A Newborn with Thrombocytopenia, Cataracts, and Hepatosplenomegaly


How common is the use of the rubella vaccine worldwide?

The acronym TORCH (toxoplasmosis, other [syphilis, varicella, parvovirus B19 infection, HIV infection], rubella, cytomegalovirus infection, and herpes simplex virus infection) is often used to identify possible congenital infections.

Clinical Pearls

Q: What are some of the clinical manifestations of the congenital rubella syndrome?

A: Cataracts, thrombocytopenia, bony abnormalities, and deafness are consistent with the congenital rubella syndrome.

Table 2. (10.1056/NEJMcpc1706110/T2) Manifestations of the Congenital Rubella Syndrome.

Q: How is the congenital rubella syndrome diagnosed?

A: Newborns with the congenital rubella syndrome shed rubella virus in the throat, nasopharynx, and urine. Because growth of the virus in cultured mammalian cell lines is relatively slow and cultivation and identification of the virus are labor-intensive, nucleic acid amplification tests have been developed to directly detect rubella virus RNA in clinical samples.

Morning Report Questions

Q: Can serologic testing also establish the diagnosis of the congenital rubella syndrome?

A: In addition to direct viral detection, evidence of the production of antibodies to rubella virus in an infant can be used to establish a diagnosis of the congenital rubella syndrome. Affected newborns produce IgM antibodies to rubella virus. These antibodies can usually be detected at birth with the use of a capture enzyme-linked immunosorbent assay; the level increases during the first 3 months of life and then declines over time. At birth, tests for IgG antibodies to rubella virus cannot be used to distinguish between transplacentally acquired maternal antibodies and antibodies produced by the neonate. However, another means of establishing a diagnosis of the congenital rubella syndrome is showing that the level of IgG antibodies to rubella virus does not substantially decrease during the first few months of life, as the maternal antibodies decay. Finally, IgG antibodies to rubella virus that are produced by infants with congenital infection are typically of low avidity; therefore, a diagnosis of the congenital rubella syndrome can be established by detecting low-avidity antibodies in the blood after the maternal antibodies have waned.

Q: How common is use of the rubella vaccine worldwide?

A: The estimated number of cases of the congenital rubella syndrome worldwide is still approximately 100,000 per year. Rubella and the congenital rubella syndrome have been eradicated from the Western hemisphere because of good vaccine coverage. Unfortunately, although rubella has been controlled in many countries in Europe, opposition to vaccination in some countries has prevented the elimination of rubella, and there is much work to be done. In contrast, routine vaccination against rubella has just begun in some Asian countries, including India, Thailand, China, Japan, and Indonesia. Coverage in Africa is spotty, but a few countries have introduced the vaccine. In Nigeria, vaccination is limited to private providers, and coverage is less than 10%. There is a campaign to introduce the combined measles–rubella vaccine throughout the world, and all regions have goals to eradicate both diseases.

Syphilis on the Rise. What Went Wrong?


As the 1990s ended, syphilis was on the decline. At least in part due to safer sexual behaviors prompted by the AIDS epidemic,1 the rate of incident syphilis declined to fewer than 4 cases per 100 000 by the year 2000, a historic nadir. Eradication of Treponema pallidum infection in the United States seemed quite possible through concentrated public health efforts in a relatively small number of high-incidence US communities, and the Centers for Disease Control and Prevention (CDC) was developing a national syphilis elimination plan.2 Timing seemed auspicious for eradication efforts to be successful. Now, in 2016, hopes for eradication have long since faded, as have many of the gains realized by the effort. Rates of syphilis have trended steadily upward since 2000, and the CDC’s syphilis elimination efforts officially ended as of December 2013.

The current resurgence of syphilis is particularly disheartening given the tools available to control the infection and the significant benefits of doing so, as noted in the US Preventive Services Task Force (USPSTF) Recommendation Statement in this issue of JAMA.3 The following 3 main conclusions of the USPSTF are based on the available evidence and a commissioned systematic review of studies4 published since the previous USPSTF statement from 2004.

