tuskegee experiment essay

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

Tuskegee Experiment: The Infamous Syphilis Study

By: Elizabeth Nix

Updated: June 13, 2023 | Original: May 16, 2017

Participants in the Tuskegee Syphilis Study

The Tuskegee experiment began in 1932, at a time when there was no known cure for syphilis, a contagious venereal disease. After being recruited by the promise of free medical care, 600 African American men in Macon County, Alabama were enrolled in the project, which aimed to study the full progression of the disease.

The participants were primarily sharecroppers, and many had never before visited a doctor. Doctors from the U.S. Public Health Service (PHS), which was running the study, informed the participants—399 men with latent syphilis and a control group of 201 others who were free of the disease—they were being treated for bad blood, a term commonly used in the area at the time to refer to a variety of ailments.

The men were monitored by health workers but only given placebos such as aspirin and mineral supplements, despite the fact that penicillin became the recommended treatment for syphilis in 1947, some 15 years into the study. PHS researchers convinced local physicians in Macon County not to treat the participants, and instead, research was done at the Tuskegee Institute. (Now called Tuskegee University, the school was founded in 1881 with Booker T. Washington as its first teacher.)

In order to track the disease’s full progression, researchers provided no effective care as the men died, went blind or insane or experienced other severe health problems due to their untreated syphilis.

In the mid-1960s, a PHS venereal disease investigator in San Francisco named Peter Buxton found out about the Tuskegee study and expressed his concerns to his superiors that it was unethical. In response, PHS officials formed a committee to review the study but ultimately opted to continue it—with the goal of tracking the participants until all had died, autopsies were performed and the project data could be analyzed.

Buxton then leaked the story to a reporter friend, who passed it on to a fellow reporter, Jean Heller of the Associated Press. Heller broke the story in July 1972, prompting public outrage and forcing the study to finally shut down.

By that time, 28 participants had perished from syphilis, 100 more had passed away from related complications, at least 40 spouses had been diagnosed with it and the disease had been passed to 19 children at birth.

In 1973, Congress held hearings on the Tuskegee experiments, and the following year the study’s surviving participants, along with the heirs of those who died, received a $10 million out-of-court settlement. Additionally, new guidelines were issued to protect human subjects in U.S. government-funded research projects.

As a result of the Tuskegee experiment, many African Americans developed a lingering, deep mistrust of public health officials and vaccines. In part to foster racial healing, President Bill Clinton issued a 1997 apology, stating, “The United States government did something that was wrong—deeply, profoundly, morally wrong… It is not only in remembering that shameful past that we can make amends and repair our nation, but it is in remembering that past that we can build a better present and a better future.”

During his apology, Clinton announced plans for the establishment of Tuskegee University’s National Center for Bioethics in Research and Health Care .

The final study participant passed away in 2004.

Herman Shaw speaks as President Bill Clinton looks on during ceremonies at the White House on May 16, 1997, during which Clinton apologized to the survivors and families of the victims of the Tuskegee Syphilis Study.

Tuskegee wasn't the only unethical syphilis study. In 2010, then- President Barack Obama and other federal officials apologized for another U.S.-sponsored experiment, conducted decades earlier in Guatemala. In that study, from 1946 to 1948, nearly 700 men and women—prisoners, soldiers and mental patients—were intentionally infected with syphilis (hundreds more people were exposed to other sexually transmitted diseases as part of the study) without their knowledge or consent.

The purpose of the study was to determine whether penicillin could prevent, not just cure, syphilis infection. Some of those who became infected never received medical treatment. The results of the study, which took place with the cooperation of Guatemalan government officials, were never published. The American public health researcher in charge of the project, Dr. John Cutler, went on to become a lead researcher in the Tuskegee experiments.

Following Cutler’s death in 2003, historian Susan Reverby uncovered the records of the Guatemala experiments while doing research related to the Tuskegee study. She shared her findings with U.S. government officials in 2010. Soon afterward, Secretary of State Hillary Clinton and Secretary of Health and Human Services Kathleen Sebelius issued an apology for the STD study and President Obama called the Guatemalan president to apologize for the experiments.

How an Enslaved African Man in Boston Helped Save Generations from Smallpox

In the early 1700s, Onesimus shared a revolutionary way to prevent smallpox.

7 of the Most Outrageous Medical Treatments in History

Why were parents giving their children heroin in the 1880s?

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

His use of Black bodies as medical test subjects falls into a history that includes the Tuskegee syphilis experiment and Henrietta Lacks.

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

Home — Essay Samples — Nursing & Health — Medical Ethics — The Tuskegee Experiment

The Tuskegee Experiment

Categories: Experiment Medical Ethics

About this sample

Words: 640 |

Published: Mar 20, 2024

Words: 640 | Page: 1 | 4 min read

Cite this Essay

To export a reference to this article please select a referencing style below:

Let us write you an essay from scratch

450+ experts on 30 subjects ready to help
Custom essay delivered in as few as 3 hours

Get high-quality help

Verified writer

Expert in: Science Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

1 pages / 642 words

5 pages / 2049 words

2 pages / 805 words

4 pages / 1596 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Medical Ethics

Consequentialism is a normative ethical theory that posits that the morality of an action is determined by its outcomes. This perspective stands in contrast to deontological ethics, which emphasizes the importance of adhering to [...]

The human eye is a remarkable piece of biological engineering. It allows us to see the world around us, admire beautiful landscapes, and connect with the people we love. However, many people take their eyes for granted until [...]

Daylight saving time (DST) has been a controversial topic for decades, with proponents and opponents arguing over its benefits and drawbacks. While the practice of changing the clocks twice a year is intended to save energy and [...]

In the world of medicine, few jobs are as respected and tough as being a surgeon. Becoming a surgeon isn't just a job choice; it's a lifelong mission to master tricky skills, stay dedicated, and have a lot of compassion. This [...]

Medical Terminology is language used to describe the human body, extensive and rich history in Latin and Greek languages. Both cultures merged, resulting in medical concepts regarding in disease treatment and containment. The [...]

In the late eighteenth century, there was an increasing trend of doctors being around the time of death of members of upper and middle class families. This trend continued to grow as the nineteenth century advanced and new [...]

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

Instructions Followed To The Letter
Deadlines Met At Every Stage
Unique And Plagiarism Free

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Say Their Names

Green Library Exhibit
3 T's (Systemic Racism)

Tuskegee Syphilis Experiment

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

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

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

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

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

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

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

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.

Dr. Walter Edmondson, doctor known for his participation in the Tuskegee Syphilis Study, taking a blood test from an unidentified patient

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.

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

Call the Midwives—Assuming Any Are Left

Close up hand of voter placing ballot in ballot box

Voting as a Tool for Environmental Justice

Print advertisement for an electron microscope and other electronics manufactured and sold by the Radio Corporation of America (RCA) for various scientific and industrial applications. The advertisement features an illustrated depiction of a bacteriologist viewing samples of the influenza virus under magnification. The accompanying text details the electron microscope's ability to make the infinitesimal visible through the use of electrons instead of light for illumination.

Viruses Through the Looking-Glass

Support JSTOR Daily

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

6.4 A Case Study – The Tuskegee Syphilis Experiment

There are different examples in the literature of unethical research that have been conducted in the past. Let’s review one of the studies .

One of the most famous pieces of unethical research undertaken in the United States was the Tuskegee Syphilis study. Officially known as the Tuskegee Syphilis Study – An American medical research study called Study of Untreated Syphilis gained attention for its unethical testing on African American patients in the rural South. 12 The U.S. Public Health Service (PHS) experiment, which ran from 1932 through 1972, looked at the untreated syphilis natural course among African American men. 12 The study aimed to find out if the natural course of syphilis in black males differed considerably from that in whites and to see if cardiovascular damage was more common from syphilis than neurological impairment. The participants were not informed that they had syphilis or that sexual activity may spread the illness. Instead, they were informed that they had “bad blood,” a phrase used locally to describe a variety of ailments. Informed consent was not collected from the participants. 12 Some patients received arsenic, bismuth, and mercury as part of the study’s initial treatment phase. However, when the initial research could not yield any valuable information, it was decided to keep track of the participants until they passed away and stop all therapy. 12 After penicillin became available in the middle of the 1940s, the sick men were refused medication; this was still the case 25 years later, in clear contravention of government regulations that required the treatment of venereal disease. More than 100 of the subjects are thought to have passed away from tertiary syphilis. 12

Watch the YouTube video below which briefly describes this study.

