Speaker 1: In nineteen seventy and nineteen seventy one, I participated in
Speaker 1: three different types of tests. Two of them, nicknamed the
Speaker 1: patch tests by inmates, dealt with the experimentation of new
Speaker 1: products not yet released to the general public. The first
Speaker 1: patch test was one that tested lotions, creams, skin moisturizers,
Speaker 1: and suntan products. The procedure for these tests was as follows.
Speaker 1: A grid made from thick strips of white hospital tape
Speaker 1: was fixed to the upper portion of an inmate's back shoulders.
Speaker 1: The grid consisted of about twenty squares. In each of
Speaker 1: these squares, a dab of lotion was applied and the
Speaker 1: inmate's back was exposed to different temperatures from a sunlamp.
Speaker 1: The exposure to the sun lamp lasted anywhere from fifteen
Speaker 1: to thirty minutes, after which each square was inspected for
Speaker 1: degree of blistering or other adverse reactions. The grid was
Speaker 1: then covered with a large solid piece of tape to
Speaker 1: prevent tampering by the inmate, and the inmate was returned
Speaker 1: to his cell. This test lasted about thirty days, and
Speaker 1: once a day the the inmate was called back over
Speaker 1: to the lab and exposed to the sun lamp. After
Speaker 1: about five days of the sun lamp, there were sections
Speaker 1: of the skin that were burnt a deep brown and
Speaker 1: the skin started to peel, itch and blister. If a
Speaker 1: certain square became too damaged, it was covered over with
Speaker 1: a permanent piece of tape and the test continued.
Speaker 2: On the grid.
Speaker 1: That sounds awful erin Yeah, it really, it really really is.
Speaker 1: And so that was from William Robb, who was at
Speaker 1: one point in Holmesburg Prison and participated in these experiments
Speaker 1: that will make up a big focus of today's episode.
Speaker 1: And that ultimately was from a book titled Acres of
Speaker 1: Skin by Alan Hornblum.
Speaker 3: Hi, I'm Aaron Welsh and I'm Eron Auman Updike.
Speaker 1: And this is this podcast will kill You.
Speaker 3: And today's episode we are covering one half of a
Speaker 3: big story all about retinoids.
Speaker 4: Yeah.
Speaker 1: You know, sometimes with the topics that we choose, you
Speaker 1: never know where you're going to end up and what
Speaker 1: most story is going to be. Yeah, and this was
Speaker 1: certainly the case for retinoids.
Speaker 4: And you know, we.
Speaker 1: Decided to do that because we were just like, what's
Speaker 1: the deal with retinoids? Yeah, and looking into the history
Speaker 1: of things like retina I found a darker story than
Speaker 1: I anticipated, and the story itself both like the origin
Speaker 1: of retina and the marketing of you know, retinoids in general,
Speaker 1: that is one half of this big story. But I
Speaker 1: also wanted to tell the story of the experiments at
Speaker 1: Holmesburg Prison from the nineteen fifties to the nineteen seventies
Speaker 1: because it's not a very commonly told story of a
Speaker 1: really dark chapter in American medical history.
Speaker 3: Also, I don't think I realized that this story is
Speaker 3: going to take place in the nineteen fifties to nineteen seventies.
Speaker 3: That's like just very depressing, Aaron, Like.
Speaker 4: How recent?
Speaker 3: How recent?
Speaker 1: I mean what Tuskegee was whistleblown in the early nineteen.
Speaker 4: Seventies, I know, Yeah, I know, I know. And then yes,
Speaker 4: so that is.
Speaker 1: What this episode is going to focus, all on the
Speaker 1: history how did retine get to market and a little
Speaker 1: bit more about one of the guys who brought it there. Yeah,
Speaker 1: and then the second episode, which will be your focus
Speaker 1: erin is do retinoids work?
Speaker 3: Right, It's gonna be more light hearted episode than this one.
Speaker 3: So next week we'll get into what retinoids are, how
Speaker 3: they work, do they work, what do we use them for.
Speaker 4: And a big.
Speaker 3: Part what I'm most excited about in that episode will
Speaker 3: be what's the difference between and over the counter retinoid
Speaker 3: and the stuff you get my prescription? And is there one?
Speaker 1: I am? I'm very excited for that because the amount
Speaker 1: of claims that I see both on product but also
Speaker 1: just on the internet in social media and whatnot for
Speaker 1: the magical powers of retinol. I want to know, like,
Speaker 1: are there magical powers it is?
Speaker 3: I mean, it's a supplement's episode two point Oh oh,
Speaker 3: can't wait for It's gonna be so fun.
Speaker 1: But first, but first we have quarantini dime, we sure do.
Speaker 4: What are we drinking this week?
Speaker 2: Aren arin?
Speaker 3: This week we could drink only skin deep skin deep ye.
Speaker 1: And in skin deep appropriately is carrot juice because retinoids
Speaker 1: are derived from vitamin A ultimately, which is found in
Speaker 1: great quantities and carrots.
Speaker 3: Yeah, it's beta carotene, which is like will convert into
Speaker 3: vitamin A in your body. It's a long.
Speaker 4: Story technically speaking.
Speaker 1: And it also has ginger and lemon juice and some
Speaker 1: simple syrup and some vodka and it's a tasty little concoction.
Speaker 4: I might have to play around with the ratios a
Speaker 4: little bit, but.
Speaker 3: It's gonna be fantastic. You can find the full recipe
Speaker 3: for that quarantini and the very healthy and non alcoholic
Speaker 3: Plosi Burita on our website This Podcast will kill You
Speaker 3: dot com and on all of our social media channels too.
Speaker 1: On our website This Podcast will Kill You dot Com.
Speaker 1: There's a lot of things that you can find. You
Speaker 1: can find the sources for each and every one of
Speaker 1: our episodes. You can find transcripts. You can find links
Speaker 1: to our bookshop dot org, affiliate account, links to our
Speaker 1: Goodreads list, links to music by Bloodmobile, links to merch
Speaker 1: links to Patreon. There's a contact us form where you
Speaker 1: can say like, hey, do this episode or hey, uh,
Speaker 1: come talk at our university whatever it is. There's also
Speaker 1: a submit your first hand account form.
Speaker 4: You know it's good safe, check it out.
Speaker 3: Check it out, and if you haven't already, be sure
Speaker 3: to check your podcatcher and make sure that you're subscribed
Speaker 3: to this podcast, which really helps us. And if you
Speaker 3: haven't already left us review, we would sure love it
Speaker 3: if you did. Okay, should we get started, Yes, please
Speaker 3: tell me erin all about how Retine came to be.
Speaker 1: All right, it's a long story, so let's take a
Speaker 1: quick break before we begin. How many of you out
Speaker 1: there listening has in their bathroom cabinet a little bottle
Speaker 1: of serum or a little tube containing retinol or retinoids.
Speaker 4: Too? I have two, I have one.
Speaker 3: Two different kinds.
Speaker 1: And how many of you have been prescribed retinee in
Speaker 1: the past? And you know if it's the end of
Speaker 1: two here one, two of two. But I'm guessing that
Speaker 1: it is a.
Speaker 4: Lot of you out there.
