Informed that they were being treated for bad blood, their doctors had no intention of curing them of syphilis at all. The data for the experiment were to be collected from autopsies of the men, and they were thus deliberately left to degenerate under the ravages of tertiary syphilis, which can include tumors, heart disease, paralysis, blindness, insanity, and death. One of the doctors involved said, ‘We have no further interest in these patients until they die.’ James Jones said that the sharecroppers were easy to manipulate because they were poor and liked the idea of free medical care. He also said they were pawns in the longest non-therapeutic experiment on human beings in medical history.
The study was to compare blacks’ and whites’ reactions to syphilis, thinking that whites experienced more neurological complications from syphilis whereas blacks would have more cardiovascular damage. How this knowledge would have changed clinical treatment of syphilis is uncertain. It took almost forty years before someone involved in the study took a hard and honest look at the end results, concluding that nothing learned would prevent, find, or cure a single case of infectious syphilis or bring us closer to our basic mission of controlling venereal disease in the United States.
When the media caught hold of the experiment in 1972, news anchor Harry Reasoner described it as an experiment that used human beings as laboratory animals in a long and inefficient study of how long it takes syphilis to kill someone. By the end of the experiment, 28 of the men had died directly of syphilis, 100 were dead of complications of the disease, 40 of their wives had been infected, and 19 of their children had congenital syphilis. To get the community to support the experiment, one of the original doctors admitted it was necessary to carry on this study under the guise of a demonstration and provide treatment. At first, the men were prescribed syphilis remedies of the day, bismuth, neoarsphenamine, and mercury, but in such small amounts that only 3 percent showed any improvement.
These token doses of medicine were good public relations and did not interfere with the true aims of the study. Eventually, all syphilis treatment was replaced with pink medicine aspirin. To ensure that the men would show up for a painful and potentially dangerous spinal tap, the PHS doctors misled them with a letter full of promotional hype: ‘Last Chance for Special Free Treatment.’ The fact that autopsies would eventually be required was also concealed. A doctor explained, ‘If the colored population becomes aware that accepting free hospital care means a post-mortem, every darky will leave Macon County . . . ‘ Even the Surgeon General of the United States participated in enticing the men to remain in the experiment, sending them certificates of appreciation after 25 years in the study. Believe it or not, not only white people took part in the experiment, but black people were also involved. The experiment’s name comes from the Tuskegee Institute, the black university founded by Booker T.
Washington. Its affiliated hospital lent the PHS its medical facilities for the study, and other predominantly black institutions, as well as local black doctors, also participated. Eunice Rivers, a black nurse, played a huge part in the experiment for 40 years. Many of them did it for the promise of great recognition. A Tuskegee doctor, for example, praised the educational advantages offered to our interns and nurses, as well as the added standing it would give the hospital. Nurse Rivers said her role was one of passive obedience: “We were taught that we never diagnosed, we never prescribed; we followed the doctor’s instructions!” It is clear that the men in the experiment trusted her and that she sincerely cared about their well-being, but not enough.
Even after the experiment was exposed to public scrutiny, she pretty much felt that nothing ethical was wrong. One of the scariest aspects of the experiment was how strongly the PHS kept these men from receiving treatment. When several nationwide campaigns to erase venereal disease came to Macon County, the men were prevented from participating. Even when penicillin was discovered in the 1940s—the first real cure for syphilis—the Tuskegee men were deliberately denied the medication. During World War II, 250 of the men registered for the draft and were consequently ordered to get treatment for syphilis, only to have the PHS exempt them.
Pleased at their success, the PHS representative stated: “So far, we are keeping the known positive patients from getting treatment.” The experiment continued in spite of the Henderson Act (1943), a public health law requiring testing and treatment for venereal disease, and in spite of the World Health Organization’s Declaration of Helsinki (1964), which specified that informed consent was needed for an experiment involving human beings. The story finally got into the Washington Star on July 25, 1972, in an article by Jean Heller of the Associated Press. Her source was Peter Buxtun, a former PHS venereal disease interviewer and one of the few whistleblowers over the years. The PHS, however, remained unmoved, claiming the men had been volunteers and were always happy to see the doctors, and an Alabama state health officer who had been involved claimed, “Somebody is trying to make a mountain out of a molehill.” Finally, because of the publicity, the government ended their experiment and, for the first time, provided the men with effective medical treatment for syphilis.
Fred Gray, a lawyer who had previously defended Rosa Parks and Martin Luther King, filed a class action suit that provided a $10 million out-of-court settlement for the men and their families. The PHS did not accept the media’s comparison of Tuskegee with the appalling experiments performed by Nazi doctors on their Jewish victims during World War II. Yet, in addition to the medical and racist parallels, the PHS offered the same morally bankrupt defense offered at the Nuremberg trials: they claimed they were just carrying out orders, mere cogs in the wheel of the PHS bureaucracy, exempt from personal responsibility. The study’s other justification for the greater good of science is equally stupid. Now in my opinion, Clinton said it best when he said: “The United States government did something that was wrong—deeply, profoundly, morally wrong.
