medical experiments alabama

Main navigation

• Our Articles
• Dr. Joe's Books
• Media and Press
• Our History
• Public Lectures
• Past Newsletters
• Photo Gallery: The McGill OSS Separates 25 Years of Separating Sense from Nonsense

Subscribe to the OSS Weekly Newsletter!

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

• Add to calendar
• Tweet Widget

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.

Want to comment on this article? View it on our Facebook page!

What to read next

The weaving history of persian carpets 23 aug 2024.

Is Genghis Khan Hiding Inside Your DNA? 23 Aug 2024

Water Cures Have Flowed Through History 16 Aug 2024

The Book Natural Healers Really Hate 16 Aug 2024

How a Crazy Claim About a 'Bottle Jumper' Led to a Riot 9 Aug 2024

From Black Goo to Blue Dye and Beyond — the Fascinating History of Aniline 2 Aug 2024

Department and University Information

Office for science and society.

• Agriculture
• Arts & Literature
• Business & Industry
• Geography & Environment
• Government & Politics
• Science & Technology
• Sports & Recreation
• Organizations
• Collections
• Quick Facts

Tuskegee Syphilis Study

Syphilis is a venereal disease caused by a microscopic spirochete (a type of bacteria) that is transmitted through sexual contact or from mothers to children at birth. It is most infectious in its early stage, when sores, called chancres, appear. In the second stage, infected individuals often experience painful rashes, sores, and swellings. Left untreated, the disease goes into a third, generally non-infectious latent stage. Syphilis does not go away, but it can stay dormant for years or even decades. It can cause complications that affect major organs, such as the heart or brain, in about two-thirds of all cases. Debility, insanity, and death are often, but not always, the consequences.

Public Health Service Conducts Syphilis Survey

In 1929, with funding from the philanthropic Rosenwald Fund, the PHS began a project in six southern counties, including Macon County in Alabama, to survey and treat black men and women with syphilis. Using the somewhat inaccurate blood tests of the day, researchers in Macon County found a 39.8-percent infection rate among the 3,684 black men and women tested. Through a combination of philanthropic and public funds, nearly 1,400 of those people began treatment for their disease. Pleased by the results, the PHS now had both a model for studies of the prevalence of disease and a way to develop a rural treatment program.

These studies raised another question. The country's leading syphilis experts were puzzled as to why some patients did well with little or no treatment in the second and third stages, while others did not. PHS officials expressed concerns about this phenomenon to public health officials in Alabama, Macon County, and Tuskegee Institute and outlined a short-term program of minimal treatment for a select group of black men who were assumed to be in the third, or dormant, stage. PHS officials anticipated that the findings might indicate that treatment at certain stages of syphilis was unnecessary. They began another smaller program on latent syphilis in Tuskegee that focused only on men. As the Great Depression deepened in the early 1930s, however, the PHS and the Rosenwald Fund became increasingly unable to continue funding. PHS officers saw in this turn of events an opportunity for what is called a "study in nature" of untreated syphilis. That is, they assumed in this case that it would be "natural" for poor African Americans not to be treated.

No Informed Consent

The PHS selected 399 black men with late-stage syphilis and 201 uninfected men to serve as controls. As was typical for medical studies at the time, there was no real informed consent. The men were led to believe that the rubs, tonics, and aspirins given them were treatments for their "bad blood," the general term used in many communities for syphilis. Even the painful spinal taps were explained not as a diagnostic procedure (to check for neurological syphilis) but as a "back shot." PHS physicians realized that the best scientific data would come from autopsies because doctors would be able to see directly how much damage the disease had done to the men's bodies. They therefore authorized Rivers to offer $50 to participating families in exchange for autopsy agreements prior to burial. Local doctors were asked to withhold treatment from the men, although the extent of their compliance is uncertain. Rivers also provided food and clothing to the men and their families and referrals for medical care for other illnesses.

During World War II , the PHS, with the help of Macon County health officer Dr. Murray Smith, made sure that none of the study's subjects were drafted. Had they been, their syphilis would have been detected and treated. When penicillin became widely available in the late 1940s as an effective cure for the disease, the PHS made an effort to ensure that the men did not receive the drug, although penicillin might not have helped those already in the last stages of the disease. Despite these efforts, some of the men did receive penicillin from other health care providers in the 1950s, probably to treat other illnesses.

Questions of Ethics

When PHS researchers published reports on the study or gave lectures at medical meetings, physicians occasionally questioned the ethics of the study. Their concerns were brushed aside by the PHS doctors, who asserted that they were doing critical public health work. Other concerns about the study expressed within the PHS also were brushed aside. Even after Nazi experiments on prisoners in Germany became public knowledge and were denounced, the Tuskegee experiment went unquestioned.

In 1966, Peter Buxtun, who was tracking venereal disease cases for the San Francisco Health Department, heard about the study from a colleague during a coffee break. He was outraged by the idea that citizens just like those he was trying to help were being willfully denied treatment by the PHS. He requested copies of the PHS reports and began a campaign through government channels to end the study. Stonewalled at every turn, Buxtun gave his information to Jean Heller, an Associated Press reporter, who published the story on July 25, 1972, in the Washington Star .

The study officially ended in 1973, and the last survivor died in 2004, but the impact continues. The Tuskegee study is often cited as the reason that many African Americans avoid medical care or refuse to participate in clinical trials, although it is clearly part of a long history of mistrust. The study is taught as a major example in bioethics courses on how not to conduct research and was fictionalized in the HBO movie Miss Evers' Boys . An outcome of the federal apology in 1997 was the creation of the National Center for Bioethics in Research and Healthcare at Tuskegee University. The racism and scientific arrogance that underlay the study's rationale continues to inform the use of human subjects in trials in the fields of health care and scientific investigation.

Further Reading

• Gray, Fred D. The Tuskegee Syphilis Study. Montgomery, Ala.: Black Belt Press, 1998.
• Jones, James H. Bad Blood: The Tuskegee Syphilis Experiment. New York: Free Press, 1993.
• Reverby, Susan M., ed. Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study. Chapel Hill: University of North Carolina Press, 2000.
• “The Deadly Deception.” NOVA. Boston: WGBH Educational Foundation, 1993. Distributed by Films of the Humanities and Sciences.
• Miss Evers’ Boys. Directed by Joseph Sargent. New York: HBO Films, 2001.

External Links

• CDC: The U.S. Public Health Service Syphilis Study at Tuskegee
• National Center for Bioethics in Research and Health Care

Susan M. Reverby Wellesley College

Last Updated

• Share on Facebook
• Send via Email

Related Articles

Limestone County

The site of numerous Civil War skirmishes, Limestone County is located in the northwest part of the state and is a center of space and technology development in the state. Three Alabama governors have called Limestone County home: Thomas Bibb, Joshua Lanier Martin, and George S. Houston. Limestone County is…

Percy Lavon Julian

Percy L. Julian (1899-1975) was an internationally acclaimed synthetic organic chemist. Only the third African American to receive a Ph.D. in chemistry, he specialized in the field of natural products chemistry, the identification of active chemical components of extracts from plants and the synthesis of those components in the laboratory…

Kathryn Tucker Windham

Kathryn Tucker Windham (1918-2011) is best known for her series of ghost story collections, beginning with 13 Alabama Ghosts and Jeffrey in 1969, as well as numerous other publications, photography, and storytelling. Windham's work focused on the South's multilayered lifeways and evokes positive qualities of the human experience: family, community,…

Mary Munson

Mary Munson (ca. 1848-1920) was known for her work on behalf of the women's suffrage movement in Vinemont, Cullman County, where she was instrumental in establishing the Vinemont Equal Suffrage Association. Munson was born Mary Ellen Kelly in 1848 in Laurel Township, Indiana, to Moses and Elizabeth Kelly; she had…

Share this Article

Official websites use .gov

A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Public Health Service Study of Untreated Syphilis at Tuskegee and Macon County, AL

In 1932, 399 African American men in Tuskegee and Macon County, Alabama were enrolled in a Public Health Service study on the long-term effects of untreated syphilis . At that time, there was no cure for syphilis, though many ineffective and often harmful treatments, such as arsenic, were used. In the 1940s, penicillin was discovered, and by the 1950s, it was widely accepted by the medical community as the quickest and most effective treatment for syphilis . The men in the study were not made aware of the availability of penicillin as treatment, however, and the study continued and was transferred to CDC along with the PHS VD Unit in 1957.

The study was intended to last only six months but continued into the 1970s. In 1968, Peter Buxton, a CDC Public Health Advisor in the USPHS, raised questions about the study. After several years of questioning by Mr. Buxton, several news articles were published, leading to a Senate investigation headed by Sen. Edward Kennedy. It was this investigation that forced the study’s end in 1972. CDC and the Department of Health and Human Services (HHS)  acknowledged the study as unethical, ended it, and compensated study survivors for medical care and burial expenses.

Shown above is a letter that then-CDC Director Dr. David J. Sencer wrote to the survivors of the U.S. Public Health Service Study of Untreated Syphilis at Tuskegee and Macon County, AL explaining that they would receive medical care for the rest of their lives. Also on display is one of the benefits cards that was distributed, which reads, “To Serve Those Who Served,” as well as a photograph of President Clinton with the survivors at the White House, where on May 16th, 1997, he officially apologized to the last living participants.

Out of this tragedy came the  Belmont Report , a comprehensive document that created new standards of research to protect participants from unethical practices.

For more information, including the names of the men in the study, please visit Voices for Our Fathers Legacy Foundation (voicesforfathers.org)   and Tuskegee Study and Health Benefit Program – CDC – OS .

Take a closer look:

• What is syphilis and how does it spread? Learn more about syphilis  and the bacterium that causes the disease, Treponema pallidum .
• View a close-up image of  Treponema pallidum under a microscope  and grimace at symptoms of syphilis symptoms on a  human hand .
• Learn more about gonorrhea  and the bacterium that causes it, Neisseria gonorrhoeae .
• Explore CDC’s STD resources  covering prevention initiatives, surveillance, treatment, training programs, and so much more.
• Did you know human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S.? Learn more in this CDC Museum Public Health Academy Teen Newsletter .

From the source:

• Meet  Brandy Maddox , Health Scientist in the Division of Sexually Transmitted Disease Prevention at CDC.
• Hear from a CDC expert about her path to public health and her work in adolescent sexual health at CDC in the  CDC Museum Public Health Academy Teen Newsletter: September 2020 – Healthy Schools Zoom .
• Keep up with the latest STD updates from CDC on  Twitter and Facebook .
• Did you know that there is a vaccine to protect against some strains of HPV that cause cancer? Learn more from the cervical cancer survivor in  this video .
• Listen to CDC experts talk about their paths to public health and their work with human papillomavirus (HPV), the most common sexually transmitted infection in the United States in the  CDC Museum Public Health Academy Teen Newsletter: January 2021 – HPV Zoom .

Then and now:

• Learn more about incidence, prevalence, and cost of STIs over time in the U.S.
• Read about CDC’s STD prevention success stories .
• View a timeline of the Untreated Syphilis Study at Tuskegee and learn how this study informed ethical data collection and changed research practices  for good.
• Explore the history of traveling and sexually transmitted diseases in this  EID issue .
• Learn about preventing antibiotic-resistant gonorrhea  and CDC measures to combat antibiotic resistance  across the U.S.
• Contemplate the impact of the Untreated Syphilis Study at Tuskegee on affected families .
• Read about nurse Eunice Rivers , the nurse who worked on the Tuskegee Study.

Give it a try:

• A Public Health Advisor (PHA) conducts a contract tracing investigation [572 KB, 1 Page]
• A Public Health Advisor (PHA) dons gear to conduct contact tracing in the community [459 KB, 1 Page]
• A patient shows symptoms to a PHA in order to be diagnosed and treated [206 KB, 1 Page]
• How does contract tracing work? Find CDC contact tracing guidance and resources .
• 3D print a model of a portion of human papillomavirus through the National Institutes of Health 3D Print Exchange .
• Looking to expand your knowledge on STDs? Check out these continuing education resources .
• Know your status. Find a testing site  near you.
• Take a deep dive into human papillomavirus (HPV), the most common sexually transmitted infection in the United States in the CDC Museum Public Health Academy Teen Newsletter: January 2021 – HPV .
• Request a Speaker
• Public Health Grand Rounds
• CDC History
• Smithsonian Institution
• CDC Museum Brochure [8.8 MB, 2 Pages, 16″ x 9″]
• CDC Museum Press Sheet [2.3 MB, 1 page]
• Hours Monday: 9am-5pm Tuesday: 9am-5pm Wednesday: 9am-5pm Thursday: 9am-7pm Friday: 9am-5pm Closed weekends & federal holidays
• Closures From Oct 25 through Nov 22, the museum will be temporarily closed for the installation of Health is a Human Right II: Achieving Health Equity. Learn more about upcoming exhibitions.
• Location 1600 Clifton Road NE Atlanta, GA 30329
• Phone 404-639-0830
• Tour Questions [email protected]
• Admission & Parking: Always Free Government–issued photo ID required for adults over the age of 18 Passport required for non-U.S. citizens
• Weapons are prohibited. All vehicles will be inspected.

