Feb 16th 2021

Reflections on the Tuskegee Study and Its Moral Harm

by Sam Ben-Meir

Sam Ben-Meir is professor of philosophy and world religions at Mercy Collage in New York.


Black History Month challenges all of us to learn, reflect and understand many things about the Black American experience, among them the Tuskegee Syphilis Study. This outrage, perpetrated by the US Public Health Service, was not conducted for a year or even a decade – it went on for forty years.

Originally intended to be a six-month study, the Tuskegee experiment conducted in Macon County, Alabama, lasted from 1932 to 1972, and initially involved 600 Black American men – 399 with syphilis, 201 who did not have the disease but were part of the control group. While the men agreed to be examined and treated for “bad blood” (a local term which included anemia, fatigue and syphilis), researchers never informed them of the study or its actual purpose. It was conducted, from beginning to end, without the patients’ informed consent.

Those who were infected were never told they carried latent syphilis, and they were never treated for the disease, even after penicillin was conclusively shown by the mid-1940s to effectively treat syphilis. Not only did the scientists conducting the study withhold the antibiotic and information about it from the patients, they deliberately prevented participants from making use of syphilis treatment programs which were available in the area. As one commentator stated: “deceit was integral to the study.”

Peter Buxtun, an epidemiologist at the USPHS, filed an official protest on ethical grounds in 1966 and again in 1968 but was twice rejected. In 1972, he finally leaked information on the study to the Associated Press and only after a significant public outcry did the USPHS end the program. Studies now require informed consent, communication of diagnosis and the reporting of test results – but Tuskegee reverberates to this day, having understandably damaged the trust of many Black Americans in their medical providers and in the US government on issues relating to their healthcare.

This study was no well-kept secret.  At least thirteen reports on the experiment appeared in scientific journals; and in most of these articles, researchers would refer to their program as precisely what it was: the “Tuskegee Study of Untreated Syphilis in the Male Negro.” The first report of the study appeared in 1936, and subsequent papers followed every four to six years, including through the 1960s. For four decades, no one sounded the moral alarm. No one publicly questioned how the program was being permitted to continue with the blessing of both the USPHS and the Center for Disease Control, which even in in 1969 determined that the research should continue. Indeed, the Tuskegee experiment was a secret only to the subjects of the study—poor, sick, and largely illiterate Black Americans.

The program’s purpose was to track the natural history of untreated syphilis in Black males. When the study began in 1932, syphilis had no effective treatment; but by 1943, penicillin had been used in the US to effectively cure the disease, and yet at no point were subjects ever given the choice of quitting the study in favor of this new and promising treatment. What the patients were instead prescribed was “fairly horrific” – namely, excruciatingly painful and dangerous spinal taps, which the Tuskegee researchers referred to as “special treatment,” that in some cases led to paralysis.

During World War II, researchers actively began preventing their subjects from accessing treatment ordered under the military draft effort. Instead, patients were tempted to remain within the program with the promise of free examinations and therapy, hot meals, and an offer of burial insurance – amounting to fifty dollars to pay for a casket and grave.

As a result, these men were completely unaware that they had put their lives in the hands of doctors who not only had no intention of healing them but were committed to observing them until the final autopsy – since it was believed that an autopsy alone could scientifically confirm the study’s findings. As one researcher wrote in a 1933 letter to a colleague, “As I see, we have no further interest in these patients until they die.”

The unquestionable ethical failure of Tuskegee is one with which we must grapple, and of which we must never lose sight, lest we allow such moral disasters to repeat themselves. One way we can begin to understand the moral harm that occurred is through the Kantian principle of dignity, which our government grossly and systematically violated at Tuskegee. The principle states that a person must never be treated simply as a means, but always also as an end in and of themselves. This principle is precisely what the US government failed to uphold by adopting a purely instrumental relationship to the patients – in a word, they were not treated as people, possessed with intrinsic self-worth, and capable of self-determination.

Tuskegee had predictably tragic consequences for the men who were part of the study, a number of whom died from advanced syphilitic lesions, while others went blind and insane. Worse still, because the subjects were never told that they actually carried the sexually transmitted disease or that they were contagious, their wives also became infected. Perhaps most disturbing of all is that many of the patients’ children were consequently born with congenital syphilis. The experiment’s consequences were so far-reaching in part because the Tuskegee study was undoubtedly the single longest experiment on human beings in the history of medicine.

