Historical literature and reference sources document that the U.S. Public Health Service deliberately withheld effective syphilis treatment from study participants and, on several occasions, actively sought to prevent them from receiving outside therapy.
In 1932 the U.S. Public Health Service (USPHS) initiated an experiment in Macon County, Alabama, to determine the natural course of untreated, latent syphilis in black males. The test comprised 400 syphilitic men, as well as 200 uninfected men who served as controls. The first published report of the study appeared in 1936 with subsequent papers issued every four to six years, through the 1960s. When penicillin became widely available by the early 1950s as the preferred treatment for syphilis, the men did not receive therapy. In fact on several occasions, the USPHS actually sought to prevent treatment. Moreover, a committee at the federally operated Center for Disease Control decided in 1969 that the study should be continued. Only in 1972, when accounts of the study first appeared in the national press, did the Department of Health, Education and Welfare halt the experiment.
This year marks the 50th anniversary of the uncovering of the Tuskegee syphilis study, when the public learned that the Public Health Service (precursor of the CDC) for 40 years intentionally withheld effective therapy against a life-threatening illness in 400 African American men. In 2010, we learned that the same research group had deliberately infected hundreds of Guatemalans with syphilis and gonorrhea in the 1940s, with the goal of developing better methods for preventing these infections. Despite 15 journal articles detailing the results, no physician published a letter criticizing the Tuskegee study. Informed consent was never sought; instead, Public Health Service researchers deceived the men into believing they were receiving expert medical care. The study is an especially powerful parable because readers can identify the key players in the narrative and recognize them as exemplars of people they encounter in daily life-these flesh-and-blood characters convey the principles of research ethics more vividly than a dry account in a textbook of bioethics. The study spurred reforms leading to fundamental changes in the infrastructure of research ethics. The reason people fail to take steps to halt behavior that in retrospect everyone judges reprehensible is complex. Lack of imagination, rationalization, and institutional constraints are formidable obstacles. The central lessons from the study are the need to pause and think, reflect, and examine one's conscience; the courage to speak; and above all the willpower to act. History, although about the past, is our best defense against future errors and transgressions.
The Tuskegee Study of Untreated Syphilis in the Negro Male was an observational study on African-American males in Tuskegee, Alabama between 1932 and 1972. The U. S. Public Health Service ran this study on more than 300 people without notifying the participants about their disease nor treating them even after the introduction of penicillin. The study included recording the progress of disease and performing an autopsy on the deaths. This paper explores historical backgrounds enabled this infamous study, and discusses three driving forces behind the Tuskegee Study. First, it is important to understand that the Public Health Service was established in the U. S. Surgeon General’s office and was operated as a military organization. Amidst the development of an imperial agenda of the U.S. in the late 19th and early 20th centuries, the PHS was responsible for protecting hygiene and the superiority of “the American race” against infectious foreign elements from the borders. The U.S. Army’s experience of medical experiments in colonies and abroad was imported back to the country and formed a crucial part of the attitude and philosophy on public health. Secondly, the growing influence of eugenics and racial pathology at the time reinforced discriminative views on minorities. Progressivism was realized in the form of domestic reform and imperial pursuit at the same time. Major medical journals argued that blacks were inclined to have certain defects, especially sexually transmitted diseases like syphilis, because of their prodigal behavior and lack of hygiene. This kind of racial ideas were shared by the PHS officials who were in charge of the Tuskegee Study. Lastly, the PHS officials believed in continuing the experiment regardless of various social changes. They considered that black participants were not only poor but also ignorant of and even unwilling to undergo the treatment. When the exposure of the experiment led to the Senate investigation in 1973, the participating doctors of the PHS maintained that their study offered valuable contribution to the medical research. This paper argues that the combination of the efficiency of military medicine, progressive and imperial racial ideology, and discrimination on African-Americans resulted in the Tuskegee Syphilis Experiment.
The United States Public Health Service (USPHS or PHS) is a collection of agencies of the United States Department of Health and Human Services which manages public health, containing nine out of the department's twelve operating divisions. The assistant secretary for health oversees the PHS. The United States Public Health Service Commissioned Corps (PHSCC) is the federal uniformed service of the
In 1932, the Public Health Service, working with the Tuskegee Institute in Tuskegee, Alabama, began a study to record the natural history of syphilis in hopes of justifying treatment programs for blacks. It was titled the Tuskegee Study of Untreated Syphilis in the Negro Male.
The study initially involved 600 black men—399 with syphilis, 201 who did not have the disease. The study was conducted without the benefit of patients' informed consent. Researchers told the men they were being treated for "bad blood", a local term referring to several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last six months, the study actually went on for 40 years. Penicillin—which can be used to treat syphilis—was discovered in the 1940s. However, the study continued and treatment was never given to the subjects. Because of this, it has been called "arguably the most 'infamous' biomedical research study in U.S. history".
Office of the Assistant Secretary for Health
Public Health Service in the Federal Register
Office of the Surgeon General
Office of the Public Health Service Historian (part of the National Institutes for Health)
PHS history and WWII women's uniforms in color – World War II US women's service organizations (WAC, WAVES, ANC, NNC, USMCWR, PHS, SPARS, ARC and WASP)
The V.D. Radio Project at The WNYC Archives
Works by United States Public Health Service at Project Gutenberg
Works by or about United States Public Health Service at the Internet Archive
This article incorporates public domain material from websites or documents of the United States Department of Health and Human Services.
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