Tuskegee Syphilis Essay Instructions Assignment Instruction: You are to read the article, Read Racism and Research: the Case of the Tuskegee Syphilis Study by Allan M. Brandt. Once you have completed reading the article you will answer the questions below in essay format. Your essay should follow APA formatting. Question 1: In your own words, write 1-2 paragraphs describing the events presented in the essay. Answer each of the following specific questions in your response: § What were the main discussion points of the essay? § What were the results and consequences of the study? § Would it be acceptable to replicate this study today? Why? Or § Why not? § Was this study ethical/unethical? Explain why. Question 2: Using one of the three major sociological perspectives presented in this course (Functional, Conflict, or Interactionist), explain the events described in the essay. For the sociological perspective you choose, apply the perspective to the article and draw one or more conclusions from your analysis. Question 3: Connect what you read in the essay to any material presented in this course – be sure to use at least 3-5 terms from the text/lecture (use your glossary) Formatting Instructions § Using APA format (which include abstract) – 12 font/double space § Assignment will consist of cover sheet (name, class, date, Professor) § A References page § Essay Should be between 3-5 pages Racism and Research: The Case of the Tuskegee Syphilis Study The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Brandt, Allan M. 1978. "Racism and research: The case of the Tuskegee Syphilis study." The Hastings Center Report 8(6): 21-29. Published Version http://www.jstor.org/stable/3561468 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:3372911 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-ofuse#LAA THE EXPERIMENT AND HEW'S ETHICALREVIEW Racism the and Research: Tuskegee The Syphilis Case I of Study by ALLAN M. BRANDT In 1932 the U.S. PublicHealthService(USPHS)initiated an experimentin MaconCounty,Alabama,to determinethe naturalcourse of untreated,latent syphilis in black males. The test comprised400 syphiliticmen, as well as 200 uninfectedmen who servedas controls.The firstpublishedreport of the studyappearedin 1936 with subsequentpapersissued every four to six years, throughthe 1960s. Whenpenicillin becamewidelyavailableby the early 1950s as the preferred treatmentfor syphilis,the men did not receive therapy.In fact on severaloccasions,the USPHSactuallysoughtto prevent treatment.Moreover,a committeeat the federallyoperatedCenterfor Disease Controldecidedin 1969 that the studyshouldbe continued.Only in 1972, when accountsof the studyfirstappearedin the nationalpress,did the Departmentof Health,Educationand Welfarehalt the experiment. At that time seventy-fourof the test subjectswere still alive; at least twenty-eight,but perhapsmore than 100, had died directlyfrom advancedsyphiliticlesions.1In August 1972, HEWappointedan investigatorypanelwhichissueda report the followingyear. The panel foundthe studyto have been "ethicallyunjustified,"and argued that penicillin should have been providedto the men.2 This articleattemptsto placethe TuskegeeStudyin a historicalcontextand to assessits ethicalimplications.Despite the mediaattentionwhichthe studyreceived,the HEWFinal Report, and the criticismexpressedby severalprofessional organizations,the experimenthas been largely misunderstood.The mostbasicquestionsof how the studywas undertaken in the firstplace and why it continuedfor forty years were never addressedby the HEW investigation.Moreover, the panel misconstruedthe natureof the experiment,failing to consult importantdocumentsavailable at the National Archiveswhich bear significantlyon its ethical assessment. Only by examiningthe specific ways in which values are engagedin scientificresearchcan the studybe understood. Racismand MedicalOpinion A brief reviewof the prevailingscientificthoughtregarding race andheredityin the earlytwentiethcenturyis fundamentalfor an understandingof the TuskegeeStudy.By the turn of the century,Darwinismhad provideda new rationM. BRANDT is a doctoralcandidatein the Department of History, Columbia University. He is presently writing a social history of venereal disease in the United States. Mr. Brandtwas a student intern at The HastingsCenterin 1977. ALLAN The HastingsCenter ale for Americanracism.3Essentiallyprimitivepeoples, it was argued,could not be assimilatedinto a complex,white civilization.Scientistsspeculatedthat in the strugglefor survival the Negro in Americawas doomed.Particularlyprone to disease, vice, and crime, black Americanscould not be helpedby educationor philanthropy.Social Darwinistsanalyzed census data to predict the virtual extinction of the Negro in the twentiethcentury,for they believedthe Negro race in Americawas in the throes of a degenerativeevolutionaryprocess.4 The medical professionsupportedthese findingsof late nineteenth-andearlytwentieth-century anthropologists,ethand biologists. Physiciansstudyingthe effects of nologists, on emancipation health concluded almost universallythat freedomhad caused the mental, moral, and physicaldeteriorationof the black population.5They substantiatedthis argumentby citingexamplesin the comparativeanatomyof the black and white races. As Dr. W. T. Englishwrote: "A careful inspectionrevealsthe body of the negro a mass of minordefectsand imperfectionsfromthe crownof the head to the soles of the feet.. .." Cranial structures, wide nasal apertures,recedingchins, projectingjaws, all typed the Negro as the lowest species in the Darwinianhierarchy.7 Interestin racialdifferencescenteredon the sexualnature of blacks.The Negro,doctorsexplained,possessedan excessive sexualdesire,which threatenedthe very foundationsof white society. As one physiciannoted in the Journalof the American Medical Association, "The negro springs from a southernrace, and as such his sexual appetiteis strong;all of his environmentsstimulatethis appetite,and as a general rule his emotionaltype of religion certainlydoes not decrease it."8 Doctors reported a complete lack of morality on the part of blacks: Virtue in the negro race is like angels' visits-few and far between.In a practiceof sixteen years I have never examined a virgin negro over fourteen years of age.9 A particularlyominousfeatureof this overzealoussexuality, doctorsargued,wasthe blackmales'desirefor whitewomen. "A perversionfrom which most races are exempt,"wrote Dr. English,"promptsthe negro'sinclinationtowardswhite women,whereasotherraces inclinetowardsfemalesof their own."10Though English estimatedthe "graymatterof the negrobrain"to be at least a thousandyears behindthat of the white races, his genital organswere overdeveloped.As Dr. WilliamLee Howardnoted: The attacks on defenseless white women are evidences of racial instinctsthat are about as amenableto ethical culture as is the inherentodor of the race .... When educationwill 21 I reducethe size of the negro'spenis as well as bring about the sensitivenessof the terminalfibers which exist in the Caucasian, then will it also be able to prevent the African'sbirthright to sexual madnessand excess." One southern medical journal proposed "Castration Instead of Lynching," as retribution for black sexual crimes. "An impressive trial by a ghost-like kuklux klan [sic] and a 'ghost' physician or surgeon to perform the operation would make it an event the 'patient' would never forget," noted the editorial.12 According to these physicians, lust and immorality, unstable families, and reversion to barbaric tendencies made blacks