What makes Tuskegee so morally abhorrent is that it was, from beginning to end, a racially driven experiment that targeted a vulnerable group. If the subjects had been white, how long would the study have continued? If the subjects had been white, would the doctors have systematically deceived them and allowed them to go on year after year receiving no treatment, so that they could observe the disease take its natural and devastating course? It is an utterly implausible suggestion, because the entire study was premised on the myth of “Negro inferiority,” and that Black men possess an excessive sexual desire. As Allan M. Brandt concluded in 1978, “the Tuskegee researchers regarded their subjects as less than human.”

Yet, to this day, the Tuskegee Syphilis Study has its defenders. In 2004, Richard Shweder, a cultural anthropologist at the University of Chicago, offered a revisionist account of Tuskegee – arguing, among other things, that standards of consent were not violated because “in 1932 the concept of informed consent had not even been imagined by medical professionals.”

In point of fact, his statement is simply untrue, as Charlotte Paul and Barbara Brookes have pointed out in “The Rationalization of Unethical Research.” Richard C. Cabot, a Harvard professor of medicine, observed already in 1928, that “experimentation upon a human being without his consent and without the expectation of benefit to him is without any ethical justification.” And Cabot was certainly not the first to insist upon the necessity of informed consent in the clinical research setting, or where human experimentation is involved.

The crucial point, however, is that we cannot afford to assume that the lessons of Tuskegee will be evident to all or for all time. What occurred was a moral catastrophe that did untold harm to people who were already especially vulnerable. Recent attempts to rationalize or defend what occurred only serve to underscore how imperative it is that we continue to revisit the Tuskegee program and examine the moral implications of what took place.

Ethical codes and requirements that emerged in the wake of Tuskegee are of great importance of course – but they do not function as guarantees that grave moral lapses on the scale and scope of Tuskegee will not reoccur. Indeed, we risk repetition of such moral travesties precisely when we conclude that we have safely inoculated ourselves against them. We must remember Tuskegee, continue to reawaken and deepen our understanding of it, and honor its victims by remaining vigilant against such injustices in the future.

 

