Study flaws and ethical considerations

Despite the knowledge that had been gained from the Terre Haute study and from other studies, the process of establishing infection with STDs still proved a difficult challenge in the Guatemala experiments. The “normal exposure” approach was notably unsuccessful. More significant, however, were the high rate of noncompliance among subjects, particularly prisoners, and the inability to reliably diagnose infection.

The Guatemala experiments remained a largely unknown event in U.S. medical history until the early 2000s. Following Cutler’s death in 2003, American historian Susan M. Reverby initiated an investigation of Cutler’s original documents, which were housed at the University of Pittsburgh, having been donated to the institution in 1990 by Cutler when he was a professor there. Reverby reported her findings in 2010 and subsequently shared them with David J. Sencer, former director of the U.S. Centers for Disease Control and Prevention (CDC). Following a review of the documents by the CDC, the materials were transferred from Pittsburgh to the federal government.

On October 1, 2010, U.S. Pres. Barack Obama, having been informed of the Guatemala experiments, contacted the president of Guatemala, Álvaro Colom, to apologize for the unethical nature of the research. Likewise, U.S. Secretary of State Hillary Rodham Clinton and Secretary of Health and Human Services Kathleen Sebelius issued an apology to the people of Guatemala. The secretaries also called on the Presidential Commission for the Study of Bioethical Issues to initiate an intense investigation of Cutler’s documents, the results of which were subsequently released in September 2011. The commission’s report revealed that Cutler was concerned about people finding out about the experiments, which he believed could jeopardize the study. He had deliberately withheld information from the PASB, including documents regarding the experimental studies of gonorrhea and the final syphilis report, prepared in 1955, which concluded that orvus-mapharsen, oral penicillin, intravenous mapharsen, and calomel ointment all were effective prophylactic strategies. It also revealed that some of Cutler’s colleagues disagreed with his approaches, including the abrasion experiments for syphilis inoculation.