As reported this summer by Prism, the notorious experiments conducted by University of Pennsylvania dermatologist Albert Kligman at Philadelphia’s Holmesburg Prison have been under renewed scrutiny as former test participants speak out. Discussions about the experimentation that took place throughout Philadelphia’s prison system have joined larger demands for reparations and conversations about what wealthy institutions and major corporations owe those who have faced inconceivable harm.
Throughout the 1950s, ’60s, and into the early ’70s, Kligman and the University of Pennsylvania conducted tests on prisoners within the Philadelphia prison system to produce cosmetic and pharmaceutical items, including perfumes, shampoos, baby products, liquid diets, and perhaps what is Kligman’s most well-known development, the popular acne product, Retin-A.
While incarcerated people have long been test participants for medical experiments in the U.S., Kligman’s tests became increasingly well known and garnered partnerships with companies such as Johnson & Johnson and Dow Chemical Corporation. Kligman even conducted experiments in partnership with the U.S. Army with the injection of mind-altering, psychedelic compounds to determine their “MED-50,” or the minimum effective dose needed to disable and incapacitate 50% of a given population. As stated by historian Allen Hornblum, Kligman and the University of Pennsylvania transformed the city’s prison system into the “largest human experimentation center in North America.”
While Hornblum’s 1998 book “Acres of Skin” blew the whistle on the Holmesburg experiments and brought it to the public’s awareness, national attention on the experiments waned until 2020, when renewed interest was brought to the subject as uprisings following George Floyd’s murder also inspired conversations about racial injustice and reparations. However, the full extent and impact of Kligman’s experiments have yet to be completely mined, and yet another dimension of his tests has been woefully under-acknowledged. That story rests in the space where reproductive health and prison experimentation collide, and it illuminates how Kligman’s tests impacted and harmed incarcerated women irreparably.
Though past events calling out Kligman’s experiments have been hosted by universities across Philadelphia, a lecture on “Acres of Skin” given by Hornblum this October was the first to take place on the University of Pennsylvania campus. The event’s location was significant given the university’s role in co-signing, funding, and benefiting from Kligman’s tests. Seven departments across the university community promoted and sponsored the event, none of which included University of Pennsylvania’s Department of Medical Ethics and Health Policy, which Hornblum says declined to sponsor.
All too often, conversations about the prison system exclude incarcerated women, including chapters of history that chronicle issues such as medical experimentation inside. However, the October event at the University of Pennsylvania, wherein Hornblum followed his lecture with a conversation with Dorothy Alston, a formerly incarcerated participant in University of Pennsylvania-funded tests at Philadelphia’s House of Correction, went a long way in expanding our understanding of the extent of Kligman’s tests.
“Something was in me that shouldn’t have been in me”
Alston was in her late 20s when she first entered into Philadelphia’s House of Correction, the city’s now defunct jail complex, on a shoplifting charge. It wasn’t until her second arrest that she was introduced to the University of Pennsylvania’s researchers’ experiments. Another woman detained at the jail told her they were running a test on diet food, and Alston was motivated to participate as the money could help her support herself and send funds back home to her family. This diet food test consisted of eating three sets of meals daily and being consistently weighed throughout the three-week testing period. Finding the first test innocuous enough, Alston signed up for a second, this time for psychedelic pills.
“But once I took that pill, I knew that this was not something I wanted,” said Alston in an interview with Prism. “I was zooming around like I was in an airplane.”
The final experiment that Alston would participate in would forever alter the trajectory of her life in ways that are unimaginable and still, to this day, inexplicable.
The “tampon test” consisted of researchers giving female test subjects tampons to use during their menstrual cycle based on their menstrual flow. Instead of discarding them when finished, participants were to place each used tampon in a baggy and return them to the University of Pennsylvania researchers.
In a 1999 testimony about the experiments, Alston noted that the “University of Pennsylvania people gave us a survey to fill out, [but] … if I had been asked to sign a consent form, I wasn’t aware of it.”
A particularly compelling point made by Alston to university students at the October event was the lack of information given to test participants before signing on. While the financial precarity of incarceration is a key to understanding why subjects volunteered for these experiments, she said, incarcerated people were and are not as easily deceivable as many would like to believe. Had many of them been made aware of the potential side effects of these tests, she noted, they would not have agreed to participate. Being made ignorant of all that researchers knew robbed participants of complete and true agency.
Early on in the test, Alston, who had never used tampons before participating in the experiment, could tell that something was going awry.
