A crowd of students, professors, and community members gathered in a packed room at St. Joseph’s University on April 26 to hear about “Philadelphia’s lasting shame” from the people who are still living under the pain of it. That shame—the horrific medical experiments conducted by dermatologist Dr. Albert Kligman in Pennsylvania’s Holmesburg Prison for more than 20 years beginning in the 1950s—has received renewed attention in recent years. Yet, much remains to be done to fully redress the experiments’ harm and reckon with their legacy.
Featured on the panel were Irvin Moore, Herbert Rice, and Lavone Miller, all of whom survived the experiments. The panel also included Adrianne Jones-Alston, the daughter of a Holmesburg experiment participant, and Allen Hornblum, a writer and historian who was among the first to extensively research and expose the experiments.
Before sharing his experience during the April 26 panel, Irvin Moore declared slowly and assuredly, “This is the truth.” The assertion is important because, for decades, the story of Holmesburg went ignored in the medical halls that benefited from the experiments’ scientific findings, and until recently, went unacknowledged by the city of Philadelphia and some of its most powerful institutions.
Dr. Kligman may not be a household name today, but the products he developed are staples in the skincare and pharmaceutical industries. Perhaps the most well-known of these is the increasingly popular tretinoin, or Retin-A, a topical medication for acne that is also remarkably effective as an anti-aging treatment. But Kligman’s discoveries came on the backs of scores of incarcerated men—an overwhelming number of whom were Black—detained in Philadelphia’s now-shuttered Holmesburg Prison. Kligman’s development of Retin-A was directly made possible by the tests conducted on men imprisoned at Holmesburg. These men—and the family members to whom they returned upon their release–have maintained over decades that Dr. Kligman’s experimentation was tortuous, unethical, and that it forever changed their lives.
Amidst national conversations about reparations, attention has turned to Holmesburg and those who survived Kligman’s experiments. The St. Joseph’s panel is a part of this new reckoning and served as a space where survivors laid out renewed demands for institutions that allowed for and benefited from Kligman’s experiments, including the University of Pennsylvania. Survivors are also demanding that these institutions meaningfully acknowledge the harm they caused and reconsider whether the scientific community should celebrate Kligman. The enduring harm of the Holmesburg experiments helps us understand why ethical standards for medical experimentation in prisons and jails have shifted, while also triggering larger questions about the risks and benefits of continuing to allow clinical trials in the prison system.
“We didn’t know what was coming home to us”
Moore, who was ultimately incarcerated for over 50 years, first learned of the experiments and the financial opportunities they could provide when he arrived at Holmesburg in 1969. Moore explained that he was driven to participate because of the ethical codes that underpin prison life, which included supporting oneself. Experiments were a straightforward way to purchase commissary items, send funds back home, or raise bail money.
“I signed up for the tests because I wanted to stand on my own two feet,” Moore recalled during the panel.
Unbeknownst to him and the hundreds of other men who participated in the tests were the specifics of what they were being injected and slathered with or made to ingest. Moore explained that he asked test administrators whether the experiments would hurt him and he said he was assured that everything was safe. In hindsight, he says he was “naive enough to believe the powers that be.”
While Holmesburg is most widely associated with the development of Retin-A, many other products and chemicals were tested on incarcerated men at the facility through contracts with pharmaceutical companies and even the U.S. military. For example, both Moore and fellow panelist Herbert Rice—who was incarcerated at Holmesburg for two years—spoke of their participation in what was known as the “milkshake tests.” In one of the more lucrative experiments, the tests required living in an isolated cellblock and only eating a milkshake product (the ingredients of which were unknown to participants) three times a day for six months. While Moore remains unsure of what he was served, he believes that these may have been safety tests of the earliest versions of what are now known as protein shakes. In a 2021 profile written about the Holmesburg experiments, Yusef Anthony, a formerly incarcerated survivor of a handful of tests conducted at the prison, notes that these milkshake tests gave him hemorrhoids that forced him to undergo numerous operations to repair his rectum.
Rice also spoke of experiments that left him scarred both emotionally and physically. He recalled his skin feeling like leather for three to four months after “they put some kind of radiation on my back.” Another set of tests over a four-day observation period required ingesting pills filled with “some type of living organism.” Rice became deeply emotional when recounting the psychological torment he endured long after his incarceration ended. He traces recurring night terrors he experienced for decades back to the experiments he underwent. In the mid-90s, while seeking mental health treatment, doctors didn’t trust his account of the experiments he participated in at Holmesburg.
