Whilst medical research can often lead to the greatest advances in healthcare, throughout history there have been many unethical experiments carried out with the aim of advancing scientific research. The Guatemala STD experiments were carried out by researchers from the United States Public Health Service (USPHS) between 1946 and 1948.
The researchers intentionally inflicted Syphilis, Gonorrhea, and Chancroid upon prisoners, soldiers and patients suffering from psychiatric conditions in Guatemala without informed consent. This was done in order to understand how diseases were transmitted and to investigate preventative treatments such as penicillin.
This research was supported by US government bodies and worked closely with the Guatemalan authorities. However it wasn’t until over 5 decades later that the true extent of these experiments was discovered.
Sexually transmitted diseases were a big issue during World War II. Researchers were looking for ways to prevent infection after exposure and effective treatments.
Penicillin had been found to be an effective treatment for Syphilis and bacterial infections however the researchers wanted to know if it could be used as prevention by being administered shortly after exposure. Other preventative treatments were also investigated such as Orvus-Mapharsen.
Before these experiments were carried out in Guatemala, US researchers had carried out similar experiments between 1943 and 1944 on prisoners at the Terre Haute Federal Penitentiary in Indiana. These were also carried out with informed consent however the researchers struggled to effectively transmit Gonorrhoea by sexual contact.
Guatemala had a large prostitution industry that was legally controlled so the researchers could work with the authorities to gain access to prisoners, soldiers, and patients within state run institutions.
This research was funded by the US National Institutes of Health (NIH). It was carried out by the USPHS Venereal Disease Research Laboratory alongside the Pan American Sanitary Bureau. Dr John Charles Cutler, a doctor from the USPHS led the field work within Guatemala. He worked alongside health officials from Guatemala including Dr Juan Funes.
They targeted people that would struggle to refuse participation.
1308 people were intentionally infected with STDs. They were split into three main categories:
Prisoners – Inmates from the Central Penitentiary were infected either by sexual contact with infected prostitutes or artificial infection.
Soldiers – Soldiers from the Guatemalan military were used to study how Gonorrhoea was transmitted and how preventative treatments worked.
Psychiatric patients – Patients from the National Mental Hospital were intentionally infected. This included direct infection.
Prostitutes were intentionally infected in some cases and used to infect males.
They tested diagnostic and serology tests on another 5128 people. This included children from state run institutions, Leprosy patients, and other vulnerable patients. This included taking blood and invasive diagnostic tests.
It is important to note that this is a separate group to the intentionally infected people.
Initially the researchers tried to infect their subjects by having sexual contact between infected prostitutes and male prisoners/soldiers. However they struggled to get the infection rate to be high enough. So they started using artificial infection methods.
The researchers used techniques to infect the subjects by rubbing infectious material onto areas of broken skin and mucous membranes. In some cases they inserted infectious material into the urethra or other areas of the body. Psychiatric patients had infection to their eyes and other mucous membranes.
They infected the patients with Syphilis, Gonorrhoea and Chancroid. They then gave them preventative treatments and monitored them.
Some were given Penicillin or other treatments but this wasn’t consistent. Only 678 of the 1308 intentionally infected people had evidence that they had received some sort of treatment. The type and quality of treatment varied.
One of the most shocking cases from the research was on a female psychiatric patient known as Berta.
In February 1948 she was intentionally infected with Syphilis by injection in her left arm. She went on to develop skin rashes and other complications. She wasn’t treated for her Syphilis for around 3 months.
On 23 August 1948, Dr Cutler noted that Berta looked very ill. Despite this they injected Gonorrhoea pus into both of her eyes, urethra and rectum. She was also re-infected with Syphilis.
Berta’s medical notes show that she had severe eye discharge and bleeding from her urethra. She sadly passed away on the 27 August 1948.
This shows how vulnerable psychiatric patients were and how they were subjected to invasive procedures without proper consent.
The experiments were never published as scientific discoveries. Much of the research was kept secret.
The records were added to Dr Cutler’s personal papers. In 1990 he donated his research notes to the University of Pittsburgh.
In June 2003 Dr Susan M. Reverby, a historian, was researching the infamous Tuskegee Syphilis Study. Whilst researching she found the records. Upon reading through the records she realised that there were intentionally infected experiments carried out in Guatemala.
She presented her findings in 2010 and contacted the relevant authorities in the US. This led to an investigation into the experiments.
President Barack Obama of the US contacted President Álvaro Colom of Guatemala in October 2010 to apologise for the research. Secretary of State Hillary Clinton and Secretary of Health and Human Services Kathleen Sebelius also formally apologised to Guatemala.
President Obama asked for an investigation to be carried out by the Presidential Commission for the Study of Bioethical Issues.
In September 2011 they published their findings. The report was titled ‘Ethically Impossible’: STD Research in Guatemala from 1946 to 1948. Their investigation found that there were serious ethical breaches throughout the experiments. This was not only due to modern ethical guidelines but also because the researchers didn’t understand what was ethical at the time.
The commission found that there was no informed consent, vulnerable people were exploited and they didn’t protect their subjects from unnecessary harm.
The experiments also raised questions about accountability. Who was responsible?
Whilst the Guatemala STD experiments didn’t help to create modern ethical guidelines for research, they helped to highlight how important ethical guidelines are to protect human subjects. Today in clinical research we have guidelines to ensure informed consent, minimise risk, ensure independent ethical review, and extra measures for vulnerable people.
A lawsuit was taken to a US federal court in 2012. The claim was made by victims and representatives from Guatemala. The claim was dismissed due to legal issues. The court didn’t look into the merits of the claim.
The Guatemala STD experiments serve as a reminder that no matter how far science progresses we shouldn’t exploit people. Research should always be carried out with people’s autonomy, dignity, and right to make an informed decision in mind.
References:
1. Presidential Commission for the Study of Bioethical Issues. “Ethically Impossible”: STD Research in Guatemala from 1946 to 1948. Washington, DC: Government Printing Office, 2011. https://www.govinfo.gov/content/pkg/GOVPUB-PR-PURL-gpo15717/pdf/GOVPUB-PR-PURL-gpo15717.pdf.
2. Reverby, Susan M. “‘Normal Exposure’ and Inoculation Syphilis: A PHS ‘Tuskegee’ Doctor in Guatemala, 1946–1948.” Journal of Policy History 23, no. 1 (2011): 6–28. https://doi.org/10.1017/S0898030610000291.
3. Centers for Disease Control and Prevention. “CDC Report on Findings from the U.S. Public Health Service Sexually Transmitted Disease Inoculation Study of 1946–1948.” 2010. https://www.hhs.gov/1946inoculationstudy/findings.html.
4. Reverby, Susan M. “The Guatemala Syphilis Experiments: An Interview with Susan Reverby.” History News Network, 2010. https://www.historynewsnetwork.org/article/the-guatemala-syphilis-experiment-an-interview-wit.
5. Gudiel v. Sebelius, 2012. United States District Court for the District of Columbia. Memorandum Opinion, June 13, 2012. https://cases.justia.com/federal/district-courts/district-of-columbia/dcdce/1%3A2011cv00527/147186/28/0.pdf.
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