“I put one in me, and the part that sticks in you came loose in my body,” said Alston. “So when I pulled the rest of it out, I didn’t realize that some of it was still stuck in me until they weighed them, and the weight didn’t come up right. But nobody said, well, let’s look in you and see what’s going on until I began to have bad pain. Something was in me that shouldn’t have been in me.”
Alston began suffering from stomach pains and was sent to the prison hospital, but doctors were unable to remove the remaining material. By the time of her release, she returned home with the same pains, and the defective tampon remnants still inside of her.
“I began to stink like … imagine rotten cabbage and an onion,” recalls Alston. “Put that combination in your mind; that was how I smelt down between my legs. So I went to an OB-GYN, and they wanted to do an ultrasound … and they saw something in me.”
After constant pain and no answers or second opinions offered by her doctors, Alston, at 40 years old, underwent a hysterectomy.
“When I went to the OB-GYN in [Jefferson] Einstein [Hospital] they said there was nothing else they could do. They had to remove my uterus, and in taking my uterus out, they took out the fallopian tubes and all the other contraptions that go with it,” said Alston.
While she had two children already, Alston and her husband hoped to grow their family. The hysterectomy decimated their plans to have more children, and the lingering mystery around the source of her ailments sowed distrust in her husband.
“My husband kind of pushed me back,” said Alston. “[Because of] what I went through, my husband thought that when I came home damaged, I had been with a man in the jail.”
With the disintegration of her marriage and the sudden, profound change to her body, Alston spiraled into drug use, describing it as “the only way I could ease my pain.”
For participating in the tampon test, Alston says she received $15.
Piecing together the truth
Among the most disturbing elements of Kligman’s University of Pennsylvania-sponsored tests throughout the city’s prison system is the lack of information given to participants about what researchers were administering them, the purpose of the tests, and what other entities would stand to benefit from the findings. Documentation from the time and newly emerging information about the experiments, however, can help us begin to piece together and make strong conjectures about the background of specific tests.
Since the late 19th century, Johnson & Johnson has manufactured menstrual hygiene products, beginning with menstrual pads released in 1897; their MEDS tampons debuted in 1940; they released their Stayfree mini and maxi pads in 1971; and their O.B. tampons were made available in the U.S. in 1978. According to historian Sharra Vostral’s essay “Of Mice and (Wo)men,” regulation on tampons has historically been very loose. Since the earliest days of the Food and Drug Administration, these products fell into a “feminized category that had little to no oversight in terms of labeling, materials content, safety, or advertising claims,” Vastral writes. Loose regulations over tampon development paired with Johnson & Johnson’s relationship to Kligman and the University of Pennsylvania’s prison experiments has made experts like Hornblum question whether the company’s experiments involving talc and asbestos were related to the test that Alston participated in and the attendant ailments that she has suffered through.
In recent years, Johnson & Johnson has been embroiled in lawsuits as tens of thousands of women have come forward alleging that their talcum baby powder gave them ovarian cancer, cysts, and led to medical interventions, including partial and complete hysterectomies. While the company’s menstrual hygiene products have not been implicated in these cases, it is known that Johnson & Johnson-funded studies were conducted throughout the Philadelphia prison system. Newly unsealed court documents reveal that in 1971 the company injected 10 incarcerated test participants with asbestos to observe the mineral’s effect on their skin compared to talc. The knowledge of these tests fuels the argument that the company was aware as early as the 1970s of the potential relationship between cancer and asbestos exposure.
The documents detailing Johnson & Johnson’s talc and asbestos tests inside are scarce given that Kligman was known to destroy documents or fail to properly record information about other tests conducted on incarcerated people. For example, information about the identities of the 70 men who participated in the dioxin experiments sponsored by Dow Chemical is scant, making it impossible to track them down and record the long-term effects such tests had on their bodies. In a 1983 article from The New York Times about the dioxin experiments, Kligman shared that he gave all test records, including the names of the participants, to Dow Chemical, and yet the company shared they had never received these names.
“All those people could have leukemia now—about 1 chance in 20 billion,” Kligman told the Times. “And I could be hit by an asteroid when I walk out on the street, but I don’t think I will.”
Invisible scars
For years after her hysterectomy, Alston said she shoplifted to support her substance use. As a result, she shuffled back and forth in and out of jail, returning to the place that was the initial source of her despair. Committed to change, however, she went into recovery in 1994 and, for the past 29 years, has lived sober.
Now, at 87, Alston and other former test participants remain in the dark about the specifics of the tests they participated in and the substances researchers exposed them to. It’s engendered within her not just physical ailments but a lingering distrust of the medical profession. Other former test participants, including those in Hornblum’s two books about the experiments, have shared that mistrust, too.
