In the April issue of the journal Sexually Transmitted Diseases, you will find a series of articles and commentaries about the Guatemala STD research studies, outlining what took place there, the ethical implications of these activities, and the extent to which Dr. Parran was involved in authorizing the research to move forward.

Be sure to read all of the articles and commentaries, for each one offers a different, important, and valuable perspective on this subject.

American Sexually Transmitted Diseases Association and the Thomas Parran Award: Past, Present, and Future
Stoner, Bradley P.; Marrazzo, Jeanne M.

The Guatemala Sexually Transmitted Diseases Studies: What Happened?
Zenilman, Jonathan

When Heroes Stumble
Lombardo, Paul A.

A Letter to Members of the American Sexually Transmitted Diseases Association on Thomas Parran and the Guatemalan Sexually Transmitted Disease Studies: What Did He Know? What Did He Do? What Do We Do?
Schachter, Julius

Remembering Thomas Parran, His Contributions and Missteps Going Forward: History Informs Us
Hook, Edward W. III

Thank you for your contributions to the STD field.

Bradley Stoner, MD PhD
President, ASTDA

Chang Lee (2/26/2013)

What Dr. Parran did in Guatemala certainly seems unethical and surely illegal by today’s point of view, but do we really need to view this from our 21^st century perspective? From everything I have read about Dr. Parran, he comes across as a person of high integrity and morals, therefore, I would view his work in Guatemala as a product of his time. I am confident that if Dr. Parran was around today, he certainly would not approve of or participating in any research work that would even remotely resemble what happened in Guatemala.

__________________________________

Richard Rothenberg (2/26/2013)

Mark Antony: “The evil that men do lives after them; The good is oft interred with their bones”

Why should we bury the evil as well?

__________________________________

Lisa Manhart (2/26/2013)

I voted to remove Thomas Parran’s name from the ASTDA Lifetime Achievement award.  Given his certain knowledge of the Guatemala study activities, tacit approval of them, and admission that the study could not have been conducted in the US, I do not believe it is appropriate for the ASTDA to name its most prestigious award after him.  This essentially turns a blind eye to his role in the Guatemala studies. At the same time, I agree that he was the greatest champion the STD research and control community has had to date.  His accomplishments will not disappear, they will continue to stand on their own merits.  But they now stand alongside conduct that was clearly unethical and, in my opinion, continuing to name the award after him would be inappropriate.

_________________________________

Dennis Fortenberry (2/26/2013)

I think ASTDA should immediately remove the name “Thomas Parran” from its most prestigious award.

A definitive statement like this means that I’ve read several documents that summarize details, I’ve listened to arguments about Parran’s culpability (or lack thereof) and reasons for/against changing the name of the award. As a member of the ASTDA Executive Committee, I will vote about changing the award’s name.

For better or worse, there is no longer a debate in my mind.

ASTDA represents many of the principles – both ethical and scientific – that have been the passion of my career. I believe unequivocally that the essence of the field of sexually transmitted diseases is a commitment to social and sexual justice. The so-called Guatemala experiments egregiously violated these principles, with Thomas Parran’s knowledge, support, and approval. A name that does not invoke our best principles shouldn’t be used to recognize our best accomplishments.

I also believe strongly that ASTDA cannot divorce itself from the Parran Award nor its awardees. Our society chose the award name and honored the recipients’ contributions to our field for good reasons. We should continue to recognize our past even as we change and move forward.

One way to accomplish this is to use the ASTDA achievement award as a time to recall the award’s earlier name, describe the reasons for changing the name, and recommit the award to ASTDA’s highest principle. Listings of award recipients in our documents and web page should contain a short explanation as well at the juncture of the name change. My hope is to maintain a memory of the mistakes of the past in order to guide the work of the future.

__________________________________

Khalil Ghanem (2/26/2013)

There are two distinct questions that are posed. One is more complicated than the other. First, the practical question: Should the ASTDA change the name of the award? The answer is yes. Unfortunately, it will always be associated (at some level) with that aspect of Parran’s career and given that it’s the most prestigious award the ASTDA bestows, it’s not practical to keep the name. It would be perfectly fine to call it the ASTDA Career Achievement Award and not diminish the award in any way.

The more complicated question is the personal one: How should we now feel about Parran given his involvement in the case and given his status as a hero to most STD practitioners? It’s always shattering to realize that our ‘hero’ was all too human. We should all be used to that by now. Was he a product of his time or should he have known better? There’s no easy answer. For me, he’s still a hero- albeit a flawed one. I can live with that. I don’t think the ASTDA award has to.