To receive email updates about this page, enter your email address:

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.

More Must-Reads from TIME

• Breaking Down the 2024 Election Calendar
• How Nayib Bukele’s ‘Iron Fist’ Has Transformed El Salvador
• What if Ultra-Processed Foods Aren’t as Bad as You Think?
• How Ukraine Beat Russia in the Battle of the Black Sea
• Long COVID Looks Different in Kids
• How Project 2025 Would Jeopardize Americans’ Health
• What a $129 Frying Pan Says About America’s Eating Habits
• The 32 Most Anticipated Books of Fall 2024

Write to Olivia B. Waxman at [email protected]

The Lasting Fallout of the Tuskegee Syphilis Study

A recent paper provides evidence that the Tuskegee Syphilis Study reduced the life expectancy of African-American men.

A new paper provides evidence that the Tuskegee Syphilis Study reduced the life expectancy of African-American men —though the Tuskegee Syphilis Study ended decades ago. What was the Tuskegee Syphilis Study and why did it have lasting reverberations?

The now-infamous 1932 Tuskegee Syphilis Study  was conducted by the U.S. Public Health Service in Macon County, Alabama. During the experiment 600 impoverished black men were studied, 399 of whom had syphilis that went untreated although the health care practitioners knew of their illness. The men were never educated about syphilis, were never told of their status or treated, although treatments did exist; they were merely told they were being seen for “bad blood.” The men underwent painful procedures like spinal taps under the guise of “free healthcare,” and were “compensated” with meals and burial insurance. The intent of the study was never even to actually help the patients, but rather to examine the course of untreated dormant syphilis in black men.

Men in the study were not allowed to access other treatment services in the area. Not only did the syphilis harm the men, many of their wives and even some of their children contracted the disease. Despite the fact that codes like the Nuremberg Code of ethics was created during the Tuskegee study, and that by 1947 penicillin had become a standard, effective treatment for syphilis, the experiment continued. The study was initially intended to be six months but continued until 1972.  It did not provide as much insight on syphilis research as it did about racism in health research.

Decades after the Tuskegee Syphilis study health statistics continue to illustrate the lack of trust black Americans have for healthcare professionals. Looking at the context and history of the beliefs can help us make sense of the trends. In the 1990s a notable chunk of the African American community believed that the government created AIDS . A 1997 study illustrated cited 32.1% of the black women surveyed agreed with a statement that scientists were not trustworthy . This significantly deviates from the 4.1 % of white women in the study who agreed with the aforementioned statement. This was despite the fact that over 80% of women surveyed recognized the benefits of medical research for society. The newer findings  delve specifically into how this mistrust of the health profession has had negative impacts on black people’s health.

Weekly Newsletter

Get your fix of JSTOR Daily’s best stories in your inbox each Thursday.

Privacy Policy   Contact Us You may unsubscribe at any time by clicking on the provided link on any marketing message.

While tenets of equity in healthcare research appear to be universal , there is a long history of disparity when it comes to the distribution and quality of healthcare amongst individual people. The Hippocratic oath  compels new doctors to make blanket commitments to ethics and accountability while serving humanity regardless of gender, race, religion, political affiliation, sexual orientation, nationality, or social standing . And yet this oath belies a legacy of racism in medicine.

Communities that have experienced such painful histories of being used as lab rats understandably may not be inclined to engage with healthcare providers. Beneficence and non-maleficence are cornerstones of health care provision, at least if you look at codes we like to think all healthcare providers adhere to. But fidelity was not upheld with Tuskegee and the ripple effect is evident today. Oaths do not guarantee an obligation to morality or veracity in healthcare, people do.

JSTOR is a digital library for scholars, researchers, and students. JSTOR Daily readers can access the original research behind our articles for free on JSTOR.

Get Our Newsletter

More stories.

When French Citrus Colonized Algeria

Dr. AI Will See You Now

Defining and Redefining Intersex

Eisenhower and the Real-Life Nautilus

Recent posts.

• A Selection of Student Confessions
• Thurgood Marshall
• Back to School
• The Bawdy House Riots of 1668
• The Sovereignty of the Latter-day Saints

Support JSTOR Daily

Sign up for our weekly newsletter.

• History Classics
• Your Profile
• Find History on Facebook (Opens in a new window)
• Find History on Twitter (Opens in a new window)
• Find History on YouTube (Opens in a new window)
• Find History on Instagram (Opens in a new window)
• Find History on TikTok (Opens in a new window)
• This Day In History
• History Podcasts
• History Vault

The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Enslaved Women

By: Brynn Holland

Updated: December 4, 2018 | Original: August 29, 2017

Few medical doctors have been as lauded—and loathed—as James Marion Sims. 

Credited as the “father of modern gynecology,” Sims developed pioneering tools and surgical techniques related to women’s reproductive health. In 1876, he was named president of the American Medical Association, and in 1880, he became president of the American Gynecological Society, an organization he helped found. The 19th-century physician has been lionized with a half-dozen statues around the country.

But because Sims’ research was conducted on enslaved Black women without anesthesia, medical ethicists, historians and others say his use of enslaved Black bodies as medical test subjects falls into a long, ethically bereft history that includes the Tuskegee syphilis experiment and Henrietta Lacks . Critics say Sims cared more about the experiments than in providing therapeutic treatment, and that he caused untold suffering by operating under the racist notion that Black people did not feel pain.

Sims, who practiced medicine at a time when treating women was considered distasteful and rarely done, invented the vaginal speculum, a tool used for dilation and examination. He also pioneered a surgical technique to repair vesicovaginal fistula, a common 19th-century complication of childbirth in which a tear between the uterus and bladder caused constant pain and urine leakage.

His defenders say the Southern-born slaveholder was simply a man of his time for whom the end justified the means—and that enslaved women with fistulas were likely to have wanted the treatment badly enough that they would have agreed to take part in his experiments. But history hasn’t recorded their voices, and consent from their owners, who had a strong financial interest in their recovery, was the only legal requirement of the time.

READ MORE: The Tuskegee Experiment: The Infamous Syphilis Study

Roots in the Market for Enslaved People

Born in Lancaster County, South Carolina in 1813, James Marion Sims entered the medical profession when doctors didn’t undergo the same rigorous coursework and training they do today. After interning with a doctor, taking a three-month course and studying for a year at Jefferson Medical College, Sims began his practice in Lancaster. He later relocated to Montgomery, Alabama, seeking a fresh start after the death of his first two patients.

It was in Montgomery that Sims built his reputation among rich, white plantation owners by treating their enslaved workers. According to Vanessa Gamble, university professor of medical humanities at George Washington University, Sims’s practice was deeply rooted in the trade for enslaved people. Sims built an eight-person hospital in the heart of the trading district in Montgomery. While most healthcare took place on the plantations, some stubborn cases were brought to physicians like Sims, who patched up enslaved workers so they could produce—and reproduce—for their masters again. Otherwise, they were useless to their owners.

“This brings up the concept of ‘soundness.’ ” says Gamble. Being "sound" meant “they produce (for men and women) and reproduce (for women). For these women having this fistula made them less sound.”

Like most doctors in the 19th century, Sims originally had little interest in treating female patients—and no specific gynecological training. Indeed, examining and treating female organs was widely considered offensive and unsavory. But his interest in treating women changed when he was asked to help a patient who had fallen off a horse and was suffering from pelvic and back pain.

To treat this woman’s injury, Sims realized he needed to look directly into her vagina. He positioned her on all fours, leaning forward, and then used his fingers to help him see inside. This discovery helped him develop the precursor to the modern speculum: the bent handle of a pewter spoon.

From his examination, Sims could see that the patient had a vesicovaginal fistula. With no known cure for the ailment, Sims began experimenting in 1845 with surgical techniques to treat such fistulas. If the patients’ owners provided clothing and paid taxes, Sims effectively took temporary ownership of the women until their treatment was completed. He later reflected in his autobiography The Story of My Life on the advantages he found to working on people that were essentially his property: “There was never a time that I could not, at any day, have had a subject for operation.” According to Sims, this was the most “memorable time” of his life.

READ MORE:  Henrietta Lacks: How Her Cells Became One of the Most Important Medical Tools in History

But Did His Enslaved Patients Consent?

Sims wrote that the women had “clamored” for the operations to relieve their discomfort—but whether they consented or not was never captured in any other historical record. As Bettina Judd, assistant professor of gender, women and sexuality studies at the University of Washington, points out, consent isn’t always about “whether you can say yes; it’s also whether you can say no.”

Today, we know three of the names of the female fistula patients from Sims’s owns records—Lucy, Anarcha, and Betsey. The first one he operated on was 18-year-old Lucy, who had given birth a few months prior and hadn’t been able to control her bladder since. During the procedure, patients were completely naked and asked to perch on their knees and bend forward onto their elbows so their heads rested on their hands. Lucy endured an hour-long surgery, screaming and crying out in pain, as nearly a dozen other doctors watched. As Sims later wrote, “Lucy’s agony was extreme.” She became extremely ill due to his controversial use of a sponge to drain the urine away from the bladder, which led her to contract blood poisoning. “I thought she was going to die… It took Lucy two or three months to recover entirely from the effects of the operation,” he wrote.

For a long time, Sims’ fistula surgeries were not successful. After 30 operations on one woman, a 17-year-old enslaved woman named Anarcha who had had a very traumatic labor and delivery, he finally “perfected” his method—after four years of experimentation. Afterward, he began to practice on white women, using anesthesia, which was new to the medical field at the time.

While some doctors didn’t trust anesthesia, Sims’ decision to not use it—or any other numbing technique—was based on his misguided belief that Black people didn’t experience pain like white people did. It’s a notion that persists today, according to a study conducted at the University of Virginia , and published in the April 4, 2016 Proceedings of the National Academy of Sciences .

READ MORE: 7 of the More Outrageous Medical Treatments in History

Experimenting on Enslaved Children

Writer and medical ethicist Harriet Washington says Sims’s racist beliefs affected more than his gynecological experiments. Before and after his gynecological experiments, he also tested surgical treatments on enslaved Black children in an effort to treat “trismus nascentium” (neonatal tetanus)—with little to no success. Sims also believed that African Americans were less intelligent than white people, and thought it was because their skulls grew too quickly around their brain. He would operate on African American children using a shoemaker’s tool to pry their bones apart and loosen their skulls.

In the 1850s, Sims moved to New York and opened the first-ever Woman’s Hospital, where he continued testing controversial medical treatments on his patients. When any of Sims’s patients died, the blame, according to him, lay squarely with “the sloth and ignorance of their mothers and the Black midwives who attended them.” He did not believe anything was wrong with his methods.

Sims’ practices ignited controversy during his lifetime, says Washington. The medical community debated his methods, and some of his white colleagues even openly objected to his experiments, saying he took things too far.

READ MORE: How an Enslaved Man in Boston Helped Save Generations from Smallpox

Statues Have Prompted Protest

J. Marion Sims continues to loom large in the medical field, celebrated as a medical trailblazer. Statues were erected to him in, among other places, New York City's Central Park, the South Carolina statehouse and outside his old medical school, Jefferson University, in Philadelphia.

After several years of activism, the Philadelphia statue was moved into storage and the statue in Central Park was removed on April 17, 2018. Its plaque was to be replaced by one that educates the public on the origins of the monument and the controversial, non-consensual medical experiments Sims used on women of color. The names (and histories) of the three known women “whose bodies were used in the name of medical and scientific advancement” by Sims, Lucy, Anarcha and Betsey, were to be recognized on the new plaque. 

It's a recognition some see as overdue. In a 1941 paper titled “The Negro’s Contribution to Surgery,” published in the Journal of the National Medical Associatio n, Dr. John A. Kenney of the Tuskegee Institute, considered the dean of Black dermatology, wrote, “I suggest that a monument be raised and dedicated to the nameless Negroes who have contributed so much to surgery by the ‘guinea pig’ route.” 

Sign up for Inside History

Get HISTORY’s most fascinating stories delivered to your inbox three times a week.

