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Under the skin

University investigates and apologizes for unethical dermatology tests conducted on prison inmates in the 1960s and 1970s

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The University of California, San Francisco (UCSF), has adopted an assertive strategy for dealing with cases of scientific misconduct that occurred in the distant past, when ethical standards for research were not so well established and behaviors considered unacceptable today were generally tolerated. A year ago, the institution created the Program for Historical Reconciliation, tasked with investigating and reporting on possible unethical misconduct committed by its scientists in the past.

In December, the program released its first report. The result of efforts by an investigation committee that analyzed more than 7,000 documents over six months, the work focused on questionable experiments involving prisoners at a prison hospital in Vacaville, California. Two researchers from UCSF’s Department of Dermatology, Howard Maibach and William Epstein, conducted studies in the 1960s and 1970s that exposed nearly 2,600 prisoners to pesticides, herbicides, and drugs with potential side effects. Substances were applied to the skin of incarcerated men and injected into their veins to assess potential reactions in humans.

In some tests, the volunteers were deliberately exposed to and bitten by mosquitoes, with the aim of monitoring how the insects are attracted to humans and how they bite them. Most prisoners were admitted to the penitentiary hospital for diagnosis or treatment of psychiatric problems. The tests were voluntary and participants were given a monthly payment of US$30.

The report identified various problems in how the research was conducted, highlighting the absence of “informed consent,” through which volunteers in clinical trials are told about the health risks they face and their rights in the event that the research causes any mental or physical harm.

The committee analyzed 34 scientific articles published between 1960 and 1980 that were directly or potentially linked to experiments involving Vacaville inmates and found virtually no mention of informed consent, even though it has been mandatory since 1966. One exception was a paper published in 1975 highlighting its approval by UCSF’s Human Research Committee (HRC), which had been established a year earlier. The pair of dermatologists apparently circumvented the university regulations by attributing management of the experiments to a nonprofit organization called the Solano Institute for Medical and Psychiatric Research, even when they were carried out at UCSF. Another aggravating factor was that the experiments had no therapeutic purpose. The prisoners had no illnesses or medical conditions that could be treated or alleviated by the substances to which they were exposed. The studies were only stopped in 1977 when the state of California prohibited testing on humans in penal institutions—a ban that had been implemented in federal prisons a year earlier.

According to the report, prior to joining UCSF, Maibach and Epstein studied at the University of Pennsylvania, where they worked under Albert Kligman [1916–2010], a dermatologist who conducted unethical experiments on Black prisoners at Holmesburg Prison in Philadelphia between 1951 and 1974. Funded by Dow Chemicals, Kligman exposed some 80 men to high doses of dioxin, used in herbicides and chemical weapons, to study the effects of the contaminant. In 2019, an investigation by Penn Medicine, the university’s medical center, concluded that the research did not violate any laws at the time, but was unethical and disrespectful to participants. Two years ago, the university acknowledged the need to reexamine Kligman’s’ legacy and promised to redirect research funds previously held in his name to scholarships and studies on diseases that affect people of color (see Pesquisa FAPESP issue no. 308). Kligman was one of the scientists behind the discovery in the late 1960s that retinoic acid (Retin-A) can be used to effectively treat acne.

Due to the fact that William Epstein died in 2006, the UCSF investigative committee focused only on the work of Maibach, who is still an active researcher. Over the course of his 60-year career, he has published some 2,500 articles and has featured on the editorial boards of more than 30 scientific journals. He was made aware of the report’s content before it was published and issued a statement explaining the context of the research and apologizing. “What I believed to be ethical as a matter 40 or 50 years ago is not considered ethical today,” he said. “The work I did with colleagues was considered by many to be appropriate by the standards of the day, although in retrospect those standards were clearly evolving. I obviously would not work under those circumstances today—as the society we live in has unambiguously deemed this inappropriate,” he continued. He stressed, however, that no harm to the participants’ health was recorded at the time and there was informed consent in many cases, although it was not mentioned in the scientific articles.

While there is no evidence that the prisoner studies in California were racially biased, the report notes that Maibach’s work on skin differences used terminology now considered inappropriate and helped perpetuate an out-of-date approach to race. The researcher also mentioned this topic in his apology, stating that he “came to the understanding that race has always been a social and not a biological construct, something not appreciated by so many of us in a prior era.”

The report made a number of recommendations for UCSF, including that the university share its findings with the community, establish an oral history project with individuals subjected to the experiments in Vacaville between 1955 and 1977, issue an official apology, and continue with further investigations. In response, UCSF’s executive vice chancellor Dan Lowenstein released an official statement regarding the Maibach and Epstein case. “UCSF apologizes for its explicit role in the harm caused to the subjects, their families, and our community by facilitating this research and acknowledges the institution’s implicit role in perpetuating unethical treatment of vulnerable and underserved populations,” he wrote. According to Lowenstein, acknowledging past failures and striving to reconcile with victims of historical misconduct are essential to promoting justice and transformation in the present.