Stoner, Bradley P. MD, PhD*; Marrazzo, Jeanne M. MD, MPH†
From the *Departments of Anthropology and Medicine, Washington University in St Louis, St Louis, MO; and †Department of Medicine, University of Washington, Seattle, WA
Correspondence: Bradley P. Stoner, MD, PhD, Washington University in St Louis, St Louis, MO 63130. E-mail: email@example.com.
Received for publication January 8, 2013, and accepted January 30, 2013.
What is in a name? That is the question that the American Sexually Transmitted Diseases Association (ASTDA) needs to address in the context of the recent controversy surrounding Dr Thomas Parran, Jr. As members of ASTDA are well aware, Dr Parran (1892–1968) is among the most revered figures in the history of sexually transmitted diseases (STDs). He, more than any single other person, ushered in what we have come to know as the modern era of STD control and prevention and provided a paradigmatic example of how scientific rigor, excellence, and commitment can be translated into meaningful public policy and action. As the sixth surgeon general of the United States (1936–1948), he fought tirelessly for greater public acceptance of the importance of venereal diseases and for recognition of the burden they place on society. His 1937 book, Shadow on the Land, laid forth the key principles of case finding and contact tracing, principles, which are now still fundamental to our current approach to partner management.1 In 1938, Parran testified before Congress in support of legislation to expand funding for STD research and public health prevention efforts.2 Standing on principle, Parran even refused an interview on national radio when CBS officials told him that he could not mention the words “syphilis” or “gonorrhea” on the air, reacting angrily to hypocrisy in radio broadcasting standards.3 Parran toiled to reduce the stigma of STDs and stood as a bold example of how a great leader can powerfully serve by great example.
In recognition of Dr Parran’s profound influence on the field, the ASTDA annually bestows the Thomas Parran Award upon its most accomplished and illustrious members. The award has been given every year since 1972, and the ASTDA Constitution and By-Laws specify that it is to recognize “long and distinguished contributions in the field of STD research and prevention.”4 The Parran Award is the association’s highest honor and recognizes those professionals who, like Dr Parran, live by example and tirelessly work for STD prevention and control in the laboratory, at the bedside, and in the halls of power. We should all be so bold, so principled, and so public in our efforts as Dr Parran was in his lifetime. The Parran Award truly is the crowning honor in STD-related science—it is a big deal.
Yet, as detailed in the accompanying article by Zenilman5 and commentaries by Lombardo,6 Schachter,7 and Hook,8 Dr Parran has recently been associated with some of the most deeply disturbing STD research studies ever conducted. Carried out between 1946 and 1948, these studies involved the intentional inoculation of vulnerable populations without their consent. Importantly, conducting these studies in Guatemala allowed the investigators to circumvent evolving US ethical research standards and oversight.
So, how do we reconcile what we have learned about the horrific events of Guatemala and the possible role that Dr Parran may have played in allowing this to happen? As an organization, ASTDA is just now beginning to struggle with this, as we gain more information about Guatemala and more time to digest its importance and impact. We now approach the ASTDA membership for guidance and assistance as we address these issues and what they may mean for our association.
What follows is a series of commentaries about the STD human experimentation research studies in Guatemala that took place in 1946 to 1948, led by Dr John C. Cutler and colleagues with funding from the US Public Health Service. What we now know about these events is nothing short of repulsive: intentional human infection with syphilis, gonorrhea, and chancroid; lack of informed consent among commercial sex workers, prisoners, and children; scarification and abrasion to enhance infectivity; pledgets held under the foreskin; and cisternal taps and direct treponemal inoculation. The list of activities goes on and on, all done in the name of science to learn more about the biology of these organisms and their response to the newly identified miracle drug, penicillin. Documentation by the President’s Commission on Bioethics has clearly demonstrated that what was done in Guatemala was “ethically impossible,” and Cutler’s role in these activities is well established.9
The larger question for our organization, however, actually pertains not to Cutler but to Dr Parran, who was aware of what was happening in Guatemala and whose support was instrumental. As head of the US Public Health Service, Parran was responsible for appointing and overseeing the National Advisory Health Council study section that approved the Guatemala proposal and recommended it for funding. Although he may not have been directly involved in reviewing the proposal, he signed off on the final recommendation in 1946, allowing the studies to proceed with funding to the Pan American Sanitary Bureau (the precursor to the Pan American Health Organization).10 These research activities only came to light after the death of Cutler and the discovery of his archives at the University of Pittsburgh in 2003. Moreover, the magnitude of what took place in Guatemala was not fully known until the Presidential Commission for the Study of Bioethical Issues published its landmark report in 2011.
