Dear HWC Members
This truly appalling action by the United States occurred just a few decades ago and comes as no surprise. So called "experiments" were carried out at a low point in history and still probably continue even to this day on the weak, vulnerable, uneducated, poverty stricken and those incarcerated in prisons.
The fact that the US has owned up to this behavior, admits through an apology that it was wrong in every way, is a step in the right direction.
This demonstrates the quality and type of ethical behavior instituted by the medical associations and governments. Do they REALLY care about the people of the world? Are populations all guinea pigs in their hands?
The horror to be told years later that the tax dollars you trustingly gave to support 'for the betterment' of society went to these actions leaves one stunned. Can we forgive them for hurting not only those people who became an 'experiment' to be manipulated, but that the general populous were partners in this crime? We can give an excuse that, "We did not know." Perhaps that is true in this instance, that the government acted covertly. But, what about today? What about inoculating millions of unsuspecting people and propagandizing safe, effective and healthy outcome for influenza or other vaccinations?
More reprehensible are those, such as John C. Cutler, the lead investigator in those experiments who to this day defend his actions without remorse. All in the name of "antibiotics." Let us question the good they have brought to humanity. Truly, they have saved lives. On the other hand, in the war on infections, we are the losers for abusing antibiotics as a panacea for every ill.
I quote from the article, "It had difficulties growing syphilis in the laboratory, and its tests on rabbits and chimpanzees told it little about how penicillin worked in humans." The truth of the matter is that we cannot always transfer what happens in other organisms with drug testing to the same outcome in human populations. And many question the moral and ethical behavior of testing drugs on innocent animals.
There is much more shocking news in this article that should be required reading for physicians to discuss the ethics of their actions. As I recently read on FaceBook, "When you point at someone else, there are three fingers pointing back at you." Clean up house and take care of the dirt. The laundry now hangs out in the wind, and it is time not just to air it out, but to clean it up and prevent this from happening again.
U.S. Apologizes for Syphilis Experiment in Guatemala By DONALD G. McNEIL Jr. | New York Times
It appears Guatemala may not be blameless
From 1946 to 1948, American public health doctors deliberately infected nearly 700 Guatemalans — prison inmates, mental patients and soldiers — with venereal diseases in what was meant as an effort to test the effectiveness of penicillin.
American tax dollars, through the National Institutes of Health, even paid for syphilis-infected prostitutes to sleep with prisoners, since Guatemalan prisons allowed such visits. When the prostitutes did not succeed in infecting the men, some prisoners had the bacteria poured onto scrapes made on their penises, faces or arms, and in some cases it was injected by spinal puncture.
If the subjects contracted the disease, they were given antibiotics.
“However, whether everyone was then cured is not clear,” said Susan M. Reverby, the professor at Wellesley College who brought the experiments to light in a research paper that prompted American health officials to investigate.
The revelations were made public on Friday, when Secretary of State Hillary Rodham Clinton and Health and Human Services Secretary Kathleen Sebelius apologized to the government of Guatemala and the survivors and descendants of those infected. They called the experiments “clearly unethical.”
“Although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health,” the secretaries said in a statement. “We deeply regret that it happened, and we apologize to all the individuals who were affected by such abhorrent research practices.”
In a twist to the revelation, the public health doctor who led the experiment, John C. Cutler, would later have an important role in the Tuskegee study in which black American men with syphilis were deliberately left untreated for decades. Late in his own life, Dr. Cutler continued to defend the Tuskegee work.
His unpublished Guatemala work was unearthed recently in the archives of the University of Pittsburgh by Professor Reverby, a medical historian who has written two books about Tuskegee.
President Álvaro Colom of Guatemala, who first learned of the experiments on Thursday in a phone call from Mrs. Clinton, called them “hair-raising” and “crimes against humanity.” His government said it would cooperate with the American investigation and do its own.
