Sixty-four years after a U.S.-funded scientist ran an experiment that infected his Guatemalan patients with syphilis, the U.S. government today issued a formal apology to the Central American nation. The scandal, which had been buried in the records of a U.S. Public Health Service researcher, is documented in work released by a historian at Wellesley College, Susan Reverby.
National Institutes of Health Director Francis Collins called the research described in Reverby's report "deeply disturbing" and "an appalling example from a dark chapter in the history of medicine." He added that U.S. regulations today "would absolutely prohibit this type of study"
Secretary of State Hillary Rodham Clinton also called Guatemalan President Alvaro Colom last night to express her regret. She issued a joint apology with Secretary of Health and Human Services Kathleen Sebelius this morning.
The results of the Guatemalan research—which Clinton described as "reprehensible"—were never published. The case only came to light when Reverby found the records of John Cutler, a former U.S. Public Health Service scientist, buried in the archives of the University of Pittsburgh. They told the story of a man who devoted his life to conquering sexually transmitted diseases and led a 2-year effort in Guatemala to monitor and treat syphilis and gonorrhea. In the 1940s, when it seemed that penicillin was successfully rooting out syphilis in the United States, Cutler worried that simply relying on the pill after the disease had been diagnosed wasn't enough. He wanted to test out various other chemicals people could apply right after having sex that would prevent the disease entirely. To do that, of course, he needed newly infected patients.
Between 1946 and 1948, Cutler performed his research on Guatemalans in a national prison, an army barracks, the country's only mental hospital, and the national orphanage. He relied on syphilis- and gonorrhea-infected prostitutes to transmit the diseases to prisoners. At the asylum and the army barracks, he and his team also infected patients with infectious syphilis bacteria taken from humans and animals, mixed with beef heart broth, distilled water, or spinal fluid. One method of inserting it involved scraping the skin off his patients' penises and dripping the solution onto the abraded flesh for an hour or two, according to letters cited by Reverby. Children at the orphanage were not infected with syphilis, but Cutler used them in blood testing. Reverby says she found no indication that patients were informed about what was happening to them. Instead Cutler gained consent from the institutions, often in exchange for showering them with supplies. Patients were treated with penicillin after an infection was confirmed.
Ethically, the Guatemala experiment may be a step below the infamous Tuskegee case, an experiment in which Cutler also took part. In Macon County, Alabama, scientists left hundreds of African American men with syphilis go untreated so they could watch the disease progress.
In addition to apologizing, the U.S. government has asked the Institute of Medicine to launch a fact-finding investigation into the Guatemala study. An international team of experts convened by the Presidential Commission for the Study of Bioethical Issues will also explore the best ways to ensure gross ethical violations do not occur in medical research in any part of the world.