Wednesday, September 14, 2011

Medical Experimentation: Ethics Optional

It's time to Break It Down!

Americans frequently assert the United States is a paragon of virtuous behavior.  Despite examples to the contrary, politicians especially, rush to belittle those who do not toe the line on the flammable, nationalistic notion that America leads a uniquely charmed existence, popularly known in the vernacular as American Exceptionalism.

For many neo-con thinkers, this status implicitly ascribes to the United States a state of being akin to the biblical ”shining city on a hill;” exempt from an array of historical forces that have affected other countries.  For half a century or more, this romanticized view has been rejected by liberal scholars.  Still, related debate roils contemporary political dialogue.

Occasionally, the ideal, and at least in some corners, the patently oversold notion that we are a uniquely stationed, righteously-oriented, global colossus, runs headlong into direct conflict with unmistakable, unalterable, and undeniable countervailing facts.  Such was the case nearly a year ago when on Friday, September 30, 2010; Secretaryof State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius apologized to Guatemala for actions taken by the U.S. PublicHealth Service.

This discovery and admission was just the most recent case of medical experimentation and exploitation that the United States government foisted upon unsuspecting pawns.  Very clearly unethical” was how the two Secretaries described the study, which was conducted between 1946 and 1948, in Guatemala.  According to the jointly worded statement, the United States maintained:

  • Although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health. We deeply regret that it happened, and we apologize to all the individuals who were affected by such abhorrent research practices."
In addition to the statement referenced above, in a separate, President Obama also spoke with Guatemalan President Álvaro Colom Caballeros, expressing his deep regret for the study.  In that conversation, President Obama reaffirmed the United States unwavering commitment that all present day studies meet U.S. and international legal and ethical standards.

Of course this is an example of the kind of thing a number of President Obama’s critics constantly pan him for; apologizing to other usually small, and in their opinions, lesser countries.  Interestingly, in their views, these kinds of transgressions, apparently, do not warrant acknowledging, or an apology.  Perhaps, as they see it, American Exceptionalism means never having to say you’re sorry!

In August 2011, the U.S. released the grisly details of how the Guatemalan study was conducted.  Included in the minutia was the fine distinction that in a similar study conducted on Indiana prisoners in 1943-44, U.S. government researchers sought volunteers, and told them they would be infected.  Disclosure was not so full in Guatemala.

There, according to the Washington Post, doctors brought infected prostitutes to unwitting inmates, or opened wounds in victim’s penises, faces, and arm with needles, then poured bacteria inside.  In some cases, infectious material was poured into victims’ spines.  In one case, researchers poured gonorrhea-infected pus into the eyes and other orifices of a woman already dying of syphilis, and then injected her with more syphilis.

Given the disparate treatment of the Guatemalan inmates versus the prisoners in Indiana (who were studied earlier), the Presidential Commission for the Study of Bioethical Issues reviewing the Guatemalan study concluded researchers knew their experiments were unethical.  Investigators reviewed over 125,000 documents.  The Guatemalan government is conducting a separate investigation.  The experiments were approved by some Guatemalan officials.

The goal of the research in was to determine whether taking penicillin after sex would protect against syphilis, gonorrhea, and chancroid.  The question was a medical priority at the time, especially in the military.  About 700 Guatemalans were treated for sexually transmitted diseases, but it remains unclear whether they were adequately treated, or what became of them.

Susan Reverby, a historian at Wellesley College in Massachusetts, discovered the Guatemalan experiments while doing research for a book on the infamous Tuskegee studies in Alabama.  She found papers from John C. Cutler, a doctor with the federal government’s Public Health Service.  Dr. Cutler had participated in the Tuskegee Experiment, in which hundreds of African American men with late-stage syphilis were left untreated to study the disease between 1932 and 1972; that’s right, forty years!  Dr. Cutler died in 2003.

After sending President Obama a report in September, 2011, the Commission will meet again in November to discuss whether current protections are adequate for research subjects, both in the United States, and internationally.  The Commission will then issue a final report in December.

Dr. Reverby’s incidental discovery was facilitated by her interest in the Mother of All lack of informed consent studies, The Tuskegee Experiment.  Originally intended to last six months, the study, a travesty in virtually every regard devolved into a 40-year exploitive invasion of the lives of 600 black men (and their families) from Tuskegee, Alabama.

The men, 201 of whom did not have the disease as the outset, were never given adequate treatment.  Even after penicillin became the acknowledged drug of choice for syphilis in 1947, researchers did not offer it to the subjects.  There is no evidence that the subjects were ever given the option to quit the study, even after penicillin was determined to be highly effective and widely used.

The timeline for the saga of the Tuskegee Experiment, which began in 1932, now spans 79 years.  The egregious treatment of the subjects of this heinous study is a classic example of why regulation, review, and oversight are important tools in ensuring the health, safety and welfare of the public; all segments of the public.  The sequence of events runs as follows:

  • 1932Public Health Service began the Tuskegee Study of Untreated Syphilis in the Negro Male”
  • July 1972 – The Associated Press ran a story about the Tuskegee study that caused a public outcry that led the Assistant Secretary for Health and Scientific Affairs to appoint an Ad Hoc Advisory Panel to review the study
  • The panel found the (600) men had agreed freely to be examined and treated, but…saw no evidence the men had been informed of the study, or its purpose, and they determined the men had been misled, and not given all the facts required for informed consent
  • October 1972 – The panel concluded the study was ethically unjustified; advised stopping the study at once
  • November 1972The Assistant Secretary for Health and Scientific Affairs announced the end of the Tuskegee Study
  • Summer 1973 – A class–action lawsuit was filed on behalf of the study participants and their families
  • 1974 – A $10 million out of court settlement was reached, and provided lifetime medical benefits and burial services to all living participants, via the Tuskegee Health Benefit Program (THBP)
  • 1975 – Wives and widows, and offspring were added to the program
  • 1995 – The program was expanded to health as well as medical benefits
  • The last participant died in January 2004
  • The last widow receiving THBP benefits died in January 2009
  • There are 15 offspring currently receiving medical and health benefits
The Centers for Disease Control and Prevention was given responsibility for the program, where it remains today in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The Guatemala and Tuskegee studies are two sad commentaries.  They demonstrate that intellect, science, and medicine in a vacuum, do not automatically result in reasoned, responsible behavior.  In Guatemala and Tuskegee, what we had were cases of, “Medical Experimentation: Ethics Optional!”  One vestige of the Tuskegee Experiment is that even today, many African Americans, especially men, are reluctant to trust doctors.  It is my sincere hope that in the future, in America at least, such a situational ethics model will not be an option.

I’m done; holla back!

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4 comments:

Anonymous said...

Disgusting...morally and otherwise..

randolph said...

very informative I truly don't trust america when it comes to our food, health or any aspect of them protecting our will being.

Alpha Heel said...

Jon:

The scary part is, while these are two documented, and fairly well-known cases, the practice of medical experimentaion, sans informed consent, has been a fairly common historical practice.

'06!

Alpha Heel said...

Randolph:

These cases should certainly give one pause; though I suspect both provide acute lessons on what it means to be powerless, and the vulnerability that accrues naturally from that state of being.