Content warning: This article contains graphic descriptions of the abuse of incarcerated people.
In 2014, Teen Vogue published a piece extolling the virtues of retinol, an organic compound derived from vitamin A that was taking the skin-care world by storm. Two years earlier, Vogue had hailed it as an “anti-aging miracle worker,” and now retinol is everywhere from Sephora shelves and influencers’ skin-care fridges to your tween cousin’s medicine cabinet. Its popularity exploded once scientists and then skin-care fans discovered that retinol is gentler on the skin than other types of retinoids. Tretinoin, retinol’s stronger, prescription-only cousin (also known by the brand name Retin-A), is having a moment too, but it’s been around much longer. Its history is also much, much uglier. That “miraculous” wrinkle-erasing, acne-fighting cream is the result of decades of horrifying medical abuse.
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Before Retin-A was approved by the FDA in 1971, it had been tested on hundreds of incarcerated people in Philadelphia as part of a long-running program led by dermatologist Albert Kligman. Between 1951 and 1974, Dr. Kligman and his team experimented on scores of vulnerable people, a majority of whom were Black and being held in the now-closed Holmesburg Prison. The goal was to produce pharmaceuticals, cosmetics, and also chemical warfare agents. The male test subjects endured “patch tests,” in which untested creams and toxic chemicals were smeared on their backs, faces, and arms, as well as biopsies of their flesh and organs, mysterious injections, and a host of other medical procedures. “I got a needle in my spine for $7,” one former participant later told author Allen M. Hornblum for his landmark book Acres of Skin: Human Experiments at Holmesburg Prison, and an unknown chemical was then injected. In 2024 currency, he’d have made about $54, enough to cover one tube of tretinoin from GoodRX.
Many were left with wounds, unsightly scars, and skin discolorations that marked them as participants even years after they’d left prison, Hornblum details in the book. While most of Dr. Kligman’s “volunteers” were men, incarcerated women were also involved in testing menstrual products. As Prism reported, survivors of the so-called “tampon tests” noted the same lack of informed consent and experienced medical and psychological issues as a result. Dr. Kligman and his team enticed incarcerated people to sign up for the medical trials by offering financial incentives and seldom told them exactly what medications or substances they were being exposed to or what kinds of negative effects they might experience. “Everything was done as cheaply as they could,” Al Butler, a former Holmesburg prisoner, told Hornblum. “They were just preying on people. Using an inmate was cheaper than buying a chimpanzee and the results were better.”
Prison jobs were scarce and extremely low-paying, and many prisoners needed money for bail or legal help. The majority of people held in Philadelphia’s prison system in the late 1960s and 1970s were waiting to be sentenced and had not yet been convicted of a crime. Many were also illiterate, as NPR noted. They did not always understand what they were signing but saw the trials as a means to an end. A lack of informed consent led to people signing up for dangerous medical trials that benefitted Dr. Kligman financially and professionally but left many of his “volunteers” in discomfort, pain, or saddled with lifelong medical and psychological problems.
The vitamin A trials that led to Dr. Kligman’s discovery that tretinoin has a positive effect on acne and facial wrinkles were only one of an extensive series of experiments. Scientists have known about vitamin A’s potential for treating acne since at least the 1940s, according to Hornblum, but studies on use stalled due to the high rate of skin irritation it caused. When a colleague wanted to see vitamin A’s impact on himself, Dr. Kligman noted the resultant irritation — and decided to conduct his experiments on prisoners anyway.
The doctor started by using extremely high doses. Currently, the most common dosage of Retin-A has a 0.025% concentration of retinoic acid and, according to the Mayo Clinic, it’s known for causing side effects like burning, stinging, peeling, redness, and irritation. Compare that with Dr. Kligman’s early studies, which used a 1% concentration on incarcerated subjects. “I damn near killed people [before] I could see a real benefit,” he told Philadelphia Magazine. “Every one of them got sick.” This lack of regard for his subjects’ pain and well-being was a constant fixture of Dr. Kligman’s time at Holmesburg, and he seemed to take pride in his drive to push the boundaries of medical ethics. “It was years before the authorities knew that I was conducting various studies on prisoner volunteers,” he once said. “Things were simpler then. Informed consent was unheard of. No one asked me what I was doing. It was a wonderful time.”
