Bioethics in Historical Context: The Other Syphilis Experiment
by Mariangels de Planell Saguer, GSAS ‘12
A syphilis study conducted in Guatemala by the United States Public Health Services was kept secret for more than sixty years until Susan Reverby, a professor of medical history at Wellesley College in Massachusetts discovered records while she was conducting research on the Tuskegee Syphilis Study. The Tuskegee study is one of the most infamous examples of research misconduct in American medical history. In this forty-year long study (1932 – 1972), conducted by the U.S. Public Health Service (PHS) in Tuskegee (Alabama), four hundred syphilis-infected African-American men were kept untreated, even after it was known that penicillin was an effective treatment for syphilis.
An even more egregious experiment, led by U.S. doctor John C. Cutler and PHS, occurred during the same period in Latin America. In this Guatemalan study, vulnerable populations, including mentally disabled persons, prison inmates, soldiers and sex workers, were intentionally exposed to sexually transmitted infections (STDs) without their knowledge or consent in an effort to test penicillin’s effectiveness against the disease. To persuade them to cooperate,researchers offered medical supplies and valuable items to inmates of the Guatemalan central penitentiary as well as alcohol and cigarettes to participants. Researchers infected female sex workers with gonorrhea or syphilis in order to spread diseases to soldiers and prison inmates. When some of the men failed to become infected through sex, they received the inoculation of bacteria by subcutaneous injection or into scrapes made on the penis, forearm or face. Subsequently, the majority of subjects were treated with penicillin, although there was no documented therapy or completion of the treatment. More than 1,500 people were exposed to venereal diseases and at least 83 died.
The Guatemalan study violates multiple principles of bioethics and human rights. Intentionally infecting people with pathogens that could cause serious illness obviously violates the medical principle “do not harm.” Inasmuch, people in the study were not able to give their informed consent. Both of these principles are included in the Nuremberg Code drafted in 1947, the same period that the Guatemalan syphilis study was taking place. In addition, these actions contradicted the 5th and 8th Constitutional Amendments and many other UN declarations that came after the study was completed.
It is clear that in current times, a situation like Guatemala’s study could not be completed because more regulations have been implemented to protect human research subjects and all clinical trials dependent on federal funding must adhere to certain ethical standards. However, not all clinical trials in US are federally funded and a growing number of drug companies are operating their studies in developing countries where regulations are less stringent. For example, a well-known study involving Pfizer in Nigeria led to the death of eleven children and disabled several others by testing an antibiotic named Trovan, which was intended to cure meningitis. More international regulation should be enforced to guarantee future research participants the same ethical standards, no matter where studies are conducted.
President Barack Obama apologized to Guatemalan president Alvaro Colom and participants involved in the study. Furthermore, on November 24th 2009, Mr. Obama established the Presidential Commission for the Study of Bioethical Issues to investigate the experiment and to create new recommendations to ensure protection for people participating in scientific studies that the US government supports. The report will be made public in December 2011 and will explore the relevance of medical trials in resource-poor settings, a rapidly globalizing research enterprise.
Published in RightsNews
Volume 30, no. 1, November, 2011.
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