History of Science 3333 H
December 8, 1997
From 1932 up until 1972, the U.S. government engaged in a scientific study in which a group of approximately 400 African-American men with syphilis were analyzed but left untreated. The Tuskegee Study of Untreated Syphilis was headed by the U.S. Public Health Service and made use of uneducated and destitute tenant farmers from Macon County, Alabama. In total, 412 men were infected with syphilis, while 214 uninfected individuals were used as controls. Of these men, more than 100 died of tertiary syphilis. (Brandt 4, 158). The study continued even with the advent and ready availability of effective treatments such as penicillin. Despite frequent publications of its findings in medical journals and the knowledge of its existence within such educated circles, the Tuskegee Study was not chastised for its unorthodox research methods. Its termination came only in 1972, when a public health worker named Peter Buxton leaked information about the study to the media.
With all of the controversy that has since enveloped the Tuskegee Study, the original purpose behind the study is often lost. The experiment's origins actually began with good intentions. In 1929, prior to the inception of the study, blood tests for African-Americans were funded by the Rosenwald Foundation for Black Community Development in the South. These blood tests were intended to locate the presence of syphilis, after which treatment could begin. Such tests were conducted in Tennessee, Georgia, Alabama, North Carolina, and Virginia. (James 60).
Of the 40,000 African-Americans whose blood samples were taken, approximately 25% individuals had syphilis. The highest rates of syphilis among black men were found in Macon County, Alabama at a rate of 36%. (86,74). Treatment studies on the effectiveness of current medication to fight syphilis were done extensively in Macon County, and were found to be effective but expensive.
At this point in time two individuals begin to play a significant role in the story. Although the Rosenwald Fund was the origin of the project's financial foundation, the actual syphilis surveys and treatments were the work of the U.S. Public Health Service (PHS). After the discovery that treating all the individuals with syphilis would be financially impossible, an alternative was suggested. Dr. Oliver Wenger, director of the PHS's venereal disease clinic in Arkansas, proposed that a more realistic goal would be to render the carriers of the disease non-infectious. This possibility sounded promising, until disaster struck in 1931. In November of that year the Rosenwald Foundation was no longer capable of financing the studies and treatments. Dr. Taliaferro Clark, director of the PHS, then made a fateful suggestion: to turn the study into one on the effects of untreated syphilis in the black male. The new study was set up at the Tuskegee Institute, in Macon county, Alabama. (86).
Although Dr. Clark's original idea was for the study to last no longer than a year, the study continued for a significantly longer time period. After Dr. Clark retired in June of 1933, Dr. Raymond
Vonderlehr succeeded him as the director of the Division of Venereal Diseases. The assumption of control by Vonderlehr marked a transition of the study into ethically questionable practices. The subjects of the study were not only denied treatment (although they were given the appearance of being treated) but were also rushed towards autopsy by Vonderlehr for purposes of studying the effects of aging. This seemed to be an important goal for the scientists and doctors of the study; although syphilis does the most damage during youth, the fatality rate increases substantially with age. (179).
Peter Buxton, a PHS Venereal Disease interviewer and investigator, first heard of the study in the 1960s. He began investigating the methods of the study and found them to be disturbing. After unsuccessful attempts to reform the project, he reported the story to the press. On July 25, 1972 Jean Heller broke the story in the Washington Star. (James 191). The Tuskegee Study was subsequently disbanded.
One of the most prominent and obvious issues stemming from the Tuskegee Study is that of race and exploitation. The fact that all the individuals that were studied were African-American suggests a serious racial bias. During the 1930s, the study's origins, syphilis was believed to be rampant among black people because of what medical people believed to be their "high rate of sexual activity." (60). The study itself was based on two racist precepts: virtually all southern blacks were infected and the men involved in the study would never be treated anyway. (Brandt 153).
Another issue in the Tuskegee Study is that of science and ethics. At what point do the interests of science and humanity in general supersede those of a handful of human subjects? Despite the widespread denouncement of the study, information collected from it can still be found in textbooks, classrooms, and journals in the U.S. and abroad. (Brandt 16). Is the study then a value to society, one whose importance far outweighs the suffering of a small group of individuals? One complication to this viewpoint is penicillin. As of 1943 its properties as an effective treatment are known.
"In 1940 the death rate for syphilis had stood at 10.7
per 100,000; a decade later, after the widespread availability of
antibiotics, it was 5 per 100,000. In 1970, it was only .2 per
100,000." (Brandt 170-171).
With such a useful treatment, arguments in favor of the study as a greater good to society lose their appeal. That the study would continue until 1972 even with the availability of such medicine substantially threatens the moral footing of the study's supporters.
The story of the Tuskegee Study ignites strong emotions from many groups and stirs up many controversial issues. The subject of race is most frequently cited and analyzed, and there will forever remain the discussion concerning science in general and the ethics of its research methods. However, a considerable body of information suggests an even more important issue underlying the Tuskegee Study debacle- the roles of class and education in victimization.
According to Bill Jenkins, Adjunct Assistant Professor of Morehouse School of Medicine, a large group of black middle class individuals worked for the Tuskegee Study and were responsible for recruiting the black subjects of the experiment. In addition, a reported 127 black interns had passed through the program throughout its 40-year lifespan. (8). The information mentioned previously illustrates that the selection of destitute and uneducated subjects seemed socially and morally acceptable, irregardless of race. The following is a quote from Walter Mondale:
"I don't think that it is simply an issue of race. I
don't believe the Tuskegee Study would have been done to the
black middle class, or black upper-middle class. The victims of
Tuskegee were impoverished, politically impotent... They were
considered dead in the water as human beings." (7).
Indeed, the subjects were poorly educated and didn't even know that they had syphilis. They were simply told that they had "bad blood" and were to be treated. The treatments that they received during the study was "pink medicine" (aspirin). Since none of the men had ever had aspirin it seemed like a very effective cure to them. Such a method of deceit would not likely prevail against educated, middle-class individuals. (James 165).
In an out of court settlement, the U.S government agreed to pay ten million dollars to the families of the men involved. In addition, President Bill Clinton has apologized for the travesties committed upon these individuals. The Tuskegee Study is a painful lesson in history; one that hopefully will be learned and never again repeated.
Brandt, Allan M. No Magic Bullet. New York: Oxford
University Press, Inc., 1985.
Jones, James H. Bad Blood: The Tuskegee Syphilis Experiment.
New York: The Free Press, 1981.
Jones, Syl. A Dual Conference Report: Race, Prejudice, and Health Care, & Critical Condition. Minneapolis: Center for Biomedical Ethics at the University of Minnesota, 1992.