What if I told you that children in a third world country were still paying the price for experiments done by the United States government almost 70 years ago? Would you believe it?
Circa traveled to Guatemala to shine a light on a dark chapter in American history, when the U.S. government went to Central America and infected people with STDs on purpose. Our story tries to make sense of a heinous act committed by the U.S. government in the name of science. We made this trip to talk to people like Gonzalo and Lazaro Ramirez, a set of brothers living in the remote Guatemalan countryside.
These brothers are sons of a dedicated Guatemalan soldier, who passed away long ago. They say he was infected with a sexually transmitted disease by Americans who came to a military base where their father served.
Experts tell Circa what happened to Gonzalo and Lazaro’s father rivals the atrocities of the Nazi medical trials and the Tuskegee Syphilis Research Study. These human experiments done on vulnerable Guatemalan people who were deliberately given syphilis and gonorrhea without their consent, without knowing what was happening or why.
The brothers currently live in modest cement buildings with no power and no running water. They were kind enough to invite us into their homes to tell us about experiments they say their father was subjected to back in the 1940s.
“We realized that he had been a victim because he told my mother. All of that was engraved in our minds,” Gonzalo said.
“The truth is, they were called to the infirmary where they were injected without any explanation. But they were never told what it was for.”
The majority of individuals used in the experiments were deliberately given STDs by American doctors between 1946 and 1948. Well-known agencies like the United States Public Health Service provided the funding. And there are allegations well-respected private institutions like Johns Hopkins University, the Rockefeller Foundation and others, were involved as well.
Harvard researcher Angel Rodriguez has been looking deeper into the historical context behind the experiments. When it comes to the Americans picking Guatemala as a potential host for the experiments, it wasn’t about strong arming some small country. Rodriguez says the research had the full cooperation of the Guatemalan government.
“It was much more difficult for a Guatemalan scientist to be recognized on an international scientific platform than it is for an American scientist. That’s why the collaboration was so valuable. Because if you can collaborate with a group of more privileged scientists, then it will bring much more merit to your work.”
Guatemala was considered an ideal location for research into STDs in part because prostitution was legal and sex workers could be used for the experiments. And the idea of using the country for research came from a Guatemalan physician. Dr. Juan Funes, who headed up the venereal disease division of the public health department in Guatemala, was trained in the U.S. by the Public Health Service.
The experiments that involved Funes and a host of American physicians affected more than more than 5,000 people according to historical records. Those documents show more than 1,300 individuals were infected with STDs in experiments that were documented in gruesome detail by researchers and then kept under wraps until about 60 years later.
WATCH: Dispatch Episode 2: Dead People's Mail
Dead People's Mail
Susan Reverby, a Wellesley College scholar, uncovered the Guatemalan experiments by chance. In an interview in her home in Massachusetts, Reverby recalled, “I’m, like, standing there, my mouth is dropping.”
Reverby was in Pittsburgh, working on another research project, when she was directed toward a set of files in a bland archive building on a dead-end street. The files belonged to a man named Doctor John Cutler, someone whose name she was familiar with from prior research, “They said there are papers for him here. So I started opening the boxes. Suddenly here’s Cutler. He’s in a third world country. He’s in Guatemala. And he’s inoculating people not only with syphilis but also gonorrhea and chancroid and other sexually transmitted diseases. I’m thinking, 'Wow! No one has ever heard of this.'”
It was another set of heinous experiments that brought Reverby to that Pittsburgh archive: the Tuskegee Syphilis Study. Up until that point, Tuskegee was the most infamous American health study ever done. In that research, African-American men who already had syphilis were misled and treated like guinea pigs. They were told they were getting free health care from the United States government. They were watched for decades but never treated. Some of them were never told they had syphilis. Cutler, a man who would go on to become assistant surgeon general, was one the researchers.
