why did the tuskegee experiment start

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Tuskegee Experiment: The Infamous Syphilis Study

By: Elizabeth Nix

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

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.

Tuskegee wasn't the first 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.

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Tuskegee syphilis study

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• Academia - The Tuskegee Syphilis Study: Some Ethical Reflections
• Encyclopedia of Alabama - Tuskegee Syphilis Study
• Centers for Disease Control and Prevention - The USPHS Untreated Syphilis Study at Tuskegee
• McGill University - Office for Science and Society - 40 Years of Human Experimentation in America: The Tuskegee Study
• JamesCook University Pressbooks - An Introduction to Research Methods for Undergraduate Health Profession Students - A Case Study – The Tuskegee Syphilis Experiment
• National Center for Biotechnology Information - PubMed Central - The Tuskegee syphilis study
• Tuskegee syphilis study - Student Encyclopedia (Ages 11 and up)

Tuskegee syphilis study , American medical research project that earned notoriety for its unethical experimentation on African American patients in the rural South .

The project, which was conducted by the U.S . Public Health Service (PHS) from 1932 to 1972, examined the natural course of untreated syphilis in African American men. The research was intended to test whether syphilis caused cardiovascular damage more often than neurological damage and to determine if the natural course of syphilis in black men was significantly different from that in whites. In order to recruit participants for its study, the PHS enlisted the support of the prestigious Tuskegee Institute (now Tuskegee University ), located in Macon county, Alabama . A group of 399 infected patients and 201 uninfected control patients were recruited for the program. The subjects were all impoverished sharecroppers from Macon county. The original study was scheduled to last only six to nine months.

The subjects were not told that they had syphilis or that the disease could be transmitted through sexual intercourse . Instead, they were told that they suffered from “bad blood,” a local term used to refer to a range of ills. Treatment was initially part of the study, and some patients were administered arsenic, bismuth, and mercury. But after the original study failed to produce any useful data, it was decided to follow the subjects until their deaths, and all treatment was halted. Penicillin was denied to the infected men after that drug became available in the mid-1940s, and it was still being withheld from them 25 years later, in direct violation of government legislation that mandated the treatment of venereal disease . It is estimated that more than 100 of the subjects died of tertiary syphilis .

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. In 1997 President Bill Clinton issued a formal apology for the study (see Sidebar: Presidential Apology for the Study at Tuskegee ).

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40 years of human experimentation in america: the tuskegee study.

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Starting in 1932, 600 African American men from Macon County, Alabama were enlisted to partake in a scientific experiment on syphilis. The “Tuskegee Study of Untreated Syphilis in the Negro Male,” was conducted by the United States Public Health Service (USPHS) and involved blood tests, x-rays, spinal taps and autopsies of the subjects.

The goal was to “observe the natural history of untreated syphilis” in black populations. But the subjects were unaware of this and were simply told they were receiving treatment for bad blood. Actually, they received no treatment at all. Even after penicillin was discovered as a safe and reliable cure for syphilis, the majority of men did not receive it.

To really understand the heinous nature of the Tuskegee Experiment requires some societal context, a lot of history, and a realization of just how many times government agencies were given a chance to stop this human experimentation but didn’t.

In 1865, the ratification of the Thirteenth Amendment of the U.S. Constitution formally ended the enslavement of black Americans. But by the early 20 th century, the cultural and medical landscape of the U.S. was still built upon and inundated with racist concepts. Social Darwinism was rising, predicated on the survival of the fittest, and “ scientific racism ” (a pseudoscientific practice of using science to reinforce racial biases) was common. Many white people already thought themselves superior to blacks and science and medicine was all too happy to reinforce this hierarchy.

Before the ending of slavery, scientific racism was used to justify the African slave trade. Scientists argued that African men were uniquely fit for enslavement due to their physical strength and simple minds. They argued that slaves possessed primitive nervous systems, so did not experience pain as white people did. Enslaved African Americans in the South were claimed to suffer from mental illness at rates lower than their free Northern counterparts (thereby proving that enslavement was good for them), and slaves who ran away were said to be suffering from their own mental illness known as drapetomania.

During and after the American Civil War, African Americans were argued to be a different species from white Americans, and mixed-race children were presumed prone to many medical issues. Doctors of the time testified that the emancipation of slaves had caused the “mental, moral and physical deterioration of the black population,” observing that “virtually free of disease as slaves, they were now overwhelmed by it.” Many believed that the African Americans were doomed to extinction, and arguments were made about their physiology being unsuited for the colder climates of America (thus they should be returned to Africa).

Scientific and medical authorities of the late 19 th /early 20 th centuries held extremely harmful pseudoscientific ideas specifically about the sex drives and genitals of African Americans. It was widely believed that, while the brains of African Americans were under-evolved, their genitals were over-developed. Black men were seen to have an intrinsic perversion for white women, and all African Americans were seen as inherently immoral, with insatiable sexual appetites.

This all matters because it was with these understandings of race, sexuality and health that researchers undertook the Tuskegee study. They believed, largely due to their fundamentally flawed scientific understandings of race, that black people were extremely prone to sexually transmitted infections (like syphilis). Low birth rates and high miscarriage rates were universally blamed on STIs.

They also believed that all black people, regardless of their education, background, economic or personal situations, could not be convinced to get treatment for syphilis. Thus, the USPHS could justify the Tuskegee study, calling it a “study in nature” rather than an experiment, meant to simply observe the natural progression of syphilis within a community that wouldn’t seek treatment.

The USPHS set their study in Macon County due to estimates that 35% of its population was infected with syphilis. In 1932, the initial patients between the ages of 25 and 60 were recruited under the guise of receiving free medical care for “bad blood,” a colloquial term encompassing anemia, syphilis, fatigue and other conditions. Told that the treatment would last only six months, they received physical examinations, x-rays, spinal taps, and when they died, autopsies.

Researchers faced a lack of participants due to fears that the physical examinations were actually for the purpose of recruiting them to the military. To assuage these fears, doctors began examining women and children as well. Men diagnosed with syphilis who were of the appropriate age were recruited for the study, while others received proper treatments for their syphilis (at the time these were commonly mercury - or arsenic -containing medicines).

In 1933, researchers decided to continue the study long term. They recruited 200+ control patients who did not have syphilis (simply switching them to the syphilis-positive group if at any time they developed it). They also began giving all patients ineffective medicines ( ointments or capsules with too small doses of neoarsphenamine or mercury) to further their belief that they were being treated.

As time progressed, however, patients began to stop attending their appointments. To greater incentivize them to remain a part of the study, the USPHS hired a nurse named Eunice Rivers to drive them to and from their appointments, provide them with hot meals and deliver their medicines, services especially valuable to subjects during the Great Depression. In an effort to ensure the autopsies of their test subjects, the researchers also began covering patient’s funeral expenses.

Multiple times throughout the experiment researchers actively worked to ensure that their subjects did not receive treatment for syphilis. In 1934 they provided doctors in Macon County with lists of their subjects and asked them not to treat them. In 1940 they did the same with the Alabama Health Department. In 1941 many of the men were drafted and had their syphilis uncovered by the entrance medical exam, so the researchers had the men removed from the army, rather than let their syphilis be treated.

It was in these moments that the Tuskegee study’s true nature became clear. Rather than simply observing and documenting the natural progression of syphilis in the community as had been planned, the researchers intervened: first by telling the participants that they were being treated (a lie), and then again by preventing their participants from seeking treatment that could save their lives. Thus, the original basis for the study--that the people of Macon County would likely not seek treatment and thus could be observed as their syphilis progressed--became a self-fulfilling prophecy.

The Henderson Act was passed in 1943, requiring tests and treatments for venereal diseases to be publicly funded, and by 1947, penicillin had become the standard treatment for syphilis , prompting the USPHS to open several Rapid Treatment Centers specifically to treat syphilis with penicillin. All the while they were actively preventing 399 men from receiving the same treatments.

By 1952, however, about 30% of the participants had received penicillin anyway, despite the researchers’ best efforts. Regardless, the USPHS argued that their participants wouldn’t seek penicillin or stick to the prescribed treatment plans. They claimed that their participants, all black men, were too “stoic” to visit a doctor. In truth these men thought they were already being treated, so why would they seek out further treatment?

The researchers’ tune changed again as time went on. In 1965, they argued that it was too late to give the subjects penicillin, as their syphilis had progressed too far for the drug to help. While a convenient justification for their continuation of the study, penicillin is (and was) recommended for all stages of syphilis and could have stopped the disease’s progression in the patients.

In 1947 the Nuremberg code was written, and in 1964 the World Health Organization published their Declaration of Helsinki . Both aimed to protect humans from experimentation, but despite this, the Centers for Disease Control (which had taken over from the USPHS in controlling the study) actively decided to continue the study as late as 1969.

It wasn’t until a whistleblower, Peter Buxtun, leaked information about the study to the New York Times and the paper published it on the front page on November 16 th , 1972, that the Tuskegee study finally ended. By this time only 74 of the test subjects were still alive. 128 patients had died of syphilis or its complications, 40 of their wives had been infected, and 19 of their children had acquired congenital syphilis.

There was mass public outrage, and the National Association for the Advancement of Colored People launched a class action lawsuit against the USPHS. It settled the suit two years later for 10 million dollars and agreed to pay the medical treatments of all surviving participants and infected family members, the last of whom died in 2009.

Largely in response to the Tuskegee study, Congress passed the National Research Act in 1974, and the Office for Human Research Protections was established within the USPHS. Obtaining informed consent from all study participants became required for all research on humans, with this process overseen by Institutional Review Boards (IRBs) within academia and hospitals.

The Tuskegee study has had lasting effects on America . It’s estimated that the life expectancy of black men fell by up to 1.4 years when the study’s details came to light. Many also blame the study for impacting the willingness of black individuals to willingly participate in medical research today.

We know all about evil Nazis who experimented on prisoners. We condemn the scientists in Marvel movies who carry out tests on prisoners of war. But we’d do well to remember that America has also used its own people as lab rats . Yet to this day, no one has been prosecuted for their role in dooming 399 men to syphilis.

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How the Public Learned About the Infamous Tuskegee Syphilis Study

A s the fight over reforms to the American health-care system continues this week, Tuesday marks the 45th anniversary of a grim milestone in the history of health care in the U.S.

On July 25, 1972, the public learned that, over the course of the previous 40 years, a government medical experiment conducted in the Tuskegee, Ala., area had allowed hundreds of African-American men with syphilis to go untreated so that scientists could study the effects of the disease.

“Of about 600 Alabama black men who originally took part in the study, 200 or so were allowed to suffer the disease and its side effects without treatment, even after penicillin was discovered as a cure for syphilis,” the Associated Press reported , breaking the story. “[U.S. Public Health Service officials] contend that survivors of the experiment are now too old to treat for syphilis, but add that PHS doctors are giving the men thorough physical examinations every two years and are treating them for whatever other ailments and diseases they have developed.”

By the time the bombshell report came out, seven men involved had died of syphilis and more than 150 of heart failure that may or may not have been linked to syphilis. Seventy-four participants were still alive, but the government health officials who started the study had already retired. And, because of the study’s length and the way treatment options had evolved in the intervening years, it was hard to pin the blame on an individual — though easy to see that it was wrong, as TIME explained in the Aug. 7, 1972, issue:

At the time the test began, treatment for syphilis was uncertain at best, and involved a lifelong series of risky injections of such toxic substances as bismuth, arsenic and mercury. But in the years following World War II, the PHS’s test became a matter of medical morality. Penicillin had been found to be almost totally effective against syphilis, and by war’s end it had become generally available. But the PHS did not use the drug on those participating in the study unless the patients asked for it. Such a failure seems almost beyond belief, or human compassion. Recent reviews of 125 cases by the PHS’S Center for Disease Control in Atlanta found that half had syphilitic heart valve damage. Twenty-eight had died of cardiovascular or central nervous system problems that were complications of syphilis. The study’s findings on the effects of untreated syphilis have been reported periodically in medical journals for years. Last week’s shock came when an alert A.P. correspondent noticed and reported that the lack of treatment was intentional.

About three months later, the study was terminated, and the families of victims reached a $10 million settlement in 1974 (the terms of which are still being negotiated today by descendants). The last study participant passed away in 2004.

Tuskegee was chosen because it had the highest syphilis rate in the country at the time the study was started. As TIME made clear with a 1940 profile of government efforts to improve the health of African Americans, concern about that statistic had drawn the attention of the federal government and the national media. Surgeon General Thomas Parran boasted that in Macon County, Ala., where Tuskegee is located, the syphilis rate among the African-American population had been nearly 40% in 1929 but had shrunk to 10% by 1939. Serious efforts were being devoted to the cause, the story explained, though the magazine clearly missed the full story of what was going on:

In three years, experts predict, the disease will be wiped out. To root syphilis out of Macon County, the U. S. Public Health Service, the Rosenwald Fund and Booker T. Washington’s Tuskegee Institute all joined forces. Leader of the campaign is a white man, the county health officer, a former Georgia farm boy who drove a flivver through fields of mud, 36 miles a day to medical school. Last month, deep-eyed, sunburned Dr. Murray Smith began his tenth year in Macon County. “There’s not much in this job,” said he, “but the love and thanks of the people.” At first the Negroes used to gather in the gloomy courthouse in Tuskegee, while Dr. Smith in the judge’s chambers gave them tests and treatment. Later he set up weekly clinics in old churches or schoolhouses, deep in the parched cotton fields. Last fall the U. S. Public Health Service gave him a streamlined clinic truck. The truck, which has a laboratory with sink and sterilizer, a treatment nook with table and couch, is manned by two young Negro doctors and two nurses. Five days a week it rumbles over the red loam roads. At every crossroads it stops. At the toot of its horn, through the fields come men on muleback, women carrying infants, eager to be first, proud to have a blood test. Some young boys even sneak in to get a second or third test, and many come around to the truck long after they have been cured. One woman who had had six miscarriages got her syphilis cured by Dr. Smith with neoarsphenamine. Proudly she named her first plump baby Neo.

In the years following the disclosure, the Tuskegee study became a byword for the long and complicated history of medical research of African Americans without their consent. In 1997, President Bill Clinton apologized to eight of the survivors. “You did nothing wrong, but you were grievously wronged,” he said. “I apologize and I am sorry that this apology has been so long in coming.” As Clinton noted, African-American participation in medical research and organ donation remained low decades after the 1972 news broke, a fact that has often been attributed to post-Tuskegee wariness.

In 2016, a National Bureau of Economic Research paper argued that after the disclosure of the 1972 study, “life expectancy at age 45 for black men fell by up to 1.5 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men and 25% of the gap between black men and women.” However, many experts argue that the discrepancy has more to do with racial bias in the medical profession.

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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.

What was the Tuskegee Syphilis Experiment

The Tuskegee Syphilis Experiment, or the Tuskegee Study of Untreated Syphilis in the Negro Male, was a United States Public Health Service (USPHS) study that ran from 1932-1972. This study was less of an experiment and more of an observation, or “study in nature,” on the course of untreated, latent syphilis in Black men. This study is highly controversial—and not just based on historical hindsight.