__________________________________

John Potterat (2/26/2013)

I suspect that Dr. Thomas Parran Jr.’s ethical lapses during his tenure as Surgeon General of the United States (1936-1948) had more to do with “White Man’s Burden” narcissism than malignant racism.  Such an attitude could easily have helped frame an unethical medical trial as a noble enterprise, in much the same way that Kipling rationalized British imperialism.  I also suspect that Dr. Parran might have rationalized infecting human subjects with syphilis, gonorrhea, and/or chancroid by viewing these STD as manageable infections, given not only his knowledge of the efficacy of long-term heavy metals treatment but also of newly available penicillin.  There is, in my opinion, a huge difference between infecting human subjects without their full knowledge or consent with a treatable (even if not completely curable) infection and the sadistic, vicious, and deadly experiments conducted by physicians on concentration camp prisoners during World War II.  Even in the event that a subject were to die due to ethical lapses or medically inappropriate management, it is not difficult to perceive the parenchymal difference between involuntary manslaughter and premeditated murder.

Before embarking on a solution —  renaming the most prestigious award in the STD domain —  that we might regret with the passing of time, we should also reflect on a couple of observations.  For example, is the University of Pittsburg’s Graduate School of Public Health planning to remove Dr. Parran’s name from its home building (Parran Hall) as a consequence of the recent (2010) revelations about the STD trials in Guatemala (1946-1948)?  Or, perhaps as a (very belated) consequence of much earlier revelations (1972) about the Tuskegee syphilis experiments, which occurred under his watch?  My guess is “No”, not any more than George Washington University is likely to plan renaming itself after (imagined or real) complaints that President Washington tacitly condoned the cruelty of slavery by owning slaves and by housing them in shabby dwellings.  The comparison may be apt, for Washington is considered the father of his country, as Parran is considered the father of modern STD control.  There is something really important and perhaps even immutable about having pioneered an endeavor.  Which should bring us to the next step.  Supposing the ASTA membership votes to rename the Parran Award, who or what comes to mind as worthier than the colossal (if now somewhat tainted) achievements associated with his name?  Is there anyone out there whose contributions to the STD field have had the breadth, depth, and crucial implementation timing of Dr. Parran’s contributions?   He was a giant:  who among us have been his equals?  A few of us have added floors or remodeled some rooms, but who has built an entire edifice, as he did?

In brief, I’m inclined to side with those (Drs. Lombardo and Hook?) who think that it may serve everyone’s interest were we to add some language – a cautionary tale for our colleagues, present and future —  to the Parran Award’s descriptive summary.  Briefly recapping what dirtied the bath water is, it seems to me, clearly superior to throwing the baby out with it.

___________________________________

Charlotte Gaydos (2/27/2013)

I must admit that at first I was conflicted as to whether to the ASTDA should change the name of the Thomas Parran award.  After thinking for many weeks about the situation, I believe we should not change the name.  Rather we should use history to recognize that Thomas Parran accomplished many  wonderful things for the field of sexual health (Shadow on the Land), yet he was human enough to fall prey to the being a product of the time.  Post war issues and military preparedness, as well as antimicrobial treatment of sexually transmitted diseases were all huge issues at the time.  Although he did not participate in the Guatemala experiments, he certainly was aware of and approved of them.  By ethical standards both today and at the time that was certainly egregious and troubling,  However,  I believe future scientists should have the opportunity to remember Parran, his good works and his not so good failings. If we keep the name, it allows history to be studied, commented on, and be improved upon in the future.  Future scientists can learn much by studying such complicated history. Many other heroes in our history have been shown to have “not-so stellar” behavioral records, yet we still hold them in esteem.

___________________________________

Sharon Hillier (2/27/2013)

I read Parran’s book, Shadow on the Land when I was awarded the Parran award in 2009 in order to learn more about how he approached issues.  It is not easy to see a situation decades later with the same eyes through which it were seen a half century ago. To me it is a bit akin to knowing about George Washington’s concerns with slavery at the same time he owned slaves in Mt Vernon or with Thomas Jefferson’s writings on liberty when he actually had children by his slaves and maintained his own children as slaves- unforgivable.

