More than 2 million prescriptions for tretinoin get filled every year. Most people know it as Retin-A, the everyday cream for acne and aging skin. Before it reached a single bathroom shelf, it was tested on the taped-up backs of men locked inside a Philadelphia prison so violent that it earned the nickname the Terrordome.
The man who patented it, University of Pennsylvania dermatologist Dr. Albert Kligman, remembered his first look at that prison with a farmer's pleasure: "All I saw before me were acres of skin."
A house call for athlete's foot
In 1951 the pharmacist at Holmesburg prison called Kligman about a problem. Athlete's foot was racing through the inmate population, about a thousand cases, and nothing was touching it. Kligman made sense for the job. He had built a reputation on ringworm, the fungal infection that's a cousin to athlete's foot, and he'd modified a lab test to detect it.
His subjects for that ringworm research had been disabled children at a state mental hospital. According to a colleague, the children were infected by roughing up their scalps and rubbing the fungus straight into the wounds.
Touring Holmesburg's cell blocks, Kligman saw a captive population whose diets and routines were already strictly controlled, what he called an "Anthropoid colony." Pharmaceutical companies would pay fortunes for access to one. And plenty of the men weren't convicts at all. They were waiting for trial because they'd been denied bail or couldn't pay it.
Steam pipes in August
Holmesburg opened in 1896, built on a spoke-and-wheel layout meant to isolate prisoners. The cells soon overflowed, lit only by narrow slits in the ceiling. In 1938, roughly half the inmates went on a hunger strike over rank and meager food. Officials dragged 25 of the leaders to a narrow cell block called the Klondike, lined with heavy steam pipes and radiators, then sealed the windows and vents during a sticky August heat wave. The temperature climbed to nearly 200 degrees Fahrenheit. Four men died, and an inquest found injuries consistent with being "boiled alive." Fourteen staffers were charged, and only two were convicted. Thirteen years later, the Klondike was still standing.
Paid, but never told
The early experiments were mostly perfumes and cosmetics. In a common patch test, strips of hospital tape formed a grid of about 30 squares on a man's back, each square got a dab of lotion, and then a sun lamp went to work while doctors watched for peeling, burning and blistering. Kligman treated pay as a stand-in for informed consent, meaning a subject's actual understanding of the risks. A test paid $10 to $300, a fortune next to jail wages of 15 or 25 cents a day, and it could mean bail money or a nest egg for the family. Most of the men were Black. Kligman liked to tell his students, "Rules don't apply to genius."
The work got stranger. In the milkshake test, men spent six months living on nothing but a mystery drink, and at least one needed multiple surgeries afterward. In 1971, Johnson & Johnson paid Kligman to find out whether asbestos in talc, the mineral in its baby powder, could do harm. Ten inmates got $10 apiece to be injected with talc and two kinds of asbestos, a known carcinogen. The injections raised clumps on the skin called granulomas, and no one followed the men long enough to learn what else happened.
Kligman had cover. The 1947 Nuremberg Code demanded informed consent, but researchers of the day thought it applied to war criminals. Federal protections for human subjects didn't arrive until the National Research Act in 1974.
Retin-A, one of America's most common skin creams, came out of 23 years of paid experiments on the backs of prisoners, many of whom hadn't been convicted of anything. It all happened in plain sight, and the local paper praised it.
Enter the Army and the CIA
In 1968 the Department of Defense and the CIA launched a covert program to test the behavioral and toxic effects of drugs on people, a follow-up to MKUltra, the agency's mind-control project. The face creams gave way to dioxin, a poisonous ingredient in the herbicide Agent Orange. The consent forms never mentioned Agent Orange, side effects or toxicity. Dow Chemical paid Kligman $10,000 and approved a cautious protocol. When low doses produced no reaction, Kligman raised the dose 500-fold. Eight of ten men developed lesions that lasted seven months, because he chose not to treat them. Dow fired him, one of the only times he ever faced consequences.
What the teacher saw
In 1971, a 23-year-old named Allen Hornblum came to Holmesburg to teach an adult literacy class. He noticed scores of shirtless men with gauze and tape striping their backs. "We rent our bodies to the University of Pennsylvania for cash," some inmates told him. One inmate described researchers offering six men $50 each to let them pull out a fingernail with pliers. The men negotiated the price up to $150.
A burglary inmate named Johnnie Williams got an injection in a padded trailer cell, began hallucinating, smashed the toilet and sheared the doors off the trailer. Men in the Army's delirium-drug tests reported walls flapping like a windblown tent, and ants. None of it was secret. A 1963 local news story praised the doctor and his "inmate volunteers."
Nothing wrong, he said
Medical testing at Holmesburg was banned in 1974. The FDA had suspended Kligman's drug-testing privileges in 1966, then gave them back within a month after his Penn colleagues rushed to his defense. He had already licensed Retin-A to Johnson & Johnson. In 1984, former inmate Leodus Jones, who volunteered to raise bail money over his mother's pleading, won a $40,000 settlement from the city. In 2000, a lawsuit brought by 300 former subjects was tossed because the statute of limitations had run out. In 2022, Philadelphia Mayor Jim Kenney formally apologized.
Kligman never did. In 2006, four years before his death, he told The New York Times, "I still don't see there having been anything wrong with what we were doing."