My test subjects were composed of 399 black

            My aim with this research is to
examine the sociological basis that permitted government funded unethical human
studies in African American men spanning over forty years.  I will examine the medical profession’s
mentality amid the proposition of the need for such information, along with a
brief detailing of the nature of the study before analyzing through sociological
perspective.  I will also offer a brief
discernment of how this impacted future medical involvement in the African
American population. 

Professional
Opinion

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In
1932, the U.S. Public Health Service launched a research experiment in Macon
County, Alabama aimed at ascertaining the progression of untreated syphilis in
black males.  The test subjects were
composed of 399 black men with latent syphilis and 201 uninfected men to serve
as controls.  This study is one of the
longest running, widely accepted unethical experimentations in history,
continuing into 1972. 

Medical professionals during the time of the
experiment believed African Americans to be a primitive people, underdeveloped,
scientifically, in comparison to the white person.  By the turn of the century, Social Darwinism
provided a vindication for American racism.(Brandt, 21)  Scientists at the time speculated that these
people could not be assimilated into white culture due to their primitive
nature.  Early twentieth-century
anthropologists, ethnologists, and biologists studied African Americans to be
in a degenerative evolutionary process. 
Comparative anatomy of blacks and whites were found to have many
imperfections, such as cranial structures, widened nasal passages, projecting
jaws with receding chins, all evidence that they were the lowest of the
Darwinism hierarchy.(Brandt, 21)  This,
along with findings of overactive sex drives, enlarged genitals and an overall
lack of morality was supported by the medical profession.  It had been deemed that the African American
population’s struggle for survival was doomed and could not be helped by
education or philanthropy. 

Although it did not originate until the
1980’s, the critical race theory will provide insight into the basis of these
findings.  CRT analyzes the role of race
and racism in perpetuating social disparities between dominant and marginalized
racial groups (Hiraldo, 7).  This theory
also provides us with a look at institutional racism, which validates the
effect of discrimination against the minority through accepted standards within
the medical health profession at the time.

The Tuskegee trials aimed to evaluate the
effects of syphilis when left untreated. 
African Americans living in the rural south were found to have an
extremely high rate of venereal disease. 
It was estimated that over 50% of blacks over the age of twenty-five
were infected with syphilis.  The reason
for this was speculated to be lust and immorality, unstable families and
barbaric tendencies.  Doctors discounted
socioeconomic reasoning for health of the black population, arguing that better
medical care would not curb the evolutionary process.  Medical professionals reported a complete
lack of morality on the part of blacks and it had been said that, “Virtue in
the negro race is like angels’ visits-few and far between. In a practice of
sixteen years I have never examined a virgin negro over fourteen years of age.”(Brandt,
21) Dr. J. E. Moore, one of the nation’s leading venereologists, studied
syphilis among white population and commended treatment of the disease even
when latent for improved outcomes, but also championed the Tuskegee study
allowing African Americans to go untreated, stating that syphilis in the
African American race was an almost different disease than in whites. 

These findings were baseless in science, yet
were used to justify the unethical withholding of treatment.  Applying critical race theory to this premise
provides understanding of the quality of racial knowledge at the time. 

 

Nature
of the Study

Researchers descended upon the town of Tuskegee,
in Macon County, Alabama to select their test subjects, for it was found to
have the highest rate of syphilitic population amongst six counties surveyed. (Brandt,
22) They had the cooperation of the local hospital and its medical staff as
long as the hospital was to be recognized in the published findings.  However, when they began selecting test
subjects they encountered a number of difficulties.  The original experiment called for subjects
to be black males over the age of twenty-five. 
Few men would respond to the beckon for subjects due to fear of being
lured into a draft physical.  Black men
were untrusting of the government and unwilling to participate.  Also, the number of persons that tested
positive for syphilis were dramatically lower than what researchers originally
believed.  This incited the doctors to
begin offering treatment in return for cooperation.  The men were told that they were going to be
treated for diseases that were unspecified, given free meals and medical exams
along with burial insurance.  However,
the subjects were given treatments that were known to be ineffective or were
below the effective dosing requirement.  In
addition, doctors conducted spinal taps to determine if neuro-syphilis was
evident in the subjects.  The patients were
told that this procedure was a “special treatment” even though it was a purely
diagnostic exam.  The letter to the
subjects announcing the spinal tap read: “Some time ago you were given a
thorough examination and since that time we hope you have gotten a great deal
of treatment for bad blood. You will now be given your last chance to get a
second examination. This examination is a very special one and after it is
finished you will be given a special treatment if it is believed you are in a
condition to stand it…. REMEMBER THIS IS YOUR LAST CHANCE FOR SPECIAL FREE
TREATMENT. BE SURE TO MEET THE NURSE.” (Brandt, 24)

