It is no secret that early scientific understandings were laden with racism guised as science. From the Valladolid Debates in the mid-16th century to slavery apologists in the 1850s. Even as recently as the late 20th century, scientific racism has been a dark cloud hanging over the scientific community. The concept of scientific racism has always existed, although it manifested itself in various ways. The pseudosciences of the late 19th and early 20th centuries led western cultures to believe that they were mentally, physically, and intellectually better than that of non-Europeans. Franz Boas was one of the few early American anthropologists that dedicated their entire career to arguing against the belief that Europeans were better than African Americans. Scientists are only recently acknowledging this problem and are taking steps to rectify the damage (Kurtz, 2004; Tucker, 2002; Gould, 1981). Beginning in the 1930s the Tuskegee Syphilis Experiment exemplifies the truly dreadful treatment black men received in the name of science.
Beginning in 1932 the United States Public Health Service (USPHS), in Macon Alabama, launched a study examining the natural course of untreated syphilis in black males (Brandt, 1978; CDC, 2015). There was a total of 600 men in the initial study 399 of which were positive for syphilis. 201 men not infected served as a control group. The first publication was published in 1936 with successive papers following every four to six years (Brandt, 1978; CDC, 2015). Even after it was discovered that penicillin was an effective method of treatment in the 1950’s the members of the study were not treated, in fact in many instances the USPHS attempted (and in most cases succeeded) in blocking members from receiving treatment. It was not until the 1970s, after multiple attempts, that the study ended due to its appearance of it circulating national media, and the bad press it generated. By the end of the experiment, only 74 individuals remained alive; many died as a direct result of syphilis lesions, while others died from arsenic therapy and other “treatments” (Brandt, 1978).
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Racism and Medicine
Early scientific understanding of black people – specifically those emancipated – was that of imminent demise. These scientists believed that blacks were prone to disease and crime and could not be saved through philanthropy or education. These ideas were supported by medical professionals of the time, as well as anthropologists and psychologists. These physicians concluded that the health effects of the emancipation of black people included mental, physical, and moral degradation; and that the black population would go extinct by the mid-20th century (Brandt, 1978). Most often the racial differences were focused on the sexual nature of blacks, specifically with “an excessive desire, which threatened the very foundations of white society” (Brandt, 1978). Doctors believed that because black people were more prone to depravity and a reversion to barbarism, they were also highly prone to venereal diseases. These racist beliefs formed the core of the medical understanding of black people.
The Tuskegee Experiment
In 1929, the United States Public Health Services (USHPS) were able to secure funding in order to study a rural black community in Macon Alabama, and the prevalence of syphilis. Due to the stock market crash and the Great Depression, all funding for the initial project fell through. However, three years later, the original author of the initial report argued that the epidemic in Macon was significant enough to be granted new attention. Current treatments at the time consisted of arsenic compounds and bismuth injections, and while these treatments were extremely dangerous due to their toxicity, they were less dangerous than other treatments – untreated syphilis could potentially lead to cardiovascular disease, insanity, and premature death (Brandt, 1978).
One of the foundational arguments used by Vonderlehr to argue against the treatment of the infected men was a similar analysis known as the Oslo Study. The Oslo Study of Untreated Syphilis lasted between 1890 and 1910, at which time some 2000 Norwegian subjects were observed but not treated for syphilis (Brandt, 1978). The chief researcher of the Oslo Study was C. Boeck believed that current treatments at the time, mercurial ointments, were of no use and should be halted; with the discovery of arsenic compounding treatment in 1910 his study was discontinued (Brandt, 1978).
The belief that the black community in Macon Alabama would not have sought medical treatment for their syphilis coupled with the practice of “natural observation” of the Oslo Study led scientists to rationalize the Tuskegee Study. The experiment was dependent on the beliefs regarding black people, their sexual behavior, and their disease. It is also worth noting that Dr. J. E. Moore a leading venereologist of the time claimed that the known information regarding syphilis did not apply to black people and he was a leading expert and continuously consulted on the Tuskegee study. The foundation of the study hinged on the belief that blacks were highly promiscuous and would not seek any medical treatment.