While the number of living survivors who participated in the Holmesburg experiments has dwindled to just a small handful, the impact of the experiments remains ever-present in the lives of their families and loved ones. Adrianne Jones-Alston’s story perhaps most clearly illustrates how the past is very much present and continues to inform the lives of each subsequent generation. At the forum, Jones-Alston recalled how her life at home dramatically changed when her father, Leodus Jones, returned home. Jones-Alston describes her father as a family man and recounted memories of them enjoying quality time before he was incarcerated, making memories all across Philadelphia. But when he returned home from Holmesburg, he was a different person.
“I didn’t know what to make of it,” Jones-Alston said, “I don’t know why our fun stopped.”
Jones participated in a number of tests at Holmesburg and Jones-Alston and the rest of her family ended up on the receiving end of the consequences long after the clinical trials ended. In addition to the scars and sores that ran down his neck and back, Jones-Alston also noticed that her father lacked the attentiveness he’d once shown. He’d also grown hostile and violent.
“While Kligman was enjoying steak dinner, my father was turning over tables,” Alston-Jones said.
The turbulence of life at home led her to run away as a teenager. Once on the streets, she experienced homelessness, violence, and mental health challenges that ultimately led to her own incarceration and repeated recidivism. Her life came to mirror her father’s troubles in a cycle that can be described as nothing short of generational trauma.
“No one thought about the children or the families of these test subjects,” Jones-Alston said. “We didn’t know what was coming home to us.”
Like a “light going off in a dark room”
When Allen Hornblum first stepped foot inside Holmesburg in 1971, he had recently finished graduate school and intended to run the prison’s educational program. But what he immediately observed inside the facility startled him and would change the trajectory of his life’s work.
“It was that first day walking in the Philly prisons—which consisted of Holmesburg detention center and the House of Correction—that I saw many startling, unexpected things,” Hornblum said in an interview with Prism. “But one of the most outlandish and shocking was scores and scores of inmates dressed in medical tape and adhesive tape —it looked like there had just been a recent riot or a gang war on a cellblock, and I couldn’t get over what had precipitated something like this. The very next day, I asked the guard on a block, ‘What’s the story with all these guys with medical tape?’ He just chuckled and said, ‘Oh, that’s nothing, Mr. Hornblum. That’s just the perfume tests for the University of Pennsylvania.'”
Kligman, a dermatology faculty member at the University of Pennsylvania, was first brought into Holmesburg prison in 1951 at the request of facility administrators who needed help treating an outbreak of athlete’s foot. But rather than a temporary problem, Kligman saw endless opportunity. In a 1966 interview with the Philadelphia Inquirer, Kligman said, “All I saw before me were acres of skin. It was like a farmer seeing a fertile field for the first time.”
Between 1951 and 1974, Kligman led experiments that advanced his own discoveries around skincare, garnered partnerships with major pharmaceutical companies and government agencies, and wreaked havoc on the bodies and minds of incarcerated men at Holmesburg. Study volunteers were given patch tests to monitor their reactions to things like perfume and baby products. Major corporations like Johnson & Johnson contracted with Kligman for tests, including one that required injecting men with asbestos to compare it against the naturally occurring mineral Talc which can contain asbestos. (Johnson & Johnson has long denied as part of lawsuits that its talc-based baby powder contained cancer-causing asbestos. In one case, the company paid $2.5 billion in damages and interest.) Prisoners at Holmesburg were also inoculated with experimental vaccines for viruses and infections, including Candida and herpes simplex, and through tests commissioned by the Dow Chemical Company, were exposed to the poison dioxin, a component of the powerful herbicide Agent Orange.
Decades after he stopped working at Holmesburg, Hornblum remained shocked that the medical experiments he saw were still undocumented and unexposed by historians or the media, so he told the story himself. Hornblum’s 1998 debut novel Acres of Skin revealed to the nation what had gone on in Holmesburg for over 20 years.
“Because I witnessed it and saw it in the flesh—literally—it always impacted me as something that was unethical, immoral, and never should have been broached,” said Hornblum. “What I found out and documented in Acres of Skin is that even though there were other states that allowed this to happen, and many prisons that did experiments, there was nothing like what occurred in the Philadelphia prison system.”
