Professionalism/The Guatemala Syphilis Experiment

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Throughout history, there have been cases where scientists and engineers have seemingly overstepped ethical boundaries in pursuit of their work. The 1940s Guatemala Syphilis Experiment is one such case in which these boundaries were blurred. Its exposure in 2010 prompted debate and review of the ethics behind medical research.

Background[edit]

In 1944, the end of Jorge Ubico's dictatorship perpetuated a state of poltical turmoil in Guatemala. Although he helped improve the county's economic situation, it came at the price of individual liberties [1]. At this vulnerable time, most people would have stayed away from Guatemala, however the officials at the U.S. Venereal Disease Research Lab (VDRL) found Guatemala City to be the premier location for their experiments. One VDRL official, Dr. John C. Cutler, captained what is known today as the Guatemala Syphilis Experiment from 1946 to 1948.

John C. Cutler[edit]

Cutler began as an official in the U.S. Public Health Service (PHS) in 1942 and served as a medical officer during World War II. However, his interest in the prevention and control of sexually transmitted diseases did not begin until he joined the U.S. Public Health VDRL in Staten Island, New York in 1943 [2]. Cutler's interest in this research can be best understood by his collaboration in the well-known Tuskegee Syphilis Experiments. While the goal of the Tuskegee Experiments was to simply monitor the progression of syphilis, researchers in the Guatemala Experiments used much more aggressive methods to study the disease.

The Motive[edit]

The researchers were primarily interested in penicillin's potential to prevent and cure syphilis infection, the establishment of better blood tests for the disease, and the process of re-infection after cures [3]. Scientists also wanted to test reactions to "flesh infective material" in order to enhance immune responses, as well as chemoprevention methods after exposure to the syphilis bacteria [4]. Cutler's known interest in population control may have also contributed to his work within Guatemala [5].

Experiments[edit]

National Institutes of Health logo.gif

In 1946, the U.S. National Institute of Health (NIH) established and funded a branch of the VDRL in Guatemala City, where Cutler managed the lab and controlled all experiments. The laboratory staff recruited legal prostitutes to enter prisons and army camps in an effort to infect the men with syphilis and other STDs [4][6].

Soon after, the project became too expensive, requiring over 3 million units of penicillin, a valuable drug at the time. The studies, therefore, ended in 1948 [6]. In 2010, the Centers for Disease Control and Prevention (CDC) stated that approximately 696 people were exposed to syphilis, 772 to gonorrhea and 142 to chancroid, with infection rates of 61%, 30% and 97%, respectively. The CDC believes that most were treated; however, they suggest that only 76% of the subjects directly inoculated were provided adequate amounts of penicillin, leaving many Guatemalans effectively untreated [4][7].

Organization Involvement[edit]

In the 1940s, the research was approved and supported by many well respected national organizations such as the NIH, the PHS, and the Pan American Health Sanitary Bureau (now called the Pan American Health Organization). These three groups collaborated to provide funding for Cutler and his experiments. The NIH supported Cutler's decisions as director of the Venereal Disease Research Lab, and funded Cutler's prostitute-driven infection program [8]. When the researchers decided that infecting soldiers and prisoners was not sufficient, Cutler's superiors at the U.S. PHS gave him approval to begin experimenting on children and patients in orphanages and mental asylums [4]. The Guatemalan government was aware of the experiments, and allowed them to continue. However, due to the current state of the central government, some argue that Guatemala cannot be held accountable for approving the program [9].

The Aftermath[edit]

In 2010, seven years after Cutler's death, Susan M. Reverby, a medical historian and professor at Wellesley College, came across Cutler's work in the University of Pittsburgh archives. The papers included patients’ records, handwritten notes, photos, and correspondence with others in the public health service [6]. Reverby presented her findings at a conference in January 2010, yet was ignored until submitting a draft article to the Journal of Policy History in June 2010. Dr. David J. Spencer, former director of Centers for Disease Control, finally "prodded the government to investigate" [8].

The Tunnel Theory[edit]

In cases within the realms of science and research, there can be found a trend where individuals or groups of people become

I think [the doctors] just really wanted their results; they fell in love with their data [4].