By submitting your information, you agree to receive emails from HISTORY and A+E Networks. You can opt out at any time. You must be 16 years or older and a resident of the United States.

More details : Privacy Notice | Terms of Use | Contact Us

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.

Get the latest History stories in your inbox?

Click to visit our Privacy Statement .

An official website of the United States government

Here's how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Digitized Document Collection from USPHS Untreated Syphilis Study at Tuskegee Now Publicly Available Through NLM

Leaders from the Voices for Our Fathers Legacy Foundation, descendants of the men who were treated unethically in the study, visit with NIH leadership in September 2023 to view contents of the physical collection before the release of the digitized collection.

A collection of reproduced documents from the 1932 study by the U.S. Public Health Service (USPHS) on the effects of untreated syphilis in Black men at Tuskegee Institute is now available as a digitized collection through the National Library of Medicine (NLM). The USPHS Untreated Syphilis Study at Tuskegee was conducted without informed consent and led to major reforms to protect participants in biomedical research. The digitized collection, which can be viewed as part of NLM’s Digital Collections , was made possible through permission from Fisk University, Nashville, a historically Black university, which holds a portion of original documents at the John Hope and Aurelia E. Franklin Library, Special Collections, Julius Rosenwald Fund Archives. NLM is part of the National Institutes of Health. NIH has worked with Fisk University to make these important documents, previously only available in their physical form, more broadly available to ensure this chapter in history is never repeated and build greater trust in current biomedical research through transparency.

The USPHS is part of the Department of Health and Human Services. HHS and its divisions, including NIH, take very seriously our responsibility to ensure the ethical conduct of the studies we support. Additionally, HHS established the Office for Human Research Protections to provide leadership in the protection of the rights, welfare, and wellbeing of those involved in HHS-conducted or -supported human research. HHS and its divisions have built mechanisms into our review, funding, and management of projects to ensure that research participants are protected and that a study like the USPHS Untreated Syphilis Study at Tuskegee will never happen again.

The collection, which consists of more than 3,000 reproduced copies of correspondence, memoranda, meeting minutes, reports, and scientific articles, constitutes a distinct historical record that has informed research led by historians, medical ethicists, and many others across a variety of disciplines. NLM’s stewardship of this collection supports its mission to enable biomedical research and support health care and public health through free online access to scholarly biomedical literature.

About the Study

Cover page of meeting minutes from the Ad Hoc Advisory Panel held on February 23, 1973, superimposed over an image of a Black participant in the study included in the NLM’s digital collection.

In 1932, a study began on the effects of untreated syphilis on Black men in Alabama. Researchers conducting the study did not obtain informed consent from participants and did not offer treatment, even after it was widely available. In 1972, an ad hoc federal panel was created to investigate the study. The final report found the study to be ethically unjustified and that participants were not informed about the nature of the disease and given treatment once a highly effective treatment was found. In 1972, the study officially ended after advisement from the panel. The investigation and its subsequent findings led to compensation for victims of the research and major changes in research practices.

In 1973, Dr. R.C. Backus, Executive Secretary of the Ad Hoc Advisory Panel, donated to NLM photocopies of the original documents on the origin, development, and investigation of the USPHS Untreated Syphilis Study at Tuskegee. In making this collection more widely available, NIH is recognizing the participants in the USPHS study and the injustices they and their families suffered. NIH also recognizes the work of the Ad Hoc Advisory Panel to address the unethical actions of the study which ushered in new protections for the rights of research participants.

The NLM collects, preserves, and makes publicly available collections such as that of the USPHS Untreated Syphilis Study at Tuskegee to advance open access, improve transparency in research, and ensure that lessons of the past inform the present and future of biomedical research, health care, public health, and healthy behavior. View NLM’s YouTube video and Circulating Now post to learn more about the USPHS Untreated Syphilis Study at Tuskegee.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Am J Respir Crit Care Med

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 .

• Death Penalty
• Children in Adult Prison
• Wrongful Convictions
• Excessive Punishment
• Prison Conditions
• Legacy of Slavery
• Racial Terror Lynching
• Racial Segregation
• Presumption of Guilt
• Community Remembrance Project
• Hunger Relief
• Unjust Fees and Fines
• Health Care
• True Justice Documentary
• A History of Racial Injustice Calendar
• Donation Questions

124 results for "Prison"

Medical Exploitation of Black Women

In the 1840s, James Marion Sims, a white doctor in Montgomery, Alabama, performed painful experiments without anesthesia on Lucy, an enslaved Black woman, while other doctors observed.

Sims was lauded as the “Father of Gynecology” after his experiments on at least seven enslaved Black women and girls in Montgomery between 1845 and 1849 helped him develop a technique to repair a chronic complication of childbirth. Though the potentially life threatening experiments caused excruciating pain, Sims legally needed permission only from the enslaved women’s “owners.”

Sims’s experiments on Lucy were unsuccessful and nearly killed her with severe blood poisoning. He nonetheless continued to perform procedures on enslaved women, sometimes drugging them so they could not resist. Sims subjected Anarcha, an enslaved teenager, to at least 13 operations without anesthesia before he developed a repair technique that was deemed safe to attempt on white patients.

Unable to refuse treatment or withhold consent, Lucy, Anarcha, and Sims’s other enslaved patients were powerless to protect themselves from medical exploitation. During and after enslavement, physicians often denied Black people basic dignity and personhood through mistreatment that reflected the prevailing and dehumanizing myth that Black people were less sensitive to pain than white people.

Sims was celebrated for his medical achievements; his statue remains on the Alabama State Capitol grounds today. But increasingly, his brutal mistreatment of Black women is informing a broader understanding of his legacy as an especially cruel chapter in our history of racial injustice. In April 2018, a statue of Sims was removed from New York City’s Central Park.

Related Resources

A History of Racial Injustice Online Calendar

More essays from A History of Racial Injustice

A History of Racial Injustice

Recent News

Another Alabama Man Killed at Ventress Prison

The History of Violent Opposition to Black Political Participation

“We Killed Him”: Jail Officer Pleads Guilty in Death of Alabama Man

Federal Investigation Finds At Least 973 Children Died in Federal Indian Boarding Schools

Tuskegee, Trust in Doctors, and the Health of Black Men

Disclosure of the Tuskegee syphilis study in 1972 coincided with increases in medical mistrust and mortality among black males.

The "Tuskegee Study of Untreated Syphilis in the Negro," conducted in the mid-20th century in Macon County, Alabama, is one of the most infamous medical experiments in American history. Conductors of the study allowed hundreds of unwitting black men to suffer needlessly for decades and sometimes die in agony, despite the availability of proven and effective medical treatments.

In Tuskegee and the Health of Black Men (NBER Working Paper 22323 ), Marcella Alsan and Marianne Wanamaker find evidence that the suffering associated with this experiment extended far beyond the tragic test subjects. They find that public revelations in 1972 of the study's existence led to a deep mistrust of the medical community among black males, many of whom afterward shunned hospital and physician interactions. The researchers estimate that life expectancy at 45 for black men fell sharply and that the life expectancy gap between black and white males significantly widened. Over the years, numerous studies have shown that the health of American black males is significantly worse than that of men in other ethnic, racial and demographic groups. African-American men have shorter life expectancy than white males and higher death rates from conditions such as cancer and heart disease. Previous studies have attributed these disparities to various factors, including poverty, inferior education, higher unemployment and underemployment, and lack of health insurance. Some have also suggested that mistrust of the medical system was a factor, but the existence and long-term effect of that mistrust has not previously been tracked or quantified. The federally funded Tuskegee study followed the lives of about 600 largely poor black males, the majority of whom had syphilis, from 1932 to 1972. The goal was to trace the course of untreated syphilis. Researchers never told the test subjects the true aim of the study, asserting instead that they were helping the men and telling some they had been diagnosed with "bad blood." Medical researchers not only deliberately withheld from the men proven treatments, such as penicillin, but also actively discouraged the test subjects from seeking medical advice elsewhere. In exchange for hot meals and promises to pay for their burial expenses, for 40 years the subjects allowed the study's principals to examine them, draw blood, conduct spinal taps, and ultimately to perform autopsies. In 1972, the study came to an abrupt halt after its disclosure by news media sparked public shock and outrage. The sudden stop created a distinct before-and-after point around which the researchers could compile and compare historical data regarding medical trust, treatments, and results. Their data on medical trust are drawn from the General Social Survey, while medical behavioral data come from the National Health Interview Survey. They also obtained annual mortality data by race, gender, age group, and causes from the Centers for Disease Control and Prevention. Focusing on black males between the ages of 45 and 74, the researchers describe changes in racial mortality and health care utilization gaps after 1972. Their main finding is that the disclosure of the syphilis study was associated with a sharpening of these racial differences along a continuous geographic gradient from Tuskegee, Alabama. In the years following disclosure of the study's tactics, they find significantly lower utilization of both outpatient and inpatient medical care by older black men in close geographic and cultural proximity to the study's subjects. The reduction in health care utilization paralleled a significant increase in the probability that such men would die before the age of 75. The researchers also document heightened medical mistrust, as measured in 1998, among black men in closer proximity to Tuskegee, Alabama. The researchers estimate that life expectancy at age 45 for black men fell by up to 1.4 years in direct response to the 1972 disclosure of the Tuskegee study. This decline in longevity could explain approximately 35 percent of the 1980 life expectancy gap between black and white men. The disclosure of the Tuskegee project appears to have stalled, or even reversed, a pre-1972 trend toward narrowing of the racial health gap.

—Jay Fitzgerald

Researchers

NBER periodicals and newsletters may be reproduced freely with appropriate attribution.

More from NBER

In addition to working papers , the NBER disseminates affiliates’ latest findings through a range of free periodicals — the NBER Reporter , the NBER Digest , the Bulletin on Retirement and Disability , the Bulletin on Health , and the Bulletin on Entrepreneurship  — as well as online conference reports , video lectures , and interviews .

© 2023 National Bureau of Economic Research. Periodical content may be reproduced freely with appropriate attribution.

Every print subscription comes with full digital access

Science News

Medical racism didn’t begin or end with the syphilis study at tuskegee.

The study is often blamed for distrust of the U.S. health care system. It’s not that simple.

By Aimee Cunningham

Biomedical Writer

December 20, 2022 at 9:00 am

The U.S. Public Health Service deceived the men in the syphilis study at Tuskegee (several participants shown here) and withheld treatment from those with the disease. “The wounds that were inflicted upon us cannot be undone,” Herman Shaw said in 1997.

National Archives

Share this:

“We were all hard-working men … and citizens of the United States.” Herman Shaw, 1997

Born in Alabama in 1902, Herman Shaw was a farmer and a cotton mill worker. He and his wife, Fannie Mae, were married for 62 years and had two children and six grandchildren.

Shaw was also a survivor of a 40-year medical experiment.

From 1932 until the Associated Press broke the story in 1972, the U.S. Public Health Service conducted a study of more than 600 Black men in Macon County, Ala., without their informed consent. The men were told they were being tested and receiving free therapies for “bad blood,” a local term for several ailments. Instead, it was a study of untreated syphilis. Roughly two-thirds of the men had the transmissible disease. The Public Health Service did not disclose to the men their diagnoses and withheld available treatments.

The experiment tracked the damage the disease inflicted on the men. The endpoint was death.

In the 50 years since its end, the U.S. Public Health Service Study of Untreated Syphilis at Tuskegee in Alabama has often been held up as a primary driver of distrust of the U.S. health care system in Black communities. Yet medical abuse of Black people has occurred throughout U.S. history.

White people have long justified abuse and mistreatment of Black people by describing them, explicitly and implicitly, as inferior. There have been “four hundred years of active decisions to dehumanize Black people and Black bodies,” says Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota School of Public Health in Minneapolis.

As John Heller, chief of the Division of Venereal Diseases at the U.S. Public Health Service from 1943 to 1948, did. Heller said in an interview with historian James Jones for his book on the syphilis study, “Bad Blood,” that “the men’s status did not warrant ethical debate. They were subjects, not patients; clinical material, not sick people.” 

Half a century later, this racist experiment can look like a product of a long-gone era, even as it gets outsize credit for distrust today. In reality, the racism that fueled the syphilis study has existed for centuries and still permeates the U.S. health care system, causing racial disparities in access to medical care and measures of health. While there are a variety of efforts to address these disparities, including medical training to bring awareness of racial biases, there is far to go.

“It is never too late to work to restore faith and trust,” Herman Shaw said in 1997 when the United States apologized for the study.  U.S. President Joe Biden echoed these words during a November 30 event acknowledging the  50th anniversary of the end of the study : “Restoring faith and trust is the work of our time.”