Selecting Subjects
Initially, Dr. Vonderlehr, the doctor in charge of the study, had a difficult time persuading members of the Macon community to be willing participants in the study. Vonderlehr found that by sending out requests looking only for men that were over twenty-five many in the community believed that Vonderlehr was conducting physicals for the military draft (Brandt, 1978) and would not show up. The scientists specifically chose Macon because of the highly illiterate and incredibly impoverished community. In order to trick people into agreeing to the study, the USPHS sent out bulletins requesting men and women over twenty-five, with the promise of treatment. This initially cost the USHPS a lot of money, much to the frustration of Drs. Clark and Vonderlehr.
“It never once occurred to me that we would be called upon to treat a large part of the county as a return for the privilege of making this study … I am anxious to keep expenditures of treatment down to the lowest point because it is one item of expenditure in connection with the study most difficult to defend despite our knowledge of the need therefor” (Leavitt, 1997).
Another difficulty arose with getting men to participate in return visits. Vonderlehr found that the only method that worked was to promise them free healthcare. However, the USPHS did not tell the men that they were part of an experiment and would in fact not receive healthcare. To keep the men interested in continuing their treatment Dr. Vonderlehr gave them a known ineffective treatment of mercurial cream. The fact that the men only continued to participate in the study due to the promise of free health services was counterintuitive to the held belief that black people would not seek medical treatment. This led to friction between Vonderlehr and Clark, due mostly to the fact that Vonderlehr wrote numerous times requesting the ineffective supplies and costing the USPHS money (Brandt, 1978).
The final phase of the initial study was to conduct a spinal tap on each of the subjects. Many of the men refused. Vonderlehr was able to convince them to come in by sending out a misleading memorandum declaring that their time for free treatment was coming to an end. This highly deceptive letter read as follows (from Brant 1978):
“Some time ago you were given a thorough examination and since that time we hope you have gotten a great deal of treatment for bad blood. You will now be given your last chance to get a second examination. This examination is a very special one and after it is finished you will be given a special treatment if it is believed you are in a condition to stand it…
Remember This Is Your Last Chance for Special Free Treatment. Be Sure to Meet The Nurse.
At the end of the summer of 1933, it was decided to continue this ruse in the name of science. Scientists believed they should continue the experiment because the samples were already accounted for. Because of the depressed economy, the cost of treatment seemed unreasonable to USHPS – however, there is never a mention of treatment even being considered for the Tuskegee men (Brandt, 1978).
There is numerous correspondence between Vonderlehr and Surgeon General R. R. Moton and Clark concerning the various ways to extend the trials. According to some of the scientists involved only an autopsy could scientifically conclude the findings of their study, so the men were considered useless until they died (Brandt, 1978). In order for the researchers to gain access to the remains of deceased subjects for autopsies the United States, Public Health Services had to formulate further intentional misrepresentations. They did this in various ways. They appointed a black doctor Eugene Dibble as the Director of the Tuskegee Hospital, they also hired a black nurse Eunice Rivers, in order to trick the men into believing the community and USHPS were there to help (Thomas and Quinn, 2000). Vonderlehr, Clark, and Moton all believed that if the men believed they were going to be autopsied they would withdraw from the experiment (Brandt, 1978). By appointing the two people of color to government positions they hoped to hide this fact from the victims.
Once it was decided that the experiment would continue Vonderlehr sent out another flyer calling for more participants. He believed that a control group would be needed. They decided to treat the healthy men with placebo drugs, under the guise of treatment, and if they happened to become symptomatic, they would move them to the infected group (Leavitt, 1997). The scientists had a difficult time convincing the men to come to the hospital if they became seriously ill. The USPHS agreed to pay funeral fees should the men die. This was the only way to convince them to attend because healthcare and funerary expenses were unavailable to the rural illiterate, that was intentionally targeted for this experiment. Complete and total dishonesty was essential for the study to effectively work.
