Guatemala syphilis experiments

Historical context Rabbits had been used to test treatments for syphilis since the early 20th century, when Sahachiro Hata injected them with arsphenamine, which became known as "the magic bullet" for treating syphilis. They were later injected in the 1940s with penicillin as part of research into methods for preventing syphilis. Around this same time, there was a push by medical professionals, including the U.S. Surgeon General Thomas Parran, to further the knowledge of sexually transmitted diseases and discover more viable prophylaxis and treatment options in humans. This search for new methods became stronger and won more supporters with the onset of World War II. This was largely due to an effort to protect the U.S. military forces from widespread infections of STDs such as gonorrhea, as well as the particularly painful regimen of prophylaxis that involved in the injection of a silver proteinate into subjects' penises. At the time, it was estimated that venereal diseases would affect 350,000 soldiers, which would equate to eliminating two armed divisions for an entire year. The cost of these losses, which would amount to about $34 million at the time, made research for STD treatments particularly urgent. The goal of this experiment was to find a more suitable STD prophylaxis by infecting human subjects recruited from prison populations with gonorrhea. Though at first the idea of using human subjects was controversial, the support of Thomas Parran and Colonel John A. Rodgers, Executive Officer of the U.S. Army Medical Corps, enabled John F. Mahoney and Cassius J. Van Slyke to begin implementing the experiments. John Cutler, a young associate of Mahoney, helped conduct the experiments, and went on to lead the Guatemala syphilis experiments. The experiments in Terre Haute were the precursor for the Guatemalan experiments. It was the first to demonstrate how earnestly military leaders pushed for new developments to combat STDs and their willingness to infect human subjects. It also explained why the study clinicians would choose Guatemala: to avoid the ethical constraints related to individual consent, other adverse legal consequences, and bad publicity. The experiments were initially supposed to be held at a prison in Terre Haute, Indiana, but were moved to Guatemala after researchers had a hard time consistently infecting prisoners with gonorrhea. The move to Guatemala was suggested by Juan Funes, head of the Guatemalan Venereal Disease Control Department. The experiments were funded by a grant from the U.S. National Institutes of Health (NIH) to the Pan American Sanitary Bureau; multiple Guatemalan government ministries also became involved. The study also aimed to discover medications other than penicillin for various venereal diseases. Furthermore, the participants had not received the opportunity to provide informed consent since the purpose and details of the research were hidden from them as well. Other attempts at passing the pathogens to participants included pouring the bacteria onto various lightly abraded body parts, such as male subjects' genitalia, forearms and faces. Some subjects were even infected through forced perforation of the spine. Eighty-three individuals died during the course of the experiment, though it is unclear as to whether or not the inoculations were the source of these deaths. Study methods The initial attempts to infect subjects of the experiment consisted of workers from the USPHS inoculating prostitutes with germs that had grown in rabbits, and then paying them to have sex with prisoners. Prostitutes in Guatemala were required to be tested twice a week for STD infection at a government clinic. For the purposes of the experiments, infected sex workers were instead sent to Cutler by the head of the Guatemalan Ministry of Public Health. This hospital was notably understaffed and lacked rudimentary equipment and medicines. $1500 that was originally intended to go to volunteers at the prison was given to the psychiatric hospital for an antiepileptic drug called Dilantin and other necessary equipment. Subjects In total, 1,308 people were confirmed to have been a part of this experiment. Of this group, 678 individuals were documented as getting some form of treatment. However, some reports say that up to 5,128 individuals were monitored for symptoms or became a part of the experiment through natural infection. A total of 83 subjects died, though the exact relationship to the experiment remains undocumented. John F. Mahoney Prior to his involvement in the Guatemalan syphilis experiment, Mahoney graduated from the University of Pittsburgh medical school in 1914. By 1918 he was the Assistant Surgeon at the United States Public Health Service. In 1929, Mahoney worked as the director of the Venereal Disease Research Lab in Staten Island, where the Terre Haute experiments began in 1943, and where Cutler first assisted him. After stopping the Terre Haute experiments for lack of accurate infection of subjects with gonorrhea, Mahoney moved on to study the effects of penicillin on syphilis. His research found huge success for penicillin treatments and the US army embraced it in STD prescription. Although this seemed promising, Mahoney and his collaborators questioned the long term prospects for eliminating the disease altogether in individuals. who had earlier joined the Public Health Service in 1942 and served as a commissioned officer. Cutler participated in the similar Terre Haute prison experiments, in which volunteer prisoners were infected with gonorrhea spanning from 1943 to 1944. While the Tuskegee experiment followed the natural progression of syphilis in those already infected, in Guatemala doctors deliberately infected healthy people with the diseases, some of which can be fatal if untreated. His team created a laboratory in Guatemala supplied by the United States military to discover if there were different transmission rates when the disease was presented to different infectious sites. Cutler created the protocol for infection site research. Cutler and his team discovered that the disease takes 93%-100% if infected through scarification or intracutaneous injection into the foreskin. After the transmission was studied, Cutler focused on the diseases' treatability. People were then recruited and infected and either put into a treatment group or a control group. The treatment group was given orvus-mapharsen or penicillin to see its effects, and the control group was given nothing to stop the disease. The researchers paid prostitutes infected with syphilis to have sex with prisoners, while