ACRES OF SKIN: HUMAN EXPERIMENTS AT HOLMESBURG PRISON BY ALLEN M. HORNBLUM Apr – Jun 1999 | Vol. 5, No. 2 Anderson, Philip C.; Hornblum, Allen M.; Proctor, Robert REVIEW BY ROBERT N. PROCTOR, PH.D Dr. Proctor is an international expert on Nazi medicine and has authored a classic work on Nazi medical experiments, Racial Hygiene (Harvard University Press). Human experimental abuse has a long and ugly history. Even after the publication of the 1947 Nuremberg Code, drafted to condemn the cruelties wrought by Nazi doctors, American physicians continued to violate various aspects of the code, especially the very first principle requiring free and informed consent. The list of violations is long: Tuskegee, Fernald, Willowbrook, Vanderbilt, the downwinders, the atomic veterans, the Bikini Islanders – all are remainders of how the Nazi doctors tried at Nuremberg were not the only ones capable of causing harm in the name of experimental progress. Allen Hornblum, a criminologist and forensic sociologist, now adds another name to this roster of shame: the Holmesburg Prison of Philadelphia. From the early 1950s through the mid 1970s, prison officials and medical consultants at Philadelphia’s largest county jail conducted a series of painful and injurious experiments, many of which clearly violated the Nuremberg Code. Prisoners were used to test the safety of various detergents, skin creams, and diet drinks, but prisoners were also exposed to far more hazardous substances, including radioactive isotopes, dioxin, mind-altering drugs, and chemical warfare agents – often without being informed of the nature or purpose of the experiments. Hornblum has done a remarkable job in documenting these abuses, many of which caused suffering for the people used as guinea pigs. Healthy fingernails were extracted – using pliers and a vice grip – to test the effectiveness of various regeneration ointments. Poison ivy vaccines were administered which caused the hospitalization of at least one inmate for low blood pressure. Inmates were also infected with various kinds of herpes and wart viruses to test experimental vaccines. Hornblum tells these and dozens of other, equally appalling, stories with the skill of a popular science writer, weaving documentary testimony with excerpts from hundreds of interviews conducted with former prisoners, prison officials, and attending physicians and orderlies. What is astonishing is how many different kinds of experiments were performed, with financial support from so many private and public agencies. The Chocolate Manufacturers Association financed experiments to see whether a high-chocolate diet exacerbated acne; R. J. Reynolds used the prisoners to explore which components of tobacco smoke might be responsible for bladder cancer. The U.S. Army funded tests of chemical warfare agents and psychoactive substances; Dow Chemical and the University of Pennsylvania financed dangerous and painful studies of the effects of dioxin rubbed into the skin. Pharmaceutical companies were major players: Hornblum shows that between 1962 and 1966, 33 different pharmaceutical companies tested a total of 153 experimental drugs on Holmesburg inmates. Many of these tests produced injuries. Burn tests left scars on many inmates, as did the scalp transplant experiments (to treat baldness) and the studies in which prisoners had gauze implants sewed under their skin (to test various kinds of potential irritants). Prisoners got rashes from experimental detergents, stomach cramps from sun tanning lotions, enlarged breasts from estrogen tests, and fungal diseases from athlete’s foot experiments (in one study, infected prisoners were required to wear their boots continually for one whole week – and were told this was part of an experiment to determine how well a particular kind of boot fit). Prisoners were often given spinal taps along with skin and nail biopsies, and in at least one series were asked to go for six months on a liquid diet. Many tests were presumably harmless, but Hornblum shows that some were clearly life threatening. In one series of liver biopsies, for example, several men had to be hospitalized following dramatic falls in blood pressure. Some of the classified experiments organized by U.S. military authorities produced long-term psychological disturbances (following exposure to hallucinogens, for example); military authorities also exposed prisoners to skin “hardening” agents such as glycol monomethyl ether, following which some subjects developed severe psychotic reactions. (The point of this last-mentioned series was to see if soldiers could be produced with skin resistant to chemical poisons.) Hornblum admits that many of the inmates welcomed the opportunity to participate in such experiments. Prison life was rough in any event, and the tests were often seen as both a relief from boredom and a chance to obtain extra medical attention. Prisoners were well paid for participating – up to $300 or even $400 per month, and even more for especially dangerous tests. (In 1966 alone $272,379 was paid out to prisoners for their participation.) Prisoners were used to getting only 15 cents per day for making shoes or shirts, so it is not hard to understand why volunteers were not in short supply. Hornblum shows that prices were sometimes negotiable: when $50 was offered to prisoners who would agree to have their nails pulled out, the excruciating pain among the first few volunteers caused many to back out, and those who