So, in Parran we have a man (a flawed human being as we all are) who was instrumental in bringing the issue of STDs, and in particular syphilis, out of the closet and into the forefront of public health. He was instrumental in forcing our nation to confront STDs and to address them as infections and not as sins. This is a key issue for me, since even with AIDS we saw many try to frame HIV as a sin, or retribution for sin, rather than as a virus which went where it was sent during sexual intercouse. I would argue that in this way he was a pioneer. As such, we cannot value that less even though he apparently knew about and tacitly condoned the unethical research inGuatemala.

I am on the faculty at theUniversityofPittsburgh, and people want to know whether there is a plan to change the name of Parran Hall, which is one of the buildings comprising the Graduate School of Public Health. To my knowledge, there has been no discussion of changing the name of Parran Hall.

As I reflect on this, I find that I am in agreement with both Paul Lombardo and Ned Hook. I would vote that we keep the Parran name, and remember Dr. Parran both for his outstanding public health contributions and failures. There are massive numbers of examples of shocking ethics in research from that era, and although it in no way excuses his failings, it is beneficial to remember the ethical context of that time when vulnerable populations were routinely used inappropriately in research. Does it excuse him? Not at all. But does it take away his enormous contributions? No.

_____________________________________

Article in USAToday – http://www.usatoday.com/story/tech/sciencefair/2013/02/26/parran-awardcontroversy/1948705/

_____________________________________

H. Hunter Handsfield (2/27/2013)

HAVING HAD THE INCOMPARABLE HONOR of receiving the 2010 Thomas Parran Award, for more than a year I have thought hard about the proposal to change the name. My opinion fluctuated; at different times I have thought rather strongly that the name should be changed or that it should be retained. But now push comes to shove. I have voted to change the name.

My reasons are complex, as I hope everyone’s are on this very important topic. I agree in principle, and generally in fact, with almost all the arguments, both pro and con, summarized in the excellent essays in Sexually Transmitted Diseases. My decision is based on my synthesis of all those arguments. However, three specific considerations tipped me off the fence.

• First and foremost, I do not entirely buy the argument, so articulately expressed by my dear friend, colleague and Parran Award recipient, Ned Hook, that many heroes have feet of clay, and that we should be cautious in applying today’s ethical standards to different times and social constructs. Such caution is of course well advised, and it suffuses the recording and reporting of all human history. However, the Guatemala investigators, and by extension Dr. Parran, were well aware they were operating beyond the ethical bounds of their own time—and not by just a little bit. The phrase used by the investigators themselves and adopted for the title of the report of the Presidential Commission for the Study of Bioethical Issues—ETHICALLY IMPOSSIBLE—tells much of what we need to know. The words were not Dr. Parran’s, but the evidence seems clear that he recognized that problem as a threat to the research but apparently not to human dignity; facilitated the solution to it; and came to understand the need to suppress the outcomes for fear of their public reception. These decisions themselves reflected their historical context. But leaders lead by taking their followers in new directions, and in this arena Dr. Parran failed to do so.
• My second reason may be considered by some to be rather minor, perhaps even a distraction. In preparing my Parran Award lecture 3 years ago, I re-read Shadow on the Land and otherwise delved into Dr. Parran’s accomplishments. I came to question the importance of his contributions to STD prevention and control. I thought it churlish to mention this at the time said nothing during my lecture or the published version. But for what it is worth, some colleagues may recall conversations along those lines well before the current controversy arose. His accomplishments were immense, but they were not silver bullets, and in my view there are currently active investigators and prevention strategists whose lifetime contributions to our field exceed Dr. Parran’s. This doesn’t imply that I would propose a new eponymous award:  if a change is made, the name going forward can be expected to generate its own debate.
• My final consideration is a very recent one, coming in a discussion with Kees Rietmeijer, another dear friend and respected colleague. There are a number of colleagues among us who can be expected to be nominated for the Parran Award or its equivalent in coming years. Some have been active participants in this debate. Retaining the name undoubtedly risks selection of an awardee who would take umbrage at Dr. Parran’s name and might even decline the award on that basis. It seems to me this would carry substantial risk of damage to ASTDA and perhaps indirectly to the cause of STD prevention.

Brad Stoner, Jeanne Marrazzo (still more close friends and colleagues), and the entire ASTDA leadership are to be congratulated for forthrightly addressing a very difficult topic, and in devising an open forum and vote. Whatever the ultimate decision, under such leadership and membership the Association will survive and thrive going forward.

