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The Truth about Tuskegee

The Tuskegee Study of Untreated Syphilis in the Negro Male has long passed into story and legend as one of the ultimate crimes perpetrated by the American White Racist Establishment against African-Americans.

And it's a story and legend that has been in the news, lately, since the very Reverend Jeremiah Wright likes to cite Tuskegee as evidence that the U.S. government would be willing to do almost anything to hurt African Americans - like, for instance, inventing the AIDS virus in a CIA laboratory and then siccing it on the black community.

Wikipedia offers the standard narrative.

But in 2004, Richard A Shweder, the William Claude Reavis Distinguished Service Professor in the Committee on Human Development at the University of Chicago, published a remarkable essay: Tuskegee Reexamined - from which one can only conclude that the standard narrative is pretty much totally wrong.

Since I'm a lazy sot, and since I don't believe in reinventing the wheel, I'm not going to offer my own summary. Instead, I'm going to quote somebody else's:

"The study was undertaken by progressives who wanted to fight a disease that afflicted many blacks, it had the full support of black medical authorities to the end, and—most important—it probably caused no harm to the 140 men (not 400) who took part.

"The U.S. Public Health Service started the study in 1932 in Macon County, Alabama, where syphilis rates for blacks ranged between 20 and 36 percent.

"At the time, there were a number of treatments for the disease but they were complicated, disagreeable, and not very effective...fully 85 percent of patients dropped out before treatment was complete. Of the 15 percent who stuck it out, few were cured.

"Public health officials knew they needed better drugs. But they also needed a baseline to which they could compare the results of treatment. This was why they wanted to know what happens if there was no treatment...

"...syphilis is not always the raging killer most of us think it is. First of all, it is only in the early stages of the disease, when sores appear on the body, that it is contagious...After that, syphilis goes into a latent state, in which there are no symptoms, and the patient is not infectious...for perhaps 80 percent of syphilitics, the disease stays latent, as if they never had it. The longer the disease is latent, the longer it is likely to stay that way...

"It was this latent stage that health authorities wanted to investigate in 1932. Consequently, when they examined 410 syphilitic blacks for possible inclusion in the study, they found many were in the early, infectious stage, and rejected them as candidates. They turned over no fewer than 178 for the standard arsenic treatment, and kept 140 for the study...

"A black nurse named Eunice Rivers ran the program...

"The outset of the program was therefore entirely unobjectionable. The men had already entered the latency stage of syphilis, for which the standard and largely ineffective cure of the day was no good at all. Foregoing that was no hardship, and in exchange they got free medical checkups and the benefits of Nurse Rivers' kind attention. The authorities at Booker T. Washington's Tuskegee Institute blessed the study...

"By the mid-1950s, however, penicillin became available as a standard cure for syphilis. Should not the Public Health Service have stopped the study and treated the men? Wasn't it 'racist' not to?

"No. By the 1950s, the men had been infected for 20 to 25 years. Some number had died of heart disease probably brought on by tertiary syphilis, but for those who were still alive in the 1950s, the disease had very likely run its course. Ninety men were still part of the program at the time of the last examination in 1963. Penicillin treatment, even when it first became available, would probably have done them no good..."

And so on.

Please do read the whole thing.

Bottom line: The Tuskegee Study was a reasonably defensible liberal project with lots of black staffing. Present-day liberals and African-American preachers who continue to parrot the standard narrative should not be trusted.

They're a-dodgin' for your dime.

Comments (22)

You do know that folks of certain races are more predisposed to certain types of diseases than those of other races.

It has nothing to do with "racism"; it has to do with "race" -- more specifically, the presence/absence of certain genes in a particular race.

Let me get this right: I offer your free treatment for some vague medical condition, then I don't provide you any treatment, I never tell you what your actual condition is, I actively prevent effective treatment once it becomes available, and last but not least I justify it by saying that my medical curiosity is more important than any possible advantage to your health. I can grant that initially they had good intentions and were only slightly more deceptive than modern drug trials, but it becomes a nightmare of thorny ethics after penicillin is shown effective.

Step2: did you by any chance take the time to read Shweder's piece?

