The Karabots Fellows Learn the “Draw” of Phlebotomy

Quincy Riley-Greene shares his experience and tools as a phlebotomist with the Karabots Junior Fellows

Recently, the Karabots Junior Fellows learned about phlebotomy. While some people may be squeamish at sight of blood, the practice of drawing blood is an important technique with a variety of applications in medicine.  To take them through the process, our very own Quincy Greene, who is a certified phlebotomist, walked the Fellows through the tools, techniques, and science surrounding drawing blood. Our intern, Kierson was brave enough to volunteer as a test subject for a blood draw. The Fellows asked a lot of questions, including whether Quincy has ever fainted while drawing (he hasn’t, although some of his patients have), and he shared his experience with aplomb.

A Karabots Junior Fellow examines some phlebotomy equipment



The Karabots Junior Fellows Become Eyewitnesses

In their continued quest to learn all there is to know about forensic science, the Karabots Junior Fellows met with Robert Hicks, Director of the Mütter Museum & the Historical Medical Library & William Maul Measey Chair for the History of Medicine at the College of Physicians of Philadelphia (Dr. Hicks frequently appears in informative videos on the Mütter Museum’s YouTube channel and recently was an expert witness in the comedy podcast Judge John Hodgman). One of many facets of a diverse career, Dr. Hicks once served as a police officer and FBI-trained investigator. During his recent session with the Fellows, he walked through the proper procedures for securing a crime scene and interviewing witnesses…

…and that’s when tragedy struck!

A hitherto unknown assailant burst into the Koop classroom to surprise of everyone present. Brandishing a knife and shouting accusations of a torrid affair between her husband and Dr. Hicks, she lunged at our speaker, rained down several blows, and stole away as quickly and as mysteriously as she had arrived. The whole affair lasted roughly seven seconds.

Mütter Museum director Robert Hicks and Curator Anna Dhody stage a mock assault to teach the Karabots Junior Fellows the role of eyewitnesses in forensic investigation

Disclaimer: Dramatization (no one actually got hurt)

Fortunately, the assailant’s blows failed to stifle the indefatigable Robert Hicks, who arose from the ground unharmed in spite of the violent attack on his person. Regaining his composure, he instructed the surprised Fellows, to write down what they saw in an attempt to parse out what happened. Students in turn acted as both eyewitnesses and investigators as they examined the events of the crime, comparing their testimonies to ascertain the order of events, what was said between the attacker and Dr. Hicks, and a physical description of the would-be assassin. Finally, Dr. Hicks had the attacker, revealed to be Mütter Museum curator Anna Dhody, re-enter the room to compare her actual appearance with the description the students provided (it was fairly close).

Robert Hicks compares the Fellows eyewitness description of Anna Dhody, his erstwhile assailant

The students learned three valuable lessons that day: the challenges facing police investigators recreating a crime scene, the subjectivity of eyewitness testimony, and never, ever mess with Anna!

CEPI Curiosities: The Holmesburg Prison Experiments

CEPI Curiosities: Tales from Medical History's Strange Side

Welcome back, fellow historio-medico enthusiasts, to the latest installment of CEPI Curiosities. Past articles have addressed such curious topics as historic forensics, the mental state of Presidential candidates, and graverobbing after graverobbing after graverobbing. This time around, we’re dealing with another important topic: medical experiments on prison inmates.

Aerial image of Holmesburg prison, Philadelphia

Holmesburg opened in 1896 as a prison for the City of Philadelphia. A massive structure with ten cellblocks, the prison’s radial design was based on that of Philadelphia’s Eastern State Penitentiary. Holmesburg still stands today; however, it has not served as an active prison since 1995 and is largely a ruin. Between 1951 and 1974, the facility was the site of a series of medical testing programs that would later become the subject of intense controversy, as the medical tests involved experiments conducted upon the inmates themselves.

Enter Albert Kligman. In 1951, Dr. Kligman was a professor of dermatology at the University of Pennsylvania Medical School. He went on to be a leader in his field; he later served as the President of the Philadelphia Dermatological Society (1975-76) and the President for the Society for Investigative Dermatology (1977-78) and earned a Distinguished Achievement Medal for his contributions to dermatology from the College of Physicians of Philadelphia (where he was also a Fellow) in 2003. He is also the creator of Retin-A, also known as tretinoin, a topical medicine of his own design now used as acne cream and anti-aging treatment. According to one account, the accomplished dermatologist came to Holmesburg in 1951 to help treat an outbreak of athlete’s foot among the inmates.

