Guatemala: New Research on Ethical Violations by White Researchers

Susan Reverby, a Wellesley College professor, recently discovered records that reveal a two-year study designed by white researchers and supported by the U.S. government was conducted in which people in Guatemala were intentionally infected with sexually transmitted diseases (STDs).

This STD study conducted from 1946-48, health researchers from the United States and Guatemala intentionally infected Guatemalan sex workers, prisoners, soldiers, and hospitalized psychiatric patients with gonorrhea, chancroid, and syphilis.  Reverby’s student prompted the U.S. Department of Health & Human services to release this information about the study.  It is officially referred to as “The 1946 STD inoculation study.”   And in an email statement, Dr. Thomas Frieden, head of the Centers for Disease Control (CDC) – the current version of the institution that originally ran the study – said this:

The 1946 STD inoculation study should never have happened.  We are committed to the respect and safety of research participants.  In this spirit, the U.S. government will convene an international group of experts to review and report on the most effective methods to ensure that all human medical research conducted around the globe today meets rigorous ethical standards and how training of researchers will ensure such abuses do not occur.  If you have questions or comments regarding ethical human research and this study, please send them to

This renewed commitment to ethical research by Dr. Frieden is an important one but may fail to persuade skeptical listeners familiar with the history of other ethical violations.

The fact is that the researcher who discovered the Guatemalan study made this discovery in the archived papers of Dr. John Cutler, a U.S. public health researcher who was also involved in the Tuskegee syphilis study.  Cutler was white and all the “participants” in the study were African American men.   While the Tuskegee study design did not intentionally infect subjects with syphilis (a common misunderstanding), the researchers violated medical and research ethics by withholding treatment – a simple shot of penicillin – that would have effectively cured the disease.   Further, the men in the study were never told that they were being used as research subjects.   The combination of these two facts (withholding medical treatment that would have cured the disease, and not telling them they were research subjects) are used as textbook examples of ethical violations in research.   The additional, and some could argue, central fact that these were white researchers violating the human rights of black subjects is an ethical violation that continues to reverberate today in a variety of ways.    (For further research on Tuskegee, see James H. Jones’ classic text, Bad Blood and the more recent, and broader in scope, Medical Apartheid, by Harriet Washington.)

The reality is that the actions of Cutler, in Tuskegee and Guatemala, were not the isolated actions of a “bad apple” working outside the aegis of the CDC (and its predecessor organization, the U.S. Public Health Service).   He was a well-respected M.D. and public health researcher who defended his involvement in the Tuskegee study until his death in 2003.  (For video footage of Cutler defending Tuskegee on camera, be sure to see the documentary The Deadly Deception, which also includes interviews with a handful of the survivors of the study.)

Both the studies designed by Cutler, in Guatemala and in Tuskegee, Alabama, were premised on several notions that remain with us today.  First, is the notion that the pursuit of “scientific knowledge” is a worthwhile goal in and of itself, followed closely by the idea that pursuing this goal justifies almost any means necessary to achieve it.  Still with us, too, is the idea that white researchers are somehow entitled to the biological “resource” of others.   As a society, we continue to subscribe to the idea that there are some groups of people who, because they are less powerful, it’s okay to conduct research on them.   Perhaps the key idea underpinning Cutler’s research was that the “course of the disease” of syphilis would be different in blacks (or Guatemalans) than in whites.  Today, many continue to cling to facile notions of racial differences in biology, while research consistently show these are insignificant.  These ideas, taken together, share much in common with the worldview of the doctors that Robert Jay Lifton describes in his book, Nazi Doctors, about the physicians who practiced medical experimentation on Jews held in concentration camps.    In an interview with Cutler, James H. Jones asked him whether he saw any similarity between his study at Tuskegee and the experimentation in the death camps.  Cutler, looking incredulous and wounded, replied, “But they were Nazis!”

When the panel Frieden is convening comes together, they would do well to not only review the historical legacy of racism in public health, but keep in mind the way these ideas continue to permeate public health research today.