First, the USPSTF found “screening algorithms with high sensitivity and specificity are available to accurately detect syphilis.”3 Although culture of pathogenic T pallidum remains impossible for clinical microbiology laboratories, accurate and inexpensive serologic testing is widely available, even in resource-constrained areas. For the most widely used treponemal and nontreponemal serologic tests, specificity is in the 98% to 100% range, and sensitivity, which varies depending on syphilis stage, is also quite high.5

Second, “treatment with antibiotics can lead to substantial health benefits in nonpregnant persons who are at increased risk for syphilis infection by curing syphilis infection, preventing manifestations of late-stage disease, and preventing sexual transmission to others.”3 Treatment of early syphilis with single-dose intramuscular administration of penicillin G benzathine is highly effective and has the advantage of assured adherence. Success rates for patients receiving this regimen are in the 90% to 100% range, depending on the stage of syphilis at the time of treatment. Successful treatment prevents progression to late-stage disease, a cause of potentially profound morbidity that can affect up to 15% of persons with untreated syphilis. Early diagnosis and treatment as facilitated by screening programs is preferable to later-stage treatment in which management recommendations are largely based on expert opinion and experience rather than rigorous clinical trials.6

Third, the USPSTF found “no direct evidence on the harms of screening for syphilis in nonpregnant persons who are at increased risk for infection.”3 The risks of not screening are clear: ongoing transmission of T pallidum (thus sustaining the epidemic) and a population of untreated, infected persons at risk for significant and progressive cardiovascular and neuropsychiatric disease. These risks more than outweigh the perceived harms associated with screening, mostly issues related to stigma and patient anxiety in the case of false-positive results. Although not inconsequential, these negatives can be minimized by careful attention to patient confidentiality and clear explanations about the characteristics of the tests used in screening.

All of these points lead to the clear conclusion that “the net benefit of screening for syphilis infection in nonpregnant persons who are at increased risk for infection is substantial.”3

Based on these readily apparent observations and the conclusion that naturally follows, control of syphilis in the United States seems quite possible, perhaps even easily achievable. Yet evidence from the last 15 years indicates quite the opposite to be true. Why is this so? What has gone wrong?

Missteps abound and unforeseen events have undermined control efforts. Consider the following 3 points.

First, interest in and funding for public health measures have diminished, including those designed to address prevention of sexually transmitted infections (STIs). Funding for public health over the past decade has not kept pace with the growing need. The CDC’s budget has decreased significantly, from $7.07 billion in fiscal year 2005 to $5.98 billion in fiscal year 2013.7 Similarly, state and territorial health agencies have experienced substantial cuts to public health programs, including services for STIs.7 These funding shortfalls were exacerbated by the economic recession of 2008-2010, such that by early 2010, more than half of local health departments in the United States were experiencing reductions in their core funding.8 In many communities, STI management and prevention are centered in local health departments, and their efforts have been seriously undermined by loss of financial security.

Second, sexual attitudes and behaviors have changed among men who have sex with men (MSM), the highest-risk group for both syphilis and HIV infection. The early years of the HIV epidemic engendered significant behavioral changes, particularly among MSM. These changes included increased condom use, reduced numbers of new sexual partners, and closure of some facilities where HIV transmission was common. Captured in the term “safe(r) sex,” these changes also favorably affected rates of other sexually acquired infections. Clearly the perceived risks and consequences of becoming infected with HIV were strong motivators for avoiding risky behaviors. However, as improvements in antiretroviral treatment accelerated, images of young men dying of AIDS largely disappeared, and the fear of AIDS receded, which was accompanied by significant declines in the previously adopted safer-sex behaviors. At the same time, use of the internet as a means of sexual partner identification surged, an event associated with higher-risk sex, including multiple sex partners, unprotected anal intercourse, and greater likelihood of substance abuse during sex.9,10 The effect on syphilis was quickly clear in San Francisco, where an outbreak of early syphilis among MSM was directly linked to an online chat room.11