especially prone to venereal diseases. One doctor estimated that over 50 percent of all Negroes over the age of twenty-five were syphilitic.13 Virtually free of disease as slaves, they were now overwhelmed by it, according to informed medical opinion. Moreover, doctors believed that treatment for venereal disease among blacks was impossible, particularly because in its latent stage the symptoms of syphilis become quiescent. As Dr. Thomas W. Murrell wrote: They come for treatmentat the beginning and at the end. When there are visible manifestationsor when harried by pain, they readily come, for as a race they are not averse to physic;but tell them not, though they look well and feel well, that they are still diseased. Here ignorance rates science a fool... 14 Even the best educated black, according to Murrell, could not be convinced to seek treatment for syphilis.15Venereal disease, according to some doctors, threatened the future of the race. The medical profession attributedthe low birth rate among blacks to the high prevalence of venereal disease which caused stillbirths and miscarriages. Moreover, the high rates of syphilis were thought to lead to increased insanity and crime. One doctor writing at the turn of the century estimated that the number of insane Negroes had increased thirteen-fold since the end of the Civil War.'1 Dr. Murrell's conclusion echoed the most informed anthropological and ethnological data: So the scourge sweeps among them. Those that are treated are only half cured, and the effort to assimilate a complex civilizationdriving their diseased minds until the results are criminalrecords.Perhapshere, in conjunctionwith tuberculosis, will be the end of the negro problem. Disease will accomplish what man cannot do.17 This particular configuration of ideas formed the core of medical opinion concerning blacks, sex, and disease in the early twentieth century. Doctors generally discounted socioeconomic explanations of the state of black health, arguing that better medical care could not alter the evolutionary scheme.'8 These assumptions provide the backdrop for examining the Tuskegee Syphilis Study. The Origins of the Experiment In 1929, under a grant from the Julius Rosenwald Fund, the USPHS conducted studies in the rural South to determine the prevalence of syphilis among blacks and explore the 22 I possibilities for mass treatment. The USPHS found Macon County, Alabama, in which the town of Tuskegee is located, to have the highest syphilis rate of the six counties surveyed. The Rosenwald Study concluded that mass treatment could be successfully implemented among rural blacks.19Although it is doubtful that the necessary funds would have been allocated even in the best economic conditions, after the economy collapsed in 1929, the findings were ignored. It is, however, ironic that the Tuskegee Study came to be based on findings of the Rosenwald Study that demonstrated the possibilities of mass treatment. Three years later, in 1932, Dr. Taliaferro Clark, Chief of the USPHS Venereal Disease Division and author of the Rosenwald Study report, decided that conditions in Macon County merited renewed attention. Clark believed the high prevalence of syphilis offered an "unusual opportunity" for observation. From its inception, the USPHS regarded the Tuskegee Study as a classic "study in nature,"* rather than an experiment.20As long as syphilis was so prevalent in Macon and most of the blacks went untreated throughout life, it seemed only natural to Clark that it would be valuable to observe the consequences. He described it as a "ready-made situation."21Surgeon General H. S. Cumming wrote to R. R. Moton, Director of the Tuskegee Institute: The recent syphiliscontrol demonstrationcarriedout in Macon County,with the financialassistanceof the Julius Rosenwald Fund, revealed the presence of an unusuallyhigh rate in this county and, what is more remarkable,the fact that 99 per cent of this group was entirely without previous treatment. This combination,togetherwith the expected cooperation of your hospital, offers an unparalleledopportunityfor carryingon this piece of scientific research which probably cannot be duplicatedanywhere else in the world.22 Although no formal protocol appears to have been written, several letters of Clark and Cumming suggest what the USPHS hoped to find. Clark indicated that it would be important to see how disease affected the daily lives of the men: The resultsof these studies of case recordssuggestthe desirability of making a further study of the effect of untreated syphilison the humaneconomy amongpeople now living and engaged in their daily pursuits.23 It also seems that the USPHS believed the experiment might demonstrate that antisyphilitic treatment was unnecessary. As Cumming noted: "It is expected the results of this study may have a marked bearing on the treatment, or conversely the non-necessity of treatment, of cases of latent syphilis."24 The immediate source of Cumming's hypothesis appears to have been the famous Oslo Study of untreated syphilis. Between 1890 and 1910, Professor C. Boeck, the chief of the *In 1865, ClaudeBernard,the famousFrenchphysiologist,outlinedthe distinctionbetweena "studyin nature"andexperimentation. A studyin naturerequiredsimpleobservation,an essentiallypassive demandedinterventionwhichalteredthe act, whileexperimentation originalcondition.The TuskegeeStudywas thus clearlynot a study in nature.The very act of diagnosisalteredthe originalconditions. "Itis on thisverypossibilityof actingor not actingon a body,"wrote Bernard,"thatthe distinctionwill exclusivelyrest betweensciences n andsciences callscincf alled sciencesof observation ens calledexperimental." Hastings Center Report, December 1978 I Oslo Venereal Clinic, withheld treatment from almost two thousand patients infected with syphilis. He was convinced that therapies then available, primarily mercurial ointment, were of no value. When arsenic therapy became widely available by 1910, after Paul Ehrlich's historic discovery of "606," the study was abandoned. E. Bruusgaard, Boeck's successor, conducted a follow-up study of 473 of the untreated patients from 1925 to 1927. He found that 27.9 percent of these patients had undergone a "spontaneous cure," and now manifested no symptoms of the disease. Moreover, he estimated that as many as 70 percent of all syphilitics went through life without inconvenience from the disease.25 His study, however, clearly acknowledged the dangers of untreated syphilis for the remaining 30 percent. Thus every major textbook of syphilis at the time of the Tuskegee Study's inception strongly advocated treating syphilis even in its latent stages, which follow the initial inflammatory reaction. In discussing the Oslo Study, Dr. J. E. Moore, one of the nation's leading venereologists wrote, "This summary of Bruusgaard's study is by no means intended to suggest that syphilis be allowed to pass untreated."26If a complete cure could not be effected, at least the most devastating effects of the disease could be avoided. Although the standard therapies of the time, arsenical compounds and bismuth injection, involved certain dangers because of their toxicity, the alternatives were much worse. As the Oslo Study had shown, untreated syphilis could lead to cardiovascular disease, insanity, and premature death.27 Moore wrote in his 1933 textbook: Though it imposesa slight though measurablerisk of its own, treatmentmarkedlydiminishesthe risk from syphilis. In latent syphilis, as I shall show, the probabilityof progression, relapse, or death is reduced from