Let’s now consider this research in relation to the key principles of research ethics.

Research merit and integrity: The Tuskegee Syphilis Experiment violated the principle of merit and integrity because it lacked scientific merit. The study was based on outdated and flawed scientific assumptions and failed to contribute to the advancement of scientific knowledge. The study also lacked integrity because the researchers did not adhere to scientific standards of ethical conduct, including obtaining informed consent from the participants.

Respect: The experiment also violated the principle of respect for persons because the researchers did not respect the autonomy of the study participants. The participants were not informed of the nature of the experiment, and they were not given the option to refuse participation. The researchers also failed to respect the dignity and worth of the participants by denying them proper medical treatment.

Beneficence: The experiment violated the principle of beneficence because the researchers failed to maximize benefits and minimize harms to the participants. The participants were denied effective medical treatment, which caused them to suffer needless pain and suffering. The researchers also failed to provide the participants with adequate medical care, even when it became clear that they had contracted syphilis.

Non-maleficence: The men were subjected to invasive, painful procedures, including spinal taps. The men were not informed about their disease, leaving their spouses and other family members vulnerable to catching the disease from them. The study violated the principle of non-maleficence because the researchers did not take steps to avoid causing harm to the participants. The researchers knowingly withheld effective medical treatment from the participants, which caused them to suffer from severe health complications, including blindness, paralysis, and death.

Justice: The study violated the principle of justice because it treated the participants unfairly. The study was conducted exclusively on African American men from a state in the south of the United States, who represented a very vulnerable population and they were denied proper medical treatment. The study also failed to provide compensation or medical care to the participants after the experiment ended.

Overall, the Tuskegee Syphilis Experiment is a significant violation of research ethics. The experiment lacked scientific merit, failed to respect the autonomy of the participants, caused needless harm, violated the principle of non-maleficence, and treated the participants unfairly. The experiment highlights the need for ethical guidelines in research to protect the rights and welfare of research participants.

In Australia, the National Statement on Ethical Conduct in Human Research was enacted to ensure the ethical conduct of human research. The National Statement was developed jointly by the National Health and Medical Research Council, the Australian Research Council and Universities Australia. Researchers must adhere to the National Statement on Ethical Conduct in Human Research, which provides guidelines for ethical research practices. This includes ensuring that the research is culturally sensitive, respectful, and acknowledges the rights of Indigenous participants. The National Statement provides guidelines for researchers, Human Research Ethics Committees (HRECs) and others conducting an ethical review of research. It also emphasises institutions’ responsibilities for the quality, safety and ethical acceptability of research that they sponsor or permit to be carried out under their auspices. 8

The National Statement is intended for use by:

any researcher conducting research with human participants;
any member of an ethical review body reviewing that research;
those involved in research governance; and
potential research participants

Before conducting a study, researchers must obtain ethics clearance from all relevant ethics governance bodies, including university bodies and medical institutions. When conducting human research, it is important to abide by the following requirements:

An individual’s decision to participate in research must be voluntary and based on a well-informed and reasonable understanding of both the proposed research and the implications of participating in it.
Voluntary and informed participation requires a proper understanding of research objectives, methods, requirements, risks and potential benefits.
This information should be presented in a manner appropriate to each participant.
The process of providing information to participants and obtaining their consent should not be just a matter of meeting formal requirements. Participants can ask questions and discuss information and decisions as needed.
Consent can be expressed orally, in writing, or by other means (eg, survey or action reply implying implied consent).
It is generally reasonable to reimburse participants for research participation costs such as travel, lodging, and parking. Participants may also be paid for their time. However, payments disproportionate to the time involved or other incentives designed to encourage participants to take risks are ethically unacceptable.

Now identify the ethical issues that may arise in the case scenario presented in the Padlet below

An Introduction to Research Methods for Undergraduate Health Profession Students Copyright © 2023 by Faith Alele and Bunmi Malau-Aduli is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

Close this Alert

Academic Calendar
Campus Directory
Campus Labs
Course Catalog
Events Calendar
Golden Tiger Gear
Golden Tiger Network
NAVIGATE 360

Tuskegee University

Campus Master Plan
Board Meeting Dates
Board Communications
Current Trustees

About the USPHS Syphilis Study

Where the Study Took Place

The study took place in Macon County, Alabama, the county seat of Tuskegee referred to as the "Black Belt" because of its rich soil and vast number of black sharecroppers who were the economic backbone of the region. The research itself took place on the campus of Tuskegee Institute.

What it Was Designed to Find Out

The intent of the study was to record the natural history of syphilis in Black people. The study was called the "Tuskegee Study of Untreated Syphilis in the Negro Male." When the study was initiated there were no proven treatments for the disease. Researchers told the men participating in the study that they were to be treated for "bad blood." This term was used locally by people to describe a host of diagnosable ailments including but not limited to anemia, fatigue, and syphilis.

Who Were the Participants

A total of 600 men were enrolled in the study. Of this group 399, who had syphilis were a part of the experimental group and 201 were control subjects. Most of the men were poor and illiterate sharecroppers from the county.

What the Men Received in Exchange for Participation

The men were offered what most Negroes could only dream of in terms of medical care and survivors insurance. They were enticed and enrolled in the study with incentives including: medical exams, rides to and from the clinics, meals on examination days, free treatment for minor ailments and guarantees that provisions would be made after their deaths in terms of burial stipends paid to their survivors.

Treatment Withheld

There were no proven treatments for syphilis when the study began. When penicillin became the standard treatment for the disease in 1947 the medicine was withheld as a part of the treatment for both the experimental group and control group.

How/Why the Study Ended

On July 25, 1972 Jean Heller of the Associated Press broke the story that appeared simultaneously both in New York and Washington, that there had been a 40-year nontherapeutic experiment called "a study" on the effects of untreated syphilis on Black men in the rural south.

Between the start of the study in 1932 and 1947, the date when penicillin was determined as a cure for the disease, dozens of men had died and their wives, children and untold number of others had been infected. This set into motion international public outcry and a series of actions initiated by U.S. federal agencies. The Assistant Secretary for Health and Scientific Affairs appointed an Ad Hoc Advisory Panel, comprised of nine members from the fields of health administration, medicine, law, religion, education, etc. to review the study.

While the panel concluded that the men participated in the study freely, agreeing to the examinations and treatments, there was evidence that scientific research protocol routinely applied to human subjects was either ignored or deeply flawed to ensure the safety and well-being of the men involved. Specifically, the men were never told about or offered the research procedure called informed consent. Researchers had not informed the men of the actual name of the study, i.e. "Tuskegee Study of Untreated Syphilis in the Negro Male," its purpose, and potential consequences of the treatment or non-treatment that they would receive during the study. The men never knew of the debilitating and life threatening consequences of the treatments they were to receive, the impact on their wives, girlfriends, and children they may have conceived once involved in the research. The panel also concluded that there were no choices given to the participants to quit the study when penicillin became available as a treatment and cure for syphilis.

Reviewing the results of the research the panel concluded that the study was "ethically unjustified." The panel articulated all of the above findings in October of 1972 and then one month later the Assistant Secretary for Health and Scientific Affairs officially declared the end of the Tuskegee Study.

Class-Action Suit

In the summer of 1973, Attorney Fred Gray filed a class-action suit on behalf of the men in the study, their wives, children and families. It ended a settlement giving more than $9 million to the study participants.

