. . . Medical institutions and individual investigators operate today with two powerful sets of values and goals. On the one hand there is the pursuit and advancement of scientific knowledge. On the other there is the provision of humane and effective therapy for patients. . . . There is evidence that the enhanced excitement attending scientific achievement and the rewards bestowed on it in recent decades have skewed the decision-making process in many cases of conflict. . . . Our data show that the social structure of competition and reward is one of the sources of permissive behavior in experimentation with human subjects...