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Ethics gone awry: the US Public Health Service studies in Guatemala; 1946–1948
  1. Jonathan M Zenilman
  1. Correspondence to Dr Jonathan M Zenilman, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Center Tower 381, Baltimore, MD 21224, USA; Jzenilma{at}

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In October 2010, the public became aware of a massive clinical research enterprise on sexually transmitted infections, conducted in Guatemala during 1946–1948.1 As the story unfolded it became very clear that the conduct of the studies was clouded by egregious ethical violations. The revelations prompted an official apology by the US Secretary of State Hilary Clinton to the Government of Guatemala, and a subsequent investigation by the Presidential Commission for the Study of Bioethical Issues, resulting in a final report that was issued in September 2011.2

The archival materials for the Guatemala studies were discovered inadvertently by Dr Susan Reverby, a historian at Wellesley College, whose work has focused on the infamous Tuskegee studies of untreated syphilis, which occurred from the late 1930s through 1972. Reverby's work focused primarily on experiential history, from the view point of the research subjects, of the health professionals who participated in the studies, and then how the story of the study travelled through the American cultural landscape.3–5 The principal figure in the Guatemala studies, Dr John Cutler, was also a physician in the Tuskegee study group at the United States Public Health Service (USPHS), and who was also an author on a number of the Tuskegee publications.6 ,7

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While researching the Cutler archive at the University of Pittsburgh, Dr Reverby discovered documents which described the Guatemala enterprise. After performing an extensive review, she contacted Dr David Sencer, the former Director of the U.S. Centers for Disease Control and Prevention, who in turn contacted CDC officials. During the summer of 2010, the US Government recovered the Cutler documents from Pittsburgh and instituted a formal review, which included an initial review of the documents by a Centers for Disease Control (CDC) team. This work, although preliminary, clearly identified major ethical lapses in …

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  • Competing interests The author was a technical consultant to the US Government and received consulting fees from the US Presidential Commission for the Study of Bioethical Issues. The opinions expressed here are the authors’ and do not represent the official positions of the US Government.

  • Provenance and peer review Commissioned; internally peer reviewed.

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