This Researcher Exploited Prisoners, Children, and the Elderly. Why Does Penn Honor Him?

“An outstanding clinician, researcher, and educator.” “A visionary leader” who led “an extraordinary life.” That’s how the University of Pennsylvania describes Albert M. Kligman on a fund-raising page for a lectureship in his name. He is also honored by not one but two chaired professorships.

What the university calls his “pioneering work with Retin-A” was estimated by a student turned critic of Kligman, Bernard Ackerman, as generating in the “many tens of millions.” Kligman himself once described to a television interviewer the sales of the acne medicine as an “explosion … a very considerable sum of money that comes to our department in the form of royalties. We are swimming in cash.”

What the university sites don’t mention is how Retin-A and Renova, an anti-wrinkle variation of the retinoic acid compound, were derived from substances first experimentally applied by Kligman’s research team to the skin of inmates at Holmesburg Prison, then a large facility in Philadelphia. From the 1950s into the 1970s, the prison served as Kligman’s “Kmart of human experimentation,” in the words of Allen M. Hornblum, an author who exhaustively documented the Penn researcher’s projects at Holmesburg in his books Acres of Skin (1998) and Sentenced to Science: One Black Man’s Story of Imprisonment in America (2007).

Colleges are questioning the morality of accepting research funds from Jeffrey Epstein, who was accused of sexually molesting young girls, and the Sacklers, makers of OxyContin. They are searching their souls over institutional ties to slavery and Jim Crow-era exploitation. Hornblum and others have asked for decades whether Penn should be honoring Kligman, and Hornblum and Yusef Anthony, the former inmate whose story Hornblum tells in Sentenced to Science, will ask again in a lecture at Princeton next month. The current ethical climate amplifies their question.

“It just pisses me off to no end,” says Hornblum. Penn is the largest private employer in Philadelphia and has one of the top bioethics programs in the country, he says. The university’s president, Amy Gutmann, and a Penn colleague, the bioethicist Jonathan D. Moreno, recently published a book on bioethics and health care. “They are advising the world on all of these different issues,” Hornblum says, “but they don’t know what’s going on on their own campus? They don’t know it’s wrong?”

Penn says it “regrets the manner in which this research was conducted” and emphasizes the university’s commitment to research ethics. But it has given no indication that it plans to take any action regarding the lectureship or the university’s portrayal of Kligman.

Kligman, who died in 2010, defended his work by saying that experiments on prisoners were common at the time, and he was right. But, Hornblum says, the scale and duration of the Holmesburg experiments stood out even then.

Besides, the argument that others were doing it is a feeble excuse for unforgivable practices, says David Egilman, a clinical professor of family medicine at Brown University and a consultant against corrupt government and corporate practices in public health.

“My view,” he says, “is that the university should apologize, and of course they should stop praising the man and honoring his memory. … It’s really pretty simple.” The experiments Kligman performed were “known to be unethical because of the Nuremberg Code,” Egilman says. “And, excuse me, you don’t need the Nuremberg Code to know that you don’t put acid on the back of somebody.”

Anthony, now 76, was a nonviolent drug addict and thief who was in and out of the Philadelphia penal system for years. Of Kligman, he says in a phone interview, “He was a monster. He didn’t see us as human beings.”

“They referred to him as Frankenstein — all the suffering that we went through,” Anthony says. The prestige accorded Kligman’s legacy “makes me feel bad because of the suffering I’ve seen within the institution and the suffering I’ve been through myself. … I don’t think he should be held with such honor after the damage he’s done to so many people.”

Since 1964, when as a Holmesburg prisoner Anthony underwent the first of several experiments, “my whole life has been on sick call,” he says.

Carcinogens, Viruses, Acids, Fungi

The experiments, prisoners were assured, would do no harm. They were called simple cosmetic, soap, or shampoo tests, and the inmates would make a little money for bail, to send to their families, or to spend at the commissary.

But at least some of the substances Kligman’s team applied to Anthony’s skin gave him an immediate toxic taste in his mouth, and caused excruciating burning and then bodywide pustules. In later years he experienced recurrent rashes and pustules and monstrous infected swelling of his extremities, on the scale of elephantiasis.

“My hands got big as eight-ounce boxing gloves,” Anthony recalls of the first such instance. “My fingernails got like claws.” His feet, usually size 11, would not fit fully into size-14 shoes, and his extremities smelled like death. The hospital had to carve away half-inch-thick slabs of the rancid flesh from his hands and feet.

Regimens of 21 “diet pills” a day and “milkshakes” that Kligman’s crew gave Anthony blocked his gastrointestinal tract, leading to hellish rectal surgery and a lifetime of digestive problems.