Speaker 1: I haven't used my retinal in a long time because
Speaker 1: it makes me break out. But I bought it because
Speaker 1: I had heard on like commercials, or on tiktoks, or
Speaker 1: like the skincare addiction subreddit that it was great for
Speaker 1: your skin, for preventing fine lines, reducing the signs of aging,
Speaker 1: like all of those things. But beyond the question of
Speaker 1: does it actually do those things is a deeper question
Speaker 1: whose answer reveals the surprisingly dark history behind this ubiquitous
Speaker 1: skincare component. How did we learn about these effects of
Speaker 1: retinoids on the skin in the first place? Lurking beneath
Speaker 1: these claims of anti aging, poor cleansing, and acne prevention
Speaker 1: claims which I know next week you're going to talk
Speaker 1: about like which is their support for, which isn't their
Speaker 1: support for? But behind all of those claims is a
Speaker 1: grim history involving human experimentation on incarcerated individuals, experiments so
Speaker 1: profoundly unethical that they were described as a violation of
Speaker 1: the Nuremberg Code, you know, like the code that was
Speaker 1: developed in nineteen forty seven in response to Nazi doctor
Speaker 1: war trials.
Speaker 3: Ooh, Warren, that's not How have we never heard of this?
Speaker 1: I don't know, because it is commonly mentioned alongside Tuskegee
Speaker 1: syphilis study, alongside the Willowbrook State Schools, alongside the birth
Speaker 1: control pill experiments in Puerto Rico, Like, it's all sort
Speaker 1: of part of it. I had never heard about this
Speaker 1: though in medical ethics class. But maybe it was just
Speaker 1: a long ago that I had forgotten.
Speaker 3: Yeah, or maybe it was just glossed over us, like
Speaker 3: the history prison and like yeah not not no detail
Speaker 3: or something.
Speaker 1: Right, still people devaluing human life because.
Speaker 3: Of yeah, yeah, yeah, okay, I want to learn, right, Okay,
Speaker 3: So what were these experiments for?
Speaker 1: How were they allowed to happen? And who brought them
Speaker 1: to light? So that's the story. That I'm going to
Speaker 1: tell today, and it's not the history of retinoids that
Speaker 1: you're likely to find on a skincare company website, And
Speaker 1: to be fair, retinoids are just one part of the story.
Speaker 1: But I wanted to focus on it today because I
Speaker 1: think it's a crucial part of the history of medical ethics,
Speaker 1: and it's one that, yeah, you don't hear about that often.
Speaker 4: How do highly.
Speaker 1: Educated and credentialed individuals get to a point where they
Speaker 1: feel like they're above the rules, where they lose any
Speaker 1: self awareness that would allow them to see that they
Speaker 1: aren't nobly championing science, but in fact committing atrocities against humans.
Speaker 1: At the heart of this story is Albert Kligman, an
Speaker 1: American dermatologist who has been credited with transforming the field
Speaker 1: of dermatology from a little acknowledged subspecialty to a full
Speaker 1: on giant of industry by the end of the twentieth century.
Speaker 1: As the co inventor of retinee and an advocate for
Speaker 1: its off label uses, Kligman saw the incredible commercial potential
Speaker 1: of dermatology in terms of pharmaceuticals and cosmetics. Cosmaceuticals, but
Speaker 1: that is certainly not his only claim to fame. For
Speaker 1: more than two decades. Between nineteen fifty one and nineteen
Speaker 1: seventy four, Kligman headed a medical research program at Holmesburg
Speaker 1: Prison in Pennsylvania, where he conducted dozens of non therapeutic
Speaker 1: experiments on incarcerated individuals, the majority of which were black.
Speaker 1: Experiments ranged from assessing the efficacy of certain deodorants to
Speaker 1: quantifying the impacts of dioxin exposure. Dioxin, if you haven't
Speaker 1: heard of it before, is a highly carcinogenic substance, like
Speaker 1: it's sometimes called the most carcinogenic substance known. It's the
Speaker 1: stuff an agent orange that makes it super toxic to humans.
Speaker 4: So he tested an on humans.
Speaker 1: What mm hm And although most experiments didn't specify like
Speaker 1: which race he was looking for, you know, this is
Speaker 1: a call for white people, this is a call for
Speaker 1: black people. The riskiest ones were reserved for black individuals only.
Speaker 1: And this is where Retine was born, at Holmesburg Prison.
Speaker 3: But I'm already so mad, Aaron, I don't.
Speaker 4: Think he's just ei. There's so many more pages being angry.
Speaker 3: My face is going to be like that talking about
Speaker 3: when it wrinkles, like I'm gonna have one.
Speaker 1: The brow is going to be too deep for retinoids
Speaker 1: to penetrate.
Speaker 3: This podcast does give me one of those constantly.
Speaker 1: This podcast will give you a froid brow, give you
Speaker 1: a brow dot com worth it.
Speaker 4: Yep.
Speaker 1: But before we get into this the backstory of retine,
Speaker 1: let's first explore how Kligman found Holmsburg, or rather how
Speaker 1: it found him. Kligman's path to dermatology was not a
Speaker 1: straight line. He started off by first getting his PhD
Speaker 1: in botany, studying fungi. At the time, mycology was lumped
Speaker 1: in with botany or like under the botany umbrella. And
Speaker 1: then he went to medical school with a specialization in
Speaker 1: dermatology so he could keep pursuing his interest in fungi
Speaker 1: like those that cause athletes foot a lot of like
Speaker 1: you know, topical conjections.
Speaker 3: Yeah.
Speaker 1: A few years after graduating with his MD, Kligman, who
Speaker 1: was faculty at the University of Pennsylvania, he received a
Speaker 1: phone call from the pharmacist at Holmsburg Prison. The prison
Speaker 1: was dealing with a huge athletes foot problem, which is
Speaker 1: common in large residential facilities, and the pharmacist was at
Speaker 1: his wits end trying to find an effective treatment. And
Speaker 1: in his searches he had stumbled upon a research article
Speaker 1: written by Kligman about athletes foot and so he called
Speaker 1: the doctor for advice. Kligman was like, all right, I'm
Speaker 1: going to see this for myself. So he went to
Speaker 1: the prison to scope out the situation. And when he
Speaker 1: got there, he didn't see an athlete's foot problem, or
Speaker 1: he didn't see that alone. But what he saw instead
Speaker 1: was limitless potential.
Speaker 4: Quote. All I saw.
Speaker 1: Before me were acres of skin. It was like a
Speaker 1: farmer seeing a fertile field for the first time.
Speaker 4: End quote.
Speaker 3: Sorry, you go to a prison, see untold numbers of
Speaker 3: incarcerated individual human beings, and all you see are acres
Speaker 3: of skin.
Speaker 4: Acres of skin. Cool?
Speaker 3: H Great?
Speaker 4: So that stand up guy, I.
Speaker 1: Think gives you a little bit of a sense for
Speaker 1: where his sense of morality was when it came to
Speaker 1: experiments on right humans.
Speaker 3: I mean, it's a lot easier to do stuff if
Speaker 3: you're just doing it on skin. Right, It's just skin.
Speaker 3: It's devoid of humanity.
