PREFACE 
(see Table 1). Institutional leaders of the PHS, the National Research Council 
(NRC), the National Institute of Health, and the Director and Assistant 
Director of the VDRL, as well as leading academic scientists encouraged and 
supported the work. Research staff for the Guatemala experiments included 
leaders and senior medical personnel of the government of Guatemala, for 
example, directors of the national Public Health Service Venereal Disease 
Section, the national psychiatric hospital, the national orphanage, and the Army 
medical department (see Table 2). The records show that these events involved 
many officials and researchers in the United States as well as Guatemala. The 
records reveal the unconscionable ways in which the researchers sometimes used 
people as a mere means to advance what Dr. Cutler sometimes called “pure 
science,” 30 hidden from public scrutiny in the United States. 
The history of U.S. -supported experimentation undertaken to advance 
medical knowledge and protect national security is complex with evolving 
ethical standards and norms. 31 Nonetheless, the experiments in Guatemala 
starkly reveal that, despite awareness on the part of government officials 
and independent medical experts of then existing basic ethical standards 
to protect against using individuals as a mere means to serve scientific and 
government ends, those standards were violated. The events in Guatemala 
serve as a cautionary tale of how the quest for scientific knowledge without 
regard to relevant ethical standards can blind researchers to the humanity of 
the people they enlist into research. 
Arising in response to cases such as these, today’s requirements for the protec- 
tion of human subjects in U.S.-funded research are expressed in the medical 
ethics literature and through government regulations and international cove- 
nants and declarations, all of which share certain standards and principles. 
Obtaining informed consent of subjects is a cornerstone ethical requirement. 
So too are requirements for minimization of risks, a reasonable balance of 
risks and benefits, sound scientific justification, protection of privacy and 
confidentiality, and special protections for those who are especially vulner- 
able, including minors and those with impaired decision making. 32 While 
research is sometimes still done with vulnerable populations, using deliberate 
exposure and infection, and without informed consent, such studies have to 
be carefully justified, reviewed, and approved often with additional protec- 
tions added. 33 
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