In addition, the use of antiretroviral drugs in HIV-uninfected persons for preexposure prophylaxis (PrEP) and the practice of “serosorting” (selection of sexual partners of concordant HIV serostatus) have both became increasingly common. While almost certainly decreasing the rate of new HIV infections, PrEP and serosorting also likely decreased the rate of condom use, with resultant increased risk of other STIs (including syphilis) in both the HIV-positive and HIV-negative networks.12

Third, focus on HIV infection as a national health priority, while appropriate and productive, reduced concerns about other preventable STIs. The clinical recognition of AIDS in 1981 quickly led to a substantial and well-funded increase in both research and patient care activities directed to this new disease, perhaps to the detriment of other communicable diseases. Thus, numbers of syphilis cases increased markedly over the following 15 years. The rates of syphilis then declined significantly in the late 1990s for reasons that are not entirely clear, perhaps only as a consequence of the observed natural periodicity and cycling of syphilis epidemics (thought to be related to changes in host immunity).13 Whatever the cause, these events may have contributed to complacency and neglect of fundamental public health measures proven to reduce the numbers of new syphilis infections.

The good news is that fixing what has gone wrong does not require huge capital investment, breakthrough technological advances, or massive restructuring of our health care system. Improvements are at hand and require mostly focus and commitment on the part of the health care community. First, awareness of the problem needs to be increased, particularly in clinical settings where patients at higher risk for syphilis are being followed up. These high-risk populations include MSM, HIV-infected persons, and younger sexually active persons, particularly persons of color and those from socioeconomically disadvantaged populations. The syphilis demographic overlaps considerably with the HIV demographic. For example, in 2014, half of all MSM diagnosed with syphilis were also coinfected with HIV.14 Younger men (aged 20-29 years) have a prevalence rate nearly 3 times that of the national average for men, and persons of color are particularly at risk, with black individuals disproportionately affected in the United States.14 Rates of primary and secondary syphilis were 18.9 cases per 100 000 in blacks compared with 3.5 per 100 000 in whites.14 Rates in other ethnic groups (aside from Asians, whose rates were lowest of all) were intermediate between blacks and whites.

Furthermore, health care practitioners need to do a much better job of taking a sexual history and applying recommended screening approaches to the persons for whom they provide care. Misplaced concerns about patient objections to sensitive questions raise the likelihood of failure to identify high-risk patients and result in missed screening opportunities. Being reluctant or unwilling to ask about sexual behaviors is a disservice to the patient. Clinicians also need to apply the recommendations of the 2006 CDC guidelines for HIV testing15 as well as the 2016 USPSTF Recommendation Statement on screening for syphilis.3 Well-planned, periodic screening of persons in at-risk groups, even in the absence of acknowledged risk behaviors, often identifies asymptomatic infections, facilitates treatment, and truncates ongoing transmission.

Although imperfect, serologic syphilis screening is highly sensitive and specific in high-prevalence populations, is inexpensive and technically simple, and has minimal potential for harm. These factors argue for much more widespread and comprehensive screening of groups at high risk for syphilis. Because treatment of early syphilis is also highly effective, identifying untreated infected persons by means of the recommended screening strategy has great potential for both eliminating the consequences of later-stage infection and substantially reducing transmission from those with early infection.

More babies being born with syphilis, which can be prevented with prenatal care


The number of babies born with syphilis — which can spread from a woman to her fetus during pregnancy — jumped 38% from 2012 to 2014, reaching the highest level since 2001, according to a report released Thursday.

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Babies with syphilis face serious risks, including death. Syphilis, a sexually transmitted infection, also can cause miscarriages and stillbirths, according to the Centers for Disease Control and Prevention, which released the report.

The overall number of babies born with syphilis is relatively small, with 458 infected infants in 2014, or 11.6 cases per 100,000 newborns, according to the report.

But the CDC considers syphilis in babies a “sentinel event” that indicates the overall strength of a health system.

