October 2, 2010 in Nation/World

Syphilis research disclosed

U.S. apologizes to Guatemala for tests that infected subjects
Rob Stein Washington Post
 

WASHINGTON – The United States issued an unusual apology Friday to Guatemala for conducting experiments in the 1940s in which doctors infected soldiers, prisoners and mental patients with syphilis and other sexually transmitted diseases.

The experiments, conducted by a physician who was later involved in the infamous Tuskegee syphilis study in Alabama, involved a total of 696 men and women who were drafted into studies aimed at determining the effectiveness of penicillin.

“The sexually transmitted disease inoculation study conducted from 1946-1948 in Guatemala was clearly unethical,” Secretary of State Hillary Rodham Clinton and Health and Human Services Secretary Kathleen Sebelius said in a joint statement.

“Although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health. We deeply regret that it happened, and we apologize to all the individuals who were affected by such abhorrent research practices,” the statement said.

Clinton called Guatemalan President Alvaro Colom to inform him about the experiment Thursday night.

“We of course are very upset about this, and we think it’s a very unfortunate event,” said Sofia Porres of the Guatemalan Embassy in Washington. “We are going to investigate. We knew they were doing investigations, but it’s very likely we didn’t know these experiments were taking place like this. We’re going to do an investigation as well to see if there are any survivors, family, etc.”

Susan Reverby, a professor of the history of ideas and of women’s and gender studies at Wellesley College in Massachusetts, discovered the experiment while investigating the Tuskegee experiment for her book “Examining Tuskegee.” In the Tuskegee experiment, perhaps the most notorious medical experiment in U.S. history, hundreds of African American men with late-stage syphilis were left untreated to study the disease for 40 years.

Reverby was reading papers in the University of Pittsburgh’s archives from John C. Cutler, a physician with the federal government’s Public Health Service who would later be involved in the Tuskegee experiment. The documents had no information about Tuskegee, it turned out, but detailed the Guatemalan studies.

“I almost fell out of my chair when I started reading this,” Reverby said. “Can you imagine? I couldn’t believe it.”

The study was sponsored by the Public Health Service, the National Institutes of Health and the Pan American Health Sanitary Bureau (now the World Health Organization’s Pan American Health Organization) and the Guatemalan government. It came when doctors were trying to determine exactly how to prevent and treat sexually transmitted diseases such as syphilis. Specifically, they were trying to assess whether giving men penicillin right after sex would prevent infections.

Cutler and colleagues decided to study men in the Guatemalan National Penitentiary because prisoners in that country were allowed to have sex.

“The doctors used prostitutes with the disease to pass it to the prisoners (since sexual visits were allowed by law in Guatemalan prisons),” Reverby wrote in a synopsis of the experiments.

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 on soldiers in an army barracks and on men and women in the National Mental Health Hospital.

Unlike the Tuskegee experiment, the subjects were treated with penicillin after they developed the disease. “However, whether everyone was then cured is not clear and not everyone received what was even then considered adequate treatment,” Reverby wrote.

Thomas Parran, who was then U.S. surgeon general, clearly knew the experiment was unethical, Reverby said. “You know, we couldn’t do such an experiment in this country,” he said, according to her synopsis.

“Deception was the key here as it had been in Tuskegee,” wrote Reverby, who described the experiment in detail in a 29-page paper that will be published in January in the Journal of Policy History. “Much of this was kept hushed even from some of the Guatemalan officials and information about the project only circulated in selected … circles.”

One mental patient with epilepsy died, but it was unclear whether the study played a role in the death, 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 federal Centers for Disease Control and Prevention, who notified current CDC officials. The CDC sent a leading syphilis specialist to examine what Reverby had found, which led to Friday’s public disclosure.

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

“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.


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