"No. By the 1950s, the men had been infected for 20 to 25 years. Some number had died of heart disease probably brought on by tertiary syphilis, but for those who were still alive in the 1950s, the disease had very likely run its course. Ninety men were still part of the program at the time of the last examination in 1963. Penicillin treatment, even when it first became available, would probably have done them no good..."

That "probably" contains within it a whole wealth of problems, doesn't it?

Steve,

I read the piece, which is why I will admit that initially the study could be justified even though it did not give informed consent. Shweder's glossing over of the change in context for continuing the study after penicillin is simply wrong.

Uh, I just hope you and yours are never treated by medical workers who have these kind of (lack of) medical ethics. Amazing how dismissive you can be when it's "those people", isn't it?

So, the antibiotic "probably" wouldn't have done any good? Hello? Why didn't they try it on their guinea pigs, I mean, patients? At least TRY, and then record the results--success or failure! "Probably" means they didn't do this.

This was the kind of "experimentation" that was done, on a larger, more horrific scale, at Nazi concentration camps. Jews and others were just guinea pigs, and unless my memory fails me, they were not told the truth of what was being done to them, either. Like the Tuskegee study, the Nazi doctors had perfectly logical, scientific reasons to do what they did. Morally bankrupt and evil, but perfectly scientific--mostly.

Read the chapter on the medical experiments in Shirer's "The Rise and Fall of the
Third Reich." I can't say that I have--every time I tried to read that part of the book, I had to put it down. To date, I cannot say I finished the book, but I got far enough to know that what they did and what was done at Tuskegee are less than a hypodermic needle's width apart.

In the face of such evil, labels like "progressive", "conservative" and "liberal" would laughable if the tragedy weren't so dark. These are your brothers, and they were wronged. Did you hear yourself? You are disregarding evil (the experiments) because you say those who are ideologically opposed to you supported it back then (progressives), and it is pointed to by liberals today. So it doesn't matter. It doesn't count. Kings's X.


You don't like Obama or Wright? More power to you. But don't try to blow off a dark chapter in our nation's history just make a point. It's too close to saying something like, "well, those Jews we packed off to concentration camps aren't coming back anyway, so we might as well keep their art collections, jewels and money; they won't be back to get them." Only it's not art jewels or cash we're talking about; it's human beings, created in God's image. I thought pro-life meant all humanity. My mistake.

I guess there is no way to find out if the men in the study voted Republican or Democratic. Oh, wait, in Alabama, they couldn't have voted anyway. Never mind...

Jean, please confine your disagreements to the substance of Mr. Burton's argument, rather than imputing malice to his motives. Thank you.

Steve,
"Bottom line: The Tuskegee Study was a reasonably defensible liberal project with lots of black staffing."

Appreciate the correction of the excesses foaming within the established narrative, but color me opposed to any experiment that marry's
liberal "good intentions" to modern medicine. The dignity of the human "subject" is usually the first thing to be crushed.

Step2:

Only about 30% of men with syphilis ever proceed to the tertiary stage. This usually occurs within 1-10 years of the initial infection.

Penicillin did not became "standardised, readily available and medically approved as a cure for syphilitic infections" until well into the 1950's.

But by that time the men in the Tuskegee study had been infected for 25 years or more.

Some sources claim that it *can* take up to *decades* for tertiary syphilis to develop - but nobody seems to have good figures on how *often* this happens.

Did doctors in the 1950's believe that penicillin was still an useful treatment for patients who had been asymptomatic for decades? The only sources I can find that bother to address this question say that they did *not*.

Do you have any information that contradicts any of this? And do you have any information about how many - if any - of the men in the study proceeded to tertiary syphilis between the examination in 1952 and the final examination in 1962?

Jean:

Standards of medical ethics were very different in 1932. At that time the concept of "informed consent" had not even occured to anybody. Doctors were routinely secretive and paternalistic. The men in the Tuskegee study were treated according to the standards of the time. I can find no evidence whatsoever that they were treated differently or worse because they were black. On the contrary: as I pointed out in the original post, the study was conducted by people who were trying to do their best to *help* poor blacks. And it was carried on with the full knowledge, approval, and cooperation of the local black medical community. The guiding spirit of the whole project, and the only staff member who served throughout its duration, was the African-American nurse Eunice Rivers.

