WEBVTT - Ep 156 Retinoids Part 1: How it started… 0:00:00.720 --> 0:00:04.280 In nineteen seventy and nineteen seventy one, I participated in 0:00:04.360 --> 0:00:08.159 three different types of tests. Two of them, nicknamed the 0:00:08.200 --> 0:00:11.680 patch tests by inmates, dealt with the experimentation of new 0:00:11.720 --> 0:00:15.000 products not yet released to the general public. The first 0:00:15.040 --> 0:00:19.239 patch test was one that tested lotions, creams, skin moisturizers, 0:00:19.280 --> 0:00:23.520 and suntan products. The procedure for these tests was as follows. 0:00:23.760 --> 0:00:27.120 A grid made from thick strips of white hospital tape 0:00:27.200 --> 0:00:30.280 was fixed to the upper portion of an inmate's back shoulders. 0:00:30.600 --> 0:00:33.680 The grid consisted of about twenty squares. In each of 0:00:33.680 --> 0:00:36.279 these squares, a dab of lotion was applied and the 0:00:36.320 --> 0:00:39.640 inmate's back was exposed to different temperatures from a sunlamp. 0:00:40.200 --> 0:00:43.120 The exposure to the sun lamp lasted anywhere from fifteen 0:00:43.159 --> 0:00:46.199 to thirty minutes, after which each square was inspected for 0:00:46.320 --> 0:00:50.040 degree of blistering or other adverse reactions. The grid was 0:00:50.080 --> 0:00:52.600 then covered with a large solid piece of tape to 0:00:52.680 --> 0:00:55.920 prevent tampering by the inmate, and the inmate was returned 0:00:55.960 --> 0:00:59.240 to his cell. This test lasted about thirty days, and 0:00:59.280 --> 0:01:01.400 once a day the the inmate was called back over 0:01:01.440 --> 0:01:03.840 to the lab and exposed to the sun lamp. After 0:01:03.920 --> 0:01:06.560 about five days of the sun lamp, there were sections 0:01:06.600 --> 0:01:09.480 of the skin that were burnt a deep brown and 0:01:09.520 --> 0:01:12.640 the skin started to peel, itch and blister. If a 0:01:12.680 --> 0:01:15.319 certain square became too damaged, it was covered over with 0:01:15.360 --> 0:01:18.240 a permanent piece of tape and the test continued. 0:01:17.720 --> 0:02:03.359 On the grid. 0:02:04.520 --> 0:02:09.480 That sounds awful erin Yeah, it really, it really really is. 0:02:10.280 --> 0:02:14.160 And so that was from William Robb, who was at 0:02:14.160 --> 0:02:18.440 one point in Holmesburg Prison and participated in these experiments 0:02:18.520 --> 0:02:22.000 that will make up a big focus of today's episode. 0:02:22.880 --> 0:02:25.720 And that ultimately was from a book titled Acres of 0:02:25.800 --> 0:02:28.720 Skin by Alan Hornblum. 0:02:30.000 --> 0:02:33.400 Hi, I'm Aaron Welsh and I'm Eron Auman Updike. 0:02:33.240 --> 0:02:35.320 And this is this podcast will kill You. 0:02:35.960 --> 0:02:41.360 And today's episode we are covering one half of a 0:02:41.400 --> 0:02:44.279 big story all about retinoids. 0:02:45.160 --> 0:02:45.680 Yeah. 0:02:46.000 --> 0:02:49.880 You know, sometimes with the topics that we choose, you 0:02:49.960 --> 0:02:51.919 never know where you're going to end up and what 0:02:52.080 --> 0:02:54.720 most story is going to be. Yeah, and this was 0:02:54.760 --> 0:02:57.320 certainly the case for retinoids. 0:02:57.960 --> 0:02:59.120 And you know, we. 0:02:59.160 --> 0:03:01.720 Decided to do that because we were just like, what's 0:03:01.800 --> 0:03:06.440 the deal with retinoids? Yeah, and looking into the history 0:03:06.520 --> 0:03:11.280 of things like retina I found a darker story than 0:03:11.400 --> 0:03:17.440 I anticipated, and the story itself both like the origin 0:03:17.680 --> 0:03:23.040 of retina and the marketing of you know, retinoids in general, 0:03:23.400 --> 0:03:26.320 that is one half of this big story. But I 0:03:26.320 --> 0:03:30.000 also wanted to tell the story of the experiments at 0:03:30.120 --> 0:03:33.840 Holmesburg Prison from the nineteen fifties to the nineteen seventies 0:03:33.880 --> 0:03:37.040 because it's not a very commonly told story of a 0:03:37.080 --> 0:03:40.440 really dark chapter in American medical history. 