WATCH: Dr. John Cutler's comments about the Tuskegee study in one of the only interviews he's ever done on the subject
Unlike Tuskegee, the patients in Guatemala did not have STDs to start. The research Reverby exposed showed men, women and children were given the diseases, with many of them deceived about what was happening. For some, infection was as simple as an injection. Records show some patients had gonorrheal pus smeared into parts of their body. Others has syphilis injected into their skulls. And a group had their genitals painstakingly scraped and then had the disease dripped into the wound in a process that could last as long as 90 minutes.
"The details were horrendous."
For a couple of years, the research stayed boxed up. The reason? Reverby assumed the patients in Guatemala had been treated. But hundreds of victims were not. Documents show only 678 of the 1,308 people whose infections were recorded had some sort of treatment listed in their paperwork. When Reverby circled back, she realized the victims likely still had STDs and had likely passed them on to their children and grandchildren. So she wrote an academic paper and sent it to a colleague for review. That colleague was a leader at the Centers for Disease Control who forwarded Reverby's work up the chain, recognizing its significance. Within weeks, President Obama was issuing a formal apology to the people of Guatemala.
President Obama called the experiments shocking and expressed deep regret in a call to President Alvaro Colom at the National Palace in Guatemala City.
Following the public apology from the Obama administration, many of the Guatemalans with ties to the experiments expected some sort of action, but it didn't happen. Lazaro Ramirez is among those who felt disappointment.
“This not about apologizing,” he said during a conversation with us inside his brother’s home in Guatemala. “This has to do with causing a disaster among many people here in Guatemala. They were sent to infect the people, not just the one person but the entire family.”
WATCH: Dispatch Episode 3: Foot Soldiers of Science
Foot Soldiers of Science
With disease continuing down hundreds of family trees, the U.S. and Guatemalan governments launched two different and completely separate studies. President Obama asked the already-formed Commission for the Study of Bioethical Issues to look at the experiments. Doctors and academics from some of the country’s finest institutions dove in to ask critical questions as part of a fact-finding investigation. (The commission meetings were taped and archived)
“Who knew about Dr. Cutler’s Guatemala studies? What did they know; when did they know it; and what did they do about it?”
Dr. Daniel Sulmasy, a medical bioethics expert who now works at Georgetown University, was part of the commission. “When we began, I thought, ‘This is ridiculous to have the ethics commission ruling on this or talking about it.’ You didn’t need a PhD in philosophy to tell this was wrong,” Sulmasy said during an interview at Georgetown.
But the U.S. government did need a panel to figure out how the experiments happened. The Bioethics Commission and its staff spent nine months looking at the experiments, reviewing thousands of documents and traveling to Guatemala. The conclusion of their work on the experiments was a report they titled, “Ethically Impossible”.
We asked Sulmasy how it was possible a group of well-intentioned and well-educated scientists could ever endorse the kind of research that was done in Guatemala. His answer, “I think part of it is a culture that people get into.” These doctors were, experts told us, blinded by science, trying to stop a very real threat to the United States military: sexually transmitted diseases.
WATCH: Sex hygiene films like this from the 1940s warned soldiers about the dangers of STDs
But it wasn’t like Cutler was some madman gone rogue. Letters exchanged during that time show up and down the ranks, people knew about the research. Even then Surgeon General Dr. Thomas Parran was aware of the experiment. One letter from 1947 from a USPHS physician to Cutler noted Parran’s reaction, “He is very much interested in the project and a merry twinkle came into his eye when he said, ‘You know we couldn’t do such an experiment in this country.'”
“The people who were in the know, did want to keep it secret because they feared that if it were to become more broadly known, it would be subject to public criticism.”
With gossip circulating, physicians and health leaders involved in the Guatemalan experiments talked about how to keep the project off the radar. They even considered putting the brakes on research until chatter cooled down. Dr. John Mahoney, the medical director of the U.S. Public Health Service, wrote in a 1947 letter to Cutler, “I hope that you will not hesitate to stop the experiment work in the event of there being an undue amount of interest. It would be preferable to delay the work than to risk the development of an antagonistic atmosphere.” Still, Cutler did all he could to keep the research “subterranean” for the good of the cause.
