Early in America's crusade to spread the wonders of modern
medicine, a group of researchers in Guatemala did something
unspeakable in the name of science. Documentation of the project
is just now coming to light, more than 60 years later, and it
reads like a horror novel: Hundreds of men systematically
infected with syphilis and other sexually transmitted
diseases in an effort, endorsed by both the U.S. and Guatemalan
governments, to research the effectiveness of drug treatment.
Researchers exposed
men to disease with varying degrees of intent. At first,
Guatemalan health official Juan Funes selected prisoners in
Guatemala City as subjects because prostitution at the
penitentiary would likely yield fresh infections. But the
researchers used more invasive tactics as well. The Washington
Post reports, "in other cases, doctors put infectious
material on the cervixes of uninfected prostitutes before they had
sex with prisoners." When they needed more infections, they took
more aggressive measures--"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," according to the research of the historian who broke
the story, Susan M. Reverby (interviewed recently on Democracy
Now!).
Many, but not all, of these people--who included prisoners,
soldiers and mental patients--were given penicillin to test
its effectiveness as an after-sex treatment of syphilis, a disease
that that can result in blindness or death. Medical personnel
carried out similar studies on gonorrhea,
which can lead to intense pain and infertility, and
chancroid, which causes genital ulcers.
The archival documents suggest the experiments didn't raise
significant ethical qualms in Washington. The surgeon general at
the time was quoted as saying, "You know, we couldn't do such an
experiment in this country."
Well, in a way, they could. A bizarre element in the story is the
connection to another shameful chapter in the history of American
medicine. The man behind the infection of incarcerated
Guatemalans, Dr. John Cutler, had a hand in the infamous Tuskegee
experiments as well.
That study (also conducted in the name of public health, of
course) involved recruiting syphilitic black men into a 40-year
program that denied them treatment without their knowledge. The
U.S. Public Health Service worked in partnership with the Tuskegee
Institute to rope hundreds of men into serving as an
unwitting control group. Many were never told about their
condition and received either insufficient treatment or none at
all. Although the Public Health Service was administering
penicillin for syphilis by 1943, the Tuskegee "subjects" received
none to continue the controlled study. Modern day informed consent
guidelines stem from the bioethical scandal that laid bare the cruel
entanglement of racism and science.
The Guatemalan research is further proof that medical abuses
against people of color wasn't limited to Tuskegee. In Puerto
Rico, for example, starting in the 1950s poor
women served as "guinea pigs" for trials of high-dosage
birth control pills, which were later embroiled in an ethical
scandal over their potentially dangerous side effects. Exploiting
Puerto Rican women's wombs was seen as a convenient alternative to
dealing with all the political and ethical hurdles that would have
surrounded studies of the pill on the mainland.
Experimentation on marginalized groups, at home and abroad, is
something of a tradition in American medicine. A Counterpunch
article documents over a century of cases of the government deliberately
sickening unwitting subjects, stretching from military
detainees in the Philippines exposed to the plague to incarcerated
men in Chicago infected with malaria.
Many of the researchers involved with these experiments may have
genuinely believed they were serving a higher purpose. They might
have thought the ends justified the means, that the lives of these
Guatemalan inmates or poor black men were somehow being redeemed
through their participation in the trials, albeit unwittingly. But
both Tuskegee and Guatemala City reflect a deep, even subconscious
belief among medical practitioners in the inferiority of the other.
The subjects, meanwhile, are tied together by their utter
powerlessness under the coercion of medical authorities--poor,
often imprisoned by the state, and lacking the knowledge they need
to control their own bodies fully. One of the cruelest outcomes of
these experiments is that they've irrevocably damaged
public trust in medical science, which has undermined the
exploited communities' health on an even broader level. Some
advocates attribute the black AIDS crisis in part to a broad
alienation of the community from the health care system.
"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," National Institutes of
Health Director Francis S. Collins told the Post after the
Guatemala story broke.
Collins is referring to yet another high-stakes consequence:
Globally, the impacts of today's most damaging diseases fall
heaviest in poor communities of color, and any new treatment
rightly demands clinical trials in those contexts. Scientists
continue to struggle to earn enough trust to fulfill those trials,
and the Guatemala history is a big reminder of why that's so. For
clinical
trials currently
operating in the Global South, the scandals of past
experiments will hopefully serve as a lesson in ethics for the
future.