User:Bchene/Guatemala syphilis experiments

John Charles Cutler[edit]
The experiments were led by United States Public Health Service physician John Charles Cutler, who had earlier joined the Public Health Service in 1942 and served as a commissioned officer. Cutler participated in the similar Terre Haute prison experiments under Dr. John F Mahoney, in which volunteer prisoners were infected with gonorrhea spanning from 1943-1944.

Cutler also later took part in the late stages of the Tuskegee syphilis experiment. While the Tuskegee experiment followed the natural progression of syphilis in those already infected, in Guatemala, doctors deliberately infected healthy people with the diseases, some of which can be fatal if untreated. The goal of the study seems to have been to determine the effect of penicillin in the prevention and treatment of venereal diseases. The researchers paid prostitutes infected with syphilis to have sex with prisoners, while other subjects were infected by directly inoculating them with the bacterium. Through intentional exposure to gonorrhea, syphilis, and chancroid, a total of 1,308 people were involved in the experiments. Of that group, with an age range of 10-72, 678 individuals (52%) can be said to have received a form of treatment. Hidden from the public, John Charles Cutler utilized healthy individuals in order to improve what he called "pure science."

Cutler was asked by the World Health Organization to head an India-based program for demonstrating venereal disease for Southeast Asia in 1949.

In 1958, Cutler would climb the ladder to become assistant surgeon general of the U.S Public Health Service.

Cutler would end his tenure in the US Public Health Service in 1967, when he started his role as a professor of international health at Pitt Graduate School of Public Health. He became the dean of the school a year later, serving for two years until 1969.

Study details[edit]
The experiments were initially supposed to be held at a prison in Terre Haute, Indiana, but were moved to Guatemala after researchers had a hard time getting the prisoners consistently infected with gonorrhea. The move to Guatemala was suggested by Dr. Juan Funes, head of the Guatemalan Venereal Disease Control Department. The experiments were funded by a grant from the U.S. National Institutes of Health (NIH) to the Pan American Sanitary Bureau and multiple Guatemalan government ministries also got involved. Some studies argue that the selection of Guatemala as a location to conduct said study was a tactic motivated by racial discrimination by the U.S., especially considering the study featured white physicians and researchers experimenting on subjects deemed by the U.S. as minority groups. Another study argues that the reasoning was due to Guatemalan prisoners' privilege to pay for prostitutes, making it seem that infections were natural due to intercourse with an infected prostitute. The study was officially led by the U.S. Public Health Service, beginning in 1946, up until 1948.

The total number of subjects involved in the experiment is unclear. Some sources argue that about 1,500 study subjects were involved, although the findings were never published. Whereas, other sources state that over 5,000 individuals participated in the study, including children. The purpose of the study was to observe the efficacy of penicillin usage in preventing infection of sexually-transmitted diseases post-intercourse, around 696 Guatemalans were intentionally infected with syphilis, gonorrhea and chancroids. The study also aimed to discover medications other than penicillin to various venereal diseases.

In archived documents, Dr. Thomas Parran, Jr., the U.S. Surgeon General at the time of the experiments, acknowledged that the Guatemalan work could not be done domestically, and details were hidden from Guatemalan officials. Furthermore, the participants had not received the opportunity to provide informed consent since the purpose and details of the research were hidden from them.

Participants were subjected to the Syphilis bacteria through the introduction of permitted visits with infectious female sex workers, paid by the funds from the U.S. government. Other attempts at passing the pathogens to participants included pouring the bacteria onto various lightly-abraded body parts, such as male subjects' genitalia, forearms and faces. Some subjects were even infected through forced perforation of the spine. Participants who then tested positive for syphilis were treated with penicillin. However, there is no evidence for adequate treatment having been provided to all subjects or whether infected individuals were cured.

While the study is known to have officially ended in 1948, doctors continued taking tissue samples and performing autopsies on former participants until 1958. Eighty-three individuals died during the course of the experiment, though it is unclear as to whether or not the inoculations were the source of these deaths.

Study Methods[edit]
The initial attempts to infect subjects of the experiment consisted of workers from the USPHS inoculating prostitutes with germs that had grown in rabbits, and then paying them to have sex w ith prisoners. They operated under an assumption that one prostitute could have sex with up to 8 men in 71 minutes, creating a large rate of infection. These these attempts failed at producing infections quick enough due to the prisoners refusing repeated blood drawings. Researchers went to the direct inoculation of subjects after Dr. Cutler accepted an offer from Dr. Carlos Salvado. Salvado was the director of the Asilo de Alienados, a psychiatric hospital in Guatemala City. This hospital was notably understaffed and lacked rudimentary equipment and medicines. $1500 that was originally intended to go to volunteers at the prison was given to the psychiatric hospital for an antiepileptic drug called Dilantin and other necessary equipment. Doctors would often inject strains of syphilis into patients' spinal fluid or wear away the skin to make infection easier. These strains that they infected patients with were collected from other infected patients or from “street strains”, which are not defined. After the patients were exposed to syphilis, only about half of the patients were given treatment for the infection. According to one source, 83 patients died during the experiments, but the relation between experiment involvement and death was unsubstantiated. In 1947, Dr. Cutler began experimenting with gonorrhea on Guatemalan soldiers. About 600 soldiers were infected with the disease after a year and a half. Infected sex workers were used to infect the soldiers, and gonorrheal pus from soldiers' penises were injected into other soldiers. Chancroid experiments were also conducted spontaneously on about 80 soldiers, in which doctors would scratch soldiers' arms and infect the wounds.