—Susan Reverby

overly engrossed in their work. Their path towards reaching a goal, the light at the end of the tunnel, consumes all attention, resulting in societal impacts being ignored or insufficiently justified. Cases such as these can be placed within the contexts of The Tunnel Theory. In the Guatemala Syphilis Experiment, John C. Cutler and his research team, became entranced by their goal of acquiring knowledge and making discoveries on venereal diseases. The impacts their experiments had on the people of Guatemala were not only improperly analyzed, but assumed to be worth the long-term benefits their research would provide humanity and society as a whole.

In response to his previous work in the Tuskegee Experiment, Cutler admitted that "some will die...It's in the interest of the total society...[those who died] were serving their race" [10]. In terms of providing any treatment for the participants, Cutler claimed it would simply "interfere with the study"[11]. This shows Cutler's passion for his work, but a lack of analysis in the total societal impact of his work.

Cutler's former colleague at the University of Pittsburgh Graduate School of Public Health, Ravi Sharma, offered: "To [Cutler], health was more than simply studying microbes. It was life"[2].

Susan Reverby herself, after analyzing the experiments, explained that the research team sincerely believed "we're in a war against disease and in war soldiers die"[12].

U.S. Government[edit]

U.S. President Barack Obama

On October 1, 2010 the U.S. Government issued a formal apology to the Guatemalan government and people" [6]. President Barack Obama personally called Guatemalan President Álvaro Colom to express his deepest regret for the past events, and to extend an apology to the nation of Guatemala and all those touched by the study [13]. The President also tasked the Presidential Commission for the Study of Bioethical Issues with a historical investigation of the treatment of human subjects in scientific research [6]. The report was issued in September 2011.

Hilary Clinton, Secretary of State, and Kathleen Sebelius, Secretary of Health and Human Services, also apologized to the Guatemalan government, survivors, and descendants, recognizing the events as "clearly unethical" [8]. In a joint statement, the two women said, "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"[14].

Guatemalan Government[edit]

Guatemalan President Álvaro Colom

Although the Guatemalan government was privy to the experiments in the 1940s, the current democratic government system expressed outrage and indignation toward the studies. After speaking with Hilary Clinton, Guatemalan President Álvaro Colom called the news shocking and "crimes against humanity," taking advantage of a vulnerable population[8][15]. In a statement to the media, Colom stated:

"I was upset and angry when I heard this news. These people were the victims of rights abuses. There’s been a very strong reaction in the Guatemalan media and by my compatriots. Of course there may have been similar incidences at other countries. But speaking as the President and a Guatemalan, I would have preferred that these events had never happened on this soil"[14].

Guatemala's Vice President, Rafael Espada, directed a Commission of Inquiry to make recommendations on Guatemala's response to the news. Colom considered talking to the international court, but instead waited on the results of the inquiry. Guatemala's Attorney General stated that the government only knows of 3 surviving victims, and that the descendents of the victims would likely never be found [16].

Guatemalan Citizens[edit]

The following video presents several contemporary perspectives of Guatemalan citizens affected by the Guatemala Syphilis Experiment.

They laid me on a bed with a doctor on each side and a nurse holding my head. And then they tried to force my legs open. I resisted with all the strength of a 10-year-old-girl...

—64 year old Guatemalan woman recalling her experience [17]

The video emphasizes that while the experiments ran for only two years, the impacts on individuals and families has lasted for over 50 years since Cutler's work.

In March 2012, "a group of Guatemalans filed a class action lawsuit against the U.S. government for intentionally infecting them with syphilis"[9]. The defendants were claimed to be "'liable under the principles of successor liability for the acts of their predecessor office-holders'"[17]. Lawyers, however, claimed that Guatemala needed to also acknowledge its own participation in the study [9]. In June 2012, the case was dismissed; U.S. District Judge Reggie Walton ruled that "federal law bars claims against the U.S. based on injuries suffered in a foreign country" [18].

Future Study[edit]

Future teams may be interested in analyzing alternative cases that fall within the limits of The Tunnel Theory, including the making of the atomic bomb and the Nuremberg Trials.

