President Obama apologises to Guatemala over 1940s syphilis studyBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5494 (Published 04 October 2010) Cite this as: BMJ 2010;341:c5494
President Barack Obama has expressed his deep regret to Álvaro Colon, president of Guatemala, about a 1940s study in which 696 Guatemalans were deliberately infected with syphilis. The president extended his apologies to President Colon and to all those who had been affected.
The US secretary of state, Hillary Clinton, and the secretary of health and human services, Kathleen Sebelius, issued a joint public statement saying that the study was “clearly unethical.” Participants had been infected with syphilis to see whether penicillin could be used immediately after sex to prevent infection.
In their statement Ms Clinton and Ms Sebelius said, “Although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health. We deeply regret that it happened, and we apologize to all the individuals who were affected by such abhorrent research practices.” Both they and the president said that current US regulations on medical research prohibit such practices.
The US Institute of Medicine, part of the National Academy of Science, will conduct a fact finding investigation and issue a report. Separately, through the Presidential Commission for the Study of Bioethical Issues, the US government will convene an international group of experts to review and report on methods to ensure that human medical research conducted around the world meets rigorous ethical standards. Foreign trials of new drugs by pharmaceutical companies are increasingly common.
The Guatemala study was uncovered by Susan Reverby, a medical historian at Wellesley College, in Massachusetts, and the author of two books on the Tuskegee experiment in the United States. In that experiment public health officials followed poor black farmers with syphilis from 1932 to 1972 in Alabama but did not offer them treatment when penicillin became available in the 1940s.
Professor Reverby was researching the life of John Cutler, who was involved in the Tuskegee experiment. She found his papers in the archive of the University of Pittsburgh, where he was later a respected professor.
“The only papers he left behind were about Guatemala,” she told the BMJ. The US Public Health Service was working to improve public health services in Guatemala. The study was funded by Public Health Service, the National Institutes of Health, the Pan American Health Sanitary Bureau (which became the Pan American Health Organization), and the Guatemalan government.
Dr Cutler’s papers included patients’ records, handwritten notes, correspondence with others in the public health service, and photos of patients.
Professor Reverby said, “They had a lot of trouble with the study and didn’t come up with very much. It was never published.”
Unlike in the Tuskegee experiment, the participants in the Guatemala study were deliberately infected with syphilis. The study, from 1946 to 1948, was conducted in hopes of finding whether the new drug, penicillin, could be used immediately after sex to prevent infection with several sexually transmitted diseases, especially syphilis.
The participants were not told of the study’s purpose and did not give informed consent. They included female sex workers, soldiers, prison inmates, and mental hospital patients. In her paper, to be published in the Journal of Policy History, Professor Reverby reports that prostitutes were used to pass the disease to prisoners during permitted visits.
Later, attempts were made to infect study participants by syphilis bacteria poured onto men’s penises or onto forearms or faces that had been lightly abraded and in a few cases through spinal punctures. Participants were given penicillin injections in an attempt to prevent infection.
Also, unlike the Tuskegee subjects, those who became infected with syphilis were treated with penicillin. It is not clear whether all participants were cured or whether everyone received adequate treatment.
Cite this as: BMJ 2010;341:c5494
Professor Reverby’s draft paper is at www.wellesley.edu/WomenSt/Reverby%20Normal%20Exposure.pdf. US government statements relating to the Guatemala study are at www.hhs.gov/1946inoculationstudy/.