A presidential ethics panel on Monday excoriated the late John C. Cutler, a former assistant U.S. surgeon general and an acting dean at the University of Pittsburgh, for deliberately infecting more than 1,000 Guatemalan prisoners, mental patients, soldiers and prostitutes with syphilis from 1946 to 1948, some of whom died.
The Presidential Commission for the Study of Bioethical Issues concluded that Dr. Cutler's experiments were morally indefensible, even for the standards of the time, and that he and his fellow U.S. Public Health Service doctors tried to keep secret what they were doing because they knew it was wrong.
Commission Chair Amy Gutmann, president of the University of Pennsylvania, said the doctors had a duty to "first do no harm" and to protect vulnerable populations.
"Clearly in this history we failed to keep that covenant," she said.
The commission spent the past nine months preparing a historical report on Dr. Cutler's unpublished research, which will be presented to President Barack Obama in the next two weeks. [See the June 12 PG article "Before Tuskegee, the Guatemala Experiment"]
As a prelude to that report, the panel provided an overview at a public meeting in Washington, D.C., detailing what members described as "basic violations of ethics" revealed in a review of some 125,000 pages of documents, including 12,000 pages of Dr. Cutler's own papers that he donated to Pitt in 1990.
The panelists said Dr. Cutler, whose boss at the time was Surgeon General Thomas Parran, founder of Pitt's Graduate School of Public Health, had to have been aware that he was violating the rights of his subjects.
Just a year before, they said, he had conducted venereal disease experiments on federal prisoners in Indiana in which volunteer inmates were informed of the nature of the research.
The panelists said he afforded his Guatemalan subjects no such protections and did so because he felt the ends justified the means.
In one case, the commission said, Dr. Cutler noted that a psychiatric patient named Berta appeared to be dying. Yet he still infected her with syphilis, introducing it through her eyes and her rectum. She later died.
The report indicates that 82 other subjects also died, although no one can say if their deaths were the direct result of the research. Several died of meningitis after Dr. Cutler and his colleagues performed lumbar punctures.
Dr. Gutmann said Dr. Cutler "did not treat them as human beings. He thought of them as material" for study.
The panel also lambasted him for not adhering to scientific standards, describing his record-keeping as sloppy and his methodology as haphazard. Some experiments were started even before others had ended, they said, and note-taking was sporadic at best.
"I'm not sure he really knew what he was doing, scientifically," said Nelson Michael of the Walter Reed Army Institute of Research, head of the U.S. military's HIV research program. "It just was bad science."
The idea of the experiments was to test the effectiveness of penicillin in preventing syphilis immediately after exposure, but none of the subjects were told they were being infected.
Even for the 1940s, when human subject research was not as vigorously safeguarded as it is today, Dr. Cutler's experiments were "bereft of merit," Dr. Michael said.
The commission cautioned that Dr. Cutler should not be judged alone, noting that many others at the Public Health Service knew what was happening and gave their consent. Those who did raise concerns, panelists said, were bypassed.
Mr. Obama last year apologized to the president of Guatemala for the study and gave his commission two mandates: Make sure no one is still doing this kind of thing; and unearth everything you can about the research.
According to Dr. Cutler's personal papers, stored at Pitt for two decades and recently released by the National Archives, the Public Health Service used taxpayer money to pay syphilis-infected prostitutes to sleep with prisoners and later introduced syphilis directly through scrapes made with needles on men's penises.
His wife, Eliese Cutler, was his photographer; the files contain hundreds of pictures that she shot for him with special photography equipment flown in from New York.
At 93, she lives in the same home she shared with Dr. Cutler until his death. In a brief interview in the spring, she said she was "just his wife" and refused to discuss the research or the controversy about it.
"That was 70 years ago," she said. "I don't want to talk to you."
But other people are talking, including the descendants of the subjects. They filed a federal suit in March against the U.S. government, saying the study represents "egregious violations" of human rights. The case is on hold pending the commission's report.
These developments haven't gone unnoticed at Pitt, where the legacies of Dr. Cutler and Thomas Parran are at stake.
Dr. Parran, who oversaw everything the Public Health Service did in the 1930s and '40s, founded Pitt's Graduate School of Public Health in 1948. Dr. Cutler came to Pitt in 1967 and served as acting dean of the Graduate School of Public Health in 1968 and 1969.
Pitt officials are awaiting the bioethics report, but the school already took some action in 2008, when a new dean, Donald Burke, discontinued a memorial lecture series created in honor of Dr. Cutler after he died in 2003.
Dr. Burke said he canceled the series because of "community sensitivities" regarding Dr. Cutler's role in the infamous experiments at Tuskegee, Ala., in which the Public Health Service withheld syphilis treatment for black sharecroppers for 40 years to track the disease.
Dr. Cutler had a dismissive attitude about concerns over the Tuskegee subjects, in one national TV appearance saying "some will die. It's in the interest of the total society."
The John C. Cutler Memorial Global Health Fund, established with contributions from hundreds of donors and worth about $100,000, is now being used to pay scholarship, research and travel awards for Pitt students involved in global health projects.
After the Guatemala revelations broke, Dr. Burke held a panel discussion featuring Susan Reverby, the Wellesley College professor who uncovered the Cutler files while researching her book, "Examining Tuskegee."
Ms. Reverby said the Guatemala study has to be evaluated in the context of the times, but even with that perspective, she said the correspondence in the Cutler files is damning. In one letter he indicated that he would infect his subjects "without any mention of our techniques," and in others he warned against too much talk.
Dr. Parran was an advocate, too. When he retired to come to Pitt, the researchers were alarmed.
"We do know that we have lost a very good friend and that it appears to be advisable to get our ducks in line," wrote one of Dr. Cutler's supervisors in 1948. "In this regard we feel that the Guatemala project should be brought to the innocuous stage as rapidly as possible."
Another supervisor expressed concern about the use of mental patients because "if some goody organization got wind of the work, they would raise a lot of smoke." He suggested they use soldiers.
In the end, the Guatemalan study shut down and Dr. Cutler returned home. "Cutler put the final report and hundreds of photographs his wife had taken in his papers," wrote Ms. Reverby in a research paper, "the only record of his decades-long research career left behind."
One curious aspect of this story is why he hung onto those records.
Ms. Reverby has three theories.
Maybe he was proud of the study and hoped someone would recognize the good work he did. Maybe he felt guilty and hoped someone would someday expose it.
Or maybe, Ms. Reverby said, "it was just taking up too much space in the house."
Torsten Ove: firstname.lastname@example.org or 412-263-1510.