Re: When medical information comes from Nazi atrocities
Dear Editor
As a genitourinary physician I was taught about the Tuskegee syphilis experiment early on in my training, where it was acknowledged that much of what we know about syphilis was obtained unethically [1]. It is now taught to a much wider audience as part of Good Clinical Practice research ethics training. However much less known are the Guatemalan syphilis experiments also carried out by the US government on soldiers, sex workers, prisoners and those with mental health issues without their consent in the late 1940s, which also made a significant contribution to our knowledge of syphilis [2].
The Tuskegee and Guatemalan syphilis experiments, along with Pernkopf’s Atlas of Topographical and Applied Human Anatomy, are some of the many examples of unethical research and experimentation done on populations claimed by many North American and European scientists at the time to be subhuman or of an inferior race. To name just a few examples: J. Marion Sims “the father of modern gynaecology” developed surgical techniques that are used today by operating on enslaved women of African descent without their consent and with inadequate pain relief [3] (it was claimed that Black people had thicker skin and felt pain less than white people [4]); grave robbing to provide bodies of enslaved people for dissection at medical schools [5]; testing the oral contraceptive pill on low-income Puerto Ricans and the mentally unwell [6,7].
Much of our medical and surgical knowledge is based on the unethical experimentation and exploitation of people from marginalised groups, a topic that is little discussed in the medical curriculum. I wholeheartedly agree with Mackinnon when she says, “As physicians and educators, we have an enduring moral duty to recount history, share knowledge with generations that follow, and protect against new versions of the atrocities of the past.” This should be an integral part of the undergraduate medical curriculum, in order to acknowledge those who suffered for the advancement of medical science. It may also help us to better understand why some communities distrust healthcare providers.
1. Jones JH. Bad Blood: the Tuskegee syphilis experiment. The Oxford Textbook of Clinical Research Ethics. New York: Free Press; 1981
2. Rodriguez MA, García R. First, do no harm: the US sexually transmitted disease experiments in Guatemala. Am J Public Health. 2013;103(12):2122–2126. doi:10.2105/AJPH.2013.301520
3. Ojanuga D. The medical ethics of the 'father of gynaecology', Dr J Marion Sims. J Med Ethics. 1993;19(1):28–31. doi:10.1136/jme.19.1.28
4. Cartwright SA. Report on the diseases and physical peculiarities of the Negro race. New Orleans Med Surg J. 1851;7:691–715
5. Humphrey DC. Dissection and discrimination: the social origins of cadavers in America, 1760-1915. Bull N Y Acad Med. 1973;49(9):819–827.
6. The Puerto Rico Pill Trials https://www.pbs.org/wgbh/americanexperience/features/pill-puerto-rico-pi... accessed 26/1/20.
7. Liao PV, Dollin J. Half a century of the oral contraceptive pill: historical review and view to the future. Can Fam Physician. 2012;58(12):e757–e760.
Rapid Response:
Re: When medical information comes from Nazi atrocities
Dear Editor
As a genitourinary physician I was taught about the Tuskegee syphilis experiment early on in my training, where it was acknowledged that much of what we know about syphilis was obtained unethically [1]. It is now taught to a much wider audience as part of Good Clinical Practice research ethics training. However much less known are the Guatemalan syphilis experiments also carried out by the US government on soldiers, sex workers, prisoners and those with mental health issues without their consent in the late 1940s, which also made a significant contribution to our knowledge of syphilis [2].
The Tuskegee and Guatemalan syphilis experiments, along with Pernkopf’s Atlas of Topographical and Applied Human Anatomy, are some of the many examples of unethical research and experimentation done on populations claimed by many North American and European scientists at the time to be subhuman or of an inferior race. To name just a few examples: J. Marion Sims “the father of modern gynaecology” developed surgical techniques that are used today by operating on enslaved women of African descent without their consent and with inadequate pain relief [3] (it was claimed that Black people had thicker skin and felt pain less than white people [4]); grave robbing to provide bodies of enslaved people for dissection at medical schools [5]; testing the oral contraceptive pill on low-income Puerto Ricans and the mentally unwell [6,7].
Much of our medical and surgical knowledge is based on the unethical experimentation and exploitation of people from marginalised groups, a topic that is little discussed in the medical curriculum. I wholeheartedly agree with Mackinnon when she says, “As physicians and educators, we have an enduring moral duty to recount history, share knowledge with generations that follow, and protect against new versions of the atrocities of the past.” This should be an integral part of the undergraduate medical curriculum, in order to acknowledge those who suffered for the advancement of medical science. It may also help us to better understand why some communities distrust healthcare providers.
1. Jones JH. Bad Blood: the Tuskegee syphilis experiment. The Oxford Textbook of Clinical Research Ethics. New York: Free Press; 1981
2. Rodriguez MA, García R. First, do no harm: the US sexually transmitted disease experiments in Guatemala. Am J Public Health. 2013;103(12):2122–2126. doi:10.2105/AJPH.2013.301520
3. Ojanuga D. The medical ethics of the 'father of gynaecology', Dr J Marion Sims. J Med Ethics. 1993;19(1):28–31. doi:10.1136/jme.19.1.28
4. Cartwright SA. Report on the diseases and physical peculiarities of the Negro race. New Orleans Med Surg J. 1851;7:691–715
5. Humphrey DC. Dissection and discrimination: the social origins of cadavers in America, 1760-1915. Bull N Y Acad Med. 1973;49(9):819–827.
6. The Puerto Rico Pill Trials https://www.pbs.org/wgbh/americanexperience/features/pill-puerto-rico-pi... accessed 26/1/20.
7. Liao PV, Dollin J. Half a century of the oral contraceptive pill: historical review and view to the future. Can Fam Physician. 2012;58(12):e757–e760.
Competing interests: No competing interests