experiments on tuskegee airmen

What Newly Digitized Records Reveal About the Tuskegee Syphilis Study

The archival trove chronicles the extreme measures administrators took to ensure Black sharecroppers did not receive treatment for the venereal disease

Caitjan Gainty, The Conversation

In 1972, a whistleblower revealed that the United States Public Health Service (USPHS) had withheld syphilis treatment from hundreds of Black men as part of a 40-year study observing the natural course of the disease. The experiment’s subjects—the majority of whom were sharecroppers from rural Alabama—believed they were undergoing treatment for “bad blood,” a colloquial name then used for a host of conditions, including venereal diseases. Instead, they received placebos and inadequate medical care, even after penicillin emerged as an effective, readily available treatment for syphilis in the mid-1940s.

The Tuskegee syphilis study , as the experiment is often called today, began in 1932 with the recruitment of 600 Black men, 399 with syphilis and 201 without, to serve as the control group. Initially intended to run for six months, the study continued for decades. Unwitting participants lured in by the promise of free medical care, hot meals and burial insurance returned regularly for aspirin, tonics, blood draws and the occasional spinal tap. But none of these treatments does any good for syphilis, and 128 of the men ultimately died of the disease or complications related to it.

When news of the study broke, Chuck Stone , a journalist and former Tuskegee Airman , responded with an impassioned editorial, writing, “It either takes a tough constitution or a rancid morality to sit quietly by and watch 200 men die without doing anything about it. I call it genocide. Have you got a better name for it?”

Historians have had decades to pore over the study’s archives. Now, the National Library of Medicine has made a collection of those documents available for public viewing online . Anyone with an internet connection can read the primary source material—hundreds of pages of administrative records, letters and meeting minutes.

No one would expect the portrait this collection paints to be pretty or redemptive. Indeed, the study has gone down in the annals of American history as one of the most notorious, but by no means only, examples of medicine at its most prejudicial, virulent and unethical. Even with this knowledge, it is galling to read about the lengths USPHS doctors went to to ensure their patients were denied treatment.

Immobile and malleable

A 1948 history of the study makes it clear that the choice to set the experiment in the Deep South was deliberate. As the paper notes, the study followed a broader survey of syphilis in the still deeply segregated region. Sponsored by the Julius Rosenwald Fund , this earlier program aimed to assess the prevalence of the disease in several Southern counties and make sensible plans for its treatment—a starkly different goal than the Tuskegee experiment. The USPHS drew on this data to identify Macon County, Alabama, the surveyed area with the highest prevalence rate of syphilis, as the right place for a new study. Macon County also had high poverty rates and low education rates, ensuring the experiment’s subjects would be both immobile and malleable.

Another contributing factor was the presence of the venerable Tuskegee University, a historically Black college then known as the Tuskegee Institute, which had the facilities necessary to carry out the autopsies and lab work the study required.

Always a hurdle was a 1927 Alabama state statute that required medical personnel to report and treat all cases of syphilis. But enforcement of this statute was so lax that the experiment could have continued unimpeded had it not been for the 1942 draft, which led the local Selective Service Board to unmask the syphilitic status of the study’s subjects. The board’s charge was to evaluate individuals for military service, a process that required testing for venereal diseases and mandatory treatment for those affected.

R.A. Vonderlehr, the assistant surgeon general and one of the originators of the study, jumped into action to prevent the subjects from receiving treatment. He wrote urgently to local health officer Murray Smith, asking him to pull some strings to get the study subjects exempted.

“I would suggest that you confer with the chairman of the local Selective Service Board,” Vonderlehr wrote. “I believe he is an old friend of yours, and I would inform him of all the circumstances connected with the study. It is entirely probable that … he will cooperate with you in the completion of the investigation.”

Smith made good use of his social connections, managing to get the 256 remaining syphilitic subjects exempted from treatment. Likewise, when the same matter reached D.G. Gill, director of the Alabama Department of Health’s Bureau of Preventable Diseases, he requested Vonderlehr’s advice on whether to “make an exception of these few individuals” to avoid “encroaching on some of your study material.”

Effective treatment denied

Even in the postwar period, when penicillin became widely available, replacing the arguably ineffective and dangerous arsenic-based syphilis treatments that had preceded it, the study ploughed ahead , still more committed to documenting the disease than treating its sufferers. There was nothing unwitting about this denial of treatment.

Indeed, the archive shows that subjects were explicitly and repeatedly lied to for decades so they wouldn’t seek treatment for syphilis on their own. Even the form letters they received bore the hallmarks of a scam. They were invited to a “special examination” with government doctors waiting to give them “special attention” to “find out how you have been feeling and whether the treatment has improved your health.” Some of these notes were signed by Smith, who was designated just below his signature as a “special expert” to the USPHS.

And then there were the spinal taps , which were widely hated by the study subjects for the severe headaches they caused and because the men worried the procedure “robbed [them] of their procreative powers (regardless of the fact that I claim it stimulates them),” wrote physician Austin V. Deibert in a 1939 letter to Vonderlehr. 

Deibert told Vonderlehr the USPHS might have to  cancel the spinal taps  for the sake of the study’s continuation. “All in all and with no attempt at humor,” he said, he was the one with the real “headache.”

Neither World War II nor the early civil rights movement seemed to move the subsequent generations of study staff and administrators. The study was widely known in medical circles, thanks to the dozen or so articles on its findings published in prominent journals. Though outsiders started criticizing the experiment in the 1950s and ’60s, these dissenting voices were few and far between.

The first confirmed critique of the study from outside the USPHS arrived in a 1955 letter written by physician Count Gibson , who had heard a USPHS official explicitly state that the study’s subjects were not informed that treatment was being withheld.

Though Gibson was reportedly unsatisfied with the response he received, his colleagues urged him not to pursue the issue for fear that speaking out against these very powerful men might jeopardize his own career. He let it drop. In 1964, cardiologist Irwin Schatz voiced similar concerns, writing a letter that also questioned the study’s ethics. He never received a reply.

Concerns waved off

Indeed, the study directors continued to wave off concerns. As a set of meeting minutes from 1965 put it, “Racial issue was mentioned briefly. Will not affect the study. Any questions can be handled by saying these people were at the point that therapy would no longer help them. They are getting better medical care than they would under any other circumstances.”

In 1970, Anne R. Yobs, a co-author of one of the published papers, acknowledged that the research should come to an end. In a letter to the director of the Centers for Disease Control, she recommended closing the study, not because the charges of racism and unethical practice that had started to pour in were merited, but rather because “changes at the program level … in sensitivity to (potential) criticism” had forced administrators’ hands.

The study had become “an increasingly emotionally charged subject,” preventing “a rational appraisal of the situation,” wrote James B. Lucas, assistant chief of the USPHS’ Venereal Disease Branch, in a memo that same year.

By 1972, Peter Buxtun , a USPHS venereal disease officer who had spoken out against the study within the organization for years to no avail, had had enough. He went to the press.

Jean Heller, an Associated Press journalist, broke the story that July. A few months later, an ad hoc committee organized to evaluate the study finally ended it .

The Tuskegee study’s legacy has reverberated across the decades. In 1974, the NAACP successfully sued the federal government for $10 million, distributing the settlement money to the study subjects and their surviving family members. In 1997, President Bill Clinton publicly apologized to the men, acknowledging that what the USPHS had done was “deeply, profoundly, morally wrong.”

The study has had a material impact on medical outcomes within the African American community more broadly. Over the past several decades, researchers have connected the experiment to lower life expectancy among Black men due to broken trust in the health care system. More recently, the Covid-19 pandemic and subsequent vaccination efforts reignited discussions around Tuskegee’s impact on medical mistrust . Susan Reverby, the preeminent historian of the Tuskegee syphilis study, argues that the experiment’s legacy is far more complex than commonly stated, in no small part because of how it has been viewed historically. She notes that tying medical skepticism directly to Tuskegee erroneously suggests that the “reason for mistrust happened a long time ago,” thus turning attention away from the structural racism of today. As historian Alice Dreger succinctly puts it, “African Americans who distrust the health care system see plenty of reasons all around them to do so. They don’t have to look back 40 years.”

Perhaps, in this light, the most important takeaway from these digitized documents is not the starkly racist, unethical enterprise they so vividly record. It’s easy to condemn Vonderlehr, Smith, Yobs, Deibert and the countless others in the story whose actions are deeply troubling. But it’s more useful to observe how professional credentials and networks, philanthropic funding, warped notions of the greater good, and devotion to the scientific method provide cover to racism—and even prop it up. For it is often in these more quotidian spaces of life that racism in medicine persists .

This article is published in partnership with the Conversation under a Creative Commons license. Read the Conversation’s version .

Caitjan Gainty is a historian of 20th-century medicine and technology at King’s College London. She initially trained in public health and worked for several years in health care research before returning to academia to pursue a PhD in the history of medicine, which she received in 2012.

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Register for the trottier 2024 symposium, 40 years of human experimentation in america: the tuskegee study.

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Starting in 1932, 600 African American men from Macon County, Alabama were enlisted to partake in a scientific experiment on syphilis. The “Tuskegee Study of Untreated Syphilis in the Negro Male,” was conducted by the United States Public Health Service (USPHS) and involved blood tests, x-rays, spinal taps and autopsies of the subjects.

The goal was to “observe the natural history of untreated syphilis” in black populations. But the subjects were unaware of this and were simply told they were receiving treatment for bad blood. Actually, they received no treatment at all. Even after penicillin was discovered as a safe and reliable cure for syphilis, the majority of men did not receive it.

To really understand the heinous nature of the Tuskegee Experiment requires some societal context, a lot of history, and a realization of just how many times government agencies were given a chance to stop this human experimentation but didn’t.

In 1865, the ratification of the Thirteenth Amendment of the U.S. Constitution formally ended the enslavement of black Americans. But by the early 20 th century, the cultural and medical landscape of the U.S. was still built upon and inundated with racist concepts. Social Darwinism was rising, predicated on the survival of the fittest, and “ scientific racism ” (a pseudoscientific practice of using science to reinforce racial biases) was common. Many white people already thought themselves superior to blacks and science and medicine was all too happy to reinforce this hierarchy.

Before the ending of slavery, scientific racism was used to justify the African slave trade. Scientists argued that African men were uniquely fit for enslavement due to their physical strength and simple minds. They argued that slaves possessed primitive nervous systems, so did not experience pain as white people did. Enslaved African Americans in the South were claimed to suffer from mental illness at rates lower than their free Northern counterparts (thereby proving that enslavement was good for them), and slaves who ran away were said to be suffering from their own mental illness known as drapetomania.

During and after the American Civil War, African Americans were argued to be a different species from white Americans, and mixed-race children were presumed prone to many medical issues. Doctors of the time testified that the emancipation of slaves had caused the “mental, moral and physical deterioration of the black population,” observing that “virtually free of disease as slaves, they were now overwhelmed by it.” Many believed that the African Americans were doomed to extinction, and arguments were made about their physiology being unsuited for the colder climates of America (thus they should be returned to Africa).

Scientific and medical authorities of the late 19 th /early 20 th centuries held extremely harmful pseudoscientific ideas specifically about the sex drives and genitals of African Americans. It was widely believed that, while the brains of African Americans were under-evolved, their genitals were over-developed. Black men were seen to have an intrinsic perversion for white women, and all African Americans were seen as inherently immoral, with insatiable sexual appetites.

This all matters because it was with these understandings of race, sexuality and health that researchers undertook the Tuskegee study. They believed, largely due to their fundamentally flawed scientific understandings of race, that black people were extremely prone to sexually transmitted infections (like syphilis). Low birth rates and high miscarriage rates were universally blamed on STIs.

They also believed that all black people, regardless of their education, background, economic or personal situations, could not be convinced to get treatment for syphilis. Thus, the USPHS could justify the Tuskegee study, calling it a “study in nature” rather than an experiment, meant to simply observe the natural progression of syphilis within a community that wouldn’t seek treatment.

The USPHS set their study in Macon County due to estimates that 35% of its population was infected with syphilis. In 1932, the initial patients between the ages of 25 and 60 were recruited under the guise of receiving free medical care for “bad blood,” a colloquial term encompassing anemia, syphilis, fatigue and other conditions. Told that the treatment would last only six months, they received physical examinations, x-rays, spinal taps, and when they died, autopsies.

Researchers faced a lack of participants due to fears that the physical examinations were actually for the purpose of recruiting them to the military. To assuage these fears, doctors began examining women and children as well. Men diagnosed with syphilis who were of the appropriate age were recruited for the study, while others received proper treatments for their syphilis (at the time these were commonly mercury - or arsenic -containing medicines).

In 1933, researchers decided to continue the study long term. They recruited 200+ control patients who did not have syphilis (simply switching them to the syphilis-positive group if at any time they developed it). They also began giving all patients ineffective medicines ( ointments or capsules with too small doses of neoarsphenamine or mercury) to further their belief that they were being treated.

As time progressed, however, patients began to stop attending their appointments. To greater incentivize them to remain a part of the study, the USPHS hired a nurse named Eunice Rivers to drive them to and from their appointments, provide them with hot meals and deliver their medicines, services especially valuable to subjects during the Great Depression. In an effort to ensure the autopsies of their test subjects, the researchers also began covering patient’s funeral expenses.

Multiple times throughout the experiment researchers actively worked to ensure that their subjects did not receive treatment for syphilis. In 1934 they provided doctors in Macon County with lists of their subjects and asked them not to treat them. In 1940 they did the same with the Alabama Health Department. In 1941 many of the men were drafted and had their syphilis uncovered by the entrance medical exam, so the researchers had the men removed from the army, rather than let their syphilis be treated.

It was in these moments that the Tuskegee study’s true nature became clear. Rather than simply observing and documenting the natural progression of syphilis in the community as had been planned, the researchers intervened: first by telling the participants that they were being treated (a lie), and then again by preventing their participants from seeking treatment that could save their lives. Thus, the original basis for the study--that the people of Macon County would likely not seek treatment and thus could be observed as their syphilis progressed--became a self-fulfilling prophecy.

The Henderson Act was passed in 1943, requiring tests and treatments for venereal diseases to be publicly funded, and by 1947, penicillin had become the standard treatment for syphilis , prompting the USPHS to open several Rapid Treatment Centers specifically to treat syphilis with penicillin. All the while they were actively preventing 399 men from receiving the same treatments.

