Susan Reverby describes three studies as the "trinity" of unholy medical research. Doctors at the Jewish Chronic Disease Hospital in New York City injected patients with live cancer cells. At Willowbrook State School, also in New York, researchers gave mentally disabled children hepatitis. In Tuskegee, Ala., doctors withheld treatment from black subjects to study the course of advanced syphilis.
Now there's a fourth.
On Friday, the U.S. government revealed that Reverby has unearthed a U.S.-sponsored study in Guatemala, where doctors in the 1940s infected soldiers, prisoners, prostitutes and mental patients with syphilis and other sexually transmitted diseases. All traces of the study, which involved as many as 1,500 men and women, lay buried in a University of Pittsburgh archive, among the papers of researcher John Cutler of the U.S. Public Health Service. Cutler, who died in 2003, would later carry on his syphilis research in Tuskegee.
The disclosure of what National Institutes of Health Director Francis Collins called "a dark chapter" in medical history prompted President Obama to call Guatemalan President Alvaro Colom on Friday and apologize.
Cutler and his co-workers were trying to determine whether they could prevent syphilis with penicillin, a new drug in short supply between 1946 and 1948 when the studies were carried out. Hundreds of unwitting subjects were infected through cuts in their skin or through sex with prostitutes who had syphilis or were infected by researchers.
Strict rules adopted
Reverby says the Guatemala study reflects an approach to science that was far different than the one embraced today, which is based on reforms adopted following disclosure of the studies at the Jewish Chronic Disease Hospital, where doctors were studying cancer in transplant patients; at Willowbrook, where they were trying to see whether injections of gamma globulin could prevent rampant hepatitis; and at Tuskegee.
Abuses in research on vulnerable people led to strict rules designed to protect human research subjects. Until the rules were introduced in the 1970s -- mandating, among other things, that subjects give informed consent -- doctors who led trials saw themselves as scientific pioneers and their patients as participants in a humanitarian mission, says Reverby, a medical historian at Wellesley College in Massachusetts.
The Guatemalan government backed the trials, asking Cutler to "test and treat" men in army barracks and supply penicillin "as part of the price for cooperation," Reverby wrote in an article on the experiments scheduled to be published in January in the Journal of Policy History.
Cutler and his team decided to study prisoners in Guatemala City's Central Penitentiary, because the men were allowed visits by prostitutes who could be used to infect them.
Seventy-one of the patients in the syphilis experiment died, but researchers couldn't link any of the deaths to the research.
Reverby says the Guatemala experiments were carried out in secrecy by researchers who lied to their subjects and fretted that the program might be "wrecked" if it became public.
The envy of researchers
Cutler's trials stoked the envy of other researchers who clamored to take part. A National Cancer Institute doctor grew so angry when his request was denied he complained to Surgeon General Thomas Parran, head of the Public Health Service. Yet Parran expressed his own concerns about what might happen if word leaked out.
"What shocked me most ... was that even Parran recognized that it was on the ethical edge," Reverby says.
Reverby discovered the records of the Guatemala experiments when she was researching a book on the Tuskegee experiment, Examining Tuskegee, published in 2009. What struck her, she says, was that she has spent years trying to dispel a misconception that doctors were infecting the Tuskegee subjects with syphilis, yet here were documents showing that Cutler was infecting people, not in Tuskegee, but in Guatemala.
Still, the impact of Tuskegee continues to resonate, breeding distrust in minorities who often are reluctant to take part in research or seek medical care.
"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," Collins says. "Today, the regulations that govern research by the U.S. government, whether funded domestically or internationally, would absolutely prohibit this kind of study."
Reverby says those protections may not be enough. "We all realize how much research on drugs is done overseas," she says. "The question is how do we keep on top of what's going on now?"
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