All of this leads us back to Dr Parran, the leading figure in the history of STD research and prevention. For ASTDA, Parran’s involvement in the Guatemala studies is troubling. In authorizing the funding to support this work, was Parran implicitly sanctioning what today we clearly recognize as unethical research on humans subjects, or alternatively, are we going too far in tarnishing Parran’s name by linking him to an ambitious and aggressive rogue investigator (Cutler) who took matters into his own hands to push the research beyond any semblance of respectability? Perhaps Parran really did not know the full extent of Cutler’s activities, or the degree to which deception and deviousness were part and parcel of the Guatemala studies. We may never know for sure. Yet, Parran’s support seems to have been necessary for getting the studies funded in the first place, and there are suggestions that Parran may have realized the work that Cutler and his colleagues were doing in Guatemala would be highly scrutinized if performed in the United States.
So we now invite ASTDA members to weigh in on this issue, specifically with regard to the future of our annual Thomas Parran Award. The discovery of the Guatemala studies has generated a robust debate among members of the ASTDA Executive Committee, with some arguing that it is time to change the name of the award in light of Dr Parran’s involvement with unethical research. Others suggest that such a move would be a harsh overreaction, a drastic step taken without reflection that would ultimately devalue the important work Parran accomplished over his long and distinguished public career. We would like to hear your comments as well, which will help guide the ASTDA Executive Committee in its deliberations on this matter. We encourage you to read and reflect on all of the commentaries that follow in this section because each author presents points and perspectives that bear on this important concern.
To facilitate this exchange among the membership, we have set up a “blog” on the ASTDA Web site (www.astda.org), which will be an open forum for views on this issue. We will also poll ASTDA members to allow them to register their own opinions, to help guide the Executive Committee in its decision making. Please take a few moments to reflect on these issues, and make your voice heard. We welcome your contributions to our discussion.
1. Parran T. Shadow on the Land. New York: Reynal and Hitchcock, 1937.
2. Presidential Commission for the Study of Bioethical Issues. “Ethically Impossible:” STD Research in Guatemala from 1946–1948. Washington, DC: The Commission, 2011: 10.
3. Brandt AM. No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880. New York: Oxford University Press, 1987: 122.
4. American Sexually Transmitted Diseases Association Constitution and By-Laws. Adopted 1948, revised 2011. ASTDA, unpublished manuscript.
5. Zenilman J. The Guatemala sexually transmitted disease studies: What happened. Sex Transm Dis 2013; 40: 277–279.
6. Lombardo PA. When heroes stumble. Sex Transm Dis 2013; 40: 280.
7. Schachter J. A letter to members of the American Sexually Transmitted Diseases Association on Thomas Parran and the Guatemalan Sexually Transmitted Disease Studies: What did he know? What did he do? What do we do? Sex Transm Dis 2013; 40: 283–284.
8. Hook EW III. Remembering Thomas Parran, his contributions and missteps going forward: History informs us. Sex Transm Dis 2013; 40: 281–282.
9. Presidential Commission for the Study of Bioethical Issues. “Ethically Impossible:” STD Research in Guatemala from 1946–1948. Washington, DC: The Commission, 2011: 27–79.
10. Presidential Commission for the Study of Bioethical Issues. “Ethically Impossible:” STD Research in Guatemala from 1946–1948. Washington, DC: The Commission, 2011: 31.