shut down, the Nazi trials began, the most infamous one called The Nuremberg trials: a series of 13 trials conducted in Nuremberg, Germany, held to bring Nazi war criminals to justice (History, 2024). The trials lasted four years and included high-ranking military officials, Nazi Party officials, lawyers, and doctors, indicted on such charges as crimes against peace and humanity. As part of the judgment on the doctors accused of war crimes, the court articulated a 10-point set of rules for the conduct of human experiments and medical research (Moren et al., 2017). This set of rules became known as the Nuremberg Code and has become one of the most influential codes in history.
It is most widely known for its statement that humane experimentation is only justified if its results benefit society and with principles that “satisfy moral, ethical, and legal concepts” (UNC- Research, n.d.). Due to its adamant requirements on consent, risks, benefits, and assurances of competent investigators, the Nuremberg Code set new standards for medical research and influenced modern codes of ethics. Though it has been close to eight decades, and there have been great strides made in the research world, there is a troubling pattern that keeps violating the current ethical codes of the medical and psychological fields: minority groups—women, ethnic and racial groups, and people with disabilities—are highly underrepresented in medical research which results in health disparities.
In clinical trials, women have historically been underrepresented, but this has gradually changed due to laws, regulations, and advocacy. Though it is clear women have been included more than ever before, there is no concrete statistic that exemplifies how much the gap has been closed. However, there are statistics for specific trials, organizations, or topics. For example, over the last six years, women in FDA drug-approval trials ranged from 40%-72% (Bierer et al., 2022). Though this does not display the increasing inclusion of women in clinical trials, it does give a slight idea of how the gap is closing.
Yet, bias remains. Researchers, though less than before, may maintain some bias towards women due to how difficult it could be to include them in trials—because of the physiological, metabolic, hormonal, and cellular differences between biological sexes. The different variables women possess to men are seen as a challenge because they are considered outside the “norm” of what is usually researched (Balch, 2024). Further, women's exclusion can be divided into more specific categories.
“One of the most underrepresented groups of people in research is people with disabilities. Recently, the National Council on Disability (NCD) released a timely report on exclusionary practices that prevent people with disabilities from participating in medical trials (NCD, 2024). The key findings showed that 61 million Americans, or 26% of American adults, live with a disability and are constantly excluded from clinical trials.”
For example, transgender people are incredibly underrepresented in medical research and are usually only included in HIV research (Castañeda, 2022). Additionally, women who have a different ethnicity and racial background to white women will be more underrepresented in a study. The FDA Annual Drug Trial perfectly encapsulates the disproportionate exclusion of women of color (Bierer, 2022). In 2015, the year with the lowest women turnout at 40% had 5% of Black/African American women, Asian women were 12%, the “Other” category was 4%, and white women were 79%. 2019 had the highest women participation at 72% with 9% Black/African American women, 9% Asian women, 18% in the Other category, and 72% in the white women category. Though the lack of representation of women in clinical trials is clearly closing, there is still much work to be done with women of color.
One of the most underrepresented groups of people in research is people with disabilities. Recently, the National Council on Disability (NCD) released a timely report on exclusionary practices that prevent people with disabilities from participating in medical trials (NCD, 2024). The key findings showed that 61 million Americans, or 26% of American adults, live with a disability and are constantly excluded from clinical trials. This exclusion can contribute to poorer health outcomes than the non-disabled population.
It is essential to realize the exclusion of disabled people often has no scientific explanation. The driving issue for the exclusion of people with disabilities from clinical research is the challenges it brings. However, it is an ethical requirement to create a study that represents the general population. A researcher must ensure that the evidence base for medicinal products is robust for major subgroups (Bierer, 2022). A person with disabilities is not exempt from getting an illness or a disorder, so why are they so often skipped in clinical trials?
For instance, there is a troubling trend in Alzheimer’s research. The number of American adults who will develop dementia each year is projected to increase from 500,000 in 2020 to 1 million in 2060 (Fang et al., 2025; The Economist, 2025). Interestingly, health trends suggest that 70-88% of people with Down syndrome will eventually develop Alzheimer’s by the age of 65, which, in the general population, the comparable figure is 8-10%. Still, clinical trials for Alzheimer’s therapeutics have and continue to exclude people with Down Syndrome. There is no good reason for this to happen since it creates more problems than it solves.
It is common sense to most that underrepresenting minorities in studies can cause problems. The failure to study medications and other interventions in a broad sampling of minorities has been proven to contribute to health disparities. A 2013, study found that women with metal hip replacements were 29% more likely than men to experience implant failure due to insufficient testing and anatomical differences (Inacio et al., 2013; Balch, 2024). Additionally, despite heart disease being a leading cause of death in the United States for both sexes, the medical field only recognized how different the symptoms are for women than men in a 1999 article in the American Heart Association journal. Interestingly, studies suggest that if health disparities were modestly reduced because of better representation in clinical trials it would result in billions of dollars of savings to the U.S. society (Bibbins-Doming, 2022; Goldman, 2009). Furthermore, inadequate research is in direct violation of the ethical codes professionals have sworn their academic careers to. If an individual is given medical treatment, such as pharmaceuticals, when it was not tested on their minority groups, it could be considered unsafe and unethical. Therefore, there is absolutely no scientific reason as to why minorities should be underrepresented in clinical studies.