a probable25-30 percent without treatmentto about 5 percent with it; and the gravity of the relapse if it occurs, is markedlydiminished.28 "Another compelling reason for treatment," noted Moore, "exists in the fact that every patient with latent syphilis may be, and perhaps is, infectious for others."29In 1932, the year in which the Tuskegee Study began, the USPHS sponsored and published a paper by Moore and six other syphilis experts that strongly argued for treating latent syphilis.30 The Oslo Study, therefore, could not have provided justification for the USPHS to undertake a study that did not entail treatment. Rather, the suppositions that conditions in Tuskegee existed "naturally"and that the men would not be treated anyway provided the experiment's rationale. In turn, these two assumptions rested on the prevailing medical attitudes concerning blacks, sex, and disease. For example, Clark explained the prevalence of venereal disease in Macon County by emphasizing promiscuity among blacks: This state of affairsis due to the paucityof doctors,ratherlow intelligenceof the Negro populationin this section, depressed economic conditions, and the very common promiscuoussex relationsof this populationgroup which not only contribute to the spreadof syphilis but also contributeto the prevailing indifferencewith regardto treatment.31 In fact, Moore, who had written so persuasively in favor The HastingsCenter of treating latent syphilis, suggested that existing knowledge did not apply to Negroes. Although he had called the Oslo Study "a never-to-be-repeated human experiment,"32 he served as an expert consultant to the Tuskegee Study: I think that such a study as you have contemplatedwould be of immense value. It will be necessary of course in the considerationof the results to evaluate the special factors introduced by a selection of the materialfrom negro males. Syphilis in the negro is in many respectsalmost a differentdisease from syphilisin the white.33 Dr. O. C. Wenger, chief of the federally operated venereal disease clinic at Hot Springs, Arkansas, praised Moore's judgment, adding, "This study will emphasize those differences."34On another occasion he advised Clark, "We must remember we are dealing with a group of people who are illiterate, have no conception of time, and whose personal history is always indefinite."35 The doctors who devised and directed the Tuskegee Study accepted the mainstream assumptions regarding blacks and venereal disease. The premise that blacks, promiscuous and lustful, would not seek or continue treatment, shaped the study. A test of untreated syphilis seemed "natural"because the USPHS presumed the men would never be treated; the Tuskegee Study made that a self-fulfilling prophecy. Selecting the Subjects Clark sent Dr. Raymond Vonderlehr to Tuskegee in September 1932 to assemble a sample of men with latent syphilis for the experiment. The basic design of the study called for the selection of syphilitic black males between the ages of twenty-five and sixty, a thorough physical examination including x-rays, and finally, a spinal tap to determine the incidence of neuro-syphilis.3(;They had no intention of providing any treatment for the infected men.:7 The USPHS originally scheduled the whole experiment to last six months; it seemed to be both a simple and inexpensive project. The task of collecting the sample, however, proved to be more difficult than the USPHS had supposed. Vonderlehr canvassed the largely illiterate, poverty-stricken population of sharecroppers and tenant farmers in search of test subjects. If his circulars requested only men over twenty-five to attend his clinics, none would appear, suspecting he was conducting draft physicals. Therefore, he was forced to test large numbers of women and men who did not fit the experiment's specifications. This involved considerable expense since the USPHS had promised the Macon County Board of Health that it would treat those who were infected, but not included in the study.38Clark wrote to Vonderlehr about the situation: "It never once occured to me that we would be called upon to treat a large part of the county as return for the privilege of making this study.... I am anxious to keep the expenditures for treatment down to the lowest possible point because it is the one item of expenditure in connection with the study most difficult to defend despite our knowledge of the need therefor."39Vonderlehr responded: "If we could find from 100 to 200 cases ... we would not have to do another Wassermann on useless individuals .. ."4 23 Significantly, the attempt to develop the sample contradicted the prediction the USPHS had made initially regarding the prevalence of the disease in Macon County. Overall rates of syphilis fell well below expectations; as opposed to the USPHS projection of 35 percent, 20 percent of those tested were actually diseased.41 Moreover, those who had sought and received previous treatment far exceeded the expectations of the USPHS. Clark noted in a letter to Vonderlehr: I find your report of March 6th quite interestingbut regret the necessityfor Wassermanning[sic] . . . such a large number of individualsin order to uncover this relativelylimited numberof untreatedcases.42 Further difficulties arose in enlisting the subjects to participate in the experiment, to be "Wassermanned," and to return for a subsequent series of examinations. Vonderlehr found that only the offer of treatment elicited the cooperation of the men. They were told they were ill and were promised free care. Offered therapy, they became willing subjects.43 The USPHS did not tell the men that they were participants in an experiment; on the contrary, the subjects believed they were being treated for "bad blood"-the rural South's colloquialism for syphilis. They thought they were participating in a public health demonstration similar to the one that had been conducted by the Julius Rosenwald Fund in Tuskegee several years earlier. In the end, the men were so eager for medical care that the number of defaulters in the experiment proved to be insignificant.44 To preserve the subjects' interest, Vonderlehr gave most of the men mercurial ointment, a noneffective drug, while some of the younger men apparently received inadequate dosages of neoarsphenamine.45This required Vonderlehr to write frequently to Clark requesting supplies. He feared the experiment would fail if the men were not offered treatment. It is desirableand essentialif the study is to be a success to maintain the interest of each of the cases examined by me through to the time when the spinal puncture can be completed. Expenditureof several hundreddollars for drugs for these men would be well worth while if their interestand cooperationwould be maintainedin so doing.... It is my desire to keep the main purposeof the work from the negroesin the county and continue their interestin treatment.That is what the vast majoritywants and the examinationseems relatively unimportantto them in comparison.It would probablycause the entire experimentto collapse if the clinics were stopped before the work is completed.46 On another occasion he explained: Dozens of patients have been sent away without treatment duringthe past two weeks and it would have been impossible to continuewithout the free distributionof drugs because of the unfavorableimpressionmade on the negro.47 The readiness of the test subjects to participate of course contradicted the notion that blacks would not seek or continue therapy. The final procedure of the experiment was to be a spinal tap to test for evidence