____________________________________

Michael Von Ah (2/27/2013)

I have 3 concerns:

1. Common sense dictates that human experimentation in the absence of permission is not an appropriate approach
2. Regardless of the profession of those experiment on they deserve to be treated in a humane manner. We are too willing to incrementally allow dissolution of our values
3. Evidence of values being upheld are noted throughout history as are the failures in that regard.  We should not blame such lack of ethics on the era

________________________________

Ward Cates (2/28/2013)

I stand “firmly” with my situational epidemiologist’s 51%-49% position I take on many issues, changing every hour…so I voted “undecided”…

If you pushed me, I would vote to change the name…more for symbolism than substance…as my Parran Award talk described, Parran himself was not a condom or FP advocate, so his legacy held back a broader consideration of a sexual health and primary prevention agenda…I loved that he moved the field from “social hygiene” to secondary prevention, but we’re ready to embrace a larger vision today…

________________________________

Fred Sparling (3/1/2013)

I was very honored by receiving this award in 1992. The issue as to whether to abolish Parran’s name from the lifetime achievement award of our society is difficult, as indicated by the varied opinions of the former Parran awardees, and also the votes on our membership, which currently favors abolishing the Parran name by a roughly 54-37 margin. My vote is for retaining the Parran Award name, but rewriting the citation so that it reflects our understanding of the ethical issues, and the truth. Clearly Parran was flawed, as we perceive him through a 21^st century lens. He did violate his own ethical standards. He may not have known of the most egregious experiments, in which subjects were inoculated inravenously or intrathecally with live T pallidum, without prophylaxis or treatment, but that is not the issue. He evidently was generally aware of what was being done in Guatemala, and that it was improper to do these experiments; otherwise why comment that they could not be done in the US? As others have said, the buck stopped with him. Expunging his name will deny us an opportunity to teach what is right. Each of us is capable of faulty judgment, regardless of our other successes. Let us learn from his example, good and bad, and not bury the truth. Parran did much that was laudable, but he was human.

________________________________

Tom Parran (3/1/2013)

I am a layman and the grandson of Dr. Parran.   Obviously this gives me a personal bias but I would  ask the voters  to consider how many of our past leaders in many fields had faults that have not disqualified them from acknowledgment for their accomplishments.

________________________________

John Parran (3/3/2013)

I ask voters to consider the following.

As noted in the USA Today article and in many posted comments, Dr. Parran’s accomplishments were very noteworthy to that point in time and remain so by today’s standards. He started and continued a conversation no one wanted to have and was steadfast in his role as the nation’s doctor. As but one example, he stood up to media censors who tried to muzzle him and said the word syphilis on national radio.

I readily acknowledge that by today’s standards the testing protocol would not be tolerated and I find it very troubling. That said, how does anyone use what we know today as the judge (and jury) for decisions made ~50-80 years ago? (In today’s lexicon I just keep saying, REALLY?) The “lens” on decisions and actions is always clearer, oftentimes crystal clear, after the fact while at the time of the decision or action it is far from clear.

Voters please consider Dr. Parran’s body of work. We beat syphilis, it did not beat us.

Thanks Granddad.

John Parran

_________________________________

Allan Ronald (3/1/2013)

I do appreciate the thoughtful answers that a number of our colleagues have posted and doubt that I can add much wisdom to what is already there.

However we need heroes, mentors and role models. Most of the individuals on whom I’ve based my own career, have been fallible with their unique blind spots. In retrospect they were prone like myself to errors of judgement. But I still honour their influence, learn from their missteps, and appreciate their willingness to assist my professional and character development. As I recall some of our initial studies of STI’s in Kenya in 1979, I cringe at the thought that  I would  be held accountable to 2013 standards. With no ethical review boards, no previous experience in the entire country with randomized clinical trials, and limited fiscal support, we proceeded to carry out studies that allowed us to effectively treat chancroid and PPNG gonococcal infections-and be better prepared for an HIV epidemic we didn’t know was in the offing.

But we should acknowledge that while we learn from history including our ignorance and unwise decisions in the past,we live in the present. In my opinion this includes a wise critique of Dr Parran and ongoing enthusiasm for what he achieved in his era. The name/award should continue.

________________________________

Richard B. Parran, Jr. (3/4/2013)

The attention that my Grandfather, Thomas Parran, brought to public health issues was unprecedented and truly groundbreaking.

The body of his work stands on its own merits, as the testimony of so many public health experts through the years have steadfastly demonstrated.

By today’s standards, and through the lense of a present day perspective, the human trials conducted on his watch are, at best, very troubling. However, when judging today one must have the intellectual honesty to understand and interpret events of the past within the framework and context of that past time. To do otherwise is grossly unfair and far too convenient.