You ask: "why didn't they try [penicillin] on their...patients?" Because by the time the question arose, they didn't believe that it would do them any good. You do realize, don't you, that *even today* medical researchers don't just "try" treatments on people until they have been proven to be not only safe, but also *effective*?

Comparing Tuskegee with what went on in the Nazi concentration camps is just beyond silly.

If the experiment had been carried out by a bunch of card-carrying members of the K.K.K. who believed that blacks were sub-human, and if they had deliberately infected their subjects with the disease, and if they had then withheld medications *that they knew to be effective,* just out of idle curiosity, then you might have a point. Unfortunately, lots of people seem to believe something of this sort about the Tuskegee study. Maybe you do too. But if you do, you are, quite simply and quite totally, wrong.

I pass over the remainder of your remarks in silence. They make be blush for you.

Kevin: believe me, I sympathize - but I think you overstate the case a bit. Lots of modern medical research is potentially quite beneficial, and is mostly carried out with, if anything, somewhat exaggerated respect for "the dignity of the human 'subject.'" While interning in bioethics at the NIH, I heard people strenuously arguing against providing treatment that might have done a lot of good on the grounds that the patient was not competent to give "informed consent." It's really become something of a fetish, and in some cases I think a bit more paternalism might have been in order.

Steve,

The fetishization of informed consent is fueled by procedural liberalism's strained and dishonest attempt at moral neutrality, coupled with our culture's deification of the autonomous individual. Stripped of moral discernment and prudent judgment, our authorities now "protect" us by simply requiring; a "living will" to pull the plug on a cancer patient, a waiver of liability to perform an abortion on a 13 year old girl, or a patient release form before sending the mentally impaired out to a life on the streets of our urban centers. In the end, those who run our social laboratory, see us more as white mice than as persons made in the image of God. The episode under discussion could still occur, only covered by a better veneer.

I wish that were an overstatement.

Did doctors in the 1950's believe that penicillin was still an useful treatment for patients who had been asymptomatic for decades? The only sources I can find that bother to address this question say that they did *not*.

I found only one source, unfortunately behind a subscription wall, whose abstract indicated that whether or not to cure the late latent disease was a debatable proposition until the mid 50's. Since it is now the gold standard of care, I guess the naysayers have deleted their research in shame. Penicillin was proven effective against early stage, secondary stage, neonatal transmission, and cardiovascular syphilis by 1950. There was also research done as early as 1946 of its impact on neurosyphilis, but that article is not available online. Further, since when did preventing even a small percentage of the patients from developing tertiary symptoms become a bad thing? That is the most disturbing aspect about this whole thing, that it was more imperative to find out what information the untreated patients could yield than allowing them to be cured.

Do you have any information that contradicts any of this? And do you have any information about how many - if any - of the men in the study proceeded to tertiary syphilis between the examination in 1952 and the final examination in 1962?

Sorry, the burden of proof is on you. You need to provide a single reason why the doctors should continue to place these patients in any jeopardy after already obtaining two decades of data, or alternatively to show that none of them suffered any negative consequences from the disease after penicillin was at least a probable cure. Keep in mind that the justification for this entire study was that the treatment was very toxic and of very unclear effectiveness.

Now, back to the main point of your post, which is that because of all these misperceptions it is unreasonable for the black community to be suspicious of the medical profession. My response to that is that it was not just an omission to deceive the patients; about the disease, the lack of treatment, or any other aspect that would impact their ability to make an informed decision about their health. The patients were forbidden from knowing or receiving treatment, that is the violation of trust involved.

Step2:

The standard narrative of the Tuskegee study has been so over-hyped for so long by so many that I simply can't accept your claim that the burden of proof is on me, here.

Just look at this recent BBC story:

"Between the years of 1932 and 1972 the United States Government conducted a secret study into the effects of untreated syphilis in Macon County, Alabama, near the Tuskegee Institute, after which the study was named. The subjects of this study were poor black sharecroppers, most of whom were illiterate. The patients were chosen using a number of criteria: they weren't supposed to have been treated previously, and they couldn't be too young, because the scientists intended to watch and see how long it would take their patients to die, and they didn't want to wait too long. None of the men were told what disease they had, or that treatment was being denied to them. They were induced into cooperating with the doctors by the promise of free medical care for unrelated sickness or injuries, free hot meals on the days they visited clinics, and a burial stipend for their families when the men inevitably died." (All emphasis added).