of neuro-syphilis. The USPHS presented this purely diagnostic exam, which often entails considerable pain and complications, to the men as a "special 24 treatment." Clark explained to Moore: We have not yet commencedthe spinal punctures.This operationwill be deferredto the last in ordernot to undulydisturb our field work by any adverse reports by the patients subjected to spinal puncturebecause of some disagreeablesensations following this procedure.These negroes are very ignorant and easily influencedby things that would be of minor significancein a more intelligent group.48 The letter to the subjects announcing the spinal tap read: Some time ago you were given a thorough examinationand since that time we hope you have gotten a great deal of treatment for bad blood. You will now be given your last chance to get a second examination.This examinationis a very special one and after it is finished you will be given a special treatmentif it is believed you are in a conditionto standit.... REMEMBERTHIS IS YOUR LAST CHANCEFOR SPECIAL FREE TREATMENT. BE SURE TO MEET THE NURSE.49 The HEW investigation did not uncover this crucial fact: the men participated in the study under the guise of treatment. Despite the fact that their assumption regarding prevalence and black attitudes toward treatment had proved wrong, the USPHS decided in the summer of 1933 to continue the study. Once again, it seemed only "natural"to pursue the research since the sample already existed, and with a depressed economy, the cost of treatment appeared prohibitive-although there is no indication it was ever considered. Vonderlehr first suggested extending the study in letters to Clark and Wenger: At the end of this projectwe shall have a considerablenumber of cases presentingvariouscomplicationsof syphilis,who have received only mercury and may still be considereduntreatedin the modernsense of therapy.Should these cases be followed over a period of from five to ten years many interesting facts could be learned regardingthe course and complicationsof untreatedsyphilis.50 "As I see it," responded Wenger, "we have no further interest in these patients until they die."51Apparently, the physicians engaged in the experiment believed that only autopsies could scientifically confirm the findings of the study. Surgeon General Cumming explained this in a letter to R. R. Moton, requesting the continued cooperation of the Tuskegee Institute Hospital: This study which was predominantlyclinical in character points to the frequentoccurrenceof severe complicationsinvolving the variousvital organsof the body and indicatesthat syphilis as a disease does a great deal of damage. Since clinical observations are not considered final in the medical world, it is our desire to continue observationon the cases selected for the recent study and if possible to bring a percentage of these cases to autopsy so that pathological confirmationmay be made of the disease processes.52 Bringing the men to autopsy required the USPHS to devise a further series of deceptions and inducements. Wenger warned Vonderlehr that the men must not realize that they would be autopsied: Hastings Center Report, December 1978 Thereis one dangerin the latterplan and that is if the colored population become aware that accepting free hospital care means a post-mortem,every darkeywill leave Macon County and it will hurt [Dr. Eugene] Dibble's hospital.'53 "Naturally," responded Vonderlehr, "it is not my intention to let it be generally known that the main object of the present activities is the bringing of the men to necropsy."54The subjects' trust in the USPHS made the plan viable. The USPHS gave Dr. Dibble, the Director of the Tuskegee Institute Hospital, an interim appointment to the Public Health Service. As Wenger noted: One thing is certain.The only way we are going to get postmortemsis to have the demise take place in Dibble'shospital and when these colored folks are told that Doctor Dibble is now a Government doctor too they will have more confidence.55* After the USPHS approved the continuation of the experiment in 1933, Vonderlehr decided that it would be necessary to select a group of healthy, uninfected men to serve as controls. Vonderlehr, who had succeeded Clark as Chief of the Venereal Disease Division, sent Dr. J. R. Heller to Tuskegee to gather the control group. Heller distributed drugs (noneffective) to these men, which suggests that they also believed they were undergoing treatment.5;'Control subjects who became syphilitic were simply transferred to the test group-a strikingly inept violation of standard research procedure.57 The USPHS offered several inducements to maintain contact and to procure the continued cooperation of the men. Eunice Rivers, a black nurse, was hired to follow their health and to secure approval for autopsies. She gave the men noneffective medicines-"spring tonic" and aspirin-as well as transportation and hot meals on the days of their examinations.58 More important, Nurse Rivers provided continuity to the project over the entire forty-year period. By supplying "medicinals," the USPHS was able to continue to deceive the participants, who believed that they were receiving therapy from the government doctors. Deceit was integral to the study. When the test subjects complained about spinal taps one doctor wrote: *Thedegreeof blackcooperationin conductingthe studyremains unclearandwouldbe impossibleto properlyassessin anarticleof this length.It seemscertainthatsomemembersof the TuskegeeInstitute staffsuchas R. R. Motonand EugeneDibbleunderstoodthe nature of the experimentand gave their supportto it. There is, however, evidencethatsome blackswho assistedthe USPHSphysicianswere not awareof the deceptivenatureof the experiment.Dr. Joshua Williams,an intern at the John A. Andrew MemorialHospital (TuskegeeInstitute)in 1932, assistedVonderlehrin takingblood samplesof the testsubjects.In 1973he told the HEWpanel:"Iknow we thoughtit was merelya servicegrouporganizedto helpthe people in thearea.Wedidn'tknowit wasa researchprojectat all at thetime." of Proceedings," TuskegeeSyphilisStudyAd Hoc (See, "Transcript National typescript. AdvisoryPanel,February23, 1973,Unpublished Libraryof Medicine,Bethesda,Maryland.)It is also apparentthat EuniceRivers,the blacknursewho had primaryresponsibilityfor maintainingcontactwith the men over the fortyyears,did not fully In anyevent,blackinvolvethedangersof theexperiment. understand of the mentin the studyin no way mitigatesthe racialassumptions theirpower. experiment,butrather,demonstrates The HastingsCenter They simply do not like spinal punctures.A few of those who were tapped are enthusiasticover the resultsbut to most, the suggestion causes violent shaking of the head; others claim they were robbed of their procreativepowers (regardlessof the fact that I claim it stimulatesthem).59 Letters to the subjects announcing an impending USPHS visit to Tuskegee explained: "[The doctor] wants to make a special examination to find out how you have been feeling and whether the treatment has improved your health."60In fact, after the first six months of the study, the USPHS had furnished no treatment whatsoever. Finally, because it proved difficult to persuade the men to come to the hospital when they became severely ill, the USPHS promised to cover their burial expenses. The Milbank Memorial Fund provided approximately $50 per man for this purpose beginning in 1935. This was a particularly strong inducement as funeral rites constituted an important component of the cultural life of rural blacks.61 One report of the study