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Copyright © 1998 Journal of Criminal Justice and Popular Culture
All rights reserved.
ISSN 1070-8286
Journal of Criminal Justice and Popular Culture, 6(1) (1998) 4-9
Review of Acres of Skin: Human Experiments at
Holmesburg Prison
Author: Allen M. Hornblum
Publisher: Routledge
Year: 1998
The philosopher Michel Foucault wrote in
Discipline and Punish: The Birth of the Prison that
"prison marks an important moment in the history of
penal justice: its access to 'humanity'." It is not
merely that "stone can make people docile and
knowable," it is also that policies of coercion
introduce "procedures for distributing individuals;
fixing them in space; classifying them; extracting
from them the maximum in time and forces; training
their bodies; coding their continuous behavior;
maintaining them in perfect visibility; forming around
them an apparatus of observation, registration and
recording; and constituting on them a body of
knowledge that is accumulated and centralized." Prison
discipline is a powerful mechanism that constrains
prisoners and defines how they can be forced to do
what we wish, to operate as we wish, with the
techniques, the speed, the control and the efficiency
that we determine. In any system of discipline and
punishment, the human body is always at issue -- its
utility and its submission to authority. Research in
prison only accentuates this. The body is used as the
seat of needs and appetites, as the locus of
physiological processes and metabolism, as the target
of germs and virus attacks, as the point of resistance
and life extension. The body is marked, trained,
"tortured," and forced to carry out tasks for
evaluation and measurement. Subtle power relations
develop between doctors and subject which have an
immediate hold upon the body of the inmates.
Incarcerated individuals are useful for medical
experiments only if their bodies are both "productive"
and subjected. That these very characteristics of
confinement have made the prison par excellence for
medical research is evidenced in Allen M. Hornblum's
Acres of Skin: Human Experiments at Holmesburg Prison.
The author describes how inmates were used at the
least cost and exploited for the benefit of specific
others and society. He explains that the utilitarian
rationale of prison confinement offers almost endless
opportunities for use and misuse of power. In his
vivid account of research activities at Holmesburg
prison, near Philadelphia, Hornblum gives prisoners a
unique platform for expressing their views, feelings,
grief, or resentment and a voice that is rarely heard.
For example, Holmesburg inmates tell us of the endless
financial opportunity that prison research offered:
"Everyone wanted to get on the gravy train." One
inmate recalled that he could not remain immune to the
lures of the testing program despite potential danger:
"It was something to do, the best game in town. The
money was good and the money was easy." First, he
tried a deodorant test and chose the one he thought
had the least chance of harming him. He went on to
test hand and body lotions and began to realize the
full financial potential of the test program: "You
could be making $300 to $400 a month." He ultimately
volunteered to a special study conducted by the US
Army: "I was given 'a talk' that described a test of [End page 4]
'experimental stuff,' but nothing too specific. I
believe I received an injection of a substance 'ten
times stronger than LSD.' Except for the "trip" he has
no recollection of his actions during that period. He
explained that despite occasional "strawberry rashes,"
overall, he felt fine, helped by the fact that he
walked out of Holmesburg "$1,500 richer because of the
drug study." Compared with the 15 cents a day
prisoners were paid to make shoes, knit socks and
shirts, sew trousers, and work in the plumbing shop,
the appeal of big research money was enough "to tempt
and convert anyone, including those opposed to human
experimentation." Apart from money, inmates also
expected better food, cleaner, safer and more
comfortable living conditions, a brief reprieve from
the eternal boredom of prison confinement and from
threats of violence, and a sentence reduction. There
were also altruistic feelings of doing something
worthwhile.
Prisoners admitted that they were not always
passive "guinea pigs." They cheated with "patch
tests," which they could easily take off upon return
to their cells, and with liquid diet tests, which they
could supplement with contraband food. Yet,
surprisingly, no one seemed to care about these
insults to study protocol, nor did scientists ever
question their "trust" in confined subjects, which is
necessary for the conduct of valid and reliable
research. Prisoners could also bargain for more pay.
For example, when they were offered $50 for having
their nails pulled out, they demanded (and obtained)
three time more per nail after experiencing
excruciating pain.