Experimentation during slavery

“A slave is not a human being in the eye of the law, and the slaveholder looks upon him just as what the law makes him; nothing more, and perhaps even something less.” John Brown, 1855

In his 1855 memoir, John Brown wrote about his enslavement in Georgia and his escape to England. He described being experimented on to test therapies for heat stroke . Brown was forced to sit in a fire-heated pit with only his head exposed.

“In about half an hour I fainted. I was then lifted out and revived, the doctor taking a note of the degree of heat when I left the pit,” Brown wrote. The experiments continued as the doctor investigated which medicine “enabled me to withstand the greatest degree of heat.”

The enslavement and abuse of Black Americans were sanctioned by prevailing medical theories. Antebellum doctors claimed that Black people “ possessed peculiar physiological and anatomical features that justified their enslavement ,” Vanessa Northington Gamble wrote in the American Journal of Preventive Medicine in 1993. “This medical distinctiveness, [the physicians] argued, made Africans not only inferior but inherently suited for slavery.” And for medical experimentation.

That included excruciatingly painful gynecological surgeries performed on enslaved Black women by white doctors, experiments that advanced the field. Thought of as biologically inferior to white women, while also deemed to have a high tolerance for pain, enslaved women were considered “perfect medical subjects” for experimentation, Deirdre Cooper Owens, a historian at the University of Nebraska–Lincoln, wrote in her 2017 book Medical Bondage: Race, Gender, and the Origins of American Gynecology .

Anarcha, Betsy and Lucy were among about a dozen enslaved women who surgeon J. Marion Sims experimented on. He performed surgeries on the women, without anesthesia, to develop a repair for an abnormal opening between the bladder and the vagina. Held on Sims’ property from 1844 to 1849, the women were trained by Sims to assist with the procedure and became his surgical nurses, Cooper Owens wrote.

The work brought Sims renown as a gynecological surgeon. But, she wrote, “the central role that enslaved women played in these advances — by providing doctors the bodies and sometimes labor needed for experimentation, treatment, and repair — went unacknowledged.”

Embedded racism

“The Alabama community offered an unparalleled opportunity for the study of the effect of untreated syphilis.” Taliaferro Clark, Public Health Service, 1932

In the early 20th century, white physicians attributed the high rates of syphilis among Black people to their supposed immorality and excessive sexual desire. White doctors alleged that the disease was difficult to treat in Black people, because they wouldn’t reliably seek out or follow a therapeutic regimen , Northington Gamble wrote in the American Journal of Preventive Medicine .

Another prevailing theory that motivated the experiment was “the belief that syphilis was a different disease in African Americans than it was in white people,” says Northington Gamble, a medical historian and physician at George Washington University in Washington, D.C. “This whole theory of Black bodies being fundamentally different was a foundation not only of the syphilis study, but also the foundation of medical practice.”

The idea persists today. Race is a social concept , but using race as though it designates biological differences informs treatment decisions about the kidneys, the lungs, pregnancy and more .

For example, an equation that estimates kidney function long included a race-based adjustment, despite a lack of evidence for its use. The adjustment could mask the kidneys’ true condition in Black people.

Without the adjustment, 3.3 million more Black Americans met a threshold for stage 3 chronic kidney disease , researchers reported in eClinicalMedicine in 2021. At this stage, complications from kidney disease start to occur, meaning Black Americans could be missing out on needed care, the researchers wrote. A new equation to estimate kidney function without a race adjustment is starting to be used in clinical practice.

In contrast, the belief that Black people experience less pain than white people hasn’t been extinguished. Today, Black people often report their pain is not taken seriously and evidence shows their pain is undertreated .  

“Racism has been baked into health care,” Hardeman says. It’s embedded in the system : in therapeutic protocols, in the distribution of health care resources , in how a physician treats a patient ( SN: 4/5/22 ).

Black people are nearly twice as likely as white people to have procedures during perinatal care and birth done without their consent , researchers reported in Birth in June. Hardeman has talked to Black people whose doctors sent their urine samples for toxicological screens in prenatal visits without their consent. “There’s this underlying assumption that there is likely drug use and that a tox screen is necessary,” she says.

Unequal outcomes

The maternal mortality rate for Black women is about three times the rate for white women and for Hispanic women, according to the U.S. Centers for Disease Control and Prevention. The latest data, from 2020, reports 55 deaths per 100,000 live births for Black women, compared with 19 per 100,000 for white women and 18 per 100,000 for Hispanic women.

U.S. maternal mortality rates by race and ethnicity, 2018–2020

This embedded, structural racism is a risk to health , and underlies health disparities at birth and throughout life in the United States. Black newborns are more likely to die than white newborns ( SN: 8/25/20 ). The rate of maternal mortality for Black women is nearly three times that of white women. Black people are more likely than white people to die early from diseases that are treatable with access to care.

Singling out the syphilis study when discussing African Americans’ attitudes towards the medical system is “overly simplistic and historically inaccurate,” Northington Gamble says. The view that “the medical profession did not always have the best interest of African Americans at heart predated the syphilis study.” And the burden shouldn’t be on African Americans to change their attitudes, she says. “Trust should be earned.”

Along with past examples, there are plenty of modern-day instances of medical racism that contribute to distrust , says Fatima Cody Stanford, an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School in Boston. “Every single day it’s still going on,” she says.

Beyond the syphilis study

“What the United States government did was shameful, and I am sorry.” President Bill Clinton, 1997

Twenty-five years after the end of the syphilis study, the U.S. government apologized. Northington Gamble was part of the committee that helped to make the apology happen . She spoke about the event during the November 30 remembrance of the syphilis study, hosted by the U.S. Centers for Disease Control and Prevention in Atlanta.

“When President Clinton said, ‘and I am sorry,’ … there were sobs around the room,” Northington Gamble said. “And it wasn’t sobs just about the syphilis study, but it was sobs about how Black people have been treated in this country.”

Addressing and dismantling the racism behind that unequal treatment “will require changing systems, laws, policies and practices ,” researchers wrote in Health Affairs in February. Those changes should include mandating standards for health care systems to achieve equitable results for patients, and medical training in the health effects of structural racism , knowledge that would be required for professional licensing, Hardeman and colleagues wrote in 2020.

Some medical schools are bolstering their curriculum with more extensive instruction on racism and health inequities .

Doriane Miller, a primary care physician at the University of Chicago Pritzker School of Medicine and director of the institution’s Center for Community Health and Vitality, leads doctors in training on tours of the surrounding area, in the south side of Chicago. People often see the area as defined by poverty and violence, Miller says. The tour offers a different story.

Miller talks about “how people came to this city looking for opportunities from the Deep South, in order to escape racism and segregation, and formed thriving businesses and communities.” She takes the new doctors by Provident Hospital, founded by the Black surgeon Daniel Hale Williams in 1891. The first Black-owned and -operated hospital in the nation, it also provided training for Black doctors and nurses. Williams performed the first successful open-heart surgery in the United States in 1893 and helped establish the National Medical Association, the first national organization of medical professionals open to African Americans.

The historical tour is a way to give new doctors “a sense of, not just physical place, but the people they will be serving,” Miller says. People “want to have you understand their circumstances, so that you can respond to them as individuals,” she says, “rather than making presumptions about who they are and where they come from.”

Like the presumptions many made about the men included in the syphilis study. “What happens is that the humanity and the individuality and the life experiences and history of the men themselves, and their families, are erased,” Northington Gamble says. “People forget the fact that these were men with lives and families and stories.”

More Stories from Science News on Health & Medicine

What is ‘Stage 0’ breast cancer and how is it treated?

People with food and other allergies have a new way to treat severe reactions

Extreme heat and rain are fueling rising cases of mosquito-borne diseases

More than 100 bacteria species can flourish in microwave ovens

50 years ago, antibiotic resistant bacteria became a problem outside hospitals

New COVID-19 booster shots have been approved. When should you get one?

A newly approved ‘living drug’ could save more cancer patients’ lives

Expanding antibiotic treatment in sub-Saharan Africa could save kids’ lives

Subscribers, enter your e-mail address for full access to the Science News archives and digital editions.

Not a subscriber? Become one now .

The Crazy True Story Of The Tuskegee Syphilis Experiment

In 1932, the US Public Health Service began conducting a study on the African-American men of Macon County, Alabama. While the men volunteered to be treated for "bad blood," they were never informed of the true nature or the risks of the Tuskegee syphilis experiment.

For 40 years, public health officials engaged in unethical testing of Black sharecroppers, under the guise of offering them free medical treatment. But the men were never really given treatment. Instead, they were given placebos while researchers documented the long-term effects of syphilis on Black men, basing the foundation of their research largely on pseudoscience and eugenics. The medical mistrust sowed by the Tuskegee study would have lasting negative impacts on the African-American community for years to come. 

According to Jean Heller, the reporter who eventually broke the Tuskegee experiment story, the men of Macon County were "strictly targets of opportunity. There was no humanity in this whatsoever. [...] They were just targets. They were just convenient guinea pigs," via "Bad Blood": The Tuskegee Syphilis Study .

"Tuskegee Study of Untreated Syphilis in the Negro Male"

In the 1920s and 1930s, public health was seeped in racial prejudice, and nowhere was it more apparent than in matters of sexual health. Dating back to the Civil War , scientists posited the idea that African Americans were a different species, and the negative effects of this harmful theory continued to influence scientific studies in America throughout the 19th century. By the turn of the 20th century, eugenics had surged in popularity in America, and scientists began presenting a series of pseudoscientific theories regarding the African-American population. Scientific and public health officials claimed that they had larger genitals and a higher sex drive than white people and were more prone to contracting sexually transmitted diseases, like syphilis, according to  McGill University . Most crucially, scientists also believed that African-American men would not seek out or accept treatment for STIs even if they were available.

It was out of this climate of prejudice and racial bias that the infamously unethical "Tuskegee Study of Untreated Syphilis in the Negro Male" was conceived.

Goal of the Tuskegee syphilis experiment

In 1932, Taliaferro Clark, the head of the venereal disease department of the US Public Health Service, designed an experiment that would study the course of untreated syphilis on Black men. While Clark is credited with founding the study, another doctor, Thomas Parran Jr., also played a significant role in beginning the experiment. The sixth US Surgeon General and a prominent Public Health Service official, Parran was a driving force behind the development and implementation of the study, per  The Philadelphia Inquirer .

Parran was influenced by a similar study that had been conducted in Norway over 20 years earlier. "The Oslo study of the natural history of untreated syphilis," conducted between 1891 and 1910, was one of the largest studies on the effects of syphilis. Two thousand patients, both men and women, who had contracted syphilis were left untreated for nearly 20 years in Oslo, per  Science Direct , to understand the natural effects the course of the disease would have on the human body.

The plan for the Tuskegee syphilis experiment was to build on that work, while also comparing the different effects syphilis might have on subjects of different races. Scientists believed that the cardiovascular systems of African Americans would be more significantly impacted by the disease. The initial purpose of the study was to examine the pathology of syphilis in African-American males for six to nine months, according to  Britannica .

"Black Belt"

US Public Health Service officials needed a location to conduct their study, and they found the perfect place in Macon County, Alabama. It was known as the "Black Belt" of the region, both because of the thick, dark soil that made land so fertile for agriculture and because of the large population of Black sharecroppers who made their living working the land, according to Tuskegee University . According to the US Census, 82 percent of Macon County's population was Black in 1930, per " Bad Blood ." The region was very rural, and most sharecroppers were not well-educated. In Macon County, 227 out of every 1,000 African Americans could not read.

A predominantly rural, Black, and illiterate population was ideal for the purposes of the Tuskegee experiment. In January 1932, after seeing Macon Country, Dr. Parran declared, "If one wished to study the natural history of syphilis in the Negro race uninfluenced by treatment, this county would be an ideal location for such a study," via  The Philadelphia Inquirer . Dr. Clark echoed a similar sentiment, saying: "Macon County is a natural laboratory; a ready-made situation. The rather low intelligence of the Negro population, depressed economic conditions, and the common promiscuous sex relations not only contribute to the spread of syphilis but the prevailing indifference with regard to treatment."

Almost 40 percent of Tuskegee's Black population had syphilis

Tuskegee also had one other major factor that made it the perfect location for the experiment: Almost 40 percent of the Black population of Tuskegee had syphilis by 1929, making it the city with the highest syphilis infection rate in the country, according to  Time .

