From the Past to the Present: The Guatemala STD Study and Multi-Layered Bioethical Critique

I use the Guatemala STD Study as a case study for modern bioethics and public policy surrounding pharmaceutical human subjects research. The Guatemala Study was a two year clinical experiment funded and executed by the United States Public Health Services (USPHS) to intentionally infect Guatemalan subjects with sexually transmitted diseases (STDs) such as syphilis, gonorrhea and cancroid, in order to understand the efficacy of chemical prophylaxis. Hope for treatment when none else is available, coupled with infrastructural weakness and social prejudice makes countless populations vulnerable to exploitation, much like the Guatemalan STD study subjects. As a case study, Guatemala highlights gaping holes in human subject protections, especially in regards to structural violence. This article is designed to add to the incisive analyses already provided by academics on the Guatemala case so far. I have taken a multi-layered approach in order to answer three important questions: 1) how the study occurred in the first place, 2) why the researchers disregarded the subjects’ lives and wellbeing and 3) how the current legal-regulatory system manufactures a form of justice (or injustice) for the surviving victims. The Guatemala study was in fact, “a dark chapter in the history of medicine” as NIH director Francis Collins lamented. Nonetheless, it also set the precedent for transnational human subject research, which has grown to extraordinary levels in recent years