“Scientists often think of themselves as generals in a war on disease. And if you’re a general, you get to figure out who dies," Reverby explained. "You send people into battle and they die for the good of the whatever you think you’re fighting for. And that happens in science too. People are sent in, essentially as the foot soldiers of science.”
In Guatemala, actual soldiers were unknowingly sent into battle, forced to follow orders according to court records. Prisoners were also used, with claims detailing they were told they were “getting vitamins”. Mental patients from a state-run asylum were documented by name and with photos in the records, posed as a stranger determined a fate to which they couldn’t possibly consent. In a letter from Cutler dated October 1948, the physician discussed obtaining a movie projector, a refrigerator and plastic giftware as a gift for the asylum "in return for the cooperation of the patients".
As for whether children were actually subjected to experimentation, there is dispute on that point. Children do appear in the archive photos of experiment subjects and court records claim some children were lined up for shots and told they were "to protect against diseases”.
One of the most horrific cases documented in Cutler’s papers, reads like a horror novel. It details what happened to a psych patient named Berta. Records show she was injected with syphilis and not given penicillin until three months after her infection. At one point, gonorrheal pus from another male patient was wiped into both of Berta’s eyes as well as in her urethra and rectum. She was also reinfected with syphilis. Several days later, the records say, Berta's eyes were filled with pus from the gonorrhea and she was bleeding from her urethra. Berta eventually died. Her death is one of more than 80 recorded in the experiment paperwork.
“What the United States did was egregiously wrong. I think the biggest surprise for me is how many people in the public still don’t know about it.”
In Guatemala, the task of determining what happened fell to a man who spent much of his life in Houston but with his heart tied to the country. Dr. Rafael Espada was a prominent surgeon associated with Baylor University in the States, but he returned home and eventually went on to become vice president in Guatemala. Espada led the inquiry into what happened.
We sat down with Dr. Espada at the medical school where he now teaches in Guatemala City. He tried to take us back in time, saying, “At that time syphilis and venereal diseases and gonorrhea were a big epidemic in the whole world. They were not very sure about a cure for syphilis. It was a big problem for the Army. Someone decided, 'Okay, let’s try it with humans.'”
Back in the late 1940s there were no specific international guidelines on human medical experimentation. The Nuremberg trials were just happening at that time, holding the Nazis accountable for torturous experiments conducted on prisoners in concentration camps. The ethics rules that would try to protect people from ever being abused in such a heinous way again, didn’t come until after those trials. The Guatemala experiment was already well underway at that point.
WATCH: Archive video details the disturbing medical experiments conducted in concentration camps that later resulted in the Nuremberg Trials & the Nuremberg Code
“There was no medical community that said, 'No, you can’t experiment on humans'. It was legal, was not ethical at all," Espada said. "None of the medical societies said you shouldn’t investigate on humans. So I told President Colom we had to situate ourselves at that time, how physicians thought, how physicians react, what the community said.”
Piecing together the tangled web of the past was a two-year effort for Espada and his team. Just like the American commission, their work ended with the publication of a report, “Consentir el Dano,” which translates to "Consent to Harm". It’s hard to even find a copy in the United States. Finding a copy of the report that has been translated into English is a near impossibility.
“The idea was to have both books together and to put them in both languages,” Espada explained. “That didn’t happen. We didn’t translate the books. The issues were almost the same, the only difference was that we had more information and we had some ideas from our university. They didn’t study the depth of the human action that happened.”
Espada’s team did something else the Americans did not. They hit the streets, scouring the country in an attempt to find former patients. By 2010, most of the victims were in their 80s and 90s. And of the 1,300 patients infected in the experiments, the Guatemalan commission found just a handful, according to Espada.
