Here are the three public health scandals that cost millions of lives

How terrible could things get in world medicine?
Interesting Engineering

The beginning of the 20th century saw some crucial advances in healthcare, 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 clean water and sanitation in reducing illness. However, there were also deadly pandemics and disease outbreaks, governments lacked authority to supervise and test newly launched drugs, food preservation was not at its best, and childbirth carried significant risk to both mothers and infants.

At the beginning of the 20th century, the development of vaccinations, antibiotics, sulfonamide drugs, overall hygiene, disease monitoring, safer workplaces, family planning, and the establishment of public health agencies such as the Federal Food and Drug Administration were still a couple of decades away. However, over the course of the century, these and other achievements increased life expectancy considerably. 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, with 25 years of this achievement due to developments in public health. 

Still, several times, public health agencies failed to take adequate precautions, failures that claimed the lives of thousands of people worldwide. 

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The thalidomide tragedy

Until the mid-1950s, many scientists generally assumed the placenta was an impenetrable barrier. Thus drugs taken by pregnant women could not pass through the placental barrier to damage the fetus in the womb. Although some researchers and drug developers already had an idea that this was not the case, it was demonstrated dramatically in a terrible tragedy.

The drug thalidomide was developed in the 1950s by the West German pharmaceutical company Chemie Grünenthal GmbH. It was initially developed as a sedative but was also used to treat many other conditions, including colds, flu, leprosy, insomnia, and morning sickness in pregnant women. Researchers deemed the drug harmless for human use, despite not having done extensive testing, and it was licensed in 1956 for over-the-counter sale in Germany. Within just a few years, thalidomide was sold in around 47 countries.

Clinical evidence that the use of the drug led to nerve damage meant that it was refused a license by the Food and Drug Administration for sale in the US.

Here are the three public health scandals that cost millions of lives
Feet of a thalidomide baby. Source:Otis Historical Archives National Museum of Health and Medicine/Flickr

By 1961, doctors had begun to notice a large uptick in the number of babies born with severe birth defects to women who had taken thalidomide while pregnant. That year, Australian doctor William McBride published a letter in The Lancet connecting thalidomide to the birth defects. The drug was withdrawn by Chemie Grünenthal later that year. However, it had been traded under many different names and remained in many medicine cabinets for some time.

Researchers later discovered that the impact on development only occurred if the drug was taken between  20 and 37 days after conception. The incident led to almost universal requirements to test drugs for their effects on fetal development before being approved. Of course, this was too late for the nearly 100,000 babies worldwide who were affected. While most of these died shortly before or shortly after birth, around 10,000 survived with severe birth defects.  

Guatemala syphilis experiments

While the thalidomide tragedy was caused by inadequate testing and a lack of regulatory procedures, other tragedies have been caused more deliberately. One of these took place in 1946 in Guatemala.

At this time, with WWII in full swing, the contraction of sexually transmitted diseases by soldiers who frequented prostitutes was a significant problem for the military. Although penicillin had recently been discovered as an effective treatment, it was unclear whether this would work in all cases, and supplies of the drug were limited. As a result, U.S. medical researchers were tasked with testing other treatments, such as orvus-mapharsen, which could be applied as a foaming wash following exposure. 

Government officials and researchers, led by the United States Public Health Service scientist John C. Cutler, deliberately infected more than 1300 Guatemalan soldiers, prisoners, sex workers, and psychiatric patients with syphilis, gonorrhea, and chancroid, in most cases without notifying the infected.

These people then passed the diseases on to others unknowingly, and tests were conducted on around 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 received no treatment.

According to a research published in the American Journal of Public Health, the experiments were often not conducted in sterile settings. According to documents published by the Presidential Commission for the Study of Bioethical Issues, in September 2011, many of the people involved either did not give their consent or actively objected to being used for the experiments and were infected against their will. The total death toll has been revealed as 83 of the 5,500 subjects, although the Presidential Commission couldn't verify whether the deaths were caused directly or indirectly by the infections, BBC reported.

This was not the first time that the U.S. government had experimented on people without their knowledge.

In 1997, President Bill Clinton issued a formal apology for the "Tuskegee Study of Untreated Syphilis in the Negro Male", a 40-year-long experiment involving hundreds of unsuspecting black men. The study, conducted by the U.S. Public Health Service at the Tuskegee Institute (now Tuskegee University), lasted 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 that they had syphilis. Most of whom had never received medical care, the men were told that they were being offered free medical care. They were then tested for syphilis and given periodic checkups to measure the progress of the disease - but were never told they were infected, and no treatment was ever offered. Instead, even as some suffered advanced effects such as blindness and insanity, they continued to be told they suffered from "bad blood," and treatment continued to be withheld.

Here are the three public health scandals that cost millions of lives
John C. Cutlerdrawing blood from a patient as part of the Tuskegee syphilis experiments. Source: National Archives Atlanta, GA/Wikimedia Commons 

After the subjects' deaths, their families were offered $50 to cover the cost of a casket and grave - if they agreed to allow an autopsy.

The research project was finally stopped after a former investigator with the PHS blew the whistle to the press. A public outcry led to Congressional hearings and federal legislation strengthening guidelines for protection of human subjects in research. A class-action lawsuit was filed on behalf of the men that resulted in a $10 million out-of-court settlement for the victims, their families, and their heirs. 

HIV-infected blood-clotting medicine

Initially reported by The New York Times back in 2003, it was claimed that a division of Bayer, the multinational pharmaceutical company, knowingly sold blood-clotting medicine at high risk of contamination with HIV to hemophiliacs in the mid-1980s. The company sold the contaminated drugs to 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 condition 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 avoid excess bleeding. Hemophiliacs had to pay hospital visits to receive their treatment through plasma transfusions. When factor concentrate produced from donors' plasma began to be available, patients were finally able to take their treatment as injections, which was not only much more convenient but saved many lives at home and receive treatments on their own when they started bleeding.  For the first time, people could be treated before a bleed, reducing the likelihood of serious damage. 

Factor concentrate was produced by pooling human blood plasma from as many as 10,000 donors and then concentrating it. If just one of those 10,000 donors was infected with a disease such as hepatitis or HIV, the entire batch could become contaminated. In addition, in the US, the blood plasma was often gathered from high-risk paid donors, such as prisoners and drug addicts. 

These risks were largely ignored until the early 1980s when hemophiliacs began contracting AIDS from 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 made available in the U.S. and some other countries, while simultaneously continuing to sell off their stocks of the more dangerous, untreated factor concentrate.

It is not known how many hemophiliacs in Asia and Latin America contracted HIV and subsequently died from the contaminated products.

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