In 1936, it was decided that the research
originally aimed to last six months, would actually follow these men through to
their death.  Unbeknownst to the
patients, scientists planned to autopsy the individuals, furthering the
deceit.  Local doctors were informed not
to treat the subjects if they were to reach out for a second opinion.  Letters were distributed throughout the Macon
County medical community asking for cooperation in referring listed men back to
the U.S. Public Health Service if they sought treatment elsewhere. (Brandt, 24)  In 1941, a number of men were drafted into
the Army.  While
most men entering the draft were offered treatment of syphilis, the draft board
complied with a request from the USPHS curtailing medications from a list of
256 names of Tuskegee subjects. (Jones, 91,93)  While the country was moving forward from
slavery, and amidst these studies, away from segregation, which appeared to be
setting standards to address racism, at the same time African Americans were
being marginalized by the government and healthcare system. 

The Tuskegee Trials continued into 1972,
ending amidst controversy after gaining the attention of a national publication.  Despite racial concerns being called into
question in earlier years, it was always the consensus of the USPHS and the CDC
to continue in the trial, rationalizing that an opportunity as such may never
be had again and the participants were at a point when therapy would no longer
help. 

 

Ethical
and Sociological Plight. 

The Tuskegee Study propelled the nation to
examine ethical principles in research in medicine and experimentation,
especially in minority groups.  The
researchers violated a plethora of human rights starting with informed
consent.  Contrary to the urban myth, the
men were not implanted with the venereal disease.  However, they were never clearly informed of
their disease process.  In the rural
south, the term “bad blood” was widely used in the black population to describe
any host of diseases from anemia to leukemia. 
The men were enticed into the study with a special treatment for bad
blood.  Many were not aware that they
were in fact infected with syphilis or what the proper treatment course should have
been.  The matter of violation of
informed consent can also be applied to their wives or bed partners.  Being that the men were not informed of their
disease process, the women were also exposed and untreated when treatment became
widely available. 

From a medical standpoint, a few major ethical
issues were at the forefront.  One being
withholding treatment when treatment became available.  Patient health and welfare was consistently
overlooked and justified in doing so. 
Although scientists found treatment methods to be effective, it was
intentionally withheld and even obstructed when men sought care outside of the
research hospital.  Subjects were never
informed of the effectiveness of antibiotics and given the opportunity to decide
whether to continue in the trial.  Also,
although the reporting of certain venereal diseases was required by law during
the time of the study, the USPHS ignored the law, choosing to disregard the
consequences of untreated disease on public health. (Reverby, 29)  Sufficient records were never kept and it is still
unknown the number of men who died from untreated disease, as well as women
subsequently infected.  Despite the
unethical approach, the study appeared in medical literature for over 40 years.  Which draws the biggest sociological
question, why had medical professionals never questioned the morality of the
study?

It is widely believed today that the morality
of the Tuskegee study was never examined based on the nature of the subjects
involved.  Physicians and those in power,
which were predominantly white men, believed almost entirely that freedom had
mentally deteriorated the black man so that they were stricken with animalistic
sexual instincts.  In the Journal of the American Medical Association,
it was published that, “The negro springs from a southern race, and as
such his sexual appetite is strong; all of his environments stimulate this
appetite, and as a general rule his emotional type of religion certainly does
not decrease it.”(Pence, 465)  They estimated
the development of brain matter in black men to be one thousand years behind
that of the white man, with overdeveloped genitalia.  A southern medical journal proposed
castrating black men for sexual crimes, although the same was not proposed for
white men committing similar crimes. 
Doctors also argued that better care could not be brought to black
communities, believing that even the most educated of black men would not seek
care.  It was widely accepted in the
medical profession that the black race was threatened by venereal disease,
which was thought to be leading to a high rate of miscarriage and still births
in black community.  Babies were born
with lower birth weights and more likely to demise in the first year of life
than that of whites. 

