TRANSCRIPT, Meeting 6, Session 1

        

              DR. HAUSER:  Thank you, Jim.  Delighted to.

  Fellow Commission Members and audience, my name is

  Stephen Hauser from the University of California, San

  Francisco.

            I would like to just briefly describe the

  details of the experiments that were carried out in

  Guatemala during this two-year period between 1946 and

  1948 and maybe as a prelude just very briefly discuss

  the scientific environment and milieu at this time.  I

  think without that, it's harder to understand the

  rationale for what happened in Guatemala.

            As we all know, sexually-transmitted diseases

  throughout the 20th Century have been a giant problem,

  both in the military and civilian populations.  In the

  military, it was estimated that hundreds of thousands

  of individuals would become infected if we could not

  develop effective prophylactic therapy post-exposure.

  In the civilian populations, these illnesses,

  particularly syphilis and gonorrhea, were also very

  widespread.

            Just as one example, it's been estimated that

  at least 20 percent of people living in psychiatric

  institutions at the time were there because of

  neuro-syphilis.  So these were enormous problems.

            How was disease prevented in the mid 20th

  Century? Well, the primary method was chemical

  prophylaxis.  I will say a few things here that are

  graphic but I will keep these to a minimum, but I think

  that without understanding a bit of the graphic detail,

  it's very difficult to understand what was done.

            Soldiers were advised after exposure to

  urinate, to wash themselves with soap and water, and

  then for gonorrhea to inject a silver solution directly

  into their urethras in the penis, and for syphilis to

  rub a calomel ointment on their genitals and pubic

  region.  I would say that the evidence that these

  chemical measures were useful was very limited at the

  time.

            There was a new very exciting advance for

  treatment of established infection, of course, with the

  development of antibiotics.  Sulfanilamide first, a sulfa

  drug for gonorrhea, in 1938, and for syphilis,

  penicillin, which was extremely effective for

  established infections, first reported in 1943,

  replaced arsenic-based therapies and earlier very toxic

  mercury-based treatments.

            So there was an earlier attempt to study the

  effectiveness of some of these prophylactic measures in

  the Terre Haute Prison earlier in 1943 to 1944 that was

  unsuccessful and these experiments included inoculation

  of some prisoners with gonorrhea.

            So it was with that as a background, as Dr.

  Wagner said, the first question that I will summarize

  is the following:  what scientific questions were the

  researchers trying to answer?  Some of what we've

  learned is retrospective, some of it is work based upon

  the reports as long as a decade later of the principals

  involved in the studies.  So there is very little

  information or proof in certain aspects of our

  understanding of this question.

            However, as stated later, in 1955, the overall

  goal was to develop an effective prevention called

  prophylaxis after exposure to syphilis as well as

  gonorrhea and then, as a second goal, prolonged

  observation of individuals exposed to early syphilis

  and treated with penicillin.

            According to Dr. Cutler, the original primary

  aim was to test this local wash named orvus mapharsen

  against syphilis in prisoners who had recently had

  sexual activity with an infected commercial sex worker.

  This primary goal never happened.

            The experimental transmission of syphilis to

  human volunteers aligned with the desire to find

  improved methods of prophylaxis was another aim.  The

  primary purpose of the gonorrhea experiments was to

  test the effectiveness of a variety of prophylactic

  measures, including a number of chemical lotions as

  well as oral penicillin.

            In his later writings, Cutler wrote that other

  aims included trying to understand the changes in the

  blood and in the body that occurred following injection

  of syphilis organisms and whether these changes were

  different when the syphilis was taken from rabbits who

  had been passaging the syphilis or from humans who were

  infected with syphilis.  So were the organisms

  different when they were coming from the experimental

  laboratory animal or directly from humans?  Was

  virulence lost when it was passaged in animals?

            What was the effectiveness of a broader

  penicillin therapy and intramuscular penicillin

  prophylaxis, and could treated subjects with early or

  late latent syphilis become re-infected?

            So the second question involves what methods

  were used to carry out these studies and they were

  basically of two main types, serologic studies, looking

  at blood and other fluids, and intentional exposure and

  inoculation studies.