Those experiments made him think he was going to die, he says. But it was the little paper cup of psychotropic formula administered by the U.S. Army, at Kligman’s invitation, that made Anthony want to die. A single dose spurred weeks of intense hallucinations and paranoia.

What exactly were the substances that did those things to him? Anthony doesn’t know precisely, but Hornblum later determined that Kligman had done hundreds of experiments for more than 30 pharmaceutical, cosmetic, and other companies as well as the U.S. Army, experiments that generated millions of dollars in revenue.

The Holmesburg prisoners — like Anthony, mostly black and functionally illiterate — were subjected to dioxin, a powerful carcinogen, and other chemical-warfare agents as well as viruses, acids, and fungi. They walked half-naked around the prison with bandages criss-crossing them and tin cups attached to their foreheads or below their genitals to collect discharges and sweat. They were injected with radioactive isotopes. Their fingernails were extracted. Their organs were biopsied. They were locked in padded trailers, brought to the center of the prison exclusively for the purpose, to wrestle with the invisible specters their minds conjured during the psychotropic tests.

In the wake of those tortures, the prisoners were left to suffer the aftereffects on their own. Subsequent medical care was sloppy or nonexistent. Many of those administering the tests were prisoners themselves, dressed in white lab coats.

Kligman largely delegated the day-to-day testing to the prisoners, medical residents, and other staff members. He dropped by Holmesburg himself only rarely, but he made an impression. Sometimes he arrived by helicopter or in riding breeches after some equestrian recreation. He was a charming man, friends, colleagues, and protégés said, a former college and high-school gymnast who could walk on his hands until his 50s. He played tennis and flew airplanes.

But he didn’t charm everyone. The U.S. Food and Drug Administration was once so put off by his sloppy methodology and recordkeeping that it suspended his authority to perform prison experiments. Dow Chemical terminated a contract with him because he was vastly overdosing his research subjects.

Colleagues discovered that he had listed them as advisers on experiments with radioactive materials despite not consulting them or informing them that they had an ostensible role in the work. One said that Kligman “was operating nuclear chemicals without the proper credentials or training. The whole damn thing was a fraud.”

In addition to his experiments on prisoners, he sought subjects to test whether testosterone would accelerate hair growth, and found them among the indigent elderly at Philadelphia’s Riverview Home for the Aged, where a protégé was the medical director. Editors of the Journal of the American Medical Association were alarmed by the hair-growth findings (which turned out to be false; Kligman blamed the subjects for inaccurate reporting), and warned readers that such testosterone treatment risked imbuing male characteristics in women and their offspring, testicular atrophy, prostate hypertrophy, and cancers, among other possible side effects.

Kligman also experimented on mentally handicapped children who had been institutionalized at facilities in New Jersey. A colleague, Hornblum writes, described how Kligman “‘encouraged the development of ringworm by rubbing it in’ the abraded scalp of retarded children. Kligman would delight an audience of medical students and residents-in-training by telling them: ‘These kids want attention so bad, if you hit them over the head with a hammer they would love you for it.’”

When he first saw the imprisoned population at Holmesburg, in 1951, he’d been called in as a consultant to help curb an outbreak of athlete’s foot. “All I saw before me,” he later said, “were acres of skin. It was like a farmer seeing a fertile field for the first time.” He described it as “an anthropoid colony, mainly healthy,” under perfect conditions for controlled experiments.

He later recalled for colleagues: “I began to go to the prison regularly, although I had no authorization. It was years before the authorities knew that I was conducting various studies on prisoner volunteers. Things were simpler then. Informed consent was unheard of. No one asked me what I was doing. It was a wonderful time.”

The key, Kligman explained, is that “many of the prisoners, for the first time in their lives, find themselves in the role of important human beings. We say to them, ‘You’re important, we need you.’ Once this is established, these guys will knock their brains out to please you. … The capacity to respond to love is greater than most people realize. I feel almost like a scoundrel — like Machiavelli — because of what I can do to them.”

Finding out what exactly he did to them took a lot of digging and public-record requests by Hornblum because Kligman destroyed all of his experimental data soon after the Holmesburg program closed, in 1974.

Years later, when details of Kligman’s experiments started to emerge, several hundred of the former prisoners filed a lawsuit, but a judge threw it out because the statute of limitations had passed. Two ex-prisoners reached a settlement in separate suits against the city, Penn, Kligman, and Dow Chemical, one disclosing that he’d received $40,000.

