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Tuskegee Experiment: The Infamous Syphilis Study

By: Elizabeth Nix

Updated: June 13, 2023 | Original: May 16, 2017

The Tuskegee experiment began in 1932, at a time when there was no known cure for syphilis, a contagious venereal disease. After being recruited by the promise of free medical care, 600 African American men in Macon County, Alabama were enrolled in the project, which aimed to study the full progression of the disease.

The participants were primarily sharecroppers, and many had never before visited a doctor. Doctors from the U.S. Public Health Service (PHS), which was running the study, informed the participants—399 men with latent syphilis and a control group of 201 others who were free of the disease—they were being treated for bad blood, a term commonly used in the area at the time to refer to a variety of ailments.

The men were monitored by health workers but only given placebos such as aspirin and mineral supplements, despite the fact that penicillin became the recommended treatment for syphilis in 1947, some 15 years into the study. PHS researchers convinced local physicians in Macon County not to treat the participants, and instead, research was done at the Tuskegee Institute. (Now called Tuskegee University, the school was founded in 1881 with Booker T. Washington as its first teacher.)

In order to track the disease’s full progression, researchers provided no effective care as the men died, went blind or insane or experienced other severe health problems due to their untreated syphilis.

In the mid-1960s, a PHS venereal disease investigator in San Francisco named Peter Buxton found out about the Tuskegee study and expressed his concerns to his superiors that it was unethical. In response, PHS officials formed a committee to review the study but ultimately opted to continue it—with the goal of tracking the participants until all had died, autopsies were performed and the project data could be analyzed.

Buxton then leaked the story to a reporter friend, who passed it on to a fellow reporter, Jean Heller of the Associated Press. Heller broke the story in July 1972, prompting public outrage and forcing the study to finally shut down.

By that time, 28 participants had perished from syphilis, 100 more had passed away from related complications, at least 40 spouses had been diagnosed with it and the disease had been passed to 19 children at birth.

In 1973, Congress held hearings on the Tuskegee experiments, and the following year the study’s surviving participants, along with the heirs of those who died, received a $10 million out-of-court settlement. Additionally, new guidelines were issued to protect human subjects in U.S. government-funded research projects.

As a result of the Tuskegee experiment, many African Americans developed a lingering, deep mistrust of public health officials and vaccines. In part to foster racial healing, President Bill Clinton issued a 1997 apology, stating, “The United States government did something that was wrong—deeply, profoundly, morally wrong… 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.”

During his apology, Clinton announced plans for the establishment of Tuskegee University’s National Center for Bioethics in Research and Health Care .

The final study participant passed away in 2004.

Tuskegee wasn't the first unethical syphilis study. In 2010, then- President Barack Obama and other federal officials apologized for another U.S.-sponsored experiment, conducted decades earlier in Guatemala. In that study, from 1946 to 1948, nearly 700 men and women—prisoners, soldiers and mental patients—were intentionally infected with syphilis (hundreds more people were exposed to other sexually transmitted diseases as part of the study) without their knowledge or consent.

The purpose of the study was to determine whether penicillin could prevent, not just cure, syphilis infection. Some of those who became infected never received medical treatment. The results of the study, which took place with the cooperation of Guatemalan government officials, were never published. The American public health researcher in charge of the project, Dr. John Cutler, went on to become a lead researcher in the Tuskegee experiments.

Following Cutler’s death in 2003, historian Susan Reverby uncovered the records of the Guatemala experiments while doing research related to the Tuskegee study. She shared her findings with U.S. government officials in 2010. Soon afterward, Secretary of State Hillary Clinton and Secretary of Health and Human Services Kathleen Sebelius issued an apology for the STD study and President Obama called the Guatemalan president to apologize for the experiments.

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Tuskegee syphilis study

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• Academia - The Tuskegee Syphilis Study: Some Ethical Reflections
• Encyclopedia of Alabama - Tuskegee Syphilis Study
• Centers for Disease Control and Prevention - The USPHS Untreated Syphilis Study at Tuskegee
• McGill University - Office for Science and Society - 40 Years of Human Experimentation in America: The Tuskegee Study
• JamesCook University Pressbooks - An Introduction to Research Methods for Undergraduate Health Profession Students - A Case Study – The Tuskegee Syphilis Experiment
• National Center for Biotechnology Information - PubMed Central - The Tuskegee syphilis study
• Tuskegee syphilis study - Student Encyclopedia (Ages 11 and up)

Tuskegee syphilis study , American medical research project that earned notoriety for its unethical experimentation on African American patients in the rural South .

