# Professionalism/The Guatemala Syphilis Experiment

Throughout history, there have been cases where scientists and engineers have seemingly overstepped ethical boundaries in pursuit of their work. The 1940s Guatemala Syphilis Experiment is one such case in which these ethical boundaries were forgotten. The sanctioned experimentation of inoculating hundreds of unknowing Guatemalans with syphilis is a forgotten piece of American history. Its exposure in 2010 prompted an apology from the United States Government and a class action lawsuit arising from the victims in Guatemala.

## Background

Attempts to understand and limit the spread of sexually transmitted diseases has been a priority throughout the history of the United States. STDs have presented a problem for both military personnel and the general public. With no established treatment, US doctors were tasked with finding an acceptable alternative with a high success rate.

### STDs and the World Wars

In WWI, medical records indicate that the U.S. Army "lost nearly 7 million person-days and discharged more than 10,000 men because of STDs." This trend continued into WWII where the rate of syphilis among U.S. Army recruits was 4.5 out of every 100 men until 1942.. In order to mitigate this problem, the War Department launched a "massive" ad campaign to warn soldiers and sailors about "excessively amorous behavior."

### The Tuskegee Syphilis Experiment

The Tuskegee Study of Untreated Syphilis in the Negro Male began in 1932, and was intended to be a six month study to examine the effects of syphilis in 399 black men who had already contracted the disease. Instead, this program ran for forty years until its exposure in 1972. The subjects of this study were told they were being treated for bad blood, which was used locally to describe ailments ranging from anemia and fatigue to syphilis. In 1947, penicillin became the standard treatment for syphilis, but this was withheld from the subjects of the study. Peter Bruxton a former employee of the United States Public Health Service exposed this story to a reporter in 1972 after repeated efforts to handle the situation internally. Following its exposure, the study was quickly shut down and an advisory panel was convened.

## Guatemala Syphilis Experiment

A series of syphilis experiments were conducted in Guatemala from 1946 to 1948. Headed by Dr. John C. Cutler, United States doctors used Guatemalan citizens as test subjects for syphilis research.

### Researchers
#### John C. Cutler

Dr. John C. Cutler, a graduate of Western Reserve University Medical School, was an employee of the United States Public Health Service. In 1943 he worked as a medical officer in the Venereal Disease Research Laboratory in Staten Island. As a result of his efforts, Cutler was appointed to head the Guatemala Syphilis Experiment. The experiments began when he arrived to Guatemala in 1946. Initially Cutler infected prostitutes with gonorrhea and used them as a vessels to infect military personnel. However, the disease did not spread as easily as Cutler thought, so his team began to inoculate test subjects. "According to the US bioethics commission's report, Cutler's team exposed 558 soldiers, 486 patients at the psychiatric hospital, 219 prisoners, 6 prostitutes and 39 other people to gonorrhea, syphilis, and chancroid". Not only did Cutler run these experiments, but he neglected to obtain consent or inform the patients as to what he was doing. Many of the test subjects lived decades without knowing that they were infected and ultimately passed syphilis and gonorrhea to the rest of their family.
However, Cutler knew that if the U.S. public found out about what was going on in Guatemala his operation would be shut down. In letters to Dr. John Mahoney,Cutler's supervisor and director of the Venereal Disease Research Lab, Cutler pleads "it would not be advisable to have too many people concerned with this work...I hope it would be possible to keep the work strictly in your hands without necessity for outside advisers...we are a little bit concerned about the possibility of having anything said about our program". This evidence shows that there were several high ranking officials that knew about the studies being done in Guatemala. Nonetheless, Cutler's experiments would not be brought to light until 2010, almost 70 years after they began.
In 1947 Penicillin became the standard treatment method for syphilis. But, the Guatemala Syphilis Experiment ran until 1948. At this point the experiment in Guatemala was now obsolete and many of the records acquired during these studies were never published or used. Dr. Cutler left Guatemala without treating many of the subjects, leaving them to live with unanswered questions about their health.

#### Thomas Purran Jr.

Thomas Purran Jr. was the sixth surgeon general of the United States (from 1936 to 1948) and is well known for the strides he took to control and prevent the spread of sexually transmitted disease. In his time as Surgeon General, he oversaw both the Tuskegee Syphilis Experiment and the Guatemala Syphilis Experiment. Parran reportedly told a contemporary that the Guatemala experiments "could not have been conducted in the United States," but was a strong supporter of both studies.

## Subjects

Test subjects during the Guatemala Syphilis Experiment ranged from military personnel and orphans to prostitutes and psychiatric patients. The majority of these individuals did not give their consent and were not informed on what was being done. Frederico Ramos, Marta Orellana, and Berta are victims whose stories were reported.

#### Frederico Ramos

Frederico Ramos was a soldier in the Guatemalan Army from 1948 until 1950. One Friday afternoon as Ramos prepared for weekend leave, he was ordered to report to a U.S. clinic. Upon arrival, Ramos was injected with an unknown substance in his right arm. The doctors told him to come back once the weekend was over. Ramos's commanders then handed him money and let him go. Ramos began to experience unexplained health issues over the next decades. At the age of 40, Ramos was finally diagnosed with syphilis and gonorrhea. Not only did Ramos test positive, but his wife and children also were infected with syphilis.

