“ETHICALLY IMPOSSIBLE” STD Research in Guatemala from 1946-1948 
Writing after a thorough historical review of practices during this time 
period, the President’s Advisory Committee on Human Radiation Experi- 
ments (the “Radiation Experiments Committee”) reached a set of equivocal 
conclusions. On one hand, the Radiation Experiments Committee found 
that, “as early as 1944 it was conventional for physicians and other biomed- 
ical scientists to obtain consent from healthy subjects of research.” 673 
However, the Committee also found that “physicians engaged in clinical 
research [i.e., research on sick patients, not healthy volunteers] generally did 
not obtain consent from patient-subjects” even when the experiment offered 
no prospect of direct benefit to the patient. 674 Nonetheless, it was “common 
for physicians to be concerned about risk in conducting research on patient- 
subjects and, in the absence of a prospect of offsetting medical benefit, to 
restrict research uses of patients to what were considered low- or minimal- 
risk interventions.” 675 Subsequent concerns that physician-investigators 
underestimated risks to patient-subjects contributed to the establishment of 
independent review mechanisms. 
By mid-century, these early examples of informed consent and risk-assessment 
practices, while not often phrased as such, were common for experiments 
involving healthy subjects like prisoners, soldiers, and conscientious objec- 
tors. 676 In particular, the Terre Haute researchers and their superiors — who 
included some of the same individuals as the experiments in Guatemala — 
carefully considered and adopted strict requirements for individual consent 
and voluntariness for the research they conducted in 1943 and 1944. 677 In 
1946, VDRL researchers Drs. Mahoney, Cutler, Van Slyke, and Blum also 
recognized a need to use only “volunteers” as experimental subjects, and 
then only after providing adequate information about risks for a prospective 
participant to make an informed choice. Writing in the American Journal 
of Syphilis, Gonorrhea , and Venereal Diseases about their work with prisoners 
at Terre Haute, the doctors insisted that participants must possess “a thor- 
ough understanding of the purpose underlying the study and the possible 
risks involved.” 678 Other researchers engaged in intentional infection research 
expressed similar sentiments. 679 Of course, it is impossible to know whether 
these sentiments were largely intended to avert public disapproval. 
The period between 1946 and 1948 was an especially important time in the 
development of human research ethics. During these years, the Nuremberg 
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