“All the medical records were given to patients. They said to patients, 'You take your record and disappear' and they went away. We found 25 patients and we brought them to Guatemala City. We interviewed them. We did a lot of testing."
WATCH: Dispatch Episode 4: The Family Curse
The Family Curse
The effort to find victims was like tracking sand thrown in the wind. Many had died. And remaining survivors and their families had scattered into remote areas of the country and were living off the grid. But we were able to find one man who says he was directly infected: Federico Ramos.
We talked with Ramos, his son, Benjamin, and other members of their family. Benjamin told us, “In that time, the Americans would come very often here to Guatemala. So they realized that in the Army there are plenty of people for their experiments.”
Ramos is now 93 years old. He lives with Benjamin and his family in an adobe home along the same mountain road as the Ramirez brothers. The group shares a modest house and a family curse: a legacy of pain that started nearly 70 years ago when Federico was infected. His memory is fading. But he can remember what the doctors did.
“There was a military base with all foreigners. They were administering injections and that’s where they injected me.”
The story has been passed on through generations, along with the disease itself. Benjamin finally understood what had happened when he read about the experiments several years ago.
“He had been serving one year in the Army when the Americans came to Guatemala to conduct their experiments. And they violated these families because it wasn’t just him, there were many. We started discovering that his illness infected the first, second and third generations,” Ramos said.
These families are passing on a disease while holding onto the memories of those they believe are responsible for their plight. Benjamin has a collection of newspaper articles related to the experiments. They are folded and faded, but he holds them close as a reminder.
“Those persons that conducted these experiments didn’t have a conscience. In that time there was no human rights yet. They were not aware of the damage they would cause on people. There were no human rights at that time. The ones that had power did whatever they pleased.”
Anger is not evident in conversations with these families. They speak clearly about the experiments and their impact, but their conversations are not tinged with aggression. As Benjamin told us during a conversation on his porch, “What can we do? The only thing we can do is ask God to forgive them. I try not to be angry because sooner or later things will be solved and we will be able to receive compensation from the United States." The families say compensation would improve their quality of life and help them obtain medicine or treatment for themselves and their children.
Victims of the experiments and their families have experienced a range of symptoms related to the diseases they were given. Severe headaches, vision loss, joint problems, pain and even deformities are mentioned in court filings. Gonzalo Ramirez explained that he and his siblings grew up with pain in their legs and joints, as well as headaches. One of his sisters lost her sight. Benjamin Ramos detailed how he’s dealt with joint pain in his knees and difficulty urinating. All the people we talked with became emotional when they discussed the pain their children have and will eventually experience.
“The problem is we keep infecting our offspring,” Ramos said. “They do not know yet. They are still 14 and 11 years old. At that age you do not really care about what you have. But perhaps later on they will notice what they are suffering from.”
Even when the children do begin to experience symptoms, the families say treatment is likely not an option for many reasons. Visiting a physician would require considerable travel. Doctors, according to the men, are not trusted to provide legitimate and effective solutions. And generally, treatment costs a great deal more than they have available.
“It is hard, it is hard. I do not have the resources. I want them cured, but I cannot help them.”
Remarkably, these families still have hope. For awhile, it was tied to a group of American lawyers who made the same trek we did into the remote villages of the Guatemalan countryside. Gonzalo Ramirez remembers one particular visit, saying, “The persons that came from the United States told us that we were going to receive compensation for our father’s death and that we would be able to pay for medical treatment for ourselves. We are still waiting for that.”
The money Ramirez is likely speaking of is linked to a court case that was dead before it ever really got started. It was a class-action lawsuit against the federal government that was filed shortly after Susan Reverby’s discovery. That lawsuit was tossed in 2012, when a judge ruled you can’t sue the U.S. for something that happened overseas.
"This Court is powerless to provide any redress to the plaintiffs."