Throughout the 40-year experiment, there were numerous occasions where the USPHS intentionally interfered with the Tuskegee men receiving actual treatment for syphilis (Brandt, 1978; Leavitt, 1997; CDC, 2015). Vonderlehr personally met with other local doctors and healthcare providers, with a list of the men participating in the study, in order to get the doctors to agree to not treat those infected with syphilis. In 1941 many of the men involved in the study were drafted by the Army. Upon realizing the men were infected with syphilis the Army demanded the men began anti syphilitic treatment. The United States Public Health Services met with the draft board and presented the members with a list of 256 men they wanted to be excluded from the treatment, and the draft board complied (Brandt, 1978; Butler, 1973).
After more than 30 years of continuous experimentation, a group of doctors met with the Center for Disease Control to discuss the continuation of the Tuskegee Study. Dr. J. Lawton Smith is quoted saying “You will never have another study like this; take advantage of it” (Brandt, 1978).
The HEW Report
After the media reported on the Tuskegee study in 1972, an investigation was launched. The Health Education and Welfare (HEW) committee was formed in order to launch a full investigation. The HEW report was part of a larger overall investigation called the Fair Information Practice. The investigation focused on two main issues: 1) was the initial study justified in 1932, and did the subjects receive their informed consent (Butler, 1973)? 2) Should treatment have been administered once a cure was found in the 1950s (Butler, 1973)? Because the committee focused on the issues of informed consent and penicillin treatment it failed to see the overall sole purpose of the study – deception.
The HEW report implied that the failure to administer penicillin was an ethical misjudgment and oversight, but not out of reason because it was believed that arsenotherapy was adequate treatment for syphilis at the beginning of the study in 1932. To be sure treating the men with the appropriate antisyphilitic medication would have undermined the study, to observe the natural progress of syphilis until death. The fact that there are several known instances of the United States Public Health Services preventing the Tuskegee men from receiving adequate treatment proves that the “entire study had been predicated on nontreatment” (Brandt, 1978; Butler, 1973).
Secondly, in regard to the informed consent. The initial HEW report cited that the researchers had not given the men the opportunity for informed consent, because volunteering for an experiment is not the same thing as informed consent. However, these men did not volunteer for an experiment they were explicitly lied to. They believed that they were receiving free treatment for an illness, from governmental doctors. In this regard Brandt (1978) calls into question the credibility of the HEW investigation, “the failure of the HEW Final Report to expose this critical fact – that the USPHS lied to the subjects – calls into question the thoroughness and credibility of their investigation”.
Conclusion
The Tuskegee Study exposes the obstinacy of beliefs within the medical and scientific communities about the nature of blacks, sex, and disease; beliefs that had lasting horrible consequences long after their so-called scientific bases were known to be incorrect. Based on communications between doctors, government officials, and other scientists involved it is blindingly clear that the researchers considered their patients less than human (Brandt, 1978). The study calls into question the entire scientific community in a professional capacity to be self-regulated. The Tuskegee Study lasted more than forty years and was widely reported on but these men had no advocacy; after the initial continuance of the study, it was highly unlikely that the study would be halted short of these men dying. The Tuskegee Study exposed more to the pathology of racism than it did the pathology of syphilis.
As a result of this incredible betrayal, multiple organizations and committees have formed in order to protect people that participate in scientific studies. In 1974 Congress passed the National Research Act, outlining guidelines for studies including human participants. The United States Department of Health and Human Services has the Office of Human Research Protections (OHRP), which oversees all clinical trials. All studies involving people now require informed consent, communication of diagnosis, and accurate reporting of results (Butler, 1973). Institutional Review Boards (IRBs) are required as a way to understand and review study protocols in order to protect patients’ interests and to guarantee that subjects are truly and fully informed.
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