Syphilis is almost entirely preventable, both in adults and babies. Adults and teens can avoid infection either by using condoms during sex, abstaining from sex or being with a monogamous partner. Giving penicillin to pregnant women prevents infection in 98% of newborns, according to the CDC.

In the study, nearly 22% of mothers got no prenatal care, and nearly 10% had no record of pregnancy care. More than 40% of women were not treated for syphilis, while 30% received inadequate care, the report said.

The American College of Obstetricians and Gynecologists recommends that all pregnant women get blood tests for syphilis and chlamydia, which may not cause obvious symptoms. The group recommends testing pregnant women for gonorrhea if they have risk factors for the disease, such as being age 25 or younger or living in an area where the disease is common.

Kevin Ault, a physician and spokesman for the American College of Obstetricians and Gynecologists, called the lack of adequate screening and care “very concerning.”

Gonorrhoea and syphilis on the rise as STI diagnoses soar among gay and bisexual men


Large increases in diagnoses of sexually transmitted infections (STIs) were seen last year in men who have sex with men (MSM), according to figures published today.

High levels of condomless sex probably accounted for most of the rise, although better detection of gonorrhoea may have contributed, said a report by Public Health England.

The total number of new cases of STIs diagnosed in England decreased by 0.3% compared with 2013 – 439,243 as opposed to 440,707.

Of the new cases, the most commonly diagnosed were chlamydia (47%), genital warts (first episode) (16%), gonorrhoea (8%) and genital herpes (first episode) (7%).

Blue = Male/Red = Female (Public Health England)Blue = Male/Red = Female (Public Health England)
Between 2013 and 2014, there was an increase in diagnoses of infectious syphilis (33% – 3,236 to 4,317) and gonorrhoea (19% – 29,419 to 34,958). During the same period, diagnoses of non-specific genital infection fell by 5%, consistent with the decline reported since 2012.

The report says the impact of STIs remains greatest in young heterosexuals under the age of 25 and in men who have sex with men.

Large increases in STI diagnoses were seen in MSM, including a 46% increase in syphilis and a 32% increase in gonorrhoea.

Recommendations include that sexually active under-25-year-old men and women should be screened for chlamydia every year, and on change of sexual partner.

MSM should have a full HIV and STI screen at least annually, or every three months if having condomless sex with new or casual partners.

Black African men and women should have a regular full HIV and STI screen if having condomless sex with new or casual partners, the report says.

Syphilis Test Gets OK for Wider Use


FDA allows use outside traditional laboratory settings.

A fingerstick blood test for syphilis is simple enough that untrained healthcare workers can use it outside of traditional laboratories, the FDA has ruled.

The agency approved the so-called Syphilis Health Check test in 2011 and categorized the assay under its Clinical Laboratory Improvement Amendments (CLIA) rules as moderate- and high-complexity, meaning it could only be performed in a lab qualified at that level.

The FDA said today it would waive that requirement, making it possible for the test to be used in physicians’ offices, emergency rooms, maternity wards, other healthcare facilities, and a range of other sites.

Also, workers using the test won’t require specific training, the agency said. The CLIA waiver is the first for a syphilis test.

“The broader availability and easier access to this test should contribute to a higher rate of detection of syphilis infection,” Alberto Gutierrez, PhD, of the FDA’s Center for Devices and Radiological Health said in a statement.

The agency made the move after the manufacturer, VEDA LAB of Alencon, France, submitted data for whole blood samples from 417 subjects collected by fingerstick over the course of 4 months at three testing sites representing typical CLIA-waived sites, such as doctors’ offices.

Twelve people not specifically trained in the use of the test performed it on patients, and results showed that in their hands the test performed with high accuracy, the FDA said.

While syphilis is easy to treat, the number of people in the U.S. who have the disease has been rising, reaching 16,663 reported cases in 2013 according to the CDC. The annual rate for that year was 5.3 primary and secondary cases per 100,000 population — nearly double what it had been 8 years earlier in 2005.