As Surgeon General my Grandfather faced a rapidly escalating public health war: the syphilis epidemic. An epidemic that many of that time refused to acknowledge, because to mention such a thing was socially unacceptable and politically incorrect. He had the courage, at great personal and professional risk, to stand up, speak about the unspeakable and rally and lead resources to fight what he termed “The Shadow of the Land.”

War is ugly. You must have the resolve to win. And you use every available tactic and weapon to your advantage, guided by the best knowledge and ethics available to you at the time. The war on syphilis was won. Generations to come were spared the ravages of this horrible disease. And the public came to understand, appreciate and support public health awareness and research. Today’s focus on HIV owes much to the groundbreaking resolve to win demonstrated so many years ago in the fight against syphilis.

Thomas Parran was not without his faults.  No man is.   But he was a decent, caring and morally and ethically grounded man.   Not to mention a talented, unselfish and dedicated physician.  He fought tirelessly for public health issues.  His legacy and the underpinnings of the public health system are intertwined, as are the accomplishments and the disappointments.  The Thomas Parran award recognizes and honors that fact.  It should continue to do so.

______________________________________

Julius Schachter (3/5/2013)

I write this to add two statements to follow  the Commentary that previously appeared in STD.:

1. I really love our STD community.  When we first discussed having a series of commentaries on the Parran controversy published in STD, I commented to the others involved in this effort how sad it would be if it turned out we wrote five commentaries and then found out that nobody else really cared.  Reading the carefully considered remarks posted in this running commentary has been gratifying. That and the number of votes show that you really do care.
2. A number of these comments take the position that some of us may be unfairly looking at what was done in 1946 from our viewpoint in the year 2013.  I think that is misreading of the record.  Certainly, what was done in Guatemala is wrong by current standards.  However, it was wrong by the standards of 1946.  Many of the same researchers involved in Guatemala also participated in a series of human inoculations in the Terra Haute prison.  It is clear that Parran made informed consent a condition for approval of that study.  The less than stellar results of that study were published in what was then the leading STD journal.  When it comes to Guatemala, several years later, we see no discussion of informed consent.  We also see no publications.  Clearly, the consent that was required to perform the studies in Terra Haute was not considered necessary in Guatemala.  That was wrong then.

________________________________

David Martin (3/6/2013)

Firstly, I would like to thank ASTDA’s leadership for taking on this difficult issue and the contributors to the series of papers soon to appear in the journal for their thorough and thoughtful reviews and opinion pieces.  My thoughts, as recorded below, follow my reading of the papers that will appear in our journal. I decided to forgo reading the blog posts until I had formulated my own opinion. I look forward to reading your opinions after I have posted this.

I will not take your time with a reiteration of the details of the Guatemala studies nor will I expound on the lapses in judgment and flagrant disregard for the ethical standards for human research that were in place at the time these studies were carried out. I believe that none of us would even think of trying to justify Dr. Cutler’s work. At issue is Thomas Parran’s level of involvement. This is the crux of the matter in deciding whether or not to retain his name on our Lifetime Achievement Award.

Dr. Parran as the Surgeon General in 1946 signed off on Dr. Cutler’s grant proposal which had been approved by the Syphilis Study Section of what was then the equivalent of the NIH. On this committee were a number of experts, experienced investigators and representative of other branches of government. Today grant program directors routinely sign off on grants approved with high enough scores to be awarded funding (unfortunately, a relatively infrequent event these days!) without any true understanding of the work they are approving. Ultimately they are responsible for the work just as Dr. Parran was in1946 and if something goes amiss at some point down the road they would no doubt officially be held accountable to at least some degree. However, morally condemning such individuals for approving unethical research that somehow escaped all the safe guards presently in place would not be likely to happen. My initial hope was that this in fact was the case with Dr. Parran. Unfortunately this does not appear to be so. Most damning is his statement as quoted by in G. Robert Coatney’s letter to John Cutler, “you know, we couldn’t do such an experiment in this country.”  (see Johnathan  Zenilman’s review in the journal) While Coatney’s comment that he delivered this statement as a “merry twinkle came into his eye” may be apocryphal, the words clearly speak for themselves; he knew what was going on though he may well have been unaware of all the distressing details.  In my view the prevailing attitude of all those involved in the Guatemala studies, including the study section members who initially approved it, reflects at best an overweening belief in one’s right to determine that the potential for “greater good” as the result of a clinical research project justifies trampling individual rights. At worst it reflects racism.