Who was studied during the Tuskegee Syphilis Experiment?

In total, about 600 Black men were enrolled in this study. About 400 of them had syphilis, and the remaining 200 were the non-syphilitic control group. When a member of the control group contracted syphilis, they were moved from the control group to the experimental group. Macon County, Alabama, was selected as the site for this study due to findings from an earlier 1929 study backed by the Julius Rosenwald Fund on “the prevalence of syphilis” among Black men. According to this study, Macon County—of which Tuskegee's city is the county seat—had “the highest syphilis rate of the six counties surveyed.” [1]

Furthermore, doctors in the USPHS wondered whether syphilis ran its course differently in whites than Blacks. While other scientists had not argued that these experiments should prevent the treatment of disease, “the doctors who devised and directed the Tuskegee Study accepted the mainstream assumptions regarding Blacks and venereal disease. The premise that Blacks, promiscuous, and lustful would not seek or continue treatment shaped the study. A test of untreated syphilis seemed ‘natural’ because the USPHS presumed the men would never be treated; the Tuskegee Study made that a self-fulfilling prophecy.” [2]

By 1936, some of the first findings from this study were shared with the American Medical Association. In 1936, “only 16 percent of the subjects gave no sign of morbidity as opposed to 61 percent of the controls. Ten years later,” their study found that the experimental group’s life expectancy was reduced by 20 percent. By 1955, they concluded, “that slightly more than 30 percent of the test group autopsied had died directly from advanced syphilitic lesions of either the cardiovascular or central nervous system.” [3]

Why was it controversial?

In 1934, Vonderlehr advised individual physicians in the area not to treat the men in their study. USPHS advised a mobile VD unit not to treat their subjects when they came to Tuskegee in the 1940s, and when the men were drafted in the Army in 1941, USPHS “supplied the draft board with a list of 256 names they desired to have excluded from treatment, and the board complied.” [5]

The Aftermath

While HEW believed the men participated of their own free will, the experiment was “ethically unjustified” because the doctors lied to their test subjects. Despite the clear ethical violations, other physicians were defending this study as late as 1974. Many of these defenses relied, too, on racial assumptions about the Black test subjects and their supposed unwillingness to seek medical treatment of their own. [6] Thankfully, Heller’s expose brought this study to an end. Still, it is possible that this experiment taught us about racist medical discourse than it did about latent syphilis in Black men.

According to the Centers for Disease Control and Prevention (CDC), "in the summer of 1973, a class-action lawsuit was filed on behalf of the study participants and their families. In 1974, a $10 million out-of-court settlement was reached. As part of the settlement, the U.S. government promised to give lifetime medical benefits and burial services to all living participants." [7] These benefits were expanded in 1975 and 1995 to include wives or widows and children, respectively. Though all the participants and their spouses are now deceased, there is still a handful of their offspring still covered by these settlements.

Additional Sources

Gray, Fred D. The Tuskegee Syphilis Study: The Real Story and Beyond . Montgomery: NewSouth Books, 1998.

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

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

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

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

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

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

Take a closer look:

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

From the source:

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

Then and now:

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

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• 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 .
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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.

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Tuskegee Syphilis Study

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

Public Health Service Conducts Syphilis Survey

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

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

No Informed Consent

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

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

Questions of Ethics

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

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

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

Further Reading

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

External Links

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

Susan M. Reverby Wellesley College

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‘You Don’t Treat Dogs That Way’: Inside The Real-Life Horror Story Of The Tuskegee Experiment

From 1932 to 1972, the tuskegee syphilis study allowed hundreds of african american men to die — all in the name of "science.".

In the midst of the Great Depression, the U.S. government appeared to be giving away free healthcare to poor African American sharecroppers in Macon County, Alabama. There was a serious syphilis outbreak there at the time. And it seemed as though the government was helping to fight it.

However, it eventually came to light that the government doctors had simply allowed 600 Black men — many of whom had syphilis — to believe that they were getting free treatment for their “bad blood.”

In reality, the doctors weren’t giving them any treatment at all.

Instead, the purpose of the Tuskegee experiment was to observe untreated Black patients as syphilis ravaged their bodies — until they died.

The Beginnings Of The Tuskegee Experiment

National Archives/Wikimedia Commons Dr. Walter Edmondson taking a blood sample from an unidentified participant in the Tuskegee study. 1932.

The United States Public Health Service ran the Tuskegee experiment from 1932 to 1972. It was the brainchild of senior official Taliaferro Clark, but he hardly worked alone. Several high-ranking members of the Public Health Service were involved and the study’s progress was regularly reported to the government and given repeated stamps of approval.

Originally, the study’s directive was to observe the effects of untreated syphilis in African American men for six to eight months — followed by a treatment phase. But as the plans were being finalized, the Tuskegee experiment lost most of its funding. The challenges of the Great Depression caused one of the funding companies to back out of the project.

This meant the researchers could no longer afford to treat the patients. But instead of canceling the study, they adjusted it — in a barbaric way.

The study now had a new purpose: to see what happened to a Black man’s body if he didn’t get any treatment for syphilis at all.

Researchers thus observed the men who had syphilis until they died, offering them only placebos such as aspirin and supplements. And all the while, they lied to them about the true nature of their condition — to prevent them from seeking true medical care anywhere else.

Related Posts

How doctors deliberately withheld treatment from vulnerable patients.

National Archives The Tuskegee syphilis study was one of the most unethical experiments performed in U.S. history.

When the Tuskegee experiment first began, doctors already knew how to treat syphilis using arsenic therapy. But the researchers deliberately withheld information about treatment. They told the patients that they were suffering from “bad blood” to keep them from learning about syphilis on their own.

The experiment was unquestionably illegal. By the 1940s, penicillin was a proven, effective treatment for syphilis. And laws requiring treatment for venereal diseases were introduced. But the researchers defied these laws.

In fact, Dr. Thomas Parran Jr., one of the study’s leads, wrote in his annual report that the study was “more significant now that a succession of rapid methods and schedules of therapy for syphilis has been introduced.”

In short, he maintained that the Tuskegee experiment was more important than ever precisely because so many cases of syphilis were getting cured. This, he argued, was their last chance to study how syphilis killed an untreated man. And so the heinous study continued — for decades.

Four Decades Of Agonizing Deaths During The Tuskegee Syphilis Study

National Archives By the time the experiment came to an end, only 74 of the test subjects had survived.

In all the years this reprehensible study was active, nobody stopped it. By the 1940s, physicians weren’t only neglecting to treat the men’s syphilis, they were also actively keeping them from finding out there was a cure.

“We know now, where we could only surmise before, that we have contributed to their ailments and shortened their lives,” Oliver Wenger , a director for the Public Health Services, wrote in a report.

But that didn’t mean he was going to stop the experiment. Instead, he said, “I think the least we can say is that we have a high moral obligation to those that have died to make this the best study possible.”

In 1969, 37 years into the study, a committee of Public Health Service officials gathered to review its progress. Of the five men in the committee, only one felt they should treat the patients. The other four ignored him.

Ethics weren’t a problem, the committee ruled, as long as they “established good liaison with the local medical society.” In other words, as long as everyone liked them, “there would be no need to answer criticism.”

The Doctors Who Allowed The Tuskegee Experiment To Happen

National Archives Eunice Rivers poses for a photograph with two doctors involved in the Tuskegee experiment.

It’s hard to imagine anyone wanting to be associated with such a horrific experiment, let alone anyone from the historically Black Tuskegee Institute and its staff of Black doctors and nurses. But their involvement is part of the sad story behind the Tuskegee syphilis study.

In fact, the patients’ main contact point was an African American nurse named Eunice Rivers. Her patients called the observation building “Mrs. Rivers’ Lodge” and regarded her as a trusted friend. She was the only staff member to stay with the experiment for the full 40 years.

Rivers was fully aware that her patients weren’t being treated for the disease ravaging their bodies. But as a young Black nurse given a major role in a government-funded project, she felt that she couldn’t turn it down.

“I was just interested. I mean I wanted to get into everything that I possibly could,” she recalled after the experiment ended.

Rivers even justified the study after it went public in 1972, telling an interviewer, “Syphilis had done its damage with most of the people.” She also mentioned that the research provided value, saying, “The study was proven that syphilis did not affect the Negro as it did the white man.”

How The Tuskegee Syphilis Study Was Revealed To The World

National Archives Nurse Eunice Rivers filling out paperwork in 1932. She later defended her role in the study.

It took 40 years for someone to break the silence and shut the study down. Peter Buxtun, a Public Health Service social worker, tried staging several protests within the department to stop the experiment. But when his superiors continued to ignore him, he finally called the press.

On July 25, 1972, The Washington Star ran Buxtun’s story and the next day it was on the cover of The New York Times .

Finally, it was revealed to America — and to the rest of the world — that the U.S. government had broken its own laws and experimented on its own citizens. And there was damning proof: Incriminating signatures from everyone in the Public Health Department were all over the documents.

Thus, the Tuskegee experiment finally came to an end.

Tragically, by then only 74 of the test subjects had survived. Approximately 40 of the patients’ wives had become infected, and 19 of the men had unknowingly fathered children born with congenital syphilis.

The Unapologetic Reaction From The Tuskegee Researchers

National Archives Doctors involved in the Tuskegee experiment with nurse Eunice Rivers.

Even after the truth came out, the Public Health Service didn’t apologize.

In fact, John R. Heller Jr. , the head of the Division of Venereal Diseases, publicly complained that the Tuskegee experiment was shut down too soon and should have gone on longer. “The longer the study,” he said, “the better the ultimate information we would derive.”

Meanwhile, Eunice Rivers insisted that none of her patients resented her for her part in the study. “They love Mrs. Rivers,” she said. “In all of this that has gone on, I have never heard anyone say anything that was bad about it.”

The Tuskegee Institute apparently agreed. In 1975, three years after the Tuskegee experiment became public knowledge, the institute presented Rivers with an Alumni Merit Award. “Your varied and outstanding contributions to the nursing profession,” they declared, “have reflected tremendous credit upon Tuskegee Institute.”

But the families of the patients certainly didn’t echo the support of Rivers — and they made sure their voices were heard. “It was one of the worst atrocities ever reaped on people by the government,” said Albert Julkes Jr., whose father died thanks to the study. “You don’t treat dogs that way.”

The Aftermath Of The Heinous Experiment

National Archives Some believe that the Tuskegee experiment damaged public trust in the U.S. healthcare system.

After news of the study came out, the American government introduced new laws to prevent another tragedy like this. These new laws required informed consent signatures, accurate communication of diagnosis, and detailed reporting of test results in every clinical study.

An Ethics Advisory Board was formed in the late 1970s to review ethical issues concerning biomedical research. And efforts to encourage the highest ethical standards in scientific research are ongoing to this day.

In 1997, the U.S. government formally apologized to the victims of the Tuskegee experiment. President Bill Clinton invited the last eight survivors and their families to the White House and apologized to them directly.

He told the five survivors that attended, “I am sorry that your federal government orchestrated a study so clearly racist. That can never be allowed to happen again… Your presence here shows us that you have chosen a better path than your government did so long ago.”

The legacy of the Tuskegee experiment is without question a horrific one. Decades later, this dark chapter in American history still looms large throughout the nation. This is especially true in Tuskegee, where this real-life horror story will never be forgotten.

After this look at the Tuskegee syphilis study, find out about the disturbing Stanford Prison Experiment . Then, read up on the horrifying medical experiments carried out by Japan’s Unit 731 during World War II.

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AP exposes the Tuskegee Syphilis Study: The 50th Anniversary

This 1950’s photo made available by the National Archives shows a man included in a syphilis study in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

In this 1950’s photo made available by the National Archives, a man included in a syphilis study has blood drawn in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

This image made available by the U.S. National Archives shows part of a 1940-dated document describing procedures for the distribution of autopsy results from subjects of the Tuskegee Syphilis Study conducted by the U.S. government. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

FILE - In this 1950’s photo made available by the National Archives, men included in a syphilis study stand for a photo in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP, File)

FILE - In this 1950’s photo released by the National Archives, a man included in a syphilis study has blood drawn by a doctor in Tuskegee, Ala. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. Finally exposed in 1972, the study ended and the men sued, resulting in a $9 million settlement. (National Archives via AP)

Lillie Tyson Head holds a photograph of her late parents, Freddie Lee and Johnnie Mae Neal Tyson, at her home in Wirtz, Va., on Saturday, July 23, 2022. Freddie Tyson was part of the infamous “Tuskegee Study,” in which hundreds of Black men in Alabama went untreated for syphilis for decades so federal government researchers could record the disease’s affects on the body. Head says her mother was later tested, and did not have the disease. (AP Photo/Allen G. Breed)

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WASHINGTON (AP) — EDITOR’S NOTE — On July 25, 1972, Jean Heller, a reporter on The Associated Press investigative team, then called the Special Assignment Team, broke news that rocked the nation. Based on documents leaked by Peter Buxtun, a whistleblower at the U.S. Public Health Service, the then 29-year-old journalist and the only woman on the team, reported that the federal government let hundreds of Black men in rural Alabama go untreated for syphilis for 40 years in order to study the impact of the disease on the human body. Most of the men were denied access to penicillin, even when it became widely available as a cure. A public outcry ensued, and nearly four months later, the “Tuskegee Study of Untreated Syphilis in the Negro Male” came to an end. The investigation would have far-reaching implications: The men in the study filed a lawsuit that resulted in a $10 million settlement , Congress passed laws governing how subjects in research studies were treated , and more than two decades later President Bill Clinton formally apologized for the study, calling it “shameful.”

Today, the effects of the study still linger — it is often blamed for the unwillingness of some African Americans to participate in medical research.

In observance of the 50th anniversary of Heller’s groundbreaking investigation, the AP is republishing the original report and a recent interview with her and others on how the story came together.

For 40 years the U.S. Public Health Service has conducted a study in which human guinea pigs, denied proper medical treatment, have died of syphilis and its side effects.

The study was conducted to determine from autopsies what the disease does to the human body.

PHS officials responsible for initiating the experiment have long since retired. Current PHS officials, who say they have serious doubts about the morality of the study, also say that it is too late to treat syphilis in any of the study’s surviving participants.

But PHS doctors say they are rendering whatever other medical services they can now give to the survivors while the study of the disease’s effects continues.

The experiment, called the Tuskegee Study began in 1932 with about 600 black men mostly poor and uneducated, from Tuskegee, Ala., an area that had the highest syphilis rate in the nation at the time.

One-third of the group was free of syphilis; two-thirds showed evidence of the disease. In the syphilitic group, half were given the best treatment known at the time, but the other half, about 200 men, received no treatment at all for syphilis, PHS officials say.

As incentives to enter the program, the men were promised free transportation to and from hospitals, free hot lunches, free medicine for any disease other than syphilis and free burial after autopsies were performed.

The Tuskegee Study began 10 years before penicillin was discovered to be a cure for syphilis and 15 years before the drug became widely available. Yet, even after penicillin became common, and while its use probably could have helped or saved a number of the experiment subjects, the drug was denied them, Dr. J.D. Millar says.