Speaker 1: I mean, and I think we'll get into this a
Speaker 1: little bit more later, but I think he did see
Speaker 1: beyond skin. But I think that what he saw was
Speaker 1: he was a little bit of the savior right Like
Speaker 1: he was like, Oh, but I am giving them freedom
Speaker 1: from boredom, I'm giving them money, I'm giving them an
Speaker 1: opportunity to learn. I'm giving them an opportunity to give back,
Speaker 1: Like this is a whole yeah, yeah, And so this
Speaker 1: acres of Skin comment is the title of the book
Speaker 1: that where most of this information that I got for
Speaker 1: today's episode comes from. It's a great book. It's by
Speaker 1: Alan Hornblum. It's one of the classic exposes of unethical
Speaker 1: human expert imitation in the US. In Kligman's eyes, Holmesburg
Speaker 1: Prison represented a near perfect study environment, and that's an
Speaker 1: opportunity that rarely, if ever comes along in medicine in
Speaker 1: an institutionalized setting. Holmesburg was not Kligman's first foray, by
Speaker 1: the way, into institutionalized settings. He also went into schools.
Speaker 1: But in all of these institutionalized settings, you could control
Speaker 1: every variable, down to how much sleep your test subjects got,
Speaker 1: what they ate, how much they ate when they ate,
Speaker 1: how much sun they got, when they could shower, how
Speaker 1: often they could shower.
Speaker 4: All of these things.
Speaker 1: You could have complete control over. Plus it was cheap
Speaker 1: to have someone in role in the types of trials
Speaker 1: that he was interested in trying out and testing. You
Speaker 1: would have to pay someone who was not in prison
Speaker 1: lots and lots of money to keep them going to
Speaker 1: be willing to do these things. By comparison, Holmesburg was
Speaker 1: very cheap, and so Kligman wasted no time in setting
Speaker 1: up shop at the prison.
Speaker 4: Quote.
Speaker 1: I began to go to the prison regularly, although I
Speaker 1: had no authorization. It was years before the authorities knew
Speaker 1: that I was conducting various studies on prisoner volunteers. Things
Speaker 1: were simpler then. Informed consent was unheard of. No one
Speaker 1: asked me what I was doing. It was a wonderful
Speaker 1: time end quote. I know, I just can't like, I
Speaker 1: can believe.
Speaker 4: It was a wonderful time.
Speaker 3: It was a informed consent didn't exist. It was a
Speaker 3: wonderful time.
Speaker 4: Yeah.
Speaker 3: Those two sentences cannot go together.
Speaker 4: Yeah.
Speaker 1: And I think the other remarkable thing about this is
Speaker 1: that so I'm not sure like when that quote was
Speaker 1: pulled from but it was later, like years later.
Speaker 3: Right, It's it's obviously him looking back on his time
Speaker 3: doing this, being like this. It was so great, wasn't it.
Speaker 4: Yeah? Cool?
Speaker 1: You know, and he wasn't entirely wrong about things being simpler.
Speaker 1: Then it seems that from my understanding, Kligman didn't do
Speaker 1: anything technically illegal while conducting experiments at Holmesburg.
Speaker 3: Well, I was just trying to remember at what point
Speaker 3: actually IRBs became a thing clearly after this.
Speaker 1: Yeah, I don't remember either. I know that Tuskegee in
Speaker 1: the early seventies kind of was one of the biggest
Speaker 1: wake up calls for you know, he.
Speaker 4: Just slipped it right in there, we need more regulation.
Speaker 1: Yeah. Yeah, But it doesn't mean that Kligman's experiments were ethical.
Speaker 1: It just means that the laws were simply inadequate at
Speaker 1: the time. In the mid twentieth century, non therapeutic medical
Speaker 1: experiments on institutionalized populations were normalized. They really were, especially
Speaker 1: on individuals and prisons, who were seen as expendable and
Speaker 1: also as needing to quote unquote give back to society.
Speaker 1: Prisons were a real popular spot for phase one clinical trials,
Speaker 1: which were intended to test the safety of a drug,
Speaker 1: not necessarily its efficacy. And so I've talked about several
Speaker 1: of these infamous unethical experiments on the podcast before, and
Speaker 1: even mentioned them earlier in this episode. You know there's
Speaker 1: intentionally infecting children with hepatitis at Willowbrook State School on
Speaker 1: Staten Island, New York. There's, of course, said it a
Speaker 1: million times a famous Tuskegee syphilis experiment. Just a few
Speaker 1: episodes ago, I talked about how incarcerated quote unquote volunteers
Speaker 1: were given a slurry containing neurovirus intended to study the
Speaker 1: effects of infection.
Speaker 3: Yep.
Speaker 1: And there are so many more examples out there, examples
Speaker 1: that the Nazi doctors being tried at Nuremberg pointed out
Speaker 1: in their defense in the late nineteen forties, like, hey,
Speaker 1: you guys do this too in the US.
Speaker 4: You do this all the time.
Speaker 1: But the American doctors conducting these experiments saw themselves as different,
Speaker 1: nothing like the Nazis, but no global warriors, doing what
Speaker 1: needed to be done in the name of science and
Speaker 1: giving their test subjects meaning quote from Kligman, okay quote,
Speaker 1: many of the prisoners, for the first time in their
Speaker 1: lives find themselves in the role of important human beings.
Speaker 1: We say to them, you're important, We need you. Once
Speaker 1: this is established, these guys will knock their brains out
Speaker 1: to please you. If the experiment does not pan out,
Speaker 1: they get depressed, they become emotionally involved in the project.
Speaker 1: The capacity to respond to love is greater than most
Speaker 1: people realize. I feel almost like a scoundrel like Machiavelli
Speaker 1: because of what I can do to them.
Speaker 3: End quote. Oh my god, Aaron, I know this guy
Speaker 3: is Okay. I didn't read any history papers, but this
Speaker 3: guy is mentioned in the textbooks and things like that.
Speaker 3: Not like this.
Speaker 1: Right, he is hailed as a modern father of dermatology.
Speaker 3: Yeah, and they'll be like, oh, and the experiments that
Speaker 3: he'd had questionable ethics. This is like he is very
Speaker 3: aware of what he is.
Speaker 1: Doing, right, he is you you know that someone like
Speaker 1: you said that to a resort that yeah, like or
Speaker 1: you wrote that like you You didn't say that like
Speaker 1: at a dinner party with like just your derm friends.
Speaker 4: Right.
Speaker 1: This isn't a private diary, dear diary. I feel like Machiavelli.
Speaker 1: This is like a brag.
Speaker 3: It's like basically the equivalent of a tweet back in
Speaker 3: the day.
Speaker 4: Exactly.
Speaker 1: You can't take you back, No, it's it's there. And
Speaker 1: I think what's like. Kligman is one of the individuals
Speaker 1: that is often put forth as an example, and there
Speaker 1: were some medical ethicists who at the time spoke against
Speaker 1: these experiments, but for the most part, conducting research on
Speaker 1: institutionalized or vulnerable populations was widely accepted, even outside of medicine.