WATCH: Dispatch Episode 5: Atonement
But the effort to get some sort of justice for the Guatemalans isn’t over yet. Another civil lawsuit was filed in 2015. This time it didn’t take aim against the federal government. Instead, the suit targeted private institutions, claiming they bear responsibility. The case, which involves as many as 800 Guatemalans, was filed in federal court in Baltimore. Paul Bekman, a Baltimore attorney, is the lead on the case. In the summer of 2017, his team argued to give the case against Johns Hopkins University, the Rockefeller Foundation and drug-maker Bristol-Myers Squibb, another chance in court.
The suit claims board members and employees at the Rockefeller Foundation, including then Surgeon General Dr. Thomas Parran, were involved. It alleges leadership at Bristol-Myers took part. And it also claims that physicians from Johns Hopkins University played key roles in reviewing and approving spending for the project.
In August 2017, a federal judge gave the billion-dollar case a shot at survival, granting a motion to allow it to move forward on some counts even though all three entities deny the allegations in their filings. We asked all three groups multiple times to sit down for interviews to discuss the case. Bristol-Myers Squibb never responded to our request for an interview. The Rockefeller Foundation declined, as did Johns Hopkins, writing, “The study conducted by the U.S. government in 1940s Guatemala was unethical, disturbing and should never have taken place. We feel profound sympathy for the individuals and families impacted by this deplorable study. However, it is important to understand that the study was initiated, funded and conducted by the U.S. Government with the cooperation of Guatemalan officials, not by Johns Hopkins.”
“I do not know if there is going to be a favorable result for our families or if not, but we would like for those damages to be paid for. Nevertheless, life is priceless.”
But the active civil lawsuit happening in the federal court system in Baltimore is not the only action taking place related to these experiments. The Archdiocese of Guatemala is one of several driving forces behind a human rights petition championed by a group called the City Project. Robert Garcia, a Guatemala native, is leading the charge for the non-profit civil rights group that’s based in Los Angeles.
The organization filed a petition with the Inter-American Commission on Human Rights on behalf of the archdiocese, asking the agency to take action. “In our opinion, the United States is guilty of human rights crimes, crimes against humanity, human rights violations for the non-consensual medical experiments against the people of Guatemala. To obtain justice for the people of Guatemala is our only goal.”
At the very least, Garcia believes the victim's families deserve medical attention, which as you’ve heard by now, many never got. He’s clear in his belief that they deserve more than apology. But when you start talking about the dynamics of global politics, atonement is complicated. Although the Bioethics Commission wasn’t asked to come to legal conclusions, the conversation as Dr. Sulmasy remembers it, was political when it came to language and recommendations.
“My view, which was not taken up by the commission, was that we actually ought to consider this a crime against humanity. We came up with the phrase 'unconscionable' as a compromise because people didn’t want to blame the United States in a way that would make it actionable in international law,” he explained. “I think there was hesitancy to tie the hands of the administration. It was rather a sort of sense that we would make some sort of atonement to the people by a gift to their public health infrastructure, which was ultimately what the administration decided on rather than individual compensation to particular victims.”
WATCH: We asked Dr. Sulmasy if a gift was ever made to Guatemala's public health infrastructure
During our conversation, former Guatemala Vice President Dr. Rafael Espada explained, “In order to pay society, we were going to create an institute for ethics and research and the Guatemalan government was going to give a building and the U.S. was going to give us money,” he said. When asked if it happened, Espada’s answer was simply, “No.”
Back in the States, our team spent the next few weeks trying to figure out why the facility Espada discussed was never built. We reached out to current and former ambassadors, the State Department, the CDC, Hillary Clinton and the Obama administration and others whom Espada said had direct knowledge or conversations about the deal to build a public health institute.