Throughout the 1960s, at least half of state prison systems hosted medical research. By 1972, FDA officials estimated that over 90% of all investigational drugs were first tested on prisoners. However, Kligman’s experiments stood apart due to the length of the tests, their scope, and the lucrative partnerships they attracted–including those with the military and the Central Intelligence Agency (CIA).
“The prison system under different mayoral administrations never should have allowed this to occur,” said Hornblum. “University of Pennsylvania should have never gotten involved with this and should have never allowed their dermatology department and one of their most important dermatologists, to do this. But they all did it—especially Penn—because they were making so much money from it and it benefited them greatly. In fact, it still is. They’re still making money from Retin-A, and Johnson & Johnson is still making money.”
“We deeply regret the conditions under which these studies were conducted, and in no way do they reflect the values or practices we employ today,” a company spokesperson for Johnson & Johnson said in an email to Prism. “Our ethical code is aligned with today’s advanced protocols and the latest ethical guidelines from leading medical institutions. At the time of these studies, nearly 50 years ago, testing of this nature among this cohort set was widely accepted, including by prominent researchers, leading public companies, and the U.S. government itself.”
Prism contacted the University of Pennsylvania for comment and will update the article with their statement when they respond.
While Kligman collected large checks—including $10,000 from Dow Chemical Company for his dioxin experiments—the incarcerated men at Holmesburg at the center of the experiments received in some cases as little as a dollar a day for lending their bodies. The money served as the primary incentive for participating in testing, making medical experimentation in prison highly coercive. Given the dearth of opportunities to earn money in prison and the necessity of funds for commissary items, supporting family back home, or paying bail, presenting these experiments as one of the only ways to earn income erodes all notions of true consent.
In fact, Kligman’s experiments were conducted without full and informed consent. In one example reported by The Philadelphia Inquirer, forms for the dioxin experiment did not mention which chemical was being used or the potential side effects. Further, Kligman failed to keep appropriate records that would allow researchers to track the long-term effects of these substances on participants’ bodies.
Hornblum views the experiments as an “egregious breach” of the Nuremberg Code, a set of ethical research principles drafted in the aftermath of World War II and in direct response to inhumane experiments conducted in Nazi concentration camps by German physicians. While American jurists penned the code, Honblum notes that American physicians “never bothered to buy into it ourselves.” The first principle of the Nuremberg Code, which explains that human subjects must voluntarily offer consent and have the legal capacity to do so, makes clear why Hornblum views medical experimentation inside the prison as inherently unethical.
“When Kligman walked into Holmesburg in 1951, there were certainly rules or attitudes or guidelines giving medical researchers guidelines that they should follow with regard to human experimentation, but the American medical community found them too rigid and detrimental to the goals of doctors, researchers, and pharmaceutical companies,” said Hornblum. “So those guidelines were not stressed, and doctors were comfortable with doing what they wanted and what was consistent with their own research interests.”
These interests, which included product development, fostering partnerships with pharmaceutical companies, or publishing in high-profile medical journals, did not align with considering the welfare of test subjects.
“They had every reason in the world to say, ‘To hell with any guidelines, and I’m going to do what’s going to foster my own pocketbook, my reputation, my career.’ And they did that over and over. What sort of changes the landscape in my view is the Tuskegee syphilis study. When that is illuminated, in 1972, it is sort of like a light going off in a dark room.”
By 1974, Kligman’s research was suspended indefinitely. Hornblum’s work exposed Kligman’s experiments on a national stage, and the Tuskegee-Syphilis study not only helped usher in new standards but raised questions about the ethics of medical research taking advantage of participants from vulnerable populations.
But even as society shifted its norms and expectations around prison experiments, Kligman never expressed remorse or acknowledged the harms of his work. Years after the Holmesburg tests ended, Kligman famously told his colleagues, “It was years before the authorities knew 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.” In 2006, he reiterated to The New York Times that it was a “big mistake” to shut down the prison experiments. Kligman’s unwavering commitment to his experiments flies in the face of the harms they caused.
“My father’s skin is in those jars”
In 2000, 298 men who’d been incarcerated at Holmesburg filed a lawsuit against the University of Pennsylvania, the City of Philadelphia, Johnson & Johnson, and Dow Chemical Company alleging that they were not properly informed of the risks inherent in participating in the experiments and that the University should acknowledge the long-term harm caused. In 2002, the Federal District Court dismissed the case asserting that the statute of limitations had passed.