Therefore, sadly, my recommendation is that Dr. Parran’s name be removed from the award. Initially, I thought that there was merit to Paul Lombardo’s recommendation (see the journal series) that we keep the name as a reminder of all the great things accomplished by Thomas Parran in the field of STD prevention but include in the award citation a description of the wrongs done in Tuskegee and Guatemala under his watch as Surgeon General. However, after further reflection I believe that the ASTDA needs to distance itself further from this sad chapter in our history so as to make it unequivocally clear that we stand for the highest clinical research ethical standards. I recommend that the award be renamed simply as the ASTDA’s “Lifetime Achievement Award.” Furthermore, I recommend that every year the President’s introduction to the award at our annual meeting include mention of the fact that the award was formerly named for a giant in our field in honor of his monumental contributions but, in keeping with the association’s unbending requirements for moral and ethical approaches to our patients and research subjects, Dr. Parran’s indirect support of human syphilis experimentation without the subjects’ consent resulted in his name being removed from the award. Overall the idea would be to remind ourselves annually of Dr. Parran’s achievements but also of the responsibilities borne by all of us who study STI’s and care for their victims while making it clear to the public where we stand.

________________________________

3/8/2013

St. Louis NPR station interview with Bradley Stoner

________________________________

Sheila Lukehart (3/11/2013)

Since I first heard, many months ago, about the discussion surrounding whether to remove Dr. Parran’s name from the highest ASTDA award, I have struggled with this question.  In recent weeks, I have read some of the early comments on the blog, and have spoken about this question with a number of friends, colleagues, and family.  I was honored to receive the Parran Award in 2007, and I was humbled to have my name associated with Dr. Parran’s, who accomplished so much good in STD recognition and control.  I am appalled and truly saddened by the circumstances that necessitate this discussion.  I want to believe the best and, consequently, I tried to argue to myself that Dr. Parran was personally unaware of the details of studies that had been approved by a committee of renown scientists.  I then read the articles in the journal, and I can no longer explain away Dr. Parran’s involvement in the Guatemala studies.  The statement by G. Robert Coatney, quoted in the Zenilman article, sealed the issue of Dr. Parran’s knowledge and complicity for me.

I then tried to convince myself that we should keep the Parran name to remind ourselves of the past, and to use it as a reminder to discuss and ponder the work in our field.  I spoke at length with my daughter, Jessie, who is an historian.  In the field of history, there are some who feel that physical sites of abhorrent events, such as the A-Bomb Dome in Hiroshima, should be preserved as a reminder of things that must never happen again.  Could retention of Dr. Parran’s name on the ASTDA award serve that same purpose?  Some members have suggested this approach, and I initially agreed with this idea.  Then, I tried to envision what might happen in the future.  Some members have very strong feelings about this issue.  What if a future awardee of the ASTDA’s highest honor should refuse to accept an award that is associated with Dr. Parran’s name?  How would our African American and developing country colleagues feel about an organization that declined to make a very clear and public stand against unethical behavior?  Ultimately, how would we all feel about ourselves?

I am deeply saddened that Dr. Parran’s many contributions are now tarnished.  This field has been tainted for so long by a few who came before us, and there have been many victims.  We cannot undo the past, but we can get it right as we move forward.  I have reached the conclusion that the ASTDA should remove Thomas Parran’s name from its highest award, and I urge the Executive Board to take this action.

_______________________________

Christina Muzny (3/12/2013)

As a young investigator in the ASTDA and as an avid reader of the history of infectious diseases,  I have been closely following the Thomas Parran controversy. There is no doubt that Dr. Parran is one of the most highly esteemed leaders in the history of STDs, displaying a great passion and conviction for his chosen field of work. Nevertheless, it is troubling to learn that he had (at a minimum) an awareness of the Guatemala research studies and was cognizant of the fact that these experiments could not be ethically conducted in the United States. I have had mixed emotions regarding my decision to vote for or against the ASTDA removing Thomas Parran’s name from the highest achievement award that the society has to offer. I agree that removing Dr. Parran’s name from this award will ultimately devalue the important contributions that he has made to the field of STD control and prevention and will take away opportunities to reflect on the achievements (and failures) that his life’s work represents. On the other hand, I am concerned about the welfare of the human subjects that were made to participate in these experiments without having the opportunity to provide informed consent. What were their thoughts, their emotions, and their personal experiences during this unfortunate chain of events? We may never fully know the details. What we do know is that leaders of the time including Dr. Parran were flawed and made ethically challenged decisions presumably with the hope of contributing to the greater good. I do not think that it is possible to accurately judge the past in the present without fully understanding the context of Dr. Parran’s decisions. Because of this, I am in favor of continuing to acknowledge his significant contributions to the field of STD control and prevention while remaining aware of his flaws and missteps and I vote not to remove his name from ASTDA’s most prestigious award.