By 1952, however, about 30% of the participants had received penicillin anyway, despite the researchers’ best efforts. Regardless, the USPHS argued that their participants wouldn’t seek penicillin or stick to the prescribed treatment plans. They claimed that their participants, all black men, were too “stoic” to visit a doctor. In truth these men thought they were already being treated, so why would they seek out further treatment?

The researchers’ tune changed again as time went on. In 1965, they argued that it was too late to give the subjects penicillin, as their syphilis had progressed too far for the drug to help. While a convenient justification for their continuation of the study, penicillin is (and was) recommended for all stages of syphilis and could have stopped the disease’s progression in the patients.

In 1947 the Nuremberg code was written, and in 1964 the World Health Organization published their Declaration of Helsinki . Both aimed to protect humans from experimentation, but despite this, the Centers for Disease Control (which had taken over from the USPHS in controlling the study) actively decided to continue the study as late as 1969.

It wasn’t until a whistleblower, Peter Buxtun, leaked information about the study to the New York Times and the paper published it on the front page on November 16 th , 1972, that the Tuskegee study finally ended. By this time only 74 of the test subjects were still alive. 128 patients had died of syphilis or its complications, 40 of their wives had been infected, and 19 of their children had acquired congenital syphilis.

There was mass public outrage, and the National Association for the Advancement of Colored People launched a class action lawsuit against the USPHS. It settled the suit two years later for 10 million dollars and agreed to pay the medical treatments of all surviving participants and infected family members, the last of whom died in 2009.

Largely in response to the Tuskegee study, Congress passed the National Research Act in 1974, and the Office for Human Research Protections was established within the USPHS. Obtaining informed consent from all study participants became required for all research on humans, with this process overseen by Institutional Review Boards (IRBs) within academia and hospitals.

The Tuskegee study has had lasting effects on America . It’s estimated that the life expectancy of black men fell by up to 1.4 years when the study’s details came to light. Many also blame the study for impacting the willingness of black individuals to willingly participate in medical research today.

We know all about evil Nazis who experimented on prisoners. We condemn the scientists in Marvel movies who carry out tests on prisoners of war. But we’d do well to remember that America has also used its own people as lab rats . Yet to this day, no one has been prosecuted for their role in dooming 399 men to syphilis.

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How the Public Learned About the Infamous Tuskegee Syphilis Study

A s the fight over reforms to the American health-care system continues this week, Tuesday marks the 45th anniversary of a grim milestone in the history of health care in the U.S.

On July 25, 1972, the public learned that, over the course of the previous 40 years, a government medical experiment conducted in the Tuskegee, Ala., area had allowed hundreds of African-American men with syphilis to go untreated so that scientists could study the effects of the disease.

“Of about 600 Alabama black men who originally took part in the study, 200 or so were allowed to suffer the disease and its side effects without treatment, even after penicillin was discovered as a cure for syphilis,” the Associated Press reported , breaking the story. “[U.S. Public Health Service officials] contend that survivors of the experiment are now too old to treat for syphilis, but add that PHS doctors are giving the men thorough physical examinations every two years and are treating them for whatever other ailments and diseases they have developed.”

By the time the bombshell report came out, seven men involved had died of syphilis and more than 150 of heart failure that may or may not have been linked to syphilis. Seventy-four participants were still alive, but the government health officials who started the study had already retired. And, because of the study’s length and the way treatment options had evolved in the intervening years, it was hard to pin the blame on an individual — though easy to see that it was wrong, as TIME explained in the Aug. 7, 1972, issue:

At the time the test began, treatment for syphilis was uncertain at best, and involved a lifelong series of risky injections of such toxic substances as bismuth, arsenic and mercury. But in the years following World War II, the PHS’s test became a matter of medical morality. Penicillin had been found to be almost totally effective against syphilis, and by war’s end it had become generally available. But the PHS did not use the drug on those participating in the study unless the patients asked for it. Such a failure seems almost beyond belief, or human compassion. Recent reviews of 125 cases by the PHS’S Center for Disease Control in Atlanta found that half had syphilitic heart valve damage. Twenty-eight had died of cardiovascular or central nervous system problems that were complications of syphilis. The study’s findings on the effects of untreated syphilis have been reported periodically in medical journals for years. Last week’s shock came when an alert A.P. correspondent noticed and reported that the lack of treatment was intentional.

About three months later, the study was terminated, and the families of victims reached a $10 million settlement in 1974 (the terms of which are still being negotiated today by descendants). The last study participant passed away in 2004.

Tuskegee was chosen because it had the highest syphilis rate in the country at the time the study was started. As TIME made clear with a 1940 profile of government efforts to improve the health of African Americans, concern about that statistic had drawn the attention of the federal government and the national media. Surgeon General Thomas Parran boasted that in Macon County, Ala., where Tuskegee is located, the syphilis rate among the African-American population had been nearly 40% in 1929 but had shrunk to 10% by 1939. Serious efforts were being devoted to the cause, the story explained, though the magazine clearly missed the full story of what was going on:

In three years, experts predict, the disease will be wiped out. To root syphilis out of Macon County, the U. S. Public Health Service, the Rosenwald Fund and Booker T. Washington’s Tuskegee Institute all joined forces. Leader of the campaign is a white man, the county health officer, a former Georgia farm boy who drove a flivver through fields of mud, 36 miles a day to medical school. Last month, deep-eyed, sunburned Dr. Murray Smith began his tenth year in Macon County. “There’s not much in this job,” said he, “but the love and thanks of the people.” At first the Negroes used to gather in the gloomy courthouse in Tuskegee, while Dr. Smith in the judge’s chambers gave them tests and treatment. Later he set up weekly clinics in old churches or schoolhouses, deep in the parched cotton fields. Last fall the U. S. Public Health Service gave him a streamlined clinic truck. The truck, which has a laboratory with sink and sterilizer, a treatment nook with table and couch, is manned by two young Negro doctors and two nurses. Five days a week it rumbles over the red loam roads. At every crossroads it stops. At the toot of its horn, through the fields come men on muleback, women carrying infants, eager to be first, proud to have a blood test. Some young boys even sneak in to get a second or third test, and many come around to the truck long after they have been cured. One woman who had had six miscarriages got her syphilis cured by Dr. Smith with neoarsphenamine. Proudly she named her first plump baby Neo.

In the years following the disclosure, the Tuskegee study became a byword for the long and complicated history of medical research of African Americans without their consent. In 1997, President Bill Clinton apologized to eight of the survivors. “You did nothing wrong, but you were grievously wronged,” he said. “I apologize and I am sorry that this apology has been so long in coming.” As Clinton noted, African-American participation in medical research and organ donation remained low decades after the 1972 news broke, a fact that has often been attributed to post-Tuskegee wariness.

In 2016, a National Bureau of Economic Research paper argued that after the disclosure of the 1972 study, “life expectancy at age 45 for black men fell by up to 1.5 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men and 25% of the gap between black men and women.” However, many experts argue that the discrepancy has more to do with racial bias in the medical profession.

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AP exposes the Tuskegee Syphilis Study: The 50th Anniversary

This 1950’s photo made available by the National Archives shows a man included in a syphilis study in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

In this 1950’s photo made available by the National Archives, a man included in a syphilis study has blood drawn in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

This image made available by the U.S. National Archives shows part of a 1940-dated document describing procedures for the distribution of autopsy results from subjects of the Tuskegee Syphilis Study conducted by the U.S. government. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

FILE - In this 1950’s photo made available by the National Archives, men included in a syphilis study stand for a photo in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP, File)

FILE - In this 1950’s photo released by the National Archives, a man included in a syphilis study has blood drawn by a doctor in Tuskegee, Ala. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. Finally exposed in 1972, the study ended and the men sued, resulting in a $9 million settlement. (National Archives via AP)

Lillie Tyson Head holds a photograph of her late parents, Freddie Lee and Johnnie Mae Neal Tyson, at her home in Wirtz, Va., on Saturday, July 23, 2022. Freddie Tyson was part of the infamous “Tuskegee Study,” in which hundreds of Black men in Alabama went untreated for syphilis for decades so federal government researchers could record the disease’s affects on the body. Head says her mother was later tested, and did not have the disease. (AP Photo/Allen G. Breed)

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WASHINGTON (AP) — EDITOR’S NOTE — On July 25, 1972, Jean Heller, a reporter on The Associated Press investigative team, then called the Special Assignment Team, broke news that rocked the nation. Based on documents leaked by Peter Buxtun, a whistleblower at the U.S. Public Health Service, the then 29-year-old journalist and the only woman on the team, reported that the federal government let hundreds of Black men in rural Alabama go untreated for syphilis for 40 years in order to study the impact of the disease on the human body. Most of the men were denied access to penicillin, even when it became widely available as a cure. A public outcry ensued, and nearly four months later, the “Tuskegee Study of Untreated Syphilis in the Negro Male” came to an end. The investigation would have far-reaching implications: The men in the study filed a lawsuit that resulted in a $10 million settlement , Congress passed laws governing how subjects in research studies were treated , and more than two decades later President Bill Clinton formally apologized for the study, calling it “shameful.”

Today, the effects of the study still linger — it is often blamed for the unwillingness of some African Americans to participate in medical research.

In observance of the 50th anniversary of Heller’s groundbreaking investigation, the AP is republishing the original report and a recent interview with her and others on how the story came together.

For 40 years the U.S. Public Health Service has conducted a study in which human guinea pigs, denied proper medical treatment, have died of syphilis and its side effects.

The study was conducted to determine from autopsies what the disease does to the human body.

PHS officials responsible for initiating the experiment have long since retired. Current PHS officials, who say they have serious doubts about the morality of the study, also say that it is too late to treat syphilis in any of the study’s surviving participants.

But PHS doctors say they are rendering whatever other medical services they can now give to the survivors while the study of the disease’s effects continues.

The experiment, called the Tuskegee Study began in 1932 with about 600 black men mostly poor and uneducated, from Tuskegee, Ala., an area that had the highest syphilis rate in the nation at the time.

One-third of the group was free of syphilis; two-thirds showed evidence of the disease. In the syphilitic group, half were given the best treatment known at the time, but the other half, about 200 men, received no treatment at all for syphilis, PHS officials say.

As incentives to enter the program, the men were promised free transportation to and from hospitals, free hot lunches, free medicine for any disease other than syphilis and free burial after autopsies were performed.

The Tuskegee Study began 10 years before penicillin was discovered to be a cure for syphilis and 15 years before the drug became widely available. Yet, even after penicillin became common, and while its use probably could have helped or saved a number of the experiment subjects, the drug was denied them, Dr. J.D. Millar says.

He is chief of the venereal disease branch of the PHS’s Center for Disease Control in Atlanta and is now in charge of what remains of the Tuskegee Study. Dr. Millar said in an interview that he has serious doubts about the program.

“I think a definite serious moral problem existed when the study was undertaken, a more serious moral problem was overlooked in the post-war years when penicillin became available but was not given to these men and a moral problem still exists,” Dr. Millar said.

“But the study began when attitudes were much different on treatment and experimentation. At this point in time, with our current knowledge of treatment and the disease and the revolutionary change in approach to human experimentation, I don’t believe the program would be undertaken,” he said.

Syphilis, a highly contagious infection spread by sexual contact, can cause if untreated, bone and dental deformations, deafness, blindness, heart disease and central nervous system deterioration.

No figures were available on when the last death occurred in the program. And one official said that apparently no conscious effort was made to halt the program after it got under way.

A 1969 CDC study of 276 treated and untreated syphilitics who participated in the Tuskegee Study showed that seven had died as a direct result of syphilis. Another 154 died of heart disease.

CDC officials say they cannot determine at this late date how many of the heart disease deaths were caused by syphilis or how many additional deaths could be linked to the disease.

However, several years ago an American Medical Association study determined that untreated syphilis reduces life expectancy by 17 per cent in black men between the ages of 25 and 50, a precise description of the Tuskegee Study subjects.

Don Prince, another official in the venereal disease branch of CDC, said the Tuskegee Study had contributed some knowledge about syphilis, particularly that the morbidity and mortality rate among untreated syphilitics were not as high as previously believed.

Like Dr. Millar, Prince said he thought the study should have been halted with penicillin treatment for participants after World War II.

“I don’t know why the decision was made in 1946 not to stop the program,” Prince said. “I was unpleasantly surprised when I first came here and found out about it. It really puzzles me.”

At the beginning of 1972, according to CDC data, 74 of the untreated syphilitics were still living. All of them, Dr. Millar said, were men who did not suffer any potentially fatal side effects from their bouts with the disease.

Some of them received penicillin and antibiotics in past years for other aliments, Prince said, but none has ever received treatment for syphilis. Now, both men agree, it’s too late

Recent reviews of the Tuskegee Study by the CDC indicate that treatment now for survivors is medically questionable, Dr. Millar said. Their average age is 74 and massive penicillin therapy, with possible ill side effects, is deemed too great a risk to individuals, particularly for those whose syphilis is now dormant.

However, Dr. Millar, added there was a point in time when survivors could have been treated with at least some measure of success.

“The most critical moral issue about this experiment arises in the post-war era, the years after the end of World War II when penicillin became widely available.

“I know some were treated with penicillin for other diseases and then dropped from the program because the drug had some positive effect on the primary disease (syphilis). Looking at it now, one cannot see any reason they could not have been treated at that time.”

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Tuskegee syphilis study

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• Academia - The Tuskegee Syphilis Study: Some Ethical Reflections
• Encyclopedia of Alabama - Tuskegee Syphilis Study
• Centers for Disease Control and Prevention - The USPHS Untreated Syphilis Study at Tuskegee
• McGill University - Office for Science and Society - 40 Years of Human Experimentation in America: The Tuskegee Study
• JamesCook University Pressbooks - An Introduction to Research Methods for Undergraduate Health Profession Students - A Case Study – The Tuskegee Syphilis Experiment
• National Center for Biotechnology Information - PubMed Central - The Tuskegee syphilis study
• Tuskegee syphilis study - Student Encyclopedia (Ages 11 and up)

Tuskegee syphilis study , American medical research project that earned notoriety for its unethical experimentation on African American patients in the rural South .

The project, which was conducted by the U.S . Public Health Service (PHS) from 1932 to 1972, examined the natural course of untreated syphilis in African American men. The research was intended to test whether syphilis caused cardiovascular damage more often than neurological damage and to determine if the natural course of syphilis in black men was significantly different from that in whites. In order to recruit participants for its study, the PHS enlisted the support of the prestigious Tuskegee Institute (now Tuskegee University ), located in Macon county, Alabama . A group of 399 infected patients and 201 uninfected control patients were recruited for the program. The subjects were all impoverished sharecroppers from Macon county. The original study was scheduled to last only six to nine months.