Hornblum meticulously recounts appalling stories
of prominent manufacturers testing their products:
drugs, chocolate, dioxin, tobacco. From 1962 to 1966,
a total of 33 pharmaceutical companies tested 153
experimental drugs at Holmesburg prison alone. But
most abuses chronicled in the book relate to
dermatology experiments at Holmesburg: facial creams,
hair lotions, skin moisturizers, suntan products, foot
powders, deodorants, detergents, anti-rash treatments,
and many, many more. The author recounts the greed and
borderline fraudulent research activities of one
scientist, the éminence grise of experimental
dermatology, Dr. Albert Kligman, Professor of
Dermatology at the University of Pennsylvania. When
Dr. Kligman entered the aging prison, he was awed by
the bare torsos of hundreds of inmates walking
aimlessly before him and by the potential they held
for his research. In 1966, he recalled in a newspaper
interview: "All I saw before me were acres of skin. It
was like a farmer seeing a fertile field for the first
time." Hence the book's title. But prisoners were
also used in eye drop, toothpaste, liquid diet, and
regeneration ointment studies and exposed to more
hazardous and potentially lethal substances such as
psychotropic drugs, radioactive isotopes and chemical
warfare agents, often without being informed of the
risks, nature and purpose of the experiments. Other
experiments involved testicular radiation at Oregon
and Washington state prisons (a total of more than 130
prisoners were irradiated), live cancer cell injection
at the Ohio state prison, mind control performed by [End page 5]
the CIA during World War II, antidotes for influenza,
malaria, typhus, and dysentery, skin graft techniques,
and exotic blood tests. Hornblum reports that in blood
test experiments, for example, 64 volunteers were
injected with an ounce of purified fraction of beef
blood before the experiment was stopped. Twenty of the
men became ill from serum sickness, eight seriously,
"with high fever, rashes, and joint pain. One died."
Hornblum has first-hand knowledge of all these
research activities carried out on willing but poorly
informed prisoners from the early 1950's to the mid-
l970's. He writes clearly and passionately about the
extent and quality (or lack of it) of this clinical
research. A former member of the Board of Trustees of
the Philadelphia Prison System and the Pennsylvania
Crime Commission, Hornblum makes good use of his
friendship with the former prisoners he interviewed.
Through extensive review of records, obtained thanks
to the Freedom of Information Act, and hundreds of
interviews of doctors, medical personnel, and prison
officials, the author compiles an incredible document
on prison research and gives ample examples of moral
indifference and greed. Eager doctors, seeking fame
and fortune, saw in prisoners the ideal subjects for
their experimental works because prisoners were less
expensive, more expendable, and more willing to accept
risks than free individuals. Moreover, life in prison
is subject to few variations so "healthy inmates were
under perfect control conditions." Hornblum explains
that "for the nascent medical-pharmaceutical industry,
the appeal of penal institutions became overwhelming .
. . . Public outcries against these experiments were
few."
Acres of Skin begins with the Nuremberg Code and
its set of 10 moral and legal requirements for
permissible human experimentation. The Nuremberg Code
was formulated in August 1947, in Nuremberg, Germany,
by American judges sitting in judgment of 23
physicians and scientists accused of murder and
torture in the conduct of medical experiments in the
concentration camps (the Doctors' Trial). The Code has
rightly been characterized as the most authoritative
set of rules for the protection of human subjects in
research, the first of which is that consent of the
human subject must be obtained without coercion in any
form:
The voluntary consent of the human subject is
absolutely essential. This means that the
person involved should have legal capacity to
give consent; should be so situated as to be
able to exercise free power of choice, without
the intervention of any element of force,
fraud, deceit, duress, overreaching or other
ulterior form of constraint or coercion; and
should have sufficient knowledge and
comprehension of the elements of the subject
matter involved as to enable him to make an
understanding and enlightened decision.
(emphasis added)
Hornblum rightly argues that the Code's first moral
and legal requirement makes it impossible to conduct
research on prisoners. This is because the very nature [End page 6]
of incarceration creates a "forcible situation" that
prevents them from exercising free, voluntary, and
informed choice. Against this background, Hornblum
then proceeds to compare the Holmesburg experiments to
those conducted by Nazi doctors on concentration camp
inmates.
It is certainly legitimate to write a history of
human experiments in prison against a background of
moral ideas and legal structures. But can one write
such a history against the background of the
concentration camp crimes committed by Nazi doctors in
World War II? At Nuremberg, 23 Nazi doctors and
scientists were condemned for conducting gruesome
medical experiments where death was the endpoint.
Concentration camp inmates could not refuse to
participate in these terminal experiments. They were
not paid and never benefitted from their participation
in research. They were tortured to death. The research
conducted at Holmesburg bears no resemblance to that
conducted in Nazi concentration camps. Contrary to
what the author seems to imply, there is a difference
in kind, not only in degree, between the murderous and
tortuous Nazi experiments and the experiments
conducted at Holmesburg. The Nazi analogy simply does
not apply.