The project, which was conducted by the U.S . Public Health Service (PHS) from 1932 to 1972, examined the natural course of untreated syphilis in African American men. The research was intended to test whether syphilis caused cardiovascular damage more often than neurological damage and to determine if the natural course of syphilis in black men was significantly different from that in whites. In order to recruit participants for its study, the PHS enlisted the support of the prestigious Tuskegee Institute (now Tuskegee University ), located in Macon county, Alabama . A group of 399 infected patients and 201 uninfected control patients were recruited for the program. The subjects were all impoverished sharecroppers from Macon county. The original study was scheduled to last only six to nine months.

The subjects were not told that they had syphilis or that the disease could be transmitted through sexual intercourse . Instead, they were told that they suffered from “bad blood,” a local term used to refer to a range of ills. Treatment was initially part of the study, and some patients were administered arsenic, bismuth, and mercury. But after the original study failed to produce any useful data, it was decided to follow the subjects until their deaths, and all treatment was halted. Penicillin was denied to the infected men after that drug became available in the mid-1940s, and it was still being withheld from them 25 years later, in direct violation of government legislation that mandated the treatment of venereal disease . It is estimated that more than 100 of the subjects died of tertiary syphilis .

The Tuskegee syphilis study finally came to an end in 1972 when the program and its unethical methods were exposed in the Washington Star . A class-action suit against the federal government was settled out of court for $10 million in 1974. That same year the U.S. Congress passed the National Research Act, requiring institutional review boards to approve all studies involving human subjects. In 1997 President Bill Clinton issued a formal apology for the study (see Sidebar: Presidential Apology for the Study at Tuskegee ).

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40 years of human experimentation in america: the tuskegee study.

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Starting in 1932, 600 African American men from Macon County, Alabama were enlisted to partake in a scientific experiment on syphilis. The “Tuskegee Study of Untreated Syphilis in the Negro Male,” was conducted by the United States Public Health Service (USPHS) and involved blood tests, x-rays, spinal taps and autopsies of the subjects.

The goal was to “observe the natural history of untreated syphilis” in black populations. But the subjects were unaware of this and were simply told they were receiving treatment for bad blood. Actually, they received no treatment at all. Even after penicillin was discovered as a safe and reliable cure for syphilis, the majority of men did not receive it.

To really understand the heinous nature of the Tuskegee Experiment requires some societal context, a lot of history, and a realization of just how many times government agencies were given a chance to stop this human experimentation but didn’t.

In 1865, the ratification of the Thirteenth Amendment of the U.S. Constitution formally ended the enslavement of black Americans. But by the early 20 th century, the cultural and medical landscape of the U.S. was still built upon and inundated with racist concepts. Social Darwinism was rising, predicated on the survival of the fittest, and “ scientific racism ” (a pseudoscientific practice of using science to reinforce racial biases) was common. Many white people already thought themselves superior to blacks and science and medicine was all too happy to reinforce this hierarchy.

Before the ending of slavery, scientific racism was used to justify the African slave trade. Scientists argued that African men were uniquely fit for enslavement due to their physical strength and simple minds. They argued that slaves possessed primitive nervous systems, so did not experience pain as white people did. Enslaved African Americans in the South were claimed to suffer from mental illness at rates lower than their free Northern counterparts (thereby proving that enslavement was good for them), and slaves who ran away were said to be suffering from their own mental illness known as drapetomania.

During and after the American Civil War, African Americans were argued to be a different species from white Americans, and mixed-race children were presumed prone to many medical issues. Doctors of the time testified that the emancipation of slaves had caused the “mental, moral and physical deterioration of the black population,” observing that “virtually free of disease as slaves, they were now overwhelmed by it.” Many believed that the African Americans were doomed to extinction, and arguments were made about their physiology being unsuited for the colder climates of America (thus they should be returned to Africa).

Scientific and medical authorities of the late 19 th /early 20 th centuries held extremely harmful pseudoscientific ideas specifically about the sex drives and genitals of African Americans. It was widely believed that, while the brains of African Americans were under-evolved, their genitals were over-developed. Black men were seen to have an intrinsic perversion for white women, and all African Americans were seen as inherently immoral, with insatiable sexual appetites.