The subjects were not told that they had syphilis or that the disease could be transmitted through sexual intercourse . Instead, they were told that they suffered from “bad blood,” a local term used to refer to a range of ills. Treatment was initially part of the study, and some patients were administered arsenic, bismuth, and mercury. But after the original study failed to produce any useful data, it was decided to follow the subjects until their deaths, and all treatment was halted. Penicillin was denied to the infected men after that drug became available in the mid-1940s, and it was still being withheld from them 25 years later, in direct violation of government legislation that mandated the treatment of venereal disease . It is estimated that more than 100 of the subjects died of tertiary syphilis .

The Tuskegee syphilis study finally came to an end in 1972 when the program and its unethical methods were exposed in the Washington Star . A class-action suit against the federal government was settled out of court for $10 million in 1974. That same year the U.S. Congress passed the National Research Act, requiring institutional review boards to approve all studies involving human subjects. In 1997 President Bill Clinton issued a formal apology for the study (see Sidebar: Presidential Apology for the Study at Tuskegee ).

Home News Highlights Best of AP — Honorable Mention The story behind Heller’s explosive 1972 ‘Tuskegee Study’ investigation

Best of AP — Honorable Mention

The story behind Heller’s explosive 1972 ‘Tuskegee Study’ investigation

Former Associated Press investigative reporter Jean Heller stands near a copy of her story printed in the front page of The New York Times at her home in Southport, N.C., on Saturday, July 9, 2022. In July 1972, Heller broke the story about the U.S. Public Health Service study in which Black men in Alabama went untreated for syphilis so researchers could document the disease's effects. (AP Photo/Allen G. Breed)

By Allen G. Breed and Alyse Martin

AP national writer and visual journalist Allen Breed and intern Alyse Martin provided the first behind-the-scenes look at one of American journalism’s biggest scoops: how the AP’s Jean Heller, then a 29-year-old reporter and the only woman on the wire service’s fledgling investigative team, broke the story of a notorious government experiment on Black men in rural Alabama.

For the 50th anniversary of the AP exclusive on the Tuskegee syphilis study — where 600 Black men were left untreated for venereal disease for more than 40 years — Breed was assigned to interview Heller on camera for a video that would accompany a republication of the original story that AP broke on July 25,1972.

But after spending hours with Heller and learning the story behind the story,global investigations editor Ron Nixon decided that a separate piece on Heller was warranted. Breed assembled his video,text reporting and photos,then worked quickly to write an engaging narrative of how a federal whistleblower passed documents to AP’s Edie Lederer,who then shared them with Heller. Investigative intern Alyse Marin coproduced the compelling video featuring archival material and Breed’s interviews, including Heller and a descendant of one of the men in the study.

Although other news outlets had stories marking the 50th anniversary of the AP disclosure of the “Tuskegee Study,” no one had the key interview with Heller. The behind-the-scenes piece was one of the most-read stories on AP News for July 25,and the video drew more than 100,000 views on social media.

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MIT Black History

Tuskegee airmen, connecting flights at mit, hide table of contents.

When the Army Air Corps found itself short on weather forecasters at the outset of WWII, it teamed up with academia to increase training of weather officers. MIT was the first of three American universities to offer graduate degrees in meteorology at the time and contributed to the training of African-American military pilots popularly known as the Tuskegee Airmen. In the summer of 1940, the Institute began offering abbreviated courses in the teaching of meteorology to select aviation cadets. Candidates requirements included: engineering or other degree, two years in mathematics (including differential equations and integral calculus), and one year in physics. 

Among the MIT alums who served as Tuskegee Airmen were  Wallace Patillo Reed  '42, Second Lieutenant  Victor L. Ransom  '48, aeronautical engineers  Yenwith Whitney  '49 and  Louis M. Young  '50, and meteorologist  Charles E. Anderson  PhD '60.

Tuskegee Institute

A 1920s War Department report stated that blacks weren't intelligent or disciplined enough to fly a plane. During World War II, black civil rights groups tried to get the U.S. military to add black pilots to its ranks. The 66th Air Force Flying School was opened at the historically black college Tuskegee Institute (today Tuskegee University) in Alabama.

The flying school was opened as an experimental training ground to test the potential of black pilots. "It was programmed to fail," said [Tuskegee Airman Yenwith] Whitney , noting that the school was set up as a tool to back up the findings of a 1920s War Department report stating that blacks weren't smart enough or disciplined enough to fly a plane. Under the direction of Charles Alfred "Chief" Anderson , the pioneering airmen practiced at Moton Field, a tiny airstrip surrounded by marshes and stands of pine near the institute founded by Booker T. Washington, the son of a slave who was a strong advocate for black rights. During their flight training, the airmen were denied rifles because the airstrip was in Alabama, a deeply segregated state where some folks didn't like the idea of blacks shooting at whites --- even if they were the enemy. The drills became bittersweet to the airmen, whose hopes of flying dimmed as they waited and waited for a call-up from the government. After months of waiting, their spirits were restored by a visitor to the airstrip.  "I've always heard colored people can't fly, but I see them flying around here," Eleanor Roosevelt reportedly said during her visit. Against the objections of her security men, the open-minded, free-spirited first lady asked to fly with Anderson. Using her political connections, Roosevelt convinced her husband to use his influence to give the airmen a chance to fight --- especially since the military was facing a critical shortage of pilots. The Tuskegee Airmen not only broke the color line, they shattered stereotypes about black pilots.  Tracie Reddick, "Tuskegee Airman Yenwith Whitney soared above barriers,"  Bradenton Herald,  27 July 2000

George L Washington

George Leward Washington  '25, MS '30 earned his Bachelors (1925) and Masters (1930), both in Mechanical Engineering (Course II). He became the first black registered engineer in the state of North Carolina. Before World War II, he helped establish an Air Force training program for black pilots at Tuskegee Institute in Alabama. Washington later served as the director of special services for the United Negro College Fund.

From "Training at Tuskegee: Turning dreams into reality" by Randy Roughton, Air Force News Service, 11 February 2014

[A driving force in why the Army considered when choosing Tuskegee as the training site for African-American pilots] was George L. Washington [MIT Class of 1925], an engineer and director of mechanical industries and the Tuskegee Institute Division of Aeronautics, who was instrumental in bringing the primary flight training program to Tuskegee. He oversaw the construction, outfitting and expansion of Moton Field, and as general manager, he hired and supervised flight instructors, airplane maintenance personnel, and other support personnel, and ensured that cadets were properly housed and fed. While the Army looked at the training of African American pilots as an experiment, Washington didn’t see it that way. “Acceptance of Negroes into the Air Corps for training as military pilots meant one thing for the Negro and another to the military establishment, and possibly white Americans,” Washington wrote in his unpublished papers that are kept in the Tuskegee University Archives. “For the Negro, it was an opportunity to further demonstrate his ability to measure arms with any other race, particularly white Americans, when given an equal opportunity. Performance in civilian aviation had certainly proven their ability to fly as individuals. And certainly this had to be the prime requisite for success in military aviation. Therefore, this was just another in the long chain of demonstrations over many years. Certainly this opportunity was far from being an experiment to the Negro.”

Warren Henry

Chemist-physicist  Warren Elliott Henry was born to two Tuskegee alums who were local schoolteachers. He grew up on a peanut farm in Alabama, where George Washington Carver often conducted research on crops.

Henry earned a Bachelor of Science (1931) from Tuskegee Institute, a Master of Science in Organic Chemistry (1937) from Atlanta University, and a PhD in Physical Chemistry (1941) from the University of Chicago. He returned as faculty to Tuskegee Institute in 1941, before being recruited by the MIT Radiation Laboratory in 1943.   

Pioneering NRL Physicist had Tuskegee Ties

U.S. Naval Research Laboratory News Release (23 February 2012)

Training Tuskegee Airmen Returning to Tuskegee [in 1941], Henry took a position as an assistant professor of chemistry. Because of his broad program of studies at Chicago the Institute qualified him to teach physics, asking him to teach special physics courses to the young men who were training to be Army Air Corps officers. These young men ultimately formed the 99th Pursuit Squadron and became world famous as the Tuskegee Airmen of World War II. MIT Radiation Laboratory During the war and a break from teaching, Henry visited fellow University of Chicago alumni, Persa Raymond Bell at the [MIT] Radiation Laboratory. Bell had shown Henry the type of research being conducted to contribute to the war effort, and asked if he would like to work there. Shortly after, Henry was recruited by MIT in 1943 to undertake a crucial project for the U.S. Navy. Classified as top-secret, Henry worked to develop video amplifiers that were used in portable radar systems on warships. The amplifiers, capable of detecting and tracking targets like German submarines, filtered and strengthened radar signals and were considered 'faster than anything else at the time.'

After Tuskegee and MIT

Henry later held positions at University of Chicago, Morehouse College, Howard University, the Naval Research Laboratory, and Lockheed Missile and Space Company. He was a Fellow of the American Physical Society and the American Association for the Advancement of Science.

Wallace Patillo Reed

Valentine’s day marks 1st for african american meteorologist.

Nellis Air Force Base News  (21 February 2012 ) by Jerry White, 99th Air Base Wing Historian

Source: Tuskegee Airmen National Historic Site On Feb. 14, 1942, the first African-American meteorologist in the armed services graduated from a specialized training course at the Massachusetts Institute of Technology. Wallace Patillo Reed was found through an extensive search by MIT officials at the request of the Army Air Forces [AAF]. In 1940, the Army had only 62 qualified weather forecasters. With WWII expansion already underway, it was initially estimated that as many as 10,000 weather officers were needed just for the AAF; by war's end, more than 6,000 had been trained.  Cadet programs were set up initially at MIT, New York University and the California Institute of Technology, with additional courses later at the University of Chicago, the University of California Los Angeles and an AAF program at Grand Rapids, MI. Potential weather officers needed engineering, math, physics or chemistry degrees, later lowered to at least two years of coursework. Reed entered MIT's second class in 1941, followed by 14 other African-American aviation cadets and one enlisted forecaster before the program closed in 1944. Upon graduation, Reed was commissioned into the Army Air Corps, three weeks before the first class of pilots graduated from pilot training at Tuskegee Army Air Field, Ala. After a three-week orientation at Mitchel Field, New York, Lt. Reed was assigned as the Tuskegee AAF base weather officer.  Reed served his entire tour in charge of the base weather station there and helped train weather officers who deployed overseas. After the war, he moved to the Philippines where he worked for Pan American Airways and the Weather Bureau. Years later he returned to the United States, passing away in 1999.  In addition to being the first African-American meteorologist in the military, Capt. Reed is believed to have been the Weather Bureau's first African-American meteorologist. 

After Tuskegee

In 1946, after serving in World War II, Reed took a post as a government official, connected with the U.S. Weather Bureau at Nickols Field. He lived in Manila for over three decades before moving back to the United States. 

Personnel of the Tuskegee weather detachment, which served with both the 332nd Fighter Group and 477th Bomb. circa 1944. Pictured (front row, left to right): Lt. Grant Franklin, Lt. Archie Williams, Capt. Wallace Reed, Lt. John Branche, Lt. Paul Wise and Lt. Robert Preer. 

Victor Ransom

Victor "Vic" Llewellyn Ransom  '42 was born in New York City to a schoolteacher and a writer, both of whom were part of the Harlem Renaissance. Chasing after top schools for Ransom, the family moved 16 times before he turned 16. He graduated from Stuyvesant High School, a magnet public school known for its rigorous math and science curriculum. By senior year, Ransom had already set his sights on studying electrical engineering at MIT.

At the Institute

Ransom's memories of his arrival to the Institute in 1941 are vivid. His impression of the campus was of a "War Department," with "massive, unsympathetic buildings". In December of that year, in fact, events at Pearl Harbor led to the United States' entry into World War II. During his sophomore year at MIT, Ransom took a leave from MIT for service training.

I received a letter from the ROTC program, which I was involved in, that said something like, "This man has had training in engineering and ought to be considered for the Signal Corps." Well, the Army had no idea what to do with that note like this about a black soldier, so I stayed in the reception center for a couple of months while they tried to figure it out. Victor Ransom in  Technology in the Dream  by Clarence G. Williams (MIT Press, 2001)

Second Lieutenant Victor L. Ransom '48, who was among the 101 Tuskegee Airmen who took part in the 1945 Freeman Field Mutiny protest against segregation, shown ca. 1942.

Freeman Field Mutiny

Black officers at Freeman Field, Indiana were segregated in an abandoned cadet field and referred to as "trainees," regardless of rank. A member of the the 477th Bombardment Group, Ransom was among the 101 Tuskegee Airmen who took part in the  Freeman Field Mutiny protest  against segregation in 1945.  

The war ended without Victor Ransom ever leaving U.S. soil. But he and other members of the 477th Bombardment Group were busy fighting a different battle. Activated in June 1944, the 477th was plagued by delays and inefficiencies, due in large part to its commander, a white colonel and rigid segregationist who moved the group from base to base 38 times in less than a year to try to quell dissent. Fed up, a group of black officers staged a quiet, nonviolent protest at Freeman Field, Indiana, on April 5, 1945, when they tried to enter a club used by white officers only... “I was the first guy into the [white] officers’ club,” says Ransom...“They said to go back to quarters and remain there. So we were under arrest in quarters for violating an order.” Cleared by a congressional inquiry, Ransom and the others were released within a few weeks. A few months later, the war ended and Ransom returned to MIT to complete his graduate work in electrical engineering... “My achievement was our efforts to integrate the officers’ club,” he says wryly. “It was silly. But it characterizes the nature of the country at the time.” "Double Victory: Jersey’s Tuskegee Airmen" by Mary Ann McGann,  New Jersey Monthly, 18 January 2013

Victor L. Ransom, MIT Class of 1948

Post-war and MIT

After the war Ransom resumed undergraduate studies at the Institute, completing his remaining years under the GI Bill in 1948. Though faced with a tough job market after MIT, Ransom received an immediate job offer from NACA--precursor to NASA--at the Langley Field Lab in Hampton, Virginia. Segregation led him to transfer to NACA's Lewis Lab in Cleveland, Ohio, where he would be able to complete graduate studies; in 1957, Ransom earned his Masters degree in Electrical Engineering from Case Institute of Technology (today Case Western). 