But that number is almost certainly an underestimate, since it is based on 34 states and the District of Columbia. The true number, the CDC thinks, is closer to 55,000 new cases a year.

The increase is almost entirely among men and most of that — about 75% — is among men who have sex with men. Some experts suggest that the blame can be laid at the door of a culture of quick anonymous sex, facilitated by Internet sites that allow easy access to a multitude of partners.

The infection, by the bacterium Treponema pallidum, can cause long-term complications or increase the likelihood of HIV transmission if not treated, the FDA statement noted, and can also infect a fetus if the mother has the disease, causing infant death, developmental delays, and seizures.

The test uses whole blood from a fingerstick and results can be available within minutes, the agency noted. The speed of the test allows healthcare workers to get a second sample at the same office visit to confirm any positive results and that, in turn, increases the probability of timely treatment, the agency said.

The treatment for primary, secondary, and early latent syphilis is a single intramuscular injection of long-acting Benzathine penicillin G, and three shots will cure later stages.

Currently, the CDC recommends syphilis screening at least once a year for all sexually active homosexual, bisexual, and other men who have sex with men. As well, the agency urges that all pregnant women be tested for syphilis at the first prenatal visit, while those who are at high risk, live in areas with high rates of syphilis, or were previously not tested should be tested in the third trimester and again at delivery.

Did Columbus really bring syphilis to Europe?


A new study is intensifying the debate over whether Christopher Columbus or his crews brought syphilis from the New World to Europe, setting the stage for hundreds of years of illness and death.

Researchers in Bosnia report that an ancient skeleton of a young Croatia-area man shows signs of the disease. That would mean that the existed there long before the era of the great explorers, they said.

Two specialists questioned the study’s findings. They said it’s still most likely that the crews of Columbus’ ships are responsible for spreading the sexually transmitted disease across Europe.

“Despite the many efforts to suggest otherwise, there is no Old World evidence of prior to 1492,” said Dr. Bruce Rothschild, a professor of medicine at the University of Kansas who studies the origins of diseases like syphilis.

But study lead author Ivana Anteric, a researcher at Croatia’s University of Split, insisted that the Columbus theory isn’t proven.

The origin of syphilis has been a big topic of debate in the scientific world, with three major theories emerging from the debate. The most common suggests that syphilis existed in the New World and traveled to Europe via Columbus’ crew upon his return to Europe.

Another theory “holds that syphilis has been present in Europe before Columbus,” but it’s difficult to find evidence for this because it looked similar to other diseases, Anteric said. Under this theory, the disease become more noticeable after Columbus’ time.

And a third theory “assumes that it existed in the Old World and New World, but four different syndromes developed,” she said.

Whatever the truth, syphilis had a devastating effect in Europe as it spread rapidly shortly after the Columbus voyage, a fact that contributed to the idea that sailors brought it back from the Americas. “In the beginning of the 16th century, about one-third of inhabitants of Paris had syphilis,” Anteric said.

“Syphilis was one of the first global diseases, so it is very important to understand where it came from and how it spread,” Anteric said. Understanding its origins may also “be helpful in combating diseases today.”

In the new study, researchers examined 403 skeletons from Croatia, in southern Europe. The skeletons were from various time periods going back to prehistory.

The researchers report that one skeleton showed signs of syphilis. It’s the skeleton of a man in his 20s thought to have lived in the period from the 2nd to 6th centuries. The study authors said their analysis determined that only syphilis could be the culprit behind the indications of disease in the skeleton. (DNA testing was not an option because, the study said, it can’t be used to confirm syphilis in an ancient body.)

As a result of their research, the study authors wrote, “we believe that the Columbian theory of syphilis origin is not sustainable.”

Not everyone is on board with the study’s findings. Rothschild said the skeleton bones actually suggest a kind of , not syphilis.

“Syphilis is clearly a New World product,” he added.

Rob Knell, a senior lecturer at Queen Mary University of London who studies the evolution of , is also skeptical.

