Tuskegee Experiment

SUMMARY | MORE FACTS | SYPHILIS FACTS | AUDIO | CLINTON APOLOGY | BIBLIOGRAPHY

Summary

For forty years between 1932 and 1972, the U.S. Public Health Service (PHS) conducted an experiment on 600 black men—399 in the late stages of syphilis and 201 in a control group. These men, for the most part illiterate sharecroppers from Macon, one of the poorest counties in Alabama, were never told what disease they were suffering from or of its seriousness. Informed that they were being treated for “bad blood,” (1) their doctors had no intention of curing them of syphilis. The data for the experiment was to be collected from autopsies of the men, and they were thus deliberately left to degenerate under the ravages of tertiary syphilis, which can include tumors, heart disease, paralysis, blindness, insanity, and death. “As I see it,” one of the doctors involved explained, “we have no further interest in these patients until they die.”

Using Human Beings as Laboratory Rats

The true nature of the experiment had to be kept from the subjects to ensure their cooperation. The sharecroppers’ grossly disadvantaged lot in life made them easy to manipulate. Pleased at the prospect of free medical care—almost none of them had ever seen a doctor before—these unsophisticated and trusting men became the pawns in what James Jones, author of the excellent history on the subject, Bad Blood, identified as “the longest nontherapeutic experiment on human beings in medical history.” The study was meant to discover how syphilis affected blacks as opposed to whites—the theory being that whites experienced more neurological complications from syphilis whereas blacks were more susceptible to cardiovascular damage. How this knowledge would have changed clinical treatment of syphilis is uncertain. Although the PHS touted the study as one of great scientific merit, from the outset its actual benefits were hazy. It took almost forty years before someone involved in the study took a hard and honest look at the end results, reporting that “nothing learned will prevent, find, or cure a single case of infectious syphilis or bring us closer to our basic mission of controlling venereal disease in the United States.” When the experiment was brought to the attention of the media in 1972, news anchor Harry Reasoner described it as an experiment that “used human beings as laboratory animals in a long and inefficient study of how long it takes syphilis to kill someone.”

A Heavy Price in the Name of Bad Science

By the end of the experiment, 28 of the men had died directly of syphilis, 100 were dead of related complications, 40 of their wives had been infected, and 19 of their children had been born with congenital syphilis. How had these men been induced to endure a fatal disease in the name of science? To persuade the community to support the experiment, one of the original doctors admitted it was “necessary to carry on this study under the guise of a demonstration and provide treatment.” At first, the men were prescribed the syphilis remedies of the day—bismuth, neoarsphenamine, and mercury—but in such small amounts that only three percent showed any improvement. These token doses of medicine were good public relations and did not interfere with the true aims of the study. Eventually, all syphilis treatment was replaced with “pink medicine”—aspirin. To ensure that the men would show up for a painful and potentially dangerous spinal tap, the PHS doctors misled them with a letter full of promotional hype: “Last Chance for Special Free Treatment.” The fact that autopsies would eventually be required was also concealed. As a doctor explained, “If the colored population becomes aware that accepting free hospital care means a post-mortem, every darky will leave Macon County . . .”  Even the Surgeon General of the United States participated in enticing the men to remain in the experiment, sending them certificates of appreciation after 25 years in the study.”

Following Doctors’ Orders

It takes little imagination to ascribe racist attitudes to the white government officials who ran the experiment, but what can one make of the numerous African Americans who collaborated with them? The experiment’s name comes from the Tuskegee Institute, the black university founded by Booker T. Washington. Its affiliated hospital lent the PHS its medical facilities for the study, and other predominantly black institutions as well as local black doctors also participated. A black nurse, Eunice Rivers, was a central figure in the experiment for most of its forty years. The promise of recognition by a prestigious government agency may have obscured the troubling aspects of the study for some. A Tuskegee doctor, for example, praised “the educational advantages offered our interns and nurses as well as the added standing it will give the hospital.” Nurse Rivers explained her role as one of passive obedience: “we were taught that we never diagnosed, we never prescribed; we followed the doctor’s instructions!” It is clear that the men in the experiment trusted her and that she sincerely cared about their well-being, but her unquestioning submission to authority eclipsed her moral judgment. Even after the experiment was exposed to public scrutiny, she genuinely felt nothing ethical had been amiss.

