Back in 1997 Bill Clinton delivered a public apology to the victims of the infamous Tuskegee study, where about 400 people infected with syphilis among the black sharecroppers in Alabama had been left deliberately without the existing cure, penicillin, so that doctors could follow the “natural course” of the disease. Together with the public apology delivered by former US president, a large financial aid (about $200,000) was offered to the people of Tuskegee and Macon Countee to set up the Tuskegee Bioethics Center, which was inaugurated in 1999.
Almost 15 years later, it is now the turn of another Clinton, namely Bill’s wife and current US secretary of State, Hillary Rodham Clinton, to give another formal apology for a study which shares many striking and scary similarities with the Tuskegee study.
Between 1946 and 1948, almost 700 Guatemalan prison inmates, mental patients and soldiers – categories which in medical ethics we would surely refer to as “vulnerable”- were deliberately infected by US doctors with the Treponema pallidum (the bacterium responsible for syphilis), with the aim of studying the effectiveness of penicillin as a treatment.
Infection modalities were to be chosen among the following three: a) infected prostitutes paid to infect their clients; b) Treponema pallidum bacteria poured directly onto the genital organs, face or arms of other individuals (for which apparently option a) was not available; or c) bacteria were injected directly by spinal puncture.
Apart from scenario a) then, it is quite difficult to imagine that individuals were not realizing that something odd was going on!
The Guatemalan experiment was brought up by Susan M. Reverby, professor at Wellesley College, who had initially presented her research on the trial at a conference last January, though without eliciting any out-of-the ordinary attention. The deserved attention arrived a few months later, when in June 2010 Reverby sent a draft of the manuscript she was working on for the Journal of Policy History to Dr David J. Sencer, former Director of the US Center for Disease Control. It was then up to Dr Spencer – apparently a person of stronger political power than Dr Reverby – to push the US government to commence a deeper investigation on the case.
Susan Reverby had already found some documents about the Guatemalan case back in 1985, when she was working at the University of Pittsburgh. The documents were signed by Dr Cutler, “principal investigator” of the trial, and also later involved in – guess what?- the Tuskegee study (to note, esteemed professor Cutler kept defending the soundness of the Tuskegee trial in terms of science and ethics until his death-bed).
Among public reactions to Clinton’s (Hillary) apology, it seems to me interesting to report here the one by professor Mark Siegler, Director of the Maclean Center for Medical Ethics at the University of Chicago. According to Siegler, the Guatemalan study is much worse from an ethical point of view than the Tuskegee study. His rationale is the following: in the Tuskegee study, the black sharecroppers in Alabama were already infected with the venereal disease, and not given the existing treatment, whereas in the Guatemalan study men were being deliberately infected with the disease (the full comment by Professor Siegler can be read on the New York Times)
Which do you think is better (or less ethically blamable, I should maybe say): to deliberately infect individuals with various -more or less pleasurable- ways, and then cure them and try to save their lives; or deliberately not curing already infected and socially disadvantaged people?