“One diagnosis in a pre-Columbian tells us very little about the origins of syphilis,” especially in light of molecular evidence suggesting that syphilis had its beginnings in North America, Knell said.

10 of the most evil medical experiments in history


The subjects are often society’s most vulnerable, and the doctors have rarely had to answer for their crimes

10 of the most evil medical experiments in history

10 of the most evil medical experiments in history
U.S. helicopter sprays Agent Orange in Vietnam
AlterNet Evil scares us. Arguably our best horror stories, the ones that give us nightmares, are about evil people doing evil things—especially evil experiments. The Island of Dr. Moreau by H.G. Wells is a classic that comes to mind. In modern cinema, movies like The Human Centipede continue that gruesome tradition. But these are fictional. The truth is that we need only look at recent human history to find real, live, utterly repugnant evil. Worse yet, it is evil perpetrated by doctors.

Here are 10 of the most evil experiments ever performed on human beings—black and other people of color, women, prisoners, children and gay people have been the predominant victims.

1. The Tuskegee Experiments

There’s a good reason many African Americans are wary of the good intentions of government and the medical estblishment. Even today, many believe the conspiracy theory that AIDS, which ravaged the African-American community, both gay and straight, was created by the government to wipe out African Americans. What happened in Tuskegee, Alabama in 1932 is one explanation for these fears.

At the time, treatments for syphilis, a sexually transmitted disease that causes pain, insanity and ultimately, death, were mostly toxic and ineffective (things like mercury, which caused, kidney failure, mouth ulcers, tooth loss, insanity, and death). Government-funded doctors decided it would be interesting to see if no treatment at all was better than the treatments they were using. So began the Tuskegee experiments.

Over the course of the next 40 years, the Tuskegee Study of Untreated Syphilis in the Negro Male denied treatment to 399 syphilitic patients, most of them poor, black, illiterate sharecroppers. Even after penicillin emerged as an effective treatment in 1947, these patients, who were not told they had syphilis, but were informed they suffered from “bad blood,” were denied treatment, or given fake placebo treatments. By the end of the study, in 1972, only 74 of the subjects were still alive. Twenty eight patients died directly from syphilis, 100 died from complications related to syphilis, 40 of the patients’ wives were infected with syphilis, and 19 children were born with congenital syphilis.

2. The Aversion Project

 

They didn’t like gay people in apartheid-era South Africa. Especially in the armed forces. How they got rid of them is shocking. Using army psychiatrists and military chaplains, who were, presumably privy to private, “confidential” confessions, the apartheid regime flushed out homosexuals in the armed forces. But it did not evict them from the military. The homosexual “undesirables” were sent to a military hospital near Pretoria, to a place called Ward 22 (which in itself sounds terrifying).

There, between 1971 and 1989, many victims were submitted to chemical castrations and electric shock treatment, meant to cure them of their homosexual “condition.” As many as 900 homosexuals, mostly 16-24 years old who had been drafted and had not voluntarily joined the military, were subjected to forced “sexual reassignment” surgeries. Men were surgically turned into women against their will, then cast out into the world, the gender reassignment often incomplete, and without the means to pay for expensive hormones to maintain their new sexual identities.

The head of this project, Dr. Aubrey Levin, went on to become a clinical professor at the University of Calgary. That is until 2010, when his license was suspended for making sexual advances towards a male student. He was sentenced to five years in prison for other sexual assaults (against males).

3. Guatemalan STD Study

Syphilis seemed to bring out the inherent racism in government-funded doctors in the 1940s. Tuskegee’s black people weren’t the only victims of morally reprehensible studies of this disease. Turns out Guatemalans were also deemed suitable unknowing guinea pigs by the U.S. government.

