In the 1940s, a young American doctor went to Guatemala to do medical experiments. He was funded by the venerable US National Institutes of Health, but he did not make anyone healthy. Instead, he deliberately exposed 1300 people to sexually transmitted diseases.
Dr John C. Cutler was no mad scientist. His experiments exposing prostitutes, prisoners and asylum inmates to STDs were carried out under the Public Health Service. They are flagrantly unethical by modern standards, but that they were deemed acceptable at the time — and perhaps that's the most horrifying part of all.
Last week, 800 Guatemalans filed a class-action lawsuit for $US1 billion against Johns Hopkins University for its role in the STD experiments. Why now, 70 years later? Cutler never published the results of his experiments, which were frankly shoddy science. And thus the experiments were simply forgotten until 2010, when Wellesley professor Susan M. Reverby stumbled across Cutler's paper while researching the Tuskegee experiments in Alabama. (Cutler also worked on these experiments, where hundreds of African-Americans infected with syphilis were not given treatment). The Obama administration issued an official apology then, but medical ethicists have since called for compensation for the Guatemalan victims.
The 1940s were a different time, of course. Sexually transmitted diseases, especially syphilis, loomed far larger in the public imagination than they do today. Even though scientists had proved that penicillin could cure syphilis by 1943, ways to prevent STDs were still lacking — a problem for soldiers just returning from WWII. That's where Cutler came in.
The road from Terre Haute to Guatemala
Twenty-eight year-old Cutler was just two years out of medical school when he began running a series of tests — called the Terre Haute prison experiment — where he infected prisoners with gonorrhea. The US military wanted to test new prophylaxis, or preventative treatments, for the common STD. And for that, they needed a reliable way to infect people with the disease.
Cutler developed the strategies he would later employ in Guatemala in the U.S. Researchers put bacteria, occasionally collected from prostitutes, directly on the penises of the prisoners. The prisoners had technically consented to the study, however questionable the idea of "consent" by prisoners is by modern standards. But at least the prisoners knew they were being infected with gonorrhea. The would not be true when Cutler relocated his work to Guatemala in 1946.
The Terre Haute experiment was eventually abandoned because researchers could find no reliable way of infecting the men. In Guatemala, however, prostitution was legal, and Cutler could run this experiments with a "natural route" of infection. Plus, the US Public Health Service (PHS) already had a presence there, and Cutler could work closely with Guatemalan health officials.
"Gross violations of ethics"
Beginning in 1946, Cutler devised a series of experiments to find reliable ways of spreading STDs, primarily syphilis. His team exposed over 1300 people in all, most of whom were not told they were being infected with diseases. ("This double talk keeps me hopping at time," he wrote in a letter to a colleague.)
Not everyone exposed got sick with syphilis. But among those who did contract syphilis, not all were treated right away either, even though penicillin was available.
Here are some of experiments Cutler carried out. The descriptions can get graphic.
- Prostitutes who tested positive for gonorrhoea or syphilis could visit prisoners at Guatemala City's Central Penitentiary — all paid for by U.S. taxpayers, notes Wellesley professor Reverby in her paper on the experiments. She goes on to write, "the researchers actually timed how long they spent with the prostitutes and thought they acted 'like rabbits'." In a similar experiment with Guatemalan soldiers, records show a prostitute servicing 8 soldiers in 71 minutes.
- At National Psychiatric Hospital of Guatemala, the team tried to infect asylum patients by scratching the arms, faces or mouths of women and the penises of men with a needle full of syphilis bacteria. Hundreds of psychiatric patients were thus exposed to syphilis.
- The single most horrific case may be that of Berta, who was infected with syphilis but not treated for three months. As Matthew Walter describes in Nature, "Her health worsened, and within another three months Cutler reported that she seemed close to death. He re-infected Berta with syphilis, and inserted pus from someone with gonorrhoea into her eyes, urethra and rectum. Over several days, pus developed in Berta's eyes, she started bleeding from her urethra and then she died."
Although Cutler's work was officially sanctioned, he clearly knew something was not right. In 1947, New York Times science editor Waldemar Kaempffert wrote up a study about penicillin preventing syphilis in rabbits, concluding that such an experiment would be "ethically impossible" in humans. Cutler wrote a letter to his superior about the Times article, which he ends with:
I hope that it would be possible to keep the work strictly in your hands without necessity for outside advisors or workers other than those who fit into your program and who can be trusted not to talk. We are just a little bit concerned about the possibility of having anything said about our program that would adversely affect its continuation.
Cutler never succeeded in finding a reliable way to get people sick with syphilis through any kind of exposure, which made testing a treatment to prevent it impossible. Eventually, with the war over, the PHS lost interest and Cutler was reassigned back in the States. He would join the ongoing Tuskegee study from 1951 to 1954, and he rose up to become assistant surgeon general of the PHS in 1958. He died in 2003, with his obit calling him a "much beloved professor".
Meanwhile, the results of his Guatemala research languished in a dusty archive until Reverby rediscovered them in a trove of his papers at the University of Pittsburgh. The rediscovery prompted a Presidential Commission for the Study of Bioethical Issues report in 2011 that concluded the experiments involved "gross violations of ethics."
Before the current lawsuit against Johns Hopkins University, a class-action lawsuit asking the US government for compensation was dismissed in 2013. Now, the suit names Johns Hopkins University for employing several professors who sat on government commissions that recommended and funded the studies in Guatemala. The suit also goes after Rockefeller University and Bristol-Meyers Squibb, the latter of whom made the penicillin used in the studies.
Cutler is now dead. So are most of the subjects of the studies. What can justice for these victims look like in 2015? It's clear that something very wrong happened here — what's less clear is how we right the wrongs of history, three generations later.
Picture: Syphilis bacterium, CDC/ Dr David Cox