0:03:40.800 --> 0:03:43.520 Also, I don't think I realized that this story is 0:03:43.560 --> 0:03:45.920 going to take place in the nineteen fifties to nineteen seventies. 0:03:45.960 --> 0:03:49.280 That's like just very depressing, Aaron, Like. 0:03:49.240 --> 0:03:49.840 How recent? 0:03:50.040 --> 0:03:50.640 How recent? 0:03:51.680 --> 0:03:55.480 I mean what Tuskegee was whistleblown in the early nineteen. 0:03:55.240 --> 0:03:59.920 Seventies, I know, Yeah, I know, I know. And then yes, 0:04:00.080 --> 0:04:01.040 so that is. 0:04:01.000 --> 0:04:02.880 What this episode is going to focus, all on the 0:04:03.000 --> 0:04:07.080 history how did retine get to market and a little 0:04:07.080 --> 0:04:09.720 bit more about one of the guys who brought it there. Yeah, 0:04:09.760 --> 0:04:12.640 and then the second episode, which will be your focus 0:04:12.760 --> 0:04:16.080 erin is do retinoids work? 0:04:16.360 --> 0:04:20.360 Right, It's gonna be more light hearted episode than this one. 0:04:20.839 --> 0:04:23.680 So next week we'll get into what retinoids are, how 0:04:23.680 --> 0:04:26.320 they work, do they work, what do we use them for. 0:04:26.920 --> 0:04:28.080 And a big. 0:04:27.920 --> 0:04:30.479 Part what I'm most excited about in that episode will 0:04:30.520 --> 0:04:34.320 be what's the difference between and over the counter retinoid 0:04:34.520 --> 0:04:37.400 and the stuff you get my prescription? And is there one? 0:04:37.800 --> 0:04:41.000 I am? I'm very excited for that because the amount 0:04:41.040 --> 0:04:44.000 of claims that I see both on product but also 0:04:44.240 --> 0:04:48.680 just on the internet in social media and whatnot for 0:04:48.920 --> 0:04:52.560 the magical powers of retinol. I want to know, like, 0:04:52.920 --> 0:04:54.720 are there magical powers it is? 0:04:54.920 --> 0:04:56.839 I mean, it's a supplement's episode two point Oh oh, 0:04:56.839 --> 0:04:58.240 can't wait for It's gonna be so fun. 0:04:58.720 --> 0:05:04.520 But first, but first we have quarantini dime, we sure do. 0:05:05.480 --> 0:05:06.760 What are we drinking this week? 0:05:06.920 --> 0:05:07.840 Aren arin? 0:05:07.920 --> 0:05:12.719 This week we could drink only skin deep skin deep ye. 0:05:13.960 --> 0:05:19.159 And in skin deep appropriately is carrot juice because retinoids 0:05:19.160 --> 0:05:22.320 are derived from vitamin A ultimately, which is found in 0:05:22.360 --> 0:05:24.240 great quantities and carrots. 0:05:24.360 --> 0:05:27.479 Yeah, it's beta carotene, which is like will convert into 0:05:27.520 --> 0:05:29.440 vitamin A in your body. It's a long. 0:05:29.240 --> 0:05:31.400 Story technically speaking. 0:05:33.920 --> 0:05:37.640 And it also has ginger and lemon juice and some 0:05:37.680 --> 0:05:41.440 simple syrup and some vodka and it's a tasty little concoction. 0:05:41.560 --> 0:05:43.240 I might have to play around with the ratios a 0:05:43.279 --> 0:05:43.880 little bit, but. 0:05:43.920 --> 0:05:46.840 It's gonna be fantastic. You can find the full recipe 0:05:46.839 --> 0:05:50.600 for that quarantini and the very healthy and non alcoholic 0:05:50.680 --> 0:05:53.040 Plosi Burita on our website This Podcast will kill You 0:05:53.120 --> 0:05:56.880 dot com and on all of our social media channels too. 0:05:57.400 --> 0:05:59.960 On our website This Podcast will Kill You dot Com. 0:06:00.360 --> 0:06:02.080 There's a lot of things that you can find. You 0:06:02.120 --> 0:06:03.800 can find the sources for each and every one of 0:06:03.800 --> 0:06:07.880 our episodes. You can find transcripts. You can find links 0:06:07.880 --> 0:06:11.040 to our bookshop dot org, affiliate account, links to our 0:06:11.040 --> 0:06:15.679 Goodreads list, links to music by Bloodmobile, links