Alston knew of how the experiments impacted other women incarcerated at Philadelphia’s House of Correction around the same time she was inside. Two other women, she recalls, who have since died, also discovered they were unable to get pregnant when they returned home. However, it wasn’t until the release of “Acres of Skin” that she learned the full extent of the University of Pennsylvania’s medical testing.
“Acres of Skin” not only brought public awareness to the existence of Kligman’s tests but also jump-started an organizing movement among former test participants who called upon entities like the Penn and the College of Physicians of Philadelphia for reparations and public acknowledgment of their wrongdoing. In 2000, a group of former test participants also filed an unsuccessful lawsuit against the University of Pennsylvania. Alston soon joined in on these efforts and shared her own testimony at public events, often finding that she was the only woman a part of these conversations.
“When they mention Holmesburg, they only think that it’s a male institution,” said Alston. “But there are other prisons that are connected to Holmesburg—there’s the Detention Center and the House of Correction, where I was at. So when I used to go to different speaking engagements, and I was telling them that I was a female and that I participated in the different tests and all, I saw their shock. They only expected men to come up and say the things that happened.”
In many public conversations about the experiments, people formerly incarcerated at Holmesburg and even Hornblum recall the horror and confusion of seeing people move around the prison with gauze strips across their bodies. Adrianne Jones-Alston, a daughter of a Holmesburg test participant and a vocal activist in the movement for reparations for them and their families, had spoken about first seeing the scars across her father’s back when he returned home. Even the cover of “Acres of Skin” forces readers to witness the physical disfigurement brought about by the tests. The image shows a participant sitting in front of a Penn researcher while their back, covered with gauze, faces the camera. These visuals are as powerful as they are disturbing.
But the marks borne by women involved in the tests are different. Alston noted at the University of Pennsylvania lecture that the marks of her pain are invisible to onlookers because her scars are internal. Her story is not readily visible to the naked eye and instead has to be shared through her telling her own story. As one of the only surviving female participants in the House of Correction tests, Alston has to contend with the heavy burden of recounting her story lest it be forgotten, but the personal toll is also heavy. She recalls a speaking engagement at Temple University years ago when the emotion became overwhelming.
“I’m reliving it … Each time I talk about it, I’m reliving it, so I got very, very emotional at Temple, and I said that I couldn’t do this no more,” said Alston. “It takes a lot out of me to speak about it.”
A call to action
In 2021, following pressure from within the medical community and on-campus organizations, the University of Pennsylvania’s Perelman School of Medicine made its first, and thus far only, acknowledgment by issuing a statement referring to Kligman’s practices as “disrespectful” and announcing new fellowship opportunities for dermatologists interested in studying “skin of color.” However, conversations about offering financial compensation to former test participants and their families have yet to get off the ground. When Kligman died in 2010, he did so without ever expressing remorse for the experiments he conducted. In a 2006 interview with The New York Times, Kligman shared his view that “shutting the prison experiments down was a big mistake.”
“I’m on the medical ethics committee at Penn,” Kligman stated, “and I still don’t see there having been anything wrong with what we were doing.”
At the October event at Penn, Hornblum lamented Kligman’s lack of remorse, reminding audience members that both at the time of the experiments and into the 21st century, “the rewards of taking advantage were greater than the risk of being held responsible.”
Still, even as the surviving former test participants grow old, they, along with their families, continue to advocate for acknowledgment and reparations. Hornblum says a recent settlement made just this August in a case brought against biotechnology company Thermo Fisher may provide a useful blueprint for descendants of Holmesburg survivors fighting for compensation.
The suit was filed by the descendants of Henrietta Lacks, the woman whose cells were the first human cells to continuously reproduce in lab dishes and which have been used in countless medical innovations, including the development of the polio and COVID-19 vaccines. While “HeLa cells” have been a priceless asset to modern medicine and have garnered billions of dollars for medical companies, including Thermo Fisher, Lacks’ family has never received any compensation from the use of their ancestor’s cells, which researchers obtained without her consent.
The success of the HelaCells suit may provide a new legal avenue for conversations about reparations for Holmesburg survivors, yet while Alston feels that she and other test participants are owed just compensation, she says she hopes most of all that medical professionals learn from the past.
“I want the up-and-up-and-coming medical generation to learn from how this harm has been done to me,” Alston said to Penn students at the close of her lecture. “I’m a living example of what this man, this medical professional, did to me. Don’t make this mistake and do it to somebody else.”
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