My aim with this research is toexamine the sociological basis that permitted government funded unethical humanstudies in African American men spanning over forty years. I will examine the medical profession’smentality amid the proposition of the need for such information, along with abrief detailing of the nature of the study before analyzing through sociologicalperspective. I will also offer a briefdiscernment of how this impacted future medical involvement in the AfricanAmerican population.
ProfessionalOpinionIn1932, the U.S. Public Health Service launched a research experiment in MaconCounty, Alabama aimed at ascertaining the progression of untreated syphilis inblack males. The test subjects werecomposed of 399 black men with latent syphilis and 201 uninfected men to serveas controls. This study is one of thelongest running, widely accepted unethical experimentations in history,continuing into 1972. Medical professionals during the time of theexperiment believed African Americans to be a primitive people, underdeveloped,scientifically, in comparison to the white person. By the turn of the century, Social Darwinismprovided a vindication for American racism.
(Brandt, 21) Scientists at the time speculated that thesepeople could not be assimilated into white culture due to their primitivenature. Early twentieth-centuryanthropologists, ethnologists, and biologists studied African Americans to bein a degenerative evolutionary process. Comparative anatomy of blacks and whites were found to have manyimperfections, such as cranial structures, widened nasal passages, projectingjaws with receding chins, all evidence that they were the lowest of theDarwinism hierarchy.
(Brandt, 21) This,along with findings of overactive sex drives, enlarged genitals and an overalllack of morality was supported by the medical profession. It had been deemed that the African Americanpopulation’s struggle for survival was doomed and could not be helped byeducation or philanthropy. Although it did not originate until the1980’s, the critical race theory will provide insight into the basis of thesefindings. CRT analyzes the role of raceand racism in perpetuating social disparities between dominant and marginalizedracial groups (Hiraldo, 7). This theoryalso provides us with a look at institutional racism, which validates theeffect of discrimination against the minority through accepted standards withinthe medical health profession at the time. The Tuskegee trials aimed to evaluate theeffects of syphilis when left untreated. African Americans living in the rural south were found to have anextremely high rate of venereal disease. It was estimated that over 50% of blacks over the age of twenty-fivewere infected with syphilis.
The reasonfor this was speculated to be lust and immorality, unstable families andbarbaric tendencies. Doctors discountedsocioeconomic reasoning for health of the black population, arguing that bettermedical care would not curb the evolutionary process. Medical professionals reported a completelack of morality on the part of blacks and it had been said that, “Virtue inthe negro race is like angels’ visits-few and far between. In a practice ofsixteen 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, studiedsyphilis among white population and commended treatment of the disease evenwhen latent for improved outcomes, but also championed the Tuskegee studyallowing African Americans to go untreated, stating that syphilis in theAfrican American race was an almost different disease than in whites. These findings were baseless in science, yetwere used to justify the unethical withholding of treatment. Applying critical race theory to this premiseprovides understanding of the quality of racial knowledge at the time. Natureof the StudyResearchers descended upon the town of Tuskegee,in Macon County, Alabama to select their test subjects, for it was found tohave the highest rate of syphilitic population amongst six counties surveyed. (Brandt,22) They had the cooperation of the local hospital and its medical staff aslong as the hospital was to be recognized in the published findings. However, when they began selecting testsubjects they encountered a number of difficulties. The original experiment called for subjectsto be black males over the age of twenty-five. Few men would respond to the beckon for subjects due to fear of beinglured into a draft physical.
Black menwere untrusting of the government and unwilling to participate. Also, the number of persons that testedpositive for syphilis were dramatically lower than what researchers originallybelieved. This incited the doctors tobegin offering treatment in return for cooperation. The men were told that they were going to betreated for diseases that were unspecified, given free meals and medical examsalong with burial insurance. However,the subjects were given treatments that were known to be ineffective or werebelow the effective dosing requirement. Inaddition, doctors conducted spinal taps to determine if neuro-syphilis wasevident in the subjects.
The patients weretold that this procedure was a “special treatment” even though it was a purelydiagnostic exam. The letter to thesubjects announcing the spinal tap read: “Some time ago you were given athorough examination and since that time we hope you have gotten a great dealof treatment for bad blood. You will now be given your last chance to get asecond examination. This examination is a very special one and after it isfinished you will be given a special treatment if it is believed you are in acondition to stand it…. REMEMBER THIS IS YOUR LAST CHANCE FOR SPECIAL FREETREATMENT.
