When doctors deliberately infected people with deadly microbes without informing them
A shameful chapter in medical history which came to light recently. Also, why we need clinical trials, why history repeats itself, and how bananas got to the Levant from India.
Hello! How have you been? We’ve only been through one week in 2021, but it’s felt like a year, hasn’t it?
I have an announcement at the end of the newsletter, but I want to get to the main topic of this newsletter first.
A shameful saga uncovered by accident
There are many examples in the brief history of modern medicine that show why transparency, independent review, and accountability when running medical experiments are necessary.
I’m going to recount a rather gruesome incident where everything went horribly wrong, and where gross misconduct and malpractice only came to light recently by accident. The incident is historic, but the lessons are clear. Informed consent of participants is important in clinical trials, even during a pandemic. Doctors must be held accountable and results of all medical experiments should be made public.
The bottom line of this story is reprehensible.
After World War II, American doctors deliberately infected around 1,300 people in Guatemala with gonorrhea, syphilis, and chancroid without their consent.
The experiments in Guatemala were done at the same time that hundreds of Black men were also being infected with syphilis in Tuskegee by the US Public Health Service and the Centers for Disease Control.
The entire saga in Guatemala reeks of heinous malfeasance, racism, wonton cruelty, and exploitation of vulnerable populations in a developing country. And an infuriating aspect is that no one has ever been punished for it. No victim has ever received any compensation. In fact, for decades the public was unware that such experiments had occurred.
Perhaps, you have never heard of these experiments before either. Some of the details are downright shocking.
Unsuspecting vulnerable populations in a “Third World” country were deliberately infected as part of a gruesome U.S. government medical experiment. The tests took place between 1946 and 1948. Over 5,500 Guatemalans were involved. Of the 1,300 who were deliberately infected with gonorrhea, syphilis, and chancroid perhaps 700 received treatment.
Not a single Guatemalan was informed of what was going on.
At least 83 Guatemalans died from the experiments. Many who survived the ordeal passed the venereal diseases to the rest of their family.
The team of American doctors were led by the renowned physician John Cutler, who had also participated in the Tuskegee syphilis experiment. Fearing public backlash, Cutler kept his experiments secret. However, Cutler’s superiors were complicit in these unethical experiments.
Those who were infected included orphans (including children as young as ten), patients of psychiatric wards, prostitutes, and military personnel. Not only were patients left untreated, but there are also documented cases where Cutler reinfected those who were already sick and let them die.
John Cutler faced no repercussions. In fact, he led a respectable life as a distinguished academic.
Cutler became assistant surgeon general of the US in 1958. Later he served as professor of international health at the University of Pittsburgh and acting dean of the Graduate School of Public Health. After his death in 2003, the university started a lecture series in his honor (which was later discontinued).
After Cutler’s death, a Wellesley College professor Susan Reverby found the original records of the experiments while searching for documents of the Tuskegee syphilis study. She found boxes of records that had been forgotten and accounts of experiments written in cold language. Had Reverby not unearthed these documents and contacted government officials, this sordid episode might’ve been forgotten.
In 2010, the Obama administration formally apologized to the people of Guatemala. Guatemalan President Álvaro Colom called the practices "crimes against humanity".
Two years later, a group of Guatemalan survivors filed a lawsuit in the U.S. The case was dismissed later that year without any compensation.
Do we need clinical trials before administering drugs and vaccines?
A lot of well-intentioned people ask, “do we need clinical trials during a pandemic?” They argue that a pandemic is not business as usual: why not give people drugs without going through preclinical trials in animals and three phases of clinical trials? And in fact safety data from trials don’t just end with provisional or emergency approval. They are accrued for many years. I’m talking about the design and need for clinical trials for vaccines and drugs (in general, and for COVID-19) in great detail in COVID-19: Separating Fact from Fiction, but a word is necessary.
During the horrific Ebola outbreak of 2014-2016, a World Health Organization and US National Academy of Medicine committee report addressed this topic, realizing there might be multiple perspectives. The emphasis below is mine.