Holmesburg prison closed in 1977. Prison research
ended when states began to limit, if not forbid,
research involving prisoners. On November 16, 1978,
the Department of Health and Human Services (DHHS)
provided guidelines for "Protection Pertaining to
Biomedical and Behavioral Research Involving Prisoners
as Subjects." Revised in 1991, these guidelines state
that "inasmuch as prisoners may be under constraints
because of their incarceration which could affect
their ability to make a truly voluntary and uncoerced
decision whether or not to participate as subjects in
research, it is the purpose of this Subpart to provide
additional safeguards for the protection of prisoners
involved in research activities:"
- 1. The Institutional Review Boards (which
review experimental protocols) shall have no
association with the prison(s) involved, apart
from their membership on the Board;
- 2. At least one member of the Board shall be a
prisoner, or a prisoner representative with
appropriate background and experience to serve
in that capacity...
- a) biomedical or behavioral research
conducted or supported by DHHS may involve
prisoners as subjects only if:
-
1) the institution responsible for
the conduct of the research has
certified to the Secretary that the
Institutional Review Board has
approved the research.
- 2) in the judgment of the Secretary
the proposed research involves
solely the following:
-
A) study of the possible
causes, effects and processes
of incarceration, and of [End page 7]
criminal behavior, provided
that the study presents no
more than inconvenience to the
subjects;
-
B) study of prisons as
institutional structures or of
prisoners as incarcerated
persons, provided that the
study presents no more
than minimal risk and no more
than inconvenience to the
subjects;
-
C) research on conditions
particularly affecting
prisoners as a class (for
example, vaccine trials and
other research on
hepatitis which is much more
prevalent in prisons than
elsewhere; and research on
social and psychological
problems such as alcoholism,
drug addition, sexual
assaults)
provided that the study may
proceed only after the
Secretary has consulted
appropriate experts in
penology medicine and ethics,
and published notice in the
Federal Register of his intent
to approve such research; or
-
D) research on practices, both
innovative and accepted,
which have the intent and
reasonable probability of
improving the health and well-
being of the subjects....
-
b) except as provided in the paragraph (a)
of this section, biomedical or behavioral
research conducted or supported by DHHS
shall not involve prisoners as subjects.
Federal regulation makes it much more difficult for
investigators to use prisoners as subjects in medical
research, and little research is currently conducted
in US prisons.
Because this book reminds us of the potential for
abuses inherent to prison research, it deserves to be
read, particularly by those concerned with the rights
and welfare of prisoners. Hornblum is deeply troubled
(and rightly so) when confined individuals are used as
research subjects. As a result, he describes the whole
effects of prison research in negative terms: it
exploits, harms, abuses, censors, abstracts, masks and
conceals. But, in fact, it also "produces:" it
produces "domains of objects and ritual of truth." For
example, dermatology was a minor medical specialty
before Dr. Kligman transformed it into a major
cosmetic enterprise; and Hornblum credits research at
Holmesburg with making possible the marketing of
retinoic acid, "Retin-A," the anti-wrinkle cream, and
Dr.Kligman's greatest accomplishment. [End page 8]
The very abuses and violation of human rights
which Hornblum describes in his book cannot be
repeated. Information systems and strict regulations
in our democratic country no longer permit such a
gross violation of human rights. Far more important, I
think, is the danger of being overly confident in the
informed consent requirement. Obtaining informed
consent is crucial and necessary. But it is not
sufficient to justify research on human beings.
Informed consent is the beginning of the protection of
human subjects, not the end.
Prisoners of poverty rather than of stone are the
current favorites of researchers. This is particularly
true in contemporary global research sponsored by
developed countries and conducted in developing
nations. Like prisoners, subjects in developing
nations are vulnerable. Before gaining access to these
subjects, a number of human rights questions must be
answered: Can the research be conducted on less
vulnerable subjects? Do developing nations have a
health care system that may ensure access to care?
Will research be perceived by subjects as the only way
to get medical attention for their conditions? Will
the benefit of research be made available to the
communities where the research is conducted? Like
research in prisons, these questions extend beyond the
mere research-subject relationships to the political,
cultural, economic and social context of research,
none of which is specifically addressed by the
Nuremberg Code or contemporary international
guidelines (i.e., the Helsinki Declaration).
Considerable progress in the regulation of human
research has been made, yet contemporary global
research may still lack adequate informed consent
procedures, and the risks to the study population may
still be disproportionate to the social benefits. The
chapter on prison research is now closed. But if we
take human rights seriously, contemporary medical
research on human subjects cannot afford to replace
prisoners of stone with prisoners of poverty -- the
poorest members of the poorest nations.
Evelyne Shuster, PhD
Philosopher and Medical Ethicist
Veterans Affairs Medical Center
Philadelphia, Pennsylvania
[End page 9]
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