Senior US researchers have been condemned for deliberately and covertly infecting more than 1000 Guatemalans with syphilis and other sexually transmitted diseases in the 1940s.
The judgement comes in a report released this week after a nine-month-long inquiry into the experiments, which were conducted between 1946 and 1948.
The report, Ethically Impossible: STD research in Guatemala from 1946 to 1948, concludes that culpability for the events of 65 years ago extends beyond the principal researcher, John Cutler of the University of Pittsburgh, Pennsylvania. Senior officials in the US Public Health Service, and even its chief, the surgeon general himself, knew of and supported Cutler's experiments.
Cutler and his colleagues deliberately infected 1308 prisoners, soldiers and psychiatric patients with the intention of finding treatments for syphilis, gonorrhoea and chancroid, a lesser-known sexually transmitted disease.
The experiments were brought to light last year by Susan Reverby of the University of Pittsburgh. The revelations led President Barack Obama and secretary of state Hillary Clinton to apologise to the Guatemalan people last October.
No consent
The commission's report, ordered by the president after the revelations, found "no evidence that consent was sought or obtained from the individual subjects? on the contrary, there were examples of active deceit".
In a covering letter to the president, published with the report, the actions are described as "especially egregious" because "many of the individuals involved held positions of public institutional responsibility".
Statements made at the time are self-incriminating. Cutler is quoted in the report as emphasising the need to increase secrecy and limit information about the project to those "who can be trusted not to talk".
They knew better
Much of the evidence that the wrongdoing was preconceived came from an earlier, very similar experiment on sexually transmitted diseases at Terre Haute prison, Indiana, in 1943 and 1944. In this case, a virtually identical team of researchers ? including Cutler ? accepted the need to obtain full informed consent from participating inmates, showing that they knew this to be a necessary precondition at the time for research involving humans.
Yet they failed to employ these same ethical safeguards in Guatemala two years later, despite the publication in 1947 of the Nuremberg code, which upheld the principle of informed consent as the cornerstone for all medical research.
"The Terre Haute work indicates that these concepts were not unfamiliar to the researchers," says the commission. "In this sense, the defence of culturally induced moral ignorance is inadequate."
The commission concludes by warning against further abuses. "We should be ever vigilant to ensure that such reprehensible exploitation of our fellow human beings is never repeated."
To that end, the commission is still engaged in an investigation to judge
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