Tuskegee Syphilis Study

Leading Up To

Antebellum Health Care Plantation owners valued employees

1860 estimated value of 4 million slaves was 2 billion dollars

Some hospitals for slaves, usually in places like New Orleans or Natchez, MS

Slaves used in medical experiments No healthcare choices– particularly reproductively Science used as a means justify inequality

“Doctrine of innate racial differences” p12 LaVeist

Leading Up To After Civil War

Federal Government set up the Freedman’s Bureau in 1865

By 1868 all but one had closed Night riders No care for freed slaves

Charities provided care to “the deserving poor, not as a service to all people in the community”; socially worthy

1896 Plessy v Ferguson rule paved the way for segregation of healthcare

Restrict Black physician education Limit community control over hospitals Exclude Black physicians from practicing with White

physicians

Provident Hospital Annual Report 1895-1896

"The hospital is intended to fulfill three purposes: - To be an institution where people of color may be attended by physicians of their own race, and secondly, that colored physicians may have an opportunity to develop themselves along the lines of specialties, and thereby, become thoroughly proficient in them, at the same time no distinction is made in regard to color and all races of people are treated promptly, and properly and Third, to establish in the near future a well organized training school for nurses where young ladies may obtain special instruction pertaining to their calling."

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Leading Up To

1900-1920sPhysician education was reformed; upper

class, white, male profession1900 seven medical schools educated

Black physiciansBy 1920 on 2 remained; Howard and MeharryMain source of Black physicians until 1960

Fear of Black physicians and encouraged community to keep separation

Flexner Report confirmed separation

Provident Hospital and Training School, Chicago

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Leading Up To

1920-1940Black physicians practiced only in Black

hospitals with Black patientsPoorest care and inferior facilities1946 Hill Burton Construction Act- proposed

by Lister Hill of AlabamaSeparate but equal facilities in Health Care

Prevailing Medical Assumptions

Diseases affected Black differently than Whites

Some kind of Health Care is better than what they had which often was nothing

Blacks were so poorly educated that they did not understand health care and being health anyway

1930s and Incidence of Syphilis

1934 for Black Adults17,700 deaths from syphilis500,000 new cases each yearPredicted that 7 million would get the

diseaseDiscrepancy between case in Blacks and

Whites so concludedDermatological CauseHereditary

Addressing the concerns

State of Alabama14 clinics175 private physicians donate a few hours

each week$2/visitSyphilis required as many as 20 visitsVery rural area had nothing

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Addressing the concerns

Rosenwald Fund1929 in conjunction with the United States

Public Health ServiceThree goals

Provide health programs for southern BlacksProvide key positions for Black health

professionalsSupport medical education and training

Addressing the concerns

Rosenwald cont’d Established syphilis treatment programs for rural

blacks One was in Macon County AL

Very poor Diet salt pork, hominy grits, cornbread and molasses and

rarely meat, veggies or milk

Rosenwald fund oversaw and sent Dr. Harris, a black to physician to assess the project

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Addressing the concerns

Dr. Taliaferro Clark had an “aha” moment! 1400 negroes admitted to treatment but only a

small number had previous treatment Near a hospital– Tuskegee Institute “In short, Macon County offered thousands of

infected Negroes who lived outside the world of modern medicine yet close to a well equipped teaching hospital that could easily double as a scientific laboratory” Clark from Bad blood : the Tuskegee syphilis experiment by Jones, J (1993)

The Players

Tuskegee Institute- medical facilitiesEunice Rivers- nurseMacon County physiciansUSPH service, AMA and the medical

communityMen of Macon County

Tuskegee Institute

Dr. Dibble agreed for the facility to provide medical servicesBlood TestSpinal Taps

In return, the physicians at Tuskegee involved, would be given co-authorship on any publications as the result of the research

Eunice Rivers

Grew up in Macon County Oldest daughter of a poor man who could

barely write his name Went to Tuskegee and became a nurse 1931 offered a job with the project She took the job and enjoyed it-”Oh, we had a

good time, We had a good time, Really and truly, when we were working with those people…….. That was the joy of my life” (Jones, Bad Blood p161)

Why did they want her?

Macon County Physicians

Asked all the physicians, both black and white, not to treat those men involved in the study

US Public Health Service

Precursor to the current CDC- Center for Disease Control

Money and personnel provided

Men of Macon County

Selected 400 men with syphilisThey were told that had “Bad Blood”They were given:

NO medicationSpinal tapsBlood test$50 toward burial expenses

So Began-1932

“The Tuskegee Study of Untreated Syphilis in the Negro Male”

The “longest know non-therapeutic experiment on humans in medical history” (Breaking the Fine Rain of Death byTownes(1998), p91

The study would end with the death of all of the participants

The Players—Why did they?

Tuskegee Institute- medical facilitiesEunice Rivers- nurseMacon County physiciansUSPH service, AMA and the medical

communityMen of Macon County

The Beginning of the END

Dr. Irwin Schatz- first medical practicioner to question the study

Peter Buxton- worked for PHS1972 Edith Lederer wrote an article1973 $1.8 billion class action suit against

the PHS, HEW (HHS), & State of Alabama; settled for $10 million

Who not named?

Responses

Tuskegee InstituteNurse RiversMedical CommunityPHSLawyers

National Apology

May 16, 1997President Bill Clinton offered a formal

apology—25 years after the conclusion

After Tuskegee

1989– vaccine on Black and Latino children; parents not informed

Polyheme Blood substitute Because the patients eligible for the study are

unlikely to be able to provide consent due to the extent and nature of their injuries, the trial will be conducted under federal regulations that allow clinical research in emergency settings using an exception from the requirement for informed consent (21 CFR 50.24). http://www.northfieldlabs.com/facts.html