Tuskegee Syphilis Study

Background of the Study

In 1928 a Chicago-based philanthropic organization, the Julius Rosenwald Fund, approached the U.S. Public Health Service (PHS) in an effort to improve health care services and education for Black Americans in the rural South. Previously, the PHS had conducted a study in Mississippi concluding that 25% of more than 2,000 Black participants had tested positive for syphilis. On the basis of these findings, the two groups collaborated to improve syphilis treatment in the region of Mississippi where the study took place. The initial project was a success, and the PHS requested additional monies from the Rosenwald Fund to expand the project into five additional poor rural counties in Georgia, Tennessee, North Carolina, Virginia, and Alabama. Referred to as “syphilis control demonstrations,” the project was designed to first test for syphilis and later provide treatment for the disease within these Black communities. The expanded program was funded from 1929 to 1931. During that time, researchers determined the Alabama site, Macon County, had the highest rates of syphilis, 35% to 40% of those tested.

Prior to the beginning of the treatment phase of the project, the financial impact of the Depression had eliminated its philanthropic funding. The PHS no longer had the financial resources needed to develop and implement treatment programs. Rather than abandon the research, the PHS decided to modify the focus of the study from detecting and treating syphilis to studying the health effects of untreated syphilis. This “revised” study was intended to continue for 6 months to 1 year. Optimistic researchers believed that documenting the negative health effects of untreated [Page 818]syphilis would lend support for improved medical attention for Blacks and force southern legislators to fund treatment programs.

How could a project originating from such good intentions result in one of the most often cited examples of unethical research? Clearly the social and cultural beliefs of the time must be considered when analyzing the design and implementation of the revised study. During that period in U.S. history, strong beliefs about racial disparities prevailed. Specifically, Blacks were still widely believed to be physically and mentally inferior to Whites; they were segregated within society and treated as second-class citizens. The PHS, Tuskegee Institute, and other participating agencies were certainly influenced by these factors when designing and carrying out the revised study.

Renamed “The Tuskegee Study of Untreated Syphilis in the Negro Male,” the study began in 1932 and ended in 1972. The new study was designed to record the long-term effects of untreated syphilis in Black males. Research conducted in Norway on untreated syphilis in White males had been published in 1929. The researcher concluded that untreated syphilis resulted primarily in cardiovascular damage. American scientists disagreed with the findings and believed syphilis affected Blacks and Whites differently. American scientists believed untreated syphilis chiefly affected neurological systems in Whites but, due to purported lower intellectual abilities, instead chiefly affected cardiovascular systems in Blacks. It was this belief that fueled the continuation of the study.

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