other subjects were infected by directly inoculating them with the bacterium. Through intentional exposure to gonorrhea, syphilis, and chancroid, a total of 1,308 people were involved in the experiments. Of that group, with an age range of 10–72, 678 individuals (52%) can be said to have received a form of treatment. Juan María Funes and Carlos Salvado Guatemalan doctors Juan María Funes and Carlos Salvado were also employees of the Pan-American Sanitary Bureau, who remained in Guatemala after their work with Cutler. Funes was Chief of the Venereal Disease section at the Guatemalan National Department of Health and was responsible for referring sex workers with STDs from the Venereal Disease and Sexual Prophylaxis Hospital (VDSPH) to Cutler. Salvado was the director of the Psychiatric Hospital in Guatemala where parts of the syphilis study were conducted. Salvado was an active participant in the intentional exposure experiments. In order to advance in their careers, they opted to stay and continue observations on subjects of the syphilis experiments, including data collection from orphans, inmates, psychiatric patients, and school children. These periodic data collections consisted of blood specimens and lumbar punctures from participants. Data was shipped back to the United States, where many of these blood samples tested positive for syphilis. Funes and Salvado continued collecting samples from participants until 1953. ==Aftermath==

Continued research After the conclusion of the Guatemalan syphilis experiments, many of the samples taken during the experiments were then moved to the United States. Records show that these samples were then given to laboratories across the United States, where they were used for research. Many of the Laboratories using the samples from the Guatemalan syphilis experiments were later given samples from the Tuskegee syphilis experiments. Due to a lack of regulations involving laboratory samples, it is unknown if the samples from the studies are still being used today; however, records show that they were in use by at least 1957. Apology and response In October 2010, the U.S. government formally apologized and announced that the violation of human rights in that medical research was still to be condemned, regardless of how much time had passed. Following the apology, Barack Obama requested an investigation to be conducted by the Presidential Commission for the Study of Bioethical Issues on November 24, 2010. The Commission concluded nine months later that the experiments "involved gross violations of ethics as judged against both the standards of today and the researchers' own understanding". President Barack Obama apologized to President Álvaro Colom, who had called the experiments "a crime against humanity". As a response to the dehumanization by human experiment, the Nuremberg Code and Helsinki Code in 1971 were developed to govern ethics in medical research. Research like this deserves the need for informed consent in any type of research in general, and it should prohibit experiments where injury, disability, or death to the participant is reasonably expected. Nevertheless, "science and society should never outweigh the wellbeing of the subject". "The way that this case in Peru was handled though, supports the view that – include monetary redress and criminal investigations – in Guatemala matter. Some would also argue that the Guatemala study constituted torture or cruel, inhuman and degrading treatment, and the US has an obligation under international law to pursue criminal investigations and provide the victims with adequate financial compensation." The Commission report, Ethically Impossible: STD Research in Guatemala from 1946 to 1948, published in September 2011, aimed to answer the following four questions: • What occurred in Guatemala between 1946 and 1948 involving a series of STD exposure studies funded by the U.S. PHS? • To what extent were U.S. government officials and others in the medical research establishment at that time aware of the research protocols and to what extent did they actively facilitate or assist in them? • What was the historical context in which these studies were done? • How did the studies comport with or diverge from the relevant medical and ethical standards and conventions of the time? Even besides the fact that U.S. never truly apologized for the study, as human rights activists have called for subjects' families to be compensated. Lawsuits Manuel Gudiel Garcia v. Kathleen Sebelius Many Guatemalans believed that the U.S. apology was not enough. In March 2011, seven plaintiffs filed a federal class-action lawsuit against the U.S. government claiming damages for the Guatemala experiments. This case argued that the United States was at fault due to not asking for consent. This lawsuit asked for money damages to compensate for medical injuries and loss of livelihood, as most of the families were living in poverty. The suit was dismissed when United States District Judge Reggie Walton determined that the U.S. government has immunity from liability for actions committed outside of the U.S. Estate of Arturo Giron Alvarez v. The Johns Hopkins University In April 2015, 774 plaintiffs launched a lawsuit against Johns Hopkins University, the pharmaceutical company Bristol-Myers Squibb, and the Rockefeller Foundation, seeking $1 billion in damages, seeking to hold the university accountable for the experiment itself because the doctors held important roles on panels that reviewed the federal spending on research for other sexually transmitted diseases. The plaintiffs claimed that Johns Hopkins was actively involved in these experiments, stating "[they] did not limit their involvement to design, planning, funding and authorization of the Experiments; instead, they exercised control over, supervised, supported, encouraged, participated in and directed the course of the Experiments." The hope was that compensation could be attained by targeting private institutions rather than the federal government. In January 2019, U.S. District Judge Theodore Chuang rejected the defendants' argument that a recent Supreme Court decision shielding foreign corporations from lawsuits in U.S. courts over human rights abuses abroad also applied to domestic corporations absent congressional authorization. However, the District Court subsequently ruled in April 2022 in favor of the defendants, holding that John and his colleagues were not acting on behalf of the Rockefeller Foundation and the employees of Johns Hopkins had not aided or abetted any violations of the law committed by Mahoney or Cutler. ==See also==