________________________________

Michael Augenbraun (3/12/2013)

Personally I gave up on heroes after the 6^th grade. People are both good and bad, productive and wasteful, empathetic and driven by self interest all to varying degrees. I’m not so troubled by having to leave Thomas Parran’s legacy behind and choosing some new honoree (who I’m sure we’ll discover in several decades did something dishonorable, leaving ASTDA members of the 22^nd century with something to grapple with).

I am unimpressed with the argument to drop Parran’s name from the award based on his apparent complicity with and foreknowledge of the nasty goings on in Guatemala. The one casual quote attributed to a separate party mentioned in John Zenilman’s article is a pretty lousy historical standard on which to vilify the man. In fact, I find it hard to understand how he could have offered concerns about the consent process in the Terre Haute gonorrhea study and then completely turned his back on the same issue a few years later. But what can’t be so easily dismissed is the fact that we now have two events which are regarded as historically unparalleled  examples of tainted and reprehensible medical research that dispensed with respect for subjects, which provided no useful information and that both of these studies were implemented and conducted by the organization Parran ran.

Can we seriously leave his name on the award? Even if he didn’t know what was happening what does that say about him as a manager and a leader? It doesn’t sound like someone to hold up as an example to others. They say that evil triumphs when good men do nothing. Maybe a good man did nothing. It’s still a problem. Time to move on.  Tied up in this mess as it is the Society should also consider creating some long lasting way to recognize the need for eternal vigilance regarding ethical standards in research. That way something good may come out of all this.

_______________________________

King Holmes (3/13/2013)

I wouldn’t recommend that ASTDA continue to refer to its highest award as the Thomas Parran Award. What we could do is call this the “ASTDA Award for Long and Distinguished Contributions in the Field of STD Research and Prevention.”

_______________________________

David Unger (3/14/2013)

After reviewing the facts of the “Guatemala Studies”, I am left with the conclusion that Dr. Parran did not act exclusively or to a large extent out of ignorance. He knew what these studies entailed and he recognized that they were ethically dubious. He knew that the studies were occurring insofar as he “signed off” on them as the Surgeon General at the time, and he knew of the ethically questionable practices of not obtaining consent and carrying out the experiments in vulnerable populations. Furthermore, he was involved in similar unethical studies both before the Guatemala studies (those carried out at Terre Haute Indiana), and to those carried out after, namely the Tuskegee studies.

I feel that we are left with the conclusion that his involvement in the Guatemala Studies did result from some degree of morally defective reasoning. I think that the next relevant ethical dimension to explore is to attempt to understand how much of this morally defective reasoning can be attributed to Dr. Parran simply as a by-product of living when he did. Was Dr. Parran simply a product (victim) of his times, and are we guilty of “presentism” in unjustly questioning him while looking at him through a “retrospectoscope.” Some of the authors in the commentaries and on the blog readily draw comparisons to Dr. Parran’s sanctioning the Guatemala studies, and George Washington’s owning slaves – the upshot being that moral acts must be viewed in the context of their time. But I think that this particular argument is specious, and I must confront it. Comparing Dr. Parran’s involvement in the Guatemala Studies to George Washington owning slaves is an incorrect comparison insofar as slave ownership was legal, commonly accepted, and philosophically (even Biblically) sanctioned, but, as I will outline presently, research ethics transgressions of this nature were not. Dr. Parran strayed from the path of virtue, George Washington did not.

I am loth to say that an ethical analysis can render a definitive solution to this issue – but I will spell out my own personal opinion. After weighing the evidence and exploring the ethical dimensions, I must, as an ethicist come down in favour of removing Dr. Thomas Parran’s name from the ASTDA award. It would seem that Dr. Parran was not acting out of ignorance in sanctioning and funding the studies, and that the Guatemala Studies would have been ethically repugnant both then and now by the standards of ethical research both then and now. Even if Dr. Parran started out with impeccable intentions there seems to have been some breach of duty that affects in some negative way – but certainly does not erase – all of the good that this man’s career accomplished. I feel that when we come to an understanding of how Dr. Parran’s name is attached to this award that no small part of that attachment is due to Dr. Parran the researcher, and this does immediately call into question the appropriateness of naming an award after someone who stood behind this unacceptable research. I also feel that the ASTDA may find themselves embarrassed in the future by offering this award to brilliant researchers who may feel compelled to refuse the award as a matter of conscience. Finally, I think that removing Dr. Parran’s name from the award may offer some small measure of restorative justice to the people of Guatemala.

