THE TUSKEGEE STUDY

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THE TUSKEGEE STUDY
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The Tuskegee Study Gregory E. Pence
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BACKGROUND INFORMATION

• Claude Bernard distinguished between an
  experiment in which some factor is manipulated,
  and a study in nature where what would happen
  anyway is just observed.
• Pence 1930s American medicine and earlier was
  widely racist . . . most physicians
  condescended to African American patients, held
  stereotypes about them, and sometimes used them
  as subjects of nontherapeutic experiments.
• Social Darwinism applies the notion of the
  survival of the fittest to society. Racist
  America thought that social Darwinism suggested
  that blacks would lose in a competition with
  whites. Social Darwinism is a misconception and
  misapplication of Darwins actual theory.

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A STUDY IN NATURE I

• A study in nature of a disease observes the
  natural history of a disease in an attempt to
  understand the disease and to know how to treat
  it.
• Pence The United States Public Health Service
  (USPHS) believed that a study in nature of
  syphilis was necessary because physicians needed
  to know it natural sequence of symptoms and final
  outcomes in order to recognize key changes during
  its course.
• In the early 1930s, the USPHS, with the Tuskegee
  Institute, decided merely to observe, and not to
  treat, 399 African American men in Macon County,
  Alabama who were identified to have had syphilis
  for years, but who had never been treated.

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A STUDY IN NATURE II

• The Tuskegee study then was a study in nature,
  and any subject in the study who thought that he
  was being treated and not merely observed was
  wrong.
• Pence The Tuskegee physicians saw themselves as
  ecological biologists, simply observing what
  occurred regularly and naturally.
• The physicians also thought that the subjects
  they were observing were racially inferior.
  Historian Alan Brandt There can be little doubt
  that the Tuskegee researchers regarded their
  subjects as less than human.
• And if that is what they thought then they would
  have seen no need to spend time and money on
  attempting to treat them rather than observing
  them in an attempt to better understand the
  disease.

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A STUDY IN NATURE III

• Pence The Tuskegee study was hardly a model of
  scientific research or scientific method and
  even on its own terms, as a study in nature, it
  was carried out rather haphazardly.
• Pence There was no continuity of medical
  personnel no central supervision no written
  protocols detailed plans of a scientific or
  medical experiment, treatment, or procedure and
  no physician was in charge.
• Pence There were large gaps in the study.

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A STUDY IN NATURE IV

• Pence The researchers never treated the
  subjects for syphilis.
• Pence There seems no doubt that the
  researchers also resorted to deception. To
  determine the progress of the disease, spinal
  punctures (called taps) were given to 271 of the
  399 syphilitic subjects. This is a delicate
  and uncomfortable process. Subjects were told
  they had bad blood and that the spinal taps
  were treatment for it moreover, the
  researchers sensationalized the effects of
  untreated bad blood.
• These procedures though were not treatment, but
  were merely part of the study in nature. Thus
  the men that had them were deceived.

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In Apology for the Study Done in
Tuskegee William J. Clinton
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GOVERNMENT DECEIT AND RACISM I

• Clinton Hundreds of men were used in research
  without their knowledge and consent.
• Men who were poor and African American, without
  resources and few alternatives, they believed
  they had found hope when they were offered free
  medical care by the United States Public Health
  Service. They were betrayed.
• Even once a cure was discovered, the men were
  denied help, and they were lied to by their
  government.

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GOVERNMENT DECEIT AND RACISM II

• Our government is supposed to protect the rights
  of its citizens their rights were trampled
  upon.
• The U. S. federal government orchestrated a
  study that was clearly racist.
• Such things hurt the progress of the nation and
  divides it.
• We cannot be one America when a whole segment of
  our nation has no trust in America.

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RESEARCH AND HEALTH CARE GOALS I

• Determine who best to involve communities,
  including minority communities, in research and
  health care every American must be involved in
  medical research in ways that are positive.
• Strengthen researchers training in bioethics
  so that all are assured that their rights and
  dignity will be respected as new drugs,
  treatments, and therapies are tested and used.

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RESEARCH AND HEALTH CARE GOALS II

• Commit to providing postgraduate fellowships to
  train bioethicists especially among African
  Americans and other minority groups.
• Call upon the thoughtful collective wisdom of
  experts and community representatives to find
  ways to further strengthen our protections for
  subjects in human research.
• No ground is gained and, indeed, much is lost if
  we lose our moral bearings in the name of
  progress.