Tuskegee in Africa: Deadly U.S. AIDS experiments
Revolutionary Worker #926, October 5, 1997
Tuskegee, Alabama, 1932<196>1972: The United States administered placebos (phony medicines) to 412 poor African-American men infected with syphilis. This experiment was done in order to study the horrible effects of these brothers dying of the disease, untreated.
Africa and the Dominican Republic, 1995<196>1997: The United States is administering placebos instead of medicine to thousands of HIV positive pregnant women so they can study the effects of these sisters passing AIDS on to their infants.
Under a deadly, and until recently unpublicized, research program run by the United States, thousands of HIV-infected women in Africa and the Dominican Republic are being denied a treatment that could potentially prevent the transmission of AIDS to their babies. Instead they are being given placebos. As a result, a thousand will needlessly be born with the HIV virus.
By the year 2000, it is estimated that six million pregnant women in Asia and central and southern Africa will be HIV positive. The large majority of them could give birth to children free of AIDS if existing medical treatment was available to the people of the world.
There is now a treatment available in the United States and France that drastically reduces the chance of an HIV positive mother passing the HIV virus to her baby. This treatment involves administering a drug called zidovudine orally to HIV positive pregnant women, administering it to them intravenously during labor, and administering it to their infants. Studies in the U.S. and France have shown that this treatment reduces the chances of a mother infecting her child with HIV by two-thirds, enabling many more children to be born free of the HIV virus.
The cost of available, effective treatment for an HIV positive pregnant woman is $1,000. That's 100 times what is spent on the average person for health care in central and southern Africa in an entire year. And with the global trend towards "privatization" of medical care, even existing medical programs in Africa are being shut down. The gross inequality in the world keeps this life-saving procedure a world away from the vast majority of women in poor third world countries. Currently, the medical industry is attempting to develop a modified version of the procedure used in the U.S. that could be marketed to women in Africa and other third world nations, as well as to women in imperialist countries who cannot afford the existing treatment. These studies involve testing the use of smaller amounts of medicine, to treat pregnant women who are HIV positive. It is these studies that include giving many participants placebos instead of any dosage at all of effective medicine.
Based on documents obtained from the Centers for Disease Control and Prevention (CDC), Dr. Peter Lurie and Dr. Sidney M. Wolfe uncovered 18 trials involving 17,000 women in testing this modified treatment. They exposed these studies in the September 18, 1997 issue of the New England Journal of Medicine (NEJM).
Two of these 18 studies are going on in the United States. In those studies, all the women have unrestricted access to zidovudine or other similar drugs. Nobody is getting placebos. But in 15 trials in Africa and the Dominican Republic, the NEJM reported that "some or all of the patients are not provided with (any effective) drugs." Nine of the 15 studies being conducted outside the United States are funded by the U.S. government through the CDC or the National Institute of Health. Five are funded by other governments and one is funded by the UN.
The plan to use placebo treatments ran into resistance from some administrators. CDC investigators in the Ivory Coast wrote to the agency's headquarters in Atlanta saying that their African collaborators "do not feel comfortable with the use of placebo." And Marc Lallemant, a Harvard University investigator in Thailand refused to use dummy medications in spite of pressure from the CDC. While Thai women in this particular CDC-sponsored study are not given placebos, other women in Thailand are given placebos in similar studies of AIDS.
Government officials claim that the studies in Africa and the Dominican Republic are different than the Tuskegee Study because the victims in these studies have been informed that some of them are getting placebos. First of all, who can trust that the participants in these studies have really been given accurate and complete information about being treated like guinea pigs in an experiment that is not in their interests? Beyond that, what possible justification can there be, under any circumstances, for giving a pregnant woman with HIV fake medicine?
When confronted with the systematic, cold-blooded nature of their experiments on women in these poor countries, the head of the National Institutes of Health (NIH) defended the research saying, "What we need to know is whether a medical intervention is better than nothing."
Why would the CDC need to do an experiment to find out what happens when pregnant women with HIV are treated with "nothing"? Untreated women around the world are already giving birth to children infected with HIV!
According to the NAJM, "The declaration of Helsinki of the World Health Organization, which is widely regarded as providing the fundamental guiding principles of research involving human subjects, states, `In any medical study, every patient including those of a control group, if any, should be assured of the best proven diagnostic and therapeutic method." But U.S. Health officials argue that such standards should be based on the "local" standards of treatment--in other words, while such a study might be unethical (or at least politically difficult) in the U.S., it's fine for the Third World.
