Recognizing that justice, healing and transformation require an acknowledgment of past harms, UCSF has created the Program for Historical Reconciliation (PHR). The program is housed under the Office of the Executive Vice Chancellor and Provost, and was started by current Executive Vice Chancellor and Provost, Dan Lowenstein, MD.
The program's first report, released this month, investigates experiments from the 1960s and 1970s involving incarcerated men at the California Medical Facility (CMF) in Vacaville. Many of these men were being assessed or treated for psychiatric diagnoses.
The research reviewed in the report was performed by Howard Maibach, MD, and William Epstein, MD, both faculty in UCSF's Department of Dermatology. Epstein was a former chair of the department who died in 2006. The committee was asked to focus on the work of Maibach, who remains an active member of the department.
Some of the experiments exposed research subjects to pesticides and herbicides or administered medications with side effects. In all, some 2,600 incarcerated men were experimented on.
The men volunteered for the studies and were paid for participating. But the report raises ethical concerns over how the research was conducted. In many cases there was no record of informed consent. The subjects also did not have any of the medical conditions that any of the experiments could have potentially treated or ameliorated.
Such practices were common in the U.S. at the time and were increasingly being criticized both by experts and in the lay press. The research continued until 1977, when the state of California halted all human subject research in state prisons, a year after the federal government did the same.
The report acknowledges that Maibach was working during a time when the governance of human subjects research was evolving, both at UCSF and at institutions across the country. Over a six-month period, the committee gathered some 7,000 archival documents, medical journal articles, interviews, documentaries and books, much of which has yet to be analyzed. UCSF has acknowledged that it may issue a follow-up report.
The report found that "Maibach practiced questionable research methods. Archival records and published articles have failed to show any protocols that were adopted regarding informed consent and communicating research risks to participants who were incarcerated."
In a review of publications between 1960 and 1980, the committee found virtually all of Maibach's studies lacked documentation of informed consent despite a requirement for formal consent instituted in 1966 by the newly formed Committee on Human Welfare and Experimentation. Only one article, published in 1975, indicated the researchers had obtained informed consent as well as approval from UCSF's Committee for Human Research (CHR), which began in 1974 as a result of new federal requirements.
"Based on our archival research of internal human subject research review board(s) records and state of California hearings proceedings, PHR has concluded that Maibach and others engaged in questionable informed consent practices at the prison, especially before 1969," the report stated.
The authors said the researchers bypassed requirements to report their research to UCSF's human subjects committee through a nonprofit organization, the Solano Institute for Medical and Psychiatric Research (SIMPR), which coordinated human subjects research at CMF. "However, solely seeking approval through SIMPR was in direct violation of the mandate communicated to all UCSF faculty in 1966," the report concluded.
The report noted that Maibach and Epstein were trained by Albert Kligman, MD, a dermatologist at the University of Pennsylvania who conducted studies at Holmesberg Prison in Philadelphia. Maibach and Epstein brought Kligman's methods to California when they joined the UCSF faculty.
In 2019, Penn Medicine stated that, while Kligman's research may have met the legal standards of its time, it was unethical and disrespectful of its subjects, many of whom were imprisoned Black men. The demographics at CMF at the time of Maibach's research are not fully known, but there is no indication the research was directed specifically at Black men.
Given the opportunity by the PHR to respond to the findings of the report, Maibach expressed regret and remorse.
"I regret having participated in research that did not comply with contemporary standards," he wrote. "The work I did with colleagues at CMF was considered by many to be appropriate by the standards of the day, although in retrospect those standards were clearly evolving. I obviously would not work under those circumstances today - as the society in which we live in has unambiguously deemed this inappropriate. Accordingly, I have sincere remorse in relationship to these efforts some decades ago."
Jack Resneck, MD, chair of the UCSF Department of Dermatology, wrote in a letter to his department that "Much of the research described clearly contradicts our community's ethical values… Even if this research may have been accepted by some in its time, it is essential that we now acknowledge the harms that were done and the inconsistency with our UCSF values."
In conclusion, the committee made a number of recommendations, including that UCSF disseminate these findings, educate its community about this history, begin an oral history project with those who were subjected to research at CMF between 1955 and 1977, offer an official statement of remorse and continue researching UCSF's past.
In recognition of the report's findings, UCSF Executive Vice Chancellor and Provost Dan Lowenstein has offered this official statement of remorse for Maibach's and Epstein's research at CMF:
"UCSF apologizes for its explicit role in the harm caused to the subjects, their families and our community by facilitating this research, and acknowledges the institution's implicit role in perpetuating unethical treatment of vulnerable and underserved populations - regardless of the legal or perceptual standards of the time. Truth-telling and rebuilding trust are foundational to our commitment to reconciliation work and, in that spirit, we must acknowledge the failures in our history in order to identify a path forward that is informed by our PRIDE values and commitment to justice, equity, diversity and inclusion."
"There's more work that we need to pursue to understand this and other parts of our history. Reconciling our past provides a way of bringing clarity to the present and the path forward," added Lowenstein, who steps down from his position as EVCP at the end of this year. "To paraphrase the German poet Goethe: 'They who cannot draw from 3,000 years are living from hand to mouth.'"
The PHR report was conducted by Aimee Medeiros, PhD, associate professor of humanities and social sciences and Polina Ilieva, associate university librarian and UCSF archivist, under the guidance of Brian Dolan, PhD, chair of the Department of Humanities and Social Sciences.