One of the most chilling aspects of the experiment was how zealously the PHS kept these men from receiving treatment. When several nationwide campaigns to eradicate venereal disease came to Macon County, the men were prevented from participating. Even when penicillin was discovered in the 1940sóthe first real cure for syphilisóthe Tuskegee men were deliberately denied the medication. During World War II, 250 of the men registered for the draft and were consequently ordered to get treatment for syphilis, only to have the PHS exempt them. Pleased at their success, the PHS representative announced: “So far, we are keeping the known positive patients from getting treatment.”  The experiment continued in spite of the Henderson Act (1943), a public health law requiring testing and treatment for venereal disease, and in spite of the World Health Organization’s Declaration of Helsinki (1964), which specified that “informed consent” was needed for experiments involving human beings.

Blowing The Whistle

The story finally broke in the Washington Star on July 25, 1972, in an article by Jean Heller of the Associated Press. Her source was Peter Buxtun, a former PHS venereal disease interviewer and one of the few whistle blowers over the years. The PHS, however, remained unrepentant, claiming the men had been “volunteers” and “were always happy to see the doctors,” and an Alabama state health officer who had been involved claimed “somebody is trying to make a mountain out of a molehill.”

Under the glare of publicity, the government ended their experiment, and for the first time provided the men with effective medical treatment for syphilis. Fred Gray, a lawyer who had previously defended Rosa Parks and Martin Luther King Jr., filed a class action suit that provided a $10 million out-of-court settlement for the men and their families. Gray, however, named only whites and white organizations in the suit, portraying Tuskegee as a black and white case when it was in fact more complex than thatóblack doctors and institutions had been involved from beginning to end.

The PHS did not accept the media’s comparison of Tuskegee with the appalling experiments performed by Nazi doctors on their Jewish victims during World War II. Yet in addition to the medical and racist parallels, the PHS offered the same morally bankrupt defense offered at the Nuremberg trials: they claimed they were just carrying out orders, mere cogs in the wheel of the PHS bureaucracy, exempt from personal responsibility.

The study’s other justification—for the greater good of science—is equally spurious. Scientific protocol had been shoddy from the start. Since the men had in fact received some medication for syphilis in the beginning of the study, however inadequate, it thereby corrupted the outcome of a study of “untreated syphilis.”

In 1990, a survey found that 10 percent of African Americans believed that the U.S. government created AIDS as a plot to exterminate blacks, and another 20 percent could not rule out the possibility that this might be true. As preposterous and paranoid as this may sound, at one time the Tuskegee experiment must have seemed equally farfetched. Who could imagine the government, all the way up to the Surgeon General of the United States, deliberately allowing a group of its citizens to die from a terrible disease for the sake of an ill-conceived experiment? In light of this and many other shameful episodes in our history, African Americans’ widespread mistrust of the government and white society in general should not be a surprise to anyone. Bad Blood

Note

1. “Bad blood” was a local term used to describe several ailments, including syphilis, anemia, and fatigue. All quotations in the article are from James H. Jones, expanded edition, Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1993). [Text from ]http://www.infoplease.com]

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More Facts

The Tuskegee Study, which lasted for four decades but was originally intended to run for six months, had nothing to do with treatment. No new drugs were tested; neither was any effort made to establish the efficacy of old forms of treatment. It was a nontherapeutic experiment, aimed at compiling data on the effects of the spontaneous evolution of syphilis on black males. What has become clear since Jean Heller’s story broke in 1972 was that the Public Health Service (PHS) was interested in using Macon County and its black inhabitants as a laboratory for studying the long-term effects of untreated syphilis, not in treating this deadly disease.

Macon County in 1930 had a population of 27,000; 82 percent were black; a typical dwelling was a shack with dirt floor, no screens, little furniture; drinking water came from an uncovered shallow well; income averaged less than $1 a day.

In a report, Taliford Clark of the PHS explained, “Macon County is a natural laboratory; a ready-made situation. The rather low intelligence of the Negro population, depressed economic conditions, and the common promiscuous sex relations not only contribute to the spread of syphilis but the prevailing indifference with regard to treatment.”

The government doctors who participated in the study failed to obtain informed consent from the subjects in a study of disease with a known risk to human life. Instead, the PHS offered the men incentives to participate: free physical examinations, free rides to and from the clinics, hot meals on examination days, free treatment for minor ailments, and a guarantee that a burial stipend would be paid to their survivors.