The US Public Health Service enlisted the help of the Tuskegee Institute, now known as Tuskegee University, and its affiliated hospital to conduct the study. They also enlisted Eunice Rivers, a local nurse, to help establish trust within the community, according to  The Washington Post . Rivers (pictured above) was charged with helping pick up subjects and bring them to their appointments, deliver hot meals, and drop off medicine, but behind the scenes, she was also in charge of keeping records on the men. She also reached out to surviving family members after a subject had passed to encourage them to consent to autopsies. Rivers served as a critical point of connection between the researchers and Macon County's African-American population for the entire 40 years of the study.

Tuskegee subjects were compensated with free food and medical exams

Health officials initially recruited subjects to the study by offering them free medical care. Macon County was not a wealthy region, and health care was not always easy to come by for Black agricultural workers, so it was an enticing offer. However, some men were initially skeptical, suspecting that they were really being examined for military recruitment. To quell these fears, officials began including women and children in their examinations while still adding any eligible men they encountered to the study, according to  McGill University .

In the 1930s, as the Great Depression worsened, the promise of free medical care was an exceptionally temping offer, particularly for an economically impoverished area. However, even the promise of free health care was not enough to entice some of the men to continue the treatments. So as the study went on, the subjects were offered more benefits, including extended medical treatment, free rides to appointments, hot meals on appointment days, medical exams, and even burial stipends, per Tuskegee University .

For some of the treatments, like the painful and ultimately unnecessary spinal taps, Public Health Service officials used a psychological tactic. Enticing them with the offer of a "special free treatment" for their "bad blood," officials convinced many of the men to undergo the dangerous spinal procedure, according to The New Social Worker .

The Tuskegee syphilis experiment went on for 40 years

The original experiment was only supposed to last six to nine months. Initially, the patients were left untreated for around six months and then treated with heavy metals, like arsenic, bismuth, and mercury, per  Britannica , which were commonly used therapies at the time. However, the study subjects were largely only given treatment in order to abide by Alabama guidelines and assuage any fears on the part of the participants.

Researchers released their initial findings in 1934 and published their major paper on the experiment in 1936. However, that same year, researchers declared that they hadn't received enough data and decided to extend the study. Rather than treat the subjects, they chose to follow the infected patients throughout the rest of their lives, documenting the long-term effects of the disease, according to the  CDC .

Initially, they'd recruited 600 Black men to the study, of whom 399 had syphilis. The remaining 201 African-American men who didn't have the disease served as the control group. All of them were then given placebos to continue the ruse that they were being treated, while in reality, none of them were receiving proper medical care. The study went on for 40 years, and when it finally came to an end in 1972, only 74 of the subjects were still alive, per  The New Social Worker .

Informed Consent

One of the main reasons the Tuskegee experiment was so unethical was because the study participants were never provided enough information to be able to give their informed consent. In fact, researchers deliberately withheld information about their disease and the true purpose of the experiment. An intern at the Tuskegee Institute's hospital admitted, "The people who came in were not told what was being done. We told them we wanted to test them. They were not told, so far as I know, what they were being treated for or what they were not being treated for. [The subjects] thought they were being treated for rheumatism or bad stomachs. We didn't tell them we were looking for syphilis. I don't think they would have known what that was," via " Bad Blood ."

The subjects were told only that they were being treated for "bad blood," which could include any number of illnesses, from syphilis to anemia to simple fatigue. None of the subjects were told they were being treated for an STD, and as a result, many unknowingly passed it on to their wives or girlfriends. Because they were not aware what illness they were being treated for, subjects were also not given the option to leave when penicillin became readily available as a syphilis treatment, per the  CDC . None of the patients were informed of the potential dangers, and none ever gave informed consent, making the Tuskegee syphilis experiment one of the most notorious and unethical studies in American history.

Researchers withheld treatment from Tuskegee subjects

When the study began in 1932, there was no known cure for syphilis. However, the study's subjects were repeatedly denied even the minorly effective treatments that were commonly used at the time, like mercury or arsenic.

In 1947, it was determined that penicillin was an effective cure for syphilis, and by the 1950s, it had become the standard treatment and was widely used. Despite knowing this, officials never gave the study subjects penicillin to treat the disease. As a result, 128 of the men died from syphilis or its complications, 40 of their wives were infected, and 19 of their children had the disease passed down to them over the course of the study, according to  McGill University

Study officials went out of their way to ensure that subjects were not treated. In 1934, officials provided all doctors in Macon County a list of study participants, telling them not to treat the subjects. In 1940, they expanded the distribution of the list to the Alabama Health Department. The following year, when some of the subjects were drafted to the Army, their medical entrance exam revealed the disease. Researchers, instead of allowing the men to be treated by Army doctors, pulled the men from the Army. The staff nurse, Eunice Rivers, even once followed a study subject to his personal doctor to ensure that he was not treated for syphilis, per  The Washington Post .

A whistleblower brought the Tuskegee syphilis experiment down

No one raised any concerns about the unethical nature of the study until 1966, when Peter Buxtun, a Public Health Service employee, became suspicious after hearing that a colleague in the venereal disease section had scolded a doctor for treating a Tuskegee study subject with penicillin.

Upon further investigation, Buxtun was shocked to discover the similarities between the syphilis experiment and the crimes that had been brought to court during the 1947 Nuremberg Doctors' Trial. The subsequent Nuremberg Code had been established to prevent unethical experimentation on human subjects, but these ethical guidelines were being steadfastly ignored in the Tuskegee study.

Buxtun wrote a report detailing his concerns about the unethical nature of the experiment, but his report was dismissed by his superiors, who insisted the subjects were all "volunteers." Buxtun argued they were "nothing more than dupes ... being used as human guinea pigs" and were "quite ignorant of the effects of untreated syphilis," via the  Government Accountability Project . When the US Public Health Service chose to continue on with the study, Buxtun decided to go public. He leaked information about the experiment to Jean Heller, a reporter at the Washington Star, who broke the story July 25, 1972. The ensuing public outcry over the unethical nature of the study led to its eventual end in October 1972.

Public outcry

After the Tuskegee story broke, public outcry was immediate. Massachusetts Senator Edward Kennedy called the experiment "outrageous and intolerable," according to the  Government Accountability Project , and held congressional hearings on the matter. An advisory panel was also established to review the study, and in October 1972, the panel ruled that the study was unethical and should be stopped immediately, officially bringing the 40-year experiment to an end.

The study's surviving participants, represented by attorney Fred Gray, filed a class-action lawsuit against the US Public Health Service in the summer of 1973, per  Tuskegee University . The study's remaining subjects were awarded a $9 million settlement. They were also granted lifetime medical benefits and burial services. In 1975, the benefits were extended to include not just the surviving subjects, but all participants' wives and children, as well. In 1995, it was extended one final time, to include health as well as medical benefits for all participants and their families. The Tuskegee Health Benefit Program was established to disperse the benefits, according to the  CDC . 

Congress also passed additional protections for human subjects, including the National Research Act, which required the approval of institutional review boards for all experiments using human test subjects, according to  Britannica . The outcry following the Tuskegee syphilis experiment helped establish many of the modern medical ethical standards that are in place today.

The Tuskegee Syphilis Study Legacy Committee

In 1994, a symposium called "Doing Bad in the Name of Good?: The Tuskegee Syphilis Study and Its Legacy" was held at the Claude Moore Health Sciences Library in Charlottesville, Virginia. The goal of the symposium was twofold: First, they wanted a public apology from the president on behalf of the government for the experiment, according to  Tuskegee University . They achieved this goal on May 16, 1997, when Bill Clinton publicly apologized for the Tuskegee syphilis experiment, saying, "You did nothing wrong, but you were grievously wronged. I apologize and I am sorry that this apology has been so long in coming, " via  Time .

Their second goal was a little more complicated. They hoped to address the lasing damage of the study and set up strategies to address unethical government studies while restoring the reputation of Tuskegee University. The result was the creation of the Tuskegee Syphilis Study Legacy Committee, which first convened in January 1996 and focused on establishing scientific ethics, as well as the founding of Tuskegee University's National Center for Bioethics in Research and Health Care.

Lasting public health effects of the Tuskegee syphilis experiment

In the aftermath of the tests, African-American communities developed a mistrust of public health initiatives that still lingers today. As a result, Black men are less likely to seek health care and treatment than their white counterparts, per  The Atlantic .

According to the  National Bureau of Economic Research , a study "comparing older black men to other demographic groups, before and after the Tuskegee revelation, in varying proximity to the study's victims" found "that the disclosure of the study in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men."

After the experiment had been made public, life expectancy for Black men at age 45 fell up to 1.5 years. The Tuskegee syphilis experiment continued to cause harm to the Black community even years after it officially ended.

50 Years Ago, the Tuskegee Syphilis Study Was Exposed. How a Reporter Broke the Story

On july 25, 1972, jean heller, a then 29-year-old investigative reporter at the associated press shocked the world with a story of what is now known as the “tuskegee study”, by allen g. breed • published july 25, 2022 • updated on july 25, 2022 at 11:16 am.

Jean Heller was toiling away on the floor of the Miami Beach Convention Center when an Associated Press colleague from the opposite end of the country walked into her workspace behind the event stage and handed her a thin manila envelope.

“I’m not an investigative reporter,” Edith Lederer told the 29-year-old Heller as competitors typed away beyond the thick grey hangings separating news outlets covering the 1972 Democratic National Convention. “But I think there might be something here.”

📺 Watch News4 now: Stream NBC4 newscasts for free right here, right now.

Inside were documents telling a tale that, even today, staggers the imagination: For four decades, the U.S. government had denied hundreds of poor, Black men treatment for syphilis so researchers could study its ravages on the human body.

The U.S. Public Health Service called it “The Tuskegee Study of Untreated Syphilis in the Negro Male.” The world would soon come to know it simply as the “Tuskegee Study” — one of the biggest medical scandals in U.S. history, an atrocity that continues to fuel mistrust of government and health care among Black Americans.

“I thought, 'It couldn’t be,’” Heller recalls of that moment, 50 years ago. “The ghastliness of this.”

A Manila Envelope

The story of how the study came to light began four years earlier, at a party in San Francisco.

Lederer was working at the AP bureau there in 1968 when she met Peter Buxtun. Three years earlier, while pursuing graduate work in history, Buxtun had taken a job at the local Public Health Service office in 1965; he was tasked with tracking venereal disease cases in the Bay Area.

In 1966, Buxtun had overheard colleagues talking about a syphilis study going on in Alabama. He called the Communicable Disease Center, now the Centers for Disease Control and Prevention, and asked if they had any documents they could share. He received a manila envelope containing 10 reports, he told The American Scholar magazine in a story published in 2017.

He knew immediately that the study was unethical, he said, and sent reports to his superiors telling them so, twice. The reply was essentially: Tend to your own work and forget about Tuskegee.

He eventually left the agency, but he couldn’t leave Tuskegee.

So, Buxtun turned to his journalist friend, “Edie,” who demurred.

“I knew that I could not do this,” Lederer said during a recent interview. “AP, in 1972, was not going to put a young reporter from San Francisco on a plane to Tuskegee, Alabama, to go and do an investigative story.”

But she told Buxtun she knew someone who could.

At the time, Heller was the only woman on the AP’s fledgling Special Assignment Team, a rarity in the industry. Still, she was not spared the casual sexism of the era. A 1968 story on the team for AP World, the wire service’s employee newsletter, described the squad as “10 men and one cute gal.”

A caption under the 5-foot-2 Heller’s photo called the “pixie-like” reporter “lovely and competent.”

Lederer knew Heller from their days together at AP's New York headquarters, then at 50 Rockefeller Plaza, where Heller started out on the radio desk.

“I knew she was a terrific reporter,” Lederer says.

During a trip to visit her parents in Florida, Lederer made a short detour to Miami Beach, where Heller was part of a team covering the convention — from which U.S. Sens. George McGovern of South Dakota and Thomas Eagleton of Missouri would emerge as the Democratic presidential and vice presidential nominees.

During a recent interview at her North Carolina home, Heller recalled putting the leaked PHS documents in her briefcase. She says she didn’t get around to reading the contents until the flight back to Washington.

Seated next to her was Ray Stephens, head of the investigative team. She showed him the documents. Stephens realized the government wasn’t denying the study’s existence, just refusing to talk about it.

Heller recalls Stephens saying: “When we get back to Washington, I want you to drop everything else you’re doing and focus on this.”

The government stonewalled her and refused to talk about the study. So, Heller began making the rounds elsewhere, starting with colleges, universities and medical schools.

She even reached out to her mother’s gynecologist, a “straight down the line, middle of the road, superior doctor.”

“I asked him if he’d ever heard about this, and he said, ‘That’s not going on. I just don’t believe it.’”

Finally, one of her sources recalled seeing something about the syphilis study in a small medical publication. She headed to the D.C. public library.

