TUSKEGEE SYPHILIS EXPERIMENT
In the early twentieth century, African Americans in the South faced numerous public health problems, including tuberculosis, hookworm, pellagra, and rickets; their death rates far exceeded those of whites. The public health problems of blacks had several causes—poverty, ignorance of proper health procedures, and inadequate medical care—all compounded by racism that systematically denied African Americans equal services. In an effort to alleviate these problems, in 1912 the federal government united all of its health-related activities under the Public Health Service (PHS). One of the primary concerns of the PHS was syphilis, a disease that was thought to have a moral as well as a physiological dimension. In 1918 a special Division of Venereal Diseases within the PHS was created.
In the late 1920s the PHS joined forces with the Rosenwald Fund (a private philanthropic foundation basedPage 2216 | Top of Article in Chicago) to develop a syphilis control program for blacks in the South. Most doctors assumed that blacks suffered a much higher infection rate than whites because blacks abandoned themselves to promiscuity. And once infected, the argument went, blacks remained infected because they were too poor and too ignorant to seek medical care. To test these theories, PHS officers selected communities in six different southern states, examined the local black populations to ascertain the incidence of syphilis, and offered free treatment to those who were infected. This pilot program had hardly gotten underway, however, when the stock market collapse in 1929 forced the Rosen-wald Fund to terminate its support, and the PHS was left without sufficient funds to follow up its syphilis control work among blacks in the South.
Macon County, Alabama, was the site of one of those original pilot programs. Its county seat, Tuskegee, was the home of the famed Tuskegee Institute. It was in and around Tuskegee that the PHS had discovered an infection rate of 35 percent among those tested, the highest incidence in the six communities studied. In fact, despite the presence of the Tuskegee Institute, which boasted a well-equipped hospital that might have provided low-cost health care to blacks in the region, Macon County was home not only to the worst poverty but the most sickly residents the PHS uncovered anywhere in the South. It was precisely this readymade laboratory of human suffering that prompted the PHS to return to Macon County in 1932. Since they could not afford to treat syphilis, the PHS officers decided to document the damage to its victims by launching a study of the effects of untreated syphilis on black males. Many white southerners (including physicians) believed that although practically all blacks had syphilis, it did not harm them as severely as it did whites. PHS officials, however, knew that syphilis was a serious threat to the health of black Americans, and they intended to use the results of the study to pressure southern state legislatures into appropriating funds for syphilis control work among rural blacks.
Armed with these good motives, the PHS launched the Tuskegee Study in 1932. It involved approximately four hundred black males who tested positive for the disease, as well as two hundred nonsyphilitic black males to serve as controls. In order to secure cooperation, the PHS told the local residents that they had returned to Macon County to treat people who were ill. The PHS did not inform the study subjects that they had syphilis. Instead, the men were told they had "bad blood," a catchall phrase rural blacks used to describe a host of ailments.
Although the PHS had not intended to treat the men, state health officials demanded, as the price of their cooperation, that the men be given at least enough medication to render them noninfectious. Consequently, all of the men received a little treatment. No one worried much about the glaring contradiction of offering treatment in a study of untreated syphilis because the men would not receive enough treatment to cure them. Thus, the experiment was scientifically flawed from the outset.
Although the original plan called for a one-year experiment, the Tuskegee Study continued until 1972, partly because many of the health officers became fascinated by the scientific potential of a long-range study of syphilis. No doubt others rationalized the study by telling themselves that the men were too poor to afford proper treatment, or that too much time had passed for treatment to be of any benefit. The health officials, in some cases, may have seen the men as clinical material rather than human beings.
At any rate, as a result of the Tuskegee Study approximately one hundred black men died of untreated syphilis, scores went blind or insane, and still others endured lives of chronic ill health from syphilis-related complications. Throughout this suffering, the PHS made no effort to treat the men, and on several occasions steps were taken to prevent them from getting treatment on their own. As a result, the men did not receive penicillin when it became widely available after World War II.
During those same four decades, civil protests raised America's concern for the rights of black people, and the ethical standards of the medical profession regarding the treatment of nonwhite patients changed dramatically. These changes had no impact, however, on the Tuskegee Study. PHS officials published no fewer than thirteen scientific papers on the experiment (several of which appeared in the nation's leading medical journals), and the PHS routinely presented sessions on it at medical conventions. The Tuskegee Study ended in 1972 because a whistle-blower in the PHS, Peter Buxtun, leaked the story to the press. At first, health officials tried to defend their actions, but public outrage quickly silenced them, and they agreed to end the experiment. As part of an out-of-court settlement, the survivors were finally treated for syphilis. In addition, the men, and the families of the deceased, received small cash payments.
The forty-year deathwatch had finally ended, but its legacy can still be felt. In the wake of its hearings, Congress enacted new legislation to protect the subjects of human experiments. The Tuskegee Study left behind a host of unanswered questions about the social and racial attitudes of the medical establishment in the United States. It served as a cruel reminder of how class distinctions and racism could negate ethical and scientific standards.
Jones, James H. Bad Blood: The Tuskegee Syphilis Experiment, expanded edition. (Originally published in 1981.) New York: Free Press, 1993.
Reverby, Susan M., ed. Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. Foreword by James H. Jones. Chapel Hill: University of North Carolina Press, 2000.
"The Tuskegee Study." 3 parts. Jet, November 9, 16, 23, 1972.
JAMES H. JONES (1996)