“Some time ago you were given a thorough examination and since that time we hope you have gotten a great deal of treatment for bad blood. You will now be given your last chance to get a second examination. This examination is a very special one and after it is finished you will be given a special treatment if it is believed you are in condition to stand it.” (Letter from Dr. Vonderlehr, director of PHS to his patients to entice them to come for a lumbar puncture/spinal tap.)

Under examination by the press, the PHS was not able to provide a formal protocol for the experiment; in fact, one never existed. While it was obvious to the American public as a whole, PHS officials maintained that they did nothing wrong. By the time the story broke, over 100 of the infected men had died, others suffered from serious syphilis-related conditions that may have contributed to their later deaths even though penicillin, an effective treatment against syphilis, was in widespread use by 1946.

The study has become a powerful symbol of racism in medicine, ethical misconduct in human research, and government abuse of the vulnerable.

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Syphilis Facts

What is syphilis?

Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.

How is syphilis spread?

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

What are the signs and symptoms in adults?

Primary Stage
The time between infection with syphilis and the start of the first symptom can range from 10—90 days (average 21 days). The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3-6 weeks, and it will heal on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage
The second stage starts when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash also may also appear on other parts of the body with different characteristics, some of which resemble other diseases. Sometimes the rashes are so faint that they are not noticed. Even without treatment, rashes clear up on their own. In addition to rashes, second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present.

Late Syphilis

The latent (hidden) stage of syphilis begins when the secondary symptoms disappear. Without treatment, the infected person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may be serious enough to cause death.

Can a newborn get syphilis?

Depending on how long a pregnant woman has been infected, she has a good chance of having a stillbirth (syphilitic stillbirth) or of giving birth to a baby who dies shortly after birth. If not treated immediately, an infected baby may be born without symptoms but could develop them within a few weeks. These signs and symptoms can be very serious. Untreated babies may become developmentally delayed, have seizures, or die.

How is syphilis diagnosed?

A health care provider can diagnose syphilis by using dark field microscopy to examine material from infectious sores. If syphilis bacteria are present in the sore, they will show up with a characteristic appearance.

How common is syphilis?

In the United States, over 35,600 cases of syphilis were reported by health officials in 1999, including 6,650 cases of primary and secondary syphilis (a decline of 5.4% from 1998) and 556 cases of congenital syphilis in newborns. More cases occur each year than come to the attention of health officials. Of the nine states with the highest 1999 syphilis rates (2-5 times higher than the national rate of 2.5 cases per 100,000), eight were in the South. Although syphilis rates remain higher in the South than in other regions, the South had a 32% decline in the primary and secondary syphilis rate from 1997 to 1999, illustrating that the greatest improvements in disease control have taken place where syphilis incidence has been the greatest. In 1999, 25 counties accounted for 50% of all primary and secondary syphilis cases. Two hundred sixty-five counties had syphilis rates above the U.S. Public Health Service’s Healthy People 2000 objective of 4 cases per 100,000. These 265 counties (9% of the total number of counties in the U.S.) accounted for approximately 74% of the total primary and secondary syphilis cases reported in 1999.

In 1999, syphilis occurred primarily in persons aged 20 to 39, and the reported rate in men was 1.5 times greater than the rate in women. The incidence of syphilis was highest in women aged 20 to 29 years and in men 30 to 39. Some fundamental societal problems, such as poverty, inadequate access to health care, and lack of education are associated with disproportionately high levels of syphilis in certain populations. Cases of primary and secondary syphilis in 1999 had the following race or ethnicity distribution: African Americans 75%, whites 16%, Hispanics 8%, and others 1%. Syphilis reflects one of the most glaring examples of racial disparity in health status, with the rate for African Americans nearly 30 times the rate for whites.What is the link between syphilis and HIV?While the health problems caused by syphilis in adults and newborns are serious in their own right, it is now known that the genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.

Is there a cure for syphilis?

Yes! A single dose of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Larger doses are needed to cure someone who has had it for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Penicillin treatment will kill the syphilis bacterium and prevent further damage, but it will not repair any damage already done. Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested, and, if necessary, receive treatment.

Will syphilis recur?

Having had syphilis does not protect a person from getting it again. Antibodies are produced as a person reacts to the disease, and, after treatment, these antibodies may offer partial protection from getting infected again, if exposed right away. Even though there may be a short period of protection, the antibody levels naturally decrease in the blood, and people become susceptible to syphilis infection again if they are sexually exposed to syphilis sores.

How can people protect themselves against infection?