The Role of the US Public Health Service

In the beginning of the 20th Century, the U.S. Public Health Service (PHS) was entrusted with the responsibility to monitor, identify trends in the heath of the citizenry, and develop interventions to treat disease, ailments and negative trends adversely impacting the health and wellness of Americans. It was organized into sections and divisions including one devoted to venereal diseases. All sections of the PHS conducted scientific research involving human beings. The research standards were for their times adequate, by comparison to today's standards dramatically different and influenced by the professional and personal biases of the people leading the PHS. Scientists believed that few people outside of the scientific community could comprehend the complexities of research from the nature of the scientific experiments to the consent involved in becoming a research subject. These sentiments were particularly true about the poor and uneducated Black community.

The PHS began working with Tuskegee Institute in 1932 to study hundreds of black men with syphilis from Macon County, Alabama.

Compensation for Participants

As part of the class-action suit settlement, the U.S. government promised to provide a range of free services to the survivors of the study, their wives, widows, and children. All living participants became immediately entitled to free medical and burial services. These services were provided by the Tuskegee Health Benefit Program, which was and continues to be administered by the Centers for Disease Control and Prevention in their National Center for HIV, STD and TB Prevention.

1996 Tuskegee Legacy Committee

In February of 1994 at the Claude Moore Health Sciences Library in Charlottesville, VA, a symposium was held entitled "Doing Bad in the Name of Good?: The Tuskegee Syphilis Study and Its Legacy." Resulting from this gathering was the creation of the Tuskegee Syphilis Study Legacy Committee which met for the first time in January 18th & 19th of 1996. The committee had two goals; (1) to persuade President Clinton to apologize on behalf of the government for the atrocities of the study and (2) to develop a strategy to address the damages of the study to the psyche of African-Americans and others about the ethical behavior of government-led research; rebuilding the reputation of Tuskegee through public education about the study, developing a clearinghouse on the ethics of scientific research and scholarship and assembling training programs for health care providers. After intensive discussions, the Committee's final report in May of 1996 urged President Clinton to apologize for the emotional, medical, research and psychological damage of the study. On May 16th at a White House ceremony attended by the men, members of the Legacy Committee and others representing the medical and research communities, the apology was delivered to the surviving participants of the study and families of the deceased.

The Tuskegee Syphilis Study

This is one of six cases from Michael Pritchard and Theodore Golding's instructor guide, " Ethics in the Science Classroom ." that provide background and some discussion guidelines around the historical Tuskegee Syphilis Study.

Categories Illustrated by This Case: Issues related to experimentation on human subjects.

1. Introduction

Although experimentation on human subjects has long been understood to be fraught with serious ethical concerns, little was done to develop national and international guidelines and regulations with regard to such research until the end of World War II. Populations that were frequently victimized by involuntary or coerced participation in potentially dangerous experiments included prisoners and insane asylum inmates. Due to popular recognition of the need to test new medical treatments, defenders of the rights of such powerless individuals found little political interest in outlawing these practices. However, the atrocities committed by Nazi doctors in the name of medical experimentation, as revealed during the Nuremberg war crimes trials, raised international consciousness about the need for an acceptable code for medical research.

The result was the promulgation in 1947 of the Nuremberg Code. This document was drafted by an international panel of experts on medical research, human rights, and ethics. It focused on the requirement for voluntary consent of the human subject and the weighing of the anticipated potential humanitarian benefits of a proposed experiment against the risks to the participant. The Code served as the initial model for those few public and private research and professional organizations that voluntary chose to adopt guidelines or rules for research involving human subjects.

In the ensuing years occasional media publicity called attention to continuing questionable biomedical and behavioral research practices. In 1972 the Tuskegee Syphilis Study, described in the case study below, became a cause celebre due to the thorough and dramatic Associate Press story written by reporter Jean Heller. Congressional hearings took place in 1973 and the following year Congress passed legislation creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Commissioners included prominent experts and scholars in the fields of medicine, psychology, civil rights, the law, ethics and religion. In 1979 they published Ethical Principles and Guidelines for the Protection of Human Subjects of Research, which is commonly referred to as "The Belmont Report." This document presents a well-developed ethical framework for the exploration of the issues associated with the use of human beings as the subjects of research. More comprehensive than the Nuremberg Code, it defined the boundary between accepted therapeutic practice and experimental research, and proposed the following three basic principles to guide in the evaluation of the ethics of research involving human subjects.

Respect for Persons - This principle incorporates the convictions that individual research subjects should be treated as autonomous agents, and that persons with diminished autonomy (such as prisoners or inmates of mental institutions) are entitled to protection.
Beneficence - Research involving human subjects should do no intentional harm, while maximizing possible benefits and minimizing possible harms, both to the individuals involved and to society at large.
Justice - Attention needs to be paid to the equitable distribution within human society of benefits and burdens of research involving human subjects. In particular, those participants chosen for such research should not be inequitably selected from groups unlikely to benefit from the work.

The Belmont report has greatly influenced the codes and regulations regarding human subjects research that have since been established in the United States by federal and many state governments, universities, professional organizations and by private research institutions, as well as similar codes and regulations elsewhere in the world.

2. Background

Syphilis was a widespread but poorly-understood disease until shortly after the turn of the century. Two of the principal steps forward were the isolation of the bacterium associated with syphilis in 1905, and shortly thereafter, the development of the Wasserman reaction to detect the presence of syphilis through a blood test.

Still, much about the disease and its progress remained unknown. Due to this lack of understanding many cases were incorrectly diagnosed as syphilis, while in other cases patients who would now be recognized as victims of the disease were missed. As the etiology of the disease was better understood, it became increasingly urgent to understand its long-term effects. The early treatments that predated the discovery of penicillin involving the use of such poisons as arsenic and mercury were dangerous, and sometimes even fatal. Thus, it was vital to learn about the likelihood that the disease itself would result in serious physical or mental disability in order to make sure that the potential benefits of treatment exceeded the risks.

One long-term study had been carried out in Oslo, Norway. This had been a retrospective study, going over the past case histories of syphilis victims then undergoing treatment, and had been undertaken on an exclusively white population.

In the early 1930s, the U.S. Public Health Service (PHS) began a program aimed at controlling venereal disease in the rural South. The Julius Rosenwald Fund - a philanthropic organization that was interested in promoting the welfare of African-Americans, provided the funds for a two-year demonstration study in Macon County, Alabama where 82% of the residents were African-Americans, most of whom lived in poverty and had never seen a doctor. A principal aim of this study was to determine the incidence of the disease in the local population, while training both white and African-American physicians and nurses in its treatment. When the results revealed that 36% of the Macon County African-Americans had syphilis, which was far higher than the national rate, the Rosenwald Fund, concerned about the racial implications of this finding, refused requests to support a follow-up project.

The discovery of the fact that the incidence of the disease was higher among African-Americans than among whites was attributed by some to social and economic factors, but by others to a possible difference in susceptibility between whites and non-whites. Indeed one Public Health Service consultant, Dr Joseph E. Moore of Johns Hopkins University School of medicine proposed that "Syphilis in the negro is in many respects a different disease from syphilis in whites. "

3. The Case

In 1932 the PHS decided to proceed with a follow-up study in Macon County. Unlike the project supported by the Rosenwald Fund, the specific goal of the new study was to examine the progression of untreated syphilis in Afro-Americans. Permission was obtained for the use of the excellent medical facilities at the teaching hospital of the Tuskegee Institute and human subjects were recruited by spreading the word among Black people in the county that volunteers would be given free tests for "bad blood," a term used locally to refer to a wide variety of ailments. Thus began what evolved into "The Tuskegee Study of Untreated Syphilis in the Negro Male," a project that would continue for forty years. The subject group was composed of 616 Afro-American men, 412 of whom had been diagnosed as having syphilis, and 204 controls.

The participants were never explained the true nature of the study. Not only were the syphilitics among them not treated for the disease -- a key aspect of the study design that was retained even after 1943 when penicillin became available as a safe, highly effective cure -- but those few who recognized their condition and attempted to seek help from PHS syphilis treament clinics were prevented from doing so.

