The early 20th century saw crucial advances in health, including a better understanding of the origins of some common diseases, the use of x-rays and ether, and a better understanding of the importance of drinking water and sanitation in disease reduction. However, there was also deadly pandemics and epidemics, governments lacked the power to oversee and test newly launched drugs, food preservation was not optimal, and childbirth carried significant risks for mothers and infants.
At the beginning of the 20th century, the development of vaccinations, antibiotics, sulfonamides, general hygiene, disease surveillance, safer workplaces, family planning and the creation of public health agencies such as the Federal Food and Drug Administration were still a few steps away. decades. However, as the century progressed, these and other achievements dramatically increased life expectancy. The Centers for Disease Control and Prevention reports that between 1900 and 1990, the average lifespan in the United States increased by more than 30 years, including 25 years of this achievement due to changes in public health.
Yet, time and time again, public health agencies have failed to take adequate precautions, failures that have claimed the lives of thousands of people around the world.
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The Thalidomide Tragedy
Until the mid-1950s, many scientists generally assumed that the placenta was an impenetrable barrier. Thus, drugs taken by pregnant women could not cross the placental barrier to damage the fetus in the womb. Although some researchers and drug developers once had the idea that this was not the case, it was dramatically demonstrated in a terrible tragedy.
The drug thalidomide was developed in the 1950s by the West German pharmaceutical company Chemie Grünenthal GmbH. It was originally developed as a sedative, but has also been used to treat many other ailments including colds, flu, leprosy, insomnia and morning sickness in pregnant women. Researchers deemed the drug harmless for human use, although it did not carry out extensive testing, and it was licensed in 1956 for over-the-counter sale in Germany. In just a few years, thalidomide has been sold in approximately 47 countries.
Clinical evidence that use of the drug resulted in nerve damage led to license denial by the Food and Drug Administration for sale in the United States.
By 1961, doctors had begun to notice a sharp increase in the number of babies born with severe birth defects to women who had taken thalidomide during pregnancy. This year, Australian physician William McBride published a letter in The Lancet linking thalidomide to birth defects. The drug was withdrawn by Chemie Grünenthal later that year. However, it had been marketed under many different names and remained in many medicine cabinets for quite some time.
The researchers later found that the developmental impact only occurred if the drug was taken between 20 and 37 days after conception. The incident led to nearly universal requirements to test drugs for their effects on fetal development before they were approved. Of course it was too late for the almost 100,000 babies around the world who have been affected. While most died shortly before or shortly after birth, around 10,000 survived. with severe birth defects.
Syphilis Experiments in Guatemala
While the thalidomide tragedy was caused by inadequate testing and a lack of regulatory procedures, other tragedies were caused more deliberately. One of them took place in 1946 in Guatemala.
At that time, when the Second World War was in full swing, the contraction of sexually transmitted diseases by soldiers who frequented prostitutes was a major problem for the military. Although penicillin was recently discovered as an effective treatment, it was not clear if it would work in all cases, and supplies of the drug were limited. As a result, American medical researchers were tasked with testing other treatments, such as orvus-mapharsen, which could be applied as a foaming wash after exposure.
Government officials and researchers, led by US Public Health Service scientist John C. Cutler, deliberately infected more than 1,300 Guatemalans. soldiers, prisoners, sex workers and psychiatric patients with syphilis, gonorrhea and chancroid, in most cases without informing those infected.
These people then transmitted the diseases to others unknowingly, and tests were performed on approximately 5,100 subjects to refine diagnostic techniques. About 820 subjects received some form of treatment, including more than 650 of those who were deliberately exposed. However, many more have received no treatment.
According to research published in the American Journal of Public Health, the experiments were often not conducted in sterile environments. According to documents released by the Presidential Commission for the Study of Bioethical Issues, in September 2011 many of those involved either did not give consent or actively opposed being used for the experiments and were infected against their will.
The total death toll was revealed as 83 of the 5,500 subjects, although the Presidential Commission could not verify whether the deaths were caused directly or indirectly by the infections, the BBC reported.
This wasn’t the first time the US government had experimented on people without their knowledge.
In 1997, the president bill clinton issued an official apology for the “Tuskegee Study of Untreated Syphilis in the Negro Male,” a 40-year experiment involving hundreds of unsuspecting black men. The study, conducted by the U.S. Public Health Service at Tuskegee Institute (now Tuskegee University), ran from 1932 to 1972.
The purpose of the study was to determine the effect of untreated syphilis in black men. The 600 men in the study were never told they had syphilis. Most of them had never received medical care, so the men were told that they were offered free medical care. They were then tested for syphilis and given periodic examinations to measure the progression of the disease – but they were never told they were infected and no treatment was ever offered. Instead, even though some were suffering from advanced effects such as blindness and insanity, they continued to be told they had “bad blood” and treatment continued to be withheld.
After the subjects died, their families were offered $50 to cover the cost of a coffin and grave – if they agreed to allow an autopsy.
The research project was eventually halted after a former PHS investigator spoke out against the press. A public outcry led to congressional hearings and federal legislation strengthening guidelines for protecting human subjects in research. A class action lawsuit was filed on behalf of the men that resulted in a $10 million settlement for the victims, their families and heirs.
HIV infected clotting drug
Originally reported by The New York Times in 2003, it was claimed that a division of Bayer, the pharmaceutical multinational, knowingly sold in the mid-1980s coagulant drugs with a high risk of HIV contamination to hemophiliacs. The company sold the contaminated drugs in Asia and Latin America, while selling a new, safer product in the West.
Hemophilia is an inherited disease that prevents blood from clotting. People with the disease lack certain clotting factors – these are proteins found in the blood that help stop bleeding when a person is injured. In severe cases, victims need medical treatment to prevent excessive bleeding. Hemophiliacs had to go to the hospital to receive their plasma transfusion treatment. When factor concentrate produced from donor plasma began to become available, patients were finally able to take their treatment in the form of injections, which was not only much more convenient but saved many lives at home and received treatments on their own when they started bleeding. For the first time, people could be treated before a bleed, reducing the likelihood of serious harm.
The factor concentrate was produced by pooling human blood plasma from 10,000 donors and then concentrating it. If just one of these 10,000 donors were infected with a disease such as hepatitis or HIV, the whole lot could be contaminated. Additionally, in the United States, blood plasma was often collected from high-risk paid donors, such as prisoners and drug addicts.
These risks were largely ignored until the early 1980s, when hemophiliacs began to contract AIDS through contaminated blood products. By 1984, heat-treated blood products had become available, in which viruses in the blood had been deactivated. It is this heat-treated product that Bayer has made available in the United States and some other countries, while continuing to sell its stocks of unprocessed, more dangerous factor concentrate.
It is not known how many hemophiliacs in Asia and Latin America have contracted HIV and subsequently died from contaminated products.