Ransom joined Bell Laboratories, moving up the ranks at Bell Labs and in the communications industry for the next 30 years. His areas of specialty included transistors and digital products, network switching technologies, systems for special needs, and environmental control systems design.

Yenwith Whitney

Yenwith K. Whitney '49 enlisted in the United States Army Air Corps in 1943. He was an 18-year-old Bronx native who had grown up attending a predominantly white school and local church. After graduating high school during World War II, he signed up for the fledgling black aviation program.

My first real experience with black kids was living in the army air corps...It was my first profound exposure to being part of a group that was exclusively black. Yenwith Whitney to MIT Technology Review , 1 November 2003

Many commanders didn’t want blacks doing anything but menial labor in World War II. They didn’t think blacks were smart enough to do things like fly airplanes...I took my basic training in Biloxi, Miss. I had never been in the South before and it didn’t make me very happy to be in Biloxi. They told us before we went South, we only had one purpose being there and that was to train. Don’t get in any kinda trouble. Yenwith Whitney at a North Port Library Black History Month lecture, Charlotte Sun,  20 February 2003

From Biloxi, Whitney went on to train at the Tuskegee Institute's 66th Air Force Flying School at the Tuskegee Institute in Alabama.

There was only one thing we dreamed of and that was getting our wings. If you washed out, it was the most devastating thing that could happen to you...We started out with 64 in our class, but only 26 got their wings and graduated. That was the greatest day of my life. I had achieved something significant. Yenwith Whitney in a North Port Library Black History Month lecture, Charlotte Sun,  20 February 2003

In 1944, he went on to serve as a pilot in one of four all-black fighter units in the 332 Fighter Group (“Red Tails”), assigned to the all-black 301st Fighter Squadron, of the 15th Air Force. During the war, Whitney flew 34 combat missions in Europe as a fighter pilot escorting heavy bombers, earning an Air Medal and three Clusters for his service.

Autographed 3x5 postcard depicting Tuskegee Airman Yenwith Whitney of the 332 Fighter Group (“Red Tails”), assigned to the all-black 301st Fighter Squadron, of the 15th Air Force, ca. 1944.

Despite earning an Air Medal and three Clusters for his service, Whitney was unable to get a job with a commercial airline after the war.

I was angry. I was just as qualified as anyone else. I enrolled in the best school I could think of. Yenwith Whitney in the Bradenton Herald , 18 April 2011

He applied to MIT under the GI Bill and was accepted. In 1949, Whitney earned a Bachelors in Aeronautics and Astronautics (Course XVI) from MIT in 1949.

After earning his degree from MIT, Whitney worked for Republic Aircraft on stress analysis, then for the EDO Corporation on structural design of aircraft floats. In 1958, he and his family moved to Cameroon, where Whitney taught math and physics at a Presbyterian mission. The family returned to New York a decade later, although Whitney continued working for the United Presbyterian Church in minority education and international education in Africa, the U.S., and Asia. Whitney also earned a Master’s degree in math education and a doctorate in International Education from Columbia University.

Louis Young

Louis M. Young  '50 was born in Detroit, Michigan, where he developed a love of airplanes. He built model airplanes and dreamed of becoming an aeronautical engineer or pilot.

After leaving the Army in 1946, Young attended Wayne State University for only a week. He quit after being told that all he "could ever do was to be a mechanic in that day". He worked at a hotel, then at a factory, before going into the military. After doing basic training, he went to Tuskegee.

At Tuskegee

I was one of the original Tuskegee Airmen...When I got to Tuskegee, I immediately got shipped up to navigation, being a navigator. They didn't have many people who were mathematical there. Here we were in a sort of segregated deal. We'd go in to breakfast at 7:00 AM, and an hour later the white students were by themselves and they ate. They kept us completely separate...In order to get a haircut, I had to go sixty miles from Hondo, Texas to San Antonio. At the barracks...they put the white boys to bed first. After they go to sleep, they bring us in and in the morning they took us out...Then later in the war, there were a lot of guys coming back from overseas. We heard about what they had done over there… We got [to the Oklahoma station] and the guy who was doing overseeing, when you walked into those barracks they made sure that we were treated right. We had separate toilets and all that sort of stuff, but we got pretty nice treatment. The thing that was bad there was you could do the least little thing wrong and they would kick you out...just looking at somebody wrong or just saying the least little thing. You had to be awfully sensitive in interacting in that place, and that's how you did the white folks. You figure out what they're trying to get you to do and you find ways to keep doing it, doing it better...You had to learn how to play [the part] quietly and not angrily or in a personal way...You had to be a person who could stay cool under pressure..."What can I do to take this pressure and reverse it the other way?" That's what I tried to do and I did it. Louis Young in  Technology and the Dream , 1997

I got out of the military in '46, and when I left there went directly to MIT...the military paid my way. At that time, it cost eighty-five dollars a year to go to MIT. What they told you when you first got into the Institute--you get in that big hall where everybody sits together--"Look at the person on your right. Next year two of you won't be here"...I was really the only black [student at MIT] my year for four years. I was the only guy in the aeronautical engineering class ['50] to get a job in 1950 for six months. I got mine immediately. But at my proudest moment, when I had this gal with me that I was going to get married to, we were standing in the elevator before graduation and this white guy got on and said, “How come this goddamn nigger can get a job and I can’t?” I learned that not only was I the only black in the aeronautical force, but none of the other students got a job until six months after I did...I was not the first black at Lockheed. I was the second one hired. Louis Young in  Technology and the Dream , 1997

After earning a Bachelor's in Aeronautical Engineering from MIT in 1950, Young became a Senior Design Specialist at Lockheed-California Corporation. He was the first African-American to work for Lockheed's engineering department. He served for 38 years and, after numerous promotions, retired in 1989 as Chairman of the Board, Planning. By 1997, Young was serving as President of the Tuskegee Airmen Scholarship Fund Program .

Luther Prince Jr

Luther T. Prince, Jr.  '52, MS '52 was born to a railroad brakeman and a homemaker in Fort Worth, TX. In 1943, he enrolled at the Tuskegee Institute, mistakenly believing it to be directly affiliated with the all-black Army Air Force 99th Pursuit Squadron, which trained the Tuskegee Airmen. Prince transferred to Ohio State University a year later, but World War II interrupted his studies in 1946. He served three years in the Army before applying to MIT. In 1952, Prince earned both his Bachelors and Masters degrees in Electrical Engineering.

He was hired a year later by the electronics company Honeywell. At the Minneapolis headquarters he designed flight-control systems for aircrafts and missiles, rising to engineering supervisor after eight years. In 1967, Prince became CEO of the ailing Ault, Inc., an electrical components maker in Minneapolis. Prince's development of a standardized plug-in wall unit increased the company's growth and paved the way for minority business in the private technology sector. Prince was the first African American to be inducted into the Minnesota Business Hall of Fame.

Charles Anderson

Charles "Chief" Alfred Anderson  PhD '60 was the first African American to hold a PhD in meteorology, which he earned from MIT in 1960. In 2007, he was awarded a Congressional Medal of Honor. 

Airport 1 would be Kennedy Field, which was no more than a sod runway with a few buildings for aircraft and refueling equipment. Kennedy became most known for Charles A. (“Chief”) Anderson’s famous flight with first lady Eleanor Roosevelt in 1941. But the program’s chief instructor meant much more to the many Tuskegee Airmen he trained. Tuskegee Institute recruited him in 1940 to be the chief civilian flight instructor for African American pilots. Anderson developed a pilot training program and taught the first advanced course, and in June 1941, the Army named him the ground commander and chief instructor for cadets in the 99th Pursuit Squadron, the nation’s first African American fighter squadron. To many Tuskegee Airmen, Anderson, who died in Tuskegee in 1996, will not only always be “Chief.” For them, he was also “the beginning” of their journey into military flight. “Chief pilot wasn’t just a position in the staff we were operating,” said Roscoe Draper, who joined Anderson as an instructor in 1942. “It was also an honorary position in our hierarchy. He was considered the coach of the pilots. “I will always feel I owe him an awful lot, the way he opened doors for me. Chief Anderson opened doors we never could have approached otherwise.”

"Charles E. Anderson '48 Awarded Congressional Medal of Honor,"   NYU-Poly eBriefs , a publication of the Polytechnic Institute of New York University, 30 March 2007

Sixty-two years after their legendary World War II exploits, the members of America's first all-black fighter squadron, the Tuskegee Airmen, were awarded the Congressional Medal of Honor on March 29, 2007.  In 1940, at a time when Blacks were barred from serving in the U.S. Military flight training program, Charles Edward "Chief" Anderson, who would later become a 1948 alum of the polymer chemistry program at the Polytechnic Institute of Brooklyn, started the Civilian Pilot Training Program (CPTP) at the Tuskegee Institute of Alabama. Anderson's CPTP and its military follow-on, which he also directed, were responsible for training the pilots who became the famous Tuskegee Airmen. "Chief" Anderson is widely acclaimed as the father of Black Aviation.  A self-taught pilot, Anderson was the first African American to receive a pilot's license in 1929. Renowned for their squadron's achievements, the Tuskegee Airmen flew more than 15,000 sorties over North Africa and Europe during World War II and destroyed more than 250 enemy aircraft on the ground and 150 in the air. The squadron never lost a bomber to enemy aircraft fire during their escort missions. No other escort unit could claim such a record.  In recognition of their outstanding service to the nation, the entire squadron is now [2007] being honored as a group with the Congressional Medal of Honor. When Eleanor Roosevelt visited Tuskegee Army Air Field in 1941, she insisted on taking a ride in an airplane with a black pilot at the controls. The First Lady's pilot was "Chief" Charles Anderson.  Mrs. Roosevelt, a pioneering Civil Rights Activist, insisted her flight with Anderson be photographed, and immediately developed the film so she could take pictures back to Washington to persuade FDR to activate the Tuskegee Airmen in North Africa and in the European Theater.

Eleanor Roosevelt (center) and Charles E. Anderson (right) at Tuskegee Army Air Field, 11 April 1941. She had insisted that the flight be photographed, and immediately developed the film in order to take the photos back to Washington and persuade FDR to activate the Tuskegee Airmen in North Africa and in the European Theater of World War II.

Credited with the training of over 900 airmen at the Tuskegee Institute, Anderson's flying squadron helped persuade President Harry Truman, in 1948, to end segregation in the U.S. military, thus opening America to a new social order.  That same year, Anderson received a Masters of Science in Chemistry from the Polytechnic Institute of Brooklyn, and went on to the Massachusetts Institute of Technology to become the first African American man to receive a PhD in Meteorology in 1960, with a dissertation entitled " A Study of the Pulsating Growth of Cumulus Clouds ". From 1965 to 1966 Anderson worked in Washington, D.C., as the director of the Office of Federal Coordination in Meteorology in the Environmental Science Service Administration, part of the U.S. Department of Commerce. In this position Anderson established the first World Weather Watch program. In 1966 Anderson began a 20-year career at the University of Wisconsin when he became the University's first tenured African-American professor. At Wisconsin, Anderson was professor of space science and engineering, professor of meteorology, chairman of the Contemporary Trends course, chairman of the Afro-American Studies Department, and chairman of the Meteorology Department. In 1978 he was appointed associate dean of the University. In 1970 Anderson participated in the Northeast Hail Research Experiment where scientists were first able to use satellite data in their research.  Having earlier worked with IBM computers at Douglass Aircraft Missiles and Space Systems Division, where he built upon the work of Joanne Simpson to produce the first moist cloud model on a computer, Anderson took full advantage of the satellite data and the growing field of computer science to study storms and tornadoes. Using remote sensing technology that had been designed for oceanography, Anderson revolutionized the field by introducing new analytical schemes and high-powered statistics, and gained national recognition for storm forecasting. In particular, Anderson discovered ways to identify tornadic storms by the way they spin, which led to scientists' ability to predict severe storms and tornadoes up to an hour before they arrived in populated areas. As a research professor, Anderson challenged fellow faculty members to strive for high quality research and to be truly productive members of the research community. Anderson continued working until his death on October 21, 1994, from cancer. In 1999 the National Center for Atmospheric Research (NCAR) established the Charles Anderson Award to honor his contributions to meteorology. According to an NCAR news release in 2000, the award was established "to recognize individuals or organizations for outstanding contributions to the promotion of educational outreach, educational service, and diversity in the atmospheric science community."

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Tuskegee Syphilis Experiment

The official title was “The Tuskegee Study of Untreated Syphilis in the Negro Male.” It is commonly called the Infamous Tuskegee Syphilis Experiment. Beginning in 1932 and continuing to 1972 the United States Public Health Services lured over 600 Black men, mostly sharecroppers in Tuskegee, Alabama, into this diabolical medical experiment with the promise of free health care. For 40 years, hundreds of African American men with syphilis went untreated, given placebos and other ineffective treatments, so that scientists could study the effects of the disease, even after there was a cure. None of the men who had syphilis were ever told they had it. Instead they were only told that they had “bad blood.” They were also never given penicillin, despite the fact that it had become a standard treatment by 1947.

The last survivor of the study died in 2004. This was not that long ago.

The Hippocratic Oath is used as a symbolic gesture that binds physicians to their patient’s well-being. Those who choose to take the oath makes an affirmation about treatment of those entrusted in their care, “I will do no harm or injustice to them.” It is commonly simply rephrased as, "First, do no harm." That was not the case with healthcare providers in Tuskegee, AL.

Below is an excerpt from an official admission of systematic racial discrimination issued by the United States President in 1997:

The President’s words confirmed the institutionally and racially discriminatory practices that have spanned not just decades as in this case, but centuries. Medical malfeasance is nothing new. Currently, amends are being made symbolically. In 2018, New York City finally removed an offensive statue from high atop a pedestal in Central Park. The statue depicted an infamous 19th-century gynecologist who experimented on enslaved women named Anarcha, Lucy and Betsey. He was part of a medical apartheid system that treated Black subjects as sub-human. He inflicted unimaginable torture because he operated under the ridiculous notion that Black people did not feel pain.

Remarkably, present day studies reveal that a frightening number of healthcare providers believe the myth that Black people have thicker skin and therefore need less pain management. The University of Virginia reported that racial bias partially explains research documenting how Black Americans are systemically undertreated for pain.

The Tuskegee Experiment was relatively recent and at least partially impacts the reactions to the current Novel Coronavirus pandemic. Black Americans have this recent example, in addition to a long history of other examples, explaining why it is reasonable to be suspicious of governmental medical information.