Eunice Rivers, an Afro-American PHS nurse assigned to monitor the study, soon became a highly trusted authority figure within the subject community. She was largely responsible for assuring the cooperation of the participants throughout the duration of the study. She was aware of the goals and requirements of the study, including the failure to fully inform the participants of their condition and to deny treatment for syphilis. It was her firm conviction that the men in the study were better off because they received superior medical care for ailments other than syphilis than the vast majority of Afro-Americans in Macon County.

The nature of the Study was certainly not withheld from the nation's medical community. Many venereal disease experts were specifically contacted for advice and opinions. Most of them expressed support for the project. In 1965, 33 years after the Study's initiation, Dr. Irwin Schatz became the first medical professional to formally object to the Study on moral grounds. The PHS simply ignored his complaint. The following year, Peter Buxtin, a venereal disease investigator for the PHS began a prolonged questioning of the morality of the Study. A panel of prominent physicians was convened by the PHS in 1969 to review the Tuskegee study. The panel included neither Afro-Americans nor medical ethicists. Ignoring the fact that it clearly violated the human experimentation guidelines adopted by the PHS in 1966, the panel's recommendation that the Study continue without significant modification was accepted.

By 1972, Buxtin had resigned from the PHS and entered law school. Still bothered by the failure of the agency to take his objections seriously, he contacted the Associated Press, which assigned reporter Jean Heller to the story. On July 25, 1972 the results of her journalist investigation of the Tuskegee Study of Untreated Syphilis in the Negro Male were published. The response to Heller's revelations was broad-based public outrage, which finally brought the Study to an immediate end.

4. Readings and Resources

A good, detailed case study of the Tuskegee Syphilis Project, with background material and suggestions about teaching the case, written for undergraduate college students is:

"Bad Blood - A Case Study of the Tuskegee Syphilis", by Ann W . Fourtner, Charles R. Fourtner, and Clyde F. Herreid, Journal of College Science Teaching , March/April 1994, pp 277-285.

An excellent dramatization of the Tuskegee Syphilis Study story, available as a 60-minute video recording is:

"The Deadly Deception," a Nova video written, produced and directed by Denisce Di Anni, WGBH Boston, 1993 production. [This video is owned by many libraries and is currently distributed by Films for the Humanities and Sciences, P.O. Box 205, Princeton, NJ 08543-2053.]

For a medical report on the Study summarizing the first thirty years of subject observation see:

"The Tuskegee Study of Untreated Syphilis: the 30 th year of observation," by D.H. Rockwell et al., Arch. Intern. Med. , 144, pp 792-798, 1964.

Recent books about the Tuskegee Study include:

The Tuskegee Syphilis Study , by Fred D. Gray (Montgomery, AL: Black Belt Press, 1998).
Bad Blood. The Tuskegee Experiment , by J. H. Jones (: Free Press, 1993).

For more information on the ethics of experimentation on human subjects read:

"The Belmont Report," by The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, OPPR Reports, NIH, PHS, HHS , April , 1979.
The Nazi Doctors and the Nuremberg Code , by G. Annas and M. Grodin, (New York: Oxford University Press, 1992).

For a report on recent revelations concerning unethical experiments that exposed many human subjects to nuclear radiation see:

"Radiation: Balancing the Record," by Charles C. Mann, Science , 263, pp 470-473, January 28, 1994.

For an excellent treatment of the history of syphilis, which raises many other interesting questions about the nature of scientific research see:

Genesis and Development of a Scientific Fact , by Ludwick Fleck, (Chicago: University of Chicago Press, 1979).

5. The Issues

Significant questions of ethics and values raised by this case:

An explicit requirement of the Tuskegee study was that the subjects not receive available treatment for a debilitating disease, a clear violation of normal medical practice. Would any study involving human subjects that violated normal medical practice necessarily be unethical?
The Tuskegee victims were not informed -- in fact they were deliberately misinformed -- about the nature of the study in which they were participants. A basic guideline for human subject research, specified in both the Nuremberg Code and the Belmont Report is the requirement of informed consent. What would have constituted informed consent in the case of the Tuskegee Study? If such informed consent had been obtained from the subjects, would this remove all questions about whether the Study was ethical?
In what sense were the premises and the practices of the Tuskegee study racist? An important question to explore when examining accusations of human rights violations or of prejudicial behavior is whether the standards being applied are those of the time the action took place, and if not, whether this should affect any judgement about the ethics of the situation. (Conforming to official social standards does not necessarily imply that you are behaving in an ethical manner. Most people would consider the medical experiments of the Nazi Doctors to be unethical even though they conformed to the principles spelled out in the Nazi ideology imposed on Germany by the Third Reich.)
Eunice Rivers, the African-American nurse who played a vital role by befriending the Tuskegee Study participants and assuring their cooperation has justified her support for the project in terms of the fact that the attention that she and the other medical staff gave to the men was more than a non-enrolled, poor, Macon County resident was likely to receive. If you had been in her place, do you think you would have come to the same conclusion with regard to the ethical choices available to you.
Ordinarily, one would not think of the media as the proper instrument for enforcing public morality. They had that role here, but should they have?
The political reaction to the Tuskegee revelations was largely responsible for establishing the committee that wrote the Belmont report, which set guidelines for experimentation on human subjects. These guidelines have been the basis for regulations, usually enforced by human subjects research panels, at most public and private institutions that conduct such research. Is this likely to assure that all future research on human subjects will be conducted in a manner that raises no ethical concerns?
The Belmont Report proposes three criteria for the evaluation of human subjects research, respect for persons , beneficence and justice , as described above in the introductory section. In what ways does the Tuskegee Study fail to conform to each of these criteria.
In experiments on infants, it is obviously impossible to obtain the informed consent of the subject. This is also true in experiments on senile individuals. Does this mean that ethical considerations preclude using such subjects in any experiment?

Related Resources

Submit Content to the OEC Donate

This material is based upon work supported by the National Science Foundation under Award No. 2055332. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

An official website of the United States government

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

Publications
Account settings
Advanced Search
Journal List

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

Martin j tobin.

Author information
Article notes
Copyright and License information

Correspondence and requests for reprints should be addressed to Martin J. Tobin, M.D., Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, IL 60141. E-mail: [email protected] .

Corresponding author.

Received 2022 Jan 19; Accepted 2022 Mar 8; Collection date 2022 May 15.

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 . For commercial usage and reprints, please e-mail Diane Gern ([email protected]) .

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.

Keywords: research ethics, racism, vulnerable patient groups, researcher responsibilities, medical history

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 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 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.

Acknowledgments

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 .