Speaker 1: Right that sentiment that he expressed, maybe minus the Machiavelli part,
Speaker 1: but the whole giving meaning, feeling important, giving back all
Speaker 1: of these things that was in the popular narrative about
Speaker 1: these experiments. So, starting in the mid nineteen fifties, for example,
Speaker 1: Life Magazine ran several stories on Kligman and his experiments
Speaker 1: at Holmesburg, with titles like quote Prisoner's Volunteer to Save
Speaker 1: Lives and Prisoner's Aid Medical Research seventy five percent here
Speaker 1: act as medical guinea pigs or the poison Ivy Picker
Speaker 1: of Penny Pack Park, which that last article detailed Kligman's
Speaker 1: quest to find a vaccine for poison ivy, not mentioning
Speaker 1: the not so mild side effects of the alleged vaccine,
Speaker 1: which caused a drop in blood pressure that made many
Speaker 1: people pass out and also just like having to have
Speaker 1: poison im oils rubbed all over your skin. In a
Speaker 1: nineteen sixty six newspaper article, Kligman did acknowledge to some
Speaker 1: degree the moral issues inherent in his research. Quote we
Speaker 1: had an ethical problem. How much right do you have
Speaker 1: to cause risk to a prisoner in medical tests from
Speaker 1: which he has no direct benefit?
Speaker 2: End quote?
Speaker 4: Seems like a rhetorical question. I don't think he answered it.
Speaker 1: In that same article, the superintendent of Holmesburg reassured readers
Speaker 1: that quote, we will not approve anything which, on the
Speaker 1: face of it, would be deleterious to the physical well
Speaker 1: being of an individual end quote. And that sounds great
Speaker 1: like nice sentiment. But who actually has the power to
Speaker 1: say whether something is deleterious or not? It was largely
Speaker 1: up to one man, Albert Kligman. Let me be clear, though,
Speaker 1: the experiments at Holmesburg Prison are not the work of
Speaker 1: one mad scientist given to my power. This was a
Speaker 1: coordinated effort with many major players involved and ample oversight.
Speaker 1: Pharmaceutical companies like Pfizer, Hoffman, Laroche, Park, Davis Abbott all
Speaker 1: hired researchers to conduct experiments at Holmesburg. Others partnered directly
Speaker 1: with Kligman for years, and this was a University of
Speaker 1: Pennsylvania project. Nor was Holmesburg Prison the only place where
Speaker 1: medical research was unethically conducted, or the University of Pennsylvania
Speaker 1: the only institution that sponsored it. I'm not defending this
Speaker 1: experimentation in any capacity. I just want to put it
Speaker 1: in historical context, like this is not a one.
Speaker 3: Off this which obviously just makes it that much worse.
Speaker 3: It makes it that much for everyone and everywhere.
Speaker 1: Right, this is just one that got more attention because
Speaker 1: there's a full fledged book about it. There are plenty
Speaker 1: more that could be that are book worthy, I am certain, right,
Speaker 1: And so on that note, let's get more into the
Speaker 1: medical research program.
Speaker 4: I'm at Holmesburg Prison.
Speaker 1: What had started out as a small program in nineteen
Speaker 1: fifty one to nineteen fifty two when he first arrived
Speaker 1: to assess the athletes foot problem, had by the early
Speaker 1: nineteen sixties become a full fledged research machine with expensive
Speaker 1: state of the art medical equipment, trailers with monitoring equipment
Speaker 1: and padded cells, and up to ninety percent of all
Speaker 1: individuals who were incarcerated at Holmesburg participating in experiments. So
Speaker 1: there were times when ninety percent of all individuals at
Speaker 1: Holmesburg Prison were involved in one experiment or multiple, which
Speaker 1: was a very common oh my situation, and also like
Speaker 1: not to mention how being involved in multiple different trials
Speaker 1: just scientifically is not great.
Speaker 3: Not great.
Speaker 1: Between nineteen sixty two and nineteen sixty six, only four years,
Speaker 1: one hundred and ninety three studies were conducted at Holmesburg,
Speaker 1: including one hundred and fifty fifty three experimental drugs and
Speaker 1: then more drugs that needed marketing permission and drugs whose
Speaker 1: new uses were tested, so some of these were purely experimental.
Speaker 4: Most of these oh wow.
Speaker 1: The types of experiments were wide ranging, as were the
Speaker 1: financial incentives. To test hand creams you could earn a
Speaker 1: dollar a day, foot powders and deodorants testing could get
Speaker 1: you one hundred dollars a month. One hundred and fifty
Speaker 1: bucks could be yours if you were willing to have
Speaker 1: your finger numbed with novacane and then your fingernail removed
Speaker 1: to see.
Speaker 4: How it would heal. Okay, yep.
Speaker 1: Other experiments included sticking your arm in a sodium laurel
Speaker 1: sulfate solution for one hour each day for fifty five
Speaker 1: days in a row, testing the relationship between chocolate and acne,
Speaker 1: walking around with steel cups drapped to your forehead to
Speaker 1: collect skin cells and perspiration testing anti dandriff shampoo that
Speaker 1: oops major hair fallout, slicing skin on back to try
Speaker 1: to induce a chiloid, Implanting different kinds of gauze or
Speaker 1: even tissue from a cadaver to just look at healing
Speaker 1: and heat and like creams to help your skin heal.
Speaker 1: Applying enormous amounts of fungi to the feet, and being
Speaker 1: forced to keep your boots on continually for a week,
Speaker 1: even overnight to see how bad ringworm infection could get.
Speaker 1: The riskier the test, the higher the potential reward, like
Speaker 1: you could get one thousand to fifteen hundred bucks to
Speaker 1: test out eye drops or hallucinogenic medications, pills that were
Speaker 1: meant to speed up sun tanning but gave people violent
Speaker 1: GI symptoms, Infecting people with pathogens like Staph aureus, candada albacans,
Speaker 1: herpes virus, influenza tests that involved liver biopsies and nearly
Speaker 1: killed seven inmates. I don't know why the liver biopsies
Speaker 1: were needed.
Speaker 3: Why are you doing liver biopsies and what?
Speaker 4: Yep, okay, don't know.
Speaker 1: Radioactive isotope testing exposing people to dioxin and observing the results.
Speaker 4: It's like, what happens? What happens if we do this?
Speaker 1: At one point, the US Army was testing psychoactive or
Speaker 1: mind controlled drugs in those padded cells. I mentioned people
Speaker 1: who used to be at the prison said that you
Speaker 1: could pick out those who were volunteers from those who
Speaker 1: weren't from their checkered backs. Like so from the first
Speaker 1: hand account how I mentioned the skin test, the patch tests.
Speaker 1: So many of those tests left physical and emotional scars,
Speaker 1: extreme sunburns leading to skin discoloration, incisions where the gauze
Speaker 1: was inserted and never quite fully healed, biopsy marks. And
Speaker 1: then you have, like the from the mind control or
Speaker 1: psychoactive drugs, you had flash People would experience flashbacks or
Speaker 1: bad trips years later, personality changes. But what choice did
Speaker 1: People will truly have other jobs at Holmesburg Prison, like
Speaker 1: making shoes, knitting socks and shirts, sewing pants, plumbing. You
Speaker 1: would get fifteen cents a day, It's no contest. Put
Speaker 1: some lotion on your hands. A dollar a day, sure, eyedrops.
Speaker 1: If you need to send money back home, yeah, I
Speaker 1: need to do this. How much choice is there? And
Speaker 1: those that were involved in the experiments would often get
Speaker 1: better treatment, better food, and higher social standing in addition
Speaker 1: to that substantial financial incentive. And a dark side of
Speaker 1: this that was kind of came out later on was
Speaker 1: that the financial disparity between people who participated in the
Speaker 1: trials and those who didn't sometimes led to coercion and
Speaker 1: sexual abuse. The researchers did not mention the health risks
Speaker 1: involved in any experiment, or even what the experiment was testing.