Two people who know that they are not infected and who have sex only with each other cannot contract syphilis. When someone’s syphilis status is unknown, a good defense against becoming infected during sex is to use a latex condom before beginning sex and to keep it on until the penis is withdrawn. However, condoms do not provide complete protection because syphilis sores can sometimes be on areas not covered by a condom. This is equally important for other STDs, including HIV, as well. Only lab tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Washing the genitals, urinating, or douching after sex does not prevent STDs, including syphilis. Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to see a doctor at once.

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Audio

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Clinton Apology

THE WHITE HOUSE

Office of the Press Secretary

For Immediate Release
May 16, 1997

REMARKS BY THE PRESIDENT IN APOLOGY FOR STUDY DONE IN TUSKEGEE

The East Room
2:26 P.M. EDT

THE PRESIDENT: Ladies and gentlemen, on Sunday, Mr. Shaw will celebrate his 95th birthday. (Applause.) I would like to recognize the other survivors who are here today and their families: Mr. Charlie Pollard is here. (Applause.) Mr. Carter Howard. (Applause.) Mr. Fred Simmons. (Applause.) Mr. Simmons just took his first airplane ride, and he reckons he’s about 110 years old, so I think it’s time for him to take a chance or two. (Laughter.) I’m glad he did. And Mr. Frederick Moss, thank you, sir. (Applause.)

I would also like to ask three family representatives who are here—Sam Doner is represented by his daughter, Gwendolyn Cox. Thank you, Gwendolyn. (Applause.) Ernest Hendon, who is watching in Tuskegee, is represented by his brother, North Hendon. Thank you, sir, for being here. (Applause.) And George Key is represented by his grandson, Christopher Monroe. Thank you, Chris. (Applause.)

I also acknowledge the families, community leaders, teachers and students watching today by satellite from Tuskegee. The White House is the people’s house; we are glad to have all of you here today. I thank Dr. David Satcher for his role in this. I thank Congresswoman Waters and Congressman Hilliard, Congressman Stokes, the entire Congressional Black Caucus. Dr. Satcher, members of the Cabinet who are here, Secretary Herman, Secretary Slater, members of the Cabinet who are here, Secretary Herman, Secretary Slater. A great friend of freedom, Fred Gray, thank you for fighting this long battle all these long years.

The eight men who are survivors of the syphilis study at Tuskegee are a living link to a time not so very long ago that many Americans would prefer not to remember, but we dare not forget. It was a time when our nation failed to live up to its ideals, when our nation broke the trust with our people that is the very foundation of our democracy. It is not only in remembering that shameful past that we can make amends and repair our nation, but it is in remembering that past that we can build a better present and a better future. And without remembering it, we cannot make amends and we cannot go forward.

So today America does remember the hundreds of men used in research without their knowledge and consent. We remember them and their family members. Men who were poor and African American, without resources and with few alternatives, they believed they had found hope when they were offered free medical care by the United States Public Health Service. They were betrayed.

Medical people are supposed to help when we need care, but even once a cure was discovered, they were denied help, and they were lied to by their government. Our government is supposed to protect the rights of its citizens; their rights were trampled upon. Forty years, hundreds of men betrayed, along with their wives and children, along with the community in Macon County, Alabama, the City of Tuskegee, the fine university there, and the larger African American community.

The United States government did something that was wrong—deeply, profoundly, morally wrong. It was an outrage to our commitment to integrity and equality for all our citizens.

To the survivors, to the wives and family members, the children and the grandchildren, I say what you know: No power on Earth can give you back the lives lost, the pain suffered, the years of internal torment and anguish. What was done cannot be undone. But we can end the silence. We can stop turning our heads away. We can look at you in the eye and finally say on behalf of the American people, what the United States government did was shameful, and I am sorry. (Applause.)

The American people are sorry—for the loss, for the years of hurt. You did nothing wrong, but you were grievously wronged. I apologize and I am sorry that this apology has been so long in coming. (Applause.)

To Macon County, to Tuskegee, to the doctors who have been wrongly associated with the events there, you have our apology, as well. To our African American citizens, I am sorry that your federal government orchestrated a study so clearly racist. That can never be allowed to happen again. It is against everything our country stands for and what we must stand against is what it was.

So let us resolve to hold forever in our hearts and minds the memory of a time not long ago in Macon County, Alabama, so that we can always see how adrift we can become when the rights of any citizens are neglected, ignored and betrayed. And let us resolve here and now to move forward together.

