Ethics

Tuskegee Syphilis Study

President Clinton on May 16 apologized to eight elderly black men from Macon County,
Ala., for their victimization in a federally sponsored medical atrocity decades ago.
Though the men may be able to forgive, no one should forget what happened to them.

The Tuskegee syphilis study ran from 1932 until 1972, when U.S. Public Health Service
whistle-blower Peter Buxtun informed the national press of its details.

Over the 40 years of the Tuskegee study's existence, the researchers systematically
prevented the 399 black men who suffered from syphilis from receiving any treatment for this contagious, deadly
disease, even after penicillin was shown to cure syphilis safely and quickly in the 1940s.

As the men's syphilis progressed, damaging them beyond repair, the scientists observed the course of the disease. They
searched for racial differences in pathology compared with results obtained in Scandinavian studies on whites in the pre-
antibiotic era of incurable syphilis. (The scientists did not entertain any research proposal to replicate the dated studies
of the effects of untreated syphilis on Caucasian males.)

The 399 syphilitic men, and the 201 uninfected who were picked to serve as controls, were all uneducated and
desperately poor. Participation in the study offered them rewards: hot meals on the days the researchers visited; rides in
a shiny government car, to the envy of neighbours and friends; and, cruellest of all, the burial insurance which otherwise
most of them could never afford.

The scientists never explained to any of the study's participants just what their purpose was in returning, year after year,
to conduct physical examinations and collect blood samples.

In fact, these government-funded researchers lied to the men about the reason why they were repeatedly enduring "back
shots"-- spinal taps. The scientists claimed that these hazardous, painful procedures were therapeutic, when their sole
purpose was to let the doctors follow the trail of infection into the sufferers' spinal canals and brains.

They never told the syphilitic men that they might have infected their wives, or doomed their children to a devastating
congenital infection.

They never mentioned the diagnosis of syphilis to any of the study participants, even in response to direct questioning, at
any time during the forty-year history of the study. Instead, the scientists used the imprecise term, "bad blood," which
could be understood to describe a variety of illnesses.

Two years after the Tuskegee syphilis study hit the national press, the federal government settled out of court for
monetary damages with the 120 known surviving study participants and the heirs of the men who had died.

The 1974 settlement included free health care for life for the surviving study participants, to be provided by health care
workers chosen by the patients themselves. (The survivors had rejected the government's first offer, free care for life
from the same Public Health Service, which had run the disastrous experiment.) A year later, the government agreed to
the same medical arrangements for the men's infected wives and any of their children who had been born with
congenital syphilis.

While the old men from Alabama heard their president ask them for forgiveness, the rest of America should think about
the significance of the Tuskegee syphilis study.

The U.S. was confident enough of its moral rectitude to put Nazi medical experimenters on trial in the years following
World War II. It should never be forgotten that black lives in Alabama were no dearer to U.S. public health authorities
during the same era, and for a quarter-century to follow, than the lives of concentration camp inmates were to the Nazi
doctors.
The Tuskegee study presented many ethical problems. The men were already disadvantaged in terms of socioeconomic
status and medical condition. As research subjects, they faced additional risks. They were uninformed about the purpose
of the study and misled about the benefits they were to receive. Those who survived were denied treatment long after it
became available. The research design was also questionable. The researchers targeted a population to study a
problem that was not confined to that group.