to merch 0:06:15.800 --> 0:06:19.000 links to Patreon. There's a contact us form where you 0:06:19.080 --> 0:06:23.000 can say like, hey, do this episode or hey, uh, 0:06:23.680 --> 0:06:27.719 come talk at our university whatever it is. There's also 0:06:27.800 --> 0:06:29.839 a submit your first hand account form. 0:06:30.120 --> 0:06:32.960 You know it's good safe, check it out. 0:06:33.040 --> 0:06:36.480 Check it out, and if you haven't already, be sure 0:06:36.520 --> 0:06:40.080 to check your podcatcher and make sure that you're subscribed 0:06:40.360 --> 0:06:42.560 to this podcast, which really helps us. And if you 0:06:42.560 --> 0:06:44.960 haven't already left us review, we would sure love it 0:06:45.000 --> 0:06:49.799 if you did. Okay, should we get started, Yes, please 0:06:49.880 --> 0:06:53.359 tell me erin all about how Retine came to be. 0:06:53.800 --> 0:06:55.600 All right, it's a long story, so let's take a 0:06:55.680 --> 0:07:15.200 quick break before we begin. How many of you out 0:07:15.200 --> 0:07:18.960 there listening has in their bathroom cabinet a little bottle 0:07:19.000 --> 0:07:24.360 of serum or a little tube containing retinol or retinoids. 0:07:25.440 --> 0:07:28.440 Too? I have two, I have one. 0:07:29.120 --> 0:07:30.080 Two different kinds. 0:07:30.200 --> 0:07:32.880 And how many of you have been prescribed retinee in 0:07:32.960 --> 0:07:35.600 the past? And you know if it's the end of 0:07:35.680 --> 0:07:38.600 two here one, two of two. But I'm guessing that 0:07:38.640 --> 0:07:39.160 it is a. 0:07:39.120 --> 0:07:40.320 Lot of you out there. 0:07:41.080 --> 0:07:42.960 I haven't used my retinal in a long time because 0:07:42.960 --> 0:07:45.520 it makes me break out. But I bought it because 0:07:45.600 --> 0:07:48.960 I had heard on like commercials, or on tiktoks, or 0:07:49.120 --> 0:07:52.920 like the skincare addiction subreddit that it was great for 0:07:53.000 --> 0:07:56.400 your skin, for preventing fine lines, reducing the signs of aging, 0:07:56.520 --> 0:08:00.760 like all of those things. But beyond the question of 0:08:01.120 --> 0:08:03.920 does it actually do those things is a deeper question 0:08:04.360 --> 0:08:09.040 whose answer reveals the surprisingly dark history behind this ubiquitous 0:08:09.080 --> 0:08:13.400 skincare component. How did we learn about these effects of 0:08:13.400 --> 0:08:17.480 retinoids on the skin in the first place? Lurking beneath 0:08:17.520 --> 0:08:21.760 these claims of anti aging, poor cleansing, and acne prevention 0:08:22.120 --> 0:08:24.040 claims which I know next week you're going to talk 0:08:24.080 --> 0:08:27.480 about like which is their support for, which isn't their 0:08:27.480 --> 0:08:30.760 support for? But behind all of those claims is a 0:08:30.800 --> 0:08:36.800 grim history involving human experimentation on incarcerated individuals, experiments so 0:08:37.080 --> 0:08:41.080 profoundly unethical that they were described as a violation of 0:08:41.120 --> 0:08:44.120 the Nuremberg Code, you know, like the code that was 0:08:44.120 --> 0:08:47.080 developed in nineteen forty seven in response to Nazi doctor 0:08:47.120 --> 0:08:48.160 war trials. 0:08:48.440 --> 0:08:52.720 Ooh, Warren, that's not How have we never heard of this? 0:08:54.200 --> 0:08:58.000 I don't know, because it is commonly mentioned alongside Tuskegee 0:08:58.000 --> 0:09:03.760 syphilis study, alongside the Willowbrook State Schools, alongside the birth 0:09:03.800 --> 0:09:07.840 control pill experiments in Puerto Rico, Like, it's all sort 0:09:07.840 --> 0:09:09.920 of part of it. I had never heard about this 0:09:09.920 --> 0:09:13.120 though in medical ethics class. But maybe it was just 0:09:13.160 --> 0:09:15.240 a long ago that I had forgotten. 0:09:15.040 --> 0:09:17.120 Yeah, or maybe it was just glossed over us, like 0:09:17.240 --> 0:09:21.560 the history prison and like yeah not not no detail 0:09:21.720 --> 0:09:22.160 or something. 