Speaker 1: None of the people who participated remember ever hearing the
Speaker 1: words informed consent.
Speaker 3: Right.
Speaker 4: I mean, even Kligman himself was like, right, didn't exit,
Speaker 4: itn't exist. We didn't do that.
Speaker 1: They remembered signing release forms, but the forms didn't have
Speaker 1: any additional information on them. As the author of Acres
Speaker 1: of Skin, Alan Hornblum puts it, quote, a drowning person
Speaker 1: does not ask penetrating questions about a life raft end quote.
Speaker 1: Even if they had asked questions, would they have gotten
Speaker 1: honest answers. With the large scale of the research program
Speaker 1: at Holmsburg, Kligman couldn't have expected to fly entirely under
Speaker 1: the radar. Even if he were a careful and detail
Speaker 1: oriented researcher, which he was, not he ended trials prematurely.
Speaker 1: There was a lot of evidence of falsified data. He had,
Speaker 1: like I said earlier, people participating in multiple trials like overlapping,
Speaker 1: that were testing different things. He was just kind of like, Oh,
Speaker 1: this looks like it's not where I'm going.
Speaker 4: We're ending the trial.
Speaker 1: Oh, this looks like where it's where I wanted to go.
Speaker 1: We're ending the trial, and saying that this is exactly.
Speaker 4: What I wanted to find.
Speaker 1: And so, sure enough, red flags were thrown up as
Speaker 1: early as the nineteen sixties, which is when it came
Speaker 1: to light that Kligmann was testing DMSO on humans, which
Speaker 1: was a solvent banned from human testing.
Speaker 4: By the FDA.
Speaker 1: Like at that point it had already been banned, and
Speaker 1: so as a result, Francis Kelsey, who you may remember
Speaker 1: from our solidamide episode as the person who was largely
Speaker 1: responsible for preventing the litamite from being marketed in the NAUS,
Speaker 1: she led the charge to disqualify Kligmann from testing new drugs.
Speaker 1: It ended up being temporary, his disqualification, much to the
Speaker 1: relief of the many pharmaceutical companies who loved the Holmesburg
Speaker 1: prison as a cheap way to try out medications, and
Speaker 1: he had a lot of other, like you know, eminent
Speaker 1: dermatologists who wrote in on his behalf like this is unprecedented.
Speaker 1: He has done nothing but good for the dermatology community.
Speaker 3: Blah blah blah.
Speaker 1: This is a this is out of hand. You need
Speaker 1: to let him do the work that he was put
Speaker 1: here on this earth to do.
Speaker 4: Oh wow, yeah, that kind of thing.
Speaker 1: But even though Kligman's disqualification was reversed, the tides had
Speaker 1: begun to turn, not just for Kligmann but for research
Speaker 1: on institutionalized populations in general. Revelations about the Tuskegee Syphlis
Speaker 1: experiment came to light in nineteen seventy two, which marked
Speaker 1: a big shift in attitudes towards medical experiments on vulnerable
Speaker 1: populations and what informed consent truly means? Can there be
Speaker 1: such a thing in prisons? In schools? Can there be
Speaker 1: such a thing? What does voluntary mean? How can you
Speaker 1: tell if someone is volunteering or if there is coercion?
Speaker 1: And this is still very much an ongoing discussion in
Speaker 1: medical ethics. Is it depriving people of an opportunity to
Speaker 1: earn money? Is it something that like, well, then you're
Speaker 1: not giving them the right to make decisions on their
Speaker 1: own behalf. But also, how are those decisions influenced by
Speaker 1: the power dynamics, by the structure of the.
Speaker 3: Power structure and the dynamics. Is it's very difficult to overcome,
Speaker 3: it is, Yeah.
Speaker 1: And all of these conversations really seemed to ramp up,
Speaker 1: of course, in the early nineteen seventies, as more and
Speaker 1: more of these experiments in institutions came to light. Kligman,
Speaker 1: for his part, never seemed to acknowledge that what he
Speaker 1: did was an ethical that he exploited a vulnerable population.
Speaker 1: He saw the work he did as quote unquote quite
Speaker 1: beneficial to all.
Speaker 4: In his mind.
Speaker 1: He gave these individual skills a reprieve from boredom, money, sure,
Speaker 1: but also excitement and a purpose. And when the medical
Speaker 1: experimentation program at Holmesburg was forced to close in nineteen
Speaker 1: seventy four, he ran against its closure quote A very
Speaker 1: good case of the triumph of the do gooders. All
Speaker 1: we did is offer them money for a little piece
Speaker 1: of their skin end quote.
Speaker 3: All these do goods go the gooters. How dare you
Speaker 3: be a do good doctor, ma'am?
Speaker 4: I know right?
Speaker 1: Like, where does this fit into under your hippocratic oath.
Speaker 3: This doctor is not supposed to be a do gooder,
Speaker 3: who is man.
Speaker 1: And that's what's so, that's what's the mental gymnastics where
Speaker 1: he did think he was doing good. Right, this is
Speaker 1: beneficial to all. I don't think that he would ever
Speaker 1: admit that he violated the hippocratic oath. Right right, no
Speaker 1: harm because he did so much good, like the net
Speaker 1: was good.
Speaker 3: It's like the train and the one person versus the
Speaker 3: train and the blah blah blah.
Speaker 1: Yeah, get real, dude, Yeah, get get real, dude. The
Speaker 1: medical experimentation program at Holmesburg did not go quietly into
Speaker 1: the night. There was denial of any wrongdoing. There was
Speaker 1: bargaining that if they improved things, could they still experiment.
Speaker 1: There was outrage, basically all the stages of grief, minus
Speaker 1: perhaps acceptance. Kligman had always seen himself as a maverick.
Speaker 1: He told his students that rules don't apply to genius,
Speaker 1: that they just get in the way of creative minds. Yeah,
Speaker 1: no one could tell him that what he did was
Speaker 1: wrong and have him actually believe it or acknowledge it.
Speaker 1: Even when the lawsuits came out, which were dismissed because
Speaker 1: of statute of limitations.
Speaker 3: Oh God.
Speaker 1: I think there was eventually some settling outside of court,
Speaker 1: although I don't remember the details of it. But even
Speaker 1: when sweeping changes were made to guidelines for obtaining informed
Speaker 1: consent in medical research and research on vulnerable populations, I
Speaker 1: still couldn't admit that what he did was wrong. Even
Speaker 1: when his research at Holmsburg was deemed to be in
Speaker 1: violation of the Nuremberg Code. He seemed to think that
Speaker 1: the ends justified the means.
Speaker 4: Wow, but what exactly were those ends?
Speaker 1: Right? Was it the advancement of science, Was it relieving
Speaker 1: people suffering? Or was it simply making.
Speaker 4: Money, making a buck? That's my guest, Aaron.
