US researchers violated ethical boundaries when they deliberately infected Guatemalan prisoners, mental health patients and prostitutes with sexually transmitted diseases in a 1940s research project, a presidential commission concluded on Tuesday.
When the awful experiments came to light in October 2010, President Barack Obama entrusted the President’s Commission for the Study of Bioethical Issues with investigating the matter. Amy Gutmann, chairwoman of the commission and president of the University of Pennsylvania, says it was no accident that the research was performed in Guatemala. “Some of the people who were involved in this experiment explicitly said, ‘We could not do this in our own country’,” she said. “It was a foreign population that was seen as ethnically, racially, nationally different.”
The work clearly opposed ethical standards of the time, according to Nelson Michael, director of the US Military HIV Research Program. “I’m not aware of any standards that would have said, ‘it’s ok to go offshore to do this kind of research’,” he said. “They did it because they found a doorway that they found darkened and they went through it.” STDs, including gonorrhea and syphilis, were among the biggest public health threats at the time. It was estimated that 20% of people living in psychiatric institutions were there because of the neurological effects of late-stage syphilis. The researchers in the Guatemalan study were looking for a way to prevent such diseases from spreading.
The commission has concluded that despite that sense of urgency, the Guatemala studies were poorly designed, poorly executed and entirely unethical. John Arras of the University of Virginia said he initially struggled with the decision over whether the researchers should be blamed for the ethical offenses. However, Arras said the details of the experiments dispelled doubts.
In one case, a patient named Berta in a psychiatric ward was injected with syphilis and not treated until 3 months after her infection. Soon after, lead researcher John Cutler, said she was about to die. The same day, he put gonorrhoeal pus from another patient into both of her eyes, her urethra and her rectum, and reinfected her with syphilis. Days later, her eyes were filled with pus from gonorrhea and she was bleeding from her urethra. She died six months later. “I would submit that this kind of case cannot be waved away by even the most acute awareness of fluctuation in medical ethics standards of the time,” Arras said.
The commission discovered evidence of 83 deaths, but could not determine the extent to which the deaths were likely to be related to the experiments. It is still writing up its conclusions, and plans to issue a report on the historical study to Obama in September. Following an inquiry into the adequacy of current policies to protect human research subjects, it will also write a second report by the end of the year. ~ Nature News, Aug 30