concluded, "Without this suasion it would, we believe, have been impossible to secure the cooperation of the group and their families."62 Reports of the study's findings, which appeared regularly in the medical press beginning in 1936, consistently cited the ravages of untreated syphilis. The first paper, read at the 1936 American Medical Association annual meeting, found "that syphilis in this period [latency] tends to greatly increase the frequency of manifestations of cardiovascular disease."63 Only 16 percent of the subjects gave no sign of morbidity as opposed to 61 percent of the controls. Ten years later, a report noted coldly, "The fact that nearly twice as large a proportion of the syphilitic individuals as of the control group has died is a very striking one." Life expectancy, concluded the doctors, is reduced by about 20 percent.64 A 1955 article found that slightly more than 30 percent of the test group autopsied had died directly from advanced syphilitic lesions of either the cardiovascular or the central nervous system.65 Another published account stated, "Review of those still living reveals that an appreciable number have late complications of syphilis which probably will result, for some at least, in contributing materially to the ultimate cause of death.""6In 1950, Dr. Wenger had concluded, "We now know, where we could only surmise before, that we have contributed to their ailments and shortened their lives."67As black physician Vernal Cave, a member of the HEW panel, later wrote, "They proved a point, then proved a point, then proved a point."68 During the forty years of the experiment the USPHS had sought on several occasions to ensure that the subjects did not receive treatment from other sources. To this end, Vonderlehr met with groups of local black doctors in 1934, to ask their cooperation in not treating the men. Lists of subjects were distributed to Macon County physicians along with letters requesting them to refer these men back to the USPHS if they sought care.69 The USPHS warned the Alabama Health Department not to treat the test subjects when they took a mobile VD unit into Tuskegee in the early 1940s.T0 In 1941, the Army drafted several subjects and told them to begin antisyphilitic treatment immediately. The 25 USPHS supplied the draft board with a list of 256 names they desired to have excluded from treatment, and the board complied.7" In spite of these efforts, by the early 1950s many of the men had secured some treatment on their own. By 1952, almost 30 percent of the test subjects had received some penicillin, although only 7.5 percent had received what could be considered adequate doses.72 Vonderlehr wrote to one of the participating physicians, "I hope that the availability of antibiotics has not interfered too much with this project."73 A report published in 1955 considered whether the treatment that some of the men had obtained had "defeated" the study. The article attempted to explain the relatively low exposure to penicillin in an age of antibiotics, suggesting as a reason: "the stoicism of these men as a group; they still regard hospitals and medicines with suspicion and prefer an occasional dose of time-honored herbs or tonics to modern drugs."74The authors failed to note that the men believed they already were under the care of the government doctors and thus saw no need to seek treatment elsewhere. Any treatment which the men might have received, concluded the report, had been insufficient to compromise the experiment. When the USPHS evaluated the status of the study in the 1960s they continued to rationalize the racial aspects of the experiment. For example, the minutes of a 1965 meeting at the Center for Disease Control recorded: Racial issue was mentionedbriefly.Will not affect the study. Any questionscan be handledby saying these people were at the point that therapywould no longer help them. They are getting better medical care than they would under any other circumstances.75 A group of physicians met again at the CDC in 1969 to de- Claude Bernard on Human Experimentation (1865) Experiments,then, may be performedon man, but within what limits? It is our duty and our right to perform an experimenton man wheneverit can save his life, cure him or gain him some personalbenefit. The principleof medical and surgical morality, therefore, consists in never performingon man an experimentwhich might be harmful to him to any extent, even though the result might be highly advantageousto science, i.e., to the healthof others. But performing experiments and operations exclusively from the point of view of the patient'sown advantagedoes not preventtheir turningout profitablyto science. ... For we must not deceive ourselves,moralsdo not forbid making experimentson one's neighboror on one's self. Christian morals forbid only one thing, doing ill to one's neighbor. So, among the experimentsthat may be tried on man, those that can only harm are forbidden, those that are innocent are permissible,and those that may do good are obligatory.Claude Bernard,An Introductionto the Study of Experimental Medicine (1865). Trans. by Henry C. Green (New York:Dover Publications,1957). 26 cide whether or not to terminate the study. Although one doctor argued that the study should be stopped and the men treated, the consensus was to continue. Dr. J. Lawton Smith remarked, "You will never have another study like this; take advantage of it."7TA memo prepared by Dr. James B. Lucas, Assistant Chief of the Venereal Disease Branch, stated: "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."77He concluded, however, that the study should be continued "along its present lines." When the first accounts of the experiment appeared in the national press in July 1972, data were still being collected and autopsies performed.78 The HEW Final Report HEW finally formed the Tuskegee Syphilis Study Ad Hoc Advisory Panel on August 28, 1972, in response to criticism that the press descriptions of the experiment had triggered. The panel, composed of nine members, five of them black, concentrated on two issues. First, was the study justified in 1932 and had the men given their informed consent? Second, should penicillin have been provided when it became available in the early 1950s? The panel was also charged with determining if the study should be terminated and assessing current policies regarding experimentation with human subjects.79The group issued their report in June 1973. By focusing on the issues of penicillin therapy and informed consent, the Final Report and the investigation betrayed a basic misunderstandingof the experiment's purposes and design. The HEW report implied that the failure to provide penicillin constituted the study's major ethical misjudgment; implicit was the assumption that no adequate therapy existed prior to penicillin. Nonetheless medical authorities From the HEW Final Report (1973) 1. In retrospect, the Public Health Service Study of UntreatedSyphilis in the Male Negro in Macon County, Alabama, was ethically unjustifiedin 1932. This judgement made in 1973 aboutthe conduct of the study in 1932 is made with the advantageof hindsightacutelysharpened over some forty years, concerningan activityin a different age with differentsocial standards.Nevertheless,one fundamentalethical rule is that a person should not be subjected to avoidablerisk of death or physical harm unless he freely and intelligentlyconsents. There is no evidence that such consent was obtained from the participantsin this study. 