Speaker 1: You know, I can't say for certain because I don't
Speaker 1: know him in his head, but given his words and
Speaker 1: actions after Holmesburg, I think that it's pretty clear that
Speaker 1: money was at least a strong motivating factor. And that
Speaker 1: brings me finally to the story of retinee. Retinoids, which
Speaker 1: include retinol and retinee, which is the brand name of Trettonoen,
Speaker 1: are all derivatives of vitamin A, and someday we'll probably
Speaker 1: do an episode just about vitamin A.
Speaker 3: For sure, because we're focusing on and like topical retinoidstadata,
Speaker 3: vitamin as is its own thing.
Speaker 1: There's any of the same thing, But there's definitely plenty
Speaker 1: more to the story of vitamin A. Yeah, And so
Speaker 1: the short story that I'll tell right now is that
Speaker 1: people have used vitamin A for likely thousands of years
Speaker 1: to treat night blindness. Beginning in the twentieth century, people
Speaker 1: grew interested in the other properties of vitamin A and
Speaker 1: other vitamins. It was like that vitamin A day revolution
Speaker 1: that I've talked about many times. And one of the
Speaker 1: things that they noticed was that vitamin A seemed like
Speaker 1: it might be effective in treating acne. In the nineteen forties,
Speaker 1: a researcher named Jonathan Stroumfjord dosed patients with one hundred
Speaker 1: thousand international units of vitamin A every day for a
Speaker 1: minimum of six months injections, right, I think so, yeah,
Speaker 1: And the results were striking. Seventy nine patients were completely
Speaker 1: cured and only three showed no improvement. That's like pretty
Speaker 1: pretty strong, yeahs. Later studies conducted in nineteen sixty two
Speaker 1: by doctor Beer and doctor Stutgen used vitamin A acid
Speaker 1: which I'm assuming is Trettonoen.
Speaker 4: I'm not sure.
Speaker 1: I don't know if it went by the name. Then
Speaker 1: this was administered orally, and they found similar benefits.
Speaker 4: All of these.
Speaker 1: Researchers noted the extreme skin irritation in the early weeks
Speaker 1: of treatment, and one researcher was like, I don't want
Speaker 1: to do any more of these studies because I am
Speaker 1: so alarmed at the strength of this reaction. This can't
Speaker 1: be good for people. But that didn't bother Albert Kligman
Speaker 1: when a UPenn medical resident tried out the vitamin A
Speaker 1: derivative at Holmsburg after reading Beer and Stuttgen's paper quote,
Speaker 1: doctor Kligmann saw that it irritated the skin and asked
Speaker 1: if he could work with it end quote. So he
Speaker 1: like saw the irritation and was like, ooh, green flag right, like.
Speaker 3: Oh, this means it's doing things.
Speaker 4: This means it's doing things.
Speaker 1: By nineteen sixty three, Kligmann had set up human trials
Speaker 1: at Holmsburg exploring the potential uses of the medication, which
Speaker 1: he received free of charge from Hoffman Laroche, who of
Speaker 1: course saw its commercial potential.
Speaker 4: At the prison, Kligman sought.
Speaker 1: To find the right dose, the right delivery system like
Speaker 1: orally or topically, and the right chemical composition of the
Speaker 1: vitamin on the backs and faces of the individuals.
Speaker 4: At Holmsburg.
Speaker 1: He's quoted as saying that early on he experimented with
Speaker 1: quote unquote very high doses of vitamin A. Quote I
Speaker 1: near killed people before I could see a real benefit.
Speaker 1: Every one of them got sick.
Speaker 4: End quote.
Speaker 3: Ah Okay, this kind of just keeps getting worse there,
Speaker 3: and he keeps.
Speaker 1: Getting I know, you're like, surely there's not more to this.
Speaker 4: Oh, trust me, there is. Yeah. Yeah.
Speaker 1: He used doses of one percent vitamin A acid trettonoen,
Speaker 1: which is one one hundred times stronger than the point
Speaker 1: one percent that it became later.
Speaker 3: On one percent. Yeah, oh my, yeah, that's way too strong.
Speaker 4: Uh.
Speaker 1: And unsurprisingly that strong of a dose caused intense irritation
Speaker 1: to the skin, but that that didn't worry Kligmann in
Speaker 1: the slightest. In fact, he took it as a good sign,
Speaker 1: an indication that this drug was working. This trait of
Speaker 1: his to keep pushing push past any obstacle. It earned
Speaker 1: him the admiration of some like a former student who
Speaker 1: said that he quote thought retine would never sell. It
Speaker 1: caused a severe reaction in patience. Their faces became quite
Speaker 1: red and irritated. But Kligmann has the capacity to push
Speaker 1: when others won't. He could see the value of retine
Speaker 1: as possible therapy. Time has shown that it has positive results.
Speaker 1: It's a fantastic drug. He's a genius end quote. Okay,
Speaker 1: And there's no denying that has been incredibly valuable for
Speaker 1: many people. But I think it's important to remember that
Speaker 1: it wasn't Kligman dealing with the irritation. He wasn't pushing himself.
Speaker 1: He was just pushing other people who had no say
Speaker 1: in the matter. More than dioxin, more than radioactive isotopes,
Speaker 1: more than the mind controlled drugs. It was vitamin a
Speaker 1: acid trettonoen that fascinated Kligman the most, and he would
Speaker 1: be rewarded handsomely for it. After switching allegiance from Hoffman
Speaker 1: Laroche to Johnson and Johnson, Kligman helped bring retine to
Speaker 1: the market where it first became available in nineteen seventy one.
Speaker 1: The timing for Kligman could.
Speaker 4: Not have been better.
Speaker 1: The research program at Holmsburg was winding down. It would
Speaker 1: fully close in nineteen seventy four, and Kligman was eager
Speaker 1: to leave that world behind to explore the realm of cosmaceuticals.
Speaker 4: The immediate success.
Speaker 1: Of retine gave Kligman the opportunity to think about not
Speaker 1: just how to study these drugs, but how to market them.
Speaker 1: He believed that retinee held promise beyond just treating acne,
Speaker 1: that it could also reduce signs of aging. Kligman, although
Speaker 1: a lot of literature would have you believe otherwise, didn't
Speaker 1: come up with this on his own. His patients did.
Speaker 1: They told him that after a course of retinee, their
Speaker 1: skin looked younger, they had fewer wrinkles, it seemed to
Speaker 1: be brighter. Kligman didn't believe them initially. Quote I have
Speaker 1: always told students that if you start to believe your patients,
Speaker 1: you're going to end up as a quack. I have
Speaker 1: a doctrine, don't believe patients. So I was a victim
Speaker 1: of my doctrine.
Speaker 4: End quote.
Speaker 3: Aaron, these quotes that cannot be real. I know.
Speaker 1: I'm like, this is a caricature of what the worst like.
Speaker 1: Did he ever study hysteria? I can only imagine, Right, I.
Speaker 3: Have a doctor and don't believe patients. Oh my, this
Speaker 3: guy is so celebrated.
Speaker 1: I cannot I know, don't believe patients. If you believe
Speaker 1: your patients, you're a quack, told students, like he trained students, right.
Speaker 3: Yeah, I'm not trained in dermatology, so I am only
Speaker 3: knowing when I'm reading on papers. So I don't know
Speaker 3: how much they like him in dermatology circles, but like,
Speaker 3: I hope they don't.
Speaker 4: What yeah, yep, so there you go.