“I asked them if they had any kind of documents, books, magazines, whatever ... that would fit a, what today we would call a profile or a search engine search, for ‘Tuskegee,’ ‘farmers’, ‘Public Health Service,’ ‘syphilis,’” Heller says.

They found an obscure medical journal — Heller can’t recall the title — that had been chronicling the study’s “progress.”

“Every couple of years, they would write something about it,” she says. “Mostly it was about the findings — none of the morality was ever questioned.”

Normally, reporters celebrate these “Eureka” moments. But Heller felt no such elation.

“I knew that people had died, and I was about to tell the world who they were and what they had,” she says, her voice dropping. “And finding any joy in that ... would have been unseemly.”

Armed with the journal, Heller went back to the PHS. They caved.

She says the lede of the story — the first paragraph or sentence of a news article — came to her quickly.

“Marv Arrowsmith, the bureau chief, walked by my desk and, I said, ‘Hey, Marv. Will you publish this?’” she recalls. “And he read it and he looked at me and he said, ‘Can you prove it?’ I said, ‘Yes.’ He said, ‘You got it.‘”

An AP medical writer helped interview doctors for the story. Within just a few short weeks, the team felt they had enough to publish.

Arrowsmith suggested they offer the story first to the now-defunct Washington Star, if it promised to run it on the front page.

“The Star was a highly respected PM (afternoon) newspaper, and if they took it seriously, others might follow,” Heller says.

AP Exposes Tuskegee Syphilis Study

The story ran on July 25, 1972, a Tuesday. It was a harrowing tale.

Starting in 1932, the Public Health Service — working with the famed Tuskegee Institute — began recruiting Black men in Macon County, Alabama. Researchers told them they were to be treated for “bad blood,” a catch-all term used to describe several ailments, including anemia, fatigue and syphilis. Treatment at the time consisted primarily of doses of arsenic and mercury.

In exchange for their participation, the men would get free medical exams, free meals and burial insurance — provided the government was allowed to perform an autopsy.

Eventually, more than 600 men were enrolled. What they were not told was that about a third would receive no treatment at all — even after penicillin became available in the 1940s.

By the time Heller’s story was published, at least seven of the men in the study had died as a direct result of the affliction, and another 154 from heart disease.

“As much injustice as there was for Black Americans back in 1932, when the study began, I could not BELIEVE that an agency of the federal government, as much of a mistake as it was initially, could let this continue for 40 years,” says Heller. “It just made me furious.”

Nearly four months after the story ran, the study was halted.

The government established the Tuskegee Health Benefit Program to begin treating the men, eventually expanding it to the participants’ wives, widows and children. A class-action lawsuit filed in 1973 resulted in a $10 million settlement.

The last participant died in 2004, but the study still casts a long shadow over the nation. Many African Americans cited Tuskegee in refusing to seek medical treatment or participate in clinical trials. It was even cited more recently as a reason not to get the COVID-19 vaccine.

At 79, Heller is still haunted by her story and the effects it had on the men and women of rural Alabama, and the nation as a whole.

For the story, Heller would win some of journalism’s highest honors — the Robert F. Kennedy, George Polk and Raymond Clapper Memorial awards. (Carl Bernstein and Bob Woodward of The Washington Post, writing about the Watergate scandal, finished in second place for the Clapper Award.)

Hanging in her office is a copy of the front-page byline she got in The New York Times, exceedingly rare for an AP staffer. But the hype surrounding Tuskegee would play a big role in Heller’s decision to leave the AP in 1974.

“I felt after all of the brouhaha over ... Tuskegee, and what came after it, that I should move on,” she says. She went on to a three-decade career that would take her from the hills of Wyoming to the beaches of South Florida.

These days, Heller spends her time cranking out fiction. She’s five books into a mystery series featuring Deuce Mora, a hard-driving female reporter who is a very un-pixie-like 6 feet tall.

Despite her distress over the state of the news business, she has never thought about returning to journalism.

“You can’t go home again; I firmly believe that,” she says. “And I don’t want to be competing against myself or against expectations.”

When asked if she regretted giving up what is arguably one of the great scoops in American journalism, Lederer replied: “Possibly, you know, a little bit.” But she knew the story was bigger than her or Heller or any individual reporter.

“What I cared about most was that this seemed to be a horrible and deadly injustice to innocent Black men,” says Lederer, who was the first woman assigned full time to cover the Vietnam War for the AP and remains its chief U.N. correspondent.

“And for me, the important thing was to verify it and to see that it got out to the broader American public — and that something was done to prevent any such experiments from happening again.”

Heller agrees.

“The story isn’t about me anyway,” she says. “It’s about them.”

This article tagged under:

• Skip to main content
• Keyboard shortcuts for audio player

• Your Health
• Treatments & Tests
• Health Inc.
• Public Health

You, Me And Them: Experiencing Discrimination In America

Troubling history in medical research still fresh for black americans.

Kolbi Brown (left), a program manager at Harlem Hospital in New York, helps Karen Phillips sign up to receive more information about the All of Us medical research program, during a block party outside the Abyssinian Baptist Church in Harlem. Elias Williams for NPR hide caption

Kolbi Brown (left), a program manager at Harlem Hospital in New York, helps Karen Phillips sign up to receive more information about the All of Us medical research program, during a block party outside the Abyssinian Baptist Church in Harlem.

It's a Sunday morning at the Abyssinian Baptist Church , a famous African-American church in the Harlem area of New York City. The organist plays as hundreds of worshippers stream into the pews. The Rev. Calvin O. Butts III steps to the pulpit.

"Now may we stand for our call to worship," says Butts, as he begins a powerful three-hour service filed with music, dancing, prayers and preaching. "How good and pleasant it is when all of God's children get together."

Then, about an hour into the service, Butts does something he has never done before. "I would like to introduce the Precision Medicine Initiative," he says, referring to a huge new project sponsored by the National Institutes of Health. It's now called All of Us .

"It is a landmark longitudinal research effort that aims to engage 1 million participants of all ethnicities to improve our ability to prevent and treat disease based on individual differences in lifestyle, environment and genetic makeup," Butts says.

Code Switch

How black americans see discrimination.

Why is this famous preacher at this famous African-American church talking about a big government medical study in the middle of Sunday service?

To understand that, I visit a clinic more than 30 blocks away at Columbia University. That's where I meet Anne and Steve Halliwell of Irvington, N.Y., who just volunteered for the study.

Steve Halliwell (left), a volunteer in the study, has his height measured for a second time by Dan Nguyen, a research assistant involved in the All of Us research initiative. Elias Williams for NPR hide caption

Steve Halliwell (left), a volunteer in the study, has his height measured for a second time by Dan Nguyen, a research assistant involved in the All of Us research initiative.

"Sorting out the huge variation in the human race is very, very important — and is the future of good medicine," Steve Halliwell says.

The Halliwells spend the next hour learning about the project and answering detailed questions about their lifestyles, medical history and health. They also get their blood pressure, height, weight and waists measured and have blood drawn so scientists can get a sample of their DNA.

Anne Halliwell is 67; Steve is 74. They're white. And that's the problem: White people like the Halliwells are much more likely than black people to volunteer for medical studies.

Shots - Health News

Poll: most americans think their own group faces discrimination.

The reasons are complicated. One is that African-Americans may not get the chance as often — they just aren't asked by their doctors or don't have the time or resources to volunteer.

But another is that medical research has a long, troubled racial history. One example is the Tuskegee study , which involved doctors letting black men die from syphilis. Another example is the case of Henrietta Lacks . She was a poor African-American woman whose cancer cells scientists and drug companies used for decades without her permission. But the list of abuses is long. So the National Institutes of Health and others have been trying to overcome all that, in part by working with groups like the Abyssinian Baptist Church.

"This research is not like the Tuskegee experiment," Butts tells his congregation. "And it is supported by some members of the Henrietta Lacks family."

"It's for all ethnicities," he says. "And you can bet your life that white folk are in this. They want to know what's gonna keep 'em alive. And we ought to know what's going to keep us alive."

The Abyssinian Baptist Church partnered with researchers on the All of Us project, allowing them to set up an information table at a block party following a Sunday church service. Elias Williams for NPR hide caption

The Abyssinian Baptist Church partnered with researchers on the All of Us project, allowing them to set up an information table at a block party following a Sunday church service.

As the service ends and the parishioners file out of the church, they find a block party starting outside. At one of the folding tables lining the block, researchers from the NIH, Columbia and two other New York hospitals are answering questions.

"So what is this?" one parishioner asks. "So you're doing research — tell me about this."

"It's really a unique program," says Kolbi Brown, the project's program manager at the Harlem Hospital. "Our goal is to get participants — a diverse range of participants. So we want women. We want minorities. We want everybody. But we really want women and minorities to participate in this community, of course."

Many people at the block party are enthusiastic. "I can't wait for this program to start," says Joanne Thigpen, who lives in Harlem. "I'm very excited about it for myself and my children." But some are wary. Deborah Fleming listens patiently but then declines an invitation to sign up.

"As an African-American, I know that sometimes these things are used against us — not to our advantage," says Fleming, who lives in Dutchess County, N.Y. "So that's why I'm reticent about joining."

Deborah Fleming declined to provide her contact information during the block party. She says she hesitated because of abuses of African-Americans that have occurred during medical research in the past. Elias Williams for NPR hide caption

Deborah Fleming declined to provide her contact information during the block party. She says she hesitated because of abuses of African-Americans that have occurred during medical research in the past.

Benjamin Vines Jr., 64, who was enjoying the party down the street, has similar feelings.

"It reminds me of the Tuskegee-type thing," he says. "And in my culture, African-Americans are scared of the doctor. They don't go to the doctor until the last minute — until we're almost on our deathbed — simply because of that."

A new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that about a third of African-Americans say they have experienced discrimination at a doctor's office or health clinic. The poll also found that 1 in 5 African-Americans avoids medical care because of concern about discrimination.

At first, I thought it was only older parishioners who feel that way. Hortensia Gooding, a 45-year-old graduate student who lives in Harlem, set me straight.

"I see my friends mentioning Tuskegee all the time on Facebook," Gooding says. "There's a lot of deep, deep-seated fear and concern that black lives don't matter and that the medical community really will harm people of African descent on purpose — just for profit or just to help someone from another race."

And some people's reluctance has nothing to do with Tuskegee or Lacks. Don't forget: The study is asking volunteers to give up a sample of their DNA.

"No. Not my DNA — I can't," says 51-year-old Clerance Johnson Jr., who also lives in Harlem. "I don't know what they might use it for," he says. "It might link me to something I don't want to be linked to — any criminal activities."

So the question remains: Will the help of the Abyssinian Baptist Church — and others — be enough to overcome these deep suspicions and other obstacles that prevent minorities from participating in medical research?

This story is part of our ongoing series , "You, Me and Them: Experiencing Discrimination in America." The series is based in part on a poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. We will be releasing results from other groups — including Latinos, whites, Asian-Americans, Native Americans and LGBTQ adults — over the next several weeks.

Correction Oct. 25, 2017

A previous version of this story misspelled Dutchess County as Duchess and a reference to Abyssinian Baptist Church as Abyssian.

• discrimination
• precision medicine
• "The Immortal Life of Henrietta Lacks"
• African-Americans
• African American health

The Surgeon Who Experimented on Slaves

Fellow doctors have been some of the most prominent defenders of J. Marion Sims, the controversial “father of gynecology.”

Their names—at least the ones we know—were Lucy, Anarcha, and Betsey. There were other women, but their identities have been forgotten.

The man whose name appears in medical textbooks, whose likeness is memorialized in statues, is J. Marion Sims. Celebrated as the “father of modern gynecology,” Sims practiced the surgical techniques that made him famous on enslaved women: Lucy, Anarcha, Betsey, and the unknown others. He performed 30 surgeries on Anarcha alone, all without anesthesia, as it was not yet widespread. He also invented the modern speculum , and the Sims’s position for vaginal exams, both of which he first used on these women.

That Sims achieved all this has long won him acclaim; how he achieved all this—by experimenting on enslaved women—started being included in his story much more recently. And on Tuesday morning, in the face of growing controversy, New York City moved a statue honoring him out of Central Park .

The move came after decades of concerted effort by historians, scholars, and activists to reexamine Sims’s legacy. Medical professionals, especially gynecologists, have not always taken kindly to criticism from outsiders. Sims was one of their own. To implicate him, his defenders implied, is to implicate medicine in mid-19th century America.

