“So unless you are Seymour Hersh, who has The New York Times backing him, or some young activists or aspiring journalist who’s willing to work an issue, [thorny issues such as these medical experiments] can fall through the floorboards.”
In 1971 shortly after finishing graduate school, Allen M. Hornblum accepted a position at Philadelphia’s Holmesburg prison to conduct an adult literacy program for inmates. It was there that Mr. Hornblum would come to notice scores of inmates covered with gauze pads. The story of these pads involved a prominent dermatologist at the University of Pennsylvania, who decided that prison inmates represented an affordable market to test experimental skin medications. 23 years later, Mr. Hornblum would leave his position at the Philadelphia Sheriff’s Office to investigate more closely the story of these experiments. The result was his first book, Acres of Skin, released to international shock and acclaim in 1998. It is now considered a classic, foundational work in medical ethics. On July 23rd, Mr. Hornblum joined Merion West‘s Erich Prince to discuss Acres of Skin, his views on the American prison system, and his journey as an investigative writer covering ethical dilemmas.
The first thing I want to ask you about is your career path. Prior to writing Acres of Skin, you held a variety of positions . You were chief of staff at the Philadelphia Sheriff’s Office, you were involved in activism, you taught literacy in prisons. What was your path to trying your hand at authorship and writing Acres of Skin?
I worked in prisons for ten years during the 1970’s. I was in the sheriff’s office in the late 1980’s and early 1990’s. I was on the crime commission during the same time, and I was with the Pennsylvania Prison Society for many years, including the Pennsylvania Commission on Crime and Delinquency. I know a lot of convicts and cops. In addition to that, I’ve sort of made my mark or earned my bones with regard to credibility in the field with Acres of Skin, which really broke new ground concerning the history of how the imprisoned were used for most of the 20th century as subjects for medical experimentation.
Since you started the interview with the book, you know that the introduction opens with me walking into Holmesburg Prison around 1970 and seeing scores and scores of men wrapped and strapped with adhesive tape and medical dressing. I certainly didn’t expect that. The whole experience of going into the prison was shocking.
The prison system is really where we keep society’s flotsam and jetsam, and we keep them in really bad condition. Nobody really gives a damn about that until there’s a riot or loss of life. That experimentation business hit me hard immediately. If there’s anything I want to stress to you is my frustration that—and I won’t say it happens all the time, but very frequently when I give a talk at a university, medical school, or doctors forum—somebody gets up and applauds my effort and wants to thank me for being the only one to recognize the problem. It flatters me, but it also irks me because the real question is: why did so many people for years, in fact, decades, observe it, be involved with it, and never think it was problematic? Why did they not think it was doing some damage or think it was unethical? That is the real question. How can people be part of something or witness something and never respond?
So that’s not an ideal comment on human nature; many people are witnessing something troubling, but they don’t have the gumption to put up their hand and say, “Stop.”
I remember in Hannah Arendt’s Eichmann in Jerusalem there’s this idea that in the SS there was an effort to make sure people who seemed to enjoy doing the work too much were excluded. Rather, the people selected were the ones who seemed to just go along with things and not put up a fuss. There’s the scene, for example, of Eichmann—the first time he gets to a concentration camp—throwing up because he’s so sick to see what’s going on. But, at the same time, he’s someone who follows orders and wants to do the job he’s assigned, regardless of the ethical consequences.
You really can’t compare post-war America to Nazi Germany. But as I do make plain in my book, my articles, and my presentations it was the Americans, not the Russians, not the French, not the British that put the Nazi doctors on trial. It was America. It was our jurists who came up with the Nuremberg Code. But it’s like we left it over there. The Code never arrived on our shores—because at the same time we’re trying the Nazi doctors—we’re doing some horrendous research over here. The Tuskegee Syphilis study is underway and continues for decades. They’re injecting hospital patients with plutonium. There are all sorts of other experiments taking place with children and the mentally retarded and prisoners. It really is very interesting. You could almost make the argument that it was a show trial in Nuremberg because if we were really serious, all of these other unethical experiments would have never taken place.
There seems to be more conversation these days about how we treat prisoners. We see this both from the left and the right. For example, Sen. Rand Paul (R-Ky.) and Sen. Patrick Leahy (D-Vt.) co-sponsored one bill seeking to reform how we approach mandatory sentencing. We had the 2003 Prison Rape Elimination Act. Do you think that attitudes are starting to change towards people who are incarcerated? Is the issue of how we treat prisoners getting more attention today than when you were working in prisons in the 1970’s?