He is chief of the venereal disease branch of the PHS’s Center for Disease Control in Atlanta and is now in charge of what remains of the Tuskegee Study. Dr. Millar said in an interview that he has serious doubts about the program.

“I think a definite serious moral problem existed when the study was undertaken, a more serious moral problem was overlooked in the post-war years when penicillin became available but was not given to these men and a moral problem still exists,” Dr. Millar said.

“But the study began when attitudes were much different on treatment and experimentation. At this point in time, with our current knowledge of treatment and the disease and the revolutionary change in approach to human experimentation, I don’t believe the program would be undertaken,” he said.

Syphilis, a highly contagious infection spread by sexual contact, can cause if untreated, bone and dental deformations, deafness, blindness, heart disease and central nervous system deterioration.

No figures were available on when the last death occurred in the program. And one official said that apparently no conscious effort was made to halt the program after it got under way.

A 1969 CDC study of 276 treated and untreated syphilitics who participated in the Tuskegee Study showed that seven had died as a direct result of syphilis. Another 154 died of heart disease.

CDC officials say they cannot determine at this late date how many of the heart disease deaths were caused by syphilis or how many additional deaths could be linked to the disease.

However, several years ago an American Medical Association study determined that untreated syphilis reduces life expectancy by 17 per cent in black men between the ages of 25 and 50, a precise description of the Tuskegee Study subjects.

Don Prince, another official in the venereal disease branch of CDC, said the Tuskegee Study had contributed some knowledge about syphilis, particularly that the morbidity and mortality rate among untreated syphilitics were not as high as previously believed.

Like Dr. Millar, Prince said he thought the study should have been halted with penicillin treatment for participants after World War II.

“I don’t know why the decision was made in 1946 not to stop the program,” Prince said. “I was unpleasantly surprised when I first came here and found out about it. It really puzzles me.”

At the beginning of 1972, according to CDC data, 74 of the untreated syphilitics were still living. All of them, Dr. Millar said, were men who did not suffer any potentially fatal side effects from their bouts with the disease.

Some of them received penicillin and antibiotics in past years for other aliments, Prince said, but none has ever received treatment for syphilis. Now, both men agree, it’s too late

Recent reviews of the Tuskegee Study by the CDC indicate that treatment now for survivors is medically questionable, Dr. Millar said. Their average age is 74 and massive penicillin therapy, with possible ill side effects, is deemed too great a risk to individuals, particularly for those whose syphilis is now dormant.

However, Dr. Millar, added there was a point in time when survivors could have been treated with at least some measure of success.

“The most critical moral issue about this experiment arises in the post-war era, the years after the end of World War II when penicillin became widely available.

“I know some were treated with penicillin for other diseases and then dropped from the program because the drug had some positive effect on the primary disease (syphilis). Looking at it now, one cannot see any reason they could not have been treated at that time.”

What Newly Digitized Records Reveal About the Tuskegee Syphilis Study

The archival trove chronicles the extreme measures administrators took to ensure Black sharecroppers did not receive treatment for the venereal disease

Caitjan Gainty, The Conversation

In 1972, a whistleblower revealed that the United States Public Health Service (USPHS) had withheld syphilis treatment from hundreds of Black men as part of a 40-year study observing the natural course of the disease. The experiment’s subjects—the majority of whom were sharecroppers from rural Alabama—believed they were undergoing treatment for “bad blood,” a colloquial name then used for a host of conditions, including venereal diseases. Instead, they received placebos and inadequate medical care, even after penicillin emerged as an effective, readily available treatment for syphilis in the mid-1940s.

The Tuskegee syphilis study , as the experiment is often called today, began in 1932 with the recruitment of 600 Black men, 399 with syphilis and 201 without, to serve as the control group. Initially intended to run for six months, the study continued for decades. Unwitting participants lured in by the promise of free medical care, hot meals and burial insurance returned regularly for aspirin, tonics, blood draws and the occasional spinal tap. But none of these treatments does any good for syphilis, and 128 of the men ultimately died of the disease or complications related to it.

When news of the study broke, Chuck Stone , a journalist and former Tuskegee Airman , responded with an impassioned editorial, writing, “It either takes a tough constitution or a rancid morality to sit quietly by and watch 200 men die without doing anything about it. I call it genocide. Have you got a better name for it?”

Historians have had decades to pore over the study’s archives. Now, the National Library of Medicine has made a collection of those documents available for public viewing online . Anyone with an internet connection can read the primary source material—hundreds of pages of administrative records, letters and meeting minutes.

No one would expect the portrait this collection paints to be pretty or redemptive. Indeed, the study has gone down in the annals of American history as one of the most notorious, but by no means only, examples of medicine at its most prejudicial, virulent and unethical. Even with this knowledge, it is galling to read about the lengths USPHS doctors went to to ensure their patients were denied treatment.

Immobile and malleable

A 1948 history of the study makes it clear that the choice to set the experiment in the Deep South was deliberate. As the paper notes, the study followed a broader survey of syphilis in the still deeply segregated region. Sponsored by the Julius Rosenwald Fund , this earlier program aimed to assess the prevalence of the disease in several Southern counties and make sensible plans for its treatment—a starkly different goal than the Tuskegee experiment. The USPHS drew on this data to identify Macon County, Alabama, the surveyed area with the highest prevalence rate of syphilis, as the right place for a new study. Macon County also had high poverty rates and low education rates, ensuring the experiment’s subjects would be both immobile and malleable.

Another contributing factor was the presence of the venerable Tuskegee University, a historically Black college then known as the Tuskegee Institute, which had the facilities necessary to carry out the autopsies and lab work the study required.

Always a hurdle was a 1927 Alabama state statute that required medical personnel to report and treat all cases of syphilis. But enforcement of this statute was so lax that the experiment could have continued unimpeded had it not been for the 1942 draft, which led the local Selective Service Board to unmask the syphilitic status of the study’s subjects. The board’s charge was to evaluate individuals for military service, a process that required testing for venereal diseases and mandatory treatment for those affected.

R.A. Vonderlehr, the assistant surgeon general and one of the originators of the study, jumped into action to prevent the subjects from receiving treatment. He wrote urgently to local health officer Murray Smith, asking him to pull some strings to get the study subjects exempted.

“I would suggest that you confer with the chairman of the local Selective Service Board,” Vonderlehr wrote. “I believe he is an old friend of yours, and I would inform him of all the circumstances connected with the study. It is entirely probable that … he will cooperate with you in the completion of the investigation.”

Smith made good use of his social connections, managing to get the 256 remaining syphilitic subjects exempted from treatment. Likewise, when the same matter reached D.G. Gill, director of the Alabama Department of Health’s Bureau of Preventable Diseases, he requested Vonderlehr’s advice on whether to “make an exception of these few individuals” to avoid “encroaching on some of your study material.”

Effective treatment denied

Even in the postwar period, when penicillin became widely available, replacing the arguably ineffective and dangerous arsenic-based syphilis treatments that had preceded it, the study ploughed ahead , still more committed to documenting the disease than treating its sufferers. There was nothing unwitting about this denial of treatment.

Indeed, the archive shows that subjects were explicitly and repeatedly lied to for decades so they wouldn’t seek treatment for syphilis on their own. Even the form letters they received bore the hallmarks of a scam. They were invited to a “special examination” with government doctors waiting to give them “special attention” to “find out how you have been feeling and whether the treatment has improved your health.” Some of these notes were signed by Smith, who was designated just below his signature as a “special expert” to the USPHS.

And then there were the spinal taps , which were widely hated by the study subjects for the severe headaches they caused and because the men worried the procedure “robbed [them] of their procreative powers (regardless of the fact that I claim it stimulates them),” wrote physician Austin V. Deibert in a 1939 letter to Vonderlehr. 

Deibert told Vonderlehr the USPHS might have to  cancel the spinal taps  for the sake of the study’s continuation. “All in all and with no attempt at humor,” he said, he was the one with the real “headache.”

Neither World War II nor the early civil rights movement seemed to move the subsequent generations of study staff and administrators. The study was widely known in medical circles, thanks to the dozen or so articles on its findings published in prominent journals. Though outsiders started criticizing the experiment in the 1950s and ’60s, these dissenting voices were few and far between.

The first confirmed critique of the study from outside the USPHS arrived in a 1955 letter written by physician Count Gibson , who had heard a USPHS official explicitly state that the study’s subjects were not informed that treatment was being withheld.

Though Gibson was reportedly unsatisfied with the response he received, his colleagues urged him not to pursue the issue for fear that speaking out against these very powerful men might jeopardize his own career. He let it drop. In 1964, cardiologist Irwin Schatz voiced similar concerns, writing a letter that also questioned the study’s ethics. He never received a reply.

Concerns waved off

Indeed, the study directors continued to wave off concerns. As a set of meeting minutes from 1965 put it, “Racial issue was mentioned briefly. Will not affect the study. Any questions can be handled by saying these people were at the point that therapy would no longer help them. They are getting better medical care than they would under any other circumstances.”

In 1970, Anne R. Yobs, a co-author of one of the published papers, acknowledged that the research should come to an end. In a letter to the director of the Centers for Disease Control, she recommended closing the study, not because the charges of racism and unethical practice that had started to pour in were merited, but rather because “changes at the program level … in sensitivity to (potential) criticism” had forced administrators’ hands.

The study had become “an increasingly emotionally charged subject,” preventing “a rational appraisal of the situation,” wrote James B. Lucas, assistant chief of the USPHS’ Venereal Disease Branch, in a memo that same year.

By 1972, Peter Buxtun , a USPHS venereal disease officer who had spoken out against the study within the organization for years to no avail, had had enough. He went to the press.

Jean Heller, an Associated Press journalist, broke the story that July. A few months later, an ad hoc committee organized to evaluate the study finally ended it .

The Tuskegee study’s legacy has reverberated across the decades. In 1974, the NAACP successfully sued the federal government for $10 million, distributing the settlement money to the study subjects and their surviving family members. In 1997, President Bill Clinton publicly apologized to the men, acknowledging that what the USPHS had done was “deeply, profoundly, morally wrong.”

The study has had a material impact on medical outcomes within the African American community more broadly. Over the past several decades, researchers have connected the experiment to lower life expectancy among Black men due to broken trust in the health care system. More recently, the Covid-19 pandemic and subsequent vaccination efforts reignited discussions around Tuskegee’s impact on medical mistrust . Susan Reverby, the preeminent historian of the Tuskegee syphilis study, argues that the experiment’s legacy is far more complex than commonly stated, in no small part because of how it has been viewed historically. She notes that tying medical skepticism directly to Tuskegee erroneously suggests that the “reason for mistrust happened a long time ago,” thus turning attention away from the structural racism of today. As historian Alice Dreger succinctly puts it, “African Americans who distrust the health care system see plenty of reasons all around them to do so. They don’t have to look back 40 years.”

Perhaps, in this light, the most important takeaway from these digitized documents is not the starkly racist, unethical enterprise they so vividly record. It’s easy to condemn Vonderlehr, Smith, Yobs, Deibert and the countless others in the story whose actions are deeply troubling. But it’s more useful to observe how professional credentials and networks, philanthropic funding, warped notions of the greater good, and devotion to the scientific method provide cover to racism—and even prop it up. For it is often in these more quotidian spaces of life that racism in medicine persists .

This article is published in partnership with the Conversation under a Creative Commons license. Read the Conversation’s version .

Caitjan Gainty is a historian of 20th-century medicine and technology at King’s College London. She initially trained in public health and worked for several years in health care research before returning to academia to pursue a PhD in the history of medicine, which she received in 2012.

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

Martin j. tobin.

1 Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois; and

2 Stritch School of Medicine, Loyola University of Chicago, Maywood, Illinois

This year marks the 50th anniversary of the uncovering of the Tuskegee syphilis study, when the public learned that the Public Health Service (precursor of the CDC) for 40 years intentionally withheld effective therapy against a life-threatening illness in 400 African American men. In 2010, we learned that the same research group had deliberately infected hundreds of Guatemalans with syphilis and gonorrhea in the 1940s, with the goal of developing better methods for preventing these infections. Despite 15 journal articles detailing the results, no physician published a letter criticizing the Tuskegee study. Informed consent was never sought; instead, Public Health Service researchers deceived the men into believing they were receiving expert medical care. The study is an especially powerful parable because readers can identify the key players in the narrative and recognize them as exemplars of people they encounter in daily life—these flesh-and-blood characters convey the principles of research ethics more vividly than a dry account in a textbook of bioethics. The study spurred reforms leading to fundamental changes in the infrastructure of research ethics. The reason people fail to take steps to halt behavior that in retrospect everyone judges reprehensible is complex. Lack of imagination, rationalization, and institutional constraints are formidable obstacles. The central lessons from the study are the need to pause and think, reflect, and examine one’s conscience; the courage to speak; and above all the willpower to act. History, although about the past, is our best defense against future errors and transgressions.

The PHS Syphilis Study

Peter buxtun, the story breaks, why was the phs syphilis study undertaken, the guatemalan epilogue.

The history of medicine is presented as a cavalcade of triumphal breakthroughs leading to marked increases in life expectancy. Advances arise from the ingenuity and industry of innumerable investigators but also depend on millions of patients who selflessly make their bodies available for experimentation. The interaction between investigators and patients is a source of pride but on occasion has also been a reason for shame. Few medical experiments are more ignominious than that conducted by physicians who for 40 years (1932–1972) intentionally withheld effective therapy from hundreds of African American men known to have a life-threatening illness ( 1 ).

One of the most disturbing features of this experiment is the realization that it was conducted by the major health arm of the federal government: the Public Health Service (PHS; precursor of the CDC). When the experiment was uncovered in 1972, it was difficult to imagine that the PHS could contain a worse chapter in its history ( 2 ). Yet in 2010, we learned that the same group of researchers had deliberately infected hundreds of Guatemalans with syphilis and gonorrhea in the 1940s in the hope of developing a better means of preventing these infections.

The PHS study has its origin with researchers who wanted to study the natural history of untreated syphilis. The site chosen, Macon County, Alabama, had a population of 27,000 in 1932, of whom 82% were African American ( 1 ). The PHS sought the cooperation of the nearby Tuskegee Institute, the Black university founded by Booker T. Washington (1856–1915), and made use of the facilities of Andrew Memorial Hospital, located on the campus ( 3 ). The study population consisted of 600 Black men: 399 with syphilis and 201 free of the disease who served as control subjects ( 4 ). By 1969, at least 28 and perhaps 100 men had died as a direct result of syphilis; despite this knowledge, the government scientists continued the experiment ( 1 , 5 ).

“In 1932, Macon County was still very much tied to its plantation past,” Britt Rusert avows ( Figure 1 ). “Most of the men selected for the syphilis experiments were poor sharecroppers with little or no formal education who worked under white farmers in a system of debt peonage” ( 6 ). The men agreed to participate because the investigators offered them free medical care and burial insurance ( 1 ). Informed consent was never sought. On the contrary, PHS researchers deceived the men into believing they were being treated for “bad blood,” a colloquialism for several ailments ( 1 ). The term is included in the title of a book by James Jones, Bad Blood: The Tuskegee Syphilis Experiment (1981), regarded as the definitive history of the experiment ( 7 ) and “the single most important book ever written in bioethics” ( 8 ).