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Fiftieth Anniversary of Uncovering the Tuskegee Syphilis Study: The Story and Timeless Lessons

Martin j. tobin.

1 Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois; and

2 Stritch School of Medicine, Loyola University of Chicago, Maywood, Illinois

This year marks the 50th anniversary of the uncovering of the Tuskegee syphilis study, when the public learned that the Public Health Service (precursor of the CDC) for 40 years intentionally withheld effective therapy against a life-threatening illness in 400 African American men. In 2010, we learned that the same research group had deliberately infected hundreds of Guatemalans with syphilis and gonorrhea in the 1940s, with the goal of developing better methods for preventing these infections. Despite 15 journal articles detailing the results, no physician published a letter criticizing the Tuskegee study. Informed consent was never sought; instead, Public Health Service researchers deceived the men into believing they were receiving expert medical care. The study is an especially powerful parable because readers can identify the key players in the narrative and recognize them as exemplars of people they encounter in daily life—these flesh-and-blood characters convey the principles of research ethics more vividly than a dry account in a textbook of bioethics. The study spurred reforms leading to fundamental changes in the infrastructure of research ethics. The reason people fail to take steps to halt behavior that in retrospect everyone judges reprehensible is complex. Lack of imagination, rationalization, and institutional constraints are formidable obstacles. The central lessons from the study are the need to pause and think, reflect, and examine one’s conscience; the courage to speak; and above all the willpower to act. History, although about the past, is our best defense against future errors and transgressions.

The PHS Syphilis Study

Peter buxtun, the story breaks, why was the phs syphilis study undertaken, the guatemalan epilogue.

The history of medicine is presented as a cavalcade of triumphal breakthroughs leading to marked increases in life expectancy. Advances arise from the ingenuity and industry of innumerable investigators but also depend on millions of patients who selflessly make their bodies available for experimentation. The interaction between investigators and patients is a source of pride but on occasion has also been a reason for shame. Few medical experiments are more ignominious than that conducted by physicians who for 40 years (1932–1972) intentionally withheld effective therapy from hundreds of African American men known to have a life-threatening illness ( 1 ).

One of the most disturbing features of this experiment is the realization that it was conducted by the major health arm of the federal government: the Public Health Service (PHS; precursor of the CDC). When the experiment was uncovered in 1972, it was difficult to imagine that the PHS could contain a worse chapter in its history ( 2 ). Yet in 2010, we learned that the same group of researchers had deliberately infected hundreds of Guatemalans with syphilis and gonorrhea in the 1940s in the hope of developing a better means of preventing these infections.

The PHS study has its origin with researchers who wanted to study the natural history of untreated syphilis. The site chosen, Macon County, Alabama, had a population of 27,000 in 1932, of whom 82% were African American ( 1 ). The PHS sought the cooperation of the nearby Tuskegee Institute, the Black university founded by Booker T. Washington (1856–1915), and made use of the facilities of Andrew Memorial Hospital, located on the campus ( 3 ). The study population consisted of 600 Black men: 399 with syphilis and 201 free of the disease who served as control subjects ( 4 ). By 1969, at least 28 and perhaps 100 men had died as a direct result of syphilis; despite this knowledge, the government scientists continued the experiment ( 1 , 5 ).

“In 1932, Macon County was still very much tied to its plantation past,” Britt Rusert avows ( Figure 1 ). “Most of the men selected for the syphilis experiments were poor sharecroppers with little or no formal education who worked under white farmers in a system of debt peonage” ( 6 ). The men agreed to participate because the investigators offered them free medical care and burial insurance ( 1 ). Informed consent was never sought. On the contrary, PHS researchers deceived the men into believing they were being treated for “bad blood,” a colloquialism for several ailments ( 1 ). The term is included in the title of a book by James Jones, Bad Blood: The Tuskegee Syphilis Experiment (1981), regarded as the definitive history of the experiment ( 7 ) and “the single most important book ever written in bioethics” ( 8 ).

Unidentified study participant in a cotton field. Reproduced from file of photographs of participants in the Tuskegee syphilis study, National Archives (in public domain).

As an active physician who has spent more than 45 years conducting research on patients and a former journal editor-in-chief who investigated various problems of research ethics and imposed sanctions on researchers for malfeasance, I reflect on how physician-scientists who dedicate their lives to a noble cause can persuade themselves that it is morally acceptable to perform disturbing experiments on unwitting individuals to attain their goals. A more detailed version of this article is available in the online supplement.

The idea for the experiment originated with Dr. Taliaferro Clark, director of the Venereal Disease Division of the PHS ( 9 – 11 ). Dr. Clark was analyzing data from an earlier study when “the thought came to me that the Alabama community offered an unparalleled opportunity for the study of the effects of untreated syphilis” ( 1 ). In time, this thought became the Tuskegee Study of Untreated Syphilis in the Negro Male.

The men remained untreated only because the government doctors deliberately withheld therapy over a 40-year period and misled the men into believing that the medications they received (vitamin tonics and aspirin as placebo) were effective against their disease ( 6 ) ( Figures 2 and ​ and3). 3 ). When seeking assistance from the principal of the Tuskegee Institute, the surgeon general, Dr. Hugh Cumming (1869–1948), wrote to him in 1932 saying that the study “offers an unparalleled opportunity for carrying on this piece of scientific research which probably cannot be duplicated anywhere else in the world.” Presumably, Dr. Cumming did not intend any irony ( 12 ).

PHS staff members Dr. David Allbritton, nurse Eunice Rivers, and Dr. Walter Edmondson, conducting an annual roundup in Macon County, 1953. On the side of the vehicle, “U.S. Department of Health, Education, and Welfare, Public Health Service” is prominently displayed. Reproduced from National Archives (in public domain). PHS = Public Health Service.

Dr. Walter Edmondson of the PHS drawing a blood sample from a study participant during an annual roundup in Milstead, Macon County, 1953. Reproduced from National Archives (in public domain). PHS = Public Health Service.

The background knowledge that led to the PHS study came from the Oslo Study of Untreated Syphilis ( 9 ). Convinced that available therapy, primarily mercury compounds that had been used since the 16th century, was harmful, Dr. Caesar Boeck withheld treatment from almost 2,000 syphilitic patients between 1890 and 1910 ( 13 ). Like tuberculosis, syphilis had been one of the most feared scourges of mankind, estimated to affect 1 in every 10 Americans in the early 20th century ( 14 ). Around this time, German investigators made a series of path-breaking discoveries that revolutionized the ability of physicians to manage the disease ( 15 ). Therapy was transformed in 1908 when Sahachirō Hata (1873–1938) and Nobelist Paul Ehrlich (1854–1915) discovered an arsenical compound, arsphenamine, which was highly toxic to spirochetes and much less so to humans ( 15 ). Arsphenamine was marketed as Salvarsan in 1910; Boeck became quickly convinced of its efficacy and immediately terminated the Oslo study ( 16 ).

Once PHS investigators had enrolled the Alabama men and obtained baseline measurements, they next decided to check for evidence of neurosyphilis. Dr. Raymond Vonderlehr realized that the men might refuse lumbar puncture if they realized it was solely for diagnostic purposes. “My idea,” he wrote to his collaborators, is that “details of the puncture techniques should be kept from them as far as possible” ( 1 ). To entice the men to cooperate, he told them he would give them a special therapy: free “spinal shots,” deceiving them into believing that lumbar punctures were therapeutic ( Figure 4 ) ( 9 ).

Lumbar puncture, 1933. From left: Dr. Jesse J. Peters, nurse Eunice Rivers, and unidentified study participant. Reproduced from National Archives (in public domain).

The final step in data collection was to obtain pathological specimens at autopsy. “As I see it,” another PHS investigator, Dr. Oliver Wenger, wrote to Dr. Vonderlehr, “we have no further interest in these patients until they die ” (underlining in original) ( 17 ). The surgeon general, Dr. Cumming, stressed this step in a letter to the director of Andrew Hospital: “Since clinical observations are not considered final in the medical world, it is our desire to continue observation on the cases selected for the recent study and if possible to bring a percentage of these cases to autopsy so that pathological confirmation may be made of the disease processes.” PHS investigators feared the enrollees would quit if they knew they would be autopsied. Dr. Wenger wrote to Dr. Vonderlehr, “If the colored population become aware that accepting free hospital care means a postmortem every darkey will leave Macon County” ( 17 ).

To coax enrollees into the hospital when they became severely ill, the PHS promised to cover their burial expenses. Given the importance of funeral rites in the cultural life of rural Black persons, this was a particularly strong inducement ( 9 ). “The grotesque violation of these men’s bodies,” chides Britt Rusert, “extended even into their death: family members were required to turn over the corpse for an autopsy to secure funeral benefits” ( 6 ).

Shortly after commencing his tenure as surgeon general (1936–1948), Dr. Thomas Parran (1892–1968) launched a vigorous campaign to eradicate venereal disease using mass screening and mobile treatment clinics ( 18 ). Dr. Parran, who had visited Tuskegee in the early 1930s, is credited for the great strides made by this nationwide campaign ( Figure 5 ). When the mobile unit reached Macon County, PHS staff members alerted local doctors about enrollees and instructed physicians: “He’s under study and not to be treated” ( 1 ).

Thomas Parran, Jr., M.D., sixth U.S. surgeon general (1936–1948), in 1946, the year the Guatemala research commenced (reproduced from Reference 109 ) (in public domain).

In 1943, Dr. John Heller succeeded Dr. Vonderlehr as director of the Division of Venereal Diseases ( 1 ). One year later, penicillin became the therapy of choice for syphilis ( 19 ), and in 1947 PHS established rapid treatment centers across the country. There was no discussion of treating the men enrolled in the study. Given the effectiveness of penicillin, PHS scientists insisted that it was all the more urgent for the experiment to continue—it had become a never-again-to-be-repeated opportunity.

Although physician-scientists intentionally withheld penicillin, the experiment was fundamentally flawed because “the vast majority of the patients” had received “effective and undocumented” penicillin “in the happenstance manner while under treatment for other conditions” ( 20 ). As such, the study was not one of untreated syphilis, but rather of undertreated syphilis ( 21 ).

When Dr. Heller left the Division of Venereal Diseases in 1948, he became director of the National Cancer Institute and, in 1960, president of the Memorial Sloan-Kettering Cancer Center in New York. His years as leader of the PHS study coincided with the introduction of penicillin for syphilis and promulgation of the Nuremberg Code. There is no evidence that the PHS study was ever discussed in the light of the Nuremberg Code ( 1 ). When the experiment was brought to public attention in 1972, Dr. Heller shocked the public by telling journalists, “There was no racial side to this. It just happened to be in a black community. I feel this was a perfectly straightforward study, perfectly ethical, with controls” ( 9 ). When Dr. Heller died in 1989, the New York Times published a glowing obituary, listing his many accomplishments without mentioning the PHS study ( 22 ).

Some believe the PHS experiment was a secret study ( 6 ). On the contrary, the first report was published in JAMA in 1936 ( 23 ), and PHS researchers issued subsequent papers every 4–6 years until 1973 ( 24 ). For those who did not read the entire articles, the titles were sufficient to have aroused suspicion. “The Tuskegee Study of Untreated Syphilis; the 30th Year of Observation” was the title of a 1964 article in Archives of Internal Medicine ( 25 ). A 1955 article on autopsy findings communicated that more than 30% of the men had died directly from advanced syphilitic lesions ( 26 ). Despite repeated accounts of the ravages of untreated syphilis, appearing in 15 articles in reputable journals spread over 37 years, no physician or scientist from anywhere around the world published a letter or commentary criticizing the ethics of the experiment ( 21 ).

In December 1965, Peter Buxtun was hired by the PHS to interview patients with venereal disease. Within a year, the 29-year-old Czech-born psychiatric social worker sent a letter to Dr. William Brown, director of the Division of Venereal Diseases of the CDC, expressing grave moral concerns about the PHS study ( 1 ) ( Figure 6 ). The CDC remained silent for months and then invited Buxtun to a meeting in Atlanta. As soon as Buxtun entered the conference room, Dr. John Cutler, a PHS investigator ( 26 , 27 ), began to harangue him. “He had obviously read my material,” Buxtun recalled, “thought of me as some form of lunatic who needed immediate chastisement and he proceeded to administer it” ( 1 ).

Mr. Peter Buxtun, a 29-year-old social worker, communicated with the CDC about the ethics of the PHS study and subsequently revealed details of the study to a newspaper reporter (reproduced from Reference 110 ) (in public domain). PHS = Public Health Service.

In November 1968, Buxtun again wrote to Dr. Brown, who showed the letter to Dr. David Sencer, director of the CDC (1966–1977). Realizing they had a problem on their hands, Sencer and Brown convened a blue-ribbon panel in February 1969 to discuss the study ( 1 ). CDC scientists presented an overview of the study and said they needed advice on deciding whether to terminate it. Dr. Brown noted that 83 men had shown evidence of syphilis at death, but he personally believed the disease was the primary cause of death in only 7 of them ( 1 ).

Dr. Lawton Smith emerged as the leading advocate for continuing the study. He stressed, “You will never have another study like this; take advantage of it,” and boasted that “20 years from now, when these patients are gone, we can show their pictures” ( 28 ). (Today one can access the Lawton Smith Lecture Series on a website hosted by the North American Neuro-Ophthalmology Society [ 29 ].) Of 17 panelists, only Dr. Gene Stollerman saw the men as patients and believed they had a right to be treated: “You should treat each individual case as such, not treat as a group” ( 5 ). The blue-ribbon panel dismissed this objection and continued to refer to the survivors as a group of subjects rather than as individual patients. It was almost as if the words, “399-Alabama-Black-rural-sharecropping-illiterate-men” constituted a single word ( 21 ).

Dr. Brown wrote to Peter Buxtun informing him that a blue-ribbon panel had reviewed the experiment and decided against treating the men. Buxtun made no attempt to challenge the panel’s medical authority but asked, “What is the ethical thing to do?” ( 1 ). The CDC did not answer him. Buxtun discussed the matter with several law professors, who were sympathetic but offered little encouragement—an illustration of Ian Kershaw’s adage that the road to Auschwitz was paved with indifference ( 30 ). Buxtun contacted a journalist, and the story finally broke in the Washington Star on July 25, 1972, and as front-page news in the New York Times the following day ( 31 ).

