The Tuskegee Study for Untreated Syphilis Uche Fabiku, RN Cheryse Jackson, RN Angela Long, RN Monique Veney, RN

Syphilis Highly contagious sexually transmitted disease Transmitted by the bacterium Treponema Pallidum Syphilis infection has 3 stages (primary, secondary and late stage)

Treatment of Syphilis 1940s- Penicillin (PCN) became the standard treatment for syphilis Penicillin G, single dose (intramuscular injection), if infected for <1 year. Penicillin once weekly (IM) x3 weeks, if infected for >1 year or for unknown period of time Doxycycline or Tetracycline for PCN allergy If left untreated, syphilis can lead to permanent blindness, dementia and/or even death.

The Tuskegee Syphilis Experiment Overview 1932- race-based medical experiment conducted by the US Public Health Service and the Tuskegee Institute initiated to determine how second-stage/latent syphilis would affect Black men compared to Caucasian men. 400 impoverished, uneducated syphilitic sharecroppers were manipulated to participate in study 1972-Study ended in when publicized and deemed unethical 1973- reparations awarding over $10 million to the survivors and their families 1997- President Clinton apologizes for the nations unethical conduct @ Tuskegee Numerous ethical guidelines and laws have been established as a result of the Tuskegee Experiment

Review of Literature Tuskegee Experiment Misconduct Impact

Review of literature Hastings Center Report (1978) -Revealed mindset of researchers and government officials regarding human nature of blacks a “primitive peoples [that] could not be assimilated into a complex, white civilization”. Researchers and medical professional made an argument that based on scientific physical findings “a careful inspection reveals the body of the negro a mass of minor defects and imperfections from the crown of the head to the soles of the feet....Cranial structures, wide nasal apertures, receding chins, projecting jaws, all aped the Negro as the lowest species in the Darwinian hierarchy” -Exposed communication between researchers and U.S.P.H.S. related to study details “there is one danger in the latter plan and that is if the colored population became aware that accepting free hospital care means post-mortem, every darkey will leave Macon county and it will hurt [Dr. Eugene] Dibble’s hospital.’

Exploration and Analysis Major ethical violations of the Tuskegee Experiment: Subjects were never told they had syphilis (told they were being treated for “bad blood”) No research protocols or guidelines were followed Subjects were coerced/manipulated into the study Subjects were never given informed consent Subjects were never treated as promised Subjects were never given the option to quit during the study or even after the introduction of Penicillin as a treatment/cure Victims included the participants, their wives and many children born with congenital defects

Exploration and Analysis cont’d 1974 –National Research Act, the Common Rule, mandates that IRBs or institutional review boards be established at all facilities that receive federal research money 1979 -Belmont Report 1979 -Establishment of the Office for Human Research (OHRP) 1993-Revitalization Act developed to mandate the inclusion and representation of women and minorities in research (has had very limited success through the years)

Exploration and Analysis cont’d 2011- US Department of Health and Human Services unsuccessful yet again in establishing another policy, Advanced Notice of Proposed Rule Making, which was also to address the underrepresentation of African Americans and other minorities in research

Conclusion The Tuskegee experiment is known to be one of the most non-therapeutic, ethically immoral studies in United States history Caused hundreds of deaths, including the infected men, their infected wives and children born with congenital syphilis Resulted in decreased trust of researchers and the medical community among many African Americans

References Beauchamp, T., & Childress, J. (2013). Principles of Biomedical Ethics (7th Ed.). New York: Oxford University Press. Brandt, A. M. (1978). Racism and research: The case of the Tuskegee Syphilis study. Retrieved from The Hastings Center: http://www.med.navy.mil/bumed/Documents/Healthcare%20Ethics/Racism-And-Research.pdf Center for Disease Control and Prevention. (2014). Syphilis- CDC fact sheet. [Online]. Retrieved from http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm Gray, Fred. (1998). The Tuskegee syphilis study. Montgomery: New South Books Heintzelman, C. (2013). The Tuskegee Syphilis Study and its Implications for the 21st Century. Social Worker , pp. 2-8. Medline Plus. (2014). Syphilis. [Online]. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000861.htm Poythress, N., Epstein, M., Stiles, P.,& Edens, J. F. (2011). Awareness of the Tuskegee Syphilis Study: Impact on Offenders' Decisions to Decline Research Participation. Behavioral Sciences& The Law, 29(6), 821-828. doi:10.1002/bsl.1012 Smolin, D. M. (2012). THE TUSKEGEE SYPHILIS EXPERIMENT, SOCIAL CHANGE, AND THE FUTURE OF BIOETHICS. Faulkner Law Review, 3(2), 229-251. Walker, C. A. (2009, Summer2009). Lest we forget: The Tuskegee Experiment. Journal of Theory Construction & Testing. pp. 5-6. William Rencher, L. W. (2013, December). Redressing Past Wrongs: Changing the Common Rule to Increase Minority Voices in Research. Public Health Ethics , pp. 2136-2140.