0:09:22.600 --> 0:09:26.400 Right, still people devaluing human life because. 0:09:26.040 --> 0:09:30.520 Of yeah, yeah, yeah, okay, I want to learn, right, Okay, 0:09:30.600 --> 0:09:32.680 So what were these experiments for? 0:09:33.080 --> 0:09:35.520 How were they allowed to happen? And who brought them 0:09:35.559 --> 0:09:37.960 to light? So that's the story. That I'm going to 0:09:37.960 --> 0:09:40.840 tell today, and it's not the history of retinoids that 0:09:40.880 --> 0:09:44.280 you're likely to find on a skincare company website, And 0:09:44.400 --> 0:09:47.559 to be fair, retinoids are just one part of the story. 0:09:48.000 --> 0:09:49.960 But I wanted to focus on it today because I 0:09:49.960 --> 0:09:52.880 think it's a crucial part of the history of medical ethics, 0:09:52.960 --> 0:09:56.000 and it's one that, yeah, you don't hear about that often. 0:09:56.960 --> 0:09:58.080 How do highly. 0:09:57.920 --> 0:10:01.600 Educated and credentialed individuals get to a point where they 0:10:01.640 --> 0:10:04.360 feel like they're above the rules, where they lose any 0:10:04.360 --> 0:10:06.800 self awareness that would allow them to see that they 0:10:06.840 --> 0:10:12.840 aren't nobly championing science, but in fact committing atrocities against humans. 0:10:14.400 --> 0:10:17.040 At the heart of this story is Albert Kligman, an 0:10:17.080 --> 0:10:20.600 American dermatologist who has been credited with transforming the field 0:10:20.600 --> 0:10:25.000 of dermatology from a little acknowledged subspecialty to a full 0:10:25.040 --> 0:10:28.240 on giant of industry by the end of the twentieth century. 0:10:29.320 --> 0:10:32.640 As the co inventor of retinee and an advocate for 0:10:32.679 --> 0:10:37.120 its off label uses, Kligman saw the incredible commercial potential 0:10:37.160 --> 0:10:43.200 of dermatology in terms of pharmaceuticals and cosmetics. Cosmaceuticals, but 0:10:43.280 --> 0:10:46.720 that is certainly not his only claim to fame. For 0:10:46.800 --> 0:10:50.160 more than two decades. Between nineteen fifty one and nineteen 0:10:50.200 --> 0:10:54.079 seventy four, Kligman headed a medical research program at Holmesburg 0:10:54.120 --> 0:10:59.040 Prison in Pennsylvania, where he conducted dozens of non therapeutic 0:10:59.120 --> 0:11:03.480 experiments on incarcerated individuals, the majority of which were black. 0:11:04.600 --> 0:11:09.160 Experiments ranged from assessing the efficacy of certain deodorants to 0:11:09.600 --> 0:11:14.520 quantifying the impacts of dioxin exposure. Dioxin, if you haven't 0:11:14.559 --> 0:11:17.920 heard of it before, is a highly carcinogenic substance, like 0:11:17.960 --> 0:11:21.559 it's sometimes called the most carcinogenic substance known. It's the 0:11:21.600 --> 0:11:25.080 stuff an agent orange that makes it super toxic to humans. 0:11:26.200 --> 0:11:29.040 So he tested an on humans. 0:11:28.960 --> 0:11:34.760 What mm hm And although most experiments didn't specify like 0:11:35.400 --> 0:11:38.640 which race he was looking for, you know, this is 0:11:38.640 --> 0:11:41.520 a call for white people, this is a call for 0:11:41.559 --> 0:11:46.680 black people. The riskiest ones were reserved for black individuals only. 0:11:47.880 --> 0:11:51.160 And this is where Retine was born, at Holmesburg Prison. 0:11:52.559 --> 0:11:54.559 But I'm already so mad, Aaron, I don't. 0:11:54.360 --> 0:11:57.560 Think he's just ei. There's so many more pages being angry. 0:11:57.679 --> 0:11:59.720 My face is going to be like that talking about 0:12:00.080 --> 0:12:02.440 when it wrinkles, like I'm gonna have one. 0:12:02.640 --> 0:12:05.520 The brow is going to be too deep for retinoids 0:12:05.520 --> 0:12:06.359 to penetrate. 0:12:06.840 --> 0:12:09.800 This podcast does give me one of those constantly. 