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The Tuskegee Syphilis Study

Title: The Tuskegee Syphilis Study


Author: James M. DuBois


Description:

From 1932 through 1972, the U.S. Public Health Service enrolled African-American men in a non-therapeutic research study to observe the natural course of syphilis. Subjects were not told they had syphilis, nor were they treated for syphilis or any secondary problems. The study continued even after penicillin became the standard treatment for syphilis in the 1940’s and was not ended until 1972, when a public health official went to the press.


Headings: Classic Historical Cases


Case Type: Decision Making


The Tuskegee Syphilis Study

The “Tuskegee Study of Untreated Syphilis in the Negro Male” was designed by an agency of the U.S. Public Health Service (PHS). It began in 1932 with what may have been reasonable motives. Treatments for syphilis in the early 20th century (primarily mercury and arsenic) often produced consequences worse than the natural course of the disease. The purpose of the syphilis study was to observe the natural course of untreated syphilis among black men. At the time, it was assumed that syphilis ran a different course among different races. Moreover, a recent study of whites with untreated syphilis conducted in Oslo claimed that in two out of three cases nothing adverse happens when syphilis is left untreated (Edgar, 1992). Dunn and Chadwick claim that PHS was a major force in promoting rural medical care, and they state that the study began from a genuine concern for minority health problems (McGuire Dunn & Chadwick, 1999). Others are not as charitable in evaluating even the origins of the study, but rather see evidence of racism and disrespect from the beginning (Brandt, 1978). For example, while current treatments were far from ideal, a documentary film, Deadly Deception, shows public health ads that promoted the use of current treatments as effective, and that they were commonly used by those who could afford them.

The study eventually enrolled over 400 black men with syphilis, and 200 black men as a control group. Subjects were not told the purpose of the study; they were told it was a study of “bad blood” (Jones, 1981) and that they would be given free medical care. This “care” involved physical exams, a detailed medical history, a spinal tap without anesthesia, and regular visits throughout the study to establish the sequela of syphilis. Eventually, it included autopsy. It did not include treatment either for syphilis or secondary problems including heart disease (Edgar, 1992).

By today’s standards the study fell short from the very beginning insofar as recruitment was deceptive and manipulative: trustworthy recruiters from the community were used, undue influence was exerted by offering significant incentives, and subjects were deceived about the actual purpose of the study. However, the most flagrant violations – those that put it on a par with other infamous instances of human rights abuses – occurred in the 1940’s when penicillin was developed and eventually became the accepted treatment for syphilis. Not only was penicillin not provided to the men, but secretly great efforts were made to ensure that they would not receive penicillin from other sources (Jones, 1993).

The study continued until 1972 when Peter Buxton, a public health official working for PHS, went to the press after complaining to officials at PHS with no effect. In July of 1972, the Washington Star and the New York Times ran front page stories on the study. While the Tuskegee syphilis study may have provoked initial outrage among the larger U.S. community, it did far more than that within the African-American community. It reinforced suspicions of the medical community, and its lasting legacy has been one of mistrust and reduced willingness to participate in medical research (Gamble, 1993; Jones, 1992).


Questions

  • Would you approve of a study designed just like the Tuskegee study – i.e., one that involved no treatment, just observation of the natural course of a disease – if participants gave genuinely informed consent?
  • Would it be better or worse if participants were compensated for participation?