1. Jones JH. Bad blood: the Tuskegee syphilis experiment . New York: Free Press; 1981. p. 1993. [ Google Scholar ]
2. Katz RV, Kegeles SS, Kressin NR, Green BL, James SA, Wang MQ, et al. Awareness of the Tuskegee syphilis study and the US presidential apology and their influence on minority participation in biomedical research. Am J Public Health . 2008;98:1137–1142. doi: 10.2105/AJPH.2006.100131. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
3. Dibble EH, Jr, Rabb LA, Ballard RB. John A. Andrew Memorial Hospital. J Natl Med Assoc . 1961;53:103–118. [ PMC free article ] [ PubMed ] [ Google Scholar ]
4. Reverby SM. In: The search for the legacy of the USPHS syphilis study. Katz RV, Warren RC, editors. Lanham: Lexington Books; 2013. The “Tuskegee” syphilis study as a “site of memory.”; pp. 29–40. [ Google Scholar ]
5. Reverby SM. Examining Tuskegee: the infamous syphilis study and its legacy. Chapel Hill, NC: University of North Carolina Press; 2009. [ Google Scholar ]
6. Rusert B. “A study in nature”: the Tuskegee experiments and the New South plantation. J Med Humanit . 2009;30:155–171. doi: 10.1007/s10912-009-9086-4. [ DOI ] [ PubMed ] [ Google Scholar ]
7. Reverby SM. Enemy of the people/enemy of the state: two great(ly infamous) doctors, passions, and the judgment of history. Bull Hist Med . 2014;88:403–430. doi: 10.1353/bhm.2014.0062. [ DOI ] [ PubMed ] [ Google Scholar ]
8. Caplan A. Bad blood: the Tuskegee syphilis experiment. Biosocieties . 2007;2:275–276. [ Google Scholar ]
9. Brandt AM. Racism and research: the case of the Tuskegee syphilis study. Hastings Cent Rep . 1978;8:21–29. [ PubMed ] [ Google Scholar ]
10. Zenilman J. The Guatemala sexually transmitted disease studies: what happened. Sex Transm Dis . 2013;40:277–279. doi: 10.1097/OLQ.0b013e31828abc1b. [ DOI ] [ PubMed ] [ Google Scholar ]
11. Frieden TR, Collins FS. Intentional infection of vulnerable populations in 1946–1948: another tragic history lesson. JAMA . 2010;304:2063–2064. doi: 10.1001/jama.2010.1554. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
12. Cumming HS. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. p. 77. [ Google Scholar ]
13. Hem E. Boeck’s sarcoidosis—a centennial. Int J Dermatol . 2000;39:545–549. doi: 10.1046/j.1365-4362.2000.00397.x. [ DOI ] [ PubMed ] [ Google Scholar ]
14. Brandt AM. No magic bullet: a social history of venereal disease in the United States since 1880 . New York, NY: Oxford University Press; 1987. [ Google Scholar ]
15. Porter R. The greatest benefit to mankind: a medical history of humanity. New York, NY: W.W. Norton; 1998. [ Google Scholar ]
16. Benedek TG. The “Tuskegee study” of syphilis: analysis of moral versus methodologic aspects. J Chronic Dis . 1978;31:35–50. doi: 10.1016/0021-9681(78)90079-6. [ DOI ] [ PubMed ] [ Google Scholar ]
17. Wenger OC. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. pp. 84–85. [ Google Scholar ]
18. Parran T. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. pp. 59–69. [ Google Scholar ]
19. Mahoney JF, Arnold RC, Sterner BL, Harris A, Zwally MR. Penicillin treatment of early syphilis: II. JAMA . 1944;126:63–67. doi: 10.1001/jama.251.15.2005. [ DOI ] [ PubMed ] [ Google Scholar ]
20. Lucas JB. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. pp. 107–109. [ Google Scholar ]
21. Reverby SM. More than fact and fiction: cultural memory and the Tuskegee syphilis study. Hastings Cent Rep . 2001;31:22–28. [ PubMed ] [ Google Scholar ]
22. Fowler G.1989. https://www.nytimes.com/1989/05/06/obituaries/dr-john-r-heller-jr-dies-at-84-headed-national-cancer-institute.html
23. Vonderlehr RA, Clark T, Wenger OC, Heller JR Jr. Untreated syphilis in the male Negro: a comparative study of treated and untreated cases. JAMA . 1936;107:856–860. [ Google Scholar ]
24. Caplan AL. Twenty years after: the legacy of the Tuskegee syphilis study. When evil intrudes. Hastings Cent Rep . 1992;22:29–32. [ PubMed ] [ Google Scholar ]
25. Rockwell DH, Yobs AR, Moore MB., Jr The Tuskegee study of untreated syphilis; the 30th year of observation. Arch Intern Med . 1964;114:792–798. doi: 10.1001/archinte.1964.03860120104011. [ DOI ] [ PubMed ] [ Google Scholar ]
26. Peters JJ, Peers JH, Olansky S, Cutler JC, Gleeson GA. Untreated syphilis in the male Negro; pathologic findings in syphilitic and nonsyphilitic patients. J Chronic Dis . 1955;1:127–148. doi: 10.1016/0021-9681(55)90204-6. [ DOI ] [ PubMed ] [ Google Scholar ]
27. Olansky S, Harris A, Cutler JC, Price EV. Untreated syphilis in the male Negro; twenty-two years of serologic observation in a selected syphilis study group. AMA Arch Derm . 1956;73:516–522. doi: 10.1001/archderm.1956.01550050094017. [ DOI ] [ PubMed ] [ Google Scholar ]
28. Reverby SM, editor. Summary of Ad Hoc Committee to Consider the Tuskegee Study. Tuskegee’s truths: rethinking the Tuskegee syphilis study. Chapel Hill, NC: University of North Carolina Press; 2000. pp. 463–472. [ Google Scholar ]
29. North American Neuro-Ophthalmology Society. 2022. https://library.med.utah.edu/NOVEL/Smith/
30. Kershaw I. Hitler, the Germans, and the final solution. New Haven, CT: Yale University Press; 2008. [ Google Scholar ]
31. Heller J. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. pp. 116–117. [ Google Scholar ]
32. Billings FT., Jr Memorial: Rudolph H. Kampmeier. Trans Am Clin Climatol Assoc . 1991;102:lxii–lxv. [ PMC free article ] [ PubMed ] [ Google Scholar ]
33. Kampmeier RH. The Tuskegee study of untreated syphilis. South Med J . 1972;65:1247–1251. [ PubMed ] [ Google Scholar ]
34. Reverby SM, editor. Tuskegee’s truths: rethinking the Tuskegee syphilis study. Chapel Hill, NC: University of North Carolina Press; 2000. [ Google Scholar ]
35. Reverby SM, editor. President William J. Clinton’s remarks. Tuskegee’s truths: rethinking the Tuskegee syphilis study. Chapel Hill, NC: University of North Carolina Press; 2000. pp. 574–577. [ Google Scholar ]
36. U.S. Department of Health, Education, and Welfare, Public Health Service. Final report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel. Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service; 1973. [ Google Scholar ]
37. Watson P. The modern mind: an intellectual history of the 20th century. New York, NY: Perennial; 2001. [ Google Scholar ]
38. Lombardo PA. A child’s right to be well born: venereal disease and the eugenic marriage laws, 1913–1935. Perspect Biol Med . 2017;60:211–232. doi: 10.1353/pbm.2017.0029. [ DOI ] [ PubMed ] [ Google Scholar ]
39. Friedlander H. The origins of Nazi genocide: from euthanasia to the final solution. Chapel Hill, NC: University of North Carolina Press; 1995. [ Google Scholar ]
40. Lombardo PA, Dorr GM. Eugenics, medical education, and the Public Health Service: another perspective on the Tuskegee syphilis experiment. Bull Hist Med . 2006;80:291–316. doi: 10.1353/bhm.2006.0066. [ DOI ] [ PubMed ] [ Google Scholar ]
41. Proctor RN. Racial hygiene: medicine under the Nazis. Cambridge, MA: Harvard University Press; 1998. [ Google Scholar ]
42. Davis RM. Achieving racial harmony for the benefit of patients and communities: contrition, reconciliation, and collaboration. JAMA . 2008;300:323–325. doi: 10.1001/jama.300.3.323. [ DOI ] [ PubMed ] [ Google Scholar ]
43. Baker RB, Washington HA, Olakanmi O, Savitt TL, Jacobs EA, Hoover E, et al. African American physicians and organized medicine, 1846–1968: origins of a racial divide. JAMA . 2008;300:306–313. doi: 10.1001/jama.300.3.306. [ DOI ] [ PubMed ] [ Google Scholar ]
44. Baker RB, Washington HA, Olakanmi O, Savitt TL, Jacobs EA, Hoover E, et al. Writing Group on the History of African Americans and the Medical Profession Creating a segregated medical profession: African American physicians and organized medicine, 1846–1910. J Natl Med Assoc . 2009;101:501–512. doi: 10.1016/s0027-9684(15)30935-4. [ DOI ] [ PubMed ] [ Google Scholar ]
45. Washington HA, Baker RB, Olakanmi O, Savitt TL, Jacobs EA, Hoover E, et al. Writing Group on the History of African Americans and the Medical Profession Segregation, civil rights, and health disparities: the legacy of African American physicians and organized medicine, 1910–1968. J Natl Med Assoc . 2009;101:513–527. doi: 10.1016/s0027-9684(15)30936-6. [ DOI ] [ PubMed ] [ Google Scholar ]
46. Baker RB. The American Medical Association and race. Virtual Mentor . 2014;16:479–488. doi: 10.1001/virtualmentor.2014.16.06.mhst1-1406. [ DOI ] [ PubMed ] [ Google Scholar ]
47. American Association for the History of Medicine. 2021. https://www.histmed.org/announcements/news/aahm-news-aahm-calls-for-properly-archiving-jamas-podcast-on-structural-racism-for-doctors-3226
48. Tanne JH. JAMA editor in chief steps down over controversial structural racism podcast. BMJ . 2021;373:n1433. doi: 10.1136/bmj.n1433. [ DOI ] [ PubMed ] [ Google Scholar ]
49. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A . 2016;113:4296–4301. doi: 10.1073/pnas.1516047113. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
50. Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med . 2000;35:11–16. doi: 10.1016/s0196-0644(00)70099-0. [ DOI ] [ PubMed ] [ Google Scholar ]
51. Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr . 2015;169:996–1002. doi: 10.1001/jamapediatrics.2015.1915. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
52. Braun L, Wolfgang M, Dickersin K. Defining race/ethnicity and explaining difference in research studies on lung function. Eur Respir J . 2013;41:1362–1370. doi: 10.1183/09031936.00091612. [ DOI ] [ PubMed ] [ Google Scholar ]
53. Bailey ZD, Feldman JM, Bassett MT. How structural racism works—racist policies as a root cause of US racial health inequities. N Engl J Med . 2021;384:768–773. doi: 10.1056/NEJMms2025396. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
54. Hardeman RR, Medina EM, Kozhimannil KB. Structural racism and supporting black lives—the role of health professionals. N Engl J Med . 2016;375:2113–2115. doi: 10.1056/NEJMp1609535. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
55. Eberly LA, Richterman A, Beckett AG, Wispelwey B, Marsh RH, Cleveland Manchanda EC, et al. Identification of racial inequities in access to specialized inpatient heart failure care at an academic medical center. Circ Heart Fail . 2019;12:e006214. doi: 10.1161/CIRCHEARTFAILURE.119.006214. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
56. Eneanya ND, Yang W, Reese PP. Reconsidering the consequences of using race to estimate kidney function. JAMA . 2019;322:113–114. doi: 10.1001/jama.2019.5774. [ DOI ] [ PubMed ] [ Google Scholar ]
57. Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight—reconsidering the use of race correction in clinical algorithms. N Engl J Med . 2020;383:874–882. doi: 10.1056/NEJMms2004740. [ DOI ] [ PubMed ] [ Google Scholar ]
58. Acosta AM, Garg S, Pham H, Whitaker M, Anglin O, O’Halloran A, et al. Racial and ethnic disparities in rates of COVID-19-associated hospitalization, intensive care unit admission, and in-hospital death in the United States from March 2020 to February 2021. JAMA Netw Open . 2021;4:e2130479. doi: 10.1001/jamanetworkopen.2021.30479. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
59. Edwards F, Lee H, Esposito M. Risk of being killed by police use of force in the United States by age, race-ethnicity, and sex. Proc Natl Acad Sci U S A . 2019;116:16793–16798. doi: 10.1073/pnas.1821204116. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
60. Washington HA. Medical apartheid: the dark history of medical experimentation on Black Americans from colonial times to the present. New York, NY: Anchor Books; 2006. [ Google Scholar ]
61. Osler W. Transactions of the Congress of American Physicians and Surgeons, Seventh Triennial Session. New Haven, CT: Congress of American Physicians and Surgeons; 1907. The evolution of the idea of experiment in medicine; pp. 1–8. [ Google Scholar ]
62. Reverby SM. In: Bioethics in action. Baylis F, Dreger A, editors. Cambridge, United Kingdom: Cambridge University Press; 2018. “So what?” Historical contingency, activism, and reflections on the studies in Tuskegee and Guatemala; pp. 32–54. [ Google Scholar ]
63. National Archives. 2017. https://www.archives.gov/research/health/cdc-cutler-records/
64. Reverby SM. “Normal exposure” and inoculation syphilis: a PHS “Tuskegee” doctor in Guatemala, 1946–1948. J Policy Hist . 2011;23:6–28. [ Google Scholar ]
65. Presidential Commission for the Study of Bioethical Issues 2011 https://bioethicsarchive.georgetown.edu/pcsbi/sites/default/files/Ethically%20Impossible%20(with%20linked%20historical%20documents)%202.7.13.pdf .
66. Presidential Commission for the Study of Bioethical Issues 2011 https://bioethicsarchive.georgetown.edu/pcsbi/sites/default/files/Moral%20Science%20June%202012.pdf .
67. Parascandola J. John Mahoney and the introduction of penicillin to treat syphilis. Pharm Hist . 2001;43:3–13. [ Google Scholar ]
68. Hook EW., III Remembering Thomas Parran, his contributions and missteps going forward: history informs us. Sex Transm Dis . 2013;40:281–282. doi: 10.1097/OLQ.0b013e31828abc55. [ DOI ] [ PubMed ] [ Google Scholar ]
69. Ove T.2011. https://www.post-gazette.com/opinion/Op-Ed/2011/06/12/The-Next-Page-Before-Tuskegee-the-Guatemala-Experiment-a-Pitt-legend-s-research-is-under-scrutiny/stories/201106120141
70. Mahoney JF, Van Slyke CJ, Cutler JC, Blum HL. Experimental gonococcic urethritis in human volunteers. Am J Syph Gonorrhea Vener Dis . 1946;30:1–39. [ PubMed ] [ Google Scholar ]
71. Walter M. Human experiments: first, do harm. Nature . 2012;482:148–152. doi: 10.1038/482148a. [ DOI ] [ PubMed ] [ Google Scholar ]
72. Spector-Bagdady K, Lombardo PA. “Something of an adventure”: postwar NIH research ethos and the Guatemala STD experiments. J Law Med Ethics . 2013;41:697–710. doi: 10.1111/jlme.12080. [ DOI ] [ PubMed ] [ Google Scholar ]
73. Zenilman JM. Ethics gone awry: the US Public Health Service studies in Guatemala; 1946–1948. Sex Transm Infect . 2013;89:295–300. doi: 10.1136/sextrans-2012-050741. [ DOI ] [ PubMed ] [ Google Scholar ]
74. Reverby SM. Ethical failures and history lessons: the US Public Health Service research studies in Tuskegee and Guatemala Public Health Rev 2012. 34 1 18 26236074 [ Google Scholar ]
75. Reverby SM. Compensation and reparations for victims and bystanders of the U.S. Public Health Service research studies in Tuskegee and Guatemala: who do we owe what? Bioethics . 2020;34:893–898. doi: 10.1111/bioe.12784. [ DOI ] [ PubMed ] [ Google Scholar ]
76. Spector-Bagdady K, Lombardo PA. US Public Health Service STD experiments in Guatemala (1946–1948) and their aftermath. Ethics Hum Res . 2019;41:29–34. doi: 10.1002/eahr.500010. [ DOI ] [ PubMed ] [ Google Scholar ]
77. Mahoney JF, Arnold RC, Harris A. Penicillin treatment of early syphilis—a preliminary report. Am J Public Health Nations Health . 1943;33:1387–1391. doi: 10.2105/ajph.33.12.1387. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
78. Millar D, Millar I, Millar J, Millar M. The Cambridge dictionary of scientists. Cambridge, United Kingdom: Cambridge University Press; 1996. [ Google Scholar ]
79. Lasker Foundation 2020 https://laskerfoundation.org/winners/penicillin-as-a-cure-for-syphilis/ .
80. Levitan S, Aragon HA, Cutler JC, Funes JM, Portnoy J, Paredes-Luna A. Clinical and serologic studies with reference to syphilis in Guatemala Central America. I. Studies of comparative performance of the Kahn, Kolmer, Mazzini, and VDRL slide tests as carried out in the national orphanage. Am J Syph Gonorrhea Vener Dis . 1952;36:379–387. [ PubMed ] [ Google Scholar ]
81. Cutler JC, Levitan S, Arnold RC, Portnoy J. Studies on the comparative behavior of various serologic tests for syphilis. II. A report on an observed pattern of entrance into seroreactivity among patients with untreated primary syphilis. Am J Syph Gonorrhea Vener Dis . 1952;36:533–544. [ PubMed ] [ Google Scholar ]
82. Portnoy J, Galvez R, Cutler JC. Clinical and serologic studies with reference to syphilis in Guatemala, Central America. III. Studies of comparative performance of the Kahn, Kolmer, Mazzini, and VDRL slide tests among leprosy patients. Am J Syph Gonorrhea Vener Dis . 1952;36:566–570. [ PubMed ] [ Google Scholar ]
83. Funes JM, Cutler JC, Levitan S, Portnoy J, Funes R. Serologic and clinical studies of syphilis in Guatemala, Central America. II. Study of a group of school children in the port of San José [in Spanish] Bol Oficina Sanit Panam . 1953;34:14–18. [ PubMed ] [ Google Scholar ]
84. Magnuson HJ, Thomas EW, Olansky S, Kaplan BI, De Mello L, Cutler JC. Inoculation syphilis in human volunteers. Medicine (Baltimore) . 1956;35:33–82. doi: 10.1097/00005792-195602000-00002. [ DOI ] [ PubMed ] [ Google Scholar ]
85. Jones JH. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. Foreword; pp. xi–xiii. [ Google Scholar ]
86. Katz J. In: The Nazi doctors and the Nuremberg code: human rights in human experimentation. Annas GJ, Grodin MA, editors. New York, NY: Oxford University Press; 1992. The consent principle of the Nuremberg Code: its significance then and now; pp. 227–239. [ Google Scholar ]
87. Caplan AL. Too hard to face. J Am Acad Psychiatry Law . 2005;33:394–400. [ PubMed ] [ Google Scholar ]
88. Caplan AL. Are existing safeguards adequate? J Calif Alliance Ment Ill . 1994;5:36–38. [ PubMed ] [ Google Scholar ]
89. Reverby SM. Inclusion and exclusion: the politics of history, difference, and medical research. J Hist Med Allied Sci . 2008;63:103–113. doi: 10.1093/jhmas/jrm030. [ DOI ] [ PubMed ] [ Google Scholar ]
90. Katz RV, Warren RC, editors. The search for the legacy of the USPHS syphilis study. Lanham, MD: Lexington Books; 2013. [ DOI ] [ PubMed ] [ Google Scholar ]
91. Shiels MS, Haque AT, Haozous EA, Albert PS, Almeida JS, García-Closas M, et al. Racial and ethnic disparities in excess deaths during the COVID-19 pandemic, March to December 2020. Ann Intern Med . 2021;174:1693–1699. doi: 10.7326/M21-2134. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
92. Glover J. Humanity: a moral history of the twentieth century. London, United Kingdom: Jonathan Cape; 1999. [ Google Scholar ]
93. Fletcher JC. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. A case study in historical relativism: the Tuskegee (Public Health Service) syphilis study; pp. 276–298. [ Google Scholar ]
94. DiAnni D. Nova. Boston, MA: WGBH; 1993. The deadly deception. [ Google Scholar ]
95. Junod T. In: Tuskegee’s truths: rethinking the Tuskegee syphilis study. Reverby SM, editor. Chapel Hill, NC: University of North Carolina Press; 2000. Deadly medicine; pp. 509–524. [ Google Scholar ]
96. Stoner BP, Marrazzo JM. American Sexually Transmitted Diseases Association and the Thomas Parran Award: past, present, and future. Sex Transm Dis . 2013;40:275–276. doi: 10.1097/OLQ.0b013e31828abc2e. [ DOI ] [ PubMed ] [ Google Scholar ]
97. Altman LK. Of medical giants, accolades and feet of clay. New York Times . 2013 https://www.nytimes.com/2013/04/02/health/link-to-ethical-scandals-tarnishes-prestigious-parran-award.html [ Google Scholar ]
98. Zenilman JM. The legacy of sexually transmitted disease research: lessons from Guatemala and Dr. Thomas Parran: the American STD Association Distinguished Career Award Lecture. Sex Transm Dis . 2013;40:901–908. doi: 10.1097/OLQ.0000000000000063. [ DOI ] [ PubMed ] [ Google Scholar ]
99. University of Pittsburgh. Parran Hall name disappears after Board of Trustees agrees with chancellor’s recommendation. University Times . 2018 https://www.utimes.pitt.edu/news/parran-hall-name [ Google Scholar ]
100. Pellegrino ED, Thomasma DC. The virtues in medical practice. New York, NY: Oxford University Press; 1993. [ Google Scholar ]
101. Henriksen K, Kaplan H. Hindsight bias, outcome knowledge and adaptive learning. Qual Saf Health Care . 2003;12:ii46–ii50. doi: 10.1136/qhc.12.suppl_2.ii46. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
102. Hochschild A. Bury the chains: prophets and rebels in the fight to free an empire’s slaves. Boston, MA: Mariner Books; 2005. [ Google Scholar ]
103. Judt T. Reappraisals: reflections on the forgotten twentieth century. London, United Kingdom: Penguin Books; 2008. [ Google Scholar ]
104. Baehr P, editor. The portable Hannah Arendt. New York, NY: Penguin; 2000. [ Google Scholar ]
105. Todorov T. Facing the extreme: moral life in the concentration camps. New York, NY: Owl Books; 1996. [ Google Scholar ]
106. Warnock M. An intelligent person’s guide to ethics. Croydon, United Kingdom: Duckbacks; 1998. [ Google Scholar ]
107. Dallaire R. Shake hands with the devil: the failure of humanity in Rwanda. Cambridge, MA: Da Capo Press; 2004. [ Google Scholar ]
108. Power S. A problem from hell: America and the age of genocide. New York, NY: Harper Perennial; 2002. [ Google Scholar ]
109. ICP. John Albert [accessed 2022 Apr 3]. Available from: . https://www.icp.org/browse/archive/objects/thomas-parran-jr-sixth-surgeon-general-of-the-united-states-new-york
110. Becker B. Plagues & people. http://faculty.humanities.uci.edu/bjbecker/plaguesandpeople/lecture10.html
View on publisher site
PDF (1.9 MB)
Collections