BE SURE TO MEET THE NURSE.” (Brandt, 24)In 1936, it was decided that the researchoriginally aimed to last six months, would actually follow these men through totheir death. Unbeknownst to thepatients, scientists planned to autopsy the individuals, furthering thedeceit. Local doctors were informed notto treat the subjects if they were to reach out for a second opinion. Letters were distributed throughout the MaconCounty medical community asking for cooperation in referring listed men back tothe U.S. Public Health Service if they sought treatment elsewhere.
(Brandt, 24) In 1941, a number of men were drafted intothe Army. Whilemost men entering the draft were offered treatment of syphilis, the draft boardcomplied with a request from the USPHS curtailing medications from a list of256 names of Tuskegee subjects. (Jones, 91,93) While the country was moving forward fromslavery, and amidst these studies, away from segregation, which appeared to besetting standards to address racism, at the same time African Americans werebeing 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 intoquestion in earlier years, it was always the consensus of the USPHS and the CDCto continue in the trial, rationalizing that an opportunity as such may neverbe had again and the participants were at a point when therapy would no longerhelp.
Ethicaland Sociological Plight. The Tuskegee Study propelled the nation toexamine ethical principles in research in medicine and experimentation,especially in minority groups. Theresearchers violated a plethora of human rights starting with informedconsent. Contrary to the urban myth, themen were not implanted with the venereal disease. However, they were never clearly informed oftheir disease process. In the ruralsouth, the term “bad blood” was widely used in the black population to describeany host of diseases from anemia to leukemia.
The men were enticed into the study with a special treatment for badblood. Many were not aware that theywere in fact infected with syphilis or what the proper treatment course should havebeen. The matter of violation ofinformed consent can also be applied to their wives or bed partners.
Being that the men were not informed of theirdisease process, the women were also exposed and untreated when treatment becamewidely available. From a medical standpoint, a few major ethicalissues were at the forefront. One beingwithholding treatment when treatment became available. Patient health and welfare was consistentlyoverlooked and justified in doing so. Although scientists found treatment methods to be effective, it wasintentionally withheld and even obstructed when men sought care outside of theresearch hospital. Subjects were neverinformed of the effectiveness of antibiotics and given the opportunity to decidewhether to continue in the trial. Also,although the reporting of certain venereal diseases was required by law duringthe time of the study, the USPHS ignored the law, choosing to disregard theconsequences of untreated disease on public health. (Reverby, 29) Sufficient records were never kept and it is stillunknown the number of men who died from untreated disease, as well as womensubsequently infected.
Despite theunethical approach, the study appeared in medical literature for over 40 years. Which draws the biggest sociologicalquestion, why had medical professionals never questioned the morality of thestudy? It is widely believed today that the moralityof the Tuskegee study was never examined based on the nature of the subjectsinvolved. Physicians and those in power,which were predominantly white men, believed almost entirely that freedom hadmentally deteriorated the black man so that they were stricken with animalisticsexual instincts. In the Journal of the American Medical Association,it was published that, “The negro springs from a southern race, and assuch his sexual appetite is strong; all of his environments stimulate thisappetite, and as a general rule his emotional type of religion certainly doesnot decrease it.”(Pence, 465) They estimatedthe development of brain matter in black men to be one thousand years behindthat of the white man, with overdeveloped genitalia.
A southern medical journal proposedcastrating black men for sexual crimes, although the same was not proposed forwhite men committing similar crimes. Doctors also argued that better care could not be brought to blackcommunities, believing that even the most educated of black men would not seekcare. It was widely accepted in themedical profession that the black race was threatened by venereal disease,which was thought to be leading to a high rate of miscarriage and still birthsin black community.
Babies were bornwith lower birth weights and more likely to demise in the first year of lifethan that of whites. Beyond the medical profession, communitieswere segregated in the south and racism was widespread. The south itself was isolated from the restof the nation after the end of the Civil War.