Unidentified study participant in a cotton field. Reproduced from file of photographs of participants in the Tuskegee syphilis study, National Archives (in public domain).

As an active physician who has spent more than 45 years conducting research on patients and a former journal editor-in-chief who investigated various problems of research ethics and imposed sanctions on researchers for malfeasance, I reflect on how physician-scientists who dedicate their lives to a noble cause can persuade themselves that it is morally acceptable to perform disturbing experiments on unwitting individuals to attain their goals. A more detailed version of this article is available in the online supplement.

The idea for the experiment originated with Dr. Taliaferro Clark, director of the Venereal Disease Division of the PHS ( 9 – 11 ). Dr. Clark was analyzing data from an earlier study when “the thought came to me that the Alabama community offered an unparalleled opportunity for the study of the effects of untreated syphilis” ( 1 ). In time, this thought became the Tuskegee Study of Untreated Syphilis in the Negro Male.

The men remained untreated only because the government doctors deliberately withheld therapy over a 40-year period and misled the men into believing that the medications they received (vitamin tonics and aspirin as placebo) were effective against their disease ( 6 ) ( Figures 2 and ​ and3). 3 ). When seeking assistance from the principal of the Tuskegee Institute, the surgeon general, Dr. Hugh Cumming (1869–1948), wrote to him in 1932 saying that the study “offers an unparalleled opportunity for carrying on this piece of scientific research which probably cannot be duplicated anywhere else in the world.” Presumably, Dr. Cumming did not intend any irony ( 12 ).

PHS staff members Dr. David Allbritton, nurse Eunice Rivers, and Dr. Walter Edmondson, conducting an annual roundup in Macon County, 1953. On the side of the vehicle, “U.S. Department of Health, Education, and Welfare, Public Health Service” is prominently displayed. Reproduced from National Archives (in public domain). PHS = Public Health Service.

Dr. Walter Edmondson of the PHS drawing a blood sample from a study participant during an annual roundup in Milstead, Macon County, 1953. Reproduced from National Archives (in public domain). PHS = Public Health Service.

The background knowledge that led to the PHS study came from the Oslo Study of Untreated Syphilis ( 9 ). Convinced that available therapy, primarily mercury compounds that had been used since the 16th century, was harmful, Dr. Caesar Boeck withheld treatment from almost 2,000 syphilitic patients between 1890 and 1910 ( 13 ). Like tuberculosis, syphilis had been one of the most feared scourges of mankind, estimated to affect 1 in every 10 Americans in the early 20th century ( 14 ). Around this time, German investigators made a series of path-breaking discoveries that revolutionized the ability of physicians to manage the disease ( 15 ). Therapy was transformed in 1908 when Sahachirō Hata (1873–1938) and Nobelist Paul Ehrlich (1854–1915) discovered an arsenical compound, arsphenamine, which was highly toxic to spirochetes and much less so to humans ( 15 ). Arsphenamine was marketed as Salvarsan in 1910; Boeck became quickly convinced of its efficacy and immediately terminated the Oslo study ( 16 ).

Once PHS investigators had enrolled the Alabama men and obtained baseline measurements, they next decided to check for evidence of neurosyphilis. Dr. Raymond Vonderlehr realized that the men might refuse lumbar puncture if they realized it was solely for diagnostic purposes. “My idea,” he wrote to his collaborators, is that “details of the puncture techniques should be kept from them as far as possible” ( 1 ). To entice the men to cooperate, he told them he would give them a special therapy: free “spinal shots,” deceiving them into believing that lumbar punctures were therapeutic ( Figure 4 ) ( 9 ).

Lumbar puncture, 1933. From left: Dr. Jesse J. Peters, nurse Eunice Rivers, and unidentified study participant. Reproduced from National Archives (in public domain).

The final step in data collection was to obtain pathological specimens at autopsy. “As I see it,” another PHS investigator, Dr. Oliver Wenger, wrote to Dr. Vonderlehr, “we have no further interest in these patients until they die ” (underlining in original) ( 17 ). The surgeon general, Dr. Cumming, stressed this step in a letter to the director of Andrew Hospital: “Since clinical observations are not considered final in the medical world, it is our desire to continue observation on the cases selected for the recent study and if possible to bring a percentage of these cases to autopsy so that pathological confirmation may be made of the disease processes.” PHS investigators feared the enrollees would quit if they knew they would be autopsied. Dr. Wenger wrote to Dr. Vonderlehr, “If the colored population become aware that accepting free hospital care means a postmortem every darkey will leave Macon County” ( 17 ).

To coax enrollees into the hospital when they became severely ill, the PHS promised to cover their burial expenses. Given the importance of funeral rites in the cultural life of rural Black persons, this was a particularly strong inducement ( 9 ). “The grotesque violation of these men’s bodies,” chides Britt Rusert, “extended even into their death: family members were required to turn over the corpse for an autopsy to secure funeral benefits” ( 6 ).

Shortly after commencing his tenure as surgeon general (1936–1948), Dr. Thomas Parran (1892–1968) launched a vigorous campaign to eradicate venereal disease using mass screening and mobile treatment clinics ( 18 ). Dr. Parran, who had visited Tuskegee in the early 1930s, is credited for the great strides made by this nationwide campaign ( Figure 5 ). When the mobile unit reached Macon County, PHS staff members alerted local doctors about enrollees and instructed physicians: “He’s under study and not to be treated” ( 1 ).

Thomas Parran, Jr., M.D., sixth U.S. surgeon general (1936–1948), in 1946, the year the Guatemala research commenced (reproduced from Reference 109 ) (in public domain).

In 1943, Dr. John Heller succeeded Dr. Vonderlehr as director of the Division of Venereal Diseases ( 1 ). One year later, penicillin became the therapy of choice for syphilis ( 19 ), and in 1947 PHS established rapid treatment centers across the country. There was no discussion of treating the men enrolled in the study. Given the effectiveness of penicillin, PHS scientists insisted that it was all the more urgent for the experiment to continue—it had become a never-again-to-be-repeated opportunity.

Although physician-scientists intentionally withheld penicillin, the experiment was fundamentally flawed because “the vast majority of the patients” had received “effective and undocumented” penicillin “in the happenstance manner while under treatment for other conditions” ( 20 ). As such, the study was not one of untreated syphilis, but rather of undertreated syphilis ( 21 ).

When Dr. Heller left the Division of Venereal Diseases in 1948, he became director of the National Cancer Institute and, in 1960, president of the Memorial Sloan-Kettering Cancer Center in New York. His years as leader of the PHS study coincided with the introduction of penicillin for syphilis and promulgation of the Nuremberg Code. There is no evidence that the PHS study was ever discussed in the light of the Nuremberg Code ( 1 ). When the experiment was brought to public attention in 1972, Dr. Heller shocked the public by telling journalists, “There was no racial side to this. It just happened to be in a black community. I feel this was a perfectly straightforward study, perfectly ethical, with controls” ( 9 ). When Dr. Heller died in 1989, the New York Times published a glowing obituary, listing his many accomplishments without mentioning the PHS study ( 22 ).

Some believe the PHS experiment was a secret study ( 6 ). On the contrary, the first report was published in JAMA in 1936 ( 23 ), and PHS researchers issued subsequent papers every 4–6 years until 1973 ( 24 ). For those who did not read the entire articles, the titles were sufficient to have aroused suspicion. “The Tuskegee Study of Untreated Syphilis; the 30th Year of Observation” was the title of a 1964 article in Archives of Internal Medicine ( 25 ). A 1955 article on autopsy findings communicated that more than 30% of the men had died directly from advanced syphilitic lesions ( 26 ). Despite repeated accounts of the ravages of untreated syphilis, appearing in 15 articles in reputable journals spread over 37 years, no physician or scientist from anywhere around the world published a letter or commentary criticizing the ethics of the experiment ( 21 ).

In December 1965, Peter Buxtun was hired by the PHS to interview patients with venereal disease. Within a year, the 29-year-old Czech-born psychiatric social worker sent a letter to Dr. William Brown, director of the Division of Venereal Diseases of the CDC, expressing grave moral concerns about the PHS study ( 1 ) ( Figure 6 ). The CDC remained silent for months and then invited Buxtun to a meeting in Atlanta. As soon as Buxtun entered the conference room, Dr. John Cutler, a PHS investigator ( 26 , 27 ), began to harangue him. “He had obviously read my material,” Buxtun recalled, “thought of me as some form of lunatic who needed immediate chastisement and he proceeded to administer it” ( 1 ).

Mr. Peter Buxtun, a 29-year-old social worker, communicated with the CDC about the ethics of the PHS study and subsequently revealed details of the study to a newspaper reporter (reproduced from Reference 110 ) (in public domain). PHS = Public Health Service.

In November 1968, Buxtun again wrote to Dr. Brown, who showed the letter to Dr. David Sencer, director of the CDC (1966–1977). Realizing they had a problem on their hands, Sencer and Brown convened a blue-ribbon panel in February 1969 to discuss the study ( 1 ). CDC scientists presented an overview of the study and said they needed advice on deciding whether to terminate it. Dr. Brown noted that 83 men had shown evidence of syphilis at death, but he personally believed the disease was the primary cause of death in only 7 of them ( 1 ).

Dr. Lawton Smith emerged as the leading advocate for continuing the study. He stressed, “You will never have another study like this; take advantage of it,” and boasted that “20 years from now, when these patients are gone, we can show their pictures” ( 28 ). (Today one can access the Lawton Smith Lecture Series on a website hosted by the North American Neuro-Ophthalmology Society [ 29 ].) Of 17 panelists, only Dr. Gene Stollerman saw the men as patients and believed they had a right to be treated: “You should treat each individual case as such, not treat as a group” ( 5 ). The blue-ribbon panel dismissed this objection and continued to refer to the survivors as a group of subjects rather than as individual patients. It was almost as if the words, “399-Alabama-Black-rural-sharecropping-illiterate-men” constituted a single word ( 21 ).

Dr. Brown wrote to Peter Buxtun informing him that a blue-ribbon panel had reviewed the experiment and decided against treating the men. Buxtun made no attempt to challenge the panel’s medical authority but asked, “What is the ethical thing to do?” ( 1 ). The CDC did not answer him. Buxtun discussed the matter with several law professors, who were sympathetic but offered little encouragement—an illustration of Ian Kershaw’s adage that the road to Auschwitz was paved with indifference ( 30 ). Buxtun contacted a journalist, and the story finally broke in the Washington Star on July 25, 1972, and as front-page news in the New York Times the following day ( 31 ).

The American public found it hard to wrap its mind around the idea that government doctors had been intentionally duping men with a disease as serious as syphilis for 40 years ( 24 ). The Afro-American of Baltimore exclaimed, “How condescending and void of credibility are the claims that racial considerations had nothing to do with the fact that 600 [all] of the subjects were black” ( 1 ). A number of physicians defended the study, the most spirited defense coming from Vanderbilt’s Rudolph Kampmeier (1898–1990), former president of the American College of Physicians (1967–1968) and editor of the Southern Medical Journal ( 32 ). Dr. Kampmeier blasted journalists for raising “a great hue and cry,” chastised them for their “complete disregard for their abysmal ignorance,” and trumpeted that his analysis would “put this ‘tempest in a teapot’ into proper historical perspective” ( 33 ).

Dr. Kampmeier considered the insinuation “that treatment was purposefully withheld” from the enrollees as unjust. On the contrary, “the subjects were not deterred from obtaining treatment if they desired it or bothered to get what was available” ( 33 ). In his mind, it was the fault of the men that they did not request penicillin as treatment for their syphilitic aortitis: “Since these men did not elect to obtain the treatment available to them, the development of aortic disease lay at the subject’s door and not in the Study’s protocol.” Regarding higher mortality in subjects with syphilis than in control subjects, Dr. Kampmeier coolly observed, “This is not surprising. No one has ever implied that syphilis was a benign infection” ( 33 ).

The Department of Health, Education, and Welfare (HEW) announced that it would undertake a review ( 1 ). In October 1972, the Ad Hoc Advisory Panel advised that the experiment be terminated and that the men receive immediate medical care. In February and March 1973, Senator Edward Kennedy conducted congressional hearings into the study, which led to the passage of the National Research Act and, in turn, the establishment of institutional review boards, principles of informed consent, and protection of vulnerable populations ( 5 ). Legal proceedings against any physician-scientist were never initiated ( 34 ).

In 1997, President Clinton finally tendered the government’s apology: “What the United States government did was shameful. . . . To our African American citizens, I am sorry that your federal government orchestrated a study so clearly racist” ( 35 ).

The HEW panel report, issued in April 1973 ( 36 ), failed to address two central questions: “Why was the experiment undertaken?” and “Why did it continue for 40 years?” The answers are complex. Insights are gained from examining the beliefs of the PHS investigators who initiated the study, scientific understanding of syphilis (treated and untreated), and prevailing cultural and social forces at the time.

In the early decades of the 20th century, eugenics was a worldwide force and judged to represent cutting-edge biology research ( 37 , 38 ). PHS study leaders were vocal advocates of eugenic measures ( 39 ). Dr. Taliaferro Clark earned his PHS stripes by undertaking eugenics-motivated projects on rural schoolchildren ( 40 ). Dr. Clark’s data would later be used by the state of Indiana to select individuals for sterilization. Because of its influence on the future of the “the race,” venereal disease was considered “directly antagonistic to the eugenic ideal” ( 14 ). Recognizing its threat to the family, several states enacted eugenic marriage laws, making venereal disease a bar to matrimony.

Racist views were not confined to the postbellum South nor directed solely at the lower echelons of Black society. When 5,000 Black physicians petitioned for membership in the American Medical Association (AMA) in 1939, their application was rejected ( 41 ). Not only did the AMA refuse to admit Black physicians as members, but it also did not allow them to attend its annual conferences. This discrimination lasted well into the civil rights era. Between 1944 and 1965, more than a dozen attempts to include Black physicians were rebuffed by the AMA ( 42 , 43 ). Black physicians consequently founded their own organization, the National Medical Association, which continues to publish its own journal to this day ( 44 , 45 ). The AMA did not officially desegregate until 1968 ( 46 ).

Fast forward to February 23, 2021: JAMA broadcasted a 16-minute podcast with the Twitter headline “No physician is racist, so how can there be structural racism in health care?” The host, Ed Livingston, M.D., a “fulltime editor of JAMA ,” dismissed structural racism as “an unfortunate term,” insisting that people are “turned off by the whole structural racism phenomenon,” concluding that “personally, I think taking racism out of the conversation will help” ( 47 ). Critics claimed the podcast exposed a culture of systemic racism in medicine. The furor arising from the podcast led to the resignation of Dr. Livingston, and the editor-in-chief, Howard Bauchner, M.D., was placed on administrative leave on March 25 and resigned on June 30 ( 48 ).

