Fewer know about the even darker Guatemala Affair. This should change now that Obama's bioethical advisory commission published its recent study, Ethically Impossible: STD Research in Guatemala from 1946 to 1948 . You might recall that shortly after taking office, the president sent a letter to the members of his predecessor's bioethics advisory council informing them that their appointments were being prematurely terminated. That council, fairly balanced between defenders of traditional values and social progressives, was not progressive enough for the new president. He appointed his own slate, which, of course, he is entitled to do since advisory councils serve at the pleasure of the sitting president.
"Ethically Impossible" is the commission's third study. It's essentially a 200-page executive summary of several thousand pages of primary documentation on the research, including immoral research, of government scientists into sexually transmitted diseases (STDs) in the years immediately following World War II.
The Guatemala Affair involved approximately 10 experiments carried out between February 1947 and October 1948 by the United States Public Health Service (PHS) into the effectiveness of certain methods for treating STDs. Three diseases were studied: syphilis, gonorrhea, and chancroid. Guatemala was considered an ideal venue since prostitution was legal and PHS scientists intended to use prostitutes to spread the STDs; and because Guatemala was out of the line of public scrutiny in the U.S.
Concern about STDs, especially in soldier populations in wartime, was heavily on the minds of public officials with the outbreak of World War II. Prophylactic treatments before penicillin were crude, including such methods as rubbing calomel ointment on the genitals for syphilis and injecting chemicals directly into the urethra for gonorrhea.
The results of earlier studies involving an intentional exposure of rabbits to syphilis were extremely promising. They found that treatment with small dosages of penicillin shortly after exposure stopped the disease from developing. But the results in rabbit populations could not be carried over with confidence to human populations. To settle the question for humans, controlled experiments introducing living syphilis germs into human bodies would be necessary, albeit terribly unethical. In August 1946, U.S. government officials signed agreements with the Guatemalan government to begin intentional exposure experiments.
Four populations were infected: prisoners, soldiers, psychiatric patients and prostitutes, the fourth being used, as said, to transmit the diseases to the others. More than 1,300 people were deliberately infected with one or another of the three STDs. Only a little more than half (678) were given any form of treatment for their disease.
The experiments were performed by a circle of scientists surrounding Dr. John C. Cutler, Senior Surgeon at the U.S. Public Health Services, with the full cooperation of the Guatemalan government. Cutler rationalized the study in the pursuit of "pure science." Eleven distinguished scientists from the National Research Council approved the proposal, including experts from Johns Hopkins University, U. Penn and Harvard. The proposal was also approved by senior officials at the National Institutes of Health (NIH), and went as high as the U.S. Surgeon General, Dr. Thomas Parran, a Roosevelt appointee.
Cutler demanded secrecy from collaborators and included only those who could be "trusted not to talk." His research subjects were intentionally deceived as regards the risks involved. In a confidential memo to a collaborator in 1947, Cutler assures that steps were being carried out with "all concerned" to "allay fears and suspicions" about his research: "To increase the number of exposures we shall bring in the sources of infection [i.e., the prostitutes] as indicated along with some not infected so as to allay fears and suspicion. In that way, we shall be able to avoid political repercussions, which are even now in the air."
Dr. Cutler went on to a distinguished career in academe researching vaginal contraceptives into the 1970s at the University of Pittsburg funded by the U.S. Agency for International Development. He died in February 2003.
It's not surprising, but disappointing, that "Ethically Impossible" avoids altogether the question of the knowledge and culpability of presidents Roosevelt (1933-1945) and Truman (1945-1953) for the violations of human rights at Guatemala. The study's final paragraph says that "blame for this episode cannot be said to fall solely on the shoulders of one or two individuals." Perhaps not solely. But the Guatemala Affair was a government-sponsored program. And the government has a chief executive officer. Blame stops at the top.
In an interview with BioEdge , John D. Arras, bioethicists at UVA and member of the President's bioethics commission, was asked whether "such an egregious violation of medical ethics [will] ever happen again." The ethicist said he thought that "given all the safeguards that have been put in place" as a result of Tuskegee and other abuses a recurrence is "highly unlikely." He continued: "There's simply no way that something like the Guatemala syphilis study would survive scrutiny by any contemporary Institutional Review Board [IRB]."
Notwithstanding the importance of good review procedures, I would have hoped the commission's study also would have explored the role that good moral values play in forming our scientists and shaping the scientific subculture. If all that stands between me and abuse at the hands of a wide-eyed researcher avaricious for scientific progress ("pure science") is procedure, then it's time to start worrying.
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E. Christian Brugger is a Senior Fellow of Ethics and director of the Fellows Program at the Culture of Life Foundation ; and the J. Francis Cardinal Stafford Chair of Moral Theology at St. John Vianney Theological Seminary in Denver, Colorado.
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