What was the Tuskegee Syphilis Experiment

Introduction and Background

The Tuskegee Syphilis Experiment, or the Tuskegee Study of Untreated Syphilis in the Negro Male, was a United States Public Health Service (USPHS) study that ran from 1932-1972. This study was less of an experiment, and more of an observation, or “study in nature,” on the course of untreated, latent syphilis in Black men. This study is highly controversial—and not just based on historical hindsight. Racist assumptions about Black men, Black sexuality, and Blackness in general paved the way for these predominantly white scientists and social scientists to conduct their experiments without spending too much time on the moral or ethical quandaries involved—which included: misinformation, lying, sitting back and watching the spread of a communicable disease, denial of treatment when one became available, and even prohibiting others from providing treatment when or if these patients sought it out on their own.

In total, about 600 Black men were enrolled in this study. About 400 of them had syphilis, and the remaining 200 were the non-syphilitic control group. When, or if, a member of the control group contracted syphilis, they were simply moved from the control group to the experimental group. Macon County, Alabama, was selected as the site for this study due to findings from an earlier 1929 study backed by the Julius Rosenwald Fund on “the prevalence of syphilis” among Black men. According to this study, Macon County—of which the city of Tuskegee is the county seat—had “the highest syphilis rate of the six counties surveyed.”

In the early 20th century, other clinics and physicians had studied syphilis treatments options. Some treatment options, like mercurial ointments, were of little value, while arsenic treatment seemed to offer some relief to some syphilitic patients. Additionally, these options were only for early syphilis symptoms like inflammation. They didn’t cure syphilis, nor did they prevent some of the maladies associated with latent syphilis—like insanity, cardiovascular disease, and death. If scientists could watch syphilis as it progressed untreated, they might be able to learn from it. Furthermore, doctors in the USPHS wondered whether syphilis ran its course differently in whites than Blacks. While other scientists had not argued that these experiments should prevent treatment of disease, “the doctors who devised and directed the Tuskegee Study accepted the mainstream assumptions regarding Blacks and venereal disease. The premise that Blacks, promiscuous and lustful, would not seek or continue treatment, shaped the study. A test of untreated syphilis seemed ‘natural’ because the USPHS presumed the men would never be treated; the Tuskegee Study made that a self-fulfilling prophecy.”

The Study

In order to recruit men for their study, the doctors involved in the experiment were quick to assure their subjects that these were not draft physicals. Officials assumed most of the subjects would test positive for syphilis and lamented the wasted studies that would be necessary to locate the small number of patients who were negative. To coerce their subjects into participation, the doctors told the men they were sick and needed treatment—that they offered for free (the treatments were essentially placebos that did nothing to interfere with their study of syphilis). The men were also given hot meals regularly. Subjects experienced examinations and painful spinal taps. To keep interest, the study also offered to cover burial expenses so that they could perform autopsies when the men died of their untreated disease.

By 1936, some of the first findings from this study were shared with the American Medical Association. In 1936, “only 16 percent of the subjects gave no sign of morbidity as opposed to 61 percent of the controls. Ten years later,” their study found that the experimental group’s life expectancy was reduced by 20 percent, and by 1955, they concluded “that slightly more than 30 percent of the test group autopsied had died directly from advanced syphilitic lesions of either the cardiovascular or central nervous system.”

A U.S. public health worker drawing blood from a man as part of the Tuskegee syphilis study in Macon county, Alabama.

The Controversies:

The very premise of this study was to see how a dangerous disease progressed in a group of test subjects the doctors and scientists described as “ignorant and easily influenced.” Dr. Raymond Vonderlehr, who was directly in charge of the study in Tuskegee once stated, “Naturally, it is not my intention to let it be generally known that the main object of the present activities is the bringing of the men to necropsy.” Given these explicit desires to see a disease run its fatal course, the scientists at the helm had little interest in providing treatment once it became available—and it did. By the 1950s, penicillin was regularly and effectively used to treat syphilis in patients, but USPHS made no effort or attempt to administer penicillin to its patients. Not only that, USPHS went out of their way to ensure that their subjects were unable to get treatment elsewhere. In 1934, Vonderlehr advised individual physicians in the area to not treat the men in their study. USPHS advised a mobile VD unit to not treat their subjects when they came to Tuskegee in the 1940s, and when the men were drafted in the Army in 1941, USPHS “supplied the draft board with a list of 256 names they desired to have excluded from treatment, and the board complied.” The test subjects were already participating in a study, and may not have felt the need to seek treatment elsewhere—believing they were already getting treatment from USPHS doctors. In the 1950s and 1960s, the USPHS voted to continue with the experiment. It was only when Jean Heller broke the story for the Associated Press on July 25, 1972 that the public became aware of this study. Even when the story broke, USPHS doctors were still collecting data.

The Aftermath

In response to public outcry, the US department of Health, Education, and Welfare (HEW) began an investigation. The primary ethical concerns were whether subjects were given proper informed consent, and whether penicillin should have been administered when it was recognized as a suitable treatment for syphilis. The dozens of men who died after that time were then preventable deaths, and the infection of wives, sexual partners, and children could have been prevented as well.

While HEW believed the men participated of their own free will, the experiment was “ethically unjustified” because the doctors lied to their test subjects. Despite the clear ethical violations, other physicians were defending this study as late as 1974. Many of these defenses relied, too, on racial assumptions about the Black test subjects and their supposed unwillingness to seek medical treatment of their own. Thankfully, Heller’s expose brought this study to an end, but it is possible that this experiment taught us about racist medical discourse than it did about latent syphilis in Black men.

According to the Centers for Disease Control and Prevention (CDC), "in the summer of 1973, a class-action lawsuit was filed on behalf of the study participants and their families. In 1974, a $10 million out-of-court settlement was reached. As part of the settlement, the U.S. government promised to give lifetime medical benefits and burial services to all living participants." These benefits were expanded in 1975, and 1995 to include wives or widows and children, respectively. Though all the participants and their spouses are now deceased, there are still a handful of their offspring who are still covered by these settlements.

Additional Sources

"About the USPHS Syphilis Study," Tuskegee University, https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-usphs-syphilis-study.

Gray, Fred D. The Tuskegee Syphilis Study: The Real Story and Beyond. Montgomery: NewSouth Books, 1998.