In the January 2011 issue of the Journal of Policy History, Susan Reverby, a historian at Wellesley College, will publish a paper detailing a particularly sordid moment in American history. From 1946 to ’48, the Public Health Service, with the assent of some Guatemalan officials, engaged in medical experiments on 700 Guatemalan soldiers, prisoners, mental patients and children. The documents Reverby discovered show that doctors intentionally sickened many of their subjects with syphilis, either by injecting infected fluids into their spines and under their skin or by supplying them with afflicted prostitutes.
Of course, this horrendous project arose from "the best of intentions"—to improve serological testing for the disease and to measure the degree to which penicillin and other medicines could act prophylactically. The US military was also interested in finding STD protections for soldiers that might be simpler and less painful than those available at the time. Ultimately, the observations in Guatemala were inconclusive because it proved harder than anticipated to infect sufficient numbers to constitute an adequate data set.
The doctor in charge of the two-year project was John Cutler, an assistant surgeon general who, in his later years, was a "beloved" professor at the University of Pittsburgh School of Public Health. It was in his archives that Reverby found notes and photographs documenting the existence of the project. Even before this revelation, however, Dr. Cutler’s long-term legacy was one of infamy: he was one of the main researchers in the Public Health Service’s Tuskegee Syphilis Study, in which black sharecroppers went purposely untreated from the 1930s to 1972, when the project finally was exposed. In 1944, moreover, Dr. Cutler directed a study in which gonorrhea was injected into prison "volunteers" at the state penitentiary in Terre Haute, Indiana. And in 1953, after returning from Guatemala, he resumed his experiments with syphilis injections, this time with prisoners in Sing Sing prison in New York.
Dr. Cutler’s experiments, while horrific, were not unique. Nonconsensual medical experiments were a prominent feature of South Africa’s oppressive regime. In America, we know about the military’s experimentation with atomic radiation on unwitting soldiers and patients from the 1950s to the ’70s and experiments with LSD in the ’70s. In the ’90s New York City foster children were used to test the effects of certain unlicensed drugs for AIDS. And let’s not forget all the "tests" done at Guantánamo Bay.
It’s important to understand how we repeatedly deceive ourselves into appalling forms of corruption by wrapping ourselves in the language of high standards. Reverby cites a telling quote from the 1967 autobiography of virologist Thomas Rivers: "I tested out live yellow fever vaccine right on my ward in the Rockefeller Hospital. It was no secret, and I assure you that the people in the New York City Department of Health knew it was being done…. Unless the law winks occasionally, you have no progress in medicine." Rationalization has ever been thus: it’s humanitarian in the long run. We confuse, in other words, motives and means.
The Holocaust Memorial Museum posits three contexts in which nonconsensual medical experimentation took place in Nazi Germany: first, in military organizations, premised on rationalizations of security, exigency and defense; second, in the hunt for new pharmaceuticals and treatment methods; third, in conjunction with ideologies of racial, ethnic or religious superiority in which "common sense" dictates that some humans are less valuable than others and can be sacrificed for the "greater good." The moral lesson of the Guatemalan experiment ought to spur public conversation and review of all these areas. My list of topics would include:
1. The Biologic and Toxin Weapons Convention is increasingly converting research facilities into biodefense containment labs. A 2004 American Journal of Public Health article points to "inadequately characterized risks," as well as concern that the program is informed by a "political rather than health agenda."
2. The weakened condition of the FDA means that many drugs have been inadequately vetted before coming to market. The scandals involving Vioxx and Avandia are great failed experiments inflicted on a trusting, unsuspecting public.
3. Pharmaceutical companies and venture capitalists are investing in miracle drugs and testing by seeking out very poor people as "volunteers" in exchange for "medical treatment" or for token amounts of money that are dwarfed by the health risks involved.
4. Our consent procedures must be scrupulously overseen and updated, particularly where "volunteers" are used in places like prisons, mental health institutions, foster care or orphanage settings or on populations living under oppressive regimes. (As Reverby points out, Guatemala in the ’40s was essentially run by the United Fruit Company.)
5. Germ line therapy and genetic manipulation will increasingly implicate future generations. We must ask ourselves if our present zeal for "transhuman," "gen-rich," "enhanced" versions of ourselves is but a vast experiment in narcissism.
Scientific revolution always tempts us with blinding hubris. How else could Dr. Cutler engage in experimentation at the same time as and of the very sort for which the United States was prosecuting Germans in Nuremberg? So while President Obama issues a formal apology to the people of Guatemala, we must interrogate our own freighted contemporary moment—of economic desperation, of rising nativism, of promises of hellfire to come, of soaring incarceration rates. These are divisions that have never been exploited to any good or decent end.