Skin care was only one of Dr. Kligman's areas of interest. As the Philadelphia Inquirer reported, his clients also included major pharmaceutical manufacturers like Pfizer and Johnson & Johnson, chemical companies, as well as the US Army. Test subjects were exposed to asbestos and radioactive isotopes as well as to diseases like herpes and staphylococcus, the latter recalling the infamous and contemporaneous Tuskegee Syphilis Study. Per the Inquirer, the Army used the Holmesburg prisoners to test chemical agents and psychotropic drugs while the CIA experimented on them with mind-control compounds. Dow Chemical funded a study in which prisoners were exposed to dioxin, an extremely poisonous, carcinogenic component of Agent Orange — but pulled the plug after Dr. Kligman radically increased the dosage they’d prescribed. "Looking back, would similar tests be done using the prison population?" a Dow spokesperson commented in 2000. "Absolutely not.”
Dr. Kligman’s testing program was shut down in 1974, but by then the doctor was set. His discovery of Retin-A gave him enormous financial and professional success and provided cover when critics spoke up. Whenever a survivor tried to hold him accountable by filing legal charges, like Jerome Roach did in 1976 and Leodus Jones did in 1987, the case was dismissed based on insufficient evidence. In Jones’s case, Dr. Kligman elected to settle for $40,000.
The story of Holmesburg reached a wider audience in 1998 with the publication of Hornblum’s book. “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,” Hornblum told Prism in a 2023 interview. When Hornblum reached out to Dr. Kligman for comment on the book, the dermatologist quickly cut off the interview after saying, “All we did… is offer them money for a little piece of their skin.”
Dr. Kligman died in 2010 at the age of 93, still insisting to the New York Times in 2006 that shutting down the human experiments had been “a big mistake.” “I’m on the medical ethics committee at Penn,” he said, “and I still don’t see there having been anything wrong with what we were doing.”
In 2000, almost 300 survivors of his Holmesburg experiments filed a lawsuit against Dr. Kligman, the University of Pennsylvania, Johnson & Johnson, and others for having exposed them to “infectious diseases, radioactive isotopes, and psychotic drugs such as LSD without having given informed consent.” The lawsuit was dismissed (the statute of limitations had expired), but Holmesburg survivors made their voices heard again in 2003 when they held a protest at Philadelphia’s College of Physicians as Dr. Kligman accepted a lifetime achievement award.
Unfortunately, the doctor was gone by the time the institutions that had funded and profited from his work truly began to grapple with his corrosive legacy. Survivors, family members like Adrianne Jones-Alston, whose father, Leodus, was experimented on by Dr. Kligman at Holmesburg, and their allies continually raised the issue, but in 2021, the dam finally began to break. Jules Lipoff, M.D., an assistant professor in the department of dermatology at the University of Pennsylvania, coauthored a piece in the Journal of the American Medical Association publication Dermatology calling on the university to finally cut ties with Dr. Kligman and pay reparations to his victims. A public petition followed and the university finally made a formal apology that summer, removing his name from an annual lecture series and professorship as well as directing research funds to study dermatological issues in people of color. The City of Philadelphia issued an apology of its own in 2022, and in 2023, the College of Physicians rescinded the doctor’s achievement award and publicly apologized to the survivors.
Apologies are nice, but survivors and their families are still calling for justice in the form of reparations. Dr. Kligman’s patent for Retin-A brought in hundreds of millions of dollars in revenue, some of which he donated to the university. ''We are swimming in cash,'' Dr. Kligman told the MacNeil/Lehrer NewsHour in 1988. Meanwhile, the people whose bodies were used to test the drug are still left with their scars or worse — deep psychological and medical complications from their time spent under Dr. Kligman’s knife.
“We’re talking billions of dollars — and my daddy’s skin is in those jars,” Jones-Alston said during a recent panel held by the University of Pennsylvania Carey Law School to highlight the survivors’ demand for restorative justice. “Share the wealth. After all, they paid the price.”
