Ethically Impossible: STD Research in Guatemala from 1946 to 1948

Report on STD Research in Guatemala, 1946-48

This report examines a study funded by the U.S. Public Health Service in Guatemala in 1946–48 on sexually transmitted diseases using experiments that were “clearly unethical.” President Barrack Obama charged the Presidential Commission for the Study of Bioethical Issues in November 2010 to research and report on the Guatemalan experiments after he learned of the experiments that deliberately infected the subjects with syphilis, gonorrhea, and chancroid. The subjects included soldiers, patients from a state-run psychiatric hospital, and commercial sex workers. Serology experiments, not involving exposure, continued in 1953, even using children.

The President also asked the Commission to review current practices in human subject research to safeguard “the health and well-being of participants in scientific studies supported by the federal government.”

The commission sought to discover to what U.S. officials and medical professionals knew of the “research protocols” employed and how the studies conformed or diverged from contemporary medical practices. The Commission used the original records, now at the National Archives, originally donated by Dr. John C. Cutler, director of the studies in Guatemala. Commission members also reviewed materials in other collections, including at the University of Pittsburgh Archives and library of the Pan American Health Organization. Much of the record is Dr. Cutler’s accounts written years after the tests. The Commission warns that the report should be read “with an awareness of the inherent limitations of fact finding based in large part on one person’s recollections, particularly those of one who played a primary role in the research.”

The Guatemalan studies were sponsored by the Pan American Sanitary Bureau (PASB) with a National Institute of Health grant. The PASB built a research facility and laboratory in Guatemala City with agreements from the Guatemalan Government that gave it authority to work with many government officials. In all, 1,308 were exposed to STD, and 678 were treated. The researchers also conducted diagnostic testing on 5,128 subjects who included soldiers, prisoners, psychiatric patients, children, leprosy patients, and Air Force personnel at the U.S. base in Guatemala. The diagnostic testing continued through 1953, including “blood draws as well as lumbar and cisternal punctures.”

The report concedes that  “ethical norms and practices were evolving, but concludes that the experiments in Guatemala starkly reveal that, despite awareness on the part of government officials and independent medical experts of then existing ethical standards to protect against using individuals as a mere means to serve scientific and government ends, those standards were violated. The events in Guatemala serve as a cautionary tale of how the quest for scientific knowledge without regard to relevant ethical standards can blind researchers to the humanity the people they enlist into research.”

This is the first report, “a historical account and ethical assessment of the Guatemala experiments.” The second report “will address contemporary standards for protecting human research subjects around the world.”

“Ethically Impossible”: STD Research in Guatemala from 1946 to 1948

Presidential Commission for the Study of Bioethical Issues Washington, DC
September 2011

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Presidential Commission for the Study of Bioethical Issues
1425 New York Avenue NW, Suite C-100
Washington, DC 20005

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