US government scientists who infected Guatemalans with syphilis and gonorrhea as part of a study that began in 1946 knew they were violating ethical rules according to a US presidential panel. The researchers infected hundreds of prisoners, psychiatric patients and sex workers during the 1940s to study the effects of penicillin. None of the Guatemalans were informed. Dr Amy Gutmann, head of the Presidential Commission for the Study of Bioethical Issues, called the research a “shameful piece of medical history”. “It is important that we accurately document this clearly unethical historical injustice. We do this to honor the victims,” she said in a statement.
The U.S. Public Health Service was facing problems after World War II with a lot of veterans suffering from sexually transmitted diseases. The experiments were lead by the US PHS, funded by a grant from the U.S. National Institutes of Health to the Pan American Sanitary Bureau. They were carried out even as the Doctors’ trial was ongoing – in which US military authorities tried German doctors for war crimes after they were found to have carried out analogous research. The publication of the Nuremberg Code did nothing to stop these experiments, but may have added to their perpetrators’ desire for secrecy.
The Commission said some 5,500 Guatemalans were involved in all the research that took place between 1946 and 1948. Of these, some 1,300 were deliberately infected with syphilis, gonorrhea or another sexually transmitted disease, chancroid. And of that group only about 700 received some sort of treatment. According to documents the commission had studied, at least 83 of the 5,500 subjects had died by the end of 1953. The commission was unable to say whether any of those deaths were caused directly or indirectly by the deliberate infections.
But Dr Gutmann lambasted those responsible for the research. “Those involved in the study failed to show a minimal respect for human rights and morality in the conduct of research,” she said in her concluding remarks to the panel. She said many of the actions were “grievously wrong” and those individuals behind the study were “morally culpable to various degrees“. “Civilizations can be judged by the way they treat their most vulnerable… we failed to keep that covenant,” she said.
Many of the same researchers had carried out studies on prisoners in Terre Haute in the US state of Indiana. But in that case, the panel said, the researchers fully informed patients of what would be happening and gave them informed consent forms to sign. In Guatemala, patients were told “little to nothing” and there were no consent forms. US President Barack Obama set up the commission when the research first came to light. He also apologized to his Guatemalan counterpart, Alvaro Colom, saying the acts ran contrary to American values.
Information about these experiments was uncovered by chance by Professor Susan Mokotoff Reverby of Wellesley College. Reverby found documents in 2005 in John C. Cutler’s (a doctor with the federal government’s Public Health Service who later participated in Tuskegee) archived papers while researching the Tuskegee syphilis study. Later she discovered that they related to a wholly unknown experiment which was carried out outside the US because of legal concerns.
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. 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 describes the tests in a 29-page paper that was published in January 2011 in the ‘Journal of Policy History’.