Yes. There has been change. It’s arguable whether it’s dramatic change, but there certainly has been change from when the medical research in prisons was common in the 1950’s into the 1970’s. We don’t allow it to that degree now. Some of it is still occurring, and we really don’t have a handle on it. But it is a fraction of what it was back then. Change is occurring in all facets of the penal system.
I think it was back in the early 1990’s maybe, there were initiatives in Pennsylvania and other states to take troubled kids, and instead of putting them in prison, they were put into boot camps. There was an effort to do that.
There was a recognition by the right that we’re putting more money into incarcerating people rather than educating people, and they’ve got to watch the money and the taxpayers. So there’s been a number of different things occurring that show there’s an evolutionary process in punishment. There’s still obviously a long way to go.
Why should Pfizer or GlaxoSmithKline travel all the way to Africa, South America, or India to do phase-one medical research when we have over two million people in prison here who would volunteer and we could pay a modest sum or release them earlier? So I think that’s a possibility. It hasn’t happened yet, but I’m saying right now I wouldn’t be surprised because it was attempted under President Bush.
In the last years of the Bush administration, he and the IOM, the Institute of Medicine, started holding hearings on the issue. Part of their recommendations was to look at this restriction, and maybe we can do it in a very sane and safe way. I was one of the people that spoke out against it, and a number of other people did as well. The media was quite struck by the whole initiative, and the results of their articles were so negative that the Bush administration dropped it. But there are some people out there in the industry and in the government who think it’s only a natural connection. We’ve got bodies on ice. We need to develop concoctions to fight Zika and other viruses. Why don’t we use the people that are already on a cell block?
I’m one of the few people, I think, who has been on both sides of these thorny criminal justice issues. In some cases, I’m not trusted by cops because they know my history as a prison reformer. In some cases, I’m not trusted by prison reformers because of my association with law enforcement. But I think I am somebody who takes investigating an issue thoroughly, educating myself and then coming to a decision. And I’ll change my decision if the evidence shows that I am wrong.
Very quick example: when I was on the board of trustees of the Philadelphia prison system, there was an effort under the city’s Surgeon General to give prisoners condoms, which everyone on the board found ridiculous. Such an initiative will only encourage sex. We want to end it, not encourage it. I was even quoted in the newspaper as saying the last thing we need is to give a good housekeeping seal of approval to sex in prison. However, I’m not one to clamp onto a position and be resistant to counter-information. So I started reading about it in different venues and in addition to that I visited prisons in Europe.
A lot of people think I’m crazy, but when I go on vacation it’s not unusual for me to spend some time going to prisons. I saw some of these programs and how they worked. And slowly but surely, I changed my position on the issue and realized that such a program can work.
On the subject of what you were saying about Europe, you hear a lot about the Norwegian prison system. There are no life sentences, and there is no death penalty. Cells have televisions and computers, and one well-documented prison allows inmates to fish and go to the adjacent beach. Also, Norway has the lowest re-offending rate in Europe. Do you think that type of model would work here?
I would rather do time in a European prison than an American prison, and you can see the impact of the atmosphere in many different ways. European prisons tend to be less harsh, less brutal, less violent. Inmate gangs are less prevalent; there is less noise, people are better behaved. An interesting observation I made is that we have prisons in America— and I’ve had oversight over them— that were built in the 1950’s and are in worse shape than prisons in England that were built in the 1850’s and 1860’s. Things just fall apart faster here.
Do you think the European model could work here? We talk about the Finnish education system or the Norwegian prisons, but some critics say that these are small, ethnically-homogenous countries of five or six million people. Can we map what they’re doing there onto this massive and diverse country, the United States, of more than 300 million?
I think we can, but it just takes political will. No one has really pushed it. There’s not a strong constituency to do it, and there’s not really very many people who have observed it like I have. I’ve walked into cells in European prisons that were in some cases were more attractive and comfortable than my bedroom. I’ve been in cells, let’s say in Switzerland, where they have rugs on the wall, where they have paintings on the wall, and where they have books. Maybe homey is a stretch, but it’s not when you compare it to let’s say a cell block in Graterford State Penitentiary [in Pennsylvania].
But gradually over time, I’m starting to recognize as I get brighter and more sophisticated that these issues are complex, and part of the problem is to educate the masses about what’s going down. For years, I knew there was a story to the Holmesburg experiments. When you have a dozen doctors in white lab coats with PhD or MD after their name and hundreds and hundreds of unschooled black prisoners, there’s a disparity.
It’s a mismatch in terms of the power dynamic and access to information?