The experiments are “a dark chapter in the history of medicine,” said Dr. Francis S. Collins, director of the National Institutes of Health. Modern rules for federally financed research “absolutely prohibit” infecting people without their informed consent, Dr. Collins said.
Professor Reverby presented her findings about the Guatemalan experiments at a conference in January, but nobody took notice, she said in a telephone interview Friday. In June, she sent a draft of an article she was preparing for the January 2011 issue of the Journal of Policy History to Dr. David J. Sencer, a former director of the Centers for Disease Control. He prodded the government to investigate.
In the 1940s, Professor Reverby said, the United States Public Health Service “was deeply interested in whether penicillin could be used to prevent, not just cure, early syphilis infection, whether better blood tests for the disease could be established, what dosages of penicillin actually cured infection, and to understand the process of re-infection after cures.”
It had difficulties growing syphilis in the laboratory, and its tests on rabbits and chimpanzees told it little about how penicillin worked in humans.
In 1944, it injected prison “volunteers” at the Terre Haute Federal Penitentiary in Indiana with lab-grown gonorrhea, but found it hard to infect people that way.
In 1946, Dr. Cutler was asked to lead the Guatemala mission, which ended two years later, partly because of medical “gossip” about the work, Professor Reverby said, and partly because he was using so much penicillin, which was costly and in short supply.
Dr. Cutler would later join the study in Tuskegee, Ala., which had begun relatively innocuously in 1932 as an observation of how syphilis progressed in black male sharecroppers. In 1972, it was revealed that, even when early antibiotics were invented, doctors hid that fact from the men in order to keep studying them. Dr. Cutler, who died in 2003, defended the Tuskegee experiment in a 1993 documentary.
Deception was also used in Guatemala, Professor Reverby said. Dr. Thomas Parran, the former surgeon general who oversaw the start of Tuskegee, acknowledged that the Guatemala work could not be done domestically, and details were hidden from Guatemalan officials.
Professor Reverby said she found some of Dr. Cutler’s papers at the University of Pittsburgh, where he taught until 1985, while she was researching Dr. Parran.
“I’m sifting through them, and I find ‘Guatemala ... inoculation ...’ and I think ‘What the heck is this?’ And then it was ‘Oh my god, oh my god, oh my god.’ My partner was with me, and I told him, ‘You aren’t going to believe this.’ ”
Fernando de la Cerda, minister counselor at the Guatemalan Embassy in Washington, said that Mrs. Clinton apologized to President Colom in her Thursday phone call. “We thank the United States for its transparency in telling us the facts,” he said.
Asked about the possibility of reparations for survivors or descendants, Mr. de la Cerda said that was still unclear.
The public response on the Web sites of Guatemalan news outlets was furious. One commenter, Cesar Duran, on the site of Prensa Libre wrote: “APOLOGIES ... please ... this is what has come to light, but what is still hidden? They should pay an indemnity to the state of Guatemala, not just apologize.”
Dr. Mark Siegler, director of the Maclean Center for Clinical Medical Ethics at the University of Chicago’s medical school, said he was stunned. “This is shocking,” Dr. Siegler said. “This is much worse than Tuskegee — at least those men were infected by natural means.”
He added: “It’s ironic — no, it’s worse than that, it’s appalling — that, at the same time as the United States was prosecuting Nazi doctors for crimes against humanity, the U.S. government was supporting research that placed human subjects at enormous risk.”
The Nuremberg trials of Nazi doctors who experimented on concentration camp inmates and prisoners led to a code of ethics, though it had no force of law. In the 1964 Helsinki Declaration, the medical associations of many countries adopted a code.
The Tuskegee scandal and the hearings into it conducted by Senator Edward M. Kennedy became the basis for the 1981 American laws governing research on human subjects, Dr. Siegler said.
It was preceded by other domestic scandals. From 1963 to 1966, researchers at the Willowbrook State School on Staten Island infected retarded children with hepatitis to test gamma globulin against it. And in 1963, elderly patients at the Brooklyn Jewish Chronic Disease Hospital were injected with live cancer cells to see if they caused tumors.