            The serologic studies included blood draws,

  preparation of smears, taking tissue from the local

  areas and culturing these materials.  They also

  involved lumbar punctures or spinal taps to sample

  fluid bathing the surface of the brain and spinal cord

  and cisternal punctures which are punctures in the neck

  rather than in the lower back as is the case for lumbar

  puncture.  So those were the serologic studies done.

            The intentional exposure experiments that

  consisted in total of about 50 different experiments

  involved, first for gonorrhea, what was called normal

  exposure which is exposure through sexual contact with

  an infected carrier, a commercial sex worker.

  Artificial direct inoculation, for sex workers

  inoculation by swabbing the cervix, for males

  inoculation inside the penis, sometimes following

  sexual exposure, and also inoculation in other body

  parts, including the rectum and the eyes.

            For syphilis experiments, there were

  experiments performed in which there was sexual contact

  with known infected commercial sex workers, direct

  injections into the cervix.  There were also

  experiments, called scarification and abrasion, where

  the penis would be scarred or abraded to make the

  epidermis possibly more accepting of the subsequently

  inoculated organisms.

            For chancroid, another sexually-transmitted

  disease, there was a single experiment involving

  abrasion of the penis, the arms, and the back.

            So let's speak about who was involved, what

  populations of individuals were involved in this series

  of experiments.  Commercial sex workers, prisoners,

  soldiers from the military Honor Guard which provided

  personal protection to the president of Guatemala, and

  psychiatric patients in a state-run mental institution,

  so those were the exposure populations.

            For the diagnostic testing, the serology,

  lumbar punctures, cisternal puncture population, most

  of the subjects consisted of children from an orphanage

  or school, leprosarium patients, U.S. Air Force

  personnel, and all of the other populations discussed

  previously in the inoculation studies, and again the

  serology experiments did not involve intentional

  inoculation.

            We believe that more than 5,000 individuals

  were involved in diagnostic testing, serology or lumbar

  or cisternal taps, and somewhat more than 1,300

  individuals were exposed by contact or inoculation to

  one of those sexually-transmitted diseases.

            Of the 1,300, under 700 received some form of

  treatment as best as could be documented.  So this

  involved in total approximately 5,500 individuals in

  both groups which overlap.

            Of these groups, we believe that there were 83

  deaths.  We do not know to what degree the deaths were

  directly or indirectly related to these experiments but

  there are a number of ways to try to get at this that

  staff and the Commission are exploring.

            We do know that with some of the cisternal

  punctures, there was inoculation of infectious material

  and that several patients developed symptoms suggestive

  of bacterial meningitis and one person became paralyzed

  for a two-month period, almost certainly related to

  damage to the spinal cord from the needle insertion in

  the neck.

            So one last question.  Was the methodology

  sound for the standards of the day?  The Commission

  identified numerous problems with both methodology and

  recordkeeping. Multiple experiments were conducted that

  were excluded from Cutler's summary reports.  The

  note-taking was, at best, haphazard.  The experiments

  at times lacked a logical progression.  Baseline

  experiments for background infection rates, for

  example, were conducted after treatment prophylaxis

  experiments began.  So the timing of the experiments

  was suboptimal.

            More experiments were started before the

  results of the previous experiment was known.  There

  was a clear deliberate effort to deceive experimental

  subjects and also the wider community, both the

  scientific and lay community, that might have objected

  to the work.

            I would say, in conclusion, that there were

  also differences in the Guatemala experiments from the

  Tuskegee experiments.  The events occurred over a

  shorter period of time, ended at an earlier date,

  subjects in Guatemala but not Tuskegee were subjected

  to deliberate inoculation, and also in Guatemala,

  subjects were citizens of a foreign country.

            DR. WAGNER:  Thanks, Steve.  Thank you, Steve.

  Appreciate that review.

            One of the conversations I know that

  we've -- a couple of us had offline and, Nelson, I

  might go to you on this, aside from the ethics

  questions that just scream from the raw facts, talk to

  us a little bit about experimental design.  Was this

  even good science beyond that?