The legacy of the study at Tuskegee has reached far and deep, in ways that hurt our progress and divide our nation. We cannot be one America when a whole segment of our nation has no trust in America. An apology is the first step, and we take it with a commitment to rebuild that broken trust. We can begin by making sure there is never again another episode like this one. We need to do more to ensure that medical research practices are sound and ethical, and that researchers work more closely with communities.

Today I would like to announce several steps to help us achieve these goals. First, we will help to build that lasting memorial at Tuskegee. (Applause.) The school founded by Booker T. Washington, distinguished by the renowned scientist George Washington Carver and so many others who advanced the health and well-being of African Americans and all Americans, is a fitting site. The Department of Health and Human Services will award a planning grant so the school can pursue establishing a center for bioethics in research and health care. The center will serve as a museum of the study and support efforts to address its legacy and strengthen bioethics training.

Second, we commit to increase our community involvement so that we may begin restoring lost trust. The study at Tuskegee served to sow distrust of our medical institutions, especially where research is involved. Since the study was halted, abuses have been checked by making informed consent and local review mandatory in federally-funded and mandated research. Still, 25 years later, many medical studies have little African American participation and African American organ donors are few. This impedes efforts to conduct promising research and to provide the best health care to all our people, including African Americans. So today, I’m directing the Secretary of Health and Human Services, Donna Shalala, to issue a report in 180 days about how we can best involve communities, especially minority communities, in research and health care. You mustóevery American group must be involved in medical research in ways that are positive. We have put the curse behind us; now we must bring the benefits to all Americans. (Applause.)

Third, we commit to strengthen researchers’ training in bioethics. We are constantly working on making breakthroughs in protecting the health of our people and in vanquishing diseases. But all our people must be assured that their rights and dignity will be respected as new drugs, treatments and therapies are tested and used. So I am directing Secretary Shalala to work in partnership with higher education to prepare training materials for medical researchers. They will be available in a year. They will help researchers build on core ethical principles of respect for individuals, justice and informed consent, and advise them on how to use these principles effectively in diverse populations.

Fourth, to increase and broaden our understanding of ethical issues and clinical research, we commit to providing postgraduate fellowships to train bioethicists especially among African Americans and other minority groups. HHS will offer these fellowships beginning in September of 1998 to promising students enrolled in bioethics graduate programs.

And, finally, by executive order I am also today extending the charter of the National Bioethics Advisory Commission to October of 1999. The need for this commission is clear. We must be able to call on the thoughtful, collective wisdom of experts and community representatives to find ways to further strengthen our protections for subjects in human research.

We face a challenge in our time. Science and technology are rapidly changing our lives with the promise of making us much healthier, much more productive and more prosperous. But with these changes we must work harder to see that as we advance we don’t leave behind our conscience. No ground is gained and, indeed, much is lost if we lose our moral bearings in the name of progress.

The people who ran the study at Tuskegee diminished the stature of man by abandoning the most basic ethical precepts. They forgot their pledge to heal and repair. They had the power to heal the survivors and all the others and they did not. Today, all we can do is apologize. But you have the power, for only you—Mr. Shaw, the others who are here, the family members who are with us in Tuskegeeóonly you have the power to forgive. Your presence here shows us that you have chosen a better path than your government did so long ago. You have not withheld the power to forgive. I hope today and tomorrow every American will remember your lesson and live by it.

Thank you, and God bless you. (Applause.)

Apology for Study Done in Tuskegee

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Bibliography

PRELIMINARY BIBLIOGRAPHY ON THE TUSKEGEE STUDY OF UNTREATED SYPHILIS IN THE NEGRO MALE

Books

Gray, Fred D. The Tuskegee Syphilis Study: The Real Story and Beyond. Black Belt Press, 1998.

Johnson, Charles Spurgeon. Shadow of the Plantation. Chicago: University of Chicago Press, 1934.

Jones, James H. Bad Blood: The Tuskegee Syphilis Experiment. Collier Macmillan, 1981.

Parran, Thomas. Shadow on the Land: Syphilis. New York: Reynal & Hitchcock, 1937.

Journal Articles and a Thesis

Benedek T. G. “The ‘Tuskegee Study’ of Syphilis: Analysis of Moral versus Methodologic Aspects.” Journal of Chronic Diseases. 1 (Jan. 31, 1978): 35-50.

Bowie, Sibyl Kaye. “The Tuskegee Syphilis Study: A Case Study in Crisis Communication in Public Relations.” Master’s thesis, University of Georgia,1986.