While the activism of the early aughts failed to yield any acknowledgment of the Holmesburg survivors, the uprisings of 2020 renewed demands for reparations on behalf of the Holmesburg survivors and a deeper interrogation of Kligman’s legacy.
In 2021, the University of Pennsylvania’s Perelman School of Medicine released a statement regarding Kligman, writing 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.”
In addition to formally apologizing, the school announced the termination of a lectureship dedicated to Kligman and renamed one of the professorships named in his honor. The school also announced the creation of a multi-year financial commitment to redirect funds that were formerly held in Kligman’s name towards scholarships, residencies, and post-doctoral research fellowships designed for dermatologists interested in conducting research related to skin disorders among people of color.
In 2022, the City of Philadelphia also issued a formal apology to those subjected to the experiments in Holmesburg, with Mayor Jim Kenney acknowledging that “it took far too long to hear these words.” Finally, this January—20 years after the Holmesburg survivors staged a protest outside of their halls—the College of Physicians of Philadelphia released a public statement offering “its deepest sympathies for those who suffered, including their families” and saying that while the apology is “long overdue, it is no less heartfelt for the delay.” The organization also pledged to work closely with the Philadelphia Inmate Justice Coalition and announced that Kligman’s 2003 award would be rescinded.
While these apologies and acknowledgments have been welcomed by Holmesurg survivors and their families, financial reparations have remained elusive. Audience members at the St. Joseph’s panel were especially keen on understanding what financial redress might look like, but the contours of it and the steps for attaining it continue to be blurry.
Jones-Alston appeared hopeful that reparations would come to pass. She also acknowledged that the process by which reparations would be doled out is something the entities that benefited most from Kligman’s research have the expertise, knowledge, and capacity to figure out if they wanted to. She outlined that financial reparations could include not just direct payments to survivors but also payments for mental health care and other medical treatments and scholarships for their descendants. Jones-Alston maintained a balance between being clear that financial reparations are owed—declaring poignantly that her “father’s skin is in those jars in CVS and Target,” a reference to the near ubiquity of retinol products—while also illuminating the need for something less tangible albeit just as important—healing.
“We need the community to wake up and help us with the healing process,” she told Prism.
But while the two may feel separate, Irvin Moore highlighted the interconnectedness of healing and financial security. While a monetary amount can never truly equal what is owed to survivors, there is a barrier to fully tending to one’s emotional and spiritual well-being when the daily task of staying financially afloat is so challenging.
“I have both dreams and nightmares,” said Moore. “I want something to abate those nightmares.”
Federal regulations and free will
Despite these more recent acknowledgments and apologies, the earliest recognition of Holmesburg’s legacy and other medical experiments that have exploited incarcerated people was the creation of new, tighter regulations governing medical experimentation in prison. A 1976 report by the U.S. Department of Health, Education, and Welfare recommended that medical experimentation inside prisons be restricted to studies that were low-risk, non-intrusive, and would also be beneficial to the individual participant. Passed in 1978, regulations based on this report outlined the categories under which federally funded research in prison would be permitted. These categories limit prison research to issues unique to the carceral environment, such as studies about the effects of incarceration, prisons as institutions, and conditions that acutely affect incarcerated people. These regulations also require independent review bodies to evaluate all potential research studies.
Despite these comprehensive regulations, their scope is limited to research receiving federal funds, excluding studies conducted by private entities. Further, companies and correction systems—both public and private—have continued to conduct studies with questionable ethics throughout the 2000s, albeit far less often than before 1976.
Still, discourse continues about the potential value of loosening restrictions so incarcerated people can participate in clinical trials. Some researchers believe expanding prison research could benefit incarcerated volunteers without compromising ethical standards. Such benefits could include the provision of healthcare that people inside may need while offering greater insight into ailments that disproportionately—though not uniquely—impact incarcerated people. Advocates of more deregulations also argue that including incarcerated populations in experimental research can remedy grave demographic disparities often found in studies. Recognizing that most clinical trials are overwhelmingly composed of white, male participants while men of color are particularly underrepresented, advocates of looser regulations argue that opening research to those in prison will ensure more people of color—particularly men of color—are adequately represented in research. Importantly, some argue that barring incarcerated people from the right to choose to participate in trials also strips them of their agency.