            DR. MICHAEL:  Thanks, Jim.  Thanks, Stephen.

  That was a great summary of the dark period.

            So I'm an experimental researcher myself.  I

  direct the U.S. Military HIV Research Program at the

  Walter Reed Army Institute of Research.  I've been

  doing science almost my entire professional life and

  when you look into what happened here, again taking off

  the ethical imprimatur which is difficult to do, when one

 does that and looks at in a cold objective way, it's actually

  difficult to perceive why these kinds of experiments

  would even pass preliminary muster for asking basic

  scientific questions in a clinical environment and

  deriving meaningful information from those kinds of

  experiments, as heinous as one would view them and one

  should view them.

            If we look at them from an objective

  standpoint, it is difficult to understand the specific

  aims.  Looking at the methodology, the absence of

  alternative strategies, the haphazard note-taking, as

  Stephen mentioned, if you look at that body of work in

  its entirety, my conclusion, and I think I said this

  pretty clearly in London, it just was bad science.  It

  was bad science.

            So regardless of what you think about the

  ethical issues and I think that it's difficult to find

  any sanction or any succor in the ethical issues which

  we'll describe and we'll talk about later, from a

  purely scientific standpoint, I found this body of work

  really bereft of merit.

            DR. WAGNER:  Barbara, yes.

            DR. ATKINSON:  I'd just like to comment the

  same way.  I absolutely agree that one of the main

  things that struck me was the work was never published

  in scientific journals by the people that did the work.

  They did -- Dr. Cutler did submit a report in 1952 for

  some of the studies and even later, I believe, for some

  of the other ones, the syphilis one wasn't reported

  till 1955, and you can wonder why it never was

  submitted or they were submitted as secret reports to

  the people that had funded it but not to scientific

  journals.

            And in my mind, it was either because the

  scientific conclusions didn't match or couldn't really

  be concluded from the way the studies were done.  The

  records were so poor and the way the studies were set

  up was so poor that you couldn't really believe the

  scientific outcome but also I think there was -- again,

  you can't separate the ethics.

            I think there was a recognition that these

  were -- had real ethical issues that would have

  horrified the public if they'd actually seen them in

  scientific journals.  So I think there were both

  aspects to the fact that this was never published.

            DR. WAGNER:  Amy, sure.

            DR. GUTMANN:  I think we are beginning with

  the science, first of all, because you can't even

  understand why these experiments were done if you don't

  know what the people who were doing them thought they

  were doing and they thought they were doing science and

  presumably they thought they were doing good science,

  but I think it's important that the Commission states

  clearly, and we will do this in our report, that there

  is no dichotomy between good science and ethics, that

  you cannot have an ethical experiment on human subjects

  that exposes human subjects to any risk, no matter how

  small, if you don't have good science.

            So good science is the precondition, it is the

  groundwork upon which any experiment with human

  subjects that's ethical can be done, and so it's very

  important if you think, well, why even ask about the

  science because there's some obvious ethical problems

  with these experiments.  The most obvious first ethical

  problem with these experiments were that they were not,

  even by the standards of the time, good science.

            DR. WAGNER:  May I ask a little conversation

  here then?  What corrupts then, Amy?  I think everybody

  agrees that there is -- you really can't divorce the

  two.  It can't be good science if it has this sort of

  violations of safety for human subjects.  But maybe we

  should have a little conversation on what were the pressures

  corrupting this.  I think one could imagine anything

  from mad science, which I don't think is entirely the

  case with Dr. Cutler, but we've spoken only about him,

  but also some of the national pressures, pressures in

  the national interests being brought to bear at that

  time.

            Nelson.

            DR. MICHAEL:  I'll be brief.  I am a military

  officer and a scientist, as well as a soldier and a

  physician So I can tell you that at the time, World War

  II was just winding down.  The United States was a much

  smaller population, had almost 11 million people in

  uniform, had just fought a war that raged across the

  entire world, and there was significant issues in terms

  of military readiness to find ways to keep troops

  healthy and doing their job and not sick and in

  hospitals.  That includes the entirety of medical

  practice, includes sexually-transmitted infections.