The American public found it hard to wrap its mind around the idea that government doctors had been intentionally duping men with a disease as serious as syphilis for 40 years ( 24 ). The Afro-American of Baltimore exclaimed, “How condescending and void of credibility are the claims that racial considerations had nothing to do with the fact that 600 [all] of the subjects were black” ( 1 ). A number of physicians defended the study, the most spirited defense coming from Vanderbilt’s Rudolph Kampmeier (1898–1990), former president of the American College of Physicians (1967–1968) and editor of the Southern Medical Journal ( 32 ). Dr. Kampmeier blasted journalists for raising “a great hue and cry,” chastised them for their “complete disregard for their abysmal ignorance,” and trumpeted that his analysis would “put this ‘tempest in a teapot’ into proper historical perspective” ( 33 ).

Dr. Kampmeier considered the insinuation “that treatment was purposefully withheld” from the enrollees as unjust. On the contrary, “the subjects were not deterred from obtaining treatment if they desired it or bothered to get what was available” ( 33 ). In his mind, it was the fault of the men that they did not request penicillin as treatment for their syphilitic aortitis: “Since these men did not elect to obtain the treatment available to them, the development of aortic disease lay at the subject’s door and not in the Study’s protocol.” Regarding higher mortality in subjects with syphilis than in control subjects, Dr. Kampmeier coolly observed, “This is not surprising. No one has ever implied that syphilis was a benign infection” ( 33 ).

The Department of Health, Education, and Welfare (HEW) announced that it would undertake a review ( 1 ). In October 1972, the Ad Hoc Advisory Panel advised that the experiment be terminated and that the men receive immediate medical care. In February and March 1973, Senator Edward Kennedy conducted congressional hearings into the study, which led to the passage of the National Research Act and, in turn, the establishment of institutional review boards, principles of informed consent, and protection of vulnerable populations ( 5 ). Legal proceedings against any physician-scientist were never initiated ( 34 ).

In 1997, President Clinton finally tendered the government’s apology: “What the United States government did was shameful. . . . To our African American citizens, I am sorry that your federal government orchestrated a study so clearly racist” ( 35 ).

The HEW panel report, issued in April 1973 ( 36 ), failed to address two central questions: “Why was the experiment undertaken?” and “Why did it continue for 40 years?” The answers are complex. Insights are gained from examining the beliefs of the PHS investigators who initiated the study, scientific understanding of syphilis (treated and untreated), and prevailing cultural and social forces at the time.

In the early decades of the 20th century, eugenics was a worldwide force and judged to represent cutting-edge biology research ( 37 , 38 ). PHS study leaders were vocal advocates of eugenic measures ( 39 ). Dr. Taliaferro Clark earned his PHS stripes by undertaking eugenics-motivated projects on rural schoolchildren ( 40 ). Dr. Clark’s data would later be used by the state of Indiana to select individuals for sterilization. Because of its influence on the future of the “the race,” venereal disease was considered “directly antagonistic to the eugenic ideal” ( 14 ). Recognizing its threat to the family, several states enacted eugenic marriage laws, making venereal disease a bar to matrimony.

Racist views were not confined to the postbellum South nor directed solely at the lower echelons of Black society. When 5,000 Black physicians petitioned for membership in the American Medical Association (AMA) in 1939, their application was rejected ( 41 ). Not only did the AMA refuse to admit Black physicians as members, but it also did not allow them to attend its annual conferences. This discrimination lasted well into the civil rights era. Between 1944 and 1965, more than a dozen attempts to include Black physicians were rebuffed by the AMA ( 42 , 43 ). Black physicians consequently founded their own organization, the National Medical Association, which continues to publish its own journal to this day ( 44 , 45 ). The AMA did not officially desegregate until 1968 ( 46 ).

Fast forward to February 23, 2021: JAMA broadcasted a 16-minute podcast with the Twitter headline “No physician is racist, so how can there be structural racism in health care?” The host, Ed Livingston, M.D., a “fulltime editor of JAMA ,” dismissed structural racism as “an unfortunate term,” insisting that people are “turned off by the whole structural racism phenomenon,” concluding that “personally, I think taking racism out of the conversation will help” ( 47 ). Critics claimed the podcast exposed a culture of systemic racism in medicine. The furor arising from the podcast led to the resignation of Dr. Livingston, and the editor-in-chief, Howard Bauchner, M.D., was placed on administrative leave on March 25 and resigned on June 30 ( 48 ).

Assumptions that racial differences are genetic in origin have become embedded within medical practice, with half of White medical students and residents holding false beliefs about biological differences between Black and White individuals ( 49 ), which result in undertreatment of pain (among other consequences) ( 50 , 51 ). For years, researchers have treated race as an innate genetic attribute, whereas the perspective of race as a social construct is now widely embraced ( 52 ). The term “structural racism” is used to convey that racism has a systemic basis, embedded in social policy and norms and not simply private prejudices of individuals ( 53 , 54 ). Structural racism is the common denominator to the PHS experiments, inferior medical care ( 49 – 51 , 55 – 57 ) and increased coronavirus disease (COVID-19) mortality among African Americans ( 58 ), and police violence against Black individuals ( 59 ).

The Ad Hoc Advisory Panel that investigated the PHS study in 1972 was constrained by the narrowness of the charges HEW gave them ( 36 ). The nine-member panel included five Black and four White members, with Broadus Butler, Ph.D. (1920–1996), president of historically Black Dillard University and a former World War II Tuskegee Airman, as chairman ( 5 ). Several panel members subsequently claimed that Dr. Butler engaged in a government whitewash ( 60 ). Members traveled to Tuskegee and conducted taped interviews with study staff members and participants ( 5 ). On their return, the tape was burned at Dr. Butler’s insistence ( 5 , 60 ). A cover letter to HEW on the front page of the final report of April 28, 1973, contains the statement, “The Chairman specifically abstains from concurrence in this final report” ( 36 ). In a private letter, Dr. Butler wrote that the panel had become “advocates,” and had “lost their objectivity” ( 5 ). Dr. Butler died without leaving papers to shed light on his actions ( 5 ).

Many commentators focus on the failure of PHS researchers to administer penicillin once it became standard therapy. That argument betrays a basic misunderstanding of the purposes of the experiment, as it assumes that satisfactory therapy for syphilis did not exist before 1945 ( 16 ). By the 1920s, leading experts had become convinced that Salvarsan-based therapy was effective in decreasing morbidity and mortality ( 15 ). The administration of any effective medication, not just penicillin, to the men would have violated the rationale of the experiment, which was to study the natural course of untreated syphilis until death and autopsy.

Another common criticism, failure to obtain informed consent, also obscures the historical facts of the experiment. That informed consent, as we know it today, was not a component of a research protocol in the 1930s does not diminish PHS researchers’ obligations. In 1907 William Osler wrote on “the limits of justifiable experimentation upon our fellow creatures,” emphasizing, “For man absolute safety and full consent are the conditions which make such tests allowable” ( 61 ). A more fundamental point is that the Tuskegee men never saw themselves as volunteers in a scientific experiment. They were told and they believed that they were getting free treatment from expert government doctors for a serious disease.

While accumulating material for her book Examining Tuskegee (2009) ( 5 ), historian Susan Reverby traveled to the University of Pittsburgh in 2003 to investigate the stored records of Dr. Thomas Parran. Library staff members informed her that Dr. John Cutler (1915–2003) had donated his research records to the university in 1990 ( 62 , 63 ). On opening the files, Reverby found almost nothing about the Alabama study but copious records of PHS studies conducted between 1946 and 1948 wherein American physicians deliberately infected hundreds of Guatemalans with syphilis and gonorrhea without their knowledge or consent.

In 2010, Reverby submitted a manuscript to the Journal of Policy History ( 64 ), sending a preprint to a former director of the CDC. The information made its way through layers of government to reach the White House. President Obama appointed a commission to investigate the matter, and the results were published in two reports in late 2011 ( 65 , 66 ).

The ideas that led to the Guatemalan research originated during the second World War. The effect of sexually transmitted disease on military manpower is always a concern in wartime ( 67 ), and the United States was experiencing more than half a million new cases of syphilis each year ( 68 ). To develop better prophylaxis regimens, PHS investigators drew up plans for an experimental model wherein infection would be induced in healthy subjects. The principal investigator, Dr. Mahoney, began experiments in September 1943.

John Mahoney (1889–1957) graduated from medical school in 1914 and after clinical training joined the PHS and was appointed director of the Venereal Diseases Research Laboratory (progenitor of the CDC) of the U.S. Marine Hospital on Staten Island, New York, in 1929 ( 67 ) ( Figure 7 ). The 54-year-old physician-scientist supervised the experiments on federal prisoners, while 28-year-old John Cutler, M.D., assisted by other PHS researchers, conducted on-site work in Terre Haute, Indiana. Dr. Cutler was born in Cleveland in 1915 and graduated from Western Reserve University Medical School in 1941, joining the PHS 1 year later ( 65 , 69 ) ( Figure 8 ). A total of 241 prisoners participated in the experiments, all of whom were inoculated with Neisseria gonorrhoeae deposited into the end of the penis. Investigators failed to consistently produce infection, and the experiments ended in July 1944 ( 70 ).

John F. Mahoney, M.D. (1889–1957), director of the Venereal Diseases Research Laboratory (progenitor of the CDC) of the U.S. Marine Hospital on Staten Island, New York. Reproduced from the National Library of Medicine (in public domain).

John C. Cutler, M.D., in 1942, the year the 27-year-old physician joined the PHS. Reproduced from the National Library of Medicine (in public domain). PHS = Public Health Service.

In 1945, Guatemalan physician Dr. Juan Funes spent a 1-year fellowship in the Venereal Diseases Research Laboratory ( 71 ). He informed his supervisors that prostitution was legal in Guatemala and that it was also legal for prostitutes to visit men in penal institutions ( 64 ). To PHS investigators, Guatemala presented an opportunity to transmute the Terre Haute disappointment into a success ( 65 ).

Funding was sought from the NIH, and in March 1946, the first ever study section approved the proposal for “the Guatemalan study dealing with the experimental transmission of syphilis to human volunteers and improved methods of prophylaxis” ( 72 ), providing $146,000 in funding (equivalent to $2.1 million today) ( 73 ). Study section members included physician-scientists from Harvard, Johns Hopkins, the University of Pennsylvania, and other institutions. In August 1946, Dr. Cutler arrived in Guatemala to conduct the experiments, assisted by other PHS physicians and staff members ( 65 ).

The original plan was to induce syphilis in prisoners in Penitenciaría Central through sexual intercourse with infected prostitutes and then test the efficacy of prophylactic regimens. When the American physicians encountered unexpected difficulties, they began to conduct studies on Guatemalan soldiers, inmates in the country’s only mental hospital, and children in the national orphanage ( 64 ) ( Figures 9 and ​ and10). 10 ). Because the rate of infection resulting from intercourse with prostitutes was lower than expected (<10%) ( 10 ), the NIH-sponsored researchers attempted to artificially inoculate subjects with syphilis, gonorrhea, and chancroid.

Left: A 25-year-old female patient in Asilo de Alienados (Psychiatric Hospital) in Guatemala was exposed to syphilis once with no record of treatment. Right: A 16-year-old female patient in Asilo de Alienados was exposed to syphilis twice and was treated with penicillin. Records indicate that the patient was “uncooperative.” Reproduced from the National Archives and Records Administration (in public domain).

The injection site of a female psychiatric patient who was exposed to syphilis three times and received some treatment. Reproduced from the National Archives and Records Administration (in public domain).

The investigators’ notebooks contain graphic accounts of steps in these experiments. A physician held the penis of a participant, pulled back the foreskin, and “with some force, rolled the large inoculating swab over the mucosa so as to try to contaminate the entire fossa navicularis” ( 65 ). If enrolled prostitutes were uninfected, investigators inoculated women by moistening a cotton-tipped swab with gonorrheal pus, inserting it into the woman’s cervix, and “swabb[ing] it around . . . with considerable vigor” ( 65 ).

Only five infections resulted when 93 soldiers engaged in 138 episodes of sexual intercourse with 12 prostitutes ( 65 ). A higher rate of transmission, 17.9%, was achieved by inserting an infected pledget under the foreskin ( 65 ). To achieve a still higher rate of infection, the PHS physicians used a hypodermic needle to abrade the dorsal surface of a subject’s glans “short of drawing blood” and then covered the abraded area with a pledget soaked in Treponema pallidum , achieving a 91.6% rate of transmission ( 65 ). Many participants actively objected. One psychiatric patient “fled the room” after being subjected to penile scarification and was not found for several hours ( 65 ).

The American physicians also studied other modes of transmission, including oral ingestion of syphilitic material and inoculating the rectum, urethra, and eyes of participants ( 65 ). One psychiatric patient, Berta, had syphilis injected into her arm in February 1948. She developed bumps and skin wasting, and 6 months later Dr. Cutler wrote that Berta appeared as if she was going to die. The same day, August 23, he put gonorrheal pus from a male participant into Berta’s eyes, urethra, and rectum. Her eyes filled up with pus, and four days later Berta died ( 65 ).

By December 1948, the NIH-sponsored investigators had intentionally exposed at least 1,308 individuals to syphilis, gonorrhea, and chancroid ( 65 , 74 ). Of those infected, 61–87% showed evidence of disease, and the majority were not provided adequate treatment ( 75 ). Eighty-three deaths were reported ( 76 ). The rate of induced infection was unexpectedly low except for experiments involving scarification of participants’ membranes, which Dr. Mahoney considered “beyond the range of natural transmission and [would] not serve as a basis for the study of a locally applied prophylactic agent” ( 65 ). Among other considerations, this was a major reason for stopping the experiments.

The Guatemala studies were halted abruptly in December 1948, and none of the experimental findings were published. One motivation for terminating the research was Dr. Parran’s imminent departure from the surgeon general’s office on April 6, 1948. As that date drew near, Dr. Mahoney wrote to Dr. Cutler, “We have lost a very good friend and that it appears to be advisable to get our ducks in line. In this regard we feel that the Guatemala project should be brought to the innocuous stage as rapidly as possible” ( 63 ).

Many journalists portray Dr. Cutler as a Dr. Mengele–type scientist acting autonomously. This characterization is wrong. Although Dr. Cutler was the main on-site investigator, the primary supervisor of the Guatemalan experiments, Dr. Mahoney, was kept fully apprised. A few months after the research commenced, Dr. Mahoney wrote encouragingly to Dr. Cutler, “Your show is already attracting rather wide and favorable attention up here. We are frequently asked as to the progress of your work” ( 65 ). Dr. Coatney, a PHS investigator, wrote to Dr. Cutler about a conversation he had with the surgeon general: “As you well know, he is very much interested in the project and a merry twinkle came into his [Dr. Parran’s] eye when he said, ‘You know, we couldn’t do such an experiment in this country’” ( 65 ).