Speaker 3: Cool, cool, cool yep.
Speaker 1: I don't know what made him decide to eventually believe
Speaker 1: at least these patients, but in the early nineteen eighties
Speaker 1: he began running experiments to see whether their claims had
Speaker 1: any basis. This time he used animal models, it seems,
Speaker 1: but the reported results were remarkable. A complete transformation, Retinee
Speaker 1: could be the most powerful anti aging drug to hit
Speaker 1: the market. According to Kligman, there was just one problem,
Speaker 1: and it was a big one. Retinee was approved by
Speaker 1: the FDA to treat acne, not as an anti aging product.
Speaker 1: To sell it as an anti aging product, Ortho, a
Speaker 1: subsidiary of Johnson and Johnson that made retine would have
Speaker 1: to get FDA approval for this new use, which meant
Speaker 1: going through all those steps that would take years and
Speaker 1: lots of resources with no guarantee of success. And so
Speaker 1: Kligman proposed a workaround, a propaganda campaign using Ortho sponsored conferences,
Speaker 1: paid for doctors, ads in medical journals, articles in medical journals,
Speaker 1: features in fashion magazines, and testimonials on TV programs to
Speaker 1: promote the anti aging, anti wrinkle properties of retinee. The
Speaker 1: campaign was a major success. In nineteen eighty seven, the
Speaker 1: year before they started spreading the propaganda, six percent of
Speaker 1: retine sales were for off label uses. The following year
Speaker 1: it shot up to sixty five percent. Okay, sales grew
Speaker 1: to around one and a half million dollars each day,
Speaker 1: which is ten times higher than it had been before
Speaker 1: the campaign. Kligman, for his part, was getting paid by
Speaker 1: Ortho for his work as a consultant and enjoying his
Speaker 1: share of the royalties. This massive change in revenue stream
Speaker 1: and in off label uses, of course, drew the attention
Speaker 1: again of the FDA. It was legal for physicians to
Speaker 1: prescribe off label usage of retine for their patients. Like
Speaker 1: if someone came in and was like, I want to
Speaker 1: try this out as an anti wrinkle cream.
Speaker 4: Can you prescribe this for me? Okay, I'm going to
Speaker 4: use it in.
Speaker 1: This way, but it was illegal for a company to
Speaker 1: promote such off label usage. F began an investigation into
Speaker 1: Ortho for off label marketing, and this caught the attention
Speaker 1: of the popular media, who saw the situation as the
Speaker 1: latest example of the sneaky doings of the pharmaceutical industry.
Speaker 1: An article about retine in Money magazine pointed out the following,
Speaker 1: it's a hefty list, but I like it because it
Speaker 1: just have any of these things changed. Number one the
Speaker 1: pharmaceutical industries increasing propensity to bypass clinical physicians and promote
Speaker 1: new prescription drugs directly to consumers through the popular press.
Speaker 3: I mean every single ad on a Hulu yep.
Speaker 1: Number two, major corporate publicity of medical researchers who abandoned
Speaker 1: objectivity for corporate dollars on behalf of new products and
Speaker 1: lavish pr campaigns.
Speaker 3: Every single dermatologist and researcher who has their own skincare
Speaker 3: line now yep, yep.
Speaker 1: Number three, the extremely close relationships between pharmaceutical companies and doctors.
Speaker 3: Weirdly, especially true in dermatology, like very I mean there's
Speaker 3: supposed to be more things in place for that, yeah
Speaker 3: than there are.
Speaker 1: Number four the shallow perusal by the general press of
Speaker 1: pharmaceutical company press releases in the quest for bold headlines.
Speaker 4: Hi.
Speaker 3: Yeah.
Speaker 1: Number five the FDA's underfunded, understaffed administrative situation in the
Speaker 1: face of well organized corporate initiatives and sophisticated publicity techniques.
Speaker 3: Imagine if we funded organizations that are supposed to protect
Speaker 3: the public.
Speaker 4: What a concept.
Speaker 3: Sorry, this was written yesterday or ID know, right, nineteen
Speaker 3: eighty eight, I believe, Yeah, yeah, so that is just
Speaker 3: have things changed.
Speaker 4: I don't think so.
Speaker 1: No, But all of this bad press was not ideal
Speaker 1: for ORTHO, and things were only going to get worse
Speaker 1: because the University of Pennsylvania had caught wind of what
Speaker 1: was going on and sued Kligman for filing a personal
Speaker 1: patent for this new anti aging retine called Renova, effectively
Speaker 1: cutting out UPEN and keeping all the profits between Kligman
Speaker 1: and Johnson and Johnson.
Speaker 3: So sorry. But also because when you said that they
Speaker 3: sued him, I got really excited, like they knew he
Speaker 3: did something wrong. But no, it's just because they weren't
Speaker 3: going to make any money.
Speaker 1: Off.
Speaker 4: You've let us out. Oh goodness me.
Speaker 1: The case was ultimately settled out of court with to
Speaker 1: presumably everyone's satisfaction, but ORTHO still had the FDA to
Speaker 1: contend with, and they were panicking. ORTHO ordered employees to
Speaker 1: start shredding documents, destroying videotapes, hiding any evidence at their
Speaker 1: personal at their employees' houses that they had entirely orchestrated.
Speaker 1: This plan to market retine for off label uses was
Speaker 1: a shredfest.
Speaker 4: I'm not kidding. Isn't this wild?
Speaker 3: They really thought that was gonna work, though, I know, I.
Speaker 4: Know, right every time.
Speaker 1: I don't know how they thought they weren't going to
Speaker 1: get caught. It doesn't make sense.
Speaker 4: And they definitely got caught.
Speaker 3: Yeah.
Speaker 1: In nineteen ninety two, the US government filed criminal charges
Speaker 1: against Johnson and Johnson, but a lot of the requested
Speaker 1: documents that were in those charges had been destroyed, so
Speaker 1: they were also charged with destroying documents. The trial went
Speaker 1: on for two years, and corporate officials were very aware
Speaker 1: that every day that the trial went on, the release
Speaker 1: of retine as an anti wrinkle medication was delayed, and
Speaker 1: so in January nineteen ninety five, they pled guilty to
Speaker 1: unlawfully promoting retine for photoaid and for other unapproved indications.
Speaker 1: To the question of did ORTHO knowingly and correctly persuade
Speaker 1: and attempt to persuade the employees to destroy, mutilate, and
Speaker 1: conceal documents and other objects, they said yes. They also
Speaker 1: answered yes to did Ortho persuade employees to destroy those
Speaker 1: documents quote with the intention to impair the integrity and
Speaker 1: availability of those documents and objects for use in an
Speaker 1: official proceeding end quote? Their guilty plea brought them a
Speaker 1: hefty fine, a total of seven and a half million dollars,
Speaker 1: which is one of the largest ever paid for.
Speaker 4: An FDA violation. Wow at the time.
Speaker 1: Yeah, but to Ortho, to Johnson and Johnson, it may
Speaker 1: have well have been pocket change, right, like they had actually.
Speaker 3: Competed to what they're about to make, Like exactly.
Speaker 1: They had already made millions, untold millions on off label
Speaker 1: well on retinee sales in general, but off label uses,
Speaker 1: and they were about to make a whole lot more
Speaker 1: with Renova. A month after the decision, the FDA approved
Speaker 1: Renova for sale with a caveat on a label quote.