A documented subject profile provides a detailed description of what the subjects faced within this experiment:"Berta was a female patient in the Psychiatric Hospital... in February 1948, Berta was injected in her left arm with syphilis. A month later, she developed scabies (an itchy skin infection caused by a mite). Several weeks later, Dr. Cutler noted that she also developed red bumps where he had injected her arm, lesions on her arms and legs, and her skin was beginning to waste away from her body. Berta was not treated for syphilis until three months after her injection. Soon after, on August 23, Dr. Cutler wrote that Berta appeared as if she was going to die, but he did not specify why. That same day he put gonorrheal pus from another male subject into both of Berta's eyes, as well as in her urethra and rectum. He also re-infected her with syphilis. Several days later, Berta's eyes were filled with pus from the gonorrhea, and she was bleeding from her urethra. Three days later, on August 27, Berta died."Consent was given by soldiers' officials or patient doctors, but was not reported to have been given by the subjects themselves.

Subjects[edit]
In total, 1,308 people were confirmed to have been a part of this experiment. Of this group, 678 individuals were documented as getting some form of treatment. However, some reports say that up to 5,128 individuals were monitored for symptoms or became a part of the experiment through natural infection. The populations involved consisted of child and adult commercial sex workers, prisoners, soldiers, orphans, leprosy patients, and mental hospital patients. Much of these populations consisted of indigenous Guatemalans and Guatemalans living in poverty. Their ages ranged from 10 to 72, though the average subject was in their 20s.

The Centers for Disease Control and Prevention acknowledges that "the design and conduct of the studies was unethical in many respects, including deliberate exposure of subjects to known serious health threats, lack of knowledge of and consent for experimental procedures by study subjects, and the use of highly vulnerable populations." A total of 83 subjects died, though the exact relationship to the experiment remains undocumented.

Manuel Gudiel Garcia v. Kathleen Sebelius
In March 2011, seven plaintiffs filed a federal class-action lawsuit against the U.S. government claiming damages for the Guatemala experiments. This case argued that the United States was at fault due to not asking for consent. This lawsuit asked for money to compensate for medical damages and livelihood because most of the families were living in poverty. Many Guatemalans believed that the U.S. apology may have not been enough. The Guatemala Syphilis experiment has brought ethics back into public focus for Medical Research. Current records show that studies sent infected prostitutes to have sex with men in prison. As the U.S. has strongly said that the research practices are completely “unethical”, “abhorrent”, and  “reprehensible” which caused a thorough investigation into the case. (citation) (The case failed when Senior United States District Judge Reggie Walton) determined that the U.S. government has immunity from liability for actions committed outside of the U.S.

Estate of Arturo Giron Alvarez et al. v. The Johns Hopkins University et al.
In April 2015, 774 plaintiffs launched a lawsuit against Johns Hopkins University, the pharmaceutical company Bristol-Myers Squibb, and the Rockefeller Foundation seeking $1 billion in damages, with one main motive being that the lawsuits held the University accountable for the experiment itself because the doctors held important roles on panels that reviewed the federal spending on research for other sexually-transmitted-diseases. As these plaintiffs claim that John Hopkins is active in these experiments they even stated “[they] did not limit their involvement to design, planning, funding and authorization of the Experiments; instead, they exercised control over, supervised, supported, encouraged, participated in and directed the course of the Experiments.” The hope was that compensation could be attained by targeting private institutions rather than the federal government. During the experiments, which took place in the 1940s-50s and was overseen by US researcher Dr John C. Cutler, as hundreds of Guatemalans were infected with syphilis, gonorrhea and many other sexually-transmitted diseases.

In January 2019, U.S. District Judge Theodore Chuang rejected the defendants' argument that a recent Supreme Court decision shielding foreign corporations from lawsuits in U.S. courts over human rights abuses abroad also applied to domestic corporations absent Congressional authorization and decided to admit the trial. However, legal experts said the lawsuits arguments could have been a stretch, today professors who frequently serve on volunteer basis with the National Institute of Health: “for example, are more likly to be considered to be acting independently and not in their capacity as university faculty said Holly Fernandez Lynch who is an executive director of the Ptrie-Flom Center for Health Law Policy Biotechnology and Bioethics at Harvard University Law School.” (cite)The case is Estate of Arturo Giron Alvarez et al v. The Johns Hopkins University et al, U.S. District Court, District of Maryland, No. 15-00950. The case was dismissed by the Fourth Circuit Court of Appeals.

Need for Reparations
The experiments that were conducted involved major human rights violations. The subjects were not consenting members to participate in the experiments and rape was involved during the experiments bringing more of awareness for the need of the reparations.

In order to handle reparations for the victims, U.N. Commission on Human Rights Guidelines focuses in on the Basic Principles meant to give people who were subjected to violations of international human rights law. It is also important to make sure that the victims are properly helped in a way that does not further harm due to ineffective reparations. Basic Principles requires that reparations are set up purposefully in through the eyes of the victim which is achieved through participatory reparation programs. Participatory reparation program is where the victims have the power to choose to be involved in the process and influence what is to be done to help better their needs. This program also gives an identity for each patient who suffered through this rather than a historical number or just another victim.

Important focus is making sure all who needs help receives help and reparations are not excluded to people who were not infected during the experiments, but were still harmed because of what was going on through some relation of the primary victim. The level of help that is needed will look different, but they should still have say in the help they require.