1. The Tuskegee Syphilis Experiment
An Ethical Breach in the Name of Science
Caela Long, Marissa McGovern, Zack Marsh, Christopher Merrill, and Christina Monnie

2. Background of the Study

3. What is Syphilis? Sexually Transmitted Disease
Symptoms include (but not limited to):
Sores
Rashes
Brain Damage/Death
Three Stages of Syphilis (examined in this study):
Primary: single sore lasting 3-6 weeks
Secondary: skin rashes and more sores
Latent: no sores, dormant form of the disease
- Late/Tertiary: deadly form, attacks central nervous system other vital organs such as the heart and liver

4. Syphilis and Study Timeline
1926: 35% prevalence of syphilis in African Americans
1931: Rosenwald Fund discontinues funding
1973: Congress holds hearings and lawsuit on behalf of participants
2004: Last participant dies
1905: Bacterium causing syphilis isolated
1945: Penicillin accepted as treatment of choice
1900
2013
1907: Blood test
for syphilis developed
1974: Participants receive $10 million settlement
1932: PHS follow up studies commenced. Interns/nurses from Tuskegee Institute get involved.
1929: mercury and bismuth treatment <30% effective
1972: First news articles condemn studies. Study ends.

5. Origins of the Study
The initial goal was to understand and examine the prevalence of syphilis in Macon County, Alabama among African American males.
Funded by the Julius Rosenwald Fund.
Cut funding in 1931 due to the racial associations of the results.
35% of African American males in Macon County had syphilis.
U.S. Public Health Service (PHS) conducted follow up studies led by:
Tuskegee Institute  provided resources and interns (for training)
Dr. Taliaferro Clark  formulation of study
Dr. Raymond Vonderlehr  selected the participants
The “modified” goal was to study untreated syphilis in African Americans compared to Europeans.
Started in 1932.

6. The Tuskegee Syphilis Experiment
The study included:
399 infected African American men
201 uninfected African American men
These men were promised:
Free medical care/treatment
Free burial
The duration of the study was from

7. How did the PHS prolong this study for 40 years?
They thought the patients wouldn’t seek medical help anyways
Since the patients were still suspicious of hospitals
Rationalized the racial aspects of the experiment:
Poor
They did not treat the control group who got syphilis
The patients thought they were being treated
The promises of free medical care/treatment and free burial
Ignored criticism from papers
Public was never informed
CDC, AMA, and NMA all supported its continuation in 1969

8. The Main Reason for the Successful Prolongation
The PHS prevented the patients in the study from being treated
Kept local doctors from providing treatment
Informed Alabama Health Department to not treat the patients
Informed the government/military not to treat the drafted patients of the study

9. The Termination of the Study
The Whistleblower
Peter Buxtun
PHS Venereal Disease Investigator
Questioned the morality and ethics of the experiment
The PHS decided to still let the project go until completion
Buxtun went to the press in the early 1970s
In 1972 it was finally brought to the public’s attention
Jean Heller of the Associated Press was published in the New York Times
The study ended quietly and suddenly

10. Ethical Concerns

11. Evidence of Ethical Violations
Never informed that they were part of a medical study
Patients were being treated for “bad blood”
Treatment was withheld from the patients

12. What caused the breach in ethics?
Early treatments using heavy metals (mercury) were not administered to the patient.
The medical staff tracked the patients assuring that patients were not administered treatment.
Penicillin treatments were never given to the patients.
Paid for their Burials  enticement
The patients and their families were never told the bodies would be autopsied.

13. Ethical or Not?
Syphilis in African American males is different than syphilis in white males and needed to be further studied
Early treatment for the disease was dangerous
Many of the men were too sick for Penicillin treatment to be effective

14. Outcomes

15. Outcomes: Patients
At least 28 of the 399 affected men died from advanced syphilis
Some wives and children of those in the study contracted the disease because the men weren’t treated
National Association for the Advancement of Colored People (NAACP) filed a class-action lawsuit
Won $10 million to be divided among the participants of the study
Those still alive, wives, widows, and children got free health care

16. Outcomes: Society National Research Act
Law created to protect human subjects in research
Passed in 1974
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was created as a result.
The Belmont Report summarized the basic ethical issues that needed to be followed when doing research

17. Outcomes: Formal Apology
President Clinton apologized to those involved and had a ceremony for them in 1997.
"What was done cannot be undone. But we can end the silence. We can stop turning our heads away. We can look at you in the eye and finally say, on behalf of the American people: what the United States government did was shameful.”
-President Clinton

18. Cost to Society
African Americans not trusting in the public health system or the government
In a survey given to African Americans by Oregon State 16% believe that AIDS was created by the government to control the black population and 15% believe it is a form of genocide
African Americans have less confidence that efforts are trying to be made to control AIDS and other health problems in their communities

19. Overview/ Recommendations

20. Overview Reported 28 men died directly: Indirect Implications
100 more died of related complications
40 wives reported having some form of syphilis
19 children were born with congenital syphilis
Indirect Implications
Who knows?

21. Who is Culpable? What Could’ve Prevented This?
Directly:
PHS
Doctors Clark and Vonderlehr
Indirectly:
Tuskegee Institute
Interns/Nurses  Afraid?
Eunice Rivers 
Government and Outside Doctors trying to administer Penicillin
Why didn’t anyone speak up?
Didn’t it cross their mind?

22. Preventing A New Tuskegee Experiment
Difficult to Imagine
Clinical Trials
Placebo vs. Treatment
Long Studies  Obsession
Recommendations: Arm Yourself with Knowledge
Institutional Review Boards  protect from outside distractions
First line of defense  present before every study
Ask questions
Look into treatments used
Be active in the studies
“See Something, Say Something”
Pressure  Superiors

23. Piecing It All Together
Relevance
Beneficiaries
Present and Future Clinical Studies
Students
Professions with Science Backgrounds
Especially Researchers

24. References
Brandt, Allan M. “Racism and Research: The Case of the Tuskegee Syphilis Study.” The Hastings Center Report , Vol. 8, No. 6 (Dec., 1978), pp
Brunner, Borgna. “The Tuskegee Syphilis Experiment.” Retrieved June 07, 2013.
"Case Study 3: The Tuskegee Syphilis Study" Online Ethics Center for Engineering 7/20/2006 National Academy of Engineering Accessed: Thursday, June 13, <
Chadwick, A. (Performer) (2002). Remembering tuskegee [Web series episode]. In Morning Edition. Washington DC: National Public Radio. Retrieved June 06, 2013, from
Manuel-Logan, R. (2012, July 26). Black Urban Legends, Black Conspiracy Theories HIV AIDS | Breaking News for Black America. Breaking News for Black America | News One. Retrieved June 06, 2013, from
“Research & Economic Development.” History of Research Ethics. Web. 13 June
“The Tuskegee Timeline." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 15 June Web. 13 June 2013
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