Instead, representation in studies can allow for greater innovation to build in the scientific world since diversity is what challenges and allows for greater exploration in research. The Economist has pointed out that scientific mysteries, such as how best to treat Alzheimer’s, would be easier solved if people with disabilities were included in clinical trials (2025). For example, researchers agree that pharmaceutical treatments would work better if given earlier, perhaps preventively. The best way to find out is to conduct clinical trials on people who are guaranteed to have Alzheimer’s: those with Down syndrome. Not only would the inclusion of those with Down’s offer them treatment, but it might also allow for a future of Alzheimer’s prevention for all.
Therefore, academics, scientists, doctors, and psychologists should remember the lack of representation of minorities in clinical trials can lead to troubling consequences, such as possible health disparities. Only after acknowledging the underrepresentation of minorities in research can actions be taken to ensure future research represents all groups in the general population, improving ethical and effective treatment for everyone. Though difficult, it is a challenge worth taking because of the significant progress that may be made in the scientific world.
References
Balch, B. (2024, March 26). Why we know so little about women’s health. Association of American Medical Colleges. https://www.aamc.org/news/why-we-know-so-little-about-women-s-health
Bibbins-Domingo K, Helman A, (Ed.). (2022). Improving representation in clinical trials and research: Building research equity for women and underrepresented groups. Washington (DC): National Academies Press (US). https://doi.org/10.17226/26479
Bierer, B. E., Meloney, L. G., Ahmed, H. R., White, S. A. (2022). Advancing the inclusion of underrepresented women in clinical research. Cell Reports Medicine, 3(4). https://doi.org/10.1016/j.xcrm.2022.100553
Castañeda, R. (2022, June 29). Overcoming obstacles in trans and nonbinary participation in clinical trials. Clinical Trials Arena. https://www.clinicaltrialsarena.com/news/transgender-clinical-trials
The Economist. (2025, January 15). Volunteers with Down’s syndrome could help find Alzheimer’s drugs. https://www.economist.com/science-and-technology/2025/01/15/volunteers-with-downs-syndrome-could-help-find-alzheimers-drugs
Fang, M., Hu, J., Weiss, J., Knopman, D. S., Albert, M., Windham, B. G., Walker, K. A., Sharrett, A. R., Gottesman, R. F., Lutsey, P. L., Mosley, T., Selving, E., & Coresh, J. (2025). Lifetime risk and projected burden of dementia. Nature Medicine, 31, 772-776. https://doi.org/10.1038/s41591-024-03340-9
Goldman, D. P., Zheng, Y., Girosi, F., Michaud, P. C., Olshansky, S. J., C., D., Rowe, J. W. (2009). The benefits of risk factor prevention in Americans aged 51 years and older. American Public Health Association, 99(11), 2096-2101. https://doi:10.2105/AJPH.2009.172627
History. (2025, February 27). Nuremberg Trails. https://www.history.com/articles/nuremberg-trials
Inacio, M. C. S., Ake, C. F., Paxton, E. W., Khatod, M., Wang, C., Gross, T. P., Kaczmarek, R. G., Marinac-Dabic, D., Sedrakyan, A. (2013). Sex and risk of hip implant failure: Assessing total hip arthroplasty outcomes in the United States. JAMA: Internal Medicine, 173(6), 435-441. https://doi:10.1001/jamainternmed.2013.3271
McCarthy, A. (2023, June 30). Embracing diversity: The imperative for inclusive clinical trials. Harvard Medical School. https://harvard.edu/trends-medicine/embracing-diversity-imperative-inclusive-clinical-trials
National Council on Disability. (2024, August 14). The implicit and explicit of people with disabilities in clinical trials. https://www.ncd.gov/report/the-implicit-and-explicit-exclusion-of-people-with-disabilities-in-clinical-trials/
Moreno, J. D., Schmidt, U., Joffe, S. (2017). The Nuremberg Code 70 years later. JAMA Network, 318(9), 795-796. https://doi:10.1001/jama.2017.10265
The University of North Carolina at Chapel Hill, Research. (n.d.). Nuremberg Code. https://research.unc.edu/human-research-ethics/resources/ccm3_019064/
About the Author
Mayra Elena Salgado immigrated from a small developing country, Honduras, to the United States of America at the age of nine. From a young age, it has been her ultimate ambition to be the best in every academic setting. She has been admitted to prestigious societies such as Phi Theta Kappa, the Alpha Society of UTC, and Honor programs because of her high grades and research efforts. She recently graduated with the highest honors from the University of Tennessee of Chattanooga. She is using her B.S. in psychology to work in a non-profit as a coordinator for the Family Support Program. She intends to continue her education by earning a Master's degree and then a Doctorate. Her goal is to work as a neuropsychologist and contribute consistently to psychological research.