Add to Collections

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

A Tuskegee study subject gets his blood drawn in the mid-20th century.

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.”

Subjects talk with study coordinator Nurse Eunice Rivers.

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.”

Letter inviting participants in the study to undergo a special treatment

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 .

The Tuskegee Syphilis Study: Analysis Essay

The Tuskegee Syphilis Study , which took place over several decades in the United States, is considered unethical due to many factors. The main reason for this is considered to be the consequence, which became visible after a long time. Because scientists conducted studies on African-American populations who were injected with poorly studied and ineffective drugs for syphilis, often these injections caused serious side effects, which, over time, undermined the black population’s confidence in American medicine (White, 2020). Ethically, violations were committed at every stage of the study, beginning with its conception, which was based on racial discrimination (White, 2020). Moreover, during the course of the organization, the subjects were not sufficiently informed of their rights and the possible consequences of experimental medical invasion.

In Wolbrook, the study was based on the fact that mentally retarded children were deliberately injected with the hepatitis virus in order to trace the stages of development of the disease. The main justification for the researchers’ actions was that the risk of infection was already high in the particular institution (Resnik, 2018). Nevertheless, the principle of humanity was fundamentally violated in all aspects of the trial, making it possible to call the experiment completely unethical.

These stories demonstrate the need to create preventive measures to avoid even the risk of such situations occurring. It is important to create a multifaceted system to educate socially unprotected groups of citizens about their rights and responsibilities in the medical field, to create anonymous hotlines where people can share their questions and complaints (Resnik, 2018). Finally, it is necessary to develop an algorithm for the control and certification of all medical projects working with social minorities.

Resnik, D. B. (2018). The ethics of research with human subjects: Protecting people, advancing science, promoting trust . Springer.

White, R. M. (2020). More on the tuskegee study of untreated syphilis . JCO Global Oncology , 6 , 1312–1313. Web.