0:12:10.360 --> 0:12:12.520 This podcast will give you a froid brow, give you 0:12:12.520 --> 0:12:14.400 a brow dot com worth it. 0:12:15.120 --> 0:12:15.400 Yep. 0:12:16.480 --> 0:12:19.400 But before we get into this the backstory of retine, 0:12:19.640 --> 0:12:24.520 let's first explore how Kligman found Holmsburg, or rather how 0:12:24.640 --> 0:12:28.480 it found him. Kligman's path to dermatology was not a 0:12:28.480 --> 0:12:31.480 straight line. He started off by first getting his PhD 0:12:31.520 --> 0:12:35.440 in botany, studying fungi. At the time, mycology was lumped 0:12:35.480 --> 0:12:38.560 in with botany or like under the botany umbrella. And 0:12:38.600 --> 0:12:40.960 then he went to medical school with a specialization in 0:12:41.000 --> 0:12:44.560 dermatology so he could keep pursuing his interest in fungi 0:12:45.080 --> 0:12:47.440 like those that cause athletes foot a lot of like 0:12:48.160 --> 0:12:50.640 you know, topical conjections. 0:12:51.000 --> 0:12:52.679 Yeah. 0:12:52.720 --> 0:12:56.360 A few years after graduating with his MD, Kligman, who 0:12:56.400 --> 0:12:59.480 was faculty at the University of Pennsylvania, he received a 0:12:59.520 --> 0:13:03.440 phone call from the pharmacist at Holmsburg Prison. The prison 0:13:03.520 --> 0:13:06.560 was dealing with a huge athletes foot problem, which is 0:13:06.600 --> 0:13:10.320 common in large residential facilities, and the pharmacist was at 0:13:10.320 --> 0:13:13.520 his wits end trying to find an effective treatment. And 0:13:13.640 --> 0:13:17.000 in his searches he had stumbled upon a research article 0:13:17.160 --> 0:13:20.760 written by Kligman about athletes foot and so he called 0:13:20.760 --> 0:13:23.760 the doctor for advice. Kligman was like, all right, I'm 0:13:23.760 --> 0:13:25.600 going to see this for myself. So he went to 0:13:25.679 --> 0:13:28.560 the prison to scope out the situation. And when he 0:13:28.640 --> 0:13:33.000 got there, he didn't see an athlete's foot problem, or 0:13:33.000 --> 0:13:36.680 he didn't see that alone. But what he saw instead 0:13:37.280 --> 0:13:38.800 was limitless potential. 0:13:39.880 --> 0:13:42.000 Quote. All I saw. 0:13:41.920 --> 0:13:45.080 Before me were acres of skin. It was like a 0:13:45.120 --> 0:13:47.480 farmer seeing a fertile field for the first time. 0:13:48.400 --> 0:13:51.280 End quote. 0:13:51.720 --> 0:13:58.040 Sorry, you go to a prison, see untold numbers of 0:13:58.200 --> 0:14:03.440 incarcerated individual human beings, and all you see are acres 0:14:03.440 --> 0:14:03.839 of skin. 0:14:04.120 --> 0:14:06.079 Acres of skin. Cool? 0:14:06.679 --> 0:14:07.520 H Great? 0:14:08.120 --> 0:14:10.040 So that stand up guy, I. 0:14:10.000 --> 0:14:12.000 Think gives you a little bit of a sense for 0:14:13.000 --> 0:14:15.880 where his sense of morality was when it came to 0:14:16.280 --> 0:14:18.160 experiments on right humans. 0:14:18.440 --> 0:14:20.080 I mean, it's a lot easier to do stuff if 0:14:20.240 --> 0:14:22.920 you're just doing it on skin. Right, It's just skin. 0:14:23.040 --> 0:14:24.360 It's devoid of humanity. 0:14:24.960 --> 0:14:26.680 I mean, and I think we'll get into this a 0:14:26.720 --> 0:14:28.720 little bit more later, but I think he did see 0:14:29.400 --> 0:14:32.320 beyond skin. But I think that what he saw was 0:14:32.360 --> 0:14:34.200 he was a little bit of the savior right Like 0:14:34.280 --> 0:14:36.800 he was like, Oh, but I am giving them freedom 0:14:36.840 --> 0:14:39.120 from boredom, I'm giving them money, I'm giving them an 0:14:39.160 --> 0:14:42.400 opportunity to learn. I'm giving them an opportunity to give back, 0:14:42.520 --> 0:14:45.640 Like this is a whole yeah, yeah, And so this 0:14:45.800 --> 0:14:49.560 acres of Skin comment is the title of the book 0:14:49.840 --> 0:14:52.440 that where most of this information that I got for 0:14:52.520 --> 0:14:55.240 