Assumptions that racial differences are genetic in origin have become embedded within medical practice, with half of White medical students and residents holding false beliefs about biological differences between Black and White individuals ( 49 ), which result in undertreatment of pain (among other consequences) ( 50 , 51 ). For years, researchers have treated race as an innate genetic attribute, whereas the perspective of race as a social construct is now widely embraced ( 52 ). The term “structural racism” is used to convey that racism has a systemic basis, embedded in social policy and norms and not simply private prejudices of individuals ( 53 , 54 ). Structural racism is the common denominator to the PHS experiments, inferior medical care ( 49 – 51 , 55 – 57 ) and increased coronavirus disease (COVID-19) mortality among African Americans ( 58 ), and police violence against Black individuals ( 59 ).

The Ad Hoc Advisory Panel that investigated the PHS study in 1972 was constrained by the narrowness of the charges HEW gave them ( 36 ). The nine-member panel included five Black and four White members, with Broadus Butler, Ph.D. (1920–1996), president of historically Black Dillard University and a former World War II Tuskegee Airman, as chairman ( 5 ). Several panel members subsequently claimed that Dr. Butler engaged in a government whitewash ( 60 ). Members traveled to Tuskegee and conducted taped interviews with study staff members and participants ( 5 ). On their return, the tape was burned at Dr. Butler’s insistence ( 5 , 60 ). A cover letter to HEW on the front page of the final report of April 28, 1973, contains the statement, “The Chairman specifically abstains from concurrence in this final report” ( 36 ). In a private letter, Dr. Butler wrote that the panel had become “advocates,” and had “lost their objectivity” ( 5 ). Dr. Butler died without leaving papers to shed light on his actions ( 5 ).

Many commentators focus on the failure of PHS researchers to administer penicillin once it became standard therapy. That argument betrays a basic misunderstanding of the purposes of the experiment, as it assumes that satisfactory therapy for syphilis did not exist before 1945 ( 16 ). By the 1920s, leading experts had become convinced that Salvarsan-based therapy was effective in decreasing morbidity and mortality ( 15 ). The administration of any effective medication, not just penicillin, to the men would have violated the rationale of the experiment, which was to study the natural course of untreated syphilis until death and autopsy.

Another common criticism, failure to obtain informed consent, also obscures the historical facts of the experiment. That informed consent, as we know it today, was not a component of a research protocol in the 1930s does not diminish PHS researchers’ obligations. In 1907 William Osler wrote on “the limits of justifiable experimentation upon our fellow creatures,” emphasizing, “For man absolute safety and full consent are the conditions which make such tests allowable” ( 61 ). A more fundamental point is that the Tuskegee men never saw themselves as volunteers in a scientific experiment. They were told and they believed that they were getting free treatment from expert government doctors for a serious disease.

While accumulating material for her book Examining Tuskegee (2009) ( 5 ), historian Susan Reverby traveled to the University of Pittsburgh in 2003 to investigate the stored records of Dr. Thomas Parran. Library staff members informed her that Dr. John Cutler (1915–2003) had donated his research records to the university in 1990 ( 62 , 63 ). On opening the files, Reverby found almost nothing about the Alabama study but copious records of PHS studies conducted between 1946 and 1948 wherein American physicians deliberately infected hundreds of Guatemalans with syphilis and gonorrhea without their knowledge or consent.

In 2010, Reverby submitted a manuscript to the Journal of Policy History ( 64 ), sending a preprint to a former director of the CDC. The information made its way through layers of government to reach the White House. President Obama appointed a commission to investigate the matter, and the results were published in two reports in late 2011 ( 65 , 66 ).

The ideas that led to the Guatemalan research originated during the second World War. The effect of sexually transmitted disease on military manpower is always a concern in wartime ( 67 ), and the United States was experiencing more than half a million new cases of syphilis each year ( 68 ). To develop better prophylaxis regimens, PHS investigators drew up plans for an experimental model wherein infection would be induced in healthy subjects. The principal investigator, Dr. Mahoney, began experiments in September 1943.

John Mahoney (1889–1957) graduated from medical school in 1914 and after clinical training joined the PHS and was appointed director of the Venereal Diseases Research Laboratory (progenitor of the CDC) of the U.S. Marine Hospital on Staten Island, New York, in 1929 ( 67 ) ( Figure 7 ). The 54-year-old physician-scientist supervised the experiments on federal prisoners, while 28-year-old John Cutler, M.D., assisted by other PHS researchers, conducted on-site work in Terre Haute, Indiana. Dr. Cutler was born in Cleveland in 1915 and graduated from Western Reserve University Medical School in 1941, joining the PHS 1 year later ( 65 , 69 ) ( Figure 8 ). A total of 241 prisoners participated in the experiments, all of whom were inoculated with Neisseria gonorrhoeae deposited into the end of the penis. Investigators failed to consistently produce infection, and the experiments ended in July 1944 ( 70 ).

John F. Mahoney, M.D. (1889–1957), director of the Venereal Diseases Research Laboratory (progenitor of the CDC) of the U.S. Marine Hospital on Staten Island, New York. Reproduced from the National Library of Medicine (in public domain).

John C. Cutler, M.D., in 1942, the year the 27-year-old physician joined the PHS. Reproduced from the National Library of Medicine (in public domain). PHS = Public Health Service.

In 1945, Guatemalan physician Dr. Juan Funes spent a 1-year fellowship in the Venereal Diseases Research Laboratory ( 71 ). He informed his supervisors that prostitution was legal in Guatemala and that it was also legal for prostitutes to visit men in penal institutions ( 64 ). To PHS investigators, Guatemala presented an opportunity to transmute the Terre Haute disappointment into a success ( 65 ).

Funding was sought from the NIH, and in March 1946, the first ever study section approved the proposal for “the Guatemalan study dealing with the experimental transmission of syphilis to human volunteers and improved methods of prophylaxis” ( 72 ), providing $146,000 in funding (equivalent to $2.1 million today) ( 73 ). Study section members included physician-scientists from Harvard, Johns Hopkins, the University of Pennsylvania, and other institutions. In August 1946, Dr. Cutler arrived in Guatemala to conduct the experiments, assisted by other PHS physicians and staff members ( 65 ).

The original plan was to induce syphilis in prisoners in Penitenciaría Central through sexual intercourse with infected prostitutes and then test the efficacy of prophylactic regimens. When the American physicians encountered unexpected difficulties, they began to conduct studies on Guatemalan soldiers, inmates in the country’s only mental hospital, and children in the national orphanage ( 64 ) ( Figures 9 and ​ and10). 10 ). Because the rate of infection resulting from intercourse with prostitutes was lower than expected (<10%) ( 10 ), the NIH-sponsored researchers attempted to artificially inoculate subjects with syphilis, gonorrhea, and chancroid.

Left: A 25-year-old female patient in Asilo de Alienados (Psychiatric Hospital) in Guatemala was exposed to syphilis once with no record of treatment. Right: A 16-year-old female patient in Asilo de Alienados was exposed to syphilis twice and was treated with penicillin. Records indicate that the patient was “uncooperative.” Reproduced from the National Archives and Records Administration (in public domain).

The injection site of a female psychiatric patient who was exposed to syphilis three times and received some treatment. Reproduced from the National Archives and Records Administration (in public domain).

The investigators’ notebooks contain graphic accounts of steps in these experiments. A physician held the penis of a participant, pulled back the foreskin, and “with some force, rolled the large inoculating swab over the mucosa so as to try to contaminate the entire fossa navicularis” ( 65 ). If enrolled prostitutes were uninfected, investigators inoculated women by moistening a cotton-tipped swab with gonorrheal pus, inserting it into the woman’s cervix, and “swabb[ing] it around . . . with considerable vigor” ( 65 ).

Only five infections resulted when 93 soldiers engaged in 138 episodes of sexual intercourse with 12 prostitutes ( 65 ). A higher rate of transmission, 17.9%, was achieved by inserting an infected pledget under the foreskin ( 65 ). To achieve a still higher rate of infection, the PHS physicians used a hypodermic needle to abrade the dorsal surface of a subject’s glans “short of drawing blood” and then covered the abraded area with a pledget soaked in Treponema pallidum , achieving a 91.6% rate of transmission ( 65 ). Many participants actively objected. One psychiatric patient “fled the room” after being subjected to penile scarification and was not found for several hours ( 65 ).

The American physicians also studied other modes of transmission, including oral ingestion of syphilitic material and inoculating the rectum, urethra, and eyes of participants ( 65 ). One psychiatric patient, Berta, had syphilis injected into her arm in February 1948. She developed bumps and skin wasting, and 6 months later Dr. Cutler wrote that Berta appeared as if she was going to die. The same day, August 23, he put gonorrheal pus from a male participant into Berta’s eyes, urethra, and rectum. Her eyes filled up with pus, and four days later Berta died ( 65 ).

By December 1948, the NIH-sponsored investigators had intentionally exposed at least 1,308 individuals to syphilis, gonorrhea, and chancroid ( 65 , 74 ). Of those infected, 61–87% showed evidence of disease, and the majority were not provided adequate treatment ( 75 ). Eighty-three deaths were reported ( 76 ). The rate of induced infection was unexpectedly low except for experiments involving scarification of participants’ membranes, which Dr. Mahoney considered “beyond the range of natural transmission and [would] not serve as a basis for the study of a locally applied prophylactic agent” ( 65 ). Among other considerations, this was a major reason for stopping the experiments.

The Guatemala studies were halted abruptly in December 1948, and none of the experimental findings were published. One motivation for terminating the research was Dr. Parran’s imminent departure from the surgeon general’s office on April 6, 1948. As that date drew near, Dr. Mahoney wrote to Dr. Cutler, “We have lost a very good friend and that it appears to be advisable to get our ducks in line. In this regard we feel that the Guatemala project should be brought to the innocuous stage as rapidly as possible” ( 63 ).

Many journalists portray Dr. Cutler as a Dr. Mengele–type scientist acting autonomously. This characterization is wrong. Although Dr. Cutler was the main on-site investigator, the primary supervisor of the Guatemalan experiments, Dr. Mahoney, was kept fully apprised. A few months after the research commenced, Dr. Mahoney wrote encouragingly to Dr. Cutler, “Your show is already attracting rather wide and favorable attention up here. We are frequently asked as to the progress of your work” ( 65 ). Dr. Coatney, a PHS investigator, wrote to Dr. Cutler about a conversation he had with the surgeon general: “As you well know, he is very much interested in the project and a merry twinkle came into his [Dr. Parran’s] eye when he said, ‘You know, we couldn’t do such an experiment in this country’” ( 65 ).

In June 1943, while submitting plans for the Terre Haute experiments, Dr. Mahoney began experiments into the efficacy of penicillin on syphilis ( 67 ). The antibiotic caused rapid and complete disappearance of spirochetal activity in infected men ( 77 ). Dr. Mahoney presented the unexpected findings at a meeting of the American Public Health Association in October 1943. The presentation had an electrifying effect on the audience, with one attendee claiming, “This is probably the most significant paper ever presented in the medical field” ( 67 ). Penicillin revolutionized the management of sexually transmitted disease. In 1940, the death rate for syphilis was 10.7 per 100,000; in 1950 it fell to 5 per 100,000, and in 1970 it reached 0.2 per 100,000 ( 14 ).

As the Guatemalan research was commencing in 1946, Dr. Mahoney was awarded the Lasker Award for his “distinguished service as a pioneer in the treatment of syphilis with penicillin.” Other awardees that year included Karl Landsteiner (1868–1943), discoverer of blood groups and Rhesus factor ( 78 ), and Ferdinand Cori (1896–1984), discoverer of the mechanism whereby glycogen is metabolized and resynthesized ( 78 ). The Lasker Award is known as the American Nobel Prize because many awardees receive both, as did Landsteiner and Cori. Accordingly, it is not an exaggeration to say that Dr. Mahoney was the preeminent American physician-scientist in 1946. As Dr. Mahoney received the award, the presenter proclaimed, “Your name will be joined in history with that of Paul Ehrlich” ( 79 ).

In pursuit of a praiseworthy goal (eradication of sexually transmitted disease), the PHS investigators rationalized to themselves that it was morally acceptable to infect people with the same fearsome disease. In all of the studies—Guatemala, Indiana, and Alabama—vulnerable people were used as a means to further the scientific ends and careers of physicians they trusted.

In their analysis of PHS research in Central America, the Presidential Commission for the Study of Bioethical Issues devoted considerable space to how stringent rules can prevent scientific misconduct. Yet, according to the commission, PHS investigators recognized the existence of such rules—clear evidence that rules provide no substitute for individual conscience. None of the PHS investigators volunteered to serve as subjects in their own experiments. The commission considered self-experimentation “as quaint and irrelevant” ( 65 ). As a physician-scientist who has conducted numerous physiological experiments on himself, I believe self-experimentation may prove a stronger deterrent than sets of rules.

The commission assumed—incorrectly—that Dr. Cutler wished to hide the results of the Guatemalan research. Researchers commonly fail to write up the results of experiments that do not produce clear answers. PHS researchers published several papers on the basis of serological studies conducted in Guatemala ( 80 – 83 ) and published other studies on the basis of induction of infection through inoculation ( 65 , 84 ). If Dr. Cutler had wished to be secretive, he would have destroyed the records rather than donate them to University of Pittsburgh 40 years after completing the work. In donating his files, he may have hoped that future scientists would build on his observations.

A striking feature of the Guatemalan research is that it did not arise through any fault in the chain of command ( 65 ). The principal investigator was the most eminent physician-scientist in the United States. The research plan was approved by an NIH study section, which included physician-investigators from the country’s leading medical schools. The surgeon general was enthusiastic about the studies and was kept informed of their progress.

Lessons from the PHS experiments are manifold. The Alabama investigation was conducted in an open society, it extended over 40 years, and it resulted in numerous publications in reputable journals read all over the world. The experiment is a story that needs to stay forever on the moral horizons of medical scientists, yet many young investigators know little of its details or lessons ( 85 ).

For the final 25 years of the Alabama experiment, the message of the Nuremberg Code had been widely disseminated. Investigators looked on it as “a good code for barbarians” ( 86 ), and it had little impact in the United States ( 87 , 88 ). Bioethicist Arthur Caplan avers that the PHS study is “the single most important event in the rise of bioethics” ( 8 ). Reforms arising from the Kennedy congressional hearings led to fundamental changes in the infrastructure of research ethics. Yet it is doubtful that these provisions benefited significantly the segments of society affected by the study: impoverished Black persons.

Some argue that revolutionary changes in research ethics obviate claims by HEW advisory panel members of a government whitewash ( 5 , 60 , 89 ). History is the story of roads taken, and counterfactual history contemplates what might have happened had a different road been ventured. The dominant factor that undergirded the PHS study was racism ( 90 ), which was played down to near invisibility in the HEW final report ( 5 ). Had society confronted the flagrant evidence of structural racism in 1972 and instituted fundamental reform of social contributors to health, the stark racial disparities of health outcomes exposed by the klieg light of COVID-19 could have been prevented ( 58 , 91 ); likewise, root reform of law enforcement in 1972 could have prevented the many deaths of Black persons consequent to unlawful police actions ( 59 ).