            So, clearly, there was that kind of pressure

  that would have provided at least some rationale for

  asking those kinds of questions, if they were asked in

  a meaningful and scientifically-rigorous way, and done

  in an ethical fashion, they would have had value.

            So I think that I've tried to ask myself

  whether or not that was really the driver for why the

  science was just so atrocious because there was just

  pressure to do that kind of work, but I must say that I

  can't find that evidence for that being a major driver.

  What I do find is a relatively junior scientist who was

  existing far away from the home laboratories that he

  reported to without much local mentorship in terms of a

  scientific mentorship and lack of periodic review.

            I think those are -- you know, I'm dealing

  with hypotheticals, but I tried to put myself in that

  individual's shoes back in 1946 and he was pretty far

  away from effective mentorship and I think his work was

  desultory and described a meandering pathway.

            I'm not sure he really knew what he was doing

  scientifically from a standpoint of rigor, but I would

  say that I think the pressures of the time of the

  military issues that were at that time had -- frankly,

  the United States was demobilizing.  We

  demobilized very, very quickly at that time.  So I don't

  think that can be a reasonable justification.

            DR. WAGNER:  Christine and then John, Nita.

            DR. GUTMANN:  Introduce yourselves, actually.

  Thank you.

            DR. GRADY:  I'm Christine Grady.  I work

  currently at the National Institutes of Health,

  Clinical Center, Department of Bioethics.

            What struck me about this question of what

  happened, the scientific questions that Steve read that

  were articulated after the fact in the reports were not

  unreasonable questions.  They were actually good

  questions. What can prevent syphilis?  You know, does

  penicillin prevent it if it's given post-exposure?

  Those are reasonable scientific questions.

            The problem is it wasn't clear from the

  history whether or not those questions preexisted the

  studies or came up later, Number 1, and, Number 2, even

  if they did preexist what the conduct of the studies,

  it doesn't justify how they tried to answer them.

            So it's a really complicated issue in terms of

  what made them do it.  I don't know that we'll ever

  really know the answer to that question, but it is

  absolutely true, also, that at that period of time,

  Nelson spoke about military readiness, but a major

  focus of research was STDs.  I mean that was one of the

  major problems in the United States for sure, maybe

  around the world, and so a lot of research was focused

  on trying to find ways to treat and prevent STDs.

            DR. WAGNER:  John.

            DR. ARRAS:  Yeah.  Thanks for that historical

  background.  It was very well done, really appreciate

  it.

            DR. GUTMANN:  Introduce yourself.

            DR. ARRAS:  Oh, I'm sorry.  John Arras.  I

  teach Philosophy at the University of Virginia.

            When we think about the moral dimensions of

  this study, we make a distinction in our report between

  contemporary standards, what we think today about the

  principles and practices in research and what people

  thought at that time, and I want to raise a similar

  question here with regard to scientific methodology,

  right, because, I mean, if you read any study published

  in a medical journal, there are always going to be

  people who are going to quibble with the methodology.

  There are always going to be people who say, well, the

  methodology isn't quite right.  It subtracts from the

  scientific value of the study.

            I'd like to get your opinions on, you know,

  the extent to which you think this set of studies

  really deviated from a contemporaneous conception of

  good enough science at the time and what was it

  precisely about the defects in their methodology that

  undercut the research.

            In other words, were the defects things that

  cast some measure of suspicion on the results or was it

  more serious than that?  Did they just completely

  subvert any kind of scientific validity that we could

  have expected?

            DR. WAGNER:  Is that to us generally or are

  you asking Steve in particular because I have my own

  view on that.

            DR. ARRAS:  Well, you know, I don't even

  pretend to be a doctor on TV, you know.  So I'm

  primarily interested in the opinions of people with

  scientific background but, you know, whoever wants to

  take a shot at it, sure.