LISTEN: Find out what it took to put this docuseries together with our behind-the-scenes podcast
We called over and over and sent dozens of emails asking for answers. After all that, what we found was a gut punch. Significant funding totaling $775,000 was given to a university in Guatemala by the CDC to treat and prevent STDs in the country. Additional funding was also set aside in 2013 for the formation of a new National Public Health Institute in Guatemala.
The U.S. government was supposed to help set up the institute and fund it, according to Espada and U.S. government representatives. The ball started rolling officially with a request from the Minister of Health in Guatemala. But the institute was never built. More than a month after first asking, a State Department spokesman eventually told us the U.S. government, through the CDC, did offer technical help and funding to support a National Public Health Institute in Guatemala. But we were told the Guatemalan government canceled the project before any money changed hands.
After months of calls and emails, we still don’t know why the project was canceled. We may never know.
“I hope in God that they will eventually help us because this was not a joke. We are not animals that they can use for testing purposes,” Lazaro Ramirez said.
His brother, Gonzalo, was more resigned to their fate, saying, “We suffer; it is painful. This disease will run its course only when we all die. That’s when it will end.”
A Modern Day Guatemala?
As for human experimentation, that did not end in the wake of the Guatemalan experiments. Unethical human experimentation can and does happen according to numerous experts interviewed by Circa. There was even disagreement within the Bioethics Commission about the possibility for something like Guatemala happening again in modern day. Dr. Susan Lederer with the University of Wisconsin presented to the commission during one of its meetings in 2011. She said, “I’m not so sure that there aren’t circumstances in which it would not happen. But what we can hope for is that the response would be dramatically different.”
The commission discussed specific rules, ethics guidelines and oversight that would make the Guatemala experiments a more difficult proposition in modern day. But Dr. Michael Carome with the advocacy group, Public Citizen, says even the strictest of rules don't stop all unethical human experimentation.
“Unfortunately there are multiple examples, through today, of research being done that is unethical, with a lack of informed consent, with a lack of making sure risks are minimized and that the research is safe to do,” Carome said during an interview at Public Citizen’s D.C. office.
Carome explained research done in third world countries can be especially problematic when it comes to a key issue for human experimentation: obtaining informed consent from participants. He told us, “There’s a lack of education perhaps and a lack of understanding of complex medical issues and terminology that does make it more difficult to get truly informed consent. Maybe in some cases it’s not going to be possible, and therefore maybe we shouldn't be doing the research in that setting. These are often people who are vulnerable because of their economic status, their educational status and they are more easily unduly influenced or even coerced to participate in research depending on the circumstances and how the subjects are approached.”
SOMO, an independent nonprofit based in the Netherlands, put out a report in 2008 documenting examples of what it believed were unethical human trials both here in the States and abroad. It found numerous examples of both private and publicly funded research it believed were unethical for a variety of reasons. The experiments the organization detailed were not from decades long ago or involving obscure groups. Some were as recent as 2006 and involved government entities and well known private companies.
Carome, through his work with Public Citizen, makes an effort to challenge experiments the organization believes go too far past the accepted boundaries. The organization has filed complaints with federal regulators to challenge experiments that it says skirt the rules. The group tries to shine a light on companies, experiments and experimental review boards that it considers to have ethical shortcomings. It’s not always enough.
“What we need are regulators to be more aggressive in enforcing the regulations, to publicly call out institutions and research when it fails to comply with the regulations protecting the subject and is unethical. And unfortunately the current regulators too often fail to do that."
Education is also key to preventing experiments like Guatemala from every happening again, according to experts like Susan Reverby. And it can’t be a lesson simply about one bad man.
“Unless we keep teaching it, unless we keep talking about it, unless it gets taught as a systemic problem rather than just one bad guy, then it just becomes a blip,” Reverby said. “When I talk to medical students in particular I say, ‘I don't want you to imagine that you shouldn't be Cutler. I want you to imagine how easy it would be for you to be Cutler.’ You have to think about the consequences of that passion on somebody else and how easily you could fall off an ethical ladder.”