Anthony never made more than $30 for his participation in the experiments and was never awarded a cent in court. Like the other inmates, he had signed release forms that he didn’t understand, documents that were described to them as a formality. “Most of us were functionally illiterate,” Anthony says. “They took advantage of that.” Prison jobs like sewing clothes paid maybe 25 cents a day, so “getting on the tests” was an irresistible chance to earn some cash.

As detailed in a city investigation, Kligman’s experiments also fueled a cell-by-cell have-and-have-not class system. Those who had cash, snacks, smokes, or influence as to which prisoners would take part in the less-harrowing of the medical tests exploited that leverage for sex in a rape culture of epidemic proportions.

Grappling With a Grim Legacy

Greg Dober is an instructor in the biomedical-ethics program at the Lake Erie College of Osteopathic Medicine and at the University of Pittsburgh’s Consortium Ethics Program. He, Hornblum, and Judith L. Newman wrote a book about Cold War experiments on children, including Kligman’s. Dober was instrumental in alerting Pitt to new evidence tying a former public-health dean at the university and former U.S. surgeon general, Thomas Parran Jr., to the infamous Tuskegee syphilis study.

Six months later, the university stripped a building of Parran’s name. What was crucial, Dober says, is that the Pitt administration was ready to accept and share shameful historical facts.

“I’m kind of proud of Pitt, what they did,” says Dober. “They blew the whistle on themselves.” With regard to Kligman, Penn doesn’t seem to have that mind-set, he says.

Carl Elliott, a bioethicist at the University of Minnesota-Twin Cities who is writing a book about medical whistle-blowers, says denial and whitewashing are the norm in such cases.

“That’s the typical thing. There’s a rewriting of history, scrubbing by the institution,” he says. “It’s really only exposure and public pressure that gets institutions to change. Sometimes they can be shamed. But even that’s pretty rare.”

If a university wants to reckon with such histories, he says, it can do “all kinds of things,” and teach a lesson in moral responsibility: “Simply say, ‘It was a horrible thing that our faculty members did, and we don’t want to cover it up, we want to learn from it.’”

But don’t count on bioethicists to help set records straight, he warns. “The field of bioethics has been thoroughly captured by academic medicine. … A lot of academic health centers think they can count on their bioethicists to keep quiet if there is a scandal.”

The Society for Investigative Dermatology has awarded several travel fellowships and one lectureship annually in Kligman’s name. “In the course of periodically evaluating all of the society’s awards, a process is underway to reconsider the Kligman awards and a decision will be made,” says the society’s president, Ponciano D. Cruz Jr., a professor at the University of Texas Southwestern Medical Center.

Is Penn similarly rethinking its Kligman honors? In response to The Chronicle’s questions as to whether it would disavow, distance itself from, or in some other way contextualize Kligman’s career in light of his experiments on vulnerable populations, the university issued this statement:

In addition to the significant medical breakthroughs for which he is known, Dr. Kligman, who passed away in 2010 at the age of 93, was involved in research over 40 years ago that would not be acceptable by today’s standards. The University of Pennsylvania has made clear it regrets the manner in which this research was conducted, and we are committed to upholding our responsibility to ensure the protection of participants in human-subjects research. We respectfully operate within a system of strict rules and regulations that are designed to ensure these protections. This process includes the review of proposed research by an Institutional Review Board (IRB) composed of physicians, scientists, ethicists, and community representatives who evaluate the merits of the research from ethical, regulatory, and safety perspectives. Both the regulatory framework and investigators alike appreciate that incarcerated individuals are a vulnerable population requiring additional protections in order to participate in any type of biomedical research. Penn Medicine takes this requirement seriously.

Hornblum asks in response: “What ‘commitment’ has Penn shown regarding medical ethics? They can’t even be truthful regarding Kligman’s tortured approach to medical research. Their online references to him are all sanitized — no mention of his use of vulnerable populations over several decades. What few advances he may have made, and the scores of journal articles he published, were accomplished on the heads, faces, and backs of retarded children, black prisoners, and indigent seniors.

“If they were so committed to do the right thing,” he continues, “they’d tell the truth, establish an ongoing lecture series on troubling aspects of medical research, and reach out to those they may have harmed.”

As for the university’s making clear its regrets, Anthony says, those regrets have never been made clear to him. Not only did he and most of his fellow inmates, most of whom are now dead, receive no monetary compensation from the university, he says, “they haven’t actually made an apology.”

Penn’s statement, Anthony says, doesn’t show Kligman “in the light he really was. What he did to us wasn’t human.”

Alexander C. Kafka is a Chronicle senior editor. Follow him on Twitter @AlexanderKafka, or email him at alexander.kafka@chronicle.com.