The Tuskegee Syphilis Study

When looking for information concerning the Tuskegee Syphilis Study, there is a small assortment of books to choose from. I chose The Tuskegee Syphilis Study by Fred Gray because he was the lawyer in the lawsuits against the government, and I thought that he would be able to provide the most in-depth analysis of the event because he was actually involved in it. It was also written fairly recently, so that enables the book to analyze the long term effects that it has had on African-Americans, the South, and history in general. Gray's book provides a very informative study, but if you're looking for more information, check out James Jones' Bad Blood. Gray takes a lot of information from this book which was written about 20 years before his. When searching the web for information on the Tuskegee Syphilis Study, the results were quite slim. Most of the results involved syllabi for college classes or websites much like our own that were prepared for a class. The website that I reviewed is from the Tuskegee University National Center for Bioethics, which was actually created from President Clinton's apology and ideas for improvement of racial relations and medical testing. The webpage's main purpose is to educate the public about the atrocities that were performed on African-Americans in the Tuskegee Syphilis Study, and to help prevent an event like this from ever happening again

The Tuskegee Syphilis Study by Fred D. Gray examines a medical study that occurred in Tuskegee, Alabama which dealt with monitoring African-American subjects discover the effects of untreated syphilis. The main goal of the study was to seek out African-American males in the second stage of syphilis, and then to sporadically perform exams on these men to determine the effects that syphilis had on their bodies. The test subjects were told that they were receiving medical treatment for "bad blood," but in reality, they never received penicillin, which was the most effective treatment for syphilis. After 40 years of this race-based experiment, the story broke nationwide, and for the first time the test subjects realized that they had been involved in this experiment and that they had not received treatment. By this time, many of the participants had died, but a group of survivors led by Charlie Pollard began to gather information to put together a law suit against the doctors who performed the medical experiment and the federal government who had financially supported the project. The author of this book, Fred D. Gray, was the lawyer who represented the participants. In 1973, the lawsuit ended in victory for the participants and they were collectively awarded $10 million to split between the living syphilitics and families of the deceased. In 1997, President Bill Clinton formally apologized for the terrible injustice done to these African-American men, but only seven of them were alive to witness it.

Fred D. Gray's book offers a personal insight into these shocking experiments because of his direct involvement with them. He describes his past work on civil rights cases in Alabama, but he considers the Tuskegee Syphilis trial to be the most important in his entire career. Gray's main reason for writing the book was to explain the events of the injustices performed on the individual test subjects, and how this incident should be an example of immorality that should never be repeated. He begins with the origins of the study. He describes that in 1932, "word spread throughout Macon County that 'government doctors' were to provide free exams to start a new health program" (49). Out of the 3,684 African Americans tested, 1,468 cases of syphilis were found, and that number was narrowed down to 408 subjects for the test. These men were told they had "bad blood," and they were offered free medical care and treatments. Although the main purpose of the study was to discover the effects of untreated syphilis, the doctors continued to lead the participants to believe that they were receiving treatment for "bad blood."

In the second phase of the experiments, a control group of 200 men was added as a comparison to the syphilitics. These men were also not informed about the basis of the study, but instead were told that they would be receiving "free treatment from government doctors." Both the syphilitic group and the control group were not to receive any medication or treatment of any kind from local hospitals or doctors. Their names were put onto lists given to local hospitals, and they were told not to treat the patients. Instead, the participants had to schedule appointments with the government doctors, and while they were told they were receiving penicillin, in actuality they were just receiving aspirin or other ineffective means of treatment. During this period, many of the participants began to die because of the effects of untreated syphilis, and autopsies were performed by white doctors without permission from the deceased.

The final phase of the study occurred from 1965 to 1972, and the end of the experiment was in sight. Over two-thirds of the original participants were deceased, and the other 200 were very difficult to locate. The climate of race relations had also changed, and many of the people involved in the study were beginning to reexamine the morality of the study. Even with these differenced and difficulties, the study continued on until the summer of 1972, when the story was revealed nationwide and abruptly stopped.

This is the point in which Fred Gray joined the surviving participants in the struggle for justice. In the first lawsuit, Pollard vs. United States of America, Gray's prosecution entailed the following accusations:

"1) The U.S. government violated the constitutional rights of the participants.

2) The government knew the participants had syphilis and failed to treat them.

3) The Public Health Service failed to fully disclose to the participants that they had syphilis, that they were participating in the study, and that treatment was available for syphilis.

4) The Public Health Service led the participants to believe that they were being properly treated for whatever diseases they had, when in fact, they were not being meaningfully treated.

5) The Public Health Service failed to obtain the participants' written consents to be a part of the study.

6) The Study was racially motivated and discriminated against African Americans in that no whites were selected to participate in the Study.

7) There were no rules and regulations governing the Study."

The final settlement went in favor of the prosecution, and they were awarded $10 million to split amongst the living syphilitics and controls, and the relatives of the deceased.

Even with the end of the study and the settlement, the survivors and Gray were not satisfied. It was not until May 16, 1997 when President Clinton publicly apologized for the harmful and prejudice injustices that the government had committed against the participants of the study. Only seven survivors were alive to hear the apology, but it still represented closure for them and for Gray.