As with many instances of scientific misconduct, senior scientists were fully aware of the nature and magnitude of the PHS irregularities and took no action. Yet when the information was communicated in the lay press, the problem was immediately obvious to the general public. How can it be that problems reported on the front page of the New York Times become clear in retrospect, yet, in the preceding years, extremely accomplished physician-scientists saw no problem? Lack of imagination, rationalization, and institutional constraints are formidable obstacles in such situations.

In Humanity: a Moral History of the Twentieth Century , philosopher Jonathan Glover ( 92 ) analyzes several genocides, bringing together ethics and history, and concludes that only moral imagination (the ability to imagine ourselves in the shoes of endangered individuals) can enable us to alter our outlook and take steps to remedy a threatening situation. Many factors deaden moral imagination—groupthink, tribalism, obedience—and prevent us from taking action. Cultivation of moral imagination, Glover contends, holds the best hope of battling against comforting conventional attitudes and official policy, making vivid the destiny of dehumanized individuals, and becoming determined to take action. A succession of physicians worked on the Tuskegee project. If the consciences of new recruits were troubled on being first exposed to the study design, they acted as if they did not notice the peril of the enrollees, looking away and keeping silent. The consciences of these physicians were protected by moral inertia—finding it easier to fall in with the momentum of established routine and policy ( 92 ).

When officials are confronted with major sociopolitical problems, they spin themselves. They convince themselves that raising the concern will be futile and may even backfire with worse consequences. The CDC used this argument when trying to persuade Peter Buxtun that the PHS study should not be stopped. The blue-ribbon panel argued that penicillin would be dangerous ( 28 ). When the men were eventually treated with penicillin, not a single complication was observed ( 1 ).

When morals collide with actions, a common response is to blame the victim—Dr. Kampmeier blamed study participants for failing to request penicillin for aortitis ( 33 ). The prefix attached to the study by PHS investigators is a variant of the blame-the-victim tactic. Tuskegee University, founded by former slave Booker T. Washington in 1881, should be celebrated as a milestone in African American history. Instead, each time the Tuskegee study is mentioned, the university and townspeople are touched by a legacy of shame. Rather than besmirching the victims and their descendants, it would be more accurate to label the experiment after the perpetrators: the Public Health Service Study of Partially Treated Syphilis ( 93 ).

None of the study scientists wrote articles reflecting on its moral lessons. “No apologies were tendered. No one admitted any wrongdoing,” inveighs James Jones ( 1 ). In 1993, Dr. Cutler appeared on the PBS Nova documentary “Deadly Deception” ( 94 ). When asked about the Tuskegee men, he declaimed, “It was important that they were supposedly untreated, and it would be undesirable to go ahead and use large amounts of penicillin to treat the disease, because you’d interfere with the study.” He remonstrated, “I was bitterly opposed to killing off the Study for obvious reasons” ( 95 ). Regarding the enrollees, he attested, “They served their race very well.”

Dr. Parran served as surgeon general (1936–1948) during the time that penicillin was advocated to treat every American with syphilis—except men in Macon County. He did more than any other person to control sexually transmitted infections ( 68 , 96 , 97 ). He was founding dean of the University of Pittsburgh Graduate School of Public Health (1948–1958), and the school’s main building was named Parran Hall in 1969. In 1972, the American Sexually Transmitted Diseases Association named its highest award in his honor ( 98 ). The Pittsburgh school introduced the John C. Cutler Memorial Lecture in Global Health in 2003 to honor another former faculty member. A new dean canceled the lecture series in 2008 because of community sensitivities regarding Dr. Cutler’s role in the Tuskegee research ( 69 ). In 2013, American Sexually Transmitted Diseases Association members voted to remove Dr. Parran’s name from its annual award ( 76 ); in 2018, his name was stripped from the Pittsburgh Graduate School of Public Health building ( 99 ).

There is a common perception that moral judgment is linked to education. Yet the person who stopped the PHS study, Peter Buxtun, had no training in research; he was a social worker and had far less conventional education than the future director of the National Cancer Institute who led the study for years and many surgeons general who had intimate knowledge of it. With characteristic concision, Thomas Jefferson captured the distinction in a letter to his nephew: “An honest heart being the first blessing, a knowing head is the second” ( 100 ). Intelligence and education are not enough in human affairs: character and conscience come first. It is tempting to compartmentalize the lessons of the PHS study into those that apply to our actions as researchers and those that apply to our behavior as lay citizens. That would be a mistake because the two blend into each other.

When we look back at the Alabama and Guatemala stories, we fall into the trap of placing ourselves on the side of the angels, of grouping ourselves with the Buxtuns of this world. Hindsight is comforting, but it is also misleading ( 101 ). Coping with challenges as they unfold in real time is very different. Only one Peter Buxtun stood up over 40 years. It is more likely that most researchers would have followed in the footprints of Drs. Vonderlehr, Wenger, and Heller and the many other investigators involved.

There is a natural tendency to believe that group effort and cooperation are more effective than the actions of an individual. Correction of the great ills of society has always started in the heart of one individual and thereafter spread to a small group who recognized the same injustice. An especially astute commentator on social affairs, Adam Smith, wrote in 1763, “Slavery has hardly any possibility of it being abolished. . . . [It] has been universall [ sic ] in the beginnings of society, and the love of dominion and authority over others will probably make it perpetual” ( 102 ). A few years later, a 25-year-old deacon, Thomas Clarkson (1760–1846), started a movement that forced British Parliament to pass an act in 1807 abolishing the slave trade ( 102 ).

Individuals such as Buxtun and Clarkson who set out to make a difference are usually branded as irrational, soft, or naive. In official and administrative circles, where discussion is performed in the cold language of interests, people who urge intervention on the basis of moral arguments are considered “emotional.”

The reason people fail to take steps to halt behavior that in retrospect everyone judges reprehensible is complex. Scholars have long pondered the question. One of the first to wonder what light the second World War shed on this question was Hannah Arendt (1906–1975). She deconstructed the psychological and moral implications of evil ( 103 ). In 1961, she attended the trial of war criminal Adolf Eichmann. Arendt published a controversial book, Eichmann in Jerusalem: A Report on the Banality of Evil (1963). The expression “banality of evil” gave rise to much criticism and misunderstanding. Some saw Arendt as exonerating Eichmann and blaming the victims. When writing early drafts, Arendt was inclined to describe the evil quality of totalitarianism as something utterly “radical” ( 104 ). One of her mentors, physician-philosopher Karl Jaspers (1883–1969), argued that such a characterization made Nazism seem somehow unique and thus, in an awful way, “great” ( 103 ). As Arendt reflected on the matter, she arrived at the conclusion that evil arises from a simple failure to think .

What struck Arendt when listening to Eichmann was his banality: “his penchant for ‘officialese,’ for stock phrases, for shallow elations, his ‘empty talk,’ his being ‘genuinely incapable of uttering a single sentence that was not a cliché’” ( 104 ). She continued, “The longer one listened to him, the more obvious it became that his inability to speak was closely connected with an inability to think , namely to think from the standpoint of somebody else” ( 104 ). As Arendt inferred, “The trouble with Eichmann was precisely that so many were like him, and that the many were neither perverted nor sadistic, that they were, and still are, terribly and terrifyingly normal . . . this normality was much more terrifying than all the atrocities put together” ( 104 ). In this sense, the evil of the PHS experiments is banal and not radical. Banality does not trivialize evil: it is precisely what makes the behavior so dangerous ( 105 ).

Allied to a lack of thinking is a lack of reflection, an examination of conscience—the courage to form a judgment. Peter Buxtun was not afraid to judge and be counted. Today, we are constantly cautioned against being judgmental—not to form a moral opinion about the actions of others ( 106 ). Ahead of her time, Arendt saw the dangers of ethical relativism. Writing to Jaspers in 1963, she reflected that “even good and, at bottom, worthy people have, in our time, the most extraordinary fear about making judgments. This confusion about judgment can go hand in hand with fine and strong intelligence, just as good judgment can be found in those not remarkable for their intelligence” ( 103 ). For Buxtun, exercising judgment was a matter of moral courage.

When faced with serious injustice in their midst, the real reason people fail to intervene is a lack of willpower. Consider the Rwandan genocide—the most efficient killing spree of the 20th century ( 107 ). Across 100 days (April 6 to July 18, 1994), 800,000 Tutsi and politically moderate Hutu were murdered—the equivalent of more than two World Trade Center attacks every day for 100 days. In contrast to the broad support for the United States after September 11, every country turned away when the Tutsi cried out. During the 3 months of the genocide, the U.S. president never once assembled his top policy advisers to discuss the killings ( 108 ). After being personally lobbied by Human Rights Watch, Anthony Lake (born 1939), the president’s national security adviser, issued a statement calling on Rwandan military leaders to “do everything in their power to end the violence immediately.”

When Lake was informed 6 years after the genocide that this statement constituted the sum total of official public attempts to shame the Rwandan government, he was stunned: “You’re kidding,” he replied. “That’s truly pathetic” ( 108 ). Here is a leader who had acquired a reputation as a person of conscience, who was in a position of enormous power, and yet he failed to act; indeed, he appeared to be unaware that he had not acted. So it is not only medical researchers who fail to act on concerns that seem repellant in retrospect. In all walks of life, people who have reputations for good conscience, who are trained at the highest level, who possess all the facts and know the harmful consequences, and who have the power to act, still fail to act. Instead, they find sound logical reasons to dismiss all the information and decide not to intervene as events unfold in real time.

We must be careful not to use the Alabama and Guatemala research as an opportunity for letting off moralistic steam. Denouncing an injustice, observes Tzvetan Todorov, “constitutes a moral act only at those times when such denunciation is not simply a matter of course and thus involves some personal risk. There is nothing moral in speaking out against slavery today” ( 105 ). One can legitimately make moral demands only on oneself. To imagine oneself floating above the fields of Macon County and Guatemala City and wagging an indignant finger at the shades of Dr. Vonderlehr and Dr. Cutler constitutes “moralism.” People who hold themselves up as examples to others are in fact acting immorally, irrespective of how commendable their conduct may otherwise be ( 105 ). Hannah Arendt again: “Goodness can exist only when it is not perceived, not even by its author; whoever sees himself performing a good work is no longer good, but at best a useful member of society” ( 104 ).

Reflection on the PHS experiments highlights that out of the crooked timber of humanity, nothing entirely straight can be fashioned. Everything we know about the PHS researchers informs us that they were perceived as being decent people who did much good in other parts of their professional lives. Given the actions of Drs. Parran, Mahoney, and Cutler and other esteemed researchers, we need to approach today’s ethical challenges with “fear and trembling” (Kierkegaard’s phrase)—and remember to pause and think, reflect and examine our conscience, and have the courage to speak and, above all, the willpower to act.

Acknowledgment

The author thanks Sidney Wolfe, M.D., and Charles Natanson, M.D., for comments on an earlier version of the manuscript.

Supported by National Institute of Nursing Research grant R01-NR016055 and Veterans Administration Research Merit Review Award 1 I01 RX002803-01A1.

This article has an online supplement, which is accessible from this issue’s table of contents at www.atsjournals.org .

Originally Published in Press as DOI: 10.1164/rccm.202201-0136SO on May 2, 2022

Author disclosures are available with the text of this article at www.atsjournals.org .

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The legacy of the Tuskegee study

By Austin Frakt

In the United States, African American men have  the worst health outcomes  of any major demographic group. At age 45,  their life expectancy  is more than three years less than that of non-Hispanic Caucasian men and more than five years less than African American women. According to  a 2017 study published  in The Quarterly Journal of Economics, one-third and one-quarter, respectively, of these life expectancy gaps may be attributed to a single event in 1972 — the disclosure of the Tuskegee study.

From 1932 to 1972, the U.S. Public Health Service studied 600 hundred low-income, African American men in Tuskegee, Alabama. The study’s purported purpose was to better understand the natural course of syphilis, which two-thirds of the men had.

Deceived about the nature of the study, the syphilitic men were provided sham treatments and were discouraged from seeking additional medical care. Physicians leading the study even contacted other doctors in the area urging them not to treat study participants. For their participation, the men received hot meals and their families were compensated for their burial costs.

Under any circumstances, this now infamous study is plainly unethical, unjust, and in violation of common sense and decency. That it wasn’t even scientifically useful — the natural history of syphilis was already largely understood —  betrayed the study’s racist motivation , as conveyed by Allan Brandt.

The doctors who devised and directed the Tuskegee Study accepted the mainstream assumptions regarding blacks and venereal disease. The premise that blacks, promiscuous and lustful, would not seek or continue treatment, shaped the study. […] In retrospect the Tuskegee Study revealed more about the pathology of racism than it did about the pathology of syphilis.

The Associated Press broke the story of the study in 1972 and it was halted. But its damage did not end with the participating men and their families. Public health researchers have cited it as a source of distrust among African Americans of the medical establishment, challenging efforts to  slow the spread of HIV , contain  tuberculosis outbreaks , and  broaden preventive care .

Marcella Aslan and Marianne Wanamaker  conducted a quantitative study of the effect of the Tuskegee Study. They found that black men at least 10 years old in 1972 and living closer to Macon County (where Tuskegee is located) are more likely to mistrust the medical system.

Perhaps as a consequence of this distrust, black men living closer to Tuskegee study participants are less likely to receive medical care and die at younger ages. Aslan and Wanamaker estimated that the

decrease in the life expectancy of black men attributable to the Tuskegee revelation represents 35% of the racial gap in male life expectancy in 1980 and 25% of the gender gap in black life expectancy.

These are large effects. And these are from just one chapter in a long history of racial discrimination and race-based beliefs in medical care (and elsewhere) that  continue to this day .

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Historical Origins of the Tuskegee Experiment: The Dilemma of Public Health in the United States

• PMID: 29311536
• PMCID: PMC10565021
• DOI: 10.13081/kjmh.2017.26.545

The Tuskegee Study of Untreated Syphilis in the Negro Male was an observational study on African-American males in Tuskegee, Alabama between 1932 and 1972. The U. S. Public Health Service ran this study on more than 300 people without notifying the participants about their disease nor treating them even after the introduction of penicillin. The study included recording the progress of disease and performing an autopsy on the deaths. This paper explores historical backgrounds enabled this infamous study, and discusses three driving forces behind the Tuskegee Study. First, it is important to understand that the Public Health Service was established in the U. S. Surgeon General's office and was operated as a military organization. Amidst the development of an imperial agenda of the U.S. in the late 19th and early 20th centuries, the PHS was responsible for protecting hygiene and the superiority of "the American race" against infectious foreign elements from the borders. The U.S. Army's experience of medical experiments in colonies and abroad was imported back to the country and formed a crucial part of the attitude and philosophy on public health. Secondly, the growing influence of eugenics and racial pathology at the time reinforced discriminative views on minorities. Progressivism was realized in the form of domestic reform and imperial pursuit at the same time. Major medical journals argued that blacks were inclined to have certain defects, especially sexually transmitted diseases like syphilis, because of their prodigal behavior and lack of hygiene. This kind of racial ideas were shared by the PHS officials who were in charge of the Tuskegee Study. Lastly, the PHS officials believed in continuing the experiment regardless of various social changes. They considered that black participants were not only poor but also ignorant of and even unwilling to undergo the treatment. When the exposure of the experiment led to the Senate investigation in 1973, the participating doctors of the PHS maintained that their study offered valuable contribution to the medical research. This paper argues that the combination of the efficiency of military medicine, progressive and imperial racial ideology, and discrimination on African-Americans resulted in the Tuskegee Syphilis Experiment.