            DR. WAGNER:  Well, it's not unusual even in

  modern science to pose a hypothesis that assumes that

  one can build an experiment around that hypothesis.

            In this case, if part of the hypothesis was what

  might be an appropriate prophylaxis for these sorts of

  diseases and the experimental design requires a pool of

  people infected and it turns out that that's the bad

  assumption, that it turns out that I can't actually

  build that experiment, and then to get stuck in that

  and run out of control because you have deviated from

  good scientific practice happens sadly all the time, I

  hope with not these sorts of tragic results, but it's

  not unusual for, particularly as you say, an unseasoned

  scientist to find that they are spending all of their

  time redefining, pursuing, reshuffling the cards of the

  experiment and almost forgetting the hypothesis that

  they had originally and losing discipline as a result

  of that.

            I'm sorry.  Steve, were you going to comment?

            DR. HAUSER:  Yes.  I would, I think, agree

  completely with Dr. Wagner's position and with what

  some of the others have said.

            The decision that one needs an experimental

  group who are infected under certain conditions so that

  you can then judge the effectiveness of therapy was

  solved by actually infecting a group experimentally.

            Second, there was a published literature at

  the time indicating that in this specific situation,

  this was unethical and not achievable.

            Third, the data was kept private and records

  not kept to standards of the time and, fourth, the data

  was not published.

            DR. WAGNER:  I think Anita was next and then

  Barbara.

            DR. ALLEN:  There seemed to be a mixing of

  research scientific goals with therapeutic goals in

  some of these experiments and the one that stands out

  that I'd love to have you comment on, Stephen, is the

  experiment in which there was cisternal puncture of

  epileptics and their rationale was, well, maybe this would

  shock the epileptics into not having seizures anymore

  which strikes me as being something that a contemporary

  neurologist might, you know, find baffling or at least

  puzzling.

            What do you think about that?  I mean, was

  there in this case an inappropriate, from a sort of

  scientific point of view, inappropriate mingling of

  research agenda and possible therapeutic medical

  treatment?

            DR. HAUSER:  We have treated epilepsy over

  time in numerous inappropriate non-evidence-based ways,

  but I thought that for this particular situation,

  Anita, that this was part of a post-hoc description of

  the variety of benefits that might accrue from these very

  sad experiments.

            Others included the goal to establish a

  competent infrastructure for STD treatment in Guatemala

  to better understand the natural history of STDs and to

  understand ethnic differences in the clinical

  manifestations of these disorders.

            So post-hoc, there were numerous

  rationalizations given for this work but clearly the

  primary goal was to establish models of infection in

  human beings to test the effectiveness of treatment.

            DR. WAGNER:  Barbara.

            DR. ATKINSON:  I just would like to go back to

  John's question a little bit and talk about the

  methodology using the syphilis as an example.

            In my mind, it goes even back further than in

  some of the mistakes they made.  In syphilis, you can't

  always tell if a person has it or not if you miss it at

  the first primary stage and so that's why they wanted

  to do the serologies to find out if there was a

  background level in the population that had it or not

  because their studies wouldn't be meaningful if there

  was and they actually found a high background level but

  they didn't do those studies until after they'd done

  the original ones infecting people.  So they did it in

  the wrong order.  They didn't look at that first.

            Then when they infected people, they tried the

  commercial sexual workers but they found almost no

  transmission that way, very low levels, five percent

  maybe transmission that way.  So they had to readjust

  right in the beginning and they just kept readjusting,

  readjusting all out of order, all out of synchrony,

  without any kind of a plan, and that really was in my

  mind what was the matter with the methodology of the

  whole thing.

            So you can't prevent something if the people

  who already have it and you can't know if the results

  are accurate in the end when you've had so many

  different changes to the protocol as you went along and

  so much variation in everything you try.

            DR. WAGNER:  I'm sorry.  Yes, Nita.