In June 1943, while submitting plans for the Terre Haute experiments, Dr. Mahoney began experiments into the efficacy of penicillin on syphilis ( 67 ). The antibiotic caused rapid and complete disappearance of spirochetal activity in infected men ( 77 ). Dr. Mahoney presented the unexpected findings at a meeting of the American Public Health Association in October 1943. The presentation had an electrifying effect on the audience, with one attendee claiming, “This is probably the most significant paper ever presented in the medical field” ( 67 ). Penicillin revolutionized the management of sexually transmitted disease. In 1940, the death rate for syphilis was 10.7 per 100,000; in 1950 it fell to 5 per 100,000, and in 1970 it reached 0.2 per 100,000 ( 14 ).

As the Guatemalan research was commencing in 1946, Dr. Mahoney was awarded the Lasker Award for his “distinguished service as a pioneer in the treatment of syphilis with penicillin.” Other awardees that year included Karl Landsteiner (1868–1943), discoverer of blood groups and Rhesus factor ( 78 ), and Ferdinand Cori (1896–1984), discoverer of the mechanism whereby glycogen is metabolized and resynthesized ( 78 ). The Lasker Award is known as the American Nobel Prize because many awardees receive both, as did Landsteiner and Cori. Accordingly, it is not an exaggeration to say that Dr. Mahoney was the preeminent American physician-scientist in 1946. As Dr. Mahoney received the award, the presenter proclaimed, “Your name will be joined in history with that of Paul Ehrlich” ( 79 ).

In pursuit of a praiseworthy goal (eradication of sexually transmitted disease), the PHS investigators rationalized to themselves that it was morally acceptable to infect people with the same fearsome disease. In all of the studies—Guatemala, Indiana, and Alabama—vulnerable people were used as a means to further the scientific ends and careers of physicians they trusted.

In their analysis of PHS research in Central America, the Presidential Commission for the Study of Bioethical Issues devoted considerable space to how stringent rules can prevent scientific misconduct. Yet, according to the commission, PHS investigators recognized the existence of such rules—clear evidence that rules provide no substitute for individual conscience. None of the PHS investigators volunteered to serve as subjects in their own experiments. The commission considered self-experimentation “as quaint and irrelevant” ( 65 ). As a physician-scientist who has conducted numerous physiological experiments on himself, I believe self-experimentation may prove a stronger deterrent than sets of rules.

The commission assumed—incorrectly—that Dr. Cutler wished to hide the results of the Guatemalan research. Researchers commonly fail to write up the results of experiments that do not produce clear answers. PHS researchers published several papers on the basis of serological studies conducted in Guatemala ( 80 – 83 ) and published other studies on the basis of induction of infection through inoculation ( 65 , 84 ). If Dr. Cutler had wished to be secretive, he would have destroyed the records rather than donate them to University of Pittsburgh 40 years after completing the work. In donating his files, he may have hoped that future scientists would build on his observations.

A striking feature of the Guatemalan research is that it did not arise through any fault in the chain of command ( 65 ). The principal investigator was the most eminent physician-scientist in the United States. The research plan was approved by an NIH study section, which included physician-investigators from the country’s leading medical schools. The surgeon general was enthusiastic about the studies and was kept informed of their progress.

Lessons from the PHS experiments are manifold. The Alabama investigation was conducted in an open society, it extended over 40 years, and it resulted in numerous publications in reputable journals read all over the world. The experiment is a story that needs to stay forever on the moral horizons of medical scientists, yet many young investigators know little of its details or lessons ( 85 ).

For the final 25 years of the Alabama experiment, the message of the Nuremberg Code had been widely disseminated. Investigators looked on it as “a good code for barbarians” ( 86 ), and it had little impact in the United States ( 87 , 88 ). Bioethicist Arthur Caplan avers that the PHS study is “the single most important event in the rise of bioethics” ( 8 ). Reforms arising from the Kennedy congressional hearings led to fundamental changes in the infrastructure of research ethics. Yet it is doubtful that these provisions benefited significantly the segments of society affected by the study: impoverished Black persons.

Some argue that revolutionary changes in research ethics obviate claims by HEW advisory panel members of a government whitewash ( 5 , 60 , 89 ). History is the story of roads taken, and counterfactual history contemplates what might have happened had a different road been ventured. The dominant factor that undergirded the PHS study was racism ( 90 ), which was played down to near invisibility in the HEW final report ( 5 ). Had society confronted the flagrant evidence of structural racism in 1972 and instituted fundamental reform of social contributors to health, the stark racial disparities of health outcomes exposed by the klieg light of COVID-19 could have been prevented ( 58 , 91 ); likewise, root reform of law enforcement in 1972 could have prevented the many deaths of Black persons consequent to unlawful police actions ( 59 ).

As with many instances of scientific misconduct, senior scientists were fully aware of the nature and magnitude of the PHS irregularities and took no action. Yet when the information was communicated in the lay press, the problem was immediately obvious to the general public. How can it be that problems reported on the front page of the New York Times become clear in retrospect, yet, in the preceding years, extremely accomplished physician-scientists saw no problem? Lack of imagination, rationalization, and institutional constraints are formidable obstacles in such situations.

In Humanity: a Moral History of the Twentieth Century , philosopher Jonathan Glover ( 92 ) analyzes several genocides, bringing together ethics and history, and concludes that only moral imagination (the ability to imagine ourselves in the shoes of endangered individuals) can enable us to alter our outlook and take steps to remedy a threatening situation. Many factors deaden moral imagination—groupthink, tribalism, obedience—and prevent us from taking action. Cultivation of moral imagination, Glover contends, holds the best hope of battling against comforting conventional attitudes and official policy, making vivid the destiny of dehumanized individuals, and becoming determined to take action. A succession of physicians worked on the Tuskegee project. If the consciences of new recruits were troubled on being first exposed to the study design, they acted as if they did not notice the peril of the enrollees, looking away and keeping silent. The consciences of these physicians were protected by moral inertia—finding it easier to fall in with the momentum of established routine and policy ( 92 ).

When officials are confronted with major sociopolitical problems, they spin themselves. They convince themselves that raising the concern will be futile and may even backfire with worse consequences. The CDC used this argument when trying to persuade Peter Buxtun that the PHS study should not be stopped. The blue-ribbon panel argued that penicillin would be dangerous ( 28 ). When the men were eventually treated with penicillin, not a single complication was observed ( 1 ).

When morals collide with actions, a common response is to blame the victim—Dr. Kampmeier blamed study participants for failing to request penicillin for aortitis ( 33 ). The prefix attached to the study by PHS investigators is a variant of the blame-the-victim tactic. Tuskegee University, founded by former slave Booker T. Washington in 1881, should be celebrated as a milestone in African American history. Instead, each time the Tuskegee study is mentioned, the university and townspeople are touched by a legacy of shame. Rather than besmirching the victims and their descendants, it would be more accurate to label the experiment after the perpetrators: the Public Health Service Study of Partially Treated Syphilis ( 93 ).

None of the study scientists wrote articles reflecting on its moral lessons. “No apologies were tendered. No one admitted any wrongdoing,” inveighs James Jones ( 1 ). In 1993, Dr. Cutler appeared on the PBS Nova documentary “Deadly Deception” ( 94 ). When asked about the Tuskegee men, he declaimed, “It was important that they were supposedly untreated, and it would be undesirable to go ahead and use large amounts of penicillin to treat the disease, because you’d interfere with the study.” He remonstrated, “I was bitterly opposed to killing off the Study for obvious reasons” ( 95 ). Regarding the enrollees, he attested, “They served their race very well.”

Dr. Parran served as surgeon general (1936–1948) during the time that penicillin was advocated to treat every American with syphilis—except men in Macon County. He did more than any other person to control sexually transmitted infections ( 68 , 96 , 97 ). He was founding dean of the University of Pittsburgh Graduate School of Public Health (1948–1958), and the school’s main building was named Parran Hall in 1969. In 1972, the American Sexually Transmitted Diseases Association named its highest award in his honor ( 98 ). The Pittsburgh school introduced the John C. Cutler Memorial Lecture in Global Health in 2003 to honor another former faculty member. A new dean canceled the lecture series in 2008 because of community sensitivities regarding Dr. Cutler’s role in the Tuskegee research ( 69 ). In 2013, American Sexually Transmitted Diseases Association members voted to remove Dr. Parran’s name from its annual award ( 76 ); in 2018, his name was stripped from the Pittsburgh Graduate School of Public Health building ( 99 ).

There is a common perception that moral judgment is linked to education. Yet the person who stopped the PHS study, Peter Buxtun, had no training in research; he was a social worker and had far less conventional education than the future director of the National Cancer Institute who led the study for years and many surgeons general who had intimate knowledge of it. With characteristic concision, Thomas Jefferson captured the distinction in a letter to his nephew: “An honest heart being the first blessing, a knowing head is the second” ( 100 ). Intelligence and education are not enough in human affairs: character and conscience come first. It is tempting to compartmentalize the lessons of the PHS study into those that apply to our actions as researchers and those that apply to our behavior as lay citizens. That would be a mistake because the two blend into each other.

When we look back at the Alabama and Guatemala stories, we fall into the trap of placing ourselves on the side of the angels, of grouping ourselves with the Buxtuns of this world. Hindsight is comforting, but it is also misleading ( 101 ). Coping with challenges as they unfold in real time is very different. Only one Peter Buxtun stood up over 40 years. It is more likely that most researchers would have followed in the footprints of Drs. Vonderlehr, Wenger, and Heller and the many other investigators involved.

There is a natural tendency to believe that group effort and cooperation are more effective than the actions of an individual. Correction of the great ills of society has always started in the heart of one individual and thereafter spread to a small group who recognized the same injustice. An especially astute commentator on social affairs, Adam Smith, wrote in 1763, “Slavery has hardly any possibility of it being abolished. . . . [It] has been universall [ sic ] in the beginnings of society, and the love of dominion and authority over others will probably make it perpetual” ( 102 ). A few years later, a 25-year-old deacon, Thomas Clarkson (1760–1846), started a movement that forced British Parliament to pass an act in 1807 abolishing the slave trade ( 102 ).

Individuals such as Buxtun and Clarkson who set out to make a difference are usually branded as irrational, soft, or naive. In official and administrative circles, where discussion is performed in the cold language of interests, people who urge intervention on the basis of moral arguments are considered “emotional.”

The reason people fail to take steps to halt behavior that in retrospect everyone judges reprehensible is complex. Scholars have long pondered the question. One of the first to wonder what light the second World War shed on this question was Hannah Arendt (1906–1975). She deconstructed the psychological and moral implications of evil ( 103 ). In 1961, she attended the trial of war criminal Adolf Eichmann. Arendt published a controversial book, Eichmann in Jerusalem: A Report on the Banality of Evil (1963). The expression “banality of evil” gave rise to much criticism and misunderstanding. Some saw Arendt as exonerating Eichmann and blaming the victims. When writing early drafts, Arendt was inclined to describe the evil quality of totalitarianism as something utterly “radical” ( 104 ). One of her mentors, physician-philosopher Karl Jaspers (1883–1969), argued that such a characterization made Nazism seem somehow unique and thus, in an awful way, “great” ( 103 ). As Arendt reflected on the matter, she arrived at the conclusion that evil arises from a simple failure to think .

What struck Arendt when listening to Eichmann was his banality: “his penchant for ‘officialese,’ for stock phrases, for shallow elations, his ‘empty talk,’ his being ‘genuinely incapable of uttering a single sentence that was not a cliché’” ( 104 ). She continued, “The longer one listened to him, the more obvious it became that his inability to speak was closely connected with an inability to think , namely to think from the standpoint of somebody else” ( 104 ). As Arendt inferred, “The trouble with Eichmann was precisely that so many were like him, and that the many were neither perverted nor sadistic, that they were, and still are, terribly and terrifyingly normal . . . this normality was much more terrifying than all the atrocities put together” ( 104 ). In this sense, the evil of the PHS experiments is banal and not radical. Banality does not trivialize evil: it is precisely what makes the behavior so dangerous ( 105 ).

Allied to a lack of thinking is a lack of reflection, an examination of conscience—the courage to form a judgment. Peter Buxtun was not afraid to judge and be counted. Today, we are constantly cautioned against being judgmental—not to form a moral opinion about the actions of others ( 106 ). Ahead of her time, Arendt saw the dangers of ethical relativism. Writing to Jaspers in 1963, she reflected that “even good and, at bottom, worthy people have, in our time, the most extraordinary fear about making judgments. This confusion about judgment can go hand in hand with fine and strong intelligence, just as good judgment can be found in those not remarkable for their intelligence” ( 103 ). For Buxtun, exercising judgment was a matter of moral courage.

When faced with serious injustice in their midst, the real reason people fail to intervene is a lack of willpower. Consider the Rwandan genocide—the most efficient killing spree of the 20th century ( 107 ). Across 100 days (April 6 to July 18, 1994), 800,000 Tutsi and politically moderate Hutu were murdered—the equivalent of more than two World Trade Center attacks every day for 100 days. In contrast to the broad support for the United States after September 11, every country turned away when the Tutsi cried out. During the 3 months of the genocide, the U.S. president never once assembled his top policy advisers to discuss the killings ( 108 ). After being personally lobbied by Human Rights Watch, Anthony Lake (born 1939), the president’s national security adviser, issued a statement calling on Rwandan military leaders to “do everything in their power to end the violence immediately.”

When Lake was informed 6 years after the genocide that this statement constituted the sum total of official public attempts to shame the Rwandan government, he was stunned: “You’re kidding,” he replied. “That’s truly pathetic” ( 108 ). Here is a leader who had acquired a reputation as a person of conscience, who was in a position of enormous power, and yet he failed to act; indeed, he appeared to be unaware that he had not acted. So it is not only medical researchers who fail to act on concerns that seem repellant in retrospect. In all walks of life, people who have reputations for good conscience, who are trained at the highest level, who possess all the facts and know the harmful consequences, and who have the power to act, still fail to act. Instead, they find sound logical reasons to dismiss all the information and decide not to intervene as events unfold in real time.