Keywords: Bad Blood; Eugenics; Progressive Empire; Racial Pathology; the Public Health Service; the U.S. Surgeon General; Tuskegee Syphilis Experiment.

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• An Editorial: Sickle Cell Anemia, A Race Specific Disease. Journal of the American Medical Association. 1947;133-1:33–34.
• Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel. (Public Health Service, U. S. Department of Health, Education, and Welfare, 1973).
• William Bennet, William P. Dillingham. Abstracts of Reports of the Immigration Commission. Washington DC: Government Printing Office; 1911.
• Ernst Philip Boas. The Relative Prevalence of Syphilis Among Negroes and Whites. Journal of Social Hygiene. 1915 September;1-4:610–616.
• Taliaferr Clark. The Control of Syphilis in Southern Rural Areas. Chicago: Julius Rosenwald Fund; 1932.

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March 31, 2021

We Learned the Wrong Lessons from the Tuskegee ‘Experiment’

It’s understandable that Black Americans are wary of vaccines, but that despicable episode involved the withholding of treatment, whereas vaccines actively prevent disease

By Melba Newsome

COVID-19 disproportionately impacts people of color—making those communities in greater need of the vaccine.

FG Trade Getty Images ( for illustrative purposes only )

Editor’s Note (12/21/21): This article is being showcased in a special collection about equity in health care that was made possible by the support of Takeda Pharmaceuticals . The article was published independently and without sponsorship.

Rarely a day goes by without national news stories about vaccine hesitancy: how many people say they definitely will or won’t get a shot and how many are in the “maybe” box. No account is complete without a particular focus on Black people who—despite contracting, being made severely ill by and dying from coronavirus at elevated rates—express a high degree of reluctance to being injected with something developed to save their lives.

When asked to explain why so many Black people simply don’t trust the federal government with their health, a common answer is “because of what happened at Tuskegee.” Reference to that seminal event has become shorthand for past medical betrayal, abuse and exploitation at the highest levels.

Beginning in 1932, the U.S. Public Health Service dangled the promise of free medical care to recruit rural Black men in Alabama’s Macon County to participate in the “Tuskegee Study of Untreated Syphilis in the Negro Male.” Even after penicillin became widely available as an effective treatment 15 years later, the researchers withheld the drug and watched as the men died or were ravaged by the effects of untreated syphilis.

Based on my reporting and personal conversations with friends and family, it’s clear many people don’t know what happened at Tuskegee. They mistakenly believe the 600 Black men were injected with something bad (syphilis) that made them sick when, in reality, the 399 men who had the disease were denied something good (a dose of penicillin) that would have healed them.

Even many who have the details right learned the wrong lesson from that shameful episode in American medical history. Instead of rejecting vaccines and new therapeutics that are routinely used to successfully treat and cure a majority of the population, Tuskegee should have taught Black people to make a simple demand: give me whatever you’re giving the white folk.

If that had happened 70 years ago, Tuskegee, Ala., might be better known for the historically Black university that bears its name than for a government injustice chronicled in books, movies, plays and congressional hearings.

My home state of North Carolina was one of the first to release coronavirus data by race. The numbers from Charlotte and Mecklenburg County showed the virus’s disparate impact on people of color and were soon confirmed by the skyrocketing COVID-19 rates in other cities with high Black populations.

I saw early on how our well-justified mistrust of public health initiatives, a penchant for baseless conspiracy theories and a misreading of medical history would allow the crisis to take an outsize toll on the Black community.

That’s why months later I decided to participate in the vaccine trials. I wanted to ensure that Black people were adequately represented in the research and to show that the vaccine should be embraced, not shunned. My motives weren’t completely altruistic: clinical trial volunteers were supposed to be at or near the front of the line when a vaccine became available. That couldn’t happen soon enough for me.

While some people thanked me for doing my part for medical science, others were perplexed and even angry that I would become a human guinea pig for the very medical establishment that has used our bodies for experimentation without care or consent.

The data and recent studies show that, rather than being recruited as lab rats, people of color are too often cut out of cutting-edge research. Black people make up about 14 percent of the U.S. population but, on average, only 5 percent of clinical trial participants for disease treatment.

It’s almost taken as a given that our distrust is responsible for the low participation rates. But a study published in the journal Cancer found that some study recruiters viewed racial and ethnic minorities as less promising participants and in some cases reported withholding trial opportunities from them based on these perceptions.

That seemed to play out in the first phase I Moderna trial of 45 people; 40 were white, and two were Black. Pfizer and Moderna said diversity was a priority for their phase III trials to help ensure the vaccines’ safety and effectiveness across populations and possibly reduce vaccine hesitancy; however, underrepresentation of Black people and other groups remained a concern.

My own experience suggests that their recruitment efforts could be improved. Last summer I started applying to participate in the clinical vaccine trials whenever I saw a call for volunteers. It took four applications and more than three months before I was at last selected for the Johnson & Johnson trial in mid-November.

Racism and discrimination in the health-care system show up in the form of neglect, indifference and dismissal. The COVID death toll was higher among Black and brown people because too many had their symptoms dismissed, were turned away from hospitals rather than admitted or were forced to work in dangerous conditions because they were deemed essential.

Much of the fear of the vaccine is prefaced on the assumption that Black people would be expected to go first to make sure it was safe for everybody else. The low numbers of people being vaccinated in the communities hardest hit by COVID-19 show that just the opposite has happened.

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The Coronavirus Crisis

In tuskegee, painful history shadows efforts to vaccinate african americans.

Debbie Elliott

A participant in the Tuskegee Study in the 1930s. A lingering mistrust of the medical system among many Black people is rooted in the infamous study. National Archives hide caption

A participant in the Tuskegee Study in the 1930s. A lingering mistrust of the medical system among many Black people is rooted in the infamous study.

A lingering mistrust of the medical system makes some Black Americans more hesitant to sign up for COVID-19 vaccines. It has played out in early data that show a stark disparity in whom is getting shots in this country — more than 60% going to white people, and less than 6% to African Americans. The mistrust is rooted in history, including the infamous U.S. study of syphilis that left Black men in Tuskegee, Ala., to suffer from the disease.

In Tuskegee today, that 20 th century tragedy is still very relevant, according to nurse Cheryl Owens, who grew up in the town. She's been talking with friends and elderly relatives who say they're afraid to get the COVID-19 vaccine.

"So, I asked why?" she says. "And it was like, 'Well, you remember that Tuskegee syphilis study. That's why.' "

Officially named the Study of Untreated Syphilis in the Negro Male , the U.S. Public Health Service, working with the Tuskegee Institute, recruited hundreds of rural Black men in 1932. The study offered free meals and checkups, but never explained that participants would be human subjects in a study designed to withhold medical treatment.

"They had local leaders, church leaders, medical people to convince them to become involved with the study," says Owens, a nurse at the Central Alabama Veterans Health Care System.

Tuskegee, now a city of about 8,000 people , has a storied African American history as home to the Tuskegee Airmen. Booker T. Washington and George Washington Carver were educators here.

But the syphilis study also looms large in Tuskegee's collective memory. Owens, who is 59, says she remembers hearing about it in elementary school, so she understands why people in this nearly all-Black community are skeptical when the government says to take a shot.

"They felt that the government really wanted to inject something in their bodies and they were going to eventually die from that," Owens explains.

To help dispel that notion, Owens penned an op-ed , published in the local newspaper The Tuskegee News, including a photo of her getting a shot of the COVID-19 vaccine.

Coronavirus Updates

Black people are more hesitant about a vaccine. a leading nurse wants to change that.

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The black doctors working to make coronavirus testing more equitable.

Beverly Terry shortly after receiving her COVID-19 vaccination. Her husband, Douglas Terry, who is a Vietnam veteran, also was vaccinated and plans on encouraging others to get their vaccine. Debbie Elliott/NPR hide caption

Beverly Terry shortly after receiving her COVID-19 vaccination. Her husband, Douglas Terry, who is a Vietnam veteran, also was vaccinated and plans on encouraging others to get their vaccine.

Ramping up vaccine rollout

Heath officials are up against a powerful sentiment as they try to ramp up vaccinations.

"I think a part of the challenge is that there's still a lot of anxiety about the vaccine," says Amir Farooqi, director of the Central Alabama VA. "It's unfortunate because it's a really great tool to help people protect their personal health as well as the public health."

The VA's Tuskegee campus has repurposed a large auditorium into a vaccine clinic, to allow for social distancing. Shots are given at one of four stations, partitioned off with privacy curtains.

Vietnam veteran Douglas Terry, 78, is relieved to be in the queue.

"With this there is hope," he says.

Terry doesn't even feel the stick when nurse Pamela Bell gives him his first jab.

"That's what we want to hear," she says, warning him that his arm might be a little sore for a while.

Terry says he intends to spread the word that he and his wife got the shot.

"To give them courage to do it also," he says.

That's what VA officials want to hear. They've set up a selfie station at the clinic and hand out stickers that proclaim, "I got vaccinated at the Central Alabama Veterans HCS to protect our Veterans and Community."

Lucenia Williams Dunn is a former mayor of Tuskegee and now runs a local community development organization. She still questions the rapid development of the vaccine and is not convinced to get it. Debbie Elliott/NPR hide caption

Lucenia Williams Dunn is a former mayor of Tuskegee and now runs a local community development organization. She still questions the rapid development of the vaccine and is not convinced to get it.

'Word of mouth will be key'

The VA's infectious disease physician, Dr. April Truett, says that kind of word of mouth will be key to overcoming reservations about the shot.

"The more people hear about the vaccine, the more they know someone else who's received the vaccine, the more they see how well they did, the more comfortable they become with the vaccine," she says.

In the broader community, elected officials in Tuskegee have also posted videos getting shots, and some residents say they've gotten letters from the presidents of historically Black universities encouraging inoculation.

"It's the biggest PR project to get Black people to take that vaccine," says Lucenia Williams Dunn, a former mayor of Tuskegee who now runs a local community development organization. She's 77 years old and has high blood pressure, but she's not convinced to get the vaccine.

Even though she's been watching the pandemic's devastating and disproportionate impact on African Americans, she still questions the rapid development of the vaccine. And then, there's the history.

"You cannot separate the experience of the past with what we believe in the present," Dunn says. "People say, 'well, you know, y'all ought not be worried about that syphilis study.' Yeah, we do, because it's part of our experience."

Mistrust And Lack Of Genetic Diversity Slow Gains In Precision Medicine

Troubling History In Medical Research Still Fresh For Black Americans

Cheryl Owens is a nurse at the Central Alabama Veterans Health Care System. Via Cheryl Owens hide caption

Descendants of men involved in Tuskegee study react

The vaccine rollout has sparked a conversation among descendants of the men involved in the syphilis study. Among them is Theilene Williams of Tuskegee. Her grandfather, Willie Fitzpatrick, died before knowing the truth about the study.

"We called him Papa," Williams says. "He was he was a good man, family man, a farmer."

Williams says there's a difference between what's happening now and what the government did to her grandfather and the other men.

"They didn't know what they were getting into," she says.

Williams, who is 72, says she was able to talk with her doctor about the vaccine.

"I went on and got it — the first shot," Williams says. "We know about it. We've been hearing, talking about it. It's not like 'come on, we're going to do this' without knowing anything about it like they did."

Her grandfather is among those now memorialized at the Tuskegee History Center on a large tile circle in the middle of the museum.

"Around here in alphabetical order, you have the names of all 623 men," says Tuskegee civil rights attorney Fred Gray, on a tour of an exhibit on the syphilis study.

Tuskegee civil rights attorney Fred Gray shows an exhibit on the syphilis study at the Tuskegee History Center. Gray represented the men when the truth about the study came out in 1972. He won a $10 million settlement for the men, and their families. Debbie Elliott/NPR hide caption

Tuskegee civil rights attorney Fred Gray shows an exhibit on the syphilis study at the Tuskegee History Center. Gray represented the men when the truth about the study came out in 1972. He won a $10 million settlement for the men, and their families.

Gray represented the men when the truth about the study came out in 1972. The men were not injected with syphilis, but those who already had it were left untreated, even once penicillin was available.

"Not only did they withhold treatment," Gray says. "But they sent these men's names to the various doctors in the area and told them if they came to their office, not to treat them for syphilis."

Gray won a $10 million settlement for the men and their families, and pressured Congress to prevent such unethical science.

"And the federal government passed laws which would prohibit now anyone, the government or anyone else from having a study like they did," he says.

Issue with people using syphilis study to refuse vaccine

Later, he got then-President Bill Clinton to apologize to the men and their descendants.

"What the United States government did was shameful," Clinton said in 1997. "And I am sorry."

Gray, now 90 years old, has had his first dose of COVID-19 vaccine. He takes issue with people citing the syphilis study as a reason not to get vaccinated. He says individuals must make their own decisions whether or not take the vaccine.

"But they shouldn't put it is because of what the government did to the men in the Tuskegee syphilis study, because they are altogether different situations," Gray says.

Herman Shaw speaks as President Bill Clinton looks on during a White House event where Clinton apologized to the survivors and families of the victims of the Tuskegee Syphilis Study. Shaw was one of hundreds of Black men who were part of a government study that followed the progress of syphilis and were told that they were being treated, but were actually given only a placebo. Paul J. Richards/AFP via Getty Images hide caption

Herman Shaw speaks as President Bill Clinton looks on during a White House event where Clinton apologized to the survivors and families of the victims of the Tuskegee Syphilis Study. Shaw was one of hundreds of Black men who were part of a government study that followed the progress of syphilis and were told that they were being treated, but were actually given only a placebo.

A January poll from the Kaiser Family Foundation found that more than half of Black adults surveyed said they did not have immediate plans to get vaccinated. Forty-three percent said they were going to wait and see how it's working.

The mistrust of the health care system among African Americans is two-fold, says Rueben Warren, director of the National Center for Bioethics in Research and Health Care at Tuskegee University — established and funded by the federal government as a result of the syphilis study.

"It's both historical and current," he says. "And not either/or but both/and."

Warren says the "use and abuse of Black bodies" dates to slavery, and continued for hundreds of years. He cites the eugenics movement, for example.

Now, he says, the coronavirus pandemic and its disparate impact on people of color have exposed the shortcomings of the U.S. health care delivery system. For instance, there's no hospital serving the general public in Tuskegee, and coronavirus testing was hard to come by early on.

So it's not just historical but it's current," he says. "The combination of that makes folks pause."

Warren says seeing the mayor or a community leader get a shot isn't the kind of assurance that people need. He says that's neglecting to consider that some people might not have health insurance that could help then manage any future complications.

"What about next year?" he asks. "Next year, if something comes up and I don't have health insurance, I'm out in the cold."

He advocates providing health coverage to the uninsured who get the vaccine.

That, Warren says, is a way of assuring people that the health care system will deliver for them in the future, despite the history.

