1. Tuskegee Syphilis Study

2. Leading Up To Antebellum Health Care Plantation owners valued employees 1860 estimated value of 4 million slaves was 2 billion dollars Some hospitals for slaves, usually in places like New Orleans or Natchez, MS Slaves used in medical experiments No healthcare choices– particularly reproductively Science used as a means justify inequality “Doctrine of innate racial differences” p12 LaVeist

3. Leading Up To After Civil War Federal Government set up the Freedman’s Bureau in 1865 By 1868 all but one had closed Night riders No care for freed slaves Charities provided care to “the deserving poor, not as a service to all people in the community”; socially worthy 1896 Plessy v Ferguson rule paved the way for segregation of healthcare Restrict Black physician education Limit community control over hospitals Exclude Black physicians from practicing with White physicians

4. Provident Hospital Annual Report 1895-1896 "The hospital is intended to fulfill three purposes: - To be an institution where people of color may be attended by physicians of their own race, and secondly, that colored physicians may have an opportunity to develop themselves along the lines of specialties, and thereby, become thoroughly proficient in them, at the same time no distinction is made in regard to color and all races of people are treated promptly, and properly and Third, to establish in the near future a well organized training school for nurses where young ladies may obtain special instruction pertaining to their calling." www.nlm.nih.gov/.../images/hubbard.jpg

5. Leading Up To 1900-1920s Physician education was reformed; upper class, white, male profession 1900 seven medical schools educated Black physicians By 1920 on 2 remained; Howard and Meharry Main source of Black physicians until 1960 Fear of Black physicians and encouraged community to keep separation Flexner Report confirmed separation

6. Provident Hospital and Training School, Chicago www.nlm.nih.gov/.../images/hubbard.jpg

7. Leading Up To 1920-1940 Black physicians practiced only in Black hospitals with Black patients Poorest care and inferior facilities 1946 Hill Burton Construction Act- proposed by Lister Hill of Alabama Separate but equal facilities in Health Care

8. Prevailing Medical Assumptions Diseases affected Black differently than Whites Some kind of Health Care is better than what they had which often was nothing Blacks were so poorly educated that they did not understand health care and being health anyway

9. 1930s and Incidence of Syphilis 1934 for Black Adults 17,700 deaths from syphilis 500,000 new cases each year Predicted that 7 million would get the disease Discrepancy between case in Blacks and Whites so concluded Dermatological Cause Hereditary

10. Addressing the concerns State of Alabama 14 clinics 175 private physicians donate a few hours each week $2/visit Syphilis required as many as 20 visits Very rural area had nothing T88

11. Addressing the concerns Rosenwald Fund 1929 in conjunction with the United States Public Health Service Three goals Provide health programs for southern Blacks Provide key positions for Black health professionals Support medical education and training

12. Addressing the concerns Rosenwald cont’d Established syphilis treatment programs for rural blacks One was in Macon County AL Very poor Diet salt pork, hominy grits, cornbread and molasses and rarely meat, veggies or milk Rosenwald fund oversaw and sent Dr. Harris, a black to physician to assess the project T90

13. Addressing the concerns Dr. Taliaferro Clark had an “aha” moment! 1400 negroes admitted to treatment but only a small number had previous treatment Near a hospital– Tuskegee Institute “In short, Macon County offered thousands of infected Negroes who lived outside the world of modern medicine yet close to a well equipped teaching hospital that could easily double as a scientific laboratory” Clark from Bad blood : the Tuskegee syphilis experiment by Jones, J (1993)

14. The Players Tuskegee Institute- medical facilities Eunice Rivers- nurse Macon County physicians USPH service, AMA and the medical community Men of Macon County

15. Tuskegee Institute Dr. Dibble agreed for the facility to provide medical services Blood Test Spinal Taps In return, the physicians at Tuskegee involved, would be given co-authorship on any publications as the result of the research

16. Eunice Rivers Grew up in Macon County Oldest daughter of a poor man who could barely write his name Went to Tuskegee and became a nurse 1931 offered a job with the project She took the job and enjoyed it-”Oh, we had a good time, We had a good time, Really and truly, when we were working with those people…….. That was the joy of my life” (Jones, Bad Blood p161) Why did they want her?

17. Macon County Physicians Asked all the physicians, both black and white, not to treat those men involved in the study

18. US Public Health Service Precursor to the current CDC- Center for Disease Control Money and personnel provided

19. Men of Macon County Selected 400 men with syphilis They were told that had “Bad Blood” They were given: NO medication Spinal taps Blood test $50 toward burial expenses

20. So Began-1932 “The Tuskegee Study of Untreated Syphilis in the Negro Male” The “longest know non-therapeutic experiment on humans in medical history” (Breaking the Fine Rain of Death byTownes(1998), p91 The study would end with the death of all of the participants

21. The Players—Why did they? Tuskegee Institute- medical facilities Eunice Rivers- nurse Macon County physicians USPH service, AMA and the medical community Men of Macon County

22. The Beginning of the END Dr. Irwin Schatz- first medical practicioner to question the study Peter Buxton- worked for PHS 1972 Edith Lederer wrote an article 1973 $1.8 billion class action suit against the PHS, HEW (HHS), & State of Alabama; settled for $10 million Who not named?

23. Responses Tuskegee Institute Nurse Rivers Medical Community PHS Lawyers

24. National Apology May 16, 1997 President Bill Clinton offered a formal apology—25 years after the conclusion

25. After Tuskegee 1989– vaccine on Black and Latino children; parents not informed Polyheme Blood substitute Because the patients eligible for the study are unlikely to be able to provide consent due to the extent and nature of their injuries, the trial will be conducted under federal regulations that allow clinical research in emergency settings using an exception from the requirement for informed consent (21 CFR 50.24). http://www.northfieldlabs.com/facts.html