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【原文标题】U.S. Apologizes for Syphilis Program in Guatemala 【中文标题】美国为危地马拉梅毒试验道歉 【登载媒体】纽约时报 【来源地址】http://www.nytimes.com/2010/10/0... /02infect.html?_r=1 【译者】 yangfuguang 【声明】本翻译供Anti-CNN使用，未经AC或译者许可，不得转载。
【译文】 1946至1948年，美国公共健康部门的医生蓄意给约700名危地马拉人——这些人包括囚犯，精神病人，士兵——注射性病病毒，原因是医生们想以此来测试盘尼西林的药效。 美国纳税人的钱，通过国家健康研究机构，甚至给了那些患有性病陪那些囚犯睡觉的妓女，因为危地马拉监狱允许这种访问。而当这些妓女没有成功使有些囚犯患病，这些囚犯会被从刮伤的阴茎、脸、或者胳膊上注射病毒，有些人还是通过脊椎穿刺来感染病毒。如果人鼠患病了，他们会给予抗生素治疗。 Susan M. Reverby是韦尔兹利大学的教授，她把在一份研究报告中曝光了此事，并促使美国健康部门的调查。她说：“然而，是不是所有人在接下来的治疗中痊愈了，就不得而知乐”。 真相在周五公布给公众，当时国务卿希拉里和卫生及公共服务部部长凯瑟琳向危地马拉政府，幸存者以及他们的后代道歉。她们说那次试验“十足的无德”。 国务卿和部长表示：“尽管事情过去了64年多了，我们还是很愤怒，这种无良的研究居然打着公共健康的幌子。我们对此事的发生深表遗憾，在此我们向所有在此事件中被感染的人道歉”。 由于对此事件的扭曲，领导该试验的公共健康部的医生John C. Cutler接下来在塔斯基吉的研究中扮演了重要的角色，在该研究中美国黑人被蓄意注射梅毒病毒，而且在数十年中他们没有得到公共健康部的治疗。在他晚年，他依旧对塔斯基吉的研究做辩护。 他还未出版的关于塔斯基吉研究的报告最近在匹兹堡大学的档案室被Reverby发现；Reverby是医疗史学家，她已经写了两本有关塔斯基吉的书。 危地马拉总统科隆最早是在周四通过克林顿夫人的电话了解此事的，他说此事是“令人毛骨悚然的”和“反人类的”。危地马拉政府表示，他们将会尽自己最大的努力和美国合作调查此事。 国立健康机构的主管Dr. Francis S. Collins博士说：“这些实验是“药物研究史上的黑暗篇章”。”Dr. Francis S. Collins博士表示，现在关于联邦资助的研究的规则是禁止在被试验者不知情的情况下开展实验。 Reverby教授周五接受电话采访时表示，她一月在一次会议上公布了她在危地马拉试验项目的发现，但没人在意。六月，她发了一份打算在2011年一月发表在《警察历史》的报告的草稿给疾病防控中心的前主管David J. Sencer博士，他促使政府对该实验的调查。 Reverby博士表示，在1940年代，美国公共健康服务部非常关注，盘尼西林是否可以预防而不仅仅是治疗早期的梅毒感染，是否对该病的血液测试可以更加完善，多大剂量的盘尼西林可以治好感染，他们也很想了解传染机制。 在实验室培养梅毒病毒是很困难的，而在兔子和黑猩猩身上进行的试验又很难说明在人身上盘尼西林是怎样起作用的。 1944年，在印第安纳州Terre Haute的联邦监狱给监狱的“志愿者”注射了实验室培养的梅毒病毒，但后来发现这种感染方式很难起作用。 Reverby 说，1946年，Cutler被任命为危地马拉研究的主管，在两年后该试验终止，部分原因是关于该实验的“流言”，部分是由于该实验使用大量供应紧张的盘尼西林。 Cutle不久之后参与了在塔斯基吉的研究，它是在1932年开始的，相对安全的，观测梅毒如何在黑人佃农身上发展的试验。1972年的发现表明，尽管早期医师们给那些人提供抗生素，这些人也没有被告知他们患有梅毒，以便继续的试验。Cutle在2003年去世，在1993年的一份文档中依旧对该实验进行了辩护。 Reverby博士说，在危地马拉，真相也没有被告知给鼠人。Thomas Parran博士是卫生署前主管，他监控了塔斯基吉试验的早期部分，他承认危地马拉的试验不会在国内做，真相被危地马拉官方隐藏。而当时她还在研究Parran医师。 Reverby教授说，她在匹兹堡大学发现了Cutler博士的一些文件，Cutler在匹兹堡教学直到1985年。她说：“当时我在筛选这些文件，我发现了危地马拉、接种这些字眼，我当时想‘这是什么鬼东西呀’，然后我狂喊‘我的上帝啊，我的上帝啊，我的上帝啊’，我的同伴当时和我在一起，我告诉他‘你可能不会相信这是真的呃’”。 Fernando de la Cerda是危地马拉驻美大使馆的大使，他表示，克林顿夫人在周四在电话中向克林总统的道歉。我们感谢美国政府在此事上的透明，告诉我们了真相。 当被问及对于幸存者及其后代的赔偿的可能性时，他表示，目前还不是很清楚。 危地马拉网络上公众在听到这个消息之后的反应是激烈的。一个评论者Cesar Duran在Prensa Libre网站留言说：“道歉？拜托，这还是曝光的部分，那隐藏的东西呢？他们应该向危地马拉政府作出补偿，而不仅仅是道歉。” Mark Siegler博士是芝加哥大学医学院临床医学伦理方向的麦克林中心的主管，他说，自己很震惊。他说：“这很让人震惊，这比塔斯基吉更差劲，因为那些人还是自然传播这种疾病的”。 他补充说：“这很讽刺，不，比那更加恶劣，这很可怕——当时美国还在极力阻止纳粹的医生对人类犯罪，美国政府却支持这种使参与者冒很大风险的试验”。 纳粹医生在纽伦堡在集中营关押的人以及囚犯的试验引起了一系列伦理犯罪，尽管当时还没有法律来约束。在1964年，赫尔辛基宣言使得很多国家的卫生部门达成了共识。 Dr. Siegler说，塔斯基吉的丑闻以及随后对其展开的深入调查为1981年美国出台监管在人身上进行的试验的法律打了基础。 它很快又被其他丑闻掩盖。1963年到1966年，斯塔顿岛的布鲁克州立大学的研究者们给智障儿童注射乙肝病毒，以测试伽马球蛋白对该病毒的免疫反应。在1963年，布鲁克林犹太人慢性病医院的年长的病人被注射活的癌症细胞，来观察这些细胞是否能产生病毒。