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The Crazy True Story Of The Tuskegee Syphilis Experiment

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

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

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

"Tuskegee Study of Untreated Syphilis in the Negro Male"

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

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

Goal of the Tuskegee syphilis experiment

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

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

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

"Black Belt"

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

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

Almost 40 percent of Tuskegee's Black population had syphilis

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

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

Tuskegee subjects were compensated with free food and medical exams

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

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

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

The Tuskegee syphilis experiment went on for 40 years

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

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

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

Informed Consent

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

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

Researchers withheld treatment from Tuskegee subjects

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

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

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

A whistleblower brought the Tuskegee syphilis experiment down

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

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

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

Public outcry

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

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

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

The Tuskegee Syphilis Study Legacy Committee

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

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

Lasting public health effects of the Tuskegee syphilis experiment

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

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

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

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Rethinking Teaching About the USPHS Untreated Syphilis Study at Tuskegee: A Revision that Centers Resistance

By Gretchen Kraig-Turner

In my classes I encourage students to revise their lab reports and essays, and like most teachers I also do minor tweaks of my lessons from year to year. But large-scale overhauls of my favorite lessons are more difficult and less common. A mixer I wrote (published in Rethinking Schools in 2016) on the United States Public Health Service (USPHS) Untreated Syphilis Study at Tuskegee (formerly known as the Tuskegee Syphilis Study) got such an overhaul for dual purposes — to teach virtually and to center resistance and agency over victimization. 

This study followed approximately 600 African American men from Macon County, Alabama, from the early 1930s until it finally ended 40 years later after an article came out exposing how these men were denied treatment — including penicillin, which was widely available since the mid-1940s. Of the men, 399 had an active syphilis infection, and by the late 1960s at least 28 but possibly up to 100 had died from syphilis. While the study was originally funded by a philanthropist from Chicago to look for treatment or a cure, the USPHS altered the design to be a “study of nature” and not an experiment.  Dr. J. E. Moore, a textbook author on STIs from the time, wrote that “syphilis in the negro is in many respects almost a different disease from syphilis in the white,” and Dr. O. C. Wenger, a doctor from Hot Springs, Arkansas, wrote that the USPHS study “will emphasize those differences.” Dr. Thomas Murrell, a key USPHS doctor in the study, spelled out a primary reason the study became what it was: “So the scourge sweeps among them. . . . Perhaps here, in conjunction with tuberculosis, will be the end of the negro problem. Disease will accomplish what man cannot do.” This study is a primary example of medical racism and is still under-taught in both science and social studies classrooms.  

In the original lessons, my students did a mixer, taking on the roles of people involved. They played the white doctors who engineered the study to withhold antibiotics from African American men suffering from syphilis. They played the men themselves, learning about the lack of medical care in rural and segregated Macon County, Alabama, and how the men eventually found out that this decades-long study did not involve any actual treatment for a curable disease. They played the role of Peter Buxtun, a whistleblower with the USPHS, and Jean Heller, a journalist who broke the story in the early 1970s. The students then wrote a testimony from the perspective of one of the roles to be delivered at the congressional hearings that followed Heller’s article. I taught this as an introduction to bioethics in a biotechnology class with juniors and seniors. When I wrote this lesson I taught at Jefferson High School, a school in Portland, Oregon, that at that time had a predominantly African American student population. I now teach in rural northwest Washington at a Title I high school where students of color make up approximately 55 percent of our population, with about 45 percent identifying as Latinx. 

When school and professional development went online in the spring of 2020, I taught this lesson to science teachers around the country who were looking for lessons that highlight social justice. I began to revise the lesson hoping to find a format that would work on Zoom — but the renewed discussion about Black resistance and agency in the wake of the 2020 Black Lives Matter protests also encouraged me to take another look at the lesson’s content. I wondered whether the previous version of the lesson focused too much on the men in the study as victims. I wanted to emphasize how the men in the study made efforts for justice that led to major changes in the way medical research is conducted, including the establishment of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research as part of the National Research Act. The lesson still needed to detail the pain these men suffered from being in this “study” unwittingly and the human rights violations perpetrated by the doctors but also allow students to see the complexity of people simultaneously being victims and fighters for change. 

After I reworked the lesson and taught it to various groups of teachers, I felt I needed to get more information from students about how the changes might affect them. Would they be able to see more perspectives? Would they get a broader view? And, most importantly, would this help to empower students to see more actions by the men in the study? I put out a call on my social media accounts the following winter for previous students willing to meet with me virtually to discuss what they remembered from the lessons. I designed the interviews to take about 20 minutes, and I compensated students for their time. I interviewed two students from the school where I currently teach and two at the school I taught at when I wrote this unit. Connecting with past students was informative and also a delightful excuse to catch up with amazing young people.

When asked “Did you get a sense from the lesson that the men in the study fought back and changed medical history? Or did that point need to be more clear and emphasized?” Daniel Ortiz-Rojo, who graduated high school in 2016 and at the time of the interview was working on a pharmacy degree, had a telling response: “I think [resistance] needs to be emphasized. I don’t remember us talking much about what the men did. . . . It sounds pretty important because it’s like you’re moving from someone who is only the victim to someone who has the agency to make change.” Another previous student, Sailor Rozema, who graduated in 2019, agreed. “The men were presented more as victims,” she said.

As I began to take a closer look at the mixer in response to student feedback, it became clear that especially for students playing someone who engineered this study or kept it going after penicillin was widely available, seeing resistance was often overshadowed by seeing the men in the study solely as victims. 

I also realized that even though I gave students the choice of which perspective to write their congressional testimony from after the mixer, most students kept with their mixer role. This meant that some students ended up spending a lot of time thinking about only one angle of the study. I also wanted to better emphasize the multifaceted roles many people played. In one of the student interviews, a former student, Anayla Warren-Premesigh, said she “felt uncomfortable and was really upset, personally upset” during the lesson. “When you are a part of that group, it reminds you of the ongoing mistreatment of Black people.” She remembered taking on the role of a white doctor and said “it was difficult to connect” to the role. Of course, the purpose of including white perpetrators was not to have students “connect” with them, but to better understand how people conducting the study justified their actions and in doing so, help students identify racist justifications still made today. Nevertheless, the way Anayla spoke about playing this role and writing the doctor’s testimony years later made it clear that for some students the key takeaway was not the full scope of what the men accomplished during the congressional hearings and the class action lawsuit their testimony inspired.

The Lesson Changes

The heart of the revision was to refocus the lesson on resistance and resilience of the targets of the study and the allies in the USPHS. The method of delivery changed from a mixer to a card sort. Card sorts are often used in science classrooms to categorize or classify organisms or other things. A very simple example of this would be giving students a set of cards with pictures of cells on them and having them sort the cards into “eukaryotes” or “prokaryotes.” Using a card sort for this lesson obviously takes much more care than sorting out cells. A cell either has a nucleus or it does not, but the people involved in this study could fit into more than one category or could start in one category and move into another as time progressed. We are categorizing the roles of people in this study, and so we are not really sorting people but rather a part of their story and how their actions in the study affected others. I used the same descriptions of people’s actions and roles in the study that I used for the mixer to make cards, adding pictures when I could find them and several new cards. 

The categories for this card sort are Perpetrator/Oppressor : Someone who harms or oppresses others; Target : Someone who is the focus of mistreatment; Bystander : Someone who sees the injustice but doesn’t speak out; and Upstander/Ally : Someone who took action on behalf of someone else. The inspiration for the categories came from an activity I saw used by an English teacher when doing character analysis of a novel. The categories could easily vary from lesson to lesson, and the categories can also be changed as our language evolves (for example, I used the word “target” instead of “victim”). This card sort also serves the purpose of students explicitly naming the perpetrators of the harm caused by the study. Students also now explicitly name the people taking action against the study.

In the fall of 2021, I finally got to teach the revised lesson to students in person. With laminated cards for each of the roles and copies of the injustice chart printed on legal size papers, I split up my Biotech class into groups of four. We used Charles Pollard’s card as an example in class before starting the card sort. 

“Target because he was in the study,” Necia called out.

“Could he be in two categories? Could he also be an upstander?” Quan asked.

 “Yes, some of the people involved in this study are both, and some might be even more than two categories,” I answered. 

In the example of Charles Pollard, students are able to see how those targeted fought back against the USPHS. After this example, I told the students, “You can jigsaw the cards. Split them up among your group, and then present them to each other. As you’re reading your cards, keep the categories in mind so you can recommend one!” The students worked to sort the other 20 cards. This method does significantly increase the amount of reading students do, but strategies like jigsawing lighten the reading load and allow students to quickly jump into conversations. 

As I rotated from group to group, listening in, I heard students paying attention to how different people played different roles. “Almost all of the targets are also upstanders for the other men in the study,” Maya noted. “Herman Shaw, Charles Pollard, the man who didn’t get into the Army: They all ended up speaking out when they found out what happened to them.” Will also questioned, “None of the doctors or nurses directly involved with the study did anything to be an ally. Why didn’t any of them see how racist this was?” Students nodded in agreement, and one student replied, “That was how it was back then, and now, too, in a lot of ways.”  The students were able to see that very few people involved in this study fit into one category and some fit into different categories as the study went on. This complexity was an integral part of the discussions, which allowed for students to push past the narrowness of the categories. 

“Why did it take a newspaper article for the study to stop? Why didn’t they stop when Dr. Jenkins told the supervisors?” Quan asked. 

“This is the stuff that has to be exposed to stop. None of us would have known about George Floyd without people posting about it and protesting,” Necia replied. Seeing all the roles let the kids work together to co-create these ideas and connections through conversations as they learned about the people in the study. 

In the previous version of the lesson, this level of discussion happened only after the mixer was complete, when students had a fuller picture of the study and how it ended. 

There were two additional changes I did to center resistance in the lesson. One was that I added two key roles: Bill Jenkins and Fred Gray, both strong allies to the men in the study and both Black men. While the original lesson discussed both men, the omission of Jenkins and Gray from the descriptions of people involved in the study was problematic and needed to be corrected; by not including them as their own roles, I was whitewashing the history, particularly in the case of Bill Jenkins. The CDC timeline we use does the same: “ 1968 Concern raised about ethics of study by Peter Buxtun and others,” with “others” including Bill Jenkins. Bill Jenkins had worked tirelessly to blow the whistle about the study while at the USPHS in the late 1960s, and he went on to do incredible work in diversifying public health leadership in the United States. Giving Peter Buxtun, a white man, full credit for whistleblowing, was an error in my original lesson. Fred Gray, famous for representing Dr. Martin Luther King and Rosa Parks, was the chief counsel for the men and their families when they sued the U.S. government for letting this study go on. His powerful actions needed to be highlighted to show how taking a stand against the racist medical practices led to positive systemic changes in how research is conducted in the United States. 

Here is an example of one of the cards:

Dr. Bill Jenkins I was working as a statistician for the U.S. Public Health Service (USPHS) when I first came across information about the syphilis study in 1968. I was hired in 1967, and I was one of the first Black people employed by the USPHS, but surely others thought this study was unethical. When I brought it up with my supervisor, I was told, “Don’t worry about it.” I was a voters’ rights activist when I was younger, registering Black people to vote in the South, and I knew this study was hurting people. I wrote up an article about the study for my anti-racist newsletter and distributed it to other African American doctors and scientists, anyone who would listen. But the article was never picked up in the mainstream media and the study continued. After another USPHS worker, Peter Buxtun, ended up getting a big newspaper article written by Jean Heller, the study stopped but my work continued. I worked in the Participants Health Benefits Program to help the men in the study. Then I went on to get my doctorate, and I devoted my career to increasing the number of Black people in public health leadership. I founded the Master of Public Health Program at Morehouse, my alma mater. I said about the Tuskegee Study later during a talk: “Things that start with a good purpose could end up being a very bad thing.” We need to keep working to make sure this type of study doesn’t happen again.

The other major change to center resistance comes after the students sort the cards into categories. At this point they solely focus on how resistance to the injustices of the study led to change. “Use what you’ve put together from the stories about the people to think about what stopped the study,” I told my class. After small group discussions we shared out with the whole group. “The newspaper article by Jean Heller got everyone to pay attention,” Necia’s group decided. “Jean Heller wouldn’t have known about it without Peter Buxtun,” countered another group. “We think it was Buxtun and Dr. Jenkins trying to get it stopped at the Public Health Service.” Maya’s group brought it back to the men in the study: “Once Charles Pollard and those guys found out, they stopped it!” 

“What if we’re all correct?” I asked them. “What if it’s all this together that stopped the study? Think about how multiple things led to stopping the study and then ultimately changing the way human subjects are treated. With your group, write down ways people involved changed things.” Students used the cards to identify the various ways people involved in the study acted to resist the study. They name the action and the outcome. For example, a student group wrote “Charlie Pollard met with Fred Gray” for the action and the outcome was “The men grouped together to sue the government for what the doctors did.” 

The students can see that change doesn’t come from one event but rather from a group of people working toward the same goal. From here the students then choose one perspective from the cards to write from and craft a testimony that might have been spoken at the congressional hearings in 1973. The unit then follows the same timeline as was previously written with a greater emphasis on the National Research Act (1974) and subsequent changes to human subjects rules that resulted from the congressional hearings on the study. 

I found that the students’ testimony writing focused more on resistance after this updated version of the lesson. In addition, none of the students chose to write their testimonies from the perspective of the white doctors who engineered and carried out the study. The students picked the men in the study, the nurse who worked directly with the men, the whistleblowers, the journalist, and the lawyer for the men. I was gratified that all students wanted to identify with and speak on behalf of the allies and targets of the study: 

When I talked to Charlie Pollard about the Tuskegee study, I knew that I wanted to give them a say and make sure that their voice about the study was heard. I wanted the world to see how racist this study was because you could see that they only used people of color and how most of the doctors who were involved in the study were white people. Since I had already dealt with a case similar to this with Rosa Parks and I was successful at making sure she didn’t get charges, I knew that he came to me because he wanted to know for sure that I was able to get them a case so that they wouldn’t continue this awful study and they would be free from what these doctors were doing. —Nydia as Fred Gray These men should not be denied treatment, they deserve the best medical care we can provide. I was an activist earlier on in my life, so when I caught wind of this unethical and unjust study I knew something needed to change. I reached out to my supervisor so they could hear my concerns about the study, but they told me not to worry about it. I later learned that my supervisor was monitoring the study. I couldn’t stop worrying about it, I knew I had to do more. Some colleagues and I wrote an article and sent it to other African American doctors, also some reporters. —Marquis as Dr. Bill Jenkins

By using valuable feedback from former students and test-driving the changes with fellow educators, I was able to rework the lesson to better honor the men in the study and their fight against a terrible injustice in medical history. Students explicitly named how people fought back against the study’s continuation and what changed because of the resistance. The revisions have been a powerful step toward a more empowering lesson. 

Gretchen Kraig-Turner teaches in northwest Washington in a community surrounded by farmlands, the foothills of the Cascades, and the Salish Sea. In between teaching, raising two great kids, and gardening, she is co-editing an upcoming science book for Rethinking Schools.

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