It is a recipe, if not for disaster, at least abuse. And I heard enough stories from inmates that I knew that was occurring. And I also knew that I, and everyone else, was supposed to keep his mouth shut and not inquire about it. So I was greatly encouraged, if not threatened, to stop inquiring about these experiments, but I knew there was a story there. So I’m waiting for years. There’s got to be a journalist, or an academic, somebody to inform the public about this. It became growingly apparent that if I don’t do, it’s not going to happen.
This is what you were saying earlier: that somebody’s got to do it. Somebody has to blow that whistle.
The Tuskegee Syphilis Study went on for 40 years. If Peter Buxtun hadn’t pursued it and finally got the story in the hands of a journalist, then it may have gone on for 50 or 60 years because there were so many people, who should have known better that went along with the scam. So while I was at the Sheriff’s Office, I’m still coming into contact with prisoners, guards, cops, and I never forgot those experiments. So I start asking guys; one thing leads to another. And, in a short time, I’m giving up my job at the Sheriff’s Office and going out on a suicide mission economically to research and write the story of the Holmesburg experiments.
I want to hit this point because it jumped out in your email. It’s a similar discussion I had in my interview with Matt Rainey earlier this summer. He won two Pulitzer Prizes, but he can no longer make a living as a journalist.
You said that your books are not bestsellers at the Jersey Shore this summer. What happens when investigative journalists or authors, like yourself, aren’t rewarded financially for the books you write on subjects such as these? Does this discourage others from pursuing projects like Acres of Skin?
Definitely with regard to long-form journalism and definitely with regard to difficult and complicated issues that are either secret—or people in substantial positions of power are blocking people from getting the information. That takes very dedicated sleuths who will either be paid by the Huffpost or The New York Times to do it—or someone like myself who will throw themselves into a personal crusade.
When I did the Holmesburg stuff, it was a very risky operation. Everybody thought I was crazy. Many people patted me on the back. They thought it was meritorious, but that sort of behavior is very unusual for somebody like me. When I ran the Sheriff’s Office, I had 300 deputies under me, had a gun and a badge, a city car. I parked up on the lip of City Hall, which was very prestigious in the minds of city people. And I gave it up. I was just doing some part-time teaching at Temple. Nobody in their right mind gives up a nice position and money, and I couldn’t get the book published. That is a story in itself.
I have so many instances of agents and publishers basically saying this is a great piece of work, but it’s too hot for us. Harvard Press said this is a great piece of investigatory journalism, but it’s too hot for us. I went to the editor of Penguin. He read it, and said, “This is wonderful, but this is a landmine of legal problems.” I’m taking on one of the more prominent dermatologists in the country. I’m taking on the economic powerhouse in Philadelphia, [the University of Pennsylvania], the largest employer in the city, and publishers were fearful. But I was so wedded to it, and I knew I had a good story.
I tried to tone down my own aggressive style so that would be more acceptable and digestible. There were so many obstacles. I should have given it up and gone back to City Hall where I would have been much better off economically. Who needs to write a book? Who needs to walk into a store and see their book on the shelf? It was one of my goals, but I didn’t have a wife and kids, I didn’t have a mortgage.
I was applauded by a number of fellow city officials who told me that they were envious because they wanted to do that too. But they have so many constraints that they could never go on that kind of crusade. So unless you are Seymour Hersh, who has The New York Times backing him, or some young activists or aspiring journalist who’s willing to work an issue, it can fall through the floorboards.
If there were more articles on this subject, if there were more pieces in the regular newspaper, and if there were more things on YouTube, if there was more interest at the university level, some of these unethical research endeavors never would have happened. But ethics, medical ethics has always, and continues to be, the caboose of the train. For example, I was asked to give a talk at a university, and when I have some time I’ll walk into the school bookstore to see what they have. I’ll go into the medical ethics sections and see what they have.
Guess what. Not only did they not have my book, and I’ve written three on the subject now, but nobody else’s book on medical ethics. And when I asked one of the employees, “Where is your medical ethics section?” she looked at me like I asked for a half pound of provolone. She then leaves and goes to the manager. The manager comes up to me and says, “Can I help you?” and I said that I was just looking for your books on medical ethics. She had no answer. What message is that?
It’s not of importance [to them]. I’ve found that at other schools as well, and that’s a very sad and telling commentary.
Why do you think they don’t carry your book: not wanting to ruffle feathers with higher-ups, disinterest in the subject?
They’re focused on what people go there for. They’re going there to learn orthopedics, they’re going there to learn ophthalmology, and they’re going there to learn the practice of medicine. Ethics is a sideline. Only if they get embarrassed in a newspaper article about somebody being damaged in an experiment will anybody address the issue. And then it’s turned over to the PR people.
Thank you for your time, Mr. Hornblum.
Of course, it’s been nice talking to you.