This American example of racially based medical experimenting began in 1932 before the Germans began their experiments on Jews, homosexuals, and other groups during the Holocaust. Both instances involved medical experiments on persecuted groups of people. The Nazi experiments were much more harsh and grotesque, and they almost always lead to immediate death. The Tuskegee study involved the hidden injustice of mistrust and deception against its participants. Although the Tuskegee study did not result in the immediate deaths of the subjects, the participants' lives were surely cut short because they were not receiving treatment. After WWII, the Nazi war criminals were put on trial at Nuremburg, and from their testimonies a lot of attention gathered around the discussion of the morality of human experimentation. According to Gray, at this time, the study was completely unaffected by these guidelines, and it continued on. In 1972, when the study was revealed publicly, many comparisons to Nazi experiments were made. One Public Service employee wrote a letter to his superiors describing how "the Tuskegee study could be compared to the German medical 'experiments' at Dachau, and that the Proceedings of the International Military Tribunal in Nuremburg could be used in an attack upon the moral justification for the study" (76). That is exactly what Gray did; he gathered information from the Nuremburg Trials along with evidence from the actual study which proved that the study was unconstitutional, and using it he won the case for the Tuskegee study participants. His book is a tribute to all of the participants, and his main focus is to tell their story.

The website, www.tuskegee.edu/bioethics, is the official website of the Tuskegee University National Center for Bioethics. This center was created in 1999 as a result of President Clinton's 1997 apology to the participants of the Tuskegee Syphilis Study. In his 1997 speech, President Clinton called for the establishment of a center for "bioethics in research and health care." He described that "the center will serve as a museum of the study and support efforts to address its legacy and strengthen bioethics training." The website claims that the center is "the nation's first initiative dedicated to the inclusion of African Americans and other communities of color in response to issues of human values in science, technology, and society."

In the general background section of the website, there are several links that connect to articles that deal with different aspects of the Tuskegee Syphilis experiment and its effects. The first of which is called America's Dirty Little Secret from The Association of the Advancement of Blacks in Health Sciences. This article details the horrible circumstances of the Tuskegee Syphilis Study, and how the black victims were misled and mistreated by the white doctors. This article also draws comparisons to Nazi Germany, asking if the study was "government sanctioned, premeditated genocide." Although the survivors and their relatives were eventually granted compensation after their lawsuit was settled out of court, the author describes that none of the doctors received punishment or even feel remorse. This article provides a short summary of the experiments and the lawsuit against the government, and its main goal is to reveal "America's dirty little secret" so that the public will know that this injustice happened.

There are about 4 other links to similar articles that briefly describe the study. All of these articles have the same layout; they all first describe the experiments and then they describe the injustices that were performed against the African Americans. The articles all address the fact that the study was racially based, the participants did not know they were part of the study, and that adequate treatment was not given to the participants.

The next section is filled with articles responding to President Clinton's apology speech. A dozen newspaper articles deal with different issues of the apology from the beginning when it was originally planned to take place in Alabama, to the survivor's families feelings concerning the apology, and finally to detail that Clinton made the apology to improve relations with blacks who still mistrust the government because of the incident in Tuskegee. All of these articles provide insight into the feelings of both the survivors and their families and the President and government officials. The articles are intended to spread knowledge about the Tuskegee Syphilis Study and the government's manipulation of these 600 African Americans.

Another section from the website is devoted to the discussion of the Tuskegee Syphilis Study's impact on health care. Several articles deal with what they describe as the "new Tuskegee" or "Tuskegee part II." They describe that AIDS patients are being refused proper treatment and in another situation anonymous infants were being tested for pediatric AIDS without the parent's consent. Another article involves the claim that the Clinton's apology was not enough, and that the white doctors responsible for the study should be prosecuted. Other articles deal with the continued mistrust of the government and doctors that still rings true in Tuskegee. All of these articles deal with the consequences of the government's decision to mislead the participants in the study, and how that mistrust has continued on for more than 60 years.

In the general background section, there is an article that deals with the similarities between the Tuskegee Syphilis Study and the Nazi experiments performed during the Holocaust. The article opens with a quote from the Nuremburg Code, "The voluntary consent of the human subject is absolutely essential." The author, Howard Wolinsky, describes that in 1947, the same year that the Nuremburg Code was created, penicillin was also discovered as the foremost effective treatment for syphilis. Yet, the Tuskegee study still continued on after this year, without intervention by the government and without the treatment of penicillin. He describes that seven Nazi doctors were executed for their crimes against humanity, while the American doctors of the Tuskegee study roam free without regret. Wolinsky also regards the Tuskegee study as a wakeup call for Americans. He quotes from Arthur Caplan, director of the medical ethics program at the University of Pennsylvania, "Tuskegee was really the experiment that set American medicine on its ear. I think Americans had this belief that they couldn't or wouldn't do the kind of evil things that the Germans did. Tuskegee was a giant wake up call." And the effects of the government's violation of trust have not yet disappeared from new generations of African Americans in Alabama. They still have not been able to trust the government or doctors, and that is a direct result from the persuasive means that the Tuskegee doctors used to find test subjects. Wolinsky describes that after WWII, Americans could not believe the atrocities that the Nazi doctors performed on their victims, and to fully understand the Nazi crimes they had to "demonize or peripheralize" that Nazis. The Tuskegee Syphilis Study forced Americans to also find demons within our own country.

This website is basically dedicated to the remembrance of the Tuskegee Syphilis Experiment itself, but especially to the participants in the study who were both misled and mistreated. The Tuskegee Center for Bioethics is living proof that the American government realized its wrong, and that it is now trying to right it.

Annotated Bibliography

Gray, Fred D. The Tuskegee Syphilis Study. Montgomery: New South Books, 1998.

www.tuskegee.edu/bioethics