Now, after reading Shweder's piece, does that strike you as even remotely fair?

It strikes me as an inexcusable farrago of pig-ignorance and/or stone-cold lying.

And there's a whole tsunami of such stuff out there on the internet. And it's left me unwilling to believe *anything* said by *anybody* touting the standard narrative that isn't fully supported by reliable citations.

I've spent the last couple of days searching for any real evidence that the Tuskegee study left anybody at all the least bit worse off then he would have been if the study had never taken place. And, so far, I've come up with nothing. Nothing. Nothing.

The fetishization of informed consent is fueled by procedural liberalism's strained and dishonest attempt at moral neutrality, coupled with our culture's deification of the autonomous individual.

Partly. It's also fueled by the fear of liability in our sue happy culture.

Steve Burton, good post and excellent point about medical standards in 1932, or earlier.

What would Oliver Wendell Holmes have thought, "three generations of imbeciles are enough", a different medical issue but not unreflective of much of opinion of the time.

There is an unfortunate tendency towards granting ourselves a moral superiority based on an historical second guessing, a we know better kind of thing. Some measure of modesty may be in order, how may we be judged in the future for medical & research practices that needn't be mentioned at the moment? Practices that are favored by some still writing and fuming about Tuskegee.

"Some measure of modesty may be in order,"

Indeed. No more so than in the area of medicine and noble intentions. Today's practices are on the same moral continuum as what allegedly happened at Tuskegee.

The key fact here is that it was not just evil white people causing poor blacks to suffer as guinea pigs. Whatever its merits, the project was biracial in execution. The blacks involved in running the study didn't object to the paternalistic paradigm anymore than the whites.

Steve,


I've spent the last couple of days searching for any real evidence that the Tuskegee study left anybody at all the least bit worse off then he would have been if the study had never taken place. And, so far, I've come up with nothing. Nothing. Nothing.

A large number of the wives and children were infected by these ignorant men, mostly dirt poor sharecroppers with little education.

http://www.tuskegee.edu/Global/Story.asp?s=1207586

According to the Ad Hoc Advisory Committee convened by the U.S. Government to report on the Tuskegee study in 1972, "noted that a 1932 study demonstrated the efficacy of then-available treatments for latent syphilis. Specifically a satisfactory clinical outcome was reported “in 85% of patients with latent syphilis that were treated in contrast to 35% if no treatment is given.” And, "The Ad Hoc Committee notes that the clinical benefits of penicillin for latent and late-stage syphilis had been “clinically documented by the early 1950s.”

Just where is the evidence that "progressives" or liberals were behind the experiment? Jonah Goldberg wrote that it was launched by the New Deal, but that's not true.

Lastly,

it had the full support of black medical authorities to the end..

There is some evidence of this but that wouldn't make what they did acceptable, and I'm skeptical of just how well publicized it was, and if there where, in fact, objections never recorded.

Russ: your claim that "a 1932 study demonstrated the efficacy of then-available treatments for latent syphilis. Specifically a satisfactory clinical outcome was reported “in 85% of patients with latent syphilis that were treated in contrast to 35% if no treatment is given" directly contradicts *everything* that I've so far been able to find out about this question.

Where are you getting this from? Can you give me a link?

Steve, the information is from the Ad hoc Advisory Committee,

http://biotech.law.lsu.edu/cphl/history/reports/tuskegee/tuskegee.htm

Russ: I can only repeat that this contradicts absolutely all other information that I have come across about latent syphilis and about the treatments available in 1932.

*Everybody* else seems to agree that latent syphilis develops into tertiary syphilis in only about 30% of cases. And *everybody* else seems to agree that the treatments available in 1932 were so unsafe and so ineffective - even in the early stages of the disease - that very few patients were willing to stick with the program, and that very few of those who did received any benefit.

Which, so far as I can tell, is simply impossible to square with the claim made in that footnote.

I have looked for more information about this Moore study, but can come up with nothing. Do *you* know anything more about it, and/or about whether the Tuskegee researchers knew about it and would have or should have taken it seriously?

Some people will try to justify any injustice done to black people in this country.

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