U.S. scientists knew 1940s Guatemalan STD studies were unethical, panel finds

August 29, 2011

U.S. government researchers who purposely infected unwitting subjects with sexually transmitted diseases in Guatemala in the 1940s had obtained consent a few years earlier before conducting similar experiments in Indiana, investigators reported Monday.

The stark contrast between how the U.S. Public Health Service scientists experimented with Americans and Guatemalans clearly shows that researchers knew their conduct was unethical, according to members of the Presidential Commission for the Study of Bioethical Issues, which is investigating the experiments.

“These researchers knew these were unethical experiments, and they conducted them anyway,” said Raju Kucherlapati of Harvard Medical School, a commission member. “That is what is reprehensible.”

At least 5,500 prisoners, mental patients, soldiers and children were drafted into the experiments, including at least 1,300 who were exposed to the sexually transmitted diseases syphilis, gonorrhea and chancroid, the commission reported. At least 83 subjects died, although the commission could not determine how many of the deaths were directly caused by the experiments, they said.

“This is a dark chapter in our history. It is important to shine the light of day on it. We owe it to the people of Guatemala who were experimented on, and we owe it to ourselves to recognize what a dark chapter it was,” said Amy Gutmann of the University of Pennsylvania, the commission’s chairwoman.

The revelations came on the opening day of a two-day hearing the commission convened to review the findings of its investigation. President Obama ordered the probe when the experiments were revealed in October. Investigators reviewed more than 125,000 documents from public and private archives around the country and conducted a fact-finding trip to the Central American nation.

The Guatemalan government is conducting its own investigation. The experiments were approved by some Guatemalan officials.

“Actually cruel and inhuman conduct took place,” said Anita L. Allen of the University of Pennsylvania. “These are very grave human rights violations.”

In one case described during Monday’s two-hour hearing, a woman who was infected with syphilis was clearly dying from the disease. Instead of treating her, the researchers poured gonorrhea-infected pus into her eyes and other orifices and infected her again with syphilis. She died six months later.

The ultimate goal of the Guatemalan research was to determine whether taking penicillin after sex would protect against syphilis, gonorrhea and chancroid. The question was a medical priority at the time, especially in the military. The Guatemalan experiments, carried out between 1946 and 1948, aimed to find a reliable way of infecting subjects for future studies.

The research included infecting prisoners by bringing them prostitutes who were either already carrying the diseases or were purposely infected by the researchers. Doctors also poured bacteria onto wounds they had opened with needles on prisoners’ penises, faces and arms. In some cases, infectious material was injected into their spines, the commission reported.

The researchers conducted similar experiments on soldiers in an army barracks and on men and women in the National Mental Health Hospital. The researchers took blood samples from children at the National Orphanage, although they did not purposely infect them.

In the studies conducted in Indiana, researchers exposed 241 inmates in Terre Haute to gonorrhea in 1943 and 1944. But there, the researchers explained the experiments in advance in detail and experimented only on the prisoners who volunteered. In contrast, many of the same researchers who began experimenting on Guatemalans a few years later actively hid what they were doing and never tried to obtain permission, the commission found.

About 700 of the Guatemalan subjects were treated for the sexually transmitted diseases, but it remains unclear whether they were treated adequately or what became of them. Gonorrhea can cause a variety of complications, including infertility. Chancroid can cause painful ulcers. Syphilis can cause blindness, major organ damage, paralysis, dementia and death.

Susan M. Reverby, a historian at Wellesley College in Massachusetts, discovered the Guatemalan experiments while doing research for a book on the infamous Tuskegee studies in Alabama. Reverby found papers from John C. Cutler, a doctor with the federal government’s Public Health Service. Cutler had participated in the Tuskegee experiment, in which hundreds of African American men with late-stage syphilis were left untreated to study the disease between 1932 and 1972. Cutler died in 2003.

After sending Obama a report in September, the commission will meet again in November to discuss whether current protections are adequate for research subjects internationally and in the United States and will issue a final report in December.

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