today's episode comes from. It's a great book. It's by 0:14:55.280 --> 0:14:59.440 Alan Hornblum. It's one of the classic exposes of unethical 0:14:59.520 --> 0:15:04.960 human expert imitation in the US. In Kligman's eyes, Holmesburg 0:15:05.000 --> 0:15:09.240 Prison represented a near perfect study environment, and that's an 0:15:09.240 --> 0:15:14.360 opportunity that rarely, if ever comes along in medicine in 0:15:14.400 --> 0:15:18.840 an institutionalized setting. Holmesburg was not Kligman's first foray, by 0:15:18.840 --> 0:15:22.360 the way, into institutionalized settings. He also went into schools. 0:15:23.040 --> 0:15:26.760 But in all of these institutionalized settings, you could control 0:15:26.920 --> 0:15:31.280 every variable, down to how much sleep your test subjects got, 0:15:31.800 --> 0:15:34.640 what they ate, how much they ate when they ate, 0:15:34.840 --> 0:15:37.880 how much sun they got, when they could shower, how 0:15:37.920 --> 0:15:38.960 often they could shower. 0:15:39.440 --> 0:15:40.840 All of these things. 0:15:40.600 --> 0:15:44.360 You could have complete control over. Plus it was cheap 0:15:45.400 --> 0:15:47.840 to have someone in role in the types of trials 0:15:47.840 --> 0:15:52.120 that he was interested in trying out and testing. You 0:15:52.160 --> 0:15:54.880 would have to pay someone who was not in prison 0:15:55.000 --> 0:15:57.400 lots and lots of money to keep them going to 0:15:57.440 --> 0:16:01.720 be willing to do these things. By comparison, Holmesburg was 0:16:02.240 --> 0:16:05.520 very cheap, and so Kligman wasted no time in setting 0:16:05.560 --> 0:16:06.400 up shop at the prison. 0:16:07.320 --> 0:16:07.680 Quote. 0:16:07.760 --> 0:16:10.320 I began to go to the prison regularly, although I 0:16:10.360 --> 0:16:14.000 had no authorization. It was years before the authorities knew 0:16:14.040 --> 0:16:17.680 that I was conducting various studies on prisoner volunteers. Things 0:16:17.680 --> 0:16:21.560 were simpler then. Informed consent was unheard of. No one 0:16:21.600 --> 0:16:23.960 asked me what I was doing. It was a wonderful 0:16:24.000 --> 0:16:29.800 time end quote. I know, I just can't like, I 0:16:29.880 --> 0:16:30.840 can believe. 0:16:32.280 --> 0:16:33.560 It was a wonderful time. 0:16:33.640 --> 0:16:37.120 It was a informed consent didn't exist. It was a 0:16:37.160 --> 0:16:38.000 wonderful time. 0:16:38.280 --> 0:16:39.360 Yeah. 0:16:39.400 --> 0:16:42.400 Those two sentences cannot go together. 0:16:42.760 --> 0:16:43.280 Yeah. 0:16:43.320 --> 0:16:46.560 And I think the other remarkable thing about this is 0:16:46.640 --> 0:16:49.560 that so I'm not sure like when that quote was 0:16:49.600 --> 0:16:52.840 pulled from but it was later, like years later. 0:16:52.720 --> 0:16:55.520 Right, It's it's obviously him looking back on his time 0:16:55.600 --> 0:16:57.880 doing this, being like this. It was so great, wasn't it. 0:16:58.080 --> 0:16:59.240 Yeah? Cool? 0:17:01.040 --> 0:17:04.600 You know, and he wasn't entirely wrong about things being simpler. 0:17:04.640 --> 0:17:09.560 Then it seems that from my understanding, Kligman didn't do 0:17:09.600 --> 0:17:14.080 anything technically illegal while conducting experiments at Holmesburg. 0:17:14.240 --> 0:17:16.480 Well, I was just trying to remember at what point 0:17:16.600 --> 0:17:20.800 actually IRBs became a thing clearly after this. 0:17:21.840 --> 0:17:25.639 Yeah, I don't remember either. I know that Tuskegee in 0:17:25.640 --> 0:17:27.880 the early seventies kind of was one of the biggest 0:17:27.920 --> 0:17:30.600 wake up calls for you know, he. 0:17:30.680 --> 0:17:33.280 Just slipped it right in there, we need more regulation. 0:17:33.480 --> 0:17:38.280 Yeah. Yeah, But it doesn't mean that Kligman's experiments were ethical. 