The U.S. government's 40-year experiment on black men with syphilis

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Feb 20, 2008, 4:38:51 PM2/20/08
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The Tuskegee Syphilis Experiment

The U.S. government's 40-year experiment on black men with syphilis

by Borgna Brunner

"The United States government did something that was wrong-deeply,
profoundly, morally wrong. It was an outrage to our commitment to integrity
and equality for all our citizens... clearly racist."

-President Clinton's apology for the Tuskegee Syphilis Experiment to the
eight remaining survivors, May 16, 1997

For forty years between 1932 and 1972, the U.S. Public Health Service (PHS)
conducted an experiment on 399 black men in the late stages of syphilis.
These men, for the most part illiterate sharecroppers from one of the
poorest counties in Alabama, were never told what disease they were
suffering from or of its seriousness. Informed that they were being treated
for "bad blood," their doctors had no intention of curing them of syphilis
at all.

The data for the experiment was to be collected from autopsies of the men,
and they were thus deliberately left to degenerate under the ravages of
tertiary syphilis-which can include tumors, heart disease, paralysis,
blindness, insanity, and death. "As I see it," one of the doctors involved
explained, "we have no further interest in these patients until they die."


Using Human Beings as Laboratory Animals

The true nature of the experiment had to be kept from the subjects to ensure
their cooperation. The sharecroppers' grossly disadvantaged lot in life made
them easy to manipulate. Pleased at the prospect of free medical care-almost
none of them had ever seen a doctor before-these unsophisticated and
trusting men became the pawns in what James Jones, author of the excellent
history on the subject, Bad Blood, identified as "the longest nontherapeutic
experiment on human beings in medical history."

The study was meant to discover how syphilis affected blacks as opposed to
whites-the theory being that whites experienced more neurological
complications from syphilis, whereas blacks were more susceptible to
cardiovascular damage. How this knowledge would have changed clinical
treatment of syphilis is uncertain.

Although the PHS touted the study as one of great scientific merit, from the
outset its actual benefits were hazy. It took almost forty years before
someone involved in the study took a hard and honest look at the end
results, reporting that "nothing learned will prevent, find, or cure a
single case of infectious syphilis or bring us closer to our basic mission
of controlling venereal disease in the United States."

When the experiment was brought to the attention of the media in 1972, news
anchor Harry Reasoner described it as an experiment that "used human beings
as laboratory animals in a long and inefficient study of how long it takes
syphilis to kill someone."


A Heavy Price in the Name of Bad Science

By the end of the experiment, 28 of the men had died directly of syphilis,
100 were dead of related complications, 40 of their wives had been infected,
and 19 of their children had been born with congenital syphilis. How had
these men been induced to endure a fatal disease in the name of science?

To persuade the community to support the experiment, one of the original
doctors admitted it "was necessary to carry on this study under the guise of
a demonstration and provide treatment." At first, the men were prescribed
the syphilis remedies of the day-bismuth, neoarsphenamine, and mercury- but
in such small amounts that only 3 percent showed any improvement.

These token doses of medicine were good public relations and did not
interfere with the true aims of the study. Eventually, all syphilis
treatment was replaced with "pink medicine"-aspirin.

To ensure that the men would show up for a painful and potentially dangerous
spinal tap, the PHS doctors misled them with a letter full of promotional
hype: "Last Chance for Special Free Treatment." The fact that autopsies
would eventually be required was also concealed.

As a doctor explained, "If the colored population becomes aware that
accepting free hospital care means a post-mortem, every darky will leave
Macon County..." Even the Surgeon General of the United States participated
in enticing the men to remain in the experiment, sending them certificates
of appreciation after 25 years in the study.