2. Because of the paucity of informationavailable today on the mannerin which the study was conceived, designed and sustained, a scientific justificationfor a short term demonstrationstudy cannot be ruled out. However, the conduct of the longitudinalstudy as initially reported in 1936 and throughthe years is judgedto be scientifically unsound and its results are disproportionatelymeager comparedwith knownrisksto humansubjectsinvolved.... HastingsCenterReport,December1978 firmly believed in the efficacy of arsenotherapy for treating syphilis at the time of the experiment's inception in 1932. The panel further failed to recognize that the entire study had been predicated on nontreatment. Provision of effective medication would have violated the rationale of the experiment-to study the natural course of the disease until death. On several occasions, in fact, the USPHS had prevented the men from receiving proper treatment. Indeed, there is no evidence that the USPHS ever considered providing penicillin. The other focus of the Final Report-informed consentalso served to obscure the historical facts of the experiment. In light of the deceptions and exploitations which the experiment perpetrated, it is an understatement to declare, as the Report did, that the experiment was "ethically unjustified," because it failed to obtain informed consent from the subjects. The Final Report's statement, "Submittingvoluntarily is not informed consent," indicated that the panel believed that the men had volunteered for the experiment.80 The records in the National Archives make clear that the men did not submit voluntarily to an experiment; they were told and they believed that they were getting free treatment from expert government doctors for a serious disease. The failure of the HEW Final Report to expose this critical fact-that the USPHS lied to the subjects-calls into question the thoroughness and credibility of their investigation. Failure to place the study in a historical context also made it impossible for the investigation to deal with the essentially racist nature of the experiment. The panel treated the study as an aberration, well-intentioned but misguided.81 Moreover, concern that the Final Report might be viewed as a critique of human experimentation in general seems to have severely limited the scope of the inquiry. The Final Report is quick to remind the reader on two occasions: "The position of the Panel must not be construed to be a general repudiation of scientific research with human subjects."82The Report assures us that a better designed experiment could have been justified: It is possiblethat a scientificstudy in 1932 of untreatedsyphilis, properlyconceived with a clear protocol and conducted with suitable subjectswho fully understoodthe implications of their involvement, might have been justified in the prepenicillin era. This is especiallytrue when one considersthe uncertain nature of the results of treatment of late latent syphilisand the highly toxic natureof therapeuticagentsthen available.83 This statement is questionable in view of the proven dangers of untreated syphilis known in 1932. Since the publication of the HEW Final Report, a defense of the Tuskegee Study has emerged. These arguments, most clearly articulated by Dr. R. H. Kampmeier in the Southern Medical Journal, center on the limited knowledge of effective therapy for latent syphilis when the experiment began. Kampmeier argues that by 1950, penicillin would have been of no value for these men.84 Others have suggested that the men were fortunate to have been spared the highly toxic treatments of the earlier period.85 Moreover, even these contemporary defenses assume that the men never would have been treated anyway. As Dr. Charles Barnett of StanThe HastingsCenter ford University wrote in 1974, "The lack of treatment was not contrived by the USPHS but was an established fact of which they proposed to take advantage."86Several doctors who participated in the study continued to justify the experiment. Dr. J. R. Heller, who on one occasion had referred to the test subjects as the "Ethiopian population," told reporters in 1972: I don't see why they should be shocked or horrified.There was no racial side to this. It just happened to be in a black community.I feel this was a perfectly straightforwardstudy, perfectly ethical, with controls.Part of our mission as physicians is to find out what happens to individualswith disease and without disease.87 These apologies, as well as the HEW Final Report, ignore many of the essential ethical issues which the study poses, The Tuskegee Study reveals the persistence of beliefs within the medical profession about the nature of blacks, sex, and disease-beliefs that had tragic repercussions long after their alleged "scientific" bases were known to be incorrect. Most strikingly, the entire health of a community was jeopardized by leaving a communicable disease untreated.88There can be little doubt that the Tuskegee researchers regarded their subjects as less than human.89As a result, the ethical canons of experimenting on human subjects were completely disregarded. The study also raises significant questions about professional self-regulation and scientific bureaucracy. Once the USPHS decided to extend the experiment in the summer of 1933, it was unlikely that the test would be halted short of the men's deaths. The experiment was widely reported for forty years without evoking any significant protest within the medical community. Nor did any bureaucratic mechanism exist within the government for the periodic reassessment of the Tuskegee experiment's ethics and scientific value. The USPHS sent physicians to Tuskegee every several years to check on the study's progress, but never subjected the morality or usefulness of the experiment to serious scrutiny. Only the press accounts of 1972 finally punctured the continued rationalizations of the USPHS and brought the study to an end. Even the HEW investigation was compromised by fear that it would be considered a threat to future human experimentation. In retrospect the Tuskegee Study revealed more about the pathology of racism than it did about the pathology of syphilis; more about the nature of scientific inquiry than the nature of the disease process. The injustice committed by the experiment went well beyond the facts outlined in the press and the HEW Final Report. The degree of deception and damages have been seriously underestimated. As this history of the study suggests, the notion that science is a value-free discipline must be rejected. The need for greater vigilance in assessing the specific ways in which sooial values and attitudes affect professional behavior is clearly indicated. REFERENCES 'The best generalaccountsof the studyare "The40-YearDeath Watch," Medical World News (August 18, 1972), pp. 15-17; and 27 1. Dolores Katz, "Why 430 Blacks with Syphilis Went Uncured for 40 Years,"Detroit Free Press (November 5, 1972). The mortality figure is based on a published report of the study which appeared in 1955. See Jesse J. Peters, James H. Peers, Sidney Olansky, John C. Cutler, and GeraldineGleeson, "UntreatedSyphilis in the Male Negro: Pathologic Findings in Syphilitic and Nonsyphilitic Patients,"Journal of Chronic Diseases 1 (February 1955), 127-48. The article estimated that 30.4 percent of the untreated men would die from syphilitic lesions. 2Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel, Department of Health, Education, and Welfare (Washington, D.C.: GPO, 1973). (Hereafter, HEW Final Report). 