Elisabeth Malkin contributed reporting from Mexico City.
A representative of the Guatemalan government said his nation will investigate, too — looking in part at the culpability of officials in that country. The records of the experiment suggest that Guatemalan government officials were fully aware of the tests, sanctioned them, and may have done so in exchange for stockpiles of penicillin.
The Guatemalan experiment happened at a time when biomedical research was expanding exponentially, but with a Wild West mentality. In Massachusetts, institutionalized children were fed oatmeal laced with radiation as part of nutrition experiments. In New York, elderly patients were injected with cancer cells.
But in the six decades since the Guatemalan experiment, much has changed in medical research. Now, before scientists can begin any study involving human subjects, their project undergoes review by panels known as IRBs — institutional review boards.
“You can’t believe some of the things people did back then, years ago,’’ said Dr. Anita Barry, top disease tracker at the Boston Public Health Commission. “Now, you’ve got IRBs, thank God — somebody looking over your shoulder making sure you’re doing something reasonable.’’
The discovery by Reverby is testament to doggedness — and serendipity.
She was in Pennsylvania four or five years ago conducting research for her recently released book, “Examining Tuskegee,’’ when she ventured to the archives of the University of Pittsburgh, which sit in an old industrial patch of the city. She was there to examine the records of a US surgeon general who was consumed with controlling syphilis, Dr. Thomas Parran Jr.
That is when she came across files belonging to a deceased researcher named John C. Cutler, who had been involved in the later years of the Tuskegee project.
“I expected to find something on Tuskegee,’’ Reverby recalled. “There was nothing. What he left behind were these records from the Guatemala study. That was all he left behind. Why he did this, I have no idea. Why would you leave this?’’
The more she read, the more dastardly the story turned. Reverby held on to copies of the documents as she labored on her Tuskegee book. Finally, with that tome complete, she returned to the documents on the Guatemala experiments. She first discussed their existence earlier this year, at a meeting of medical historians.
Reverby said she did not publicize her findings sooner because no one was in immediate danger and because, unlike Tuskegee, most of the subjects were treated. “It’s not like I could have stopped something that was happening now,’’ she said.
Arthur Caplan, a specialist in bioethics at the University of Pennsylvania who describes himself as a friend of Reverby’s, said he wishes she had disclosed her findings sooner. “But I also know historians move on a clock that’s slower,’’ he said.
After finishing a research paper describing the experiment, Reverby contacted a former director of the US Centers for Disease Control and Prevention, Dr. David Sencer, who had helped her on the Tuskegee book. “He said, ‘Do you mind if I show it to other people before it’s published?’ ’’ Reverby said.
US government officials were stunned by the contents when shown the paper this summer. The CDC began its own review of Cutler’s papers.
In a synopsis of her paper scheduled to appear in the January issue of the Journal of Policy History, Reverby writes that the Public Health Service embarked on the Guatemalan experiments even as it continued the work in Tuskegee.
The researchers wanted to know whether penicillin could prevent — not just cure — syphilis. They also hoped their experiments would lead to better blood tests and dosing strategies for antibiotics.
Initially, Reverby reports, there was great enthusiasm for Cutler’s work. One federal researcher told him that “your show is already attracting rather wide and favorable attention up here.’’
But the fascination with the Guatemalan experiment was fleeting, in no small part because the results were unimpressive. The physician who supervised Cutler from the home base, according to documents found by Reverby, told the researcher, “I am a bit, in fact more than a bit, leery of the experiment with the insane people. They can not give consent, do not know what is going on, and if some goody organization got wind of the work, they would raise a lot of smoke.’’
Two years after the experiment began, it was ended. The final report was secreted away in Cutler’s papers — along with photos taken by his wife, herself a Wellesley alumna.
Stephen Smith can be reached at firstname.lastname@example.org