Willamette University law professor Laura Appleman has written about the importance of maintaining, if not tightening, current restrictions around experimental prison research. Yet, in an interview with Prism, the professor acknowledged the concern that regulations also mean outside forces are dictating what those inside can participate in. The answer “depends on what you think about free will, agency, and cost.”
“Most states are very wary of having prisoners consent to medical trials because you can’t truly consent under correctional control,” said Appleman.
This question around agency and trusting that those inside can and should be able to make decisions around their health and the value of participating in clinical trials—with adequate information—becomes particularly urgent during public health crises. When trials for the COVID-19 vaccine were underway, there were public discussions about whether opening up participation to incarcerated people would be exploitative or ethically sound. In an interview with Science, Lauren Brinkley-Rubinstein, a sociologist and epidemiologist at the University of North Carolina at Chapel Hill, noted the considerations that must be made with expanding access to clinical trials to those inside prison.
“Incarcerated people do have different risks, in terms of the barriers they face to getting certain elements of routine health care along with their potential to be exploited,” said Dr. Brinkley-Rubinstein. “But they also potentially would gain more from vaccination, given these settings are extreme amplifiers of infection.”
While arguments about the viability of including incarcerated people in vaccine clinical trials raised questions about its potential impact on keeping people inside safe, the rollout of the approved vaccines suggests that the health and well-being of people inside continue to be deprioritized when not outright ignored. Appleman noted that in states like Oregon, incarcerated people were among the last to receive the vaccine.
Laws without Morals
Despite the potential benefits to individual health and personal sense of agency, the precarity of the prison environment poses staggering questions. It implements important ethical limitations even as our society is more vigilant about potential exploitation than it was just 50 years ago. The perceived benefits of allowing medical experimentation inside must also be considered alongside the profit incentives that the prison system itself stands to gain when contracting with companies or universities eager to do their research with incarcerated populations.
Outside of the seemingly altruistic desire to improve prisoner health, there are unique features of prison life borne out of poor conditions that can also prove attractive to researchers. As recently as 2018, there was a raging debate in the medical community regarding a research proposal to use prisoners for a large-scale, five-year study measuring the impact of daily sodium intake and the potential benefits and risks of a low-sodium diet. The proposal called for 10,000 to 20,000 incarcerated people to participate, with half being administered a low-sodium diet and the other half maintaining their current diet. Volunteers would not be given the option to choose the group they were in.
While advocates of the study argued that the findings could improve the health of participating volunteers as well as the broader community, ethical questions abound. The features of prison life—namely, the inability of incarcerated people to shape their own diets and receive healthy food—created an attractive environment for these particular researchers. Thus, correctional facilities may not be incentivized to change unhealthy conditions if they continue to garner partnerships with research entities.
In an essay from the Harvard Civil Rights Civil Liberties Law Review, this point is underscored that “the dependency of prisoners on the outcome of a salt study is not an argument for their participation in studies that contribute to societal knowledge and may influence prison leaders. It is an indictment of the oppressive state in which prisoners live.”
Applemanhas asserted that “there is no way to properly oversee medical experiments or make up for the coercive nature of incarceration.” A potential solution, she says, could come in using synthetic cadavers, skin, and bones instead of humans in experimental research, but such biotechnology is expensive and may fail to fully replicate the human body.
The question for the medical field is not simply whether it will learn from the past but what specific lessons it will glean. Should it continue to seek new ways to benefit from incarcerated populations, without fully acknowledging that such benefits are made possible by the harmful nature of incarceration itself? As long as researchers seek to make new advancements, medical experimentation will be required and the use of captive populations may continue to be incentivized. As such, debates about the use of captive populations will abound even as societal standards on what is appropriate and ethical shift.
But perhaps the true measure of how far our ethical standards have pivoted will be whether those who have borne the greatest cost of past experimentation will be compensated and their losses fully recognized. Survivors are not just living with ongoing pain, but also the gnawing unknowing of which experiments might have caused what ailments and the total incomprehension of what their bodies were subjected to.
Early on during Moore’s testimony, he made clear that much of what he has learned in life was gleaned inside prison, including the meaning of ethics. But those moral codes never aligned with the actions of entities like the University of Pennsylvania, whose motto—Leges sine Moribus vanae, he pointed out—translates to “laws without morals are useless.”
“Were we not human beings?” asked Moore. “Did that not apply to us?”