One administrator admitted that "If you tried to do this study in the U.S., you would have to do it through a throng of demonstrators and a sea of reporters...I wouldn't do this study without a design that would let me run it without a placebo. I think you owe that to your subjects even if they are not educated enough, savvy enough to demand it from you."
But the Director of the medical ethics program at the University of Wisconsin said that's OK if you're doing the study on people in the Third World, stating in imperialist double-speak that "The facts are different in different places." Another administrator tried to justify the cruel experiments by saying, "Part of doing ethical trials is that you are answering questions that are relevant for those countries."
FROM TUSKEGEE TO AFRICA: HUMAN GUINEA PIGS
This argument for a double-standard boils down to claiming that "life is cheap" for the oppressed, and the "ethics" that apply in an imperialist country don't apply where people are just going to die anyway!
That argument--that these children would die anyway--is the exact same argument that was made during the Tuskegee study. There, it was claimed that these men would never see a doctor or get medical care anyway, so who cares if they are systematically kept from treatment for their disease. And in reality, the administrators of the Tuskegee study actually prevented these men from getting treated. The CDC contacted doctors treating the victims and told them not to administer penicillin for any reason to their patients.
In her editorial, "The Ethics of Clinical Research in the Third World," that accompanied the exposé in the NEJM, Dr. Marcia Angell points out that the "local" treatment standard for medical research "could result in widespread exploitation of vulnerable Third World populations for research programs that could not be carried out in the sponsoring country."
That's not just a possibility, it's happening. In their article in the NEJM, Dr. Peter Lurie and Dr. Sidney M. Wolfe wrote:
"What are the potential implications of accepting such a double standard? Researchers might inject live malaria parasites into HIV positive subjects in China in order to study the effect on the progression of the HIV infection, even though the study protocol had been rejected in the United States and Mexico. Or researchers might randomly assign malnourished San (bushmen) to receive vitamin-fortified or standard bread. One might also justify trials of HIV vaccines in which the subjects were not provided with condoms or state-of-the-art counseling about safe sex by arguing that they are not customarily provided in the developing countries in question. These are not simply hypothetical worst-case scenarios; the first two studies have already been performed and the third has been proposed and criticized."
MONEY IN AIDS
In her editorial in the NEJM, Dr. Marcia Angell poses that: "The retreat from technical principles may also be explained by some of the exigencies of doing clinical research in an increasingly regulated and competitive environment. Research in the Third World looks relatively attractive as it becomes better funded and regulations at home become more restrictive. Despite the existence of codes requiring that human subjects receive at least the same protection abroad as at home, they are still honored partly in the breach. The fact remains that many studies are done in the Third World that simply could not be done in the countries sponsoring the work. Clinical trials have become big business, with many of the same imperatives. To survive, it is necessary to get work done as quickly as possible with a minimum of obstacles."
The U.S. imperialists' utter contempt for human life intersects with an increasingly vicious and profit-driven capitalist medical industry. To these bloodsuckers, the millions of AIDS sufferers around the world are both cheap guinea pigs and a potential source of profits for whoever comes up first with a product.
The horrifying impact of untreated AIDS in Africa and other parts of the Third World is a shocking outrage. While treatments are developed that are giving hope to a small number of people who can afford them in North America and Europe, 14 million people living with HIV in southern Africa have practically no access to treatment. The death toll from AIDS in Africa has left many children orphans and devastated many countries. A report in the NEJM said that in rural Uganda, more than 80 percent of deaths among men and women aged 25 to 44 were attributable to AIDS. Dr. Marcia Angell wrote, "It seems as if we have not come very far from Tuskegee after all."
The world doesn't have to be this way. The technology exists today to make effective treatment available, and to make much more rapid advances in preventing and curing AIDS. What stands in the way is the same evil system that put Black men in The South in a test tube to watch them die a horrible death, while telling them they were being treated. Today, that same system is purposely handing out phony medicine to women in Africa and the Dominican Republic, keeping 1,000 babies from being born free of HIV. It is this system that stands in the way of turning the vast productive power in the world against the horror of AIDS.
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