One of the nicest [American] scientists I know was heard to say, “Criminals in our penitentiaries are fine experimental material—and much cheaper than chimpanzees.”

—“Pertinax,” British Medical Journal, January 1963

In 1998, Allen Hornblum published Acres of Skin, which powerfully documented the wide spectrum of abusive medical experimentation conducted at Philadelphia’s Holmesburg Prison complex by Dr. Albert M. Kligman between the 1950s and 1970s. By drawing back the veil obscuring the medical abuse of captive men, Allen has done a great service not only to the abused subjects but also to all Americans by allowing them to witness the questionable milieu in which prison experimentation has been conducted.

Seventy-five percent of Holmesburg’s inmate population, including Edward “Butch” Anthony, the subject of this book, were administered cosmetics, powders, and shampoos that caused many of them baldness, extensive scarring, and permanent skin and nail injury. Fingernails were removed or deformed and the subjects’ backs were covered in checkerboard patterns of flayed, discolored, and scarred skin. Jailed subjects were also inoculated with herpes, vaccinia, and wart viruses. Dow Chemical Company also paid Kligman to test the suspected carcinogen dioxin, on seventy prisoners, mostly black. “Most of this research was practiced upon African American men,” revealed Hornblum. “It was not uncommon for them to be used for the worst, most dangerous experiments.”

Kligman, a dermatologist, was initially invited to Holmesburg Prison in 1951 to treat an outbreak of athlete’s foot. But his initial reaction to Holmesburg was far from therapeutic and gave Hornblum’s book its title: “All I saw before me were acres of skin. It was like a farmer seeing a fertile field for the first time.” Soon Kligman was inducing foot fungus, instead of treating it, because he saw the opportunity to conduct lucrative experiments upon thousands of captive bodies for at least thirty-three major pharmaceutical and cosmetic companies, such as Johnson & Johnson, Merck, Helena Rubenstein, and DuPont.

During World War II, prisoners had been commonly used as research subjects and, after the war, the United States was the only nation in the world continuing to legally use prisoners in clinical trials. This corporate capital catalyzed a thirty-year boom in research with prisoners, and throughout the 1950s and 1960s Kligman gained exclusive experimental use of inmate bodies, testing 153 experimental drugs between 1962 and 1966 alone.

Each participant earned anywhere from ten to seven hundred dollars, while Kligman made millions for himself, the university, and his pharmaceutical partners. As Hornblum notes in Acres of Skin, when Kligman used prisoners to devise the anti-acne medication. Retina-A, it alone made him a millionaire. “It was years before the authorities knew that I was conducting various studies on prisoner volunteers,” recalls Kligman. “Things were simple then. Informed consent was unheard of. No one asked me what I was doing. It was a wonderful time.”

Far from being castigated for the harms visited on prisoners, Kligman has been honored for elevating the specialty of dermatology. But he did not confine his research to his specialty. Kligman oversaw research into many hazardous agents, including Army and CIA mind-control experiments in which men were given experimental psychoactives and Schedule II drugs (those with a high abuse risk). Some men insist that they have never recovered from these experiences.

The men of Holmesburg prison were not alone. In 1952, Chester M. Southam of the Sloan-Kettering Institute injected at least 396 inmates at Ohio State Prison—more than 180 of them black—with live human cancer cells — years before the similar and infamous Jewish Chronic Disease Hospital experiments. Between 1963 and 1971, a Dr. Heller irradiated the gonads of 131 prisoners in Oregon, including at least 66 “negro volunteers,” with radioactive thymidine. Inmates also were used in flawed, unhygienic, blood-plasma trials testing “high-volume plasmapheresis”—transfusions utilizing large amounts of plasma—between 1967 and 1969 throughout the state of Alabama. Austin R. Stough, the doctor who performed these experiments, also made millions.

Informed consent is always questionable in the prison arena, where subjects have already lost their most important civil rights and where literacy is so low that the presence of a signed consent form signifies little. Allen also reminds us that prison have been closed to mainstream American society, making the sub rosa medical exploitation of prisoners something that could be conducted on the powerless in secret.

Recognizing this, the Ethical Committee of the World Medical Association, in its 1961 code of ethics on human experimentation, declared, “Persons detained in prisons, penitentiaries, or reformatories— being ‘captive groups’—should not be used as subjects of human experiments.” But in American prisons research thrived and prisoners’ desperate need for money— to purchase everything from toiletries to freedom in the form of bail money—means that paying the incarcerated far more for medical research than they could earn elsewhere constitutes undue inducement or even coercion.

However, by the 1970s, research in prisons began to disappear, succumbing to scandals that unmasked the racially unbalanced, abusive, dangerous, and scientifically sloppy nature of experimentation with prisoners. The exploitation of large numbers of black male prisoners caused public-relations problems for researchers and institutions in the wake of the increasingly violent and bitter civil rights battles and the revelations of the “Tuskegee syphilis study,” in which effective treatment was withheld from about four hundred poor black sharecroppers with syphilis. The deaths of twenty-nine inmates and at least ten white authority figures in the 1971 Attica prison riot sent a chill through prison medical research programs and so did the burgeoning influence of the Black Muslims who emerged as powerful critics of prison research, dissuading black inmates from participating and intimidating the overwhelmingly white medical researchers.

Research programs suffered legal repercussions, as well when, in 1979, nine Oregon prison subjects sued and shared $2,215 in damages. A January 1973 Atlantic Monthly story by investigative journalist Jessica Mitford uncovered the exploitative nature of prison medical research and Senator Edward Kennedy held hearings that led to the National Commission for the Protection of Biomedical and Behavioral Research (CPBBR), which investigated medical experimentation on prisoners. It considered banning such research outright, but settled instead upon sharply curtaining medical research— which all but disappeared in prisons. The 1979 Belmont Report, placed the onus on researchers for ensuring that research with prisoners provided informed consent and is therapeutic under what is called the “Common Rule”: this set strict limits on nontherapeutic research and research done with prisoners and requires the review of proposed studies by institutional review boards.

When Allen published Acres of Skin, many former subjects realized for the first time that they had rights as experimental subjects and could sue the University of Pennsylvania, Kligman’s home institution, despite the indemnification waivers that some had signed. In September 2000, 298 former Holmesburg prisoners filed a class-action lawsuit against the university, Johnson & Johnson, Dow Chemical Company, Dr. Kligman and the City of Philadelphia. But the years and the experiments had taken their physical toll. Most subjects are dead, and the survivors, now in their sixties and seventies, suffer from skin and nail problems, breathing difficulties, cancers, and stubborn, sometimes unidentified infections. Former inmates have joined as the Experimentation Survivors and Allen remains their vocal advocate.

Today, most people don’t realize that prison medical research is enjoying a quiet renaissance. Since the late 1980s, prison research has been planned and conducted in Arkansas, Maryland, South Carolina, Texas, Florida, Connecticut, and Rhode Island.

In 2006 the Institute of Medicine, which advises the federal government on biomedical issues, appointed the Committee on Ethical Considerations for Protection of Prisoners Involved in Research to study the issue and recommended that prisons again be opened widely to medical research. If the doors are flung wide to investigators, will they admit therapy or exploitation? Allen’s work has served an important purpose in demonstrating that the laws enacted to protect prisoners’ rights and health consistently have failed to do so.

Now, in Sentenced to Science, Allen Hornblum expounds on this hidden history by crafting a narrative that details one man’s odyssey in Holmesburg’s stygian scientific kingdom. I hope it may serve as a cautionary tale.

            Harriet A. Washington

Author, Medical Apartheid