Allen M. Hornblum, Acres of Skin: Human Experiments at Holmesburg Prison. New York:

 

Allen M. Hornblum, Acres of Skin: Human Experiments at Holmesburg Prison. New York:
Routledge, 1998.

This story is of the no-less-than criminal abuse of human subjects at Holmesburg Prison, a
country jail for Philadelphia, 1951 through 1974. These abuses terminated only with the scandal
surrounding the infamous Tuskegee Syphilis "Experiment" and the mind control experiments of
the CIA. My feeling is that this outrageous case will similarly arouse public anger: the Black
community in particular will feel this a good example of exploitation and another example
terrible example of what happened at Tuskegee. However, it's much bigger than that: this is
nothing less than an indictment of Big Science in the United States.

Be clear on this: The agencies involved in this scandalous science are the University of
Pennsylvania and its Medical College (especially the department of dermatology), its chief Big
Name dermatologist, Albert M. Kligman (now emeritus), every big pharmaceutical company in
the country, the FDA, the NIH, DOD, AEC, the Army and, of course, the CIA (operating through
the Macy Foundation and the Geschicker Fund). All of these were the abusers. That's a very
telling list.

The abused were prisoners at Holmesburg. And many of the abused were not convicts but poor
people who could not raise bail and so were simply "detainees" in the jail. And along comes the
University of Pennsylvania researchers and these poor people are offered $50 and more to
participate in experiments. Fifty bucks seemed a lot of money at the time and so these men
"volunteered" and, thereby - at least as far as Kligman was concerned - gave their informed
consent. Of course their " participation" was not "completely voluntary" according to the
Nuremberg Code (which was in effect in 1947). But apparently that code applied to those
German brutes but not to hustling academics and their finance officers.

Over the years, no one seemed to object even though the research was very public. There were
plenty of publications - and not merely ones in medical journals but also in Life and Reader's
Digest where Kligman was made out a hero, a successful researcher. No one seemed to give a
damn for the prisoners. Of course there was the Hippocratic Oath and that old idea of "primum
non nocere" (first, do no harm) but that was not applied to the case of Holmesburg. So everyone
looked the other way and poor men suffered in the name of science. It would appear that anything
can be done in the name of science if, of course, you have the right credentials and the right
academic background.

It would be a serious mistake to oversimplify this case and see it involving "the old days" which
are gone and best forgotten. This should not be seen in terms of the culture of the 1950s and 60s
which did not use "today's standards. Today's standards are no different! Oh, a little more
paperwork may be needed but the methods used in science to protect human subjects are totally
inadequate and IRBs are used today, just as they were in Holmesburg, to protect the scientists
and their universities, not the subjects. Similarly, it would be a serious error to see this case as
pathological; this is not a case of a "mad physician" and a greedy "business officer" doing
"pathological science" at an otherwise wonderful university whose faculty were members of a
fine profession. Quite the contrary, this tale as very instructive: the oppressed and the vulnerable
are at risk in our society which promotes science uncritically and thoughtlessly, and relies on
something as flimsy as professional self-control to prevent abuses. Clearly, self-control in science
is NOT enough. Kligman and the University of Pennsylvania are guilty of what should be crimes
and misdemeanors and yet we tell these stories of abuse as if they were aberrations. This is not an
aberration. One does not have to be among the fringe elements to fear the power of institutions
intent on their own aggrandizement. One can legitimate ask of science: where are the controls?
Where are the limits to the hustlers' greed?

Those who understand sciences know that it is a hit or miss process. They know that science
proceeds very slowly. They also know that in spite of their pretensions, scientists are ambitious,
untrained in ethics (qua scientists), typically unsupervised, well-funded, and usually convinced of
the rightness of their ideas. Such men and women are dangerous as they are willing to do
whatever is deemed necessary by them, of course for the greater good. They are willing to use
subjects with the explanation, "I am only doing science." Frankly, that sounds awfully close to "I
was only following orders."

And what Dr. Albert M. Kligman did in those years at Holmesburg prison is, in a sense,
impressive. He developed Retin-A, a fabulously successful dermatological cream which has
made big bucks for him and for Johnson and Johnson (and the marketing of which was, itself,
pretty sleazy). He also got FDA approval for hundreds of pharmaceuticals, he tested various
mind altering substances for the CIA and the military. In short, he conducted a research
laboratory at top speed for more than two decades. He was a one-man research institution and
wonderfully successful in his academic career. The simple number of studies the guy was
conducting should have been a warning that some hustling was being done but, again, nobody
seemed to notice or care. So long as Kligman was a "productive scientist" he could and did
continue to do his work on prisoners.

Kligman's work was ended by not by complaints from subjects, nor from prison authorities, and
certainly not from the university or the medical school. His fell victim to a changing climate of
opinion brought about by the exposure of the Tuskegee experiment and the exposure of the
CIA's efforts at mind control. There was a new awareness of government-sponsored or
university-sponsored research; attitudes toward scientific research were changing. There had
been horror stories. Holmesburg was victim of changing attitudes, and a temporary awareness of
subject abuse by the public and Congress. I should add: no one at Holmesburg suffered any
punishment for what they did to prisoners. They just went out of business.

After all, who was there to complain? The prisoners had not complained over the years and, in
their terms, were "well-paid" for their participation. And some enterprising prisoners found uses
in the University's research efforts as some trustees used their position on the university's staff
for sexual and financial profit. Over the years, the prison used the continuing experiments as a
point of pride and regarded the laboratory work as a controlling mechanism: "it was great for
morale." The university did not complain so long as the money kept coming in; and Kligman's
dermatology colleagues envied his successes with his money-making medicine. Indeed, Kligman
put his low-prestige medical specialty of dermatology high on the list of money-makers; his
colleagues loved him because he raised their standing in science.
This story will certainly be as notorious as Bad Blood and it will again stimulate Congressional
inquiries from which there will ensue more Congressional Reports to which the AAU and its
representatives will respond and, in time, the whole thing will go away - but there will be a few
moments of chest beating and mea culpas before Big Science continues on its monied ways.

Over the years, I've had trouble using Jones' wonderful book with my students in sociology.
Whenever students read that book, they tend to interpret the story in terms of racism and turn
Jones' tale into just another example of the ways Blacks are treated in the United States. (Jones
even warns his readers not to do this but students do it anyway.) One of the advantages of this
book is that it is a clear study of subject abuse (yes, many were Black at Holmesburg but in
Hornblum's new book, it's not a question of race) here the issue is straightforward: all prisoners
at Holmesburg in these experiments were abused by a uncaring and abusing dermatologist and a
thoughtless and money-grubbing major research university. This peach of a pair didn't a hoot for
the patient's race: they abused everybody. They dished their filth with bravado and made
megabucks for themselves as they served their masters in various drug houses, the CIA, the U.S.
Army - whoever wanted quickie, down and dirty "evaluations" of their latest drugs. This is a very
useful case study of Big Science in the United States. Students will be outraged - as well they
should be.