The first serious challenge to Sims’s lionization came in a 1976 book by the historian G.J. Barker-Benfield titled The Horrors of the Half-Known . Barker-Benfield juxtaposed Sims’s “extremely active, adventurous policy of surgical interference with woman’s sexual organs” with his considerable ambition and self-interest. The man who once admitted “if there was anything I hated, it was investigating the organs of the female pelvis,” took to gynecology with a “monomania” once he realized it was his ticket to fame and fortune, writes Barker-Benfield.

In response, during the 1978 annual meeting of the American Gynecological Society, doctors took turns vigorously defending Sims against Barker-Benfield’s book. The most fervent of them was Lawrence I. Hester Jr., who said, “I rise not to reappraise J. Marion Sims, but to praise him.” He then announced that his institution, the Medical University of South Carolina, which Sims also attended, was raising $750,000 for an endowed chair named after J. Marion Sims.

Another doctor, Irwin Kaiser, in a more tempered defense asked the audience to consider how Sims ultimately helped the enslaved women he experimented upon. The surgery that he practiced on Lucy, Anarcha, Betsey, and the other enslaved women was to repair a vesicovaginal fistula—a devastating complication of prolonged labor. When a baby’s head presses for too long in the birth canal, tissue can die from lack of blood, forming a hole between the vagina and the bladder. The condition can be embarrassing, as women with it are unable to control urination. “Women with fistulas became social outcasts,” Kaiser said. “In the long run, they had reasons to be grateful that Sims had cured them of urinary leakage.” He concluded that Sims was “a product of his era.”

This did not quell criticisms, of course. Over the next few decades, scholars continued to criticize Sims’s practice of experimenting on enslaved women . The story became well-known enough to join a list of commonly cited examples—along with the Tuskegee experiments and Henrietta Lacks—of how the American medical system has exploited African Americans.

Medical textbooks, however, were slow to mention the controversy over Sims’s legacy. A 2011 study found that they continued to celebrate Sims’s achievement, often uncritically. “In contrast to the vigorous debate of Sims’s legacy in historical texts and even in the popular press, medical textbooks and journals have largely remained static in their portrayal of Sims as surgical innovator,” the authors wrote.

In recent years, one of the most prominent defenders of Sims’s legacy has been Lewis Wall, a surgeon and an anthropologist at Washington University in St. Louis. Wall has traveled to Africa to perform the vesicovaginal fistula surgery that Sims pioneered, and he has seen firsthand what a difference it makes in women’s lives. “Sims’s modern critics have discounted the enormous suffering experienced by fistula victims,” he wrote in a 2006 paper . “The evidence suggests that Sims’s original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time.” Wall also defended Sims on the charge that he refused to give anesthesia only to black patients. Anesthesia was not yet widespread in 1845, and physicians who trained without anesthesia sometimes preferred their patients to be awake.

There is debate over whether Sims’s specific surgical practices were unusually gruesome for his time. But his practice of operating on enslaved women was certainly not unusual. He wrote about it openly. It is this ordinariness that is noteworthy.

Recommended Reading

Why a Statue of the 'Father of Gynecology' Had to Come Down

Nature 's Disastrous ‘Whitewashing’ Editorial

Why No One Can Design a Better Speculum

Sims was able to advance so quickly, argues Deirdre Cooper Owens, a historian at Queens College, City University of New York, in her book, Medical Bondage , because he had access to bodies—first enslaved women in the South, and later also poor Irish women when he moved to New York. “These institutions that existed in this country, which allowed easy access to enslaved women’s bodies [and] poor women’s bodies, allowed certain branches of professional medicine to advance and grow and to also become legitimate,” she says. The history of medicine has often been written as the history of great men . Owens wants to the turn the focus from the doctors hailed as heroes to the forgotten patients.

This first part—taking the focus away from Sims—is happening. In 2006, the University of Alabama at Birmingham removed a painting that depicted Sims as one of the “Medical Giants of Alabama.” In February, the Medical University of South Carolina quietly renamed the endowed chair honoring J. Marion Sims—the one announced by Hester after the publication of The Horrors of the Half-Known . The minutes of the board of trustees meeting where it happened did not even mention Sims’s name—just the new name of the endowed chair. “The decision was made in recognition of the controversial and polarizing nature of this historical figure despite his contributions to the medical field,” an MUSC spokesperson confirmed in an email to The Atlantic .

The J. Marion Sims statue that stood in Central Park is being relocated to Green-Wood Cemetery in Brooklyn, where Sims is buried. There, The New York Times reports , the statue will be demoted to a lower pedestal and displayed with a sign explaining the statue’s history. There may be an opportunity, now, to use the statue to tell the full story—to tell the stories of Lucy, Anarcha, Betsey, and the other enslaved women and their place in the history of medicine.

About the Author

More Stories

Why People Are Breaking Open Their Mounjaro Pens

Why I Buy German Toothpaste Now

• Newsletters

IE 11 Not Supported

Nsf grant brings genetics opportunities to students in alabama, a huntsville research center’s share of a national science foundation grant will bring chances for high-tech hands-on learning to middle and high school students enrolled in that area..

The Nuremberg Code isn’t just for prosecuting Nazis − its principles have shaped medical ethics to this day

Director of the Center for Health Law, Ethics & Human Rights, Boston University

Disclosure statement

George J Annas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Boston University provides funding as a founding partner of The Conversation US.

View all partners

After World War II, Nuremberg, Germany, was the site of trials of Nazi officials charged with war crimes and crimes against humanity. The Nuremberg trials were landmarks in the development of international law. But one of them has also been applied in peacetime: the “ Medical Trial ,” which has helped to shape bioethics ever since.

Twenty Nazi physicians and three administrators were tried for committing lethal and torturous human experimentation , including freezing prisoners in ice water and subjecting them to simulated high-altitude experiments. Other Nazi experiments included infecting prisoners with malaria, typhus and poisons and subjecting them to mustard gas and sterilization. These criminal experiments were conducted mostly in the concentration camps and often ended in the death of the subjects.

Lead prosecutor Telford Taylor, an American lawyer and general in the U.S. Army, argued that such deadly experiments were more accurately classified as murder and torture than anything related to the practice of medicine. A review of the evidence, including physician expert witnesses and testimony from camp survivors , led the judges to agree. The verdicts were handed down on Aug. 20, 1947.

As part of their judgment, the American judges drafted what has become known as The Nuremberg Code , which set forth key requirements for ethical treatment and medical research. The code has been widely recognized for, among other things, being the first major articulation of the doctrine of informed consent. Yet its guidelines may not be enough to protect humans against new potentially “species-endangering” research today.

10 key values

The code consists of 10 principles that the judges ruled must be followed as both a matter of medical ethics and a matter of international human rights law.

The first and most famous sentence stands out: “The voluntary consent of the human subject is absolutely essential.”

In addition to voluntary and informed consent, the code also requires that subjects have a right to withdraw from an experiment at any time. The other provisions are designed to protect the health of the subjects, including that the research must be done only by a qualified investigator, follow sound science, be based on preliminary research on animals and ensure adequate health and safety protection of subjects.

The trial’s prosecutors, physicians and judges formulated the code by working together. As they did, they also set the early agenda for a new field: bioethics. The guidelines also describe a scientist-subject relationship that obligates researchers to do more than act in what they think is the best interests of subjects, but to respect the subject’s human rights and protect their welfare. These rules essentially replace the paternalistic model of the Hippocratic oath with a human rights approach.

Under President Dwight D. Eisenhower, who had been the commanding general in Europe, the U.S. Department of Defense adopted the code’s principles in 1953 – one sign of its influence. Its fundamental consent principle is also summarized in the U.N.’s International Covenant on Civil and Political Rights , which declares that “no one shall be subjected without his free consent to medical or scientific experimentation.”

Yet some physicians tried to distance themselves from the Nuremberg Code because its source was judicial rather than medical, and because they did not want to be linked in any way to the Nazi physicians on trial at Nuremberg.

The World Medical Association, a physicians group set up after the Nuremberg Doctors Trial, formulated its own set of ethical guidelines , named the “ Helsinki Declaration .” As with Hippocrates, Helsinki permitted exceptions to informed consent, such as when the physician-researcher thought that silence was in the best medical interest of the subject.

The Nuremberg Code was written by judges to be applied in the courtroom. Helinski was written by physicians for physicians.

There have been no subsequent international trials on human experimentation since Nuremberg, even in the International Criminal Court, so the text of the Nuremberg Code remains unchanged.

New research, new procedures?

The code has been a major focus of my work on health law and bioethics , and I spoke in Nuremberg on its 50th and 75th anniversaries, at conferences sponsored by the International Physicians for the Prevention of Nuclear War. Both events celebrated the Nuremberg Code as a human rights proclamation.

I remain a strong supporter of the Nuremberg Code and believe that following its precepts is both an ethical and a legal obligation of physician researchers. Yet the public can’t expect Nuremberg to protect it against all types of scientific research or weapons development.

Soon after the U.S. dropped atomic bombs over Hiroshima and Nagasaki – two years before the Nuremberg trials began – it became evident that our species was capable of destroying ourselves.

Nuclear weapons are only one example. Most recently, international debate has focused on new potential pandemics, but also on “ gain-of-function” research , which sometimes adds lethality to an existing bacteria or virus to make it more dangerous. The goal is not to harm humans but rather to try to develop a protective countermeasure . The danger, of course, is that a super harmful agent “escapes” from the laboratory before such a countermeasure can be developed.

I agree with the critics who argue that at least some gain-of-function research is so dangerous to our species that it should be outlawed altogether. Innovations in artificial intelligence and climate engineering could also pose lethal dangers to all humans, not just some humans. Our next question is who gets to decide whether species-endangering research should be done, and on what basis?

I believe that species-endangering research should require multinational, democratic debate and approval. Such a mechanism would be one way to make the survival of our own endangered species more likely – and ensure we are able to celebrate the 100th anniversary of the Nuremberg Code.

• Medical ethics
• Human research ethics
• Informed consent
• Biomedical ethics
• Ethical question
• War crimes trials
• On-human experimentation

Director of STEM

Community member - Training Delivery and Development Committee (Volunteer part-time)

Chief Executive Officer

Finance Business Partner

Head of Evidence to Action

• Anniston/Gadsden

Alabama law banning puberty blockers, hormones for transgender minors remains in effect

• Updated: Aug. 28, 2024, 9:33 p.m.
• | Published: Aug. 28, 2024, 9:19 p.m.

Parents and other advocates protest against a bill that would ban puberty blockers and hormones as transgender treatments for minors.

• Howard Koplowitz | [email protected]

Alabama can continue to enforce a state law banning gender-affirming care for minors after a federal appeals court on Wednesday declined to put the question of a preliminary injunction before the full court.

A panel of the 11th Circuit U.S. Court of Appeals reversed U.S. District Court Judge Liles Burke’s preliminary injunction last year, prompting transgender minors and their parents suing Alabama over the law to ask the full 11th Circuit to take up the issue.

But the full federal appeals court declined to consider a preliminary injunction on Wednesday.

The Vulnerable Child Compassion and Protection Act makes it a felony — punishable by up to 10 years in prison — for doctors to treat people under 19 with puberty blockers or hormones to help affirm a new gender identity.

The law, signed by Gov. Kay Ivey in 2022, is still being challenged on its merits, but the case was put on hold last month because the U.S. Supreme Court is hearing a challenge to a similar law out of Tennessee.

The plaintiffs’ attorneys, in a statement issued through GLBTQ Legal Advocates & Defenders (GLAD), said they were “disappointed” by the decision but “encouraged” that nearly half of the circuit’s 12 judges dissented with the majority.

Along with GLAD, the plaintiffs are represented by lawyers with the Southern Poverty Law Center, the National Center for Lesbian Rights (NCLR), the Human Rights Campaign (HRC), King & Spalding LLP and Lightfoot, Franklin & White LLC.

“As the dissenting judges point out, the panel’s decision is not only wrong, but dangerous. Families, not the government, should make medical decisions for children,” they said. “The evidence presented in the case overwhelmingly showed that the banned treatments provide enormous benefits to the adolescents who need them, and that parents are making responsible decisions for their own children. We will continue to challenge this harmful measure and to advocate for these young people and their parents. Laws like this have no place in a free country.”

Chief Judge Bill Pryor, who agreed with the majority of the court not to put the preliminary injunction issue before the full circuit, argued against a dissenting judge’s view that the full court should have heard the case because of the substantive due process doctrine -- the idea that legislatures cannot pass laws without a valid reason for interfering with citizens’ liberty.

“The doctrine of substantive due process does violence to the text of the Constitution, enjoys no historical pedigree, and offers judges little more than shifting and unilluminating standards with which to protect unenumerated rights,” Pryor wrote.

