ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
Dr. Cutler justified his “heroic challenge methods” 504 in the Final Syphilis 
Report as a means to provide more rigorous experimentation: 
“It was realized at the outset that the mechanical abrasion would 
probably be more severe than that occurring naturally and might 
permit more ready penetration of the organisms. But it was felt 
that under such circumstances any agent to be tested for prophy- 
lactic value would be subjected to a more severe test condition 
than that occurring naturally.” 505 
Fie offered a parallel rationale for the artificial exposure techniques in his 
Experimental Studies in Gonorrhea report: 
“A comparison between the rate of infection of (5/93) 5.4% 
following normal exposure to an infected female and (47/87) 54% 
following superficial inoculation indicates that a prophylactic 
agent tested against superficially inoculated patients is subjected 
to a very severe test indeed, so that a preparation found to be 
effective under these circumstances should be expected to show 
up well when subjected to the less-severe test of routine risk of 
infection.” 506 
In addition, based on observations of “reddened and battered-looking” 
penises, Dr. Cutler concluded that there was “probably a good deal of 
penile trauma during intercourse with breaks in the membrane.” 507 Dr. 
Cutler reasoned that the infection with syphilis might be dependent on 
these “breaks in the continuity of the mucous membrane” and that “any 
method of inoculation which destroyed the continuity of the skin or mucous 
membrane might offer a more nearly physiological approach to the problem 
of bringing about experimental infection.” 508 Dr. Cutler made this argu- 
ment justifying scarification to both Dr. Arnold 509 and Dr. Mahoney 510 in 
September. Later, in a historical review of STD control (written in 1989), Dr. 
Cutler concluded, “studies on human inoculation with syphilis demonstrated 
the value of intact, healthy skin and mucous membrane in preventing infec- 
tion.” 511 The evidence he cited for this assertion was “a conversation with JM 
Funes, MD (December 1947).” 512 
The researchers continued to employ the contact method after they had begun 
abrasion because “[a]s yet there was doubt as to the advisability of utilizing a 
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