_______________________________

Cristina Rodriguez-Hart (3/14/2013)

I voted strongly to change the name of the award. I find the attitude expressed by some of the commentary in April’s issue and on this blog, that Parran had essentially a “lapse in judgement,” to be disturbing. I also find the sentiment that he was a product of his times an erroneous excuse. When I read the letter from G. Robert Coatney to John Cutler in Jonathan Zenilman’s commentary, “I saw Dr. Parran on Friday…he is very much interested in the project and a merry twinkle came into his eye when he said ‘you know, we couldn’t do such an experiment in this country’,” it was clear to me this was no momentary lapse, and that he may have actually taken delight in the secretive and immoral nature of the experiments. The letter also clearly shows that Parran was not a product of his times. The observation by Parran that the experiments would’ve been unacceptable in the US demonstrates that Parran’s view on it does not reflect the opinion of many Americans of that day. For those that say keeping the name will help us to remember the lessons of history, we can find other ways. The pernicious legacy of Parran doesn’t need to taint what should be an honorable award that fills the recipient with pride. What is also disturbing about the Tuskegee and Guatemala experiments is that they both have people of color as the victim, and yet we wonder why many people of color are suspicious of research and individuals who conduct it. It would have been nice if the April issue focusing on the Guatemala experiments had delved deeper into the racial implications of these experiments. We want target populations to trust that the work we do is in their best interest, and yet, some still feel that we should support a legacy that broke the trust between the research community and the people we are supposed to be helping.

_______________________________

Jeffrey Pagan (3/19/2013)

I think that we should all understand the man within his historical context. But understanding, forgiving and honoring a man of “his time” should not necessarily mean linking his name to the highest award bestowed by the organization. At any rate, using the “man of his time” argument actually reduces Dr. Parran to an almost unacceptable level of mediocrity and diminishes the moral stature of other “men of their time” such as Abraham Lincoln and William Wilberforce. We all make mistakes and deserve restoring forgiveness. However, viewing Guatemalan citizens as ideal Guinea pigs is a negation of the higher values that we have come to admire in any human being whose name is immortalized in an award. In fact, ethically, it might not be so distant from what his contemporaries found repugnant in Auschwitz or Dachau. I will always respect Dr. Parran’s accomplishments, but an award like this? I’m not so sure about it.

_______________________________

Claudia Shuster (4/4/2013)

After reading the April 2, 2013 article about your reconsideration of an award in Dr. Parran’s name, I strongly support removing his name from the award.

Presiding over a 40 year study maintaining syphilis infection in Black men is appalling and in my mind eliminates Dr. Parran as a name to be honored.

Thank you for the opportunity to comment.

_______________________________

Alice DuBon (4/4/2013)

While it is not necessary to strike Dr. Parran from the “pantheon of public health,” continuing to use his name for this singular award seems inappropriate.  Dr. Parran, like so many of us, had feet of clay. However, his apparent willingness to look the other way while human beings were victimized in the name of science is very disturbing.  After all, public health exists to ensure the well being of populations. That being said, this ethical lapse should not completely outweigh his good work, not the least of which was to see the sufferers of STDs as people worthy of helping and the treatment of STDs as important.

Perhaps, in general, awards should not be named for humans. We are so, well, human.  The award should be called what it is.  In this case, the award for excellence in STD control and prevention.

_______________________________

Judith Wasserheit (4/8/2013)

A bit belatedly, I have read all of the articles about the Guatemala experiments and the very thoughtful comments of colleagues on the ASTDA website.  The pivotal issue for me with respect to retaining or changing the name of ASTDA’s most prestigious award is whether Thomas Parran recognized that the experiments were unethical.  The clear evidence that he did, indeed, acknowledge that these studies betrayed ethical standards in the United States at the time profoundly tarnishes this ASTDA award.  Although Parran made numerous landmark contributions to our field, we should change the name of the award to something like Distinguished Leadership and Career Achievement Award to reflect the impressive accomplishments of the recipients.