Following Doctors' Orders


It takes little imagination to ascribe racist attitudes to the white
government officials who ran the experiment, but what can one make of the
numerous African Americans who collaborated with them? The experiment's name
comes from the Tuskegee Institute, the black university founded by Booker T.
Washington. Its affiliated hospital lent the PHS its medical facilities for
the study, and other predominantly black institutions as well as local black
doctors also participated. A black nurse, Eunice Rivers, was a central
figure in the experiment for most of its forty years.

promise of recognition by a prestigious government agency may have obscured
the troubling aspects of the study for some. A Tuskegee doctor, for example,
praised "the educational advantages offered our interns and nurses as well
as the added standing it will give the hospital." Nurse Rivers explained her
role as one of passive obedience: "we were taught that we never diagnosed,
we never prescribed; we followed the doctor's instructions!"

It is clear that the men in the experiment trusted her and that she
sincerely cared about their well-being, but her unquestioning submission to
authority eclipsed her moral judgment. Even after the experiment was exposed
to public scrutiny, she genuinely felt nothing ethical had been amiss.

One of the most chilling aspects of the experiment was how zealously the PHS
kept these men from receiving treatment. When several nationwide campaigns
to eradicate venereal disease came to Macon County, the men were prevented
from participating. Even when penicillin-the first real cure for
syphilis-was discovered in the 1940s, the Tuskegee men were deliberately
denied the medication.

During World War II, 250 of the men registered for the draft and were
consequently ordered to get treatment for syphilis, only to have the PHS
exempt them. Pleased at their success, the PHS representative announced: "So
far, we are keeping the known positive patients from getting treatment." The
experiment continued in spite of the Henderson Act (1943), a public health
law requiring testing and treatment for venereal disease, and in spite of
the World Health Organization's Declaration of Helsinki (1964), which
specified that "informed consent" was needed for experiments involving human
beings.

Blowing the Whistle

The story finally broke in the Washington Star on July 25, 1972, in an
article by Jean Heller of the Associated Press. Her source was Peter Buxtun,
a former PHS venereal disease interviewer and one of the few whistle blowers
over the years. The PHS, however, remained unrepentant, claiming the men had
been "volunteers" and "were always happy to see the doctors," and an Alabama
state health officer who had been involved claimed "somebody is trying to
make a mountain out of a molehill."

Under the glare of publicity, the government ended their experiment, and for
the first time provided the men with effective medical treatment for
syphilis. Fred Gray, a lawyer who had previously defended Rosa Parks and
Martin Luther King, filed a class action suit that provided a $10 million
out-of-court settlement for the men and their families. Gray, however, named
only whites and white organizations as defendants in the suit, portraying
Tuskegee as a black and white case when it was in fact more complex than
that-black doctors and institutions had been involved from beginning to end.

The PHS did not accept the media's comparison of Tuskegee with the appalling
experiments performed by Nazi doctors on their Jewish victims during World
War II. Yet in addition to the medical and racist parallels, the PHS offered
the same morally bankrupt defense offered at the Nuremberg trials: they
claimed they were just carrying out orders, mere cogs in the wheel of the
PHS bureaucracy, exempt from personal responsibility.

The study's other justification-for the greater good of science-is equally
spurious. Scientific protocol had been shoddy from the start. Since the men
had in fact received some medication for syphilis in the beginning of the
study, however inadequate, it thereby corrupted the outcome of a study of
"untreated syphilis."


The Legacy of Tuskegee

In 1990, a survey found that 10 percent of African Americans believed that
the U.S. government created AIDS as a plot to exterminate blacks, and
another 20 percent could not rule out the possibility that this might be
true. As preposterous and paranoid as this may sound, at one time the
Tuskegee experiment must have seemed equally farfetched.

Who could imagine the government, all the way up to the Surgeon General of
the United States, deliberately allowing a group of its citizens to die from
a terrible disease for the sake of an ill-conceived experiment? In light of
this and many other shameful episodes in our history, African Americans'
widespread mistrust of the government and white society in general should
not be a surprise to anyone.

1. All quotations in the article are from Bad Blood: The Tuskegee Syphilis
Experiment, James H. Jones, expanded edition (New York: Free Press, 1993).

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