Albert Kligman in 1955. Image Source: National Library of Medicine; used under Fair Use

Albert Kligman in 1955. Image Source: National Library of Medicine; used under Fair Use

In his eyes, he came across something much more valuable in the Northeast Philadelphia correctional facility than itchy, burning feet: a treasure trove of potential test subjects. “All I saw before me were acres of skin,” Kligman later told a Philadelphia newspaper reporter, “It was like a farmer seeing a field for the first time.” Kligman certainly found fertile soil in the Holmesburg inmates, a predominantly poor, African American population. Kligman and his associates convinced the prisoners to opt into medical experiments in exchange for small stipends. The facilitators of the experiments reassured them there were no hazardous materials or risk of long-term effects and hundreds of inmates served as test subjects over the next twenty years.

Under Kligman’s supervision, tests focused on the effects of various additives on human skin. These included medicated skin creams for treating various ailments, such as ringworm, herpes simplex, and herpes zoster and bacteria staphylococcus aureus (Staph infection). Other tests exposed prisoners to to biological agents, such as dioxin (a toxic chemical used in herbicides and an ingredient in Agent Orange) and hallucinatory drugs (as part of a federal government program known as “Project Often”). Inmates involved in the experiments could be easily identified by patchwork patterns of tape on their backs and arms demarcating the numerous skin tests. The tests continued until 1974, when public outcry prompted the researchers to bring the programs to an end.

Popular accounts during the course of the program were fairly favorable; the use of prisoners for medical testing was a common practice (see also the malaria experiments on inmates at the Statesville Penitentiary in Illinois as a contemporary example) at the time. However, opinion turned against the Holmesburg experiments following public outcry over the “Tuskegee Study of Untreated Syphilis in the Negro Male.” Conducted at the Tuskegee Institute in Alabama from 1931 to 1972, the study examined rural sharecroppers from the surrounding area in an experiment on the long-term effects of untreated syphilis on the human body (the effects of which are illustrated by this skull and this wax model from the Mütter Museum collection). The syphilitic patients, predominantly poor African American sharecroppers, were not made aware they suffered from the disease (rather, their condition was described as “bad blood”); all the while scientists monitored the progress of the disease. The program continued even after the development of antibiotics that could combat the disease and did not cease until 1972, when a public backlash ended the program. A lawsuit ensued and the Institute and the federal government reached an out-of-court settlement in 1974 for $10 million. The Tuskegee experiments had long-term consequences, prompting local mistrust in healthcare professionals (in fact, fears over Tuskegee may have played a role in the progression of a tuberculosis outbreak in the region in January 2016).

Skull with Syphilitic Necrotic

Skull with Syphilitic Necrosis, Mütter Museum, 1161.07

Calls for similar compensation for the Holmesburg inmates persisted for many years after the experiments ceased. During the early 1980s, several inmates filed suit against the agencies involved in the experiments, including the City of Philadelphia, the University of Pennsylvania, Dow Chemical, and Kligman himself. One former test subject–Leodus Jones–received a $40,000 settlement from the City of Philadelphia in 1984.

As in the Tuskegee case, the argument over the experiments conducted at Holmesburg revolved around informed consent and whether the volunteers were made properly aware of the risks involved in participating. Informed consent is an important issue, especially when it comes to testing experimental drugs, and debates over what it means and who can give consent continue to this day. In the case of the Holmesburg inmates, Kligman asserted his experiments followed the proper procedures and emphasized the medical benefits yielded from his research. According to a statement he issued in 1998:

As I have stated repeatedly in the past whenever this issue has arisen, my use of paid prisoners as research subjects in the 1950s and 1960s was in keeping with this nation’s standard protocol for conducting scientific investigations at that time.

To the best of my knowledge, the result of those experiments advanced our knowledge of the pathogenesis of skin disease, and no long-term harm was done to any person who voluntarily participated in the research program.