“Difficult questions of morality, parental rights, and medicine are properly left to democracy, and we should not pretend that the Due Process Clauses give unelected judges the authority to second-guess public policy,” he went on to say.

In her dissent, U.S. Circuit Judge Robin Rosenbaum claimed the panel’s decision not to uphold Burke’s preliminary injunction had far-reaching consequences beyond transgender care for minors.

“The panel opinion’s reasoning strips every parent in this Circuit of their fundamental right to direct that their children receive any medical treatment (no matter how well-established and medically endorsed)—except for those medical treatments in existence as of 1868. Yes, 1868—before modern medicine,” Rosenbaum wrote.

“So in the states of Alabama, Florida, and Georgia, blistering, blood-letting, and leeches are in, but antibiotics, antivirals, and organ transplants are out,” she continued.

Rosenbaum called the panel’s opinion “wrong and dangerous.

“Make no mistake: while the panel opinion continues in force, no modern medical treatment is safe from a state’s misguided decision to outlaw it, almost regardless of the state’s reason,” she wrote. “Worse still, if a state bans a post-1868 treatment, no parent has legal recourse to provide their child with that necessary, life-saving medical care in this Circuit. And if an individual can’t access a medical treatment because of their sex or transgender status, they are similarly without legal recourse.”

U.S. Circuit Judge Adalberto Jordan, whose dissent was criticized in Pryor’s opinion, gave similar reasoning as Rosenbaum.

“The panel’s decision necessarily means that the fundamental right of parents to obtain medical treatment for their children extends only to procedures and medications that existed in 1868, and not to modern advances like the polio vaccine (developed in the 1950s), cardiac surgery (first performed in 1983), organ transplants (first successfully completed in 1954), and treatments for cancer like radiation (first used in 1899) and chemotherapy (which started in the 1940s),” he wrote.

Stories by Howard Koplowitz

• UAH student accidentally shoots themself on campus parking lot, university says
• Death investigation underway in Montgomery after gunshot victim dies at hospital
• 11-year-old Birmingham girl reported missing found safe
• Pedestrian dies 2 days after being hit by car in Mobile County
• West Birmingham shooting victim with life-threatening injuries drives himself 5 miles to fire station

If you purchase a product or register for an account through a link on our site, we may receive compensation. By using this site, you consent to our User Agreement and agree that your clicks, interactions, and personal information may be collected, recorded, and/or stored by us and social media and other third-party partners in accordance with our Privacy Policy.

Trump says he wants to make IVF treatments paid for by government or insurance companies if elected

POTTERVILLE, Mich. — Former President Donald Trump said in an interview with NBC News on Thursday that if he is elected, his administration would not only protect access to in-vitro fertilization but would also have either the government or insurance companies cover the cost of the expensive service for American women who need it.

"We are going to be, under the Trump administration, we are going to be paying for that treatment," Trump said before adding, "We're going to be mandating that the insurance company pay."

Asked to clarify whether the government would pay for IVF services or whether insurance companies would do so, Trump reiterated that one option would be to have insurance companies pay "under a mandate, yes."

Abortion and IVF have been political liabilities for the GOP this year. Democrats have blasted Republicans over IVF in recent months, saying GOP-led restrictions on abortion could lead to restrictions on IVF, as well.

In a statement, Sarafina Chitika, a spokesperson for Vice President Kamala Harris' campaign, said that "Donald Trump’s own platform could effectively ban IVF and abortion nationwide" and that "because Trump overturned Roe v. Wade, IVF is already under attack and women’s freedoms have been ripped away in states across the country. There is only one candidate in this race who trusts women and will protect our freedom to make our own health care decisions: Vice President Kamala Harris.”

The statement refers to the GOP platform's language about the 14th Amendment in its section on abortion policy: "We believe that the 14th Amendment to the Constitution of the United States guarantees that no person can be denied Life or Liberty without Due Process, and that the States are, therefore, free to pass Laws protecting those Rights." The platform later says specifically that the party will support "mothers and policies that advance ... IVF." The Alabama state Supreme Court ruled this year that embryos created via IVF were to be considered people, a move that led the largest fertility clinics in the state to pause their IVF care.

Trump’s stance could put him at odds with anti-abortion-rights advocates who oppose certain parts of the IVF process that involve discarding unused embryos.

Currently, few people have insurance plans that cover fertility treatments like IVF, leaving many couples to pay out of pocket for the treatment’s high costs. The Department of Health and Human Services estimates the cost per patient for one cycle of IVF at $20,000.

The Society for Assisted Reproductive Technology says its member clinics performed 389,993 IVF cycles in 2022. At a cost of around $20,000 apiece, that would come to $7.8 billion for that one year.

A growing number of employers have begun to offer fertility benefits over the last decade, however. Some pay for fixed amounts of patients’ costs, while others have lifetime maximums of particular numbers of cycles.

Sen. JD Vance of Ohio, Trump's running mate, spoke in a recent, separate NBC News interview about his "frustration that reproductive rights is a whole suite of pro-family things that Republicans are way better at than Democrats. And the media always focus on abortion. But, you know, we’ve actually done a lot of things to try to promote fertility treatments to people who are struggling with it."

Trump’s stance on IVF is the latest instance of his addressing criticism of his presidential administration through 2024 campaign policy proposals. After Democrats complained that his 2017 tax plan favored the wealthy, he announced that if he is elected again, he would eliminate taxes on tips for service workers.

Now, as he and other Republicans face criticism for supporting the Supreme Court justices who struck down Roe, Trump is proposing to protect IVF and address its costs.

Trump didn't explicitly say in the interview how we would vote on a ballot measure in his home state, Florida, that would guarantee a right to abortion until fetal viability, which is around 24 weeks of pregnancy. He repeated his criticism that Florida’s current six-week limit on abortion, which was signed by Gov. Ron DeSantis, is “too short.” Trump added, “It has to be more time.”

Pressed about how he will vote in November, he said, “I am going to be voting that we need more than six weeks.”

In response to questions from NBC News clarifying what that statement meant about how Trump would vote on the Florida ballot measure, senior adviser Jason Miller said Trump hasn't yet revealed whether he'll support the amendment.

Trump has long gone back and forth on abortion before he arrived at his current position that the issue should be up to the states.As president, before Roe v. Wade was overturned, he once urged the Senate to pass a 20-week ban on abortion. After he left office, he celebrated the Supreme Court's decision to overturn Roe and the national right to abortion, at one point going as far as to say, "I was able to kill Roe v. Wade," in a social media post .

But as the presidential race has taken shape this year, he has inched further away from other Republicans on the issue, especially as abortion has emerged as a key issue for Harris and her allies.

In a speech at the Democratic convention last week, Harris said Trump and Vance were "out of their minds" and accused them of planning to "ban medication abortion and enact a nationwide abortion."

In the interview, Trump said about abortion policy that “exceptions are very important for me,” adding later, “I believe in exceptions for life of the mother ... incest, rape.”

Trump also pushed back Thursday on criticism of his visit to Arlington National Cemetery on Monday, saying a family “asked me whether or not I would stand for a picture at the grave of their loved one who should not have died.”

He said he didn't initiate the photo, adding: "While I was there, I didn’t ask for a picture. While I was there, they said, 'Sir, could we have a picture at the grave?'"

Trump's campaign has faced criticism this week after reports emerged that a member of Trump’s staff  “abruptly pushed aside” a cemetery staff member  who tried to prevent Trump and others from taking photo and videos in Section 60 of the cemetery in the Virginia suburbs of Washington, where service members killed in Iraq and Afghanistan are buried and where filming is typically prohibited.

Trump also blasted Harris on immigration and border security, reprising his usual language about the increased number of migrants entering the country in recent years.

"Our country is going to hell. We’ve never been in a position like this," he said, adding: "There’s never been a country that’s been invaded like we have been invaded. And I think that alone loses them the election."

Dasha Burns is a correspondent for NBC News.

Abigail Brooks is a producer for NBC News.

Alexandra Marquez is a politics reporter for NBC News.

• Site Search:
• Site Search
•  Help/Tutorials
•  Settings
•  Messages

Job Posting: Human Resources Support Staff

Department of Water Resources

$3,178.00 - $4,316.00 per Month

Final Filing Date: 9/9/2024

Job Description and Duties

Under close supervision of the Administrative Officer I, Resources Agency (RA), the incumbent provides clerical support to the Division of Human Resources.

You will find additional information about the job in the Duty Statement .

Minimum Requirements

OFFICE ASSISTANT (TYPING)

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details

Department information.

Division of Human Resources, HR Support Services, Sacramento

Department of Water Resources (DWR) was established in 1956 by the California State Legislature.  We manage California’s water resources, systems, and infrastructure, including the State Water Project, in a responsible sustainable way.

At DWR, we are embedding climate change response into every project we undertake. We have set standards to help evaluate how each project incorporates climate resilience principles and ensure consistency across the Department.  Our mission is to sustainably manage the water resources of California, in cooperation with other agencies, to benefit the state’s people and protect, restore, and enhance the natural and human environments.

DWR also strives to create a trusting and welcoming workplace where employees embrace diverse viewpoints and treat each other with civility and respect.  An important component of DWR’s equal employment opportunity program centers around +diversity, equity, and inclusion.

Department Website:  https://water.ca.gov

Free career consultation services including one-on-one State career consultations, application/resume review, tips for applying, and mock interviews, provided by experienced recruiters are now available at the California Natural Resources Agency (CNRA) Career Center, located at the Poppy Pavilion, 715 P Street, Sacramento, CA 95814. Walk-ins are welcome every Tuesday and Thursday from 11am-4pm.

Special Requirements

• The position(s) require(s) the ability to type at a minimum speed as designated on the Class Specifications (link available in the additional documentation section). You must obtain a valid typing certificate confirming your ability to meet the minimum typing speed, prior to being hired. Additional information regarding acceptable typing tests is available at the CalCareers.ca.gov website.

This position could become eligible for telework one (1) day a month in the future.

Application Instructions

Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application.

Who May Apply

How To Apply

Address for Mailing Application Packages

You may submit your application and any applicable or required documents to:

Address for Drop-Off Application Packages

You may drop off your application and any applicable or required documents at:

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at www.CalCareers.ca.gov. All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is required and must be included.
• Other - Cover Letter

Desirable Qualifications

Must possess excellent customer service, interpersonal and communication skills (both verbal and in writing) and attention to detail; experience with Microsoft Office Suite including Outlook, Word, and Excel; clerical experience and dealing effectively with the public; excellent organizational and computer skills; ability to work independently; good judgment in providing sensitive, technical, HR, personnel-related information to telephone, email, and other inquiries; work cooperatively with others and maintain regular, consistent, and predictable attendance.

Our headquarters located at 7 th  & P Street in downtown Sacramento is the newest high rise  tower  that features sustainable construction, plenty of natural lighting and functionally-designed work spaces including sit-stand work stations. Our Leadership in Energy and Environmental Design ( LEED ) Platinum headquarters has a full-service cafe, an onsite free fitness center, indoor bicycle storage, and is walking distance to nearby restaurants.  Visit our Natural Resources Agency website for more exciting information:  https://thrive.cnra.ca.gov/  

In addition to state-of-the-art amenities, we offer an award-winning employee recognition program, ongoing learning and development opportunities, and new daycare facilities are in the making. We’re also located right next to Light Rail for an easy commute – we’ll even reimburse you for a portion of your monthly public transit pass! 

DWR offers a competitive pay schedule and work-life balance for all its employees.  The State of California provides comprehensive benefits packages determined by the employee’s bargaining unit and conditions of employment.   Click here to read about the outstanding benefits offered to eligible employees.

Contact Information

The Hiring Unit Contact is available to answer questions regarding the position or application process.

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

Special Instructions

To be considered in joining our team, please ensure you submit a completed State application (STD. 678), cover letter, and resume.   Please reference SAP Position # 50028423 and Job Control #447066 in the “examination(s) or job title(s) for which you are applying” section of your application.

The following basis of eligibility will be considered:  List eligibility, transfer, LEAP, reinstatement, and SROA/Surplus.

Resumes, cover letters, and/or other attachments will not be accepted in lieu of a completed application.

Click here to complete DWR’s Recruitment Survey . This survey is for research purpose only and will not affect the application status.

Examination/Assessment

For more information about the State hiring process,  click here . To learn more about how to get a State job, click here .

List eligibility can be established by taking and passing the examination/assessment.

Click the examination(s)/assessment(s) information link:

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.

Automatic log out in

Select 'Stay Logged In' below to resume your activity.

You must enable Javascript to use this site.