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There are contributions that document the negativity that has been aroused with respect to clinical, observational and/or therapeutic trials based on international experiences.  This very well researched book by scholastic medical historian Susan Reverby specifically describes the more horrible and closer to the United States of America real life example, or examples of unethical clinical interventions. These are the very recently re-exposed scandals of very old date, which makes their resolution and comprehension much more difficult. There are two monstrous clinical trials that are intrinsically interrelated: the shameful executor of the one, a Dr. John C. Cutler in the case of the Tuskegee experiment, went on to participate in the just recently uncovered and even more hideous other, the one in Guatemala. [Interestingly it was the deep research unto the Tuskegee one that lead to the deeply buried in the bureaucracy Guatemala one]. One has to travel back in time to first reach the Tuskegee Experiment. That famous city of the State of Alabama that gave us the famous Tuskegee Institute, nowadays called The Tuskegee University, and the heroic Tuskegee squadron of black pilots of the 1940s, also was the location for a criminal attempt to test the consequences of chronic syphilis in human populations. Except that the chosen population was the poor, already underserved and defenseless African American peoples of the city. When black patients with syphilis were identified, they were put unto observation: The study took place in the years 1932-1972, the latter date when US Senator Edward Kennedy denounced it and had it stopped. During the period of the study effective treatment against syphilis became available through the at the time recent availability of the miracle drug, penicillin: however, conscientiously but also unconscionably, the studied patients were let without treatment as an “observation” group. Of course the application of no-treatment helped to spread syphilis unto spouses, sexual partners and progeny of the "observed" patients. Not even that minimum level of compassion, the treatment, was applied, in a situation that was already unacceptable in all accounts. No, the patients were not treated. As they were not treated in the more recent and recently discovered other trial, that surpasses, incredibly, the Tuskegee's one by much. It happened in Guatemala, of course far away from the USA, in a still more deprived, more defenseless population, and with the aggravation that patients under observation were not only let to rot with venereal disease, but by design purposely infected by inoculation, or by, can you believe it?, intentionally provided by-the premeditated-designed provision by the investigators themselves, sexual intercourse with certainly already sick prostitutes. Faced with these horrors the situation for this reviewer reads as more incomprehensive and pitiful taking into account that these criminal acts were perpetrated by some of the most cherished health institutions of  this reviewer scientific world: the Center for Disease Control and Prevention (CDC), the Public Health Service (PHS) and its uniformed commissioned officers corps and the pan American Health Organization, PAHO. PAHO, which at the time of the scandal was the Pan American Sanitary Bureau (PASB) is the WHO agency for the Americas. It is interesting to note here that Dr. Cutler's career was never affected by his design and participation in the Tuskegee and Guatemala experiments, but on the contrary prospered in the Public Health Service (PHS) and out of it in his subsequent academic and academic-administrative career. 

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