0:17:38.280 --> 0:17:41.560 It just means that the laws were simply inadequate at 0:17:41.560 --> 0:17:45.040 the time. In the mid twentieth century, non therapeutic medical 0:17:45.080 --> 0:17:51.840 experiments on institutionalized populations were normalized. They really were, especially 0:17:51.840 --> 0:17:55.280 on individuals and prisons, who were seen as expendable and 0:17:55.400 --> 0:17:58.480 also as needing to quote unquote give back to society. 0:17:59.160 --> 0:18:02.400 Prisons were a real popular spot for phase one clinical trials, 0:18:02.520 --> 0:18:05.040 which were intended to test the safety of a drug, 0:18:05.400 --> 0:18:09.240 not necessarily its efficacy. And so I've talked about several 0:18:09.320 --> 0:18:12.919 of these infamous unethical experiments on the podcast before, and 0:18:13.000 --> 0:18:15.920 even mentioned them earlier in this episode. You know there's 0:18:16.040 --> 0:18:20.000 intentionally infecting children with hepatitis at Willowbrook State School on 0:18:20.040 --> 0:18:23.000 Staten Island, New York. There's, of course, said it a 0:18:23.040 --> 0:18:27.040 million times a famous Tuskegee syphilis experiment. Just a few 0:18:27.040 --> 0:18:31.280 episodes ago, I talked about how incarcerated quote unquote volunteers 0:18:31.320 --> 0:18:34.960 were given a slurry containing neurovirus intended to study the 0:18:34.960 --> 0:18:36.280 effects of infection. 0:18:36.720 --> 0:18:37.000 Yep. 0:18:37.359 --> 0:18:41.680 And there are so many more examples out there, examples 0:18:42.000 --> 0:18:46.080 that the Nazi doctors being tried at Nuremberg pointed out 0:18:46.320 --> 0:18:48.920 in their defense in the late nineteen forties, like, hey, 0:18:49.080 --> 0:18:50.760 you guys do this too in the US. 0:18:50.960 --> 0:18:52.119 You do this all the time. 0:18:53.160 --> 0:18:57.760 But the American doctors conducting these experiments saw themselves as different, 0:18:58.400 --> 0:19:01.399 nothing like the Nazis, but no global warriors, doing what 0:19:01.560 --> 0:19:03.959 needed to be done in the name of science and 0:19:04.040 --> 0:19:10.040 giving their test subjects meaning quote from Kligman, okay quote, 0:19:10.320 --> 0:19:12.720 many of the prisoners, for the first time in their 0:19:12.840 --> 0:19:16.920 lives find themselves in the role of important human beings. 0:19:17.400 --> 0:19:20.400 We say to them, you're important, We need you. Once 0:19:20.440 --> 0:19:23.440 this is established, these guys will knock their brains out 0:19:23.440 --> 0:19:26.200 to please you. If the experiment does not pan out, 0:19:26.320 --> 0:19:29.960 they get depressed, they become emotionally involved in the project. 0:19:30.720 --> 0:19:33.480 The capacity to respond to love is greater than most 0:19:33.480 --> 0:19:37.520 people realize. I feel almost like a scoundrel like Machiavelli 0:19:37.680 --> 0:19:39.080 because of what I can do to them. 0:19:39.560 --> 0:19:45.560 End quote. Oh my god, Aaron, I know this guy 0:19:45.760 --> 0:19:48.439 is Okay. I didn't read any history papers, but this 0:19:48.560 --> 0:19:51.600 guy is mentioned in the textbooks and things like that. 0:19:52.359 --> 0:19:53.920 Not like this. 0:19:54.480 --> 0:19:57.520 Right, he is hailed as a modern father of dermatology. 0:19:57.600 --> 0:19:59.800 Yeah, and they'll be like, oh, and the experiments that 0:19:59.800 --> 0:20:04.280 he'd had questionable ethics. This is like he is very 0:20:04.440 --> 0:20:05.920 aware of what he is. 0:20:05.880 --> 0:20:11.240 Doing, right, he is you you know that someone like 0:20:11.320 --> 0:20:15.080 you said that to a resort that yeah, like or 0:20:15.160 --> 0:20:17.879 you wrote that like you You didn't say that like 0:20:17.960 --> 0:20:20.840 at a dinner party with like just your derm friends. 0:20:21.000 --> 0:20:21.119 Right. 0:20:21.200 --> 0:20:24.920 This isn't a private diary, dear diary. I feel like Machiavelli. 