3See George M. Frederickson,The Black Image in the White Mind (New York: Harper and Row, 1971), pp. 228-55. Also, John H. Haller, Outcasts From Evolution (Urbana, Ill.: University of Illinois Press, 1971), pp. 40-68. 4Frederickson,pp. 247-49. 5"Deteriorationof the American Negro," Atlanta Journal-Record of Medicine 5 (July 1903), 287-88. See also J. A. Rodgers, "The Effect of Freedom upon the Psychological Development of the Negro," Proceedings of the American Medico-Psychological Association 7 (1900), 88-99. "From the most healthy race in the country forty years ago," concluded Dr. Henry McHatton, "he is today the most diseased." "The Sexual Status of the Negro-Past and Present,"American Journal of Dermatology and Genito-UrinaryDiseases 10 (January 1906), 7-9. 6W. T. English, "The Negro Problem from the Physician'sPoint of View," Atlanta Journal-Recordof Medicine 5 (October 1903), 461. See also, "Racial Anatomical Peculiarities," New York Medical Journal 63 (April 1896), 500-01. 7"RacialAnatomical Peculiarities,"p. 501. Also, Charles S. Bacon, "The Race Problem,"Medicine (Detroit) 9 (May 1903), 338-43. 8H. H. Hazen, "Syphilis in the American Negro," Journal of the American Medical Association 63 (August 8, 1914), 463. For deeper backgroundinto the historicalrelationshipof racism and sexuality see WinthropD. Jordan, White Over Black (Chapel Hill: University of North Carolina Press, 1968; Pelican Books, 1969), pp. 32-40. ODanielDavid Quillian, "RacialPeculiarities:A Cause of the Prevalence of Syphilis in Negroes," American Journal of Dermatology and Genito-UrinaryDiseases 10 (July 1906), p. 277. 10English,p. 463. 11WilliamLee Howard, "The Negro as a Distinct Ethnic Factor in Civilization," Medicine (Detroit) 9 (June 1903), 424. See also, Thomas W. Murrell, "Syphilis in the American Negro," Journal of the American Medical Association 54 (March 12, 1910), 848. 12"CastrationInstead of Lynching," Atlanta Journal-Record of Medicine 8 (October 1906), 457. The editorial added: "The badge of disgrace and emasculation might be branded upon the face or forehead, as a warning, in the form of an 'R,' emblematicof the crime for which this punishmentwas and will be inflicted." 13SearleHarris, "The Future of the Negro from the Standpointof the Southern Physician," Alabama Medical Journal 14 (January 1902), 62. Other articles on the prevalenceof venereal disease among blacks are: H. L. McNeil, "Syphilisin the Southern Negro," Journal of the AmericanMedical Association 67 (September30, 1916), 100104; Ernest Philip Boas, "The Relative Prevalence of Syphilis Among Negroes and Whites," Social Hygiene 1 (September 1915), 610-16. Doctors went to considerabletrouble to distinguishthe morbidityand mortalityof various diseases among blacks and whites. See, for example, Marion M. Torchia, "TuberculosisAmong American Negroes: Medical Research on a Racial Disease, 1830-1950," Journal of the History of Medicine and Allied Sciences 32 (July 1977), 252-79. 14ThomasW. Murrell, "Syphilisin the Negro: Its Bearing on the Race Problem,"American Journal of Dermatology and Genito-Urinary Diseases 10 (August 1906), 307. 15"Evenamong the educated, only a very few will carry out the most elementary instructionsas to personal hygiene. One thing you cannot do, and that is to convince the negro that he has a disease that he cannot see or feel. This is due to lack of concentrationrather than lack of faith; even if he does believe, he does not care; a child of fancy, the sensations of the passing hour are his only guides to the future." Murrell, "Syphilisin the American Negro," p. 847. 28 16"Deteriorationof the American Negro," Atlanta Journal-Record of Medicine 5 (July 1903), 288. 17Murrell,"Syphilis in the Negro; Its Bearing on the Race Problem," p. 307. 18"Theanatomicaland physiologicalconditions of the African must be understood,his place in the anthropologicalscale realized, and his biological basis accepted as being unchangeable by man, before we shall be able to govern his natural uncontrollable sexual passions." See, "As Ye Sow That Shall Ye Also Reap," Atlanta Journal-Record of Medicine 1 (June 1899), 266. 19TaliaferroClark, The Control of Syphilis in Southern Rural Areas (Chicago: Julius Rosenwald Fund, 1932), 53-58. Approximately 35 percent of the inhabitants of Macon County who were examined were found to be syphilitic. 20See Claude Bernard, An Introduction to the Study of Experimental Medicine (New York: Dover, 1865, 1957), pp. 5-26. 21TaliaferroClark to M. M. Davis, October 29, 1932. Records of the USPHS Venereal Disease Division, Record Group 90, Box 239, National Archives, Washington National Record Center, Suitland, Maryland. (Hereafter, NA-WNRC). Materials in this collection which relate to the early history of the study were apparentlynever consulted by the HEW investigation. Included are letters, reports, and memorandawritten by the physicians engaged in the study. 22H. S. Cumming to R. R. Moton, September 20, 1932, NAWNRC. 23Clarkto Davis, October 29, 1932, NA-WNRC. 24Cummingto Moton, September20, 1932, NA-WNRC. 2oBruusgaardwas able to locate 309 living patients, as well as records from 164 who were diseased. His findings were published as "Ueber das Schicksal der nicihtspecifizch behandeltenLuetiken,"Archives of Dermatology and Syphilis 157 (1929), 309-32. The best discussion of the Boeck-Bruusgaarddata is E. Gurney Clark and Niels Danbolt, "The Oslo Study of the Natural History of Untreated Syphilis,"Journal of Chronic Diseases 2 (September 1955), 311-44. 26JosephEarle Moore, ThleModern Treatment of Sypliilis (Baltimore: Charles C. Thomas, 1933), p. 24. 27Moore, pp. 231-47; see also John H. Stokes, Modern Clinical Syphilology (Philadelphia: W. B. Saunders, 1928), pp. 231-39. 28Moore, p. 237. 29Moore,p. 236. s?J. E. Moore, H. N. Cole, P. A. O'Leary,J. H. Stokes, U. J. Wile, T. Clark, T. Parran, J. H. Usilton, "CooperativeClinical Studies in the Treatment of Syphilis: Latent Syphilis," Venereal Disease Information 13 (September 20, 1932), 351. The authors also concluded that the latently syphilitic were potential carriers of the disease, thus meriting treatment. 31Clark to Paul A. O'Leary, September 27, 1932, NA-WNRC. O'Leary, of the Mayo Clinic, misunderstoodthe design of the study, replying: "The investigation which you are planning in Alabama is indeed an intriguing one, particularly because of the opportunity it affords of observing treatment in a previously untreated group. I assure you such a study is of interest to me, and I shall look forward to its report in the future." O'Leary to Clark, October 3, 1932, NAWNRC. a2Joseph Earle Moore, "Latent Syphilis," unpublished typescript (n.d.), p. 7. American Social Hygiene Association Papers, Social Welfare History Archives Center, University of Minnesota, Minneapolis, Minnesota. 33Moore to Clark, September 28, 1932, NA-WNRC. Moore had written in his textbook, "In late syphilis the negro is particularly prone to the development of bone or cardiovascular lesions." See Moore, The Modern Treatmentof Syphilis, p. 35. 340. C. Wenger to Clark, October 3, 1932, NA-WNRC. 35Wengerto Clark, September 29, 1932, NA-WNRC. 36ClarkMemorandum,September 26, 1932, NA-WNRC. See also, Clark to Davis, October 29, 1932, NA-WNRC. 37As Clark wrote: "You will observe that our plan has nothing to do with treatment. It is purely a diagnostic procedurecarried out to determine what has happened to the syphilitic Negro who has had no treatment." Clark to Paul A. O'Leary, September 27, 1932, NAWNRC. 