Lynching of African Americans for crimes against whites was standardpractice and riots against blacks trying to attain employment werecommonplace. Prejudice in the south, apathyof the rest of the nation and skewed professional opinion, left an enduringpatrimony of wariness in the African American community. Institutionalized racism can also be seen inthe inaction when there was a need for action and the trivialization of blackhealth by professionals. LastingEffects. No scientific experiment inhistory inflicted more damage on the collective psyche of black Americans thanthe Tuskegee Study. (Corbie, 5) In theyears following the national press attention, word of the tragedy spreadamongst the black population. The newsspread via newspapers, television, and personal account. Spread of information through personal accountand oral message accounted for misinformation amongst both black and whitemembers of society.
Some believed thatthe men were inoculated with the syphilis virus and left to their demise, whileothers understood that men who had already contracted the disease weremistreated. Despite the overabundance ofmisinformation, the majority of AfricanAmericans understood the basicmessage: that for 40 years, the federalgovernment intentionally withheld treatment from men with a disease known to causedamage to the brain, nerves, eyes, heart, blood vessels, liver, and bones.(nakedtruth.idaho.gov/syphilis) People had learned that a majority of the menhad died from the disease, while others went blind or insane, so thatscientists could understand what the course of the disease was when leftuntreated. Many blacks lost what littlefaith they had in the government and medical community. The Tuskegee experiments continued to haveeffects on health studies over the next decades.
In the 1980’s authorities were left with nochoice but to abandon a study of HIV in black communities in the District ofColumbia, impeding the government’s efforts to control HIV in the blackcommunity. (Thomas, Quinn, 1501) Similarly, in 2005, when pharmaceutical company Nitromed sought tointroduce a heart medication on the basis of race, itwas met with much of the same mistrust. The company sought approval for the drug, BiDil, to specifically treatself-identified African Americans with heart disease based on the clinicalassumption that African Americans have a differing nitric oxide uptake thanthat of Caucasians.(Reverby, 479) The committee meeting was met with argumentsfrom both sides that referred to the archives of Tuskegee and its lastingimplications. While some championed thedrug, suggesting its approval acknowledged the racism that led to historicaldenial of treatment, others proffered that the willingness to allow an unknownbiological implication to dictate treatment conjures a feeling of the rhetoricemployed by Tuskegee researchers.(Reverby, 479) While nitric oxide uptake has been clinically implied to differ inblacks, scientific research on the genetic implications lacks. Jay Cohn, the inventor of BiDil, stated inhis testimony that the reasons were unclear for the differing uptake and then wenton to claim that there are biological foundations to this response.(Reverby, 480)In an effort to address thesuspicion and doubt lingering in the black community, President Bill.
Clintonheld a public ceremony at the White House on May 16, 1997 and officiallyapologized for the Tuskegee Study. Speaking to eight of Tuskegee Studysurvivors, and three family representatives who had been brought to the WhiteHouse, Clinton delivered an apology that constituted a masterly performance ofpolitics to attempt to facilitate the healing process within the black community,”To our African Americancitizens, I am sorry that your federal government orchestrated a study soclearly racist. That can never be allowed to happen again. It is againsteverything our country stands for and what we must stand against is what itwas. So let us resolve to hold forever in our hearts and minds the memory of atime not long ago in Macon County, Alabama, so that we can always see howadrift we can become when the rights of any citizens are neglected, ignored andbetrayed. And let us resolve here and now to move forward together.” (cdc.gov/tuskegee/clintonp)The President went on todetail the building of a memorial at Tuskegee and an initiative to begin torestore faith in the minority communities to elicit trust to restore faith inmedical research.
Despite Clinton’s bestattempt, the Tuskegee Study remains a symbol of research misconduct in whichprinciples of ethical treatment of minority subjects was violated. It is also still remains a symbol of the institutionalizedracism that minorities face yet today. Althoughsome solutions have addressed the problems of the Tuskegee trials, blacks are stillconsidered a disadvantaged minority group in government and healthcare by some sociologists. Despite laws regarding ethical means of conductinghuman research and experimentation, many in the African American communities stillhave a distrust of the healthcare system, leading to further health disparities.
Authority and power contribute to inequalityamongst members of society in which the majority of influence is allotted to onerace.