#### Marta Orellana

Marta Orellana was a Guatemalan orphan. At the age of ten she was taken to an infirmary against her will. Orellana recalls "they laid me on a bed, with a doctor on each side and the nurse holding my head. And then they tried to force my legs open. I resisted with all the strength of a ten-year-old girl." She began pleading for them to stop but the doctors repeatedly told her that she did not have a choice. After this, Orellana became extremely ill and was bedridden for weeks. She continued to visit the clinic and was frequently accompanied by other female orphans.

#### Berta

Berta was a patient in a Guatemalan psychiatric hospital. She was given syphilis by Dr. Cutler's team, but was not treated for the disease for three months. Cutler began to notice that her health was declining but continued to withhold treatment. After another three month period Cutler reported that she seemed "close to death". "He re-infected Berta with syphilis, and inserted pus from a gonorrhea patient into her eyes, urethra and rectum." Over the next several days Berta's health plummeted and she ultimately died.

## Exposure
### Susan Reverby

In 2010, seven years after Cutler's death, Susan M. Reverby, a medical historian and professor at Wellesley College, discovered Cutler's work in the University of Pittsburgh archives. The papers included patients’ records, handwritten notes, photos, and correspondence with others in the public health service. Reverby presented her findings at a conference in January 2010, but she was ignored until submitting a draft article to the Journal of Policy History in June 2010. Dr. David J. Spencer, former director of Centers for Disease Control, finally "prodded the government to investigate".

### U.S. Government

On October 1, 2010 the U.S. Government issued a formal apology to the Guatemalan government and people". President Barack Obama personally called Guatemalan President Álvaro Colom to express his deepest regret for the past events, and to extend an apology to the nation of Guatemala and all those touched by the study. The President also tasked the Presidential Commission for the Study of Bioethical Issues with a historical investigation of the treatment of human subjects in scientific research. The report was issued in September 2011.
Hillary Clinton, Secretary of State, and Kathleen Sebelius, Secretary of Health and Human Services, also apologized to the Guatemalan government, survivors, and descendants, recognizing the events as "clearly unethical". In a joint statement, the two women said, "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".

### Guatemalan Government

Although the Guatemalan government was privy to the experiments in the 1940s, the current democratic government system expressed outrage and indignation toward the studies. After speaking with Hillary Clinton, Guatemalan President Álvaro Colom called the news shocking and "crimes against humanity," taking advantage of a vulnerable population. In a statement to the media, Colom stated:
Guatemala's Vice President, Rafael Espada, directed a Commission of Inquiry to make recommendations on Guatemala's response to the news. Colom considered talking to the international court, but instead waited on the results of the inquiry. Guatemala's Attorney General stated that the government only knows of 3 surviving victims, and that the descendants of the victims would likely never be found.

### Guatemalan Citizens

In March 2012, "a group of Guatemalans filed a class action lawsuit against the U.S. government for intentionally infecting them with syphilis". The defendants were claimed to be "'liable under the principles of successor liability for the acts of their predecessor office-holders'". Lawyers, however, claimed that Guatemala needed to also acknowledge its own participation in the study. In June 2012, the case was dismissed; U.S. District Judge Reggie Walton ruled that "federal law bars claims against the U.S. based on injuries suffered in a foreign country".

## The Lucifer Effect

The Lucifer Effect, first coined by Dr. Philip Zimbardo, attempts to explain why good people turn evil. It refers to the point in time when an ordinary person crosses the boundary between good and evil to engage in an evil action. Dr. Zimbardo explains that these transformations are more likely to occur in novel settings that cause people to set aside temporarily their morality, compassion, or sense of justice. In the Guatemala Syphilis Experiments, Dr. Cutler was in a third world country whose citizens were often looked upon as lesser beings due to their lack of European ancestry and education. These ubiquitous racist tendencies of the time, paired with the goal of curing syphilis, allowed Dr. Cutler to set aside his morality to intentionally harm his patients. This dehumanization of the Guatemalan people clouded Dr. Cutler's thoughts and allowed him to treat his 'patients' with such disdain.