Meanwhile, the former inmates argued they had not be made fully aware of the risks. As Jones stated during a protest that same year:

These tests were unfair; they were barbaric…We were lied to; we were used and were exploited. We were human guinea pigs.

There have also been those who have argued that by their status as incarcerated individuals that prisoners cannot make a fully informed consent because, as people legally deprived of certain rights, they are subject to institutional coercion (there are studies arguing for or against inmate medical volunteers as being coerced). The issue a thorny legal and ethical discussion.

The debate over informed consent return to prominence in the the late 1990s when Allen Hornblum, a professor of criminal justice at Temple University, published Acres of Skin, a detailed history of the experiments. Hornblum’s first encounter with the Holmesburg inmates was while teaching an adult literacy course at the prison in the early 1970s. Naming his book after Kligman’s infamous comments, Hornblum documented the experiments through prison records, declassified government papers, and inmate accounts. The shocking accounts depicted in Acres of Skin triggered renewed outrage. In 1998, Jones and several other former inmates staged protests outside of the University of Pennsylvania Hospital. On October 29, 2003, ten former Holmesburg inmates, along with Jones armed with a megaphone, staged a protest on 22nd Street, just outside the College of Physicians of Philadelphia, while Kligman accepted his Distinguished Achievement Award.

Protests led to legal action. On October 17, 2000, nearly three hundred former inmates filed suit against Kligman, the University of Pennsylvania, Dow Chemical, Johnson & Johnson, Ivy Research Laboratories, and the City of Philadelphia, citing mistreatment, exploitation, and lack of disclosure over the severity of the tests. Some argued they had suffered long-term illnesses as a result of the experiments. The suit demanded financial compensation and free medical care to any inmates who had served as test subjects. However, in 2002 a federal court ruled the statute of limitations had passed and dismissed the case.

The question of whether incarcerated individuals should be used as test subjects in medical experiments has been a subject of intense debate. Regardless of where one stands on the issue, the Holmesburg prison experiments have become a textbook case addressing ethics and informed consent in medical testing and shaped how we view the issue of medical research on prisoners today.

Until next time, catch you on the strange side.


The Karabots Junior Fellows Ask Questions About Justice and Prisons

Daytime facade of Eastern State Penitentiary

Image Source: Eastern State Penitentiary Historic Site

As part of their year-long focus on forensic science, the Karabots Junior Fellows have been exposed to issues related to the larger criminal justice system, of which forensics comprises a small part. This week the Fellows learned about American prisons and the complex political issue that is mass incarceration. On Saturday, May 21, they along with students from the Teva Pharmaceuticals Internship Program will be making a visit to Eastern State Penitentiary to view the historic site and its new exhibit on the impact of prisons in America.

Eastern State Penitentiary opened in 1829 as an ambitious new approach to criminal justice. The prison operated on the idea of rehabilitating inmates to inspire “penitence,” or deep regret (hence the word “penitentiary”, of which ESP was the first). While at Eastern State, they will take a tour of the building’s history, explore the cellblocks, and learn about the role prisons play in America today.

Lauren Zalut, Director of Education at Eastern State Penitentiary, works with the Karabots Junior Fellows to find a definition of "justice"

In preparation for their visit to the Penitentiary, the Karabots Junior Fellows met with Lauren Zalut, Director of Education and Tour Programs for Eastern State Penitentiary Historic Site. In keeping with the site’s focus on discussion-based programming, Lauren offered a deceptively simple question for the Fellows to ponder: “What is justice?” The Fellows went around the room, with each offering their own definition and addressing topics such as fairness, civil rights, retribution, and social injustice.

One of the Karabots Junior Fellows shares his opinion of justice and prisons

Lauren then had the Fellows divide into pairs and share with each other the first time they had ever encountered injustice. Each student then shared personal stories of their encounters with injustice, from violence, to discrimination, to racial profiling. In doing so, Lauren challenged the Fellows to consider the economic, social, political, and racial factors that have contributed to the United States having the world’s largest prison population (the US currently has roughly 2.2 million people in prison and houses roughly 25% of the world’s prisoners). Finally, she had them write on a note card one subject they hope to learn more about during their visit. We will see how many new facts about prisons and the criminal justice system they learn when they visit this weekend.

