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***H:Human experiments: First, do harm***

Posted by on Oct. 10, 2014 at 10:35 AM
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http://www.nature.com/news/human-experiments-first-do-harm-1.9980

Human experiments: First, do harm

In the 1940s, US doctors deliberately infected thousands of Guatemalans with venereal diseases. The wound is still raw.

  1. EVOLVING ETHICS
    Sexually transmitted diseases (STDs) were a prime concern for health officials in the 1940s, and many medical studies — including the US experiments in Guatemala — used methods that would be considered unethical today. Although standards improved over the decades, clinical researchers continued to push the boundaries of acceptable science.
  2. Presidential Commission for the Study of Bioethical Issues
  3. 1941
    A 12-month-old baby in California is deliberately infected with herpes as part of an experiment. One editor objects to publishing the work, but it appears in 1942 in the Journal of Pediatrics.

    R. J. Green/SPL

  4. 1940s
    During the Second World War, the US military and Public Health Service combat STDs through an all-out campaign of research, treatment programmes and advertising.

    US Natl Lib. Med.

  5. 1943
    Penicillin is demonstrated to be an effective treatment for syphilis and gonorrhoea.

    Bettman/Corbis

  6. 1944
    John Cutler, a physician with the US Public Health Service, works on a prison experiment in Terre Haute, Indiana, in which inmate volunteers are infected with STDs to test a prophylactic method.

    US Natl Lib. Med.

  7. 1946
    Cutler starts experiments in Guatemala that eventually expose 1,308 prisoners, soldiers and patients at a psychiatric hospital to STDs. The US team also takes blood from 1,384 orphans and other children to assess STD diagnostic tests. Evidence suggests that the participants in the study did not give their consent.

    US Natl Archives & Records Administration

  8. 1946–7
    The trial of Nazi doctors leads to the establishment of the Nuremberg Code of medical ethics, which holds that experimenters must obtain voluntary consent from participants and should avoid unnecessary harm.

    Bettmann/Corbis

  9. 1953
    Cutler starts an experiment at Sing Sing prison in New York, in which he injects syphilis into inmate volunteers, some of whom had received an experimental vaccine.

    Bettmann/CORBIS

  10. 1956
    Researchers launch a 15-year study at the Willowbrook State School in New York, where they infect children with mental disabilities with hepatitis.

    Eye of Science/SPL

  11. 1963
    Chester Southam of the Sloan-Kettering Institute for Cancer Research and his colleagues injected live cancer cells into patients at the Jewish Chronic Disease Hospital in New York without their consent. Outrage over the experiment helps to spark a debate about research ethics and prompts federal authorities to develop tighter controls on research.

    Special Collections and Archives, Univ. Idaho Library

  12. 1972
    The United States halts a 40-year experiment in Tuskegee, Alabama, where hundreds of African American men with syphilis were observed for decades without being treated.

    US Natl Archives & Records Administration

  13. 2010
    Historian Susan Reverby exposes the abuses of Cutler’s Guatemalan experiments, prompting US President Barack Obama to apologize to Guatemala and launch an investigation, which finds that the “experiments involved unconscionable violations of ethics”.

    Wellesley College

The injections came without warning or explanation. As a low-ranking soldier in the Guatemalan army in 1948, Federico Ramos was preparing for weekend leave one Friday when he was ordered to report to a clinic run by US doctors.

Ramos walked to the medical station, where he was given an injection in his right arm and told to return for another after his leave. As compensation, Ramos's commanding officer gave him a few coins to spend on prostitutes. The same thing happened several times during the early months of Ramos's two years of military service. He believes that the doctors were deliberately infecting him with venereal disease.

Now 87 years old, Ramos says that he has suffered for most of his life from the effects of those injections. After leaving the army, he returned to his family's remote village, on a steep mountain slope northeast of Guatemala City. Even today, Las Escaleras has no electricity or easy access to medical attention. It wasn't until he was 40, nearly two decades after the injections, that Ramos saw a doctor and was diagnosed with syphilis and gonorrhoea. He couldn't pay for medication.

“For a lack of resources, I was here, trying to cure myself,” says Ramos. “Thanks to God, I would feel some relief one year, but it would come back.” Over the decades, he has endured bouts of pain and bleeding while urinating, and he passed the infection onto his wife and his children, he told Nature last month in an interview at his home.

Ramos's son, Benjamin, says that he has endured lifelong symptoms, such as irritation in his genitals, and that his sister was born with cankers on her head, which led to hair loss. Ramos and his children blame the United States for their decades of suffering from venereal disease. “This was an American experiment to see if it caused harm to human beings,” says Benjamin.

Ramos is one of a handful of survivors from US experiments on ways to control sexually transmitted diseases (STDs) that ran in semi-secrecy in Guatemala from July 1946 to December 1948. US government researchers and their Guatemalan colleagues experimented without consent on more than 5,000 Guatemalan soldiers, prisoners, people with psychiatric disorders, orphans and prostitutes. The investigators exposed 1,308 adults to syphilis, gonorrhoea or chancroid, in some cases using prostitutes to infect prisoners and soldiers. After the experiments were uncovered in 2010, Ramos and others sued the US government, and US President Barack Obama issued a formal apology. Obama also asked a panel of bioethics advisers to investigate, and to determine whether current standards adequately protect participants in clinical research supported by the US government.

When details of the Guatemalan experiments came to light, US health officials condemned them as 'repugnant' and 'abhorrent'. Last September, the Presidential Commission for the Study of Bioethical Issues went further, concluding in its report1, that “the Guatemala experiments involved unconscionable violations of ethics, even as judged against the researchers' own understanding of the practices and requirements of medical ethics of the day” (see 'Evolving ethics').

M. MCDONALD

Federico Ramos has suffered excruciating symptoms after US experiments.

Yet that report and documents written by the researchers involved in the Guatemalan work paint a more complex picture. John Cutler, the young investigator who led the Guatemalan experiments, had the full backing of US health officials, including the surgeon general.

“Cutler thought that what he was doing was really important, and he wasn't some lone gunman,” says Susan Reverby, a historian at Wellesley College in Massachusetts, whose discovery of Cutler's unpublished reports on the experiments led to the public disclosure of the research2.

 

 

by on Oct. 10, 2014 at 10:35 AM
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