Speaker 1: Renova does not eliminate wrinkles, repair sun damaged skin, reverse photoaging,
Speaker 1: or restore a more youthful or younger dermal histologic pattern.
Speaker 4: End quote.
Speaker 3: Sorry, so it was proved to treat photoaging, but they
Speaker 3: had to say that it doesn't treat.
Speaker 4: Doesn't reverse photoaging.
Speaker 5: Yeah, okay, yeah, histologically histologically okay, I don't know what
Speaker 5: the standard for we'll get you know, evidence was, I guess.
Speaker 3: Yep.
Speaker 1: But it didn't really seem to make a difference in sales, right,
Speaker 1: or at least like I don't know if it did
Speaker 1: having that caveat on there, Because for every skin care
Speaker 1: product that promises eternal youthfulness and a wrinkle free life,
Speaker 1: you'll find diehard supporters, you'll find clinically supported claims.
Speaker 4: And you'll find it next to impossible to actually.
Speaker 1: Get to the bottom of whether or not a product
Speaker 1: works as it's supposed to, all because of the vast
Speaker 1: sums of money to be made obscuring the truth. And
Speaker 1: I know that that's like a very cynical take, and
Speaker 1: I'm sure that there are products out there that work
Speaker 1: or that work for some people, which is why I'm
Speaker 1: really excited for next week's episode, where you'll tell me
Speaker 1: all about the actual data on tretnoen and retinol and
Speaker 1: all of the rest of the retinoids. But before I
Speaker 1: finally wrap this up for good and tell you my
Speaker 1: short list of sources, I want to circle back to
Speaker 1: what I said at the beginning of this history section,
Speaker 1: how we don't think enough about where our knowledge comes
Speaker 1: from and who bore the cost. We know about different
Speaker 1: hepatitis viruses and had an early hepatitis B vaccine in
Speaker 1: part because of the unethical experiments performed by Saul Krugman
Speaker 1: at Willowbrook State School on Staten Island. We know how
Speaker 1: syphilis progresses untreated, in part because of the Tuski Yeesifless study,
Speaker 1: which continued even though treatment was available. We know how
Speaker 1: the birth control pill works in part because Gregory Pinkus
Speaker 1: measured its efficacy by testing it out on women in.
Speaker 4: Puerto Rico who were never told the purpose of the
Speaker 4: pill or.
Speaker 1: Any risks involved. We know about tretton noan as a
Speaker 1: treatment for acne and possibly for wrinkles, in part because
Speaker 1: of the unethical experiments performed by Albert Kligmant at Holmesburd Prison.
Speaker 1: I'm not saying throw out your retinol in protests, but
Speaker 1: just that I think it's so important that we remember
Speaker 1: how we came about this knowledge and all the knowledge
Speaker 1: that we have.
Speaker 3: I feel like it's also what is so often missing
Speaker 3: from all of the discussions about the scientific achievements and advancements,
Speaker 3: like not just current ones, but ones that we don't
Speaker 3: even think that much about. I think for me, I know,
Speaker 3: it's one of my favorite parts of this podcast is
Speaker 3: learning how even though it's usually very depressing and horrific,
Speaker 3: I can always never believe that we didn't already know this,
Speaker 3: like that I didn't learn this in all of the
Speaker 3: training that I've gotten. It's just it's it's so left
Speaker 3: out of the story it.
Speaker 4: Is, and I sometimes wonder why that is.
Speaker 1: Like obviously, in a classroom setting, your time is limited
Speaker 1: and you need to get across this, this and this,
Speaker 1: But is it Do people think that it's a distraction,
Speaker 1: you know, so like for instance, how the Upton Sinclair's
Speaker 1: The Jungle highlighted how gross the meat was instead of
Speaker 1: the worker conditions, Like do people think that it's just
Speaker 1: going to distract from how retinoids help with acne?
Speaker 4: I don't know.
Speaker 3: I think it's bigger. I think it's in partant Maybe
Speaker 3: this is just me like hypothesizing too much or whatever,
Speaker 3: but I think it's also in part like the way
Speaker 3: that we always learn everything in isolation, right, Like we're
Speaker 3: so used to like, well, you have to learn your
Speaker 3: history in a history class, and like, well, you don't
Speaker 3: take a history of medicine class in med school. That's
Speaker 3: not a thing. So you're never getting that then, because
Speaker 3: you learned like what European history or like whatever history
Speaker 3: that you took in college as like a you know,
Speaker 3: general requirement that has nothing to do with the specific
Speaker 3: field that you might be in, and you never might
Speaker 3: learn the history of that field because there, I mean,
Speaker 3: there's just too much to know, the same way there's
Speaker 3: too much science to know, there's too much history to
Speaker 3: know too, so right.
Speaker 1: Yeah, but it is that sort of like that siloed
Speaker 1: nature of education where if you learn about unethical human experiments,
Speaker 1: you're going to learn about it in a medical ethics class,
Speaker 1: right in your ethics class, right, But you're not going
Speaker 1: to learn about it in your dermatology class.
Speaker 3: No. Also, I'm not sure that we even had it
Speaker 3: specific ethics class in med school.
Speaker 1: I think I did in my EPI masters.
Speaker 3: Yeah, I might have had one there, but that's a
Speaker 3: that zine problematic. Yes, certainly, we all just need to learn.
Speaker 3: We need to learn it, we need to learn more
Speaker 3: learn it.
Speaker 1: And speaking of learning it, sources, so I pretty much
Speaker 1: just had one for this episode, which was Acres of
Speaker 1: Skin by Alan Hornblum. I also have a few other
Speaker 1: papers that I'll post that are by Kligman in case
Speaker 1: you are interested in reading, like firsthand how he wrote
Speaker 1: about some of these experiments, and it's really funny. One
Speaker 1: has at the top like this was research was sponsored
Speaker 1: by an unrestricted educational grant from Orthopharmaceuticals, which is least
Speaker 1: it's like you know, at least.
Speaker 3: Easily disclosed and not like in the subfooting.
Speaker 1: It's not in the very very last page after you've
Speaker 1: read it and you're like, are you kidding me? This
Speaker 1: is now like disclosure here? Uh? But yeah, So I
Speaker 1: will post all of those sources and also aarin your
Speaker 1: sources next week we'll go on the same page on
Speaker 1: our website, this podcast will Kill You dot com.
Speaker 3: You can find the list of sources from this episode
Speaker 3: in every single one of our episodes there.
Speaker 4: Check it out.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 3: Thank you to Leona Squilacci and Tom Bryfogel for the
Speaker 3: incredible audio mixing.
Speaker 4: And thank you to everyone at Exactly Right.
Speaker 3: And thank you to you listeners. We hope that you
Speaker 3: enjoyed this episode and are super stoked for next week's episode,
Speaker 3: where we're going to get into what are these writtenoids
Speaker 3: anyways and what is their evidence?
Speaker 1: And a big thank you as always to our wonderful,
Speaker 1: generous patrons.
Speaker 4: We appreciate your support so so so so very much.
Speaker 3: Yesh, we do thank you well.
Speaker 4: Until next time, wash your hands you.
Speaker 3: Feel the animals
Speaker 5: E