By: Leonard H. Glantz, Professor of Health Law, Bioethics and Human Rights at Boston University School of Public Health, PRIM&R Board Member
Professor Susan Reverby’s important discovery and disclosure of experiments in which American public health doctors intentionally infected Guatemalan prisoners with syphilis has been received with shock. Some commentators have described this as worse than the Tuskegee syphilis experiments in which black men afflicted with syphilis had effective treatment withheld from them by US Public Health physicians. But grading atrocities is not a worthwhile exercise. Rather such revelations should remind us of the need for vigilance over these activities. Sadly, Professor Reverby’s discovery is not unique but rather one more addition to the growing collection of examples of the misuse of human subjects.
In the early 1900s Captain Richard Strong infected 900 condemned Filipino prisoners with plague to determine if he could invent an effective plague vaccine. During World War II and later, prisoners in American correctional facilities were infected with malaria, typhoid, dysentery, malaria and a number of other dangerous diseases. Indeed, the Maryland House of Corrections had something called the "Infectious Disease Area" where these studies were conducted in a thirty-three bed ward. As in the Guatemala case, these healthy subjects were intentionally infected with a serious disease to enable researchers to test hoped-for treatments. During the Nuremberg trials, which resulted in the execution of several Nazi doctors for their heinous use of Jewish prisoners for their experiments, Dr. Andrew Ivy, an expert witness for the prosecution, was cross-examined about the malaria and plague research conducted in US prisons. The Nazi’s defense lawyers claimed their clients’ research was similar to that in US prisons. Ivy argued that the American researchers didn't actually harm their subjects and obtained their consent. When asked why Strong only used condemned prisoners for his plague research Ivy responded "I do not know."
Only a little more than a decade following the hangings of the Nazi doctors, Dr. Chester Southam injected live cancer cells into incompetent residents at the New York Jewish Chronic Disease Hospital for research purposes. During a state disciplinary hearing Southam argued that the injections were risk free. He was asked if had injected himself with this risk free substance. He replied he had not. In 1965 Southam was placed on licensure probation for a year and allowed to continue to practice. In 1968 his colleagues elected him president of the American Association for Cancer Researchers.
We should not think of misuse of human subjects as an historical oddity. It is only this year that the US Environmental Protection Agency decided to ban experiments in which investigators knowingly expose human subjects to toxic chemicals to determine just how toxic they are. Until this year researchers could, and did, such experiments.
In 2003 both the FDA and a number of institutional review boards across the country permitted researchers to withhold available blood from unconscious patients suffering from hemorrhagic shock who had been taken to emergency rooms. Emergency room doctors were permitted to administer an unproven blood substitute to determine if that substance was as good as human blood, the proven, effective treatment for this deadly condition. Neither the subject nor family member consented to this research which presented a deadly risk. The research showed that the blood substitute was inferior to blood and resulted in an excess number of deaths. The research imperative once again dominated our notion of ethics and human rights.
Putting the Guatemalan research revelations in historical context in no way excuses the atrocious behavior of those researchers. Rather, it once again demonstrates our ability to misuse human beings in our efforts to make scientific advances. It is all too easy for scientists, their institutions, and their sponsors to believe that their unethical means justify their desirable ends.
Professor Reverby’s important historical work should remind us that those who do not know history are doomed to repeat it. But knowing it obviously does not mean we won’t.