By Dan O’Connor, PhD


Earlier today, President Obama’s bioethics commission released, “Moral Science“, their report on protections for human research subjects. The report was inspired by historian Susan Reverby’s expose of a 1940s research study, funded by the US government, which saw the deliberate infection of prisoners in Guatemala with syphillis. The question the report seeks to answer is, essentially, could this happen again?


To this, commission Chair, Prof Amy Gutmann, responds: “The Commission is confident that what happened in Guatemala in the 1940s could not happen today.”

 

This is perhaps unsurprising, given the vast changes that have taken place in human subjects research protections since the 1940s. The 1950s saw the growth of internal hospital oversight committees, as well as the emergence of the ‘gold standard’ clinical trial – both of which developments placed constraints on the unfettered freedom of the physician researcher. The 1960s, of course, saw the first stirrings of public scandal around human experimentation – most obviously in Henry Beecher’s classic list of unethical research studies – and the federal government’s linking of funding to the existence of Institutional Review Boards. The 1970s saw the greatest scandals – Tuskegee, Willowbrook, DepoProvera – and a concerted legislative effort to regulate the conduct of research and the ethics which guide it. This culminated, in this truncated history at least, in the publication of the Belmont Report and the enshrinement of the holy trinity of informed consent, risk/benefit balance and fair subject selection in federal regulations regarding human subjects research. Since Belmont, ‘research ethics’ has emerged as a professional speciality within the law and public health and, most obviously, within bioethics itself. The regulatory apparatus that now surrounds human subjects research in the United States is vast, encompassing tens of thousands of lawyers, nurses, ethicists, physicians, pharmacists, community representatives, consent form specialists and compliance officers. Indeed, it would be very surprising if the president’s bioethics commission had come to any other conclusion than that to which they came.

 

And yet…

 

When Prof. Gutmann says that “The Commission is confident that what happened in Guatemala in the 1940s could not happen today”, I think it is important for us to be clear about the meaning of ‘what happened in Guatemala’.

 

We know what happened in Guatemala – Susan Reverby has done an entirely brilliant job of elucidating the foul procession of unethical activities which took place there. We know that researchers from the US Public Health Service deliberately infected prisoners – some barely teenagers – with syphillis. The details need not trouble us here (although, make no mistake, they are nothing if not troubling), but long story short: an almost complete lack of oversight within the federal government allowed the Guatemala studies to happen. The abbreviated history I gave you above could well be characterised as little more than the massive expansion of oversight of human subjects research. Upon this shift lies the commission’s confidence ‘that what happened in Guatemala in the 1940s could not happen today’.

 

Here, ‘what happened in Guatemala’ is a stand-in for ‘US-funded researchers deliberately infecting vulnerable persons with a disease’ and so the commission is quite right to be confident that it won’t happen again. I’m not going to suggest that the current system of oversight is perfect (no-one can sit on an IRB and hold such a view, I imagine), but if it does anything well it is protect against reckless risk and endangerment.

 

But what if there is a different meaning to ‘what happened in Guatemala’? What if the meaning of ‘what happened in Guatemala’ wasn’t ‘US-funded researchers deliberately infecting vulnerable persons with a disease’ but ‘researchers from a quasi-colonial power deliberately abusing an imbalance of political and economic power to exploit colonial subjects and further their own scientific interests’?

 

During the period of the Guatemala studies, the United States operated, in effect, as an occupying colonial power in Guatemala. We are not talking here, about an official imperium in the manner of the British or Roman Empires, but rather a matrix of economic and political ties which, almost exclusively, operated in the favor of US government and corporations at the expense of the Guatemalan people and land. In this, we ought to note, the (not entirely legitimate) Guatemalan government of the time was wholly complicit. The US, despite their avowedly anti-imperial foreign policy history, had numerous quasi-imperial arrangements throughout the twentieth century – most notably in Japan directly after WWII, but also in the Phillipines and any number of minor Central American nations. In these quasi-imperial situations (as in truly imperial settings), actors from the colonial power (the US) are able to exploit the local population for their own benefit, because of the imblance of power which defines empire.

 

The United Fruit Company played a

very significant role in early 20th C.Guatemala


This is, it seems fair to say, what happened in Guatemala: agents of a quasi-imperial power exploited the local people in order to advance (or try to advance) their interests (in this case, a pre-infection treatment for syphillis – a nice way of not having to send soliders home from battle when they caught the clap).

 

So, if the meaning of ‘what happened in Guatemala’ isn’t ‘US-funded human subjects protection violations’, but ‘quasi-imperial exploitation of colonised persons’, then can we be quite so confident that it will not happen again?

 

Certainly, we can, I think, be reasonably confident that the US federal government will never again operate as a quasi-imperial power in this fashion. The oversight mechanisms now in place make it all but impossible, even if there were the institutional desire within HHS or the NIH to exploit vulnerable persons, which there is not.

 

What’s interesting though, is that as the US and other nation states have slowly ceased to act as quasi-imperial (or just imperial) powers, their trans-national reach has been taken up by global corporations. Today, it is not the US which operates as a quasi-imperial power, but global corporations. Myriad are the examples from the developing world of local populations exploited and used for the benefit of multi-national corporations with head-quarters and shareholders located far far away. Think of the oil reserves of Nigeria. Think of the rainforests of Brazil. Think of the mineral wealth of Namibia. Some global corporations operate as quasi-imperial entities, making use of the imbalance of power that implies, in order to further their own interests. It would hardly take a conspiracy theorist (or even John leCarre) to speculate that an multi-national pharmaceutical organisation could, quite easily, avoid the stringent oversight of the US government in order to further their own economic interests and, in the process of research, deliberately infect vulnerable persons in a developing nation.

 

The president’s commission of bioethics has, I think, done a great job of showing how the US government’s current system of oversight would never permit US-funded researchers to deliberately infect people. Indeed, the commission’s recommendation of a public database of federally-funded research, would only strengthen this state of affairs. Nevertheless, the commission has only answered this one ‘meaning’ of ‘what happened in Guatemala’. I am not so confident that, if the meaning of ‘what happened in Guatemala’ is ‘quasi-imperial exploitation’, it could never happen again.

 

Dan O’Connor – Research Scientist, Faculty, Johns Hopkins Berman Institute of Bioethics. Dan has two main research areas: the ethics of social media in healthcare and historicising the ethics of emerging diseases

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