Planning and conducting clinical research during the Ebola epidemic required confronting a number of ethical issues. First and foremost, stakeholders debated whether it was ethical to conduct clinical trials at all in the midst of a public health emergency…Properly designed clinical research is essential for answering questions about disease processes and for evaluating the safety and efficacy of potential therapeutics and vaccines; indeed, for diseases such as Ebola, an outbreak or epidemic presents the only opportunity to conduct such research. The high mortality of Ebola and the uncertainty about how the epidemic would progress produced a sense of urgency to quickly identify effective therapeutics or vaccines. Despite this sense of urgency, research during an epidemic is still subject to the same core scientific and ethical requirements that govern all research on human subjects.
The committee also discussed which kinds of clinical trials would be suitable and agreed that even in a pandemic randomized controlled trials with some patients receiving drug and others placebo (and both blinded) was the best option.
Quoting from the report—
There was a great deal of disagreement among researchers over how clinical trials should be designed during the Ebola epidemic, particularly over whether trials should use randomization and concurrent control groups. Randomized controlled trials (RCTs) are the preferred research design because they allow researchers to directly compare the outcomes of similar groups of people who differ only in the presence or absence of the investigational agent… This committee found, however, that the RCT was an ethical and appropriate design to use, even in the context of the Ebola epidemic.
Whether it’s drugs or vaccines for COVID-19, we have to run randomized controlled trials. Period.
Time is a flat circle
The 16th century manual on social distancing
During a 16th plague outbreak in a small Sardinian town, people were told to keep six feet apart, avoid handshaking and minimize interactions during shopping. Four hundred years ago there was a manual on preventing the spread of infectious diseases.
First, citizens were advised not to leave their houses, or move from one to another. Along these lines, Angelerio also forbade all meetings, dances and entertainments – and stipulated that only one person per household should leave to do the shopping, a rule that should be familiar to many enduring pandemic restrictions today.
Immunity hierarchies of the 19th century
Today it is famous for jazz, good food, and Mardi Gras, but New Orleans has a dark past. It was once nicknamed Necropolis— city of the dead— because of a virus. Today we are talking about vaccine certificates and immunity passports for those vaccinated against COVID-19 and those with antibodies, but this isn’t a new idea.
A social hierarchy developed in New Orleans around who was "acclimated" (people who had lived through yellow fever) and "unacclimated" (people who hadn't).
"If you're unacclimated, you basically languish in professional and social purgatory," says Olivarius, who is writing a book about how the disease shaped the city's social structure. "Bosses will not hire clerks and bookkeepers who are not expressly acclimated. Women will not marry men not described as acclimated. You can't live in certain neighborhoods, and people will not rent rooms unless you're acclimated. Certain social circles will exclude you. And so this creates this hierarchy where you have people who are actively seeking to get sick."
Plants that originated in India were eaten in the Middle East 3,700 years ago
Looking at tooth tartar of people who lived in the Levant, scientists now know they ate bananas, soybeans, and turmeric- plants that originated in ancient India. There was robust trade in "exotic" food 3,700 years ago.
Excavation of Megiddo (Area K). Credit: the Meggido Expedition
"This is the earliest direct evidence to date of turmeric, banana and soy outside of South and East Asia."
The findings of this study confirm that long-distance trade in culinary goods has connected these distant societies since at least the Bronze Age. People obviously had a great interest in exotic foods from very early on.
A companion piece summarized the broader point of the study.
We need to get rid of the assumption that people in the past only ate what grew in their immediate surroundings.
The results are pretty incredible, but the analytical tools are impressive too. It’s hard to imagine that scientists can look at teeth scum from 3,000-4,000 years ago and know what people ate. I don’t know about you, but I’m certainly brushing and flossing my teeth a little better tonight.
Here’s the link to the Kindle version on Amazon.com.
Here’s the link to the hardcover version on Amazon’s Indian site.
Here’s an excerpt of the book in which I talk about how so many COVID-19 vaccines were developed so quickly (and why they’re not the same).
If you enjoy the book, please do leave me a review on Amazon or on Goodreads.
I will have more information on the Kindle and U.S. versions when they become available.
Writing a book is a conscious act of isolation. More so during a pandemic. I had never imagined writing about the reason for the withdrawal of humanity during months of actual physical isolation. I’m grateful to my family and friends both near and online for keeping me sane and rooted. Thank you!
I owe a debt of gratitude (which I can never repay) to those who read and reviewed chapters and provided input, and to everyone online who I had discussions with last year. Trust me. It’s all in the book.
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Keep us posted about kindle version.