### Abu Ghraib

The scandal of the Iraq prison Abu Ghraib in 2003 highlights another instance of inhumane treatment of foreign individuals by US personnel. After the invasion of Iraq, Abu Ghraib was set up as a detention center for potential terrorists and Iraqi insurgents. In March 2003, US and CIA personnel who were members of the Tier 1A Night Shift committed a spree of human rights violations against the detainees. The violations included physical and sexual abuse, torture, rape, and even murder. These atrocities continued for months, until in late 2003 when Amnesty International and the Associated Press uncovered incriminating photos taken by the soldiers.
At first, the Bush administration did not acknowledge the alleged violations. But as evidence mounted, the Bush administration labelled these atrocities as isolated incidences that do not reflect American military policy. Further investigation showed that these techniques were part of a wider pattern of torture and brutal treatment at American overseas detention centers around the world. The recommendation for the use of illegal techniques stems from the Torture Memos, where the CIA, FBI, and the President were advised to use extreme torture methods because the Geneva Convention rules may not apply to "unlawful combatants" captured in Iraq. Authorization of these acts allegedly stems from Secretary of Defense Donald Rumsfeld. Substantial evidence was never found to convict Rumsfeld of breaking the Geneva Convention Accords.
The torture at Abu Ghraib mimics the nature of treatment given to the Guatemalan citizens during the Syphilis Experiments. These people were viewed as lesser beings that do not deserve the dignity and rights given to an official POW. Placing Americans in Iraq to fight an enemy that despises everything America stands for caused the soldiers to lose any compassion they might have had for the foreign detainees. With no sense of compassion or justice, the soldiers of Abu Ghraib were free to express their darkest desires upon the captives with no apparent repercussions. The prisoners were dehumanized, giving the soldiers a free pass to torment, torture, and even murder the detainees.

## Conclusion

In the case of the Guatemala Syphilis Experiment, John C. Cutler and his colleagues succumbed to the Lucifer Effect. Their unyielding pursuit of data resulted in generations of psychological and physical distress for the Guatemalan people, as well as a negative portrayal of the United States's role in medical research. In Abu Ghraib, soldiers dehumanized the detainees, which led to horrendous acts of obscene torture performed with no consequences. Both cases had higher goals, curing syphilis in Dr. Cutler's case and winning the War on Terror in Abu Ghraib's case. These goals clouded the judgement of the participants, causing them to dehumanize the foreigners. This dehumanization justified the mistreatment of the Guatemalans and detainees, leading to public relations nightmares for the American government to handle.

## References

* 1 2 Rasnake, Mark S., History of U.S. Military Contributions to the Study of Sexually Transmitted Diseases
* ↑ Encyclopedia of Military Science, Edited by Piehler, G. Kurt, Pg 1263
* 1 2 3 4 Center for Disease Control: U.S. Public Health Service Syphilis Study at Tuskegee, http://www.cdc.gov/tuskegee/timeline.htm
* 1 2 John C. Cutler, Tuskegee and Guatemalan Syphilis Doctor, in His Own Words, http://historynewsnetwork.org/article/132061
* 1 2 3 4 5 6 7 8 Human experiments: First, do harm, http://www.nature.com/news/human-experiments-first-do-harm-1.9980
* ↑ Records of Dr. John C. Cutler, http://www.archives.gov/research/health/cdc-cutler-records/
* ↑ Altman, Lawrence K., "Of Medical Giants, Accolades and Feet of Clay" http://www.nytimes.com/2013/04/02/health/link-to-ethical-scandals-tarnishes-prestigious-parran-award.html?_r=0
* 1 2 Tuskegee Syphilis Experiment-Guatemala-Dr. John C. Cutler, https://www.youtube.com/watch?v=yi5RNp2XS3k
* 1 2 3 Semeniuk, I. (2010). A shocking discovery. Nature, 467(645).
* 1 2 3 http://www.nytimes.com/2010/10/02/health/research/02infect.html?_r=0
* ↑ The White House Office of the Press Secretary. (2010, October 1). Read-out of the president's call with Guatemalan President Colom [Press release].
* 1 2 BBC. (2010, October 1). U.S. medical tests in Guatemala 'crime against humanity'. http://www.bbc.co.uk/
* ↑ Doyle, K. (2011, April 5). Decades later, NARA posts documents on Guatemalan syphilis experiments. http://nsarchive.wordpress.com/
* ↑ Matalone, L., The World, PRI, BBC, & WGBh. (2010, November 26). Guatemala syphilis study still provokes anger. The World. http://www.theworld.org/
* 1 2 Guatemala played a role in the U.S. 1940s syphilis experiment, says victims' lawyer http://world-news.mpelembe.net/home/guatemala-played-a-role-in-the-us-1940s-syphilis-experiment-says-victims-lawyer
* ↑ Huffington Post. (2012, June 23). Guatemala syphilis study lawsuit: Dismissal despite United States experiments on natives in 1940s. Huffington Post. http://www.huffingtonpost.com/
* ↑ CBCNews. (2012, June 13). Lawsuit over U.S. Guatemala syphilis experiment dismissed. http://www.cbc.ca/
* ↑ Zimbardo, Philip http://www.lucifereffect.com/about_synopsis.htm
* ↑ Zimbardo, Philip http://www.lucifereffect.com/dehumanization.htm
* ↑ Hanley, Charles J., (2004) Early accounts of extensive Iraq abuse met U.S. silence, http://www.semissourian.com/story/137193.html
* ↑ Hanley, Charles J., (2003) Former Iraqi detainees tell of riots, punishment in the sun, good Americans and pitiless ones, http://legacy.utsandiego.com/news/world/iraq/20031101-0936-iraq-thecamps.html
* ↑ Worden, Leon, (2004) Karpinski: Rumsfeld OK'd Methods at Abu Ghraib, http://www.scvhistory.com/scvhistory/signal/iraq/sg070204.htm