10:832:356 Lecture Notes - Lecture 7: Cardiovascular Disease, Fetus, Formal System
9 May 2018
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Lecture #7: Tuskegee and the Ethics of Public Health Initiatives
I. What is Syphilis?
• STI- Has four stages of development and spreads through direct sexual contact (vaginal, anal,
or oral) and/or from mother to fetus.
• Symptoms: Sores and rashes.
• Tertiary Phase- Rare phase that occurs 10-30 years after infection.
• Multiple organs are effected, including the heart and brain- fatal.
II. History of the Experiment
• USPHS ran it from 1932-1972.
• Who was chosen?
• Participants were actively recruited by the USPHS, but were wary of going to a USPHS
clinic; they believed it may be a trick to get them into a military draft. The USPHS wound
up testing a number of people not involved in the study in order to assuage these
suspicions.
• 400 African American males.
• 35-60 years.
• Diagnosed with syphilis.
• 200 African American males without syphilis (control group).
• Largely poor and illiterate.
• Intent of the study:
• To leave the participants infected with syphilis untreated and follow the course of the
disease until death and an autopsy was performed.
• They were never told that they were part of a study, had a deadly disease, and were not being
treated. They thought they were receiving health services.
• Even when penicillin was discovered, the doctors decided not to treat the subjects.
III. Purpose and Hypothesis
• Study Purpose: To determine how syphilis affects the daily lives of the men in the experiment.
• Hypothesis: The treatment of syphilis is unnecessary.
• Totally against all known medical advice at the time (1932), which recommended treatment
(with arsenic).
• Syphilis had been medically proven to cause cardiovascular disease, insanity, and/or death.
• Known to be very infectious if left untreated.
• Racist Reasoning Behind the Study: “The premise that blacks, promiscuous and lustful, would
not seek or continue treatment, shaped the study.” The USPHS essentially made their
presumption true by failing to provide treatment to the infected population.
IV. What Did Participants Receive?
• Physical exams.
• X-rays to determine the overall condition of the participants.
• Spinal tap to determine the incidence of neuro-syphilis.
• All this was done, however, without any intention to provide treatment.
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Document Summary
They thought they were receiving health services: even when penicillin was discovered, the doctors decided not to treat the subjects. What did participants receive: physical exams, x-rays to determine the overall condition of the participants, spinal tap to determine the incidence of neuro-syphilis, all this was done, however, without any intention to provide treatment. Final paragraph of the case of the tuskegee syphilis study by allan m. brandt. Page !2: in retrospect the tuskegee study revealed more about the pathology of racism than it did about the pathology of syphilis; more about the nature of scientific inquiry then the nature of the disease process. The injustice committed by the experiment went well beyond the fact outlined in the press and the hew final report. The degree of deception and damages have been seriously underestimated. As this history of the study suggests, the notion that science is a value-free discipline must be rejected.