38D. G. Gill to O. C. Wenger, October 10, 1932, NA-WNRC. Hastings Center Report, December 1978 _ 39Clarkto Vonderlehr,January 25, 1933, NA-WNRC. 40Vonderlehrto Clark, February 28, 1933, NA-WNRC. 41Vonderlehrto Clark, November 2, 1932, NA-WNRC. Also, Vonderlehr to Clark, February 6, 1933, NA-WNRC. 42Clarkto Vonderlehr, March 9, 1933, NA-WNRC. 43Vonderlehrlater explained: "The reason treatment was given to many of these men was twofold: First, when the study was started in the fall of 1932, no plans had been made for its continuation and a few of the patients were treated before we fully realized the need for continuing the project on a permanent basis. Second it was difficult to hold the interest of the group of Negroes in Macon County unless some treatmentwas given."Vonderlehrto Austin V. Diebert, December 5, 1938, Tuskegee Syphilis Study Ad Hoc Advisory Panel Papers, Box 1, National Library of Medicine, Bethesda, Maryland. (Hereafter, TSS-NLM). This collection contains the materials assembled by the HEW investigationin 1972. 44Vonderlehrto Clark, February 6, 1933, NA-WNRC. 45H. S. Cummingto J. N. Baker, August 5, 1933, NA-WNRC. 46January22, 1933; January 12, 1933, NA-WNRC. 47Vonderlehrto Clark, January28, 1933, NA-WNRC. 48Clarkto Moore, March 25, 1933, NA-WNRC. 49Macon County Health Department, "Letter to Subjects," n.d., NA-WNRC. 50Vonderlehrto Clark, April 8, 1933, NA-WNRC. See also, Vonderlehr to Wenger, July 18, 1933, NA-WNRC. 51Wengerto Vonderlehr, July 21, 1933, NA-WNRC. The italics are Wenger's. 52Cummingto Moton, July 27, 1933, NA-WNRC. 53Wengerto Vonderlehr, July 21, 1933, NA-WNRC. 54Vonderlehrto Murray Smith, July 27, 1933, NA-WNRC. 55Wengerto Vonderlehr, August 5, 1933, NA-WNRC. 56Vonderlehrto Wenger, October 24, 1933, NA-WNRC. Controls were given salicylates. 57Austin V. Diebert and Martha C. Bruyere, "UntreatedSyphilis in the Male Negro, III," VenerealDisease Information27 (December 1946), 301-14. 58EuniceRivers, Stanley Schuman, Lloyd Simpson, Sidney Olansky, "Twenty-Yearsof Followup Experience In a Long-Range Medical Study," Public Health Reports 68 (April 1953), 391-95. In this article Nurse Rivers explains her role in the experiment. She wrote: "Becauseof the low educationalstatus of the majorityof the patients, it was impossible to appeal to them from a purely scientificapproach. Therefore, various methods were used to maintain their interest. Free medicines, burial assistance or insurance (the project being referred to as 'Miss Rivers'Lodge'),free hot meals on the days of examination, transportationto and from the hospital, and an opportunityto stop in town on the returntrip to shop or visit with their friends on the streets all helped. In spite of these attractions, there were some who refused their examinations because they were not sick and did not see that they were being benefitted."(p. 393). 59Austin V. Diebert to Raymond Vonderlehr, March 20, 1939, TSS-NLM, Box 1. 60MurraySmith to Subjects, (1938), TSS-NLM, Box 1. See also, Sidney Olansky to John C. Cutler, November 6, 1951, TSS-NLM, Box 2. 61TheUSPHS originally requestedthat the Julius RosenwaldFund meet this expense. See Cumming to Davis, October 4, 1934, NAWNRC. This money was usually divided between the undertaker, pathologist, and hospital. Lloyd Isaacs to Raymond Vonderlehr, April 23, 1940, TSS-NLM, Box 1. 62StanleyH. Schuman,Sidney Olansky,Eunice Rivers, C. A. Smith, Dorothy S. Rambo, "Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study,"Journal of Chronic Diseases 2 (November 1955), 555. 63R. A. Vonderlehr and Taliaferro Clark, "Untreated Syphilis in the Male Negro," VenerealDisease Information 17 (September1936), 262. 64J. R. Heller and P. T. Bruyere, "UntreatedSyphilis in the Male Negro: II. Mortality During 12 Years of Observation,"VenerealDisease Information 27 (February 1946), 34-38. 65JesseJ. Peters, James H. Peers, Sidney Olansky, John C. Cutler, and GeraldineGleeson, "UntreatedSyphilis in the Male Negro: PathThe Hastings Center ologic Findings in Syphilitic and Non-Syphilitic Patients,"Journal of Chronic Diseases 1 (February 1955), 127-48. 66SidneyOlansky,Stanley H. Schuman,Jesse J. Peters, C. A. Smith, and Dorothy S. Rambo, "Untreated Syphilis in the Male Negro, X. Twenty Years of Clinical Observation of Untreated Syphilitic and Presumably Nonsyphilitic Groups," Journal of Chronic Diseases 4 (August 1956), 184. 670. C. Wenger, "UntreatedSyphilis in Male Negro," unpublished typescript,1950, p. 3. Tuskegee Files, Center for Disease Control, Atlanta, Georgia. (Hereafter TF-CDC). 68VernalG. Cave, "Proper Uses and Abuses of the Health Care Delivery System for Minorities with Special Reference to the Tuskegee Syphilis Study,"Journal of the National Medical Association 67 (January 1975), 83. 69See for example, Vonderlehr to B. W. Booth, April 18, 1934; Vonderlehr to E. R. Lett, November 20, 1933, NA-WNRC. 70"Transcriptof Proceedings-Tuskegee Syphilis Ad Hoc Advisory Panel," February23, 1973, unpublishedtypescript,TSS-NLM, Box 1. 71Raymond Vonderlehr to Murray Smith, April 30, 1942; and Smith to Vonderlehr, June 8, 1942, TSS-NLM, Box 1. 72StanleyH. Schuman,Sidney Olansky,Eunice Rivers, C. A. Smith, and Dorothy S. Rambo, "Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study," Journal of Chronic Diseases 2 (November 1955), 550-53. 73RaymondVonderlehrto Stanley H. Schuman, February 5, 1952. TSS-NLM, Box 2. 74Schumanet al., p. 550. 75"Minutes, April 5, 1965" unpublished typescript, TSS-NLM, Box 1. 76"TuskegeeAd Hoc Committee Meeting-Minutes, February 6, 1969," TF-CDC. 77JamesB. Lucas to William J. Brown, September 10, 1970, TFCDC. 78ElizabethM. Kennebrew to Arnold C. Schroeter, February 24, 1971, TSS-NLM, Box 1. 79See Medical Tribune (September 13, 1972), pp. 1, 20; and Report on HEW's Tuskegee Report,"Medical World News (September 14, 1973), pp. 57-58. 80HEWFinal Report,p. 7. 81Thenotable exception is Jay Katz's eloquent "ReservationsAbout the Panel Report on Charge 1," HEW Final Report, pp. 14-15. 82HEWFinal Report, pp. 8, 12. 83HEWFinal Report, pp. 8, 12. 84SeeR. H. Kampmeier,"The Tuskegee Study of Untreated Syphilis," Southern Medical Journal 65 (October 1972), 1247-51; and "Final Report on the 'Tuskegee Syphilis Study,'" Southern Medical Journal 67 (November 1974), 1349-53. 85LeonardJ. Goldwater, "The Tuskegee Study in Historical Perspective," unpublished typescript, TSS-NLM; see also "Treponemes and Tuskegee," Lancet (June 23, 1973), p. 1438; and Louis Lasagna, The VD Epidemic (Philadelphia: Temple University Press, 1975), pp. 64-66. 86Quotedin "Debate Revives on the PHS Study," Medical World News (April 19, 1974), p. 37. 87Heller to Vonderlehr, November 28, 1933, NA-WNRC; quoted in Medical Tribune (August 23, 1972), p. 14. 88Althoughit is now known that syphilis is rarely infectious after its early phase, at the time of the study's inception latent syphilis was thought to be communicable. The fact that members of the control group were placed in the test group when they became syphilitic proves that at least some infectious men were denied treatment. 89When the subjects are drawn from minority groups, especially those with which the researchercannot identify, basic human rights may be compromised.Hans Jonas has clearly explicated the problem in his "PhilosophicalReflections on Experimentation,"Daedalus 98 (Spring 1969), 234-37. As Jonas writes: "If the properties we adduced as the particularqualificationsof the members of the scientific fraternity itself are taken as general criteria of selection, then one should look for additional subjects where a maximum of identification, understanding,and spontaneitycan be expected-that is, among the most highly motivated, the most highly educated, and the least 'captive' members of the community." 29
Purchase answer to see full attachment