Browse articles by author

More Essays

Jun 25th 2022
EXTRACT: "Many veterans, refugees and other people who have experienced trauma and have mental health issues spend little time thinking about the future. Instead, they are narrowly focused on the negative past. However, people who have experienced trauma and developed a healthy future perspective report being better at coping with life, having fewer negative thoughts about the past, and getting better sleep compared with those who have a negative future perspective. So, instead of dwelling on the past, people who have suffered trauma should be encouraged to think about the future and set goals that help them develop hope for a good life."
Jun 8th 2022
EXTRACT: " The devastation of war is a recurring theme in Turner’s work, and unlike his contemporaries Turner is willing to forego the occasion to bolster national pride or the patriotism of its fallen heroes. In “The Field of Waterloo” (1818), Turner’s great tragic vision of war, “The…  dead of both sides lay intertwined, nearly indistinguishable surrounded by the gloom of night.” Near the bottom center there are three women. The one farthest from us is bearing a child and in her right hand a torch which illumines the sea of mangled bodies. Beside her is another woman struggling to keep a third (also with child) from collapsing outright. Turner reflects not only on the dead and dying, but on the widows and orphans that war produces."
May 19th 2022
EXTRACTS: "Thus experimental creativity could be witnessed, but not verbalized.  When five leading Abstract Expressionist painters founded an art school in New York in the late 1940s, they offered no formal courses, because, as Robert Motherwell explained, "in a basic sense art cannot be taught." ------ "Conceptual artists are ...... more inclined to use written texts to accompany their works in other genres.  In 1883, Vincent van Gogh wrote to his brother, "One of these days I will write you a letter;  I shall write it carefully and try to make it short, but say everything I think necessary."
May 17th 2022
EXTRACT: "Unfortunately, it’s common for dark triad personalities to become leaders. ..... their ruthlessness and ability to manipulate means they attain positions of power quite easily. When a “dark” leader attains power, conscientious, moral people rapidly fall away. A government operating under these conditions soon becomes what the Polish psychologist Andrzej Lobaczewski called a “pathocracy” – an administration made up of ruthless individuals devoid of integrity and morality. This happened with Donald Trump’s presidency, as the “adults in the room” gradually headed for the exit, leaving no one but staffers defined by their personal allegiance to Trump. A similar decay in standards has occurred in the UK."
May 11th 2022
EXTRACT: "The proportion of US electricity deriving from wind and solar in the month of April climbed to 20%. Thus, the renewables total was 26.5 if we add in hydro. This statistic is unprecedented."
Apr 24th 2022
EXTRACT: "Every year, around 12,000 men in the UK die from prostate cancer, but many more die with prostate cancer than from it. So knowing whether the disease is going to advance rapidly or not is important for knowing who to treat." ...... "For some years, we have known that pathogens (bacteria and viruses) can cause cancer. We know, for example, that Helicobacter pylori is associated with stomach cancer and that the human papillomavirus (HPV) can cause cervical cancer." ....... "....we have identified five types (genera) of bacteria linked to aggressive prostate cancer." ...... "We examined prostate tissue and urine samples from over 600 men with and without prostate cancer," ..... "....men who had one or more of the bacteria were nearly three times more likely to see their early stage cancer progress to advanced disease, compared with men who had none of the bacteria in their urine or prostate."
Apr 13th 2022
EXTARCTS: "Steve Jobs dreaded turning 30, because he knew it would be fatal to his creativity: "It's rare that you see an artist in his 30s or 40s able to contribute something amazing." ....... "When Ford introduced the Model T, he was 45 years old" ...... "Ford’s Model T arrived only after a series of earlier cars – Models A, B, C, K, N, R, and S." .... "Sam Walton opened Wal-Mart No. 1 in Rogers, Arkansas, at 44, and discovered “that there was much, much more business out there in small-town American than anybody, including me, had ever dreamed of.” At 53, Warren Buffett wrote in his annual letter to Berkshire Hathaway shareholders that “your chairman, always a quick study, required only 20 years to recognize how important it was to buy good businesses.” "
Mar 29th 2022
EXTRACT: ".... Christie's web site calls Shot Sage Blue Marilyn [1964], to be auctioned in May, 'among the most iconic paintings in history', " ------ "Andy Warhol's annus mirabilis was not 1964, but 1962. This is recognized both by the market and by scholars. Thus in a paper published in the Journal of Applied Economics, Simone Lenzu and I found that in all auctions held during 1965-2015, the average price of Warhol's paintings executed in 1964 was significantly lower than the average price of those he made in 1962. And in a survey of 61 textbooks of art history published during 1991- 2015, whose authors included such eminent scholars as Martin Kemp and Rosalind Krauss, we found that fully 45% of the total of 137 illustrations of Warhol's paintings were of works from 1962, compared to only 12% of works from 1964. Thus not only do collectors value Warhol's works of 1962 more highly than those of 1964, but so do scholars of art history,.... "
Mar 29th 2022
EXTRACTS:".....there is plenty of space to scale. For internet-based businesses, the addressable total market is often large. In many areas, such as software, it spans the globe. Chinese estimates indicate that the average distance between seller and buyer on e-commerce platforms is roughly 1,000 kilometers (621 miles), compared to five kilometers for a traditional retail or service business." ------- "While the internet has removed many geographical barriers, high-growth companies cannot emerge just anywhere. In fact, though such firms can be found in more countries than ever, they remain concentrated in entrepreneurial hotspots. For example, of the 24 unicorns in Germany (as of March 2022), 17 are based in Berlin and five in Munich. Of France’s top 24 unicorns, 19 are based in Paris and one in a Paris suburb." ------ "Tech entrepreneurship has become global, but its beating heart remains local."
Mar 27th 2022
