LAWRENCE K ALTMAN
Medicine honours its heroes in many ways. But sometimes high accolades can turn out to be highly embarrassing.
Consider the annual award for lifetime achievement in preventing and controlling sexual infections,given since 1972 by the American Sexually Transmitted Diseases Association. The prize is named for an authentic giant of medicine: Dr Thomas Parran Jr,United Statess sixth surgeon general (from 1936 to 1948),who used what was then a supremely powerful position to lift American public health to the front ranks.
At a time when venereal diseases were spoken of in whispers,Parran influenced Congress to finance rapid-treatment centers to control and prevent syphilis,gonorrhea and chancroid. He was largely responsible for requiring syphilis tests for marriage licence applications.
Beyond that,he fought to clean up polluted waterways,crusaded for truth in radio drug advertising and was an architect of the World Health Organisation.
But if Parran was ahead of his time,he was also complicit in two of the most egregious medical scandals of the 20th century. And that blight on his record is now endangering his honoured place in the world of public health.
The two medical scandals revolved around experiments that are now universally regarded as shocking. Parran did not perform either study. Though national experts approved them both,he presided over them,strongly supported them and followed their progress in medical journals.
One,the Tuskegee study,observed the course of untreated syphilis among hundreds of men who were infected naturally in Alabama. The study began in 1932,and it was not halted by the US Public Health Service until 1972,after a whistle-blower complained that infected patients in the study were not given penicillin,the standard therapy after World War II. Some participants died of the disease,some of their sexual partners contracted it,and some children were born infected.
In the other study,even more odious,US researchers from 1946 to 1948 intentionally exposed more than 1,300 Guatemalans,including many in mental institutions,to syphilis,gonorrhea and chancroid. Although Parran had said that consent was needed before individuals participated in experiments,no evidence exists that the researchers sought such permission. The unpublished Guate-malan experiments were hidden for more than half a centuryuntil 2010,when the records were found and released,causing worldwide outrage and prompting a formal apology to Guatemala from then secretary of state Hillary Rodham Clinton.
Few would disagree with Julius Schachter,a Parran Award recipient from the University of California,San Francisco,who wrote that the incredible inhumanity of these actions is mind-boggling. But should the association drop Parrans name from the award?
There is precedent for altering medical awards to take account of new information. In recent years,two European doctors who had Nazi affiliationsHans Reiter and Friedrich Wegenerhave had their names stripped from disorders they studied.
Few doctors are taught medical history,and Parrans achievements deserve to be remembered alongside his inexcusable ethical lapses.