Beyond the medical profession, communities
were segregated in the south and racism was widespread.  The south itself was isolated from the rest
of the nation after the end of the Civil War. 
Lynching of African Americans for crimes against whites was standard
practice and riots against blacks trying to attain employment were
commonplace.  Prejudice in the south, apathy
of the rest of the nation and skewed professional opinion, left an enduring
patrimony of wariness in the African American community.  Institutionalized racism can also be seen in
the inaction when there was a need for action and the trivialization of black
health by professionals. 

Lasting
Effects.  No scientific experiment in
history inflicted more damage on the collective psyche of black Americans than
the Tuskegee Study. (Corbie, 5)  In the
years following the national press attention, word of the tragedy spread
amongst the black population.  The news
spread via newspapers, television, and personal account.  Spread of information through personal account
and oral message accounted for misinformation amongst both black and white
members of society.  Some believed that
the men were inoculated with the syphilis virus and left to their demise, while
others understood that men who had already contracted the disease were
mistreated. 

Despite the overabundance of
misinformation, the majority of  African
Americans  understood the basic
message:  that for 40 years, the federal
government intentionally withheld treatment from men with a disease known to cause
damage to the brain, nerves, eyes, heart, blood vessels, liver, and bones.(nakedtruth.idaho.gov/syphilis)

  People had learned that a majority of the men
had died from the disease, while others went blind or insane, so that
scientists could understand what the course of the disease was when left
untreated.  Many blacks lost what little
faith they had in the government and medical community.  The Tuskegee experiments continued to have
effects on health studies over the next decades.  In the 1980’s authorities were left with no
choice but to abandon a study of HIV in black communities in the District of
Columbia, impeding the government’s efforts to control HIV in the black
community. (Thomas, Quinn, 1501) 
Similarly, in 2005, when pharmaceutical company Nitromed sought to
introduce a heart medication on the basis of race, it
was met with much of the same mistrust. 
The company sought approval for the drug, BiDil, to specifically treat
self-identified African Americans with heart disease based on the clinical
assumption that African Americans have a differing nitric oxide uptake than
that of Caucasians.(Reverby, 479) The committee meeting was met with arguments
from both sides that referred to the archives of Tuskegee and its lasting
implications.  While some championed the
drug, suggesting its approval acknowledged the racism that led to historical
denial of treatment, others proffered that the willingness to allow an unknown
biological implication to dictate treatment conjures a feeling of the rhetoric
employed by Tuskegee researchers.(Reverby, 479) 
While nitric oxide uptake has been clinically implied to differ in
blacks, scientific research on the genetic implications lacks.  Jay Cohn, the inventor of BiDil, stated in
his testimony that the reasons were unclear for the differing uptake and then went
on to claim that there are biological foundations to this response.(Reverby, 480)

In an effort to address the
suspicion and doubt lingering in the black community, President Bill. Clinton
held a public ceremony at the White House on May 16, 1997 and officially
apologized for the Tuskegee Study. Speaking to eight of Tuskegee Study
survivors, and three family representatives who had been brought to the White
House, Clinton delivered an apology that constituted a masterly performance of
politics to attempt to facilitate the healing process within the black community,

“To our African American
citizens, I am sorry that your federal government orchestrated a study so
clearly racist. That can never be allowed to happen again. It is against
everything our country stands for and what we must stand against is what it
was. So let us resolve to hold forever in our hearts and minds the memory of a
time not long ago in Macon County, Alabama, so that we can always see how
adrift we can become when the rights of any citizens are neglected, ignored and
betrayed. And let us resolve here and now to move forward together.” (cdc.gov/tuskegee/clintonp)

The President went on to
detail the building of a memorial at Tuskegee and an initiative to begin to
restore faith in the minority communities to elicit trust to restore faith in
medical research.  Despite Clinton’s best
attempt, the Tuskegee Study remains a symbol of research misconduct in which
principles of ethical treatment of minority subjects was violated.  It is also still remains a symbol of the institutionalized
racism that minorities face yet today.  Although
some solutions have addressed the problems of the Tuskegee trials, blacks are still
considered a disadvantaged minority group in government and healthcare by some sociologists.
 Despite laws regarding ethical means of conducting
human research and experimentation, many in the African American communities still
have a distrust of the healthcare system, leading to further health disparities.
 Authority and power contribute to inequality
amongst members of society in which the majority of influence is allotted to one
race.