Healthcare: Ethical Principles Violated
Radiology Professionals' Ethical Obligations
Tuskegee Syphilis Experiment and Ethical Principles
Violation of Human Rights: Tuskegee Syphilis Study
Informed Consent in Tuskegee Syphilis Experiment
Medical Negligence and Ethical Issues
Organ Donation and Voluntary Euthanasia
The Issue of Ethics and Poverty
Ethical Dilemma of Human Cloning
Factors that Place Vulnerable Populations at Risk for Abuse in Research
Chicago (A-D)
Chicago (N-B)

IvyPanda. (2024, May 27). The Tuskegee Syphilis Study: Analysis. https://ivypanda.com/essays/the-tuskegee-syphilis-study-analysis/

"The Tuskegee Syphilis Study: Analysis." IvyPanda , 27 May 2024, ivypanda.com/essays/the-tuskegee-syphilis-study-analysis/.

IvyPanda . (2024) 'The Tuskegee Syphilis Study: Analysis'. 27 May.

IvyPanda . 2024. "The Tuskegee Syphilis Study: Analysis." May 27, 2024. https://ivypanda.com/essays/the-tuskegee-syphilis-study-analysis/.

1. IvyPanda . "The Tuskegee Syphilis Study: Analysis." May 27, 2024. https://ivypanda.com/essays/the-tuskegee-syphilis-study-analysis/.

Bibliography

IvyPanda . "The Tuskegee Syphilis Study: Analysis." May 27, 2024. https://ivypanda.com/essays/the-tuskegee-syphilis-study-analysis/.

To find inspiration for your paper and overcome writer’s block
As a source of information (ensure proper referencing)
As a template for you assignment

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.

The CDC Museum will be closed October 28th through November 22nd while we install our new temporary exhibition "Health Is a Human Right: Achieving Health Equity." The museum will reopen on November 25th. Please visit our Upcoming Exhibitions page for more information

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.

President Clinton with the survivors at the White House

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
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:

IMAGES

The Tuskegee Experiment in Public Health
Tuskegee syphilis study
The Tuskegee Experiment
📚 Essay Example. The Tuskegee Experiment Case Study
Racism Research the Case Study of Tuskegee Syphilis Study Free Essay
Tuskegee Experiment Essay

VIDEO

1st : TUSKEGEE Experiment, African American History

COMMENTS

Tuskegee Experiment: The Infamous Syphilis Study
Learn about the unethical and deadly study of 600 African American men with syphilis by the U.S. Public Health Service from 1932 to 1972. Find out how the Tuskegee experiment affected the community, the government and the medical research ethics.
Tuskegee Syphilis Study
The Tuskegee Study of Untreated Syphilis in the Negro Male [1] (informally referred to as the Tuskegee Experiment or Tuskegee Syphilis Study) was a study conducted between 1932 and 1972 by the United States Public Health Service (PHS) and the Centers for Disease Control and Prevention (CDC) on a group of nearly 400 African American men with syphilis. [2] [3] The purpose of the study was to ...
Tuskegee syphilis study
The Tuskegee syphilis study finally came to an end in 1972 when the program and its unethical methods were exposed in the Washington Star.A class-action suit against the federal government was settled out of court for $10 million in 1974. That same year the U.S. Congress passed the National Research Act, requiring institutional review boards to approve all studies involving human subjects.
The Tuskegee Experiment: [Essay Example], 640 words
The Tuskegee Experiment, also known as the Tuskegee Study of Untreated Syphilis in the Negro Male, is considered one of the most notorious instances of unethical conduct in the history of medical research. The study, which began in 1932 and lasted until 1972, was conducted by the United States Public Health Service (USPHS) and the Tuskegee ...
Tuskegee Syphilis Experiment
Learn about the infamous medical experiment that exploited over 600 Black men with syphilis in Tuskegee, Alabama, from 1932 to 1972. Explore the historical and current implications of this racist and unethical study for healthcare and society.
The Tuskegee Syphilis Experiment Essay
This essay examines the Tuskegee Syphilis Study, wherein for 40 years (1932-1972) hundreds of black men suffering from advanced syphilis were studied but not treated. The 40-year study was controversial for reasons related to ethical standards; primarily because researchers knowingly failed to treat patients appropriately after the 1940s ...
The Untreated Syphilis Study at Tuskegee Timeline
In 1932, the U.S. Public Health Service, working with the Tuskegee Institute, began a study to record the natural history of syphilis. It was originally called the "Tuskegee Study of Untreated Syphilis in the Negro Male" (now referred to as the "USPHS Untreated Syphilis Study at Tuskegee") 1. The study initially involved 600 Black men ...
Essay on tuskegee syphilis study
This essay examines the Tuskegee Syphilis Study, wherein for 40 years (1932-1972) hundreds of black men suffering from advanced syphilis were studied but not treated. The 40-year study was controversial for reasons related to ethical standards; primarily because researchers knowingly failed to treat patients appropriately after the 1940s ...
The Tuskegee Experiment on Syphilis
The Tuskegee Experiment on Syphilis Essay. The Tuskegee experiment on syphilis became one of the most controversial examples of a crime against humanity in the field of health and care which was supported and sponsored by the United States Public Health Service. The issues of protection of human beings in research and violation of the people ...
The Lasting Fallout of the Tuskegee Syphilis Study
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 ...
6.4 A Case Study
The study also failed to provide compensation or medical care to the participants after the experiment ended. Overall, the Tuskegee Syphilis Experiment is a significant violation of research ethics. The experiment lacked scientific merit, failed to respect the autonomy of the participants, caused needless harm, violated the principle of non ...
About The Untreated Syphilis Study at Tuskegee
50th anniversary event. This event was held Wednesday, November 30, 2022. Watch our recorded session and related videos below. This event acknowledged the 50th anniversary of the end of the United States Public Health Service Study of Untreated Syphilis in the Negro Male at Tuskegee and Macon County, Alabama, 1932 -1972. The intention was to create a space for authentic, accurate storytelling.
About the USPHS Syphilis Study
Learn about the Tuskegee Study of Untreated Syphilis in the Negro Male, a 40-year nontherapeutic experiment on Black men in Alabama by the U.S. Public Health Service. Find out the history, ethical issues, compensation, and legacy of the study.
The Tuskegee Study and Ethics Essay (Critical Writing)
The initial purpose of the Tuskegee Study was to determine what effects untreated syphilis could have and how it was possible to treat African Americans who had this disease. That is why the first documents about the experiment stated useful information. For example, it was mentioned that "morbidity in the male Negroes with untreated syphilis ...
The Tuskegee Syphilis Study Controversy Essay
Get a custom essay on The Tuskegee Syphilis Study Controversy. The Tuskegee syphilis study is the most controversial research ever performed on the black race. It was carried out in a small town of Tuskegee in Alabama. The participants of the study were completely ignorant of the experiment. The hope of treatment for the participants of the ...
The Tuskegee Syphilis Study
In the ensuing years occasional media publicity called attention to continuing questionable biomedical and behavioral research practices. In 1972 the Tuskegee Syphilis Study, described in the case study below, became a cause celebre due to the thorough and dramatic Associate Press story written by reporter Jean Heller.
The Tuskegee Syphilis Experiment: What Do We Learn from Alsan ...
In a recent article in the Quarterly Journal of Economics, Marcella Alsan and Marianne Wanamaker present results from an empirical analysis that purports to show a causal link between the Tuskegee Experiment and Black male mortality. I reassess the foundation of the Alsan and Wanamaker hypothesis and the empirical evidence on the research question.
Fiftieth Anniversary of Uncovering the Tuskegee Syphilis Study: The
Abstract. 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 ...
What Newly Digitized Records Reveal About the Tuskegee Syphilis Study
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 ...
The Tuskegee Syphilis Study: Analysis Essay
The Tuskegee Syphilis Study, which took place over several decades in the United States, is considered unethical due to many factors.The main reason for this is considered to be the consequence, which became visible after a long time. Because scientists conducted studies on African-American populations who were injected with poorly studied and ineffective drugs for syphilis, often these ...
Public Health Service Study of Untreated Syphilis at Tuskegee and Macon
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.