Tuskegee Study

The Tuskegee Study of untreated syphilis in the African American male was conducted between 1932 and 1972. It was the longest nontherapeutic study conducted on humans in the history of medicine. When the numerous breaches of ethical behavior by researchers conducting the Tuskegee Study became known, public outcry was so great that the protection of the rights of participants in medical research were made a priority through legislation and administration.

The Tuskegee Study, conducted by the U.S. Public Health Service, included 616 participants (412 infected with syphilis and 204 controls). The study participants were low-income African American males in Macon County, Alabama, a poor community with a high prevalence of the disease. The purpose of the study was to assess the course of untreated syphilis in African American males and to compare it with that noted in the Oslo, Norway, Study (1929), a retrospective study of untreated primary and secondary syphilis in whites, which was conducted at a time when minimal treatment and no cure was available for syphilis. Other purposes of the Tuskegee Study included raising the public's consciousness of the problem of syphilis, maintaining the momentum of public health work in the area by sustaining cooperative arrangements among state and local governments and the Tuskegee Institute medical personnel, and standardization and developing invention of serologic tests for syphilis.

The researchers involved in the Tuskegee Study believed it represented high-quality research and published various articles on its findings; the idea that the study was unethical on any level was not considered. [Page 1049]Although the researchers may have had good intentions, multiple ethical violations occurred, including (1) there was no informed consent of participants, even though in 1914 the U.S. Supreme Court ruled that every adult human being of sound mind has the right to determine what is to be done with his or her own body; (2) participants were denied treatment of their disease (arsenic and bismuth were available as a treatment for syphilis at the initiation of the study, and penicillin became available as a cure for syphilis during the 1940s); (3) participants were not informed of their illness; (4) participants were not educated as to how their illness was transmitted; and (5) participants were not informed of the risks of participating in the study.

The Tuskegee Study has also been criticized as being the first to address potential biological and genetic differences as rationale for the differences in syphilis among blacks and whites rather than addressing differences in social class, environment, education level, cultural differences, and access to health care. The ramifications of the study are still apparent today with mistrust of the medical and research fields by minorities in America.

The study has been credited by some for its attempt to be culturally sensitive in its approaches to recruitment and retention of research subjects in the midst of unethical practices. Eunice Rivers, an African American nurse, was the liaison for the Public Health Service physicians and the subjects. Eunice Rivers also provided transportation to subjects along with organizing and tracking them for physical examinations.

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