0:20:26.720 --> 0:20:27.960 This is like a brag. 0:20:28.200 --> 0:20:30.840 It's like basically the equivalent of a tweet back in 0:20:30.880 --> 0:20:31.560 the day. 0:20:31.720 --> 0:20:32.280 Exactly. 0:20:32.480 --> 0:20:49.479 You can't take you back, No, it's it's there. And 0:20:49.520 --> 0:20:53.080 I think what's like. Kligman is one of the individuals 0:20:53.080 --> 0:20:56.960 that is often put forth as an example, and there 0:20:57.040 --> 0:21:00.639 were some medical ethicists who at the time spoke against 0:21:00.680 --> 0:21:03.679 these experiments, but for the most part, conducting research on 0:21:03.880 --> 0:21:09.800 institutionalized or vulnerable populations was widely accepted, even outside of medicine. 0:21:10.280 --> 0:21:13.720 Right that sentiment that he expressed, maybe minus the Machiavelli part, 0:21:13.880 --> 0:21:18.360 but the whole giving meaning, feeling important, giving back all 0:21:18.400 --> 0:21:22.400 of these things that was in the popular narrative about 0:21:22.520 --> 0:21:27.120 these experiments. So, starting in the mid nineteen fifties, for example, 0:21:27.280 --> 0:21:31.480 Life Magazine ran several stories on Kligman and his experiments 0:21:31.520 --> 0:21:35.720 at Holmesburg, with titles like quote Prisoner's Volunteer to Save 0:21:35.880 --> 0:21:40.640 Lives and Prisoner's Aid Medical Research seventy five percent here 0:21:40.760 --> 0:21:44.480 act as medical guinea pigs or the poison Ivy Picker 0:21:44.520 --> 0:21:48.360 of Penny Pack Park, which that last article detailed Kligman's 0:21:48.400 --> 0:21:51.760 quest to find a vaccine for poison ivy, not mentioning 0:21:51.800 --> 0:21:54.840 the not so mild side effects of the alleged vaccine, 0:21:54.880 --> 0:21:57.640 which caused a drop in blood pressure that made many 0:21:57.680 --> 0:22:00.720 people pass out and also just like having to have 0:22:01.240 --> 0:22:05.960 poison im oils rubbed all over your skin. In a 0:22:06.080 --> 0:22:10.440 nineteen sixty six newspaper article, Kligman did acknowledge to some 0:22:10.560 --> 0:22:15.159 degree the moral issues inherent in his research. Quote we 0:22:15.240 --> 0:22:17.960 had an ethical problem. How much right do you have 0:22:18.040 --> 0:22:20.719 to cause risk to a prisoner in medical tests from 0:22:20.760 --> 0:22:22.360 which he has no direct benefit? 0:22:23.119 --> 0:22:23.720 End quote? 0:22:24.000 --> 0:22:26.520 Seems like a rhetorical question. I don't think he answered it. 0:22:27.119 --> 0:22:30.960 In that same article, the superintendent of Holmesburg reassured readers 0:22:31.000 --> 0:22:34.359 that quote, we will not approve anything which, on the 0:22:34.400 --> 0:22:37.200 face of it, would be deleterious to the physical well 0:22:37.240 --> 0:22:41.359 being of an individual end quote. And that sounds great 0:22:41.920 --> 0:22:45.240 like nice sentiment. But who actually has the power to 0:22:45.280 --> 0:22:49.640 say whether something is deleterious or not? It was largely 0:22:49.760 --> 0:22:54.640 up to one man, Albert Kligman. Let me be clear, though, 0:22:55.160 --> 0:22:58.000 the experiments at Holmesburg Prison are not the work of 0:22:58.119 --> 0:23:01.399 one mad scientist given to my power. This was a 0:23:01.440 --> 0:23:06.520 coordinated effort with many major players involved and ample oversight. 0:23:07.160 --> 0:23:12.120 Pharmaceutical companies like Pfizer, Hoffman, Laroche, Park, Davis Abbott all 0:23:12.280 --> 0:23:17.720 hired researchers to conduct experiments at Holmesburg. Others partnered directly 0:23:17.720 --> 0:23:21.200 with Kligman for years, and this was a University of 0:23:21.320 --> 0:23:26.200 Pennsylvania project. Nor was Holmesburg Prison the only place where 0:23:26.240 --> 0:23:30.200 medical research was unethically conducted, or the University of Pennsylvania 0:23:30.359 --> 0:23:34.119 the only institution that sponsored it. I'm not defending this 0:23:34.280 --> 0:23:36.840