In the late 1940s, a group of doctors and researchers traveled to Guatemala and conducted extensive and often ghastly STD experiments there. This is the story behind who was responsible, what the test subjects did and didn’t know, and the onerous task of meting out justice.
On April 1, close to 800 plaintiffs filed a $1 billion suit in Baltimore City Circuit Court that alleges that, in the 1940s and ’50s, doctors and medical researchers from Johns Hopkins University played a substantial role in experimenting on hundreds of Guatemalans, inoculating them with sexually transmitted diseases—including gonorrhea, syphilis, and chancroid—and using various methods to transmit the diseases to their subjects.
The lawsuit specifically alleges that, between 1945 and 1956, physicians and scientists from Johns Hopkins were involved in exposing prison inmates, psychiatric patients, prostitutes, and soldiers to the aforementioned STDs, as well as potentially infected animal fluids and tissue. The plaintiffs are threefold: direct survivors of the experiments; spouses and children of test subjects who themselves contracted venereal disease, either sexually or congenitally; and descendants who are filing wrongful death suits for parents and relatives who died from complications resulting from the experiments.
There are several pressing questions. Who, specifically, was responsible for this non-consensual experimentation on human subjects? What sort of subterfuge, if any, was used to infect so many Guatemalans? And why did it take half a century for these experiments to see the light of day?
To understand exactly who was involved in the Guatemala experiments and gauge their levels of accountability, it’s important to understand the historical context out of which the experiments rose.
During World War II, STDs became a scourge for American troops. Dr. Joseph Earle Moore, chairman of the Subcommittee on Venereal Diseases for the National Research Council, estimated that gonorrhea could account for seven million lost days of work a year for the war effort, according to correspondence notes pored over by the Bioethics Commission. Army and Navy leaders, as well as prominent figures in public health agencies, agreed that the prevalence of STDs among American soldiers and the resulting lost manpower required serious attention; substantial resources, they argued, should be committed to STD research and prevention.
In addition to cotton swabs and intracutaneous injection, researchers began scarifying male subjects’ penises before swabbing them with syphilis emulsions, hoping to increase transmission rates.
Moore would prove an important figure in the escalating effort for STD prophylaxis and a vital connective between various government agencies and Johns Hopkins University. He was able to win enough support from various surgeons general and health departments to go ahead with the first major STD prophylaxis research study in response to the crisis facing the troops: the Terre Haute experiments, which took place at the United States Penitentiary at Terre Haute, Indiana, and began in September 1943. The study, however, would only last 10 months.
Researchers working at Terre Haute were unable to come up with a method for consistently infecting prison inmates with gonorrhea, and therefore couldn’t study the disease effectively or administer potential treatments. Despite their apparent failure, the Terre Haute experiments paved the way and served as the direct antecedent for a much more sprawling, comprehensive study to follow.
At least three men played important roles in both Terre Haute and what would become known as the Guatemala Project: Moore, Dr. John F. Mahoney, and Dr. John C. Cutler.
Mahoney, the director of the Venereal Disease Research Laboratory in Staten Island, New York, had submitted the original proposal for the Terre Haute experiments to the Office of Scientific Research and Development in June of 1943. Cutler worked on-site at Terre Haute and would eventually head the experiments in Guatemala City. The pair was eager to follow up on their decidedly unfinished work at Terre Haute. Dr. Juan Funes, a Guatemalan physician who worked with Mahoney and Cutler at the VDRL on a one-year fellowship in 1945, suggested they carry out their new research in Guatemala.
How the Guatemala experiments were funded, and who, specifically, approved them, has become a matter of exigent importance now that Johns Hopkins, The Rockefeller Foundation, and Bristol-Myers Squibb face a $1 billion lawsuit. The funding streams were both intricate and convoluted, a bureaucratic labyrinth that makes agency difficult to pinpoint.
Shortly before the Guatemala proposal, the NIH Research Grants Office was created. Headed by former VDRL Associate Director Dr. Cassius J. Van Slyke, the office relied on study sections and advisory councils to review grant applications. A 2011 government report on the Guatemala experiments, “Ethically Impossible,” refers to this as the “dual-review structure.” In what will inevitably become a crucial point in the lawsuit, the study sections and advisory councils that approved funding were composed of both civilian scientists and government representatives.
The first group of doctors and medical officers assembled to review grant applications under the NIH Research Grants Office was the Syphilis Study Section, a 12-member team chaired by Moore, both a professor at Johns Hopkins University School of Medicine and the chair of the NRC Subcommittee on Venereal Diseases. Including Moore, four of the members were employed by Johns Hopkins at the time. The study section approved the Guatemala proposal. While it was funded through the NIH Research Grants Office, the money itself—roughly $110,000—came from the VDRL.
Cutler arrived in Guatemala City in August of 1946. His first initiative was to provide STD treatment to the Guatemalan Army using penicillin and salvarsan. In his first six months there, Cutler treated syphilis among Guatemalan soldiers, advised military doctors on prophylactic plans, and provided medical equipment and training for Guatemalan physicians.
In addition, Cutler and his associates engaged in comprehensive diagnostic and serological testing among both inmates at Guatemala City Penitentiary and children. Almost 1,400 children from the Guatemala City Orphanage and other schools were used for serological testing, which included drawing blood and lumbar punctures. Serological testing was also conducted in a psychiatric hospital and leprosarium near Guatemala City.
Cutler would not begin intentionally infecting Guatemalans with STDs until about six months later, in February of 1947. His first major study group would be the Guatemalan Army—the same army Cutler had, in the preceding months, treated with penicillin—scarce and coveted in the city—and drew up an STD prevention plan for.
In total, 446 psychiatric patients were intentionally exposed to syphilis between May of 1947 and October of 1948; 71 patients in the psychiatric hospital died during the experiments.
In Cutler’s first experiment with Army soldiers, he sought to infect them with gonorrhea through what is referred to as “normal exposure”—i.e. sexual intercourse. He did this by recruiting at least four commercial sex workers who presented with gonorrhea and were referred to him by the Venereal Disease and Sexual Prophylaxis Hospital; later, he would intentionally inoculate sex workers with gonorrhea while continuing the normal exposure experiments. Research notes suggest that some of the sex workers were paid $25 for their participation in the experiment. Ultimately, only five out of 93 men contracted gonorrhea from a total of 138 intentional exposures. Just as in Terre Haute, consistent and effective inoculation was elusive.
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