remained bargained the price up to $150 per nail. The author also shows that the prisoners did not submit passively to these experiments. Many “cheated” on their tests, removing their bandages once they were back in their cells, or buying contraband food when they were supposed to be on experimental diets. Hornblum notes that many of the results were no doubt flawed from such behavior, but he also reports the even more remarkable fact that no one in the prison research hierarchy seems to have cared. One gets the sense that many of the experiments were shoddily supervised, with administrators having little sense of how the particulars of the prison environment might compromise the validity of the results. Hornblum also makes it clear that prisoners often had only vague ideas of what they were being exposed to. One could quibble over how closely the Holmesburg prison and other U.S. experiments paralleled those of the Nazi doctors (a comparison Hornblum often draws); there are clearly both similarities and differences. In his introduction, Hornblum writes that the experiments performed by Nazi doctors at Auschwitz, Ravensbruck, and Dachau were “not significantly different from giving retarded orphans breakfast cereal in milk laced with radioactive calcium” at the Walter E. Fernald State School in Massachusetts – but I would disagree. Many Nazi experiments were “terminal experiments,” planned to end in the death of the experimental subject. The Fernald experiments were unethical and perhaps even criminal, but they were never deliberately designed to kill their subjects. The Holmesburg prisoners were apparently able to terminate their participation (Hornblum cites several cases where this happened); in the most notorious Nazi experiments, this was not an option. I strongly recommend this book, especially for anyone concerned with the ethical context of medicine, especially in the experimental context (dermatologists should find this of particular interest, because most of the abuses chronicled here concern experiments performed on the skin). The book includes a damning overview of Albert M. Kligman’s role as architect of the Holmesburg experiments, some insightful remarks on the transition of dermatology from a minor medical specialty to a major cosmetic enterprise, and a solid review of prison experiments outside Holmesburg, including the testicular transplant studies at San Quentin, the testicular irradiation of Oregon and Washington prisoners, live cancer cell injections at the Ohio State Penitentiary, and the mind control experiments performed by CIA scientists at the Iona State Hospital in Michigan. The book is carefully researched and fully documented; Hornblum lets the facts speak for themselves. The ethical message, however, is clear: there is potential ethical abuse whenever confined or vulnerable populations are used as experimental subjects. Hornblum cites one unnamed medical critic from the early 1970s, pointing out that free consent is essentially impossible in the prison environment: If the researchers really believe these experiments are safe for humans, why do they go to the prison for the subjects? Why don’t they try them out in their own laboratories on students or other free world volunteers? Because they know the university would never permit this – and furthermore it would never enter their minds to do these things to people they associate with in daily life. They make a distinction between people they think of as social equals or colleagues and men behind bars, whom they regard as less than human. The scholars who launched such studies had little regard for the rights or well being of their experimental subjects. The dermatologist Albert M. Kligman made this clear in his 1966 reminiscence of how he first viewed the prisoners, on arriving at the prison in the early 1950s: “All I saw before me were acres of skin. It was like a farmer seeing a fertile field for the first time.” Ethics was not one of his primary concerns, as these comments of his reveal: “Things were simpler then. Informed consent was unheard of. No one asked me what I was doing. It was a wonderful time.” Kligman elsewhere describes the prison as an “anthropoid colony, mainly healthy, under perfect control conditions.” Holmesburg of course was just one case, but Hornblum gives us a clear sense that the example set in Philadelphia was copied elsewhere in the country: doctors and medical students trained at Holmesburg’s prison laboratory went on to establish prison skin labs in other parts of the country. Prison experiments finally came to an end in 1974, following U.S. Senate hearings denouncing such experiments as a violation of human rights. Hornblum notes the irony in the fact that many prisoners protested the passing of the opportunity, one of the few ways they had of earning good money. The ethical issues of human experimentation are not obvious or subtle, and Hornblum in his account does not shy from the complexities. Familiarity with the more dramatic examples of such abuses will hopefully help guide us in our search for creative ways to avoid them.
Acres of skin: Human experiments at Holmesburg Prison by Allen M. Hornblum – Derm101
Clinical Reference / Dermatopathology: Practical & Conceptual / Apr – Jun 1999 | Vol. 5, No. 2 / Acres of skin: Human experiments at Holmesburg Prison by Allen M. Hornblum Acres of skin: Human experiments at Holmesburg Prison by Allen M. Hornblum Apr – Jun 1999 | Vol. 5, No. 2 Anderson, Philip C…