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U.S. infected Guatemalans for STD tests

Cutler, Guatemalan health official Juan Funes and colleagues decided to study men in Guatemala City's Central Penitentiary because its prisoners were allowed to have sex with prostitutes. Some of the prostitutes tested positive for syphilis; in other cases, doctors put infectious material on the cervixes of uninfected prostitutes before they had sex with prisoners.

But because so few men were getting infected, the researchers then attempted "direct inoculations made from syphilis bacteria poured into the men's penises and on forearms and faces that were slightly abraded . . . or in a few cases through spinal punctures," Reverby wrote in a synopsis of the experiments.

They conducted similar experiments involving gonorrhea and chancroid and on soldiers in an army barracks and on men and women in the National Mental Health Hospital. In some cases, the subjects drank "syphilitic tissue mixed with distilled water," Reverby wrote in a synopsis of the testing. Doctors used needles to scrape the arms, faces or mouths of the women to try to infect them.

A number of high-ranking U.S. government officials knew about the research, including Thomas Parran Jr., who was then U.S. surgeon general, the documents show. "You know, we couldn't do such an experiment in this country," Parran said, according to Cutler. Parran died in 1968.

The gonorrhea studies involved 772 subjects, 234 of whom became infected and 233 of whom received treatment, according to an investigation by the federal Centers for Disease Control and Prevention. The chancroid studies involve 142 subjects, including 138 who became infected and 129 who received treatment. The syphilis experiments involved 497 subjects who were exposed to the bacteria that causes the disease, 427 of whom became infected and 332 of whom received treatment. A total of 443 of the subjects actually developed syphilis; 331 received treatment, although only 85 could be documented to have received full treatment, the CDC found.

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.

Seventy-one of the syphilis subjects died during the study, including one from a fatal epileptic seizure, but it was unclear whether any were caused by the studies. The fates of the other subjects will be investigated, officials said.

The researchers also took blood samples from 438 children at the National Orphanage, but in that case, they did not purposefully infect anyone, Reverby said.

Cutler discontinued the experiments "when it proved difficult to transfer the disease and other priorities at home seemed more important," she wrote. The results were never published. Cutler died in 2003.

Reverby shared her discovery last spring with David Sencer, a retired director of the CDC, who notified current CDC officials, leading to Friday's public disclosure. Reverby describes the tests in a 29-page paper that will be published in January in the Journal of Policy History.

NIH Director Francis S. Collins condemned the experiment and said strict prohibitions are in place to prevent such abuses from happening today.

"This case of unethical human subject research represents an appalling example from a dark chapter in the history of medicine," Collins told reporters during a telephone briefing Friday.

Although Collins said it was important that the experiments had been made public, he acknowledged that the revelation could deepen entrenched suspicions about scientists and doctors. The Tuskegee experiment continues to be blamed for making many minorities reluctant to participate in medical studies or even seek medical care.

"We are concerned about the way in which this horrendous experiment, even though it was 60 years ago, may appear to people hearing about it today as indicative of research studies that are not conducted in an ethical fashion," Collins said. "Today, the regulations that govern research funded by the United States government, whether conducted domestically or internationally, would absolutely prohibit this type of study."

The National Academy of Sciences' Institute of Medicine will also investigate the experiment and the Presidential Commission for the Study of Bioethical Issues will form a panel of international experts to "ensure that all human medical research conducted around the globe today meets rigorous ethical standards," officials said.

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