【原文】 From 1946 to 1948, American public healthdoctors deliberately infected nearly 700 Guatemalans — prison inmates, mentalpatients and soldiers — with venereal diseases in what was meant as an effortto test the effectiveness of penicillin. American tax dollars, through the NationalInstitutes of Health, even paid for syphilis-infected prostitutes to sleep withprisoners, since Guatemalan prisons allowed such visits. When the prostitutesdid not succeed in infecting the men, some prisoners had the bacteria pouredonto scrapes made on their penises, faces or arms, and in some cases it wasinjected by spinal puncture. If the subjects contracted the disease,they were given antibiotics.
“However, whether everyone was then cured is not clear,” said SusanM. Reverby, the professor at Wellesley College who brought theexperiments to light in a research paper that prompted American healthofficials to investigate. The revelations were made public on Friday,when Secretary of State Hillary Rodham Clinton and Health and Human ServicesSecretary Kathleen Sebelius apologized to the government of Guatemala and thesurvivors and descendants of those infected. They called the experiments“clearly unethical.” “Although these events occurred more than 64 years ago, we are outraged that such reprehensibleresearch could have occurred under the guise ofpublic health,” the secretaries said in a statement. “We deeply regret that ithappened, and we apologize to all the individuals who were affected by suchabhorrent research practices.” In a twist to the revelation, the publichealth doctor who led the experiment, John C. Cutler, would later have animportant role in the Tuskegee study in which black American men with syphiliswere deliberately left untreated for decades. Late in his own life, Dr. Cutlercontinued to defend the Tuskegee work. His unpublished Guatemala work wasunearthed recently in the archives of the University of Pittsburgh by ProfessorReverby, a medical historian who has written two books about Tuskegee. President Álvaro Colom of Guatemala, whofirst learned of the experiments on Thursday in a phone call from Mrs. Clinton,called them “hair-raising” and “crimes against humanity.” His government said itwould cooperate with the American investigation and do its own. The experiments are “a dark chapter in the historyof medicine,” said Dr. Francis S. Collins, director ofthe National Institutes of Health. Modern rules for federally financed research“absolutely prohibit” infecting people without their informed consent, Dr.Collins said. Professor Reverby presented her findingsabout the Guatemalan experiments at a conference in January, but nobody tooknotice, she said in a telephone interview Friday. In June, she sent a draft ofan article she was preparing for the January 2011 issue of the Journal ofPolicy History to Dr. David J. Sencer, a former director of the Centers forDisease Control. He prodded the government to investigate.
