US apologizes for 1940s unethical research in Guatemala

President Obama on the phone to President ColomIt was bioethical bow, scrape and grovel time on Friday in Washington DC. After learning that public health researchers had infected about 700 Guatemalans with syphilis between 1946 and 1948, US President Barack Obama had to telephone Guatemalan President Alvaro Colom to apologize.

The appalling story of coercion and deception came to light through archival research by Professor Susan M. Reverby, of Wellesley College, near Boston. What she found was that American public health officials wanted to know whether the new miracle drug penicillin would prevent sexually transmitted diseases as well as cure them. After doing some research in US prisons, they organised research subjects in Guatemala.

Dr John C. Cutler, a PHS physician, first chose men in the Guatemala National Penitentiary, then men in an army barracks, and then men and women in the National Mental Health Hospital. In all, 696 subjects were infected. Permissions were gained from government authorities but not from individuals, not an uncommon practice at the time.

Initially the doctors used prostitutes with the disease to pass it to the prisoners (since sexual visits were allowed by law in Guatemalan prisons). When “normal exposure” produced little disease they did direct inoculations. These were made from syphilis bacteria poured onto the men’s penises or on forearms and faces that were slightly abraded. In some cases they used spinal punctures. The subjects were given penicillin after they contracted the illness. However, whether everyone was then cured is not clear and not everyone received what was even then considered adequate treatment.

The results were never even published.

This disturbing story has been confirmed by the US Centers for Disease Control and the government has launched its own investigations. The Obama Administration is falling over itself to apologise. "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,” declared Secretary of State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius.

Even by the standards of the time, the research was regarded as unethical. After all, only a few months before, Nazi death camp doctors had been condemned to death and long prison terms for human experimentation without informed consent. 

It appears that Dr Cutler, who became a respected professor at the University of Pittsburgh with an interest in population control, had few qualms. Others were more squeamish but they did not stop the project. Cutler’s superior confided, “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.” When the US Surgeon General, Thomas Parran, was told of the project, he commented, “You know, we couldn’t do such an experiment in this country.” But he did not put an end to it.

Dr Reverby discovered the material in her research on the infamous mid-century Tuskegee syphilis experiment. That left hundreds of African-American men with late stage syphilis untreated and deceived about their disease. Dr Cutler was a key researcher in that project as well. Her conclusion is that “the scientific enterprise must always be watched over, even when the intentions are good and the ‘best men’ do it.” ~ Journal of Policy History, Jan 2011

MORE ON THESE TOPICS | deception, Guatemala, informed consent

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