File 020 · 1946–1948 · Medical ethics

The Guatemala syphilis experiments

US Public Health Service doctors deliberately infected prisoners, soldiers and psychiatric patients in Guatemala with syphilis to test treatments, without their consent. The US government apologized in 2010.

Background

In the 1940s penicillin was a new drug and researchers wanted to know whether it could prevent sexually transmitted infections as well as cure them. A team led by Dr. John Cutler of the US Public Health Service went to Guatemala, where US-funded work could be done with fewer restrictions than at home. They worked with Guatemalan health officials and used prisoners, soldiers, sex workers and patients at a psychiatric hospital as subjects.

Participants were exposed to syphilis and other diseases, some by direct inoculation, and none gave informed consent. The work went largely unnoticed until 2010, when Wellesley College historian Susan Reverby found Cutler's papers in an archive while researching the Tuskegee study, on which Cutler also worked.

What the record shows

• Cutler's own records, which survive, list the people exposed and the methods used.
• The 2011 bioethics commission report documented that researchers deliberately exposed people to infection, and that the research was unethical even by the standards of the time.
• Estimates differ by source: roughly 700 people were deliberately infected, and the commission counted more than 1,300 people in total exposed to one or more diseases.
• Records list at least 83 deaths among the subjects, though they do not show how many were caused by the experiments.

Timeline

• 1946–48 Experiments are carried out in Guatemala with US funding.
• 1950s The results are never published in full; Cutler later takes part in the Tuskegee study.
• 2010 Susan Reverby publishes her findings from Cutler's archive.
• 1 Oct 2010 Secretary of State Hillary Clinton and Health Secretary Kathleen Sebelius issue a joint apology; President Obama phones Guatemala's president.
• 2011 A presidential bioethics commission calls the experiments 'unconscionable' and publishes a detailed report.

Checking the claims

The claim: the US government experimented on foreign people in a way it would not have allowed at home. The documents confirm this. The archived correspondence shows that some officials in Washington were uneasy about the project and that Cutler was aware of how it could be perceived if the public found out.

It also shows what the record does not: there is no evidence of a plan to hide the experiments for decades. They were simply not publicized, and the findings were not widely used. The lesson most researchers draw is about how research ethics rules, such as informed consent, were applied unevenly depending on who the participants were.

Claimed, but not shown

The documented wrong is the deliberate exposure of unwitting people to disease. Claims about a secret plan to harm a whole population are not supported.

Verdict

Sources

• Presidential Commission for the Study of Bioethical Issues, 'Ethically Impossible': STD Research in Guatemala from 1946 to 1948 (2011)
• Susan M. Reverby, 'Normal Exposure and Inoculation Syphilis', Journal of Policy History (2011)
• Joint statement by Secretary Clinton and Secretary Sebelius, 1 October 2010

Connected files (red threads)

• The Tuskegee Study — The same doctor worked on both; both are cases of research without consent
• MKUltra — More experiments on people who had not agreed to them
• Operation Sea-Spray — Cold War-era testing on people who did not know

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