It was bioethical bow, scrape and grovel time last week in Washington. After learning that public health researchers had deliberately infected about 700 Guatemalans with syphilis between 1946 and 1948, US President Barack Obama had to telephone Guatemalan President Alvaro Colom to apologize. And not only Obama. "Although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health,” declared Secretary of State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius. The consistent theme of American apologies was that in 2010 deceiving and experimenting on vulnerable populations without their consent are unthinkable. “Today the regulations that govern research funded by the United States Government, whether it is conducted domestically or internationally, would prohibit this type of study,” a Department of Health & Human Services fact sheet declared. Perhaps. But ensuring that exploiting poor, uneducated people in distant counties will never happen is more than setting up regulations and paperwork. First of all, we need to understand why it happened. The Guatemala story came to light during archival research by Professor Susan M. Reverby, of Wellesley College, near Boston. In the 1940s American public health officials wanted to know whether the new miracle drug penicillin could prevent sexually transmitted diseases as well as cure them. After doing some research on American prisoners, they went offshore to Guatemala. There, in exchange for medical supplies, Guatemalan authorities gave them access to research subjects. The American in charge was John C. Cutler, a Public Health Service physician. Five years after graduating from medical school he had been put in charge of the two-year-long Guatemala project. His wife accompanied him and helped to document the results. Cutler first experimented on inmates of the Guatemala National Penitentiary, then on men in an army barracks, and then on men and women in the National Mental Health Hospital. In all 696 subjects were infected. Permissions were gained from government authorities but not from individuals -- not an uncommon practice at the time. Initially the doctors used prostitutes with the disease to pass it to the prisoners (since sexual visits were legal in Guatemalan prisons). When so-called “normal exposure” did not infect people, they did direct inoculations. Solutions of syphilis bacteria were then poured onto abrasions on the men’s penises, forearms or faces. In some cases they used spinal punctures. If the subjects contracted syphilis, they were given penicillin. Dr Reverby is not sure whether everyone was cured. In any case, not everyone received what was even then considered adequate treatment. The results were never published. Even by the standards of the time, the research was regarded as ethically suspect and it was carried out with great discretion. After all, only a few months before, Nazi doctors had been condemned to death and long prison terms for conducting dangerous experiments on men and women without their informed consent. Dr Cutler had no qualms. Others were more squeamish. According to Dr Reverby, Cutler’s superior wrote, “I am a bit, in fact more than a bit, leery of the experiment with the insane people. They can not give consent, do not know what is going on, and if some goody organization got wind of the work, they would raise a lot of smoke.” But he did not stop Cutler’s work.When the US Surgeon General, Thomas Parran, was told of the project, he observed, “You know, we couldn’t do such an experiment in this country.” But he did not stop Culter’s work either. In fact, according to a doctor cited by Dr Reverby, his observation was delivered with a “merry twinkle”. In 1948 Cutler returned to the US. There he continued his research into sexually-transmitted disease and became involved in yet another scandalous violation of human rights -- this time on Americans. He was a key figure in the infamous Tuskegee syphilis experiment. Hundreds of Southern African-American men with late stage syphilis were left untreated and deceived about their disease. In fact, Cutler remained one of staunchest defenders of the Tuskegee experiment. So the real question is not why Guatemala happened, but why was such an eminent doctor so hard-hearted, so indifferent to human rights, when it came to investigating human sexuality? He was not the only villain. A similar abuse happened in 1956 when scientists conducted trials of the contraceptive pill in Puerto Rico. They ignored side effects and failed to investigate the deaths of three women. One clue might be Cutler’s views on sexuality. Apart from his expertise in STDs, he was also a strong supporter of population control His wife Eleise served on the board of Planned Parenthood. He took a very pragmatic view of sexuality. In 1988 he commented on the AIDS crisis. "The control of AIDS will come only when there's a shift from a preachy, moral approach to a medical viewpoint," he said. Does this sound familiar? It is exactly the view taken by Hillary Clinton and the State Department on family planning and AIDS. Ethical consideration are a nuisance compared to the urgency of the task. AIDS has to be combated with truckloads of condoms rather than abstinence and stable monogamous marriages. Is it too much to conclude that American health experts haven’t really learned much? Sixty years after the deplorable abuses in Guatemala, and then in Puerto Rico and Tuskegee, they lack a holistic, humanistic view of sexuality. They are still focusing on technology and belittling ethical consideration. With such assumptions, abuses will inevitably occur. In fact, they are still happening in Guatemala. This impoverished country, which has long been a centre for international adoptions, is now being exploited as a hub for surrogate mothers. Karen Smith Rotabi, of Virginia Commonwealth University, observed recently in the reproductive health blog RH Reality Check that “As adoption has become more difficult, the global surrogacy industry has begun to surge to meet the fertility demands of individuals and couples seeking to secure healthy infants.” A Miami-based company called Advocates for Surrogacy catering for gay and lesbian couples is advertising Guatemala as an excellent source of cheap babies. It describes its program as “A Great Opportunity for Surrogates” who are “extraordinary women who bring to you the gift of life”. Different words, but the same tune of exploitation of poverty and ignorance. If Hillary Clinton is truly remorseful about abuses in Guatemala in 1946, she ought to put an end to abuses which are happening here and now.Michael Cook is editor of MercatorNet.