The Karabots Junior Fellows examine cards on which they have written what they want to learn during their upcoming trip to Eastern State Penitentiary

The Karabots Junior Fellows Test The Pox Hunter

Much of the curriculum of the current cohort of the Karabots Junior Fellows Program has revolved around games, from using games to teach our fellows about STEM concepts such as the spread of disease, crime scene investigation, and the Scientific Method to our Fellows designing their own forensic science-themed games. Recently, our Fellows got the chance to flex their game development muscles by acting as play testers for a computer game about vaccines.

The Karabots Junior Fellows test The Pox Hunter, a game about vaccination

The Fellows met with John Theibault who is part of a development team designing a game centered around public health and vaccination. The Pox Hunter puts players in the role of a physician in early 1800s Philadelphia whose goal is to convince people in the city to receive smallpox vaccinations in order to curtail a potentially deadly outbreak. The player pleads their case using different conversation tactics, such as empathy, reason, and intimidation, to convince a variety of characters representing different racial and socioeconomic groups throughout the city. Working individually or in pairs, the Fellows played through the game and offered their feedback. Drawing upon their experience developing and playtesting their own game prototypes, the Fellows shared what they felt were the game’s strengths and weaknesses and offered recommendations for what they would like to see in the final completed version.

The Karabots Junior Fellows navigate The Pox Hunter, a vaccination theme game currently in development

While The Pox Hunter is still in development, if you are interested in using games to learn more about vaccines, feel free to check out Illsville: Fight the Disease, an interactive activity that explores the evolution of vaccination developed by The College of Physicians of Philadelphia.

The Karabots Junior Fellows Untangle Common Threads and Meet their Mentors

The Karabots Junior Fellows take part in "Speed dating" with your medical professionals who will serve as mentors

As part of the program, the Karabots Junior Fellows are paired with a local health professional who serves as a mentor, providing advice and guidance through the Fellows’ high school years and beyond. Recently CEPI hosted a meet-and-greet where the Fellows had the chance to meet with our pool of energetic young professionals who have volunteered their time to serve as mentors. Together, they and the Fellows participated in a variety of icebreakers and team-building activities to better get to know one another and find mentors who will be a good fit for our Fellows.

The Karabots Junior Fellows work with aspiring mentors to untangle a human knot

The activities focused around the theme of string. First, they broke into small groups to discover a “common thread” between them, something about them which everyone in the group had in common. They then put their camaraderie to the test by working together to form and untangle a human knot. After our string-themed activities the mentors and Fellows took part in some “speed dating,” sitting across from each other and holding 30-60 second conversations to get to know each other.

We are extremely thankful for all the potential mentors who volunteered to help us make a difference for these promising students.


The Karabots Junior Fellows Become Game Developers

The Karabots Junior Fellows work in teams to develop forensic science-themed tabletop games

The current cohort of the Karabots Junior Fellows Program has had a great deal of exposure to both forensic science and the use of games in the classroom. Their exploits throughout the year have involved studying diverse fields of forensics, including forensic anthropology, document analysis, and even lie detection. They have used games to learn about the Scientific Method, crime scene investigation, and the basic principles of computer coding. As part of their year-long project, it is their goal to bring the worlds of gaming and forensics together by designing their own forensic science-themed tabletop games.

Over the last few months, they have been responsible for breaking into teams (called Houses) to plan and design their own games. They have been given complete creative freedom to shape their games however they like, with each House deciding the theme, tone, mechanics, rules, and objectives. Their only restriction placed on them is that the game must involve some aspect of forensic science.

A list of challenges for the Karabots Junior Fellows' Houses to complete while designing their own games

Recently, the Fellows took a big step in bringing their visions to life. In a recent session, Mr. Kevin issued a major challenge to the Houses with a significant amount of House Points on the line (each semester, the House with the most points earns a prize). The challenge: complete and play test their first prototype, and share their games with other Houses. Each House assembled, and set to work.

Students in the Karabots Junior Fellows Program discuss their forensics-themed game

The Houses worked feverishly to complete all the challenges in the allotted time. In the end, all but one successfully completed their prototype and put them to the test. Along the way, they learned to channel their creativity, to work under deadlines, how to manage successes (and failures) and, most important, how to work together. We look forward to sharing their completed products in the near future!