EXTRACTS: " We are supposed to be living in a post-ideological era, where everyone one is a cynic, not so gullible as to believe in anything anymore, least of all in the quaint notion of objective truth. This rejection of truth as such is among the great disasters to have befallen our relations with each other and between nations.  We appear to be beyond truth’s demise – we are now witnessing its unpleasant putrefaction and decay." ------ " If we want to grasp how ideology functions in America today, there is no better place to look than at the phenomenon of Trumpism. While he may be only a symptom, Trump himself is the quintessential embodiment of America’s moral and epistemic decline. " ------ "By its disavowal of truth and perpetuation of lies for the sake of self-aggrandizement, Trumpism represents an existential threat to this country and to the future of the Republic. It is a cancer that threatens whatever is good and decent in American life. " ----- "All they know is negative freedom – freedom from – but ignore the need for positive freedom, the freedom to… as in the freedom to flourish, to realize oneself in the world; to make and re-make oneself and the world through action."
Feb 14th 2022
EXTRACT: "In the decades since its inception, there has been heavy criticism directed towards the War on Drugs. These complaints include the increased incarceration rates, the increase in the number of prisoners in jail due to nonviolent offenses, uneven sentencing guidelines often based on the drug type and race, and suggestions of a racist component in terms of who was targeted by law enforcement. Various studies show that instead of reducing crime, the strict sentencing guidelines created more criminals and undermined many of the communities most strictly targeted by law enforcement. Long sentences for non-violent offenses made it difficult for those released to find work and weakened their bonds with family and their broader community."
Feb 2nd 2022
EXTRACT: "......... there are countries that have had a relatively high number of infections but which have still managed to keep their death numbers low – countries like Japan. It’s had 17,612 infections per million people yet only 146 deaths per million. This is despite almost one in three people in Japan being over the age of 65 and so at greater risk of severe COVID (the average age of people dying from COVID is over 80). What has kept the death rate there down? A recent Japenese study has proposed an answer. It reports that the risk of people dying of COVID in Japan is related to the microbes present in their guts. "
Jan 26th 2022
EXTRACT: "Then there was a revolution. In 1964, Bob Dylan created a new kind of popular music. The simple, clear love songs ...... were replaced by complex and opaque lyrics, filled with literary allusions and symbolism. Dylan rejected the role of craftsman: "I'm an artist. I try to create art." Nor were his songs intended to be universal: "My songs were written with me in mind." "
Dec 13th 2021
EXTRACT: " We all know that Father Christmas would struggle to deliver presents to everyone around the world without the help of his magical reindeer. But why were they chosen to pull the sleigh rather than any other animal? It turns out that the biology of reindeer makes them ideal for the job. Here are five reasons why."
Dec 4th 2021
EXTRACT: "Planting more forests is a potent tool for mitigating the climate crisis, but forests are like complex machines with millions of parts. Tree planting can cause ecological damage when carried out poorly, particularly if there is no commitment to diversity of planting. Following Darwin’s thinking, there is growing awareness that the best, healthiest forests are ones with the greatest variety of trees - and trees of various ages."
Nov 19th 2021
EXTRACTS: "At a time when the struggle between authoritarianism and democracy is so intense, if not fateful for the future of democracies, NATO and the EU must warn these countries [Editor's note: Poland and Hungary, EU and NATO, Turkey NATO] that they are on the precipice of being kicked out if they do not change their governing practice. They must be required to restore the principles of democracy by upholding universal human rights and abiding the rule of law, or else they will forfeit their membership and suffer from the consequences of their crimes." ------ "A narcissistic leader, such as Trump, whose hunger for power seems to know no limit, has happily sacrificed the good of the country on the altar of his twisted ego. America’s democracy cannot be repaired unless he and those who helped him are held accountable and face the weight of the law."
Nov 18th 2021
EXTRACT: "Many people who go through intense trauma, for example, become deeper and stronger than they were before. They may even undergo a sudden and radical transformation that makes life more meaningful and fulfilling. Indeed, research shows that between half and one-third of all people experience significant personal development after traumatic events, such as bereavement, serious illness, accidents or divorce. Over time, they may feel a new sense of inner strength and confidence and gratitude for life and other people. They may develop more intimate and authentic relationships and have a wider perspective, with a clear sense of what is important in life and what isn’t. In psychology, this is referred to as “post-traumatic growth”. "
Nov 11th 2021
EXTRACT: "Notably, Murdoch thinks that really knowing or understanding another person is a difficult task: “It is a task to come to see the world as it is”. According to the Freudian psychology Murdoch subscribes to in The Sovereignty of Good, humans are prone to “fantasy” – refusing to face the truth because it can damage our fragile egos."
Nov 9th 2021
EXTRACT: "People do not believe false information because they are ignorant. There are many factors at work, but most researchers would agree that the belief in misinformation has little to do with the amount of knowledge a person possesses. Misinformation is a prime example of motivated reasoning. People tend to arrive at the conclusions they want to reach as long as they can construct seemingly reasonable justifications for these outcomes."
Oct 28th 2021
EXTRACTS: "Brood with me on the latest delay of the full release of the records pertaining to the murder of President John F. Kennedy in Dallas on November 22, 1963. That was 58 years ago." -----"Mark my words: ...... No one who remembers 1963 will live to see the US government admit the full truth about Kennedy’s murder. And the American people’s faith in democracy will continue to fade. There is only one way to prevent this, and that is to release every record, withholding nothing – and to do it now."