Between the years of 1932 and 1972, the United States Public Health Service conducted a study of untreated syphilis on black men in Macon County, Alabama. Although these men were not purposely infected with the disease, the USPH service did recruit physicians, white and black, to NOT treat those men already diagnosed. It was felt that syphilis in a white male created more neurological deficits whereas in a black male, more cardiovascular, these of course not able to be determined while either was among the living and was only to be determined after the subject died and an autopsy was completed. Doctors not giving them treatment as they deserved, certainly deemed them as subjects, similar to lab specimens versus patients that warranted compassionate, proper and timely medical care. Over 600 black men were chosen for this study with over half already carrying the diagnosis of syphilis and 200 who did not. These men were picked mainly because of their environment, education, and race, with race being the largest factor. Those chosen for the study were mainly sharecroppers, with a lack of education and medical care; they were told that they were being treated for ‘bad blood’, which could have meant any number of different maladies, including syphilis.
“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” (Jones) Ethical implications of this study are wide and varied. The many methods that were used throughout the course of the study, such as failure to completely inform the men of their disease, or that they had the option quit the study at any time, failure to provide proper medical treatment, or that their families as well would become affected by this disease, all under the guise of free medical treatment, meals, transportation and burial insurance. Providing inadequate dosing for their disease insured that the public would see treatment being given without disturbing the true goals of the study. The men were misled and failed to receive all of the information necessary to make any sort of informed consent, although they freely agreed to be part of the study thinking they were receiving all they would need.
In the years that this experiment was being conducted, the black man did not, as a rule speak his mind or question what was being done. To do so, would surely mean jailing or death. With that being said the Public Health Service saw no problem to conducting this study. During the time of this study, it appears that the Public Health Service conducted this study with unwitting subjects under the umbrella of a government sanctioned medical investigation. No new drugs were tested, nor was there any effort to change the way syphilis was currently being treated. “What has become clear since the story was broken by Jean Heller in 1972 was that the Public Health Service was interested in using Macon County and its black inhabitants as a laboratory for studying the long term effects of untreated syphilis, not in treating this deadly disease.” (Reverby) The principal players were government physicians, with the subjects that were chosen, to be ones that were least able to speak for or to protect themselves.
It appears that with the offer of free incentives, the government took full advantage of these men and was openly “performing unethical and immoral experiments on human subjects.” (Reverby) These actions show that our government at this time, held very low regard for black male or his family. Not even to consider those that came after, those that were infected by the already diagnosed men, those that were born with congenital syphilis of that union or others that may be been infected through other means. This experiment only proved to be “the longest non therapeutic experiment on human beings in medical history”. (Reverby) These men were never given the adequate treatment for their disease. When Penicillin was proved to be the drug of choice in 1947, it was never offered or given to those already suffering the effects of syphilis. This also proves that our government was not interested in these men, but only what would be found after their demise. With all of this being brought to light, how would any black man, of the day and even the present, completely trust our government or its officers?
“In July 1972, under examination by the press, the PHS was not able to provide any formal protocol for the experiment, in fact, one never existed. While it was obvious to the American public as a whole, PHS officials maintained they did nothing wrong. By the time the story broke, over 100 of the infected men had died; others suffered from serious syphilis related conditions that may have contributed to their later deaths even though Penicillin, an effective treatment against syphilis, was in widespread use in 1946.” (Reverby) According to history, the physicians involved in the study never were held responsible and in fact felt betrayed by the government’s failure to defend the study they commissioned. It seemed that the physicians involved, counted on the fact that these poor, uneducated sharecroppers would not question the workings of the US government. This does not, however, answer the question of the Tuskegee Institute, a black university, and the black physicians and nurses that also played a role in the experiment. The promise of recognition from the government may have obscured any ethical questions that arose.
There was one nurse that was present throughout the study, Eunice Rivers. She provided unquestioned care and concern to the men in the study. “Her role was described 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.” (Reverby) At the end of this study, the government had no proof of the difference in a disease course between the white male versus the black male. As reported by Vanessa Northington Gamble, a physician and medical historian that chaired the presidential committee on the legacy of Tuskegee that secured an apology from the government;” In the 30 years since the newspaper story broke, the syphilis study has become a powerful metaphor, symbolizing racism in medicine, misconduct in human research, the arrogance of physicians and the government abuse of black people.
Efforts to improve the health status of African Americans have frequently come up against the legacy of the Tuskegee Syphilis Study. Many African Americans point to the study as a reason why they won’t participate in clinical trials, donate organs and more recently in the case of postal workers at the Brentwood post office in Washington, DC, are wary of being vaccinated against anthrax.” (Gamble) The distrust of our government has been an ever present scar on the face of our society. “Who could imagine the government, all the way to the Surgeon General of the United States, deliberately allowing a group of 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.” One would hope ( and pray) that with the advent of complete informed consent, training medical professionals in critical thinking and patient advocacy, the act of full disclosure would be utilized, and the progress of technology would keep the government from performing any other such heinous acts. Certainly, as in the case of the Tuskegee syphilis experiment, which was only expected to last 6 months and went on for 40 years, I do believe it would be possible to conduct such experiments, but then with the social media as wide spread as it is, and only getting larger, I do not feel that it would go on any great length of time without someone questioning its validity and ethical value.
Gamble, Vanessa N. “Tuskegee Lessons Syphilis Study Leaves behind Legacy of Mistrust”
Jones, James H. Bad Blood: The Tuskegee Syphilis Experiment. 1993. Infoplease.com/spot/bhmtuskegeel.html
Reverby, Susan M. “America’s Nuremberg,” The Tuskegee Study. 08-30-1932