Robert Oppenheimer, one of the key players in the making of the atomic bomb, thought of the following passage from a Hindu holy book on witnessing one of the first test explosions. Passion for his project and brainchild allowed Oppenheimer to lose sight of the potential implications of this technological innovation.

"Now I am become Death, the destroyer of worlds."

Alex Dekel, a former Auschwitz prisoner during the Holocaust, claimed that Josef Mengele, one of the Nazi doctors mentioned during the trials, had the following to say regarding his work:

"The patients did not count. He professed to do what he did in the name of science, but it was a madness on his part."

Conclusion[edit]

In the case of the Guatemala Syphilis Experiment, John C. Cutler and his colleagues succumbed to the effects of The Tunnel Theory. Their unyielding pursuit of data resulted in generations of psychological and physical distress for the Guatemalan people, as well as a negative portrayal of the United States's role in medical research. In cases within the field of science or medical research, ethical boundaries can be difficult to define and limit. In such cases, each participant can have a unique perspective on how to define these ethical boundaries; however, it is up to professionals to hold themselves responsible for how their judgments could impact society.

References[edit]

  1. Constitutional limits on government: Country studies - Guatemala. (n.d.). Retrieved from http://www.democracyweb.org/limits/guatemala.php
  2. a b Ackerman, J. (2003, February 12). Obituary: John Charles Cutler / Pioneer in preventing sexual diseases. Post-Gazette.
  3. Gorski, D. (2010). The Guatemala syphilis experiment and medical ethics in science-based medicine. Science-Based Medicine.
  4. a b c d e Minogue, K., & Marshall, E. (2010, October 8). Guatemala study from 1940s reflects a 'dark chapter' in medicine. Science, 330, 1.
  5. University of Pittsburgh. (n.d.). Eleise S. Cutler and the late Dr. John C. Cutler, friends of Pitt. http://www.google.com/imgres?imgurl=http://saynsumthn.files.wordpress.com/2010/
  6. a b c d e Semeniuk, I. (2010). A shocking discovery. Nature, 467(645).
  7. United States Centers for Disease Control and Prevention. (2010). CDC report on findings from the U.S. Public Health Service sexually transmitted disease inoculation study of 1946-1948, based on review of archived papers of John Cutler, MD, at the University of Pittsburgh.
  8. a b c d McNeil, D. G., Jr. (2010, October 1). U.S. apologizes for syphilis tests in Guatemala. The New York Times.
  9. a b c Mpelembe. (2011, April 5). Guatemala played a role in the U.S. 1940s syphilis experiment, says victims' lawyer [Newsgroup post]. http://world-news.mpelembe.net/
  10. Ove, T. (2011, August 30). Late Pitt dean Cutler denounced for infecting Guatemalans with syphilis in research experiment. Pittsburgh Post-Gazette.
  11. The deadly deception - 1993 rare documentary [Video file]. (n.d.). Retrieved from http://www.youtube.com/watch?v=HCYdI2b_9Vs
  12. Selyukh, A. (2011, August 29). U.S. researchers broke rules in Guatemala syphilis study. Retrieved from http://www.reuters.com/article/2011/08/29/us-usa-guatemala-syphilis-idUSTRE77S3L120110829
  13. The White House Office of the Press Secretary. (2010, October 1). Read-out of the president's call with Guatemalan President Colom [Press release].
  14. a b BBC. (2010, October 1). U.S. medical tests in Guatemala 'crime against humanity'. http://www.bbc.co.uk/
  15. Doyle, K. (2011, April 5). Decades later, NARA posts documents on Guatemalan syphilis experiments. http://nsarchive.wordpress.com/
  16. Matalone, L., The World, PRI, BBC, & WGBh. (2010, November 26). Guatemala syphilis study still provokes anger. The World. http://www.theworld.org/
  17. a b Huffington Post. (2012, June 23). Guatemala syphilis study lawsuit: Dismissal despite United States experiments on natives in 1940s. Huffington Post. http://www.huffingtonpost.com/
  18. CBCNews. (2012, June 13). Lawsuit over U.S. Guatemala syphilis experiment dismissed. http://www.cbc.ca/