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America’s Bioethics Shame

By Michael Cook

President Obama’s bioethics commission finds that US experiments in post-war Guatamala turned a blind eye to ethical concerns.

For the past year it has been bioethical bow, scrape and grovel time in Washington DC. After learning that American public health researchers had infected hundreds of Guatemalans with venereal diseases between 1946 and 1948, President Obama had to telephone his Guatemalan counterpart to apologise. He then set up a commission to investigate the appalling story of coercion and deception. A detailed historical report was published on 13 September.

The tale came to light long after the doctors and participants had passed away. After World War II, thousands of STD-infected servicemen were being demobbed. American public health officials needed to know more about the effectiveness of the new miracle drug penicillin to control the spread of STDs in the US, and after researching this on volunteers in an Indiana prison they went to Guatemala.

Dr John C. Cutler, a Public Health Service physician, first selected men in the Guatemala National Penitentiary, then men in an army barracks, and then men and women in the National Mental Health Hospital.

The commission concluded that researchers deliberately exposed about 1300 inmates, psychiatric patients, soldiers and commercial sex workers to syphilis, gonorrhoea or chancroid. Permissions were obtained from government authorities but not from individuals.

Initially the doctors used prostitutes with the disease to infect the prisoners (since sexual visits were allowed by law in Guatemalan prisons). When “normal exposure” failed to infect them they performed direct inoculations. These were made from syphilis bacteria poured onto the men’s penises or on forearms and faces that had been slightly abraded. In some cases they used spinal punctures. The subjects were given penicillin after they contracted the illness.

The results were never published and gathered dust in archives at the University of Pittsburgh.

Even by the standards of the time, this project was regarded as unethical. After all, only a few months before, Nazi death camp doctors had been condemned to death and there were long prison terms handed out for medical experiments conducted without informed consent.

Principles later formalised as the Nuremberg code of medical ethics had been published in the Journal of the American Medical Association in 1947. In April 1947, New York Times science editor Waldemar Kaempffert observed, as if it were universally accepted, that deliberately injecting human subjects with syphilis microbes was “ethically impossible”.

Despite this Cutler, who became a respected academic with an interest in population control, pushed ahead. “The attitude toward the Guatemalan people was pretty much what you’d expect if they were doing research on rabbits,” said a member of Obama’s commission, bioethicist John Arras of the University of Virginia.

Cutler’s higher-ups in the public health hierarchy were more squeamish but they did not stop the project. His superior confided: “I am a bit, in fact more than a bit, leery of the experiment with the insane people. They cannot 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 stop it.

Bioethics today tends to be more concerned with protocols than with judgmental words like “right” and “wrong”. But President Obama’s bioethics commission did not hesitate to describe the Guatemala experiments as “reprehensible” and “morally wrong”.

The commission is currently working on a second report about standards for protecting human research participants. This is a live issue. Many pharmaceutical companies are outsourcing clinical trials to countries in the developing world where costs are lower and the paperwork is less onerous. There is enormous potential for the abuse of vulnerable people.

What lessons from this shameful episode can be applied to contemporary medical research?

One, says the commission, is “never to take ethics for granted, let alone confuse ethical principles with burdensome obstacles to be overcome or evaded”. Another is that “the quest for scientific knowledge without regard to relevant ethical standards can blind researchers to the humanity of the people they enlist into research”.

Eternal vigilance is the price of bioethical rectitude.

Michael Cook is editor of BioEdge, an online bioethics newsletter.