Penicillin having emerged as a cure for syphilis in 1947, the government decided to see just how effective it was. The way to do this, the government decided, was to turn syphilitic prostitutes loose on Guatemalan prison inmates, mental patients and soldiers, none of whom consented to be subjects of an experiment. If actual sex didn’t infect the subject, then surreptitious inoculation did the trick. Once infected, the victim was given penicillin to see if it worked. Or not given penicillin, just to see what happened, apparently. About a third of the approximately 1,500 victims fell into the latter group. More than 80 “participants” in the experiment died.

The Guatemalan study was led by John Charles Cutler, who subsequently participated in the later stages of Tuskegee. In 2010, Secretary of State Hillary Clinton formally apologized to Guatemala for this dark chapter in American history.

4. Agent Orange Experiments

Prisoners, like people of color, have often been the unwilling objects of evil experiments. From 1965 to 1966, Dr. Albert Kligman, funded by Dow Chemical, Johnson & Johnson, and the U.S. Army, conducted what was deemed “dermatological research” on approximately 75 prisoners. What was actually being studied was the effects of Agent Orange on humans.

Prisoners were injected with dioxin (a toxic byproduct of Agent Orange)—468 times the amount the study originally called for. The results were prisoners with volcanic eruptions of chloracne (severe acne combined with blackheads, cysts, pustules, and other really bad stuff) on the face, armpits and groin. Long after the experiments ended, prisoners continued to suffer from the effects of the exposure. Dr. Kligman, apparently very enthusiastic about the study, was quoted as saying, “All I saw before me were acres of skin… It was like a farmer seeing a fertile field for the first time.” Kligman went on to become the doctor behind Retin-A, a major treatment for acne.

5. Irradiation of Black Cancer Patients

During the Cold War, the U.S. and the Soviet Union spent much of their time trying to figure out if they could survive a nuclear catastrophe. How much radiation could a human body take? This would be important information for the Pentagon to know, in order to protect its soldiers in the event they were crazy enough to start an atomic holocaust. Enter the seeming go-to government choice for secret experimentation: unknowing African Americans.

From 1960 until 1971, Dr. Eugene Saenger, a radiologist at the University of Cincinnati, led an experiment exposing 88 cancer patients, poor and mostly black, to whole body radiation, even though this sort of treatment had already been pretty well discredited for the types of cancer these patients had. They were not asked to sign consent forms, nor were they told the Pentagon funded the study. They were simply told they would be getting a treatment that might help them. Patients were exposed, in the period of one hour, to the equivalent of about 20,000 x-rays worth of radiation. Nausea, vomiting, severe stomach pain, loss of appetite, and mental confusion were the results. A report in 1972 indicated that as many as a quarter of the patients died of radiation poisoning. Dr. Saenger recently received a gold medal for “career achievements” from the Radiological Society of North America.

6. Slave Experiments

It should be no surprise that experiments were often conducted on human chattel during America’s shameful slavery history. The man considered the father of modern gynecology, J. Marion Sims, conducted numerous experiments on female slaves between 1845 and 1849. The women, afflicted with vesico-vaginal fistulas, a tear between the vagina and the bladder, suffered greatly from the condition and were incontinent, resulting in societal ostracism.

Because Sims felt the surgery was, “not painful enough to justify the trouble,” as he said in an 1857 lecture, the operations were done without anesthesia. Being slaves, the women had no say as to whether they wanted the procedures or not, and some were subjected to as many as 30 operations. There are many advocates for Dr. Sims, pointing out that the women would have been anxious for any possibility of curing their condition, and that anesthetics were new and unproven at the time. Nevertheless, it is telling that black slaves and not white women, who presumably would have been just as anxious, were the subjects of the experiments.

7. “The Chamber”

Back to the Cold War. Prisoners were again the victims, as the Soviet Secret Police conducted poison experiments in Soviet gulags. The Soviets hoped to develop a deadly poison gas that was tasteless and odorless. At the laboratory, known as “The Chamber,” unknowing and unwilling prisoners were given preparations of mustard gas, ricin, digitoxin, and other concoctions, hidden in meals, beverages or given as “medication.” Presumably, many of these prisoners were not happy with their meals, although, being the gulag, records are spotty. The Secret Police apparently did finally come up with their dream poison, called C-2. According to witnesses, it caused actual physical changes (victims became shorter), and victims subsequently weakened and died within 15 minutes.