Brandt, Allan. “Racism and Research: The Case of the Tuskegee Syphilis Study,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, edited by Judith Walzer Leavitt and Ronald L. Numbers (Madison: University of Wisconsin Press, 1985), 331-343. Originally published in the Hastings Center Report 8 (6) (Dec. 1978): 21-29.

Caplan, Arthur L. “When Evil Intrudes.” Hastings Center Report 22 (6) (Nov. 1992): 29-32.

Cave, V. G. “Proper Uses and Abuses of the Health Care Delivery System for Minorities with Special Reference to the Tuskegee Syphilis Study.” Journal of National Medical Association 67 (1) (Jan. 1975): 82-84.

Cobb, W. M. “The Tuskegee Syphilis Study.” Journal of National Medical Association 65 (4) (July 1973): 345-48.

Curran, W. J. “The Tuskegee Syphilis Study.” New England Journal of Medicine 289 (14) (Oct. 4, 1973): 730-31.

Edgar, Harold. “Outside the Community.” Hastings Center Report 22 (6) (Nov. 1992): 32-35. Discusses how the researchers did not see the participants in the study as part of their community, and how this attitude enabled the researchers to continue their study.

Fourtner, A.W., C.F. Fourtner, and C.F. Herreid. “Bad Blood—A Case Study of the Tuskegee Syphilis Project.” Journal of College Science Teaching 23 (1994): 277-85.

Gamble, Vanessa. “Under the Shadow of Tuskegee: African Americans and Health Care.” American Journal of Public Health 87 (11) (Nov. 1997): 1773-78.

Jones, James. “The Tuskegee Legacy: AIDS and the Black Community.” Hastings Center Report 22 (6) (Nov. 1992): 38-40.

Junod, Tom. “Deadly Medicine.” GQ: Gentlemen’s Quarterly 63 (6) (June 1993): 164-71.

Kampmeier, R. H. “The Tuskegee Study of Untreated Syphilis.” Southern Medical Journal 65 (10) (Oct1972): 1247-51.

—. “Final Report on the ‘Tuskegee Syphilis Study.’” Southern Medical Journal 67 (11) (Nov. 1974): 1349-53.

MacDonald, C. J. “Communications: The Contribution ofthe Tuskegee Study to Medical Knowledge.” Journal of National Medical Association 66 (1) (Jan. 1974): 1-7.

King, Patricia A. “The Dangers of Difference.” Hastings Center Report 22 (6) (Nov. 1992): 35-38. Discusses the racist criteria for the study.

Rothman, D. J. “Were Tuskegee and Willowbrook ‘Studies in Nature?’” Hastings Center Report 12 (2) (April 1982): 5-7.

Roy, B. “The Julius Rosenwald Fund Syphilis Seroprevalence Studies.” Journal of National Medical Association 88 (5) (May 1996): 315-22.

—. “The Tuskegee Syphilis Experiment: Biotechnology and the Administrative State.” Journal of National Medical Association 87 (1) (Jan. 1995): 56-67.

Savitt, Todd L. “The Use of Blacks for Medical Experimentation and Demonstration in the Old South,” Journal of Southern History 48 (Aug. 1982): 331-48.

Shick, Tom W. “Race, Class, and Medicine: ‘Bad Blood’ in Twentieth-Century America,” Journal of Ethnic Studies 10 (summer 1982): 97-105.

Shelton, Deborah L. “The Legacy of Tuskegee.” American Medical News 39 (21) (June 3, 1996): 10-14.

Smith, Susan L. “Neither Victim nor Villain: Nurse Eunice Rivers, the Tuskegee Syphilis Experiment, and Public Health Work.” Journal of Women’s History 8 (1) (spring 1996): 95-113.

Solomon, Martha. “The Rhetoric of Dehumanization: An Analysis of Medical Reports of the Tuskegee Syphilis Project.” In Critical Questions: Invention, Creativity, and the Criticism of Discourse and Media, edited by William L. Nothstine, Carole Blair, Gary A. Copeland. New York: St. Martin’s Press, 1994.

—. “The Rhetoric of Dehumanization: An Analysis of Medical Reports of the Tuskegee Syphilis Project.” Western Journal of Speech Communication 49 (4) (1985): 233-47.

Thomas, S. B. and S. C. Quinn. “The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community.” American Journal of Public Health 81 (1991): 1498-1506.

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