In the 1940s, Professor Reverby said, theUnited States Public Health Service “was deeply interested in whetherpenicillin could be used to prevent, not just cure, early syphilis infection,whether better blood tests for the disease could be established, what dosagesof penicillin actually cured infection, and to understand the process ofre-infection after cures.”
It had difficulties growing syphilis in thelaboratory, and its tests on rabbits and chimpanzees told it little about howpenicillin worked in humans.
In 1944, it injected prison “volunteers” atthe Terre Haute Federal Penitentiary in Indiana with lab-grown gonorrhea, butfound it hard to infect people that way.
In 1946, Dr. Cutler was asked to lead theGuatemala mission, which ended two years later, partly because of medical “gossip” about the work,Professor Reverby said, and partly because he was using so much penicillin,which was costly and in short supply. Dr. Cutler wouldlater join the study in Tuskegee, Ala., which had begun relatively innocuouslyin 1932 as an observation of how syphilis progressed in black malesharecroppers. In 1972, it was revealed that, even when early antibiotics wereinvented, doctors hid that fact from the men in order to keep studying them.Dr. Cutler, who died in 2003, defended the Tuskegee experiment in a 1993documentary.
Deception was also used in Guatemala,Professor Reverby said. Dr. Thomas Parran, the former surgeongeneral who oversaw the start of Tuskegee, acknowledged that the Guatemala workcould not be done domestically, and details were hidden from Guatemalanofficials.
Professor Reverby said she found some ofDr. Cutler’s papers at the University of Pittsburgh, where he taught until1985, while she was researching Dr. Parran. “I’m sifting through them, and I find‘Guatemala ... inoculation ...’ and I think ‘What the heck is this?’ And thenit was ‘Oh my god, oh my god, oh my god.’ My partner was with me, and I toldhim, ‘You aren’t going to believe this.’ ”
Fernando de la Cerda, minister counselor at the Guatemalan Embassy in Washington, saidthat Mrs. Clinton apologized to President Colom in her Thursday phone call. “Wethank the United States for its transparency intelling us the facts,” he said.
Asked about the possibility of reparations for survivors or descendants, Mr. de lACerda said that was still unclear. The public response on the Web sites ofGuatemalan news outlets was furious. One commenter, Cesar Duran, on the site ofPrensa Libre wrote: “APOLOGIES ... please ... this is what has come to light,but what is still hidden? They should pay an indemnity to the state ofGuatemala, not just apologize.”
Dr. Mark Siegler,director of the Maclean Center for Clinical Medical Ethics at the University ofChicago’s medical school, said he was stunned.“This is shocking,” Dr. Siegler said. “This is much worse than Tuskegee — atleast those men were infected by natural means.”
He added: “It’s ironic — no, it’s worsethan that, it’s appalling — that, at the same time as the United States wasprosecuting Nazi doctors for crimes against humanity, the U.S. government wassupporting research that placed human subjects at enormous risk.”
The Nuremberg trials of Nazi doctors whoexperimented on concentration camp inmates and prisoners led to a code ofethics, though it had no force of law. In the 1964 Helsinki Declaration, themedical associations of many countries adopted a code. The Tuskegee scandal and the hearings intoit conducted by Senator Edward M. Kennedy became thebasis for the 1981 American laws governing research on human subjects,Dr. Siegler said.
It was preceded by other domestic scandals.From 1963 to 1966, researchers at the Willowbrook State School on Staten Islandinfected retarded children with hepatitis to test gamma globulin against it. And in1963, elderly patients at the Brooklyn Jewish Chronic Disease Hospital wereinjected with live cancer cells to see if they caused tumors. | 
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