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A Truly Impure Science: Researchers, Industrialists, and the Cigarette

In 1948, U.S. public health service (PHS) researcher John Cutler traveled to Guatemala to study the prevention of syphilis. The initial project was to recruit volunteers who would receive detailed information on the experiments’ goals and risks, sign informed consent forms, and receive financial compensation. When it became clear that the study could not be implemented as planned, Cutler and his colleagues decided to experiment on uninformed and vulnerable people: soldiers, orphans, and, in the worst case of abuse, psychiatric patients. The syphilis experiments in Guatemala, revealed in 2010 by the historian Susan Reverby, were investigated by the Presidential Commission for the Study of Bioethical Issues. The commission’s report reveals that the principal means employed by Cutler and his collaborators to enroll psychiatric patients was the distribution of cigarettes: “Each time a patient was used in an experiment or had blood or cerebro-spinal fluid withdrawn, he was given a packet of local cigarettes. Each time he was seen for a clinical observation he was given a single cigarette. The patients would often attempt to make numerous trips past the physicians for blood letting, cisternal puncture or examination, just to augment their supply of tobacco.” Cutler also distributed cigarettes to secure the collaboration of workers at the psychiatric hospital. The main difference was that patients received local cigarettes, while hospital staff received cigarettes manufactured in the United States. Luckily, Cutler added, their budget was sufficiently flexible to allow for the purchase of tobacco: “without the availability of cigarettes, the type of patient management that we were able to achieve, we feel would have been impossible.”1 One of the main contributions of Robert Proctor’s important new study, Golden