The Tuskegee Syphilis Study

The medical experiments traditionally evoked a number of ethical issues since subjects involved in medical experiments exposed their health and life at risk for the sake of the effective treatment of other people. In such a situation, health care professionals should be particularly effective to needs of subjects and ethical issues involved in the experiment. However, in some cases, subjects remained unaware of potential risks and threats of the medical experiment they were involved in. In this respect, it is possible to refer to the Tuskegee Syphilis Study, which affected dramatically the life of hundreds of subjects involved in the experiment as well as the life of their heirs. At this point, it is important to lay emphasis on the fact that along with a traditional physician-patient ethical issues, typical for medical experiments, this study also involved racial issues, since the subjects of the study were representatives of the African American community.

From 1932 to 1972 white physicians of the United States Public Health Service (USPHS) carried out an experiment on approximately 400 rural black men in Macon County, Alabama. The study, which historians have described as “the longest nontherapeutic experiment on human beings in medical history” (Gray, 1998, p.137), was predicated on following the course of untreated syphilis until death. Historians have focused on the study as scientifically unjustifiable and as an unethical experiment that highlights the racism of American medicine and the federal government.

The study had been started in Macon County, Alabama on the ground of the 1930 survey, which had identify the county as to have the highest prevalence of syphilis of the six Southern states examined. The rural setting of Tuskegee, which was characterized by a deprived socioeconomic status, high level of illiteracy, and especially a paucity of medical care. All these factors were exploited by the investigators of the syphilis study, who led the poor sharecroppers to believe they were being treated for “bad Blood”, a euphemism for syphilis (Jones, 1981).

Paradoxically, the study had lasted for forty years, though it had a dramatic impact on the health of the subjects, who were unaware of the risks they were exposed to. The reason for such a long period of study was quite simple ”“ the study included only sporadic clinical reexaminations when a Public Physician cam to Tuskegee and denied the individuals any form of anti-syphilis therapy. Moreover, the subjects were prevented from anti-syphilis treatment on purpose. Even after the introduction of penicillin, an effective anti-syphilis drug, it was not given to the subjects. As a result, by the time the study was exposed in 1972, and ended on November 16th of the same year, 28 men had died of syphilis, 100 others were dead due to syphilis related complications, at least 40 wives had been infected and 19 children had contracted the disease at birth (Reverby, 2001).

Traditionally, the Tuskegee study was viewed as a racist study, which involved white health care professionals and black subjects. However, some specialists (Reverby, 2000) argue that  black health workers and educators associated with Tuskegee Institute, a leading black educational institution founded by Booker T. Washington in Alabama, played a critical role in the experiment. Robert Moton, head of Tuskegee Institute in the 1930s, and Dr. Eugene Dibble, the Medical Director of Tuskegee’s Hospital, both lent their endorsement and institutional resources to the government study. However, no one was more vital to the experiment than Eunice Rivers, a black public health nurse. Rivers acted as the liaison between the men in the study and the doctors of the USPHS. She worked in the public health field from 1923 until well after her retirement in 1965. She began her career with the Taskegee Institute Movable School during the 1920s in rural Alabama. This traveling school for African Americans provided adult education programs in agriculture, home economics, and health.

After a decade of service with the school, Rivers became involved in the infamous Tuskegee Syphilis Study in 1932 (Reverby. 2000). How could a nurse dedicated to preserving life participate in such a project?

Although historians have noted the key role that Rivers played in the experiment, they have presented her as a victim by virtue of her status as a woman, an African American, and a nurse. Groundbreaking work by James Jones, for example, interpreted much of Rivers’s participation as driven by obedience to higher authority. A more satisfactory consideration of her role as an historical subject is in order; yet, examination of Rivers’s role does not necessarily lead to an interpretation of her as an evil nurse.

Nevertheless, it is obvious that the Tuskegee study was initiated and controlled by the white authorities, while its effects were disastrous to the local community and the subjects involved in the experiment. In fact, they needed to cope with effects of the study even after the official end of the experiment. In this respect, the role of Rossenwald fund was particularly significant since the fund, a major Chicago-based philanthropy devoted to black education and development in the South, provided financial support to pay for the eventual treatment of the patients.

The Tuskegee study had a profound impact on the medical experiments and related-legislation in the USA. In fact, the study forced the authorities to improve the legislation concerning medical experiments and strengthen the control over such experiments. For instance, in 1974 the Congress passed the National Research Act and created a commission to study and write regulations governing studies involving human participants (Reverby, 2000). However, it was only in 1997 the US President, Bill Clinton, formally apologized and held a ceremony for the Tuskegee participants.

Thus, taking into account all above mentioned, it is possible to conclude that the Tuskegee study violated fundamental ethical norms, which health care professionals were supposed to observe. The racial issues played probably the determinant factor since African American subjects of the experiments were apparently neglected, while the white authorities remained indifferent to their problems for 40 years for which the experiment lasted. Nevertheless, the outcomes of the Tuskegee study, being tragic for hundreds of its participants, had a considerable impact on the further development of medical experiments in the USA. The Tuskegee study contributed to the introduction of stricter rules and thorough control over medical experiments involving human participants.

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