8. World War II: Heyday of Evil Experiments

While evil experiments may have been going on in the U.S. during World War II (Tuskegee, for example), it’s hard to argue that the Nazis and the Japanese are the indisputable kings of evil experimentation. The Germans, of course, conducted their well-known experiments on Jewish prisoners (and, to a much lesser extent, Romany people and homosexuals and Poles, among others) in their concentration/death camps. In 1942, the Luftwaffe submerged naked prisoners in ice water for up to three hours to study the effects of cold temperatures on human beings and to devise ways to rewarm them once subjected.

Other prisoners were subjected to streptococcus, tetanus and gas gangrene. Blood vessels were tied off to create artificial “battlefield” wounds. Wood shavings and glass particles were rubbed deep into the wounds to aggravate them. The goal was to test the effectiveness of sulfonamide, an antibacterial agent. Women were forcibly sterilized. More gruesomely, one woman had her breasts tied off with string to see how long it took for her breastfeeding child to die. She eventually killed her own child to stop the suffering. And there is the infamous Josef Mengele, whose experimental “expertise” was on twins. He injected various chemicals into twins, and even sewed two together to create conjoined twins. Mengele escaped to South America after the war and lived until his death in Brazil, never answering for his evil experiments.

Not to be outdone, the Japanese killed as many as 200,000 people during numerous experimental atrocities in both the Sino-Japanese War and WWII. Some of the experiments put the Nazis to shame. People were cut open and kept alive, without the assistance of anesthesia. Body limbs were amputated and sewn on other parts of the body. Limbs were frozen and then thawed, resulting in gangrene. Grenades and flame-throwers were tested on living humans. Various bacteria and diseases were purposely injected into prisoners to study the effects. Unit 731, led by Commander Shiro Ishii, conducted these experiments in the name of biological and chemical warfare research. Before Japan surrendered, in 1945, the Unit 731 lab was destroyed and the prisoners all executed. Ishii himself was never prosecuted for his evil experiments, and in fact was granted immunity by Douglas MacArthur in exchange for the information Ishii gained from the experiments.

9. The Monster Study

Add children to the list of vulnerable people subjected to evil experiments. In 1939, Wendell Johnson, University of Iowa speech pathologist, and his grad student Mary Tudor, conducted stuttering experiments on 22 non-stuttering orphan children. The children were split into two groups. One group was given positive speech therapy, praising them for their fluent speech. The unfortunate other group was given negative therapy, harshly criticizing them for any flaw in their speech abilities, labeling them stutterers.

The result of this cruel experiment was that children in the negative group, while not transforming into full-fledged stutterers, suffered negative psychological effects and several suffered from speech problems for the rest of their lives. Formerly normal children came out of the experiment, dubbed “The Monster Study,” anxious, withdrawn and silent. Several, as adults, eventually sued the University of Iowa, which settled the case in 2007.

10. Project 4.1

Project 4.1 was a medical study conducted on the natives of the Marshall Islands, who in 1952 were exposed to radiation fallout from the Castle Bravo nuclear test at Bikini Atoll, which inadvertently blew upwind to the nearby islands. Instead of informing the residents of the island of their exposure, and treating the victims while they studied them, the U.S. elected instead just to watch quietly and see what happened.

At first the effects were inconclusive. For the first 10 years, miscarriages and stillbirths increased but then returned to normal. Some children had developmental problems or stunted growth, but no conclusive pattern was detectable. After that first decade, though, a pattern did emerge, and it was ugly: Children with thyroid cancer significantly above what would be considered normal. By 1974, almost a third of exposed islanders developed tumors. A Department of Energy report stated that, “The dual purpose of what is now a DOE medical program has led to a view by the Marshallese that they were being used as ‘guinea pigs’ in a ‘radiation experiment.’”

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