            DR. FARAHANY:  I want to build on that just to

  be crystal clear.  So as we talk about the methodology

  being flawed and the fact that the reports weren't

  published, are we clear that there was no -- nothing

  that we've learned from these experiments -- I mean,

  for example, given that at the time this was such a

  priority for the military, that it was such a priority

  for understanding STDs and the effect of penicillin for

  having models, were these studies in fact -- did they

  yield valuable science nevertheless or, Barbara, as you

  put it, is it such that because the methodology was so

  tainted the accuracy of any of the studies, whether

  they are models or the treatment of penicillin for

  syphilis or for any other studies, that simply there

  was no value to the studies whatsoever?

            DR. MICHAEL:  There was no value, Nita.  I

  mean, it was -- I think Stephen laid it out pretty

  nicely when he went down the list that included, you

  know, poor note-keeping, but a meandering research

  series of questions.

            I think what stings the most for them in terms

  of it being bad science is that the work never passed

  peer review, it was never published, and in my world,

  if it's not published, it's as good as not done and

  therefore it doesn't influence medical practice or

  advance the field.

            DR. WAGNER:  You can't build on it.  Yes, Amy.

            DR. GUTMANN:  When we talk about bad science,

  when it is science involving human subjects, one of the

  things that comes most glaringly in focus is how bad

  science abuses human subjects when there's any risk

  involved.

            In this case, as I read through the historical

  documents and reread them and read them again, I kept

  asking the question of what -- how could they do this?

  These were people who had a certain pedigree.  I mean,

  they were as young and inexperienced as Dr. Cutler was,

  Dr. Mahoney was not inexperienced, and people all the

  way up the chain who knew about the experiments.  There

  were other people kept in the dark but the people who

  knew about them approved of them, and this is a segue

  to the discussion of the ethical aspects of it, but the

  conclusion that I come to in this is the only way such

  bad science could be done, so serology studies done

  after the evidence was needed that they would yield on

  human subjects.

            Now mind you, the serology studies didn't

  impose the worst risks on some of the human subjects,

  except the ones that included lumbar and cisternal

  punctures which did, how could that happen?

            My conclusion is, and it has to be a reluctant

  conclusion when you're judging other human beings, that

  the people who were doing these, people in positions of

  authority and responsibility and privilege, doctors did

  not treat those human beings as if they were human

  beings worthy of respect, worthy of consideration as

  human beings, that the only way you could continue

  doing this is to think of what you were acting on as

  material as opposed to other human subjects, and that

  I'm not saying that's the way they thought but that's

  the way you could only act like that if you think,

  Number 1, you're doing good science which I think no

  doubt they must have believed, and, secondly, the

  people you were doing it on don't matter as much as the

  people you would normally be associating with in your

  daily life, your family, your friends, and other

  people, because as we will get into the next section,

  the people weren't asked to consent to these

  experiments, they weren't told what the risks were, and

  the experiments were not done according to the

  standards of science at the time, the good standards of

  science at the time.

            DR. WAGNER:  I'd love to take your segue but I

  do have one other --

            DR. GUTMANN:  No, I didn't mean it to be, but

  it's the way in which you can't separate science and

  the fact that it's operating on human beings.

            DR. WAGNER:  I think Nelson would suggest that

  if it were even dealing on things, it was still bad

  science.

            The point there --

            DR. GUTMANN:  But not as bad.

            DR. WAGNER:  One point I'd like to hear us say

  to each other, and I hope we can say this, it is so

  easy to look back on a whole history of failed science

  of all different kinds, you know, and to bash it from

  our perspective.

            I want to make sure that we are not doing that

  and I don't think we are.  I just want to hear the

  Commission say that, that we believe really at the

  standards available at the time, with the

  sophistication of scientific practice in that era, and

  not just in our own hindsight, do we feel that this was

  appropriate science.

            Raju, you haven't said anything.  Let me turn

  it to you and introduce yourself, please.

            DR. KUCHERLAPATI:  Raju Kucherlapati from

  Harvard Medical School.

            I think there are a couple different points

  that have not been mentioned.  I think that they're

  very important.

            One is that prior to the initiation of the

  study, there was a proposal that was made and the

  proposal was reviewed by a group of peers and there

  were different points of view by that group.  So the

  original proposal to do the experiments, whatever they

  were, were, indeed, reviewed by the peers and the

  funding was based upon that review.  So that's an

  important component.

