Acres of Skin: The Cost of Scientific Innovation Cynthia Schneider

Acres of Skin: The Cost of Scientifc Innovation

Some of the greatest scientifi c advancements of the last century have been at the expense of ethics. The famous HeLa cells were extracted from an unconsenting African-American woman with cancer, but now polio is almost entirely eradicated. Even a former University of Pennsylvania dermatologist, researcher, and scientifi c pioneer in dermatology, Albert Kligman, performed unethical experiments on African-American prisoners for years. However, these experiments propagated a revolutionary antiaging/acne prescription known as Retin-A.

Retin-A is a commonly used topical prescription medication within a group of chemicals made of vitamin A known as retinoids, including Retin-A and retinol (a slower-acting retinoid for skincare treatment)1. The skincare and the anti-aging industry is a multi-billion dollar industry that relies on the wonders of these products like Retin-A that was discovered by Albert Kligman. Kligman’s 1986 study titled “Topical tretinoin for photoaged skin” detailed how 0.05% topical tretinoin, which is Retin-A, heals sun-damaged and acne-prone skin2. Kligman’s work determined that tretinoin could be used to aid those with damaged skin because of its properties of repairing skin, removing any atypical tissues, forming collagen, increasing newly formed small vessels in the dermis, and reducing precancerous sites2. Kligman mentions multiple times throughout the manuscript the difference in the skin between white and black subjects, which we now understand was the black prisoners used in many of his studies in the 20th century.

His work gave rise to dermatology becoming a more respected and researched scientifi c fi eld. He published over a hundred papers detailing other retinoic acid effects such as acne progression, herpes simplex, the human hair cycle, or simply testing the effects of different products on the skin (shampoos, deodorants, drugs, etc.). This wealth of data Kligman acquired during his time as a researcher transformed the fi eld3. He invented Retin-A, which is still widely regarded as an effective prescription for those with acne, wrinkly skin, or damaged skin (sundamaged, precancerous, etc.).

He conducted most of his infamous experiments at Holmesburg Prison in Philadelphia in what is now known as “The Holmesburg Prison Experiments”. While his contributions to the skincare industry cannot go unnoticed, his data was from prisoners who did not give informed consent, a concept in medical ethics where test subjects are required to have suffi cient information to make a

Written By Cynthia Schneider Designed By Phuong Ngo

decision about participating in a study. Following Kligman and others’ studies, prisoners are now considered a vulnerable and protected group in medical law. Many of his experiments infl icted immense pain on the prisoners. He tested the effects of materials like shampoo, deodorant, drugs, and sometimes radioactive material on the skin of prisoners4. Kligman’s studies irrevocably damaged the prisoners’ skin, leaving them with permanent cysts, lesions, and even resulted in death for some3 .

His dangerous studies were mainly performed on unconsenting African American prisoners. An example of this in his work are his fi ndings on tretinoin’s effect on melanocytes. Kligman did not care for the medical ethics laws of the late 20th century, even going on to say that “things were simpler then. Informed consent was unheard of. No one asked me what I was doing. It was a wonderful time”3 . His incarcerated “volunteers” in his studies were subjects not people to him. When Kligman details his time conducting research in the prison, he said the infamous quote “all I saw before me were acres of skin”3 .

In August of 2021, Penn made a statement about Kligman, removing his name from the prominent Penn Medicine lectureships/professorships due to the dark history of his actions. The university still acknowledges the importance of his work as a clinician and researcher but has worked since 2019 to formulate new action in regard to

Kligman’s legacy at Penn Medicine5. A quote from Penn’s statement acknowledges the ethical implications of Kligman’s discoveries: “Penn Medicine acknowledges that the work done by Dr. Kligman was terribly disrespectful of individuals – many of whom were imprisoned Black men – denying them the autonomy and informed consent which the medical community now considers to be foundational underpinnings for conducting ethical research. Legality, of itself, does not excuse these activities, which are not now, and never were, morally acceptable, even if Dr. Kligman and his contemporaries believed them to be”5 .

The abuse of minorities, specifi cally black and African American people, for scientifi c advancement is common in modern medical history. Henrietta Lacks and Tuskegee syphilis experiments are examples of how researchers, especially in the 20th century, choose science over ethics. Despite the lasting contribution of Kligman’s fi ndings, ethical consideration is essential for the improvement of research—working towards revolutionary change but not at the expense of ethics.

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