Given enough time, some folks who committed atrocious acts are able to see the error of their ways. And then there are the people who will kick and scream to the bitter fuck end that, despite all evidence to the contrary, they did nothing wrong.
Today’s Moment of Science… Wrinkle cream and prison labor.
In 1949, a German study showed that a perfectly safe dose of a perfectly safe form of vitamin A could slow the rate of skin cell growth in rats. Which was all researchers needed to hear to go mucking about with that form vitamin A in humans. While retinyl palmitate taken orally could treat psoriasis lesions, the dosage caused toxicity. When applied topically, it did approximately bupkis.
Researchers suspected vitamin A was metabolized into something more useful and went hunting for the right metabolite. They found one of my favorite varieties of medical duct tape: tretinoin.
Marketed under the brand name Retin-A, retinoic acid was originally researched for the treatment of acne. Its resumé has expanded to include plenty of skin-deep aggravations. You got acne? Slap some tretinoin on it. Hyperpigmentation? So much tretinoin. Wrinkles? Slater on the tretinoin starting yesterday, baby. If I’m seeing my dermatologist for anything involving, uh, skin, I expect to leave their office drowning in the stuff.
Impressively for the spot-cream-that-could, in early research tretinoin was observed to have anti-tumor properties on basal cell carcinoma. Further investigation showed that it wasn’t as effective at achieving lasting remission as other available therapies though, so please don’t try to DIY it with that suspicious mole and your zit cream. Today it’s used as adjunctive therapy in treating certain types of precancerous skin lesions. A pill form of the retinoid is also approved as a treatment for refractory cases of acute promyelocytic leukemia.
As anyone who’s been handed a tube of the stuff without thorough instructions can attest, it’s been known to leave some unsuspecting faces in a red and peeling state vaguely reminiscent of a steamed tomato. The highest available concentration of tretinoin cream is 0.1%. Which leads me to believe that early in the research process of this peeling-redness-burning-ouchies medicine, they may have tried out a strength that was- scientific term- a bit much.
I told you that story to tell you this story about Dr. Albert Kligman.
Albert Kligman was an asshole.
(This all gets super dark from here, subscribe to my patreon, thx).
A newly trained dermatologist, he was hired by Holmesburg Prison in Philadelphia, PA to help treat an outbreak of athlete’s foot. In Holmesburg, he saw far more than fungal infections; he saw potential. In an interview years later about his work at the prison, Kligman said “All I saw before me were acres of skin. I was like a farmer seeing a fertile field for the first time.” Yikes.
Between 1951 and 1974, Kligman ran dozens of clinical trials at the prison for private companies and various government agencies alike. It’s true that inmates signed something resembling consent forms, they were paid for putting their skin on the line for science, and experiments like this were going on elsewhere. Howthefuckever, the scale of the madness counts.
Note, the current maximum prescription for tretinoin is 0.1%. They started testing at 1%. Inmates who were experimented on with tretinoin experienced “lots of skin peeling, open wounds and sores.” If only it had ended there. Patients were exposed to various diseases including staph, ringworm, and herpes. They were exposed to radioactive isotopes and chemicals that made the skin blister. Some were given hallucinogens, some received drugs that caused violent behavior.
Running the experiments and record keeping was delegated to the inmates. A group of men who weren’t scientifically trained keeping records while tripping balls produced scientific research about as coherent as you’d expect. In light of his trash lab notebooks, Kligman was the first researcher banned by the FDA from researching drugs in human subjects (eh, temporarily). That didn’t stop him from subjecting people to chemical tests for a bit longer there.
Dow Chemical paid to have inmates exposed to dioxin, the temperamental component of Agent Orange. But Kligman didn’t follow their agreed upon protocols of exposing them to a maximum of 16 micrograms, no. He exposed inmates to 7,500 micrograms. Horrified by his misconduct, Dow terminated his contract.
He also published a paper on ringworm in which he stated the data came from “experimentally infected humans” at a “a state institution for congenital mental defectives.” It was a children’s institute, and that was the nicest phrase he called them.
Kligman would go on to claim that nobody suffered for anything he’d done, which was news to the men who suffered with health effects the rest of their lives. Nearly 300 of the men sued for violations of the Nuremberg Code. It unfortunately was dismissed because the statute of limitations had passed.
But, even if that hadn’t been the case? The history of everyone getting on board with following the Nuremberg Code was not a linear one. The ten points defining permissible medical experimentation involving human subjects came out of the nazi doctors’ trial; those fuckers had a bit of trouble differentiating between a legit experiment and a goddamn war crime. Little known fact though, Germany already had the 1931 Guidelines for Human Experimentation that covered quite a bit of the same material. Those guidelines apparently needed to be treated a bit more like a code.
So, this code was written, signed, and sent to every medical institute on the planet to follow from the word go, right? Eh. It barely made waves for a few decades. Researchers continued to (sorta) follow their region’s guidelines until something made them change.
In the US, that ‘something’ was Tuskegee.
In 1972 when the scandal broke, it directly led to the 1974 development of Title 45 of the Code of Federal Regulations, Part 46 (45 CFR 46). It was a real, set in stone policy for protection of human research subjects. Which is absolutely why Kligman had to close up shop at Holmesburg in 1974.
The only admission I can find from Kligman in having erred is that he shouldn’t have had inmates keep records for him. “That was dumb. It very nearly ruined me.” Retin-A went on the market in 1971.
This has been your Moment of Science, just reminding everyone that no, things were not even a little bit better back in the day.
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