            The second thing that I think that's also

  important to recognize is that throughout the period of

  the time that the experiments were conducted, there

  were reports that were sent from Guatemala to

  Washington, D.C., and there are individuals who had the

  opportunity to actually see the reports and they're not

  the people who are inexperienced people.  These are

  people who are tremendously experienced and

  knowledgeable about what is going on and are at a

  distance from the experiments.

            So one cannot say that the principal, Dr.

  Cutler, who was doing the experiments, whatever the

  motivations and however he did the experiments, there

  were, indeed, opportunities for other people to review

  what was happening and that the other groups had the

  opportunity to have those findings reviewed by the

  appropriate people, if they didn't know by themselves,

  or they would be able to say that, you know, these

  experiments are not scientifically -- this is not the

  way to go and that you should, you know, do

  differently.

            So those two are actually very important

  points to mention.

            DR. GUTMANN:  That's why whatever we say, I

  think it's very important that this is not the action

  solely of a principal investigator.  This principal

  investigator reported up, Cutler to Mahoney and all the

  way up.  They did, the people who were in the know, did

  want to keep it secret because they feared that if it

  were to become more broadly known, it would be subject

  to public criticism.

            There were some doctors who dissented.  There

  was a doctor who wanted to be involved and they were

  afraid to involve him because he might be critical.  So

  there were different views in the scientific community

  at the time but what Raju is saying is absolutely

  right.  This is not the actions of one person and what

  I've said is to suggest that it was not an accident

  that this happened in Guatemala with a foreign

  population that was seen as ethnically, racially,

  nationally different because we do know that some of

  the people who were involved in this experiment said,

  explicitly said we could not do this in our own

  country.

            DR. WAGNER:  Christine had a comment, Lonnie,

  and then I think we'll wrap this session.

            DR. GRADY:  I wanted to respond, Jim, to your

  comment that we should not bash science without

  understanding it and go back to Nita's question about

  value.

            I think some of the serological work actually

  probably did have some value.  They were published.

  They compared different serological tests, you know.

  That was not useless science in some respects, and also

  for the most part, although there were some exceptions,

  as Steve pointed out, did not expose the people that

  were involved in them to a great deal of risk.  So

  there is some value perhaps in those studies.

            The second thing I think is important to put

  on the table is I think Steve mentioned that one of the

  scientifically wrong aspects of this set of experiments

  was using human beings as a model, an infectious

  disease model, and I think we need to be very cognizant

  of the fact that this was certainly not the only study

  that did that and that even today, we use those kinds

  of models.

            So that if that is not in my view anyway the

  thing that makes these set of experiments wrong but

  there are lots of things about how those kinds of

  infection experiments are done that are very important

  to make them acceptable.

            DR. WAGNER:  Lonnie.

            MS. ALI:  Hi.  I'm Lonnie Ali, caregiver.

  Coming from a lay point of view and not having the

  medical background and just reading this and being

  horrified by a lot of what I was reading, I just don't

  want to belabor Dr. Gutmann's point, but I think it's

  important to note that if  -- that these being doctors

  and medical scientists and doctors who are supposed to

  do no harm, to do good, I think it's important to note

  that even though during these course of experiments and

  studies that were going on and there was actually a

  prophylactic that was discovered, penicillin, that was

  effective and they decided to change course and figure

  out whether or not penicillin could prevent infection,

  but what was important to me, too, is that the way they

  viewed the Guatemalans is that they left so many people

  untreated after they had infected them.

            It was like they were disposed of, they didn't

  care what happened to them, and, you know, what

  happened to them after they had actually been infected

  with something that they intentionally infected them

  with.  So I think that's important to note, that when

  it goes to how these people were viewed, that when they

  had the opportunity to treat them and cure them of this

  STD, that they failed to do so.  They left so many who

  were actually involved in the study, not people outside

  in the general population but people who were actually

  involved in the study, left them untreated.