We must be careful not to use the Alabama and Guatemala research as an opportunity for letting off moralistic steam. Denouncing an injustice, observes Tzvetan Todorov, “constitutes a moral act only at those times when such denunciation is not simply a matter of course and thus involves some personal risk. There is nothing moral in speaking out against slavery today” ( 105 ). One can legitimately make moral demands only on oneself. To imagine oneself floating above the fields of Macon County and Guatemala City and wagging an indignant finger at the shades of Dr. Vonderlehr and Dr. Cutler constitutes “moralism.” People who hold themselves up as examples to others are in fact acting immorally, irrespective of how commendable their conduct may otherwise be ( 105 ). Hannah Arendt again: “Goodness can exist only when it is not perceived, not even by its author; whoever sees himself performing a good work is no longer good, but at best a useful member of society” ( 104 ).

Reflection on the PHS experiments highlights that out of the crooked timber of humanity, nothing entirely straight can be fashioned. Everything we know about the PHS researchers informs us that they were perceived as being decent people who did much good in other parts of their professional lives. Given the actions of Drs. Parran, Mahoney, and Cutler and other esteemed researchers, we need to approach today’s ethical challenges with “fear and trembling” (Kierkegaard’s phrase)—and remember to pause and think, reflect and examine our conscience, and have the courage to speak and, above all, the willpower to act.

Acknowledgment

The author thanks Sidney Wolfe, M.D., and Charles Natanson, M.D., for comments on an earlier version of the manuscript.

Supported by National Institute of Nursing Research grant R01-NR016055 and Veterans Administration Research Merit Review Award 1 I01 RX002803-01A1.

This article has an online supplement, which is accessible from this issue’s table of contents at www.atsjournals.org .

Originally Published in Press as DOI: 10.1164/rccm.202201-0136SO on May 2, 2022

Author disclosures are available with the text of this article at www.atsjournals.org .

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Tuskegee Airmen

By: History.com Editors

Updated: January 26, 2021 | Original: November 9, 2009

The Tuskegee Airmen were the first Black military aviators in the U.S. Army Air Corps (AAC), a precursor of the U.S. Air Force. Trained at the Tuskegee Army Air Field in Alabama, they flew more than 15,000 individual sorties in Europe and North Africa during World War II. Their impressive performance earned them more than 150 Distinguished Flying Crosses, and helped encourage the eventual integration of the U.S. armed forces.

Segregation in the Armed Forces

During the 1920s and ‘30s, the exploits of record-setting pilots like Charles Lindbergh and Amelia Earhart had captivated the nation, and thousands of young men and women clamored to follow in their footsteps.

But young African Americans who aspired to become pilots met with significant obstacles, starting with the widespread (racist) belief that Black people could not learn to fly or operate sophisticated aircraft.

In 1938, with Europe teetering on the brink of another great war, President Franklin D. Roosevelt announced he would expand the civilian pilot training program in the United States.

At the time, racial segregation remained the rule in the U.S. armed forces—as well as much of the country. Much of the military establishment (particularly in the South) believed Black soldiers were inferior to whites, and performed relatively poorly in combat.

But as the AAC began ramping up its training program, Black newspapers like the Chicago Defender and Pittsburgh Courier joined civil rights groups like the NAACP in arguing that Black Americans be included.

Tuskegee Experiment

In September 1940, Roosevelt’s White House responded to such lobbying campaigns by announcing that the AAC would soon begin training Black pilots.

For the training site, the War Department chose the Tuskegee Army Air Field in Tuskegee, Alabama , then under construction. Home to the prestigious Tuskegee Institute, founded by Booker T. Washington , it was located in the heart of the Jim Crow South.

The program’s trainees, nearly all of them college graduates or undergraduates, came from all over the country. In addition to some 1,000 pilots, the Tuskegee program trained nearly 14,000 navigators, bombardiers, instructors, aircraft and engine mechanics, control tower operators and other maintenance and support staff.

Benjamin O. Davis Jr.

Among the 13 members of the first class of aviation cadets in 1941 was Benjamin O. Davis Jr., a graduate of West Point and the son of Brig. Gen. Benjamin O. Davis, one of two Black officers (other than chaplains) in the entire U.S. military.

The “Tuskegee Experiment” took a great leap forward in April 1941 thanks to a visit by Eleanor Roosevelt to the airfield. Charles “Chief” Anderson, then the chief flight instructor in the program, took the first lady on an aerial tour, and photos and film of that flight helped publicize the program.

Tuskegee Airmen in World War II

In April 1943, the Tuskegee-trained 99th Pursuit Squadron deployed to North Africa, which the Allies had occupied.

In North Africa and then Sicily, they flew missions in second-hand P-40 planes, which were slower and more difficult to maneuver than their German counterparts. After the commander of the 99th’s assigned fighter group complained about the squadron’s performance, Davis had to defend his men before a War Department committee.

Rather than being shipped home, the 99th was moved to Italy, where they served alongside the white pilots of the 79th Fighter Group. In early 1944, pilots from the 99th shot down 12 German fighters in two days, going some distance toward proving themselves in combat.

In February 1944, the 100th, 301st and 302nd fighter squadrons arrived in Italy; together with the 99th, these squadrons of Black pilots and other personnel made up the new 332nd Fighter Group.

After this transfer, the pilots of the 332nd began flying P-51 Mustangs to escort the heavy bombers of the 15th Air Force during raids deep into enemy territory. The tails of their planes were painted red for identification purposes, earning them the enduring nickname “Red Tails.”

Though these were the best-known of the Tuskegee Airmen, Black aviators also served on bomber crews in the 477th Bombardment Group, formed in 1944.

A popular myth arose during the war—and persisted afterwards—that in more than 200 escort missions, the Tuskegee Airmen had never lost a bomber. The truth wasn’t uncovered until years later, when a detailed analysis found that enemy aircraft shot down at least 25 bombers they escorted.

Nonetheless, that was a much better success rate than other escort groups of the 15th Air Force, which lost an average of 46 bombers.

Tuskegee Airmen Legacy

By the time the 332nd flew its last combat mission on April 26, 1945, two weeks before the German surrender, the Tuskegee Airmen had flown more than 15,000 individual sorties over two years in combat.

They had destroyed or damaged 36 German planes in the air and 237 on the ground, as well as nearly 1,000 rail cars and transport vehicles and a German destroyer. In all, 66 Tuskegee-trained aviators were killed in action during World War II , while another 32 were captured as POWs after being shot down.

6 Renowned Tuskegee Airmen

These pioneering Black aviators not only took on the Germans; they shattered racist stereotypes and helped advance civil rights.

How Tuskegee Airmen Fought Military Segregation With Nonviolent Action

Their coordinated efforts to integrate a white officers' club set an example that wasn't lost on leaders of the burgeoning civil rights movement.

Did World War II Launch the Civil Rights Movement?

Centuries of prejudice and discrimination against blacks fueled the civil rights crusade, but World War II and its aftermath were arguably the main catalysts.

Armed Forces Integrated

After their brave service, the Tuskegee Airmen returned home to a country where they continued to face systematic racism and prejudice.

But they did represent an important step forward in preparing the nation for the racial integration of the military, which began with President Harry Truman who issued Executive Order 9981 desegregating the U.S. Armed Forces and mandating equality of opportunity and treatment on July 26, 1948.

A number of the original Tuskegee Airmen would go on to longer careers in the military, including Davis, who would become the first Black general in the new U.S. Air Force; George S. “Spanky” Roberts, who became the first Black commander of a racially integrated Air Force unit before retiring as a colonel; and Daniel “Chappie” James Jr., who would become the nation’s first Black four-star general in 1975.

More than 300 of the original Tuskegee Airmen were on hand to receive the Congressional Gold Medal from President George W. Bush in 2007.

Two years later, the surviving Tuskegee-trained pilots and support crew were invited to attend the inauguration of the nation’s first African American president, Barack Obama , who once wrote that his “career in public service was made possible by the path heroes like the Tuskegee Airmen trail-blazed.”

HISTORY Vault: Tuskegee Airmen: Legacy of Courage

Robin Roberts explores the legacy of the Tuskegee Airmen, the legendary group of African American pilots—including her father—that served in WWII and helped pave the way for the civil rights movement.

Todd Moye, Freedom Flyers: The Tuskegee Airmen of World War II ( New York : Oxford University Press, 2010). Who Were They? Tuskegee Airmen National Historical Museum . Daniel Haulman, “Nine Myths About the Tuskegee Airmen,” Tuskegee.edu . Katherine Q. Seelye, “Inauguration is a Culmination for Black Airmen, New York Times , December 9, 2008.

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Research Implications

After the U.S Public Health Service’s (USPHS) Untreated Syphilis Study at Tuskegee, the government changed its research practices.

In 1974, the National Research Act was signed into law, creating the  National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research . The group identified basic principles of research conduct and suggested ways to ensure those principles were followed.

In addition to the Commission’s recommendations, regulations were passed in 1974 that required researchers to get voluntary informed consent from all persons taking part in studies done or funded by the Department of Health, Education, and Welfare (DHEW). They also required that all DHEW-supported studies using human subjects be reviewed by Institutional Review Boards, which decide whether research protocols meet ethical standards.

The rules and policies for human subjects research have been reviewed and revised many times since they were first approved and efforts to promote the highest ethical standards in research are ongoing.

An Ethics Advisory Board was formed in the late-1970s to review ethical issues of biomedical research. As a result of their work, the 1979 publication commonly known as The Belmont Report summarized the three ethical principles that should guide human research: respect for persons ; beneficence ; justice. From 1980-1983, the  President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research  reported “every two years on the adequacy and uniformity of the Federal rules and policies, and their implementation, for the protection of human subjects in biomedical and behavioral research.” In 1991, federal departments and agencies (16 total) adopted the Federal Policy for the Protection of Human Subjects .

In October 1995, President Bill Clinton created a  National Bioethics Advisory Commission , funded and led by the Department of Health and Human Services. The commission’s task was to review current regulations, policies, and procedures to ensure all possible safeguards are in place to protect research volunteers. It was succeeded by the  President’s Council on Bioethics , which was established in 2001, and then the  Presidential Commission for the Study of Bioethical Issues  established in 2009.

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• Facts & Information about Syphilis
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• Tuskegee University National Center for Bioethics in Research and Health Care

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How This 101-Year-Old Tuskegee Airman Helped Keep the 'Red Ball Express' Running During WWII

When David Fax was a cadet in the Air Force ROTC detachment at Howard University in the early 1970s, one of his professors asked him what he knew about the Tuskegee Airmen. Stumbling for an answer, Fax sheepishly admitted he didn't know anything about the historic group of Black military pilots and service members who fought heroically during World War II.

Fax was about to get an education, largely courtesy of that professor: retired Air Force Lt. Col. Shelton "Ivan" Ware, one of the few remaining Documented Original Tuskegee Airmen , or DOTA, still alive.

"We fought two wars," Ware, 101, told Military.com recently. "You had to fight the war of segregation, and you also had to do your duty as far as the enemy was concerned. Keep them from killing you and the rest of your buddies."

When Ware joined the Army Enlisted Reserve Corps on April 1, 1942, he not only started down a path that would culminate in a 32-year military career. He also became part of history, serving as a weapons and vehicle maintenance technician with the famed Red Ball Express , a collection of predominantly Black troops that helped supply Allied forces during World War II.

The Red Ball Express -- named for the red balls that marked its routes and trucks -- brought essential supplies, including gasoline, food and ammunition, to the front lines, and it is no exaggeration to state that without the contributions of Ware and others, the Allies might have suffered a different outcome. For more than two years, Ware ensured that weapons and vehicles operated as smoothly as possible while stationed throughout Europe.

Ware told Military.com that, before joining the Red Ball Express, he had no experience as a mechanic.

"My specialty was small arms," Ware said. "Give me anything from a .22 to a .75 mm Howitzer, and I can do a job on it."

During the war, Ware did not realize exactly what Black pilots were accomplishing through their service at the time. He said that in the early days of the critical Allied invasion of Normandy that began in June 1944 -- Ware did not step foot onto Omaha Beach until four weeks after D-Day -- he had heard stories of some Black airmen, and later learned they were part of the all-Black 332nd Fighter Wing .

Nearly 75% of soldiers assigned to the Red Ball Express were Black, and collectively, they did yeoman's work until the program was disbanded in November 1944, accounting for transporting roughly 412,000 tons of munitions, fuel and sustenance that kept the Allied troops armed and fortified. Even in the face of discrimination, they focused on completing their job.

"Day after day after day, they were barraged by a bunch of garbage that they had to deal with, and rather than get upset, get in fights, throw your hat down and walk away, they said, 'I'm a professional first. I'm going to do my job,'" said Fax, Ware's former student at Howard.

Despite occasionally being the subject of racism from his fellow service members, Ware says he experienced some uplifting moments during WWII. He said receiving mail from home was always an emotional game-changer, going so far as to term it "a religious moment" when a letter or package arrived.

Ware, who was awarded two Service Stars, achieved the rank of staff sergeant by the time he was honorably discharged from the Army in June 1946. Two years later, he completed the Air Force ROTC program at Howard and was commissioned as a second lieutenant. After WWII, Ware helped train Air Force cooks and bakers, served as a training officer at the Air Reserve Center Program in Ohio, was director of military training at Wiesbaden Air Base, Germany, for three years and served with AFROTC programs at the Tuskegee Institute in Alabama and at Howard, where he mentored students like Fax.

"Everybody was glad the war was over," said Ware, who also served during the Korean War. "Even if you weren't directly affected, you knew that it was affecting a lot of families, both the enemies and ours. People were dying for nothing."

Ware retired from the Air Force in September 1974.

"He is healthy. Sometimes he moves better than me," said Jerome Hodge, president of the East Coast chapter of Tuskegee Airmen Inc. "What he talks about is if you have opportunities, you make a decision, you stand on it and you move on it."

Even into his second century on this Earth, Ware is still moving. He credits his longevity to "outrunning [his] age," staying one step ahead. As an active member of Tuskegee Airmen Inc., he has not stopped spreading the gospel of what those brave men represented and why it is so important for younger generations to hear those stories.

Asked what he would like current military members to take from the Tuskegee Airmen's example, Ware was as succinct as any 101-year-old man has earned the right to be.

"That all war is stupid," Ware said. "Avoid it at all costs, and you come out ahead."

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Stephen Ruiz

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McGee is the daughter of the late Tuskegee Airman, Brigadier General Charles McGee. She talks about his accomplishments and shares how she has made a name for herself in the organization as Co-chair of the Youth in Aviation Program (YIAP) East Coast Chapter, Tuskegee Airmen Inc.

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