RACISM AND RESEARCH The Case of the Tuskegee Syphilis Experiment ALLAN M. BRANDT In 1952 the US, Public Health Service (uspiis} initiated an experiment in Macon County, Alabama, to determine the natural course of untreated, latent syphilis in black males. The test comprised 400 syphilitic men, as well 2s 200 tuninfected men who served as controls. The first published report of the study appeared in 1936 with subsequent papers issued every four to six years through the 1960s. When penicillin became widely available by the early 1950s as the preferred treatment for syphilis, the men did not receive therapy. In f sions, the usPHs actually sought to prevent treatment. Moreaver, a committee st the federally operated Center for Disease Control decided in 1969 that the study should be continued. Only in 1972, when accounts of the study first appeared in the national press, did the Department of Health, Education and Welfare halt the experiment. At that time 74 of the test subjects were still alive; at least 28, but Wy from advanced syphilitic lesions. In n several occe- pethaps more than 100, had died di ‘August 1972, HEWw appointed an investigatory panel which issued report the following veat. The panel found the studs to have been “ethically unjustified,” and argued that penicillin should have been provided to the men? This iv in a historical context and to assess its ethical implic ceived, the sew Final Report, and the eriticism expressed by several profession] ‘organizations, the experiment has beer largely misunderstood. The most basic ‘questions of how the study was undertaken in th ile attempts to place the Tuskegee St jons. Despite the media attention which the study re- 1 place and why it continued for 40 years were never addressed by the s8£¥° investigation. Moreover, the pane! ‘nisconstrued the nature of the experiment, failing to consult important docu- ments available at the National Archives which bear significantly on its ethical assessment. Only by examining the specific ways in which values are engaged in scientific research can the study be understood. Allan Brandis the Amalie Moses Ks Pres of the Histor of Medicine and Scions ‘Harvard University and Harvard Medial School (Original pulsed The Hastings Center Repart 8 (December 978 2 Permission ofthe Hastings Cemcer and la, Brad, 1. Reprinted byett <1 ML care cout not alter the evolutionary scheme." These assumptions pot Ma) _pkarop for examining the Tuskegee Syphilis Stud re gee Syp by. The Origins of the Experiment In1192s, under a grant from the Julius Rosenveald Fund, the useus cond stutlesin the rural South to determine the prevalence ofyphits amongblacks and explore the possibilities for mass treatments. The sets found Macon County ‘Alabama, in which the tow of Tuskegee is located, to have the highest syphilis rate ofthe si counties surveyed, The Rosenwald Study concluded that mss treatment could be successfully implemented among rural blacks. Although itis doubuful that the necessary funds would have bsen allocated even in the best econ * They hacl no intention of providing any treatment for the infected mea.” The usows originally scheduled the whole eaperiment (0 last six months; it seemed to be both a simple and inexp sive project The tsk of collecting the smmple, ‘seas had supposed, Voruderlehr canvassed the legely literate, poverty-stricken population of sharecroppers and nant farmees in search of test subjects Irs men over 25 to attend his clinies, none would appear, owever, proved to be more dificult than the circulars req suspecting he was conducting draft physicals. Therefore, he was forced to test large numbers of women and men veho did not fi the experiments specifications. This involved considerable expense, since the uses had promised the Macon County Booed of Healt that it would treat those who were infected, but nt included in the study Clark wrote to We {terme that we vould be called upon to onderieh about the situation: “It never once occured Tange part ofthe county as etura for the privilege of making this study... (am anxious (o keep the expenditures for treatment down tothe lowest possible point because it isthe one ite tute in connection with the study most dificue to defend despite our knowledge ‘of the need therefor Vanlerlebr responded: "If we could fin! fron 100 9 200 ‘cases... we would not have to do another Wassermann on useless inviduale™ Significantly, the attempt to develop the sample contradicted the prediction the uses had! made initially regarding the prevalence of the disease in Macon County, ‘Overall rates of syphilis fll well helow expectations; as opposed to the usnits projection of 35 percent, 20 percent of those tested were netualy diseased." More- lover, those who Had sought ond received previous treatment far exceeded the cexyeciations ofthe uses. Clark noted ina letter to Vander cof expendi | find your report of March Gils quite interesting but regret the necessity for ‘Wassermianning [si]... such a large numberof individuals in order to uncover this relatively listed number oF untreated cases urther diicuties arose in enlisting the subjects to participate in the experi- ment, to be "Wassermanned,” and to relurn for a subsequent series of examina ‘ions, Vondetlehr found that only the offer of restent elicted the cooperation of “They were told they wore ill nd were promised free care. fered therapy, I the ven that they were they became willing subjecis."” ‘The ustus did not