People detained at a jail in northwestern Arkansas recently reported that the facility’s medical professionals deceived them into taking ivermectin — a drug being touted by Republican lawmakers, talk show hosts and a small number of doctors and patient advocates for treating covid-19 — although the Food and Drug Administration has not approved the drug for this purpose.

Ivermectin can be toxic for humans and can cause vomiting, coma, seizures and even death. The jail’s doctor, Rob Karas, advocated ivermectin use on Facebook and claimed that 350 people detained at the jail voluntarily took the drug. However, Karas and nurses allegedly told inmates they were taking vitamins. Learning about Karas’s treatments through a news report, however, one man responded: “It was not consensual. They used us as an experiment, like we’re livestock.”

This incident recalls a period in the 20th century when doctors working in Guatemala for the Pan American Sanitary Bureau infected almost 1,500 marginalized Guatemalans, including Indigenous and poor people, prisoners, soldiers, women and the disabled with syphilis, gonorrhea and chancroid without their consent to study whether penicillin and other drugs prevented the spread of sexually transmitted infections. It reminds us how nonconsensual research and the experimental use of drugs on vulnerable people remain common — despite evidence of its danger and laws designed to prevent it.

In the late 1940s, 23 Nazi doctors and scientists stood trial before an American military tribunal in Nuremberg, Germany, for deadly experiments that they performed on people in concentration camps. In the end, seven were sentenced to death and many others received long prison sentences. And yet, during the trial, German doctors accused U.S. researchers of conducting similar nontherapeutic experiments on prisoners during World War II. The German doctors’ efforts to deflect blame were ignored, but they weren’t incorrect. At the time of the trial, U.S. and Guatemalan doctors were inserting syphilis into Guatemalan people’s eyes and abrading men’s penises.

The convictions paved the way for the Nuremberg Code, which established the ethical imperative for researchers to obtain informed consent from their subjects. Still, they caused little soul searching among American researchers. Years after the end of the infamous 40-year (1932-1972) U.S. Public Health Service study in Tuskegee, Ala. — in which researchers withheld treatment for syphilis in African Americans — PHS doctor John Heller balked at the question of whether the Nuremberg Code had inspired the U.S. group to reflect on its own research. “But they were Nazis,” Heller said.

While dismissing the idea that the Nuremberg Code should apply to them, U.S. researchers still made an effort to hide research that they knew was ethically questionable. As historian Susan Lederer has shown in her study of medical ethics, “at no time were American investigators free to do whatever they pleased with their human subjects.” In 1947, U.S. researchers shared among themselves a New York Times article that said, “shooting living syphilis germs” into humans, as researchers had tried in rabbits, would be “ethically impossible.”

They opted to conduct this research away from the eyes of the American public, in Guatemala, where the United States bolstered the fortunes of United Fruit and had stationed soldiers during World War II. U.S. doctors formed close ties with Guatemala’s Ladino (non-Indigenous) medical professionals, even though Guatemala was undergoing a revolution (1944-1954) in which leaders decried U.S. imperialism. In 1954, the CIA backed a coup overthrowing Guatemala’s democratically elected leader, Jacobo Árbenz, unceremoniously ending the revolution and ushering in 36 years of civil war.

U.S. doctors also went to Guatemala because their experiments deployed sex workers to pass STIs to Guatemalan prisoners and soldiers. Sex work was illegal in the United States, and Surgeon General Thomas Parran (who knew about the research in Guatemala and remarked that such experiments could never be done in the United States), had enforced its criminalization during World War II. Yet sex work was legal in Guatemala and women were allowed to visit male prisoners.

From the beginning, doctors dehumanized the people they experimented on — likening them to rabbits and calling them “Mayans from the backwoods.” U.S. doctors initially hired sex workers and infected them before they had sex with the men. When they encountered challenges infecting Guatemalans through “natural” methods, the doctors attempted to infect Guatemalans by injecting STIs into their urethras, rectums, eyes and by mutilating their genitals. In 1948, these experiments ended when Parran lost his appointment as surgeon general. Senior PHS members felt they had “lost a very good friend” and needed to “get our ducks in a line.”

The experiments remained secret for years after they ended, although PHS doctors gossiped about them, showing a startling indifference to the lives and health of Guatemalans.

Some doctors who had been in Guatemala also worked in Tuskegee. Like the Guatemala experiments, the Alabama study reflected how the U.S. medical community failed to grasp the ethical and moral complications of such experiments — because they saw their human subjects as undeserving of care. For example, White U.S. researchers’ racial perceptions of African Americans as hypersexual and “syphilis-soaked” justified their deception in Alabama.

And because of the broader climate of racism in the United States, it failed to raise red flags. During the 40 years of the study, PHS researchers published numerous articles in leading medical journals and gave talks, but they received no pushback. Yet in the 1960s, as the civil rights movement gained ground, some doctors and CDC researchers grew increasingly concerned about potential fallout.

Even so, the study did not end until 1972, after the Associated Press reported on it. The public reaction was explosive. “Tuskegee” became symbolic of the U.S. government’s abuse of and denial of the human rights of African Americans. The Black Panthers charged the government with genocide.

Two years later, in 1974, Congress passed the National Research Act, which established formal protections for human subjects, including prisoners who were classified as a “vulnerable population” for whom special care must be taken to obtain consent.

It took until 2010 for the world to learn about what happened in Guatemala. Historian Susan Reverby discovered the experiments during her research on Alabama, and by revealing her findings, she brought attention to unethical research in the global south.

Although federal protections have reduced research on incarcerated people and other vulnerable populations in the United States, problems in human-subject research and nonconsensual medical procedures persist. This is especially the case among people who are in jails, detention centers and prisons and are poor, immigrants and people of color. For example, in 2020, reports surfaced that a doctor removed the uteri of migrant women in an Immigration and Customs Enforcement detention facility in Georgia without their consent.

These practices continue because of problems with enforcing uniform standards and a lack of oversight in prisons, jails and detention centers, particularly privatized ones. They also occur because of perceptions by medical professionals and authorities that people in carceral settings are less than human, and meaningful consent can be absent.

Guatemala and Alabama are frequently mentioned as reasons that African American and Latino populations harbor concerns about the coronavirus vaccine, even though their trepidations go far beyond these two examples of unscrupulous research. Now we have another example of dishonest medical practice in Arkansas. As one incarcerated person said after the news broke about the ivermectin treatments: “I’m scared. If you were so willing to put something in my pills and give me a pill without my acknowledgment, you could do the same thing and be deceptive and put it in my juice, my food. … I can’t trust any of the medical staff. I can’t trust any of the guards.” This lack of trust reflects his recognition of the violent and dehumanizing conditions of penal institutions that remain antithetical to care — even as we know the dangerous and deadly consequences of such treatment.