This all matters because it was with these understandings of race, sexuality and health that researchers undertook the Tuskegee study. They believed, largely due to their fundamentally flawed scientific understandings of race, that black people were extremely prone to sexually transmitted infections (like syphilis). Low birth rates and high miscarriage rates were universally blamed on STIs.

They also believed that all black people, regardless of their education, background, economic or personal situations, could not be convinced to get treatment for syphilis. Thus, the USPHS could justify the Tuskegee study, calling it a “study in nature” rather than an experiment, meant to simply observe the natural progression of syphilis within a community that wouldn’t seek treatment.

The USPHS set their study in Macon County due to estimates that 35% of its population was infected with syphilis. In 1932, the initial patients between the ages of 25 and 60 were recruited under the guise of receiving free medical care for “bad blood,” a colloquial term encompassing anemia, syphilis, fatigue and other conditions. Told that the treatment would last only six months, they received physical examinations, x-rays, spinal taps, and when they died, autopsies.

Researchers faced a lack of participants due to fears that the physical examinations were actually for the purpose of recruiting them to the military. To assuage these fears, doctors began examining women and children as well. Men diagnosed with syphilis who were of the appropriate age were recruited for the study, while others received proper treatments for their syphilis (at the time these were commonly mercury - or arsenic -containing medicines).

In 1933, researchers decided to continue the study long term. They recruited 200+ control patients who did not have syphilis (simply switching them to the syphilis-positive group if at any time they developed it). They also began giving all patients ineffective medicines ( ointments or capsules with too small doses of neoarsphenamine or mercury) to further their belief that they were being treated.

As time progressed, however, patients began to stop attending their appointments. To greater incentivize them to remain a part of the study, the USPHS hired a nurse named Eunice Rivers to drive them to and from their appointments, provide them with hot meals and deliver their medicines, services especially valuable to subjects during the Great Depression. In an effort to ensure the autopsies of their test subjects, the researchers also began covering patient’s funeral expenses.

Multiple times throughout the experiment researchers actively worked to ensure that their subjects did not receive treatment for syphilis. In 1934 they provided doctors in Macon County with lists of their subjects and asked them not to treat them. In 1940 they did the same with the Alabama Health Department. In 1941 many of the men were drafted and had their syphilis uncovered by the entrance medical exam, so the researchers had the men removed from the army, rather than let their syphilis be treated.

It was in these moments that the Tuskegee study’s true nature became clear. Rather than simply observing and documenting the natural progression of syphilis in the community as had been planned, the researchers intervened: first by telling the participants that they were being treated (a lie), and then again by preventing their participants from seeking treatment that could save their lives. Thus, the original basis for the study--that the people of Macon County would likely not seek treatment and thus could be observed as their syphilis progressed--became a self-fulfilling prophecy.

The Henderson Act was passed in 1943, requiring tests and treatments for venereal diseases to be publicly funded, and by 1947, penicillin had become the standard treatment for syphilis , prompting the USPHS to open several Rapid Treatment Centers specifically to treat syphilis with penicillin. All the while they were actively preventing 399 men from receiving the same treatments.

By 1952, however, about 30% of the participants had received penicillin anyway, despite the researchers’ best efforts. Regardless, the USPHS argued that their participants wouldn’t seek penicillin or stick to the prescribed treatment plans. They claimed that their participants, all black men, were too “stoic” to visit a doctor. In truth these men thought they were already being treated, so why would they seek out further treatment?

The researchers’ tune changed again as time went on. In 1965, they argued that it was too late to give the subjects penicillin, as their syphilis had progressed too far for the drug to help. While a convenient justification for their continuation of the study, penicillin is (and was) recommended for all stages of syphilis and could have stopped the disease’s progression in the patients.

In 1947 the Nuremberg code was written, and in 1964 the World Health Organization published their Declaration of Helsinki . Both aimed to protect humans from experimentation, but despite this, the Centers for Disease Control (which had taken over from the USPHS in controlling the study) actively decided to continue the study as late as 1969.

It wasn’t until a whistleblower, Peter Buxtun, leaked information about the study to the New York Times and the paper published it on the front page on November 16 th , 1972, that the Tuskegee study finally ended. By this time only 74 of the test subjects were still alive. 128 patients had died of syphilis or its complications, 40 of their wives had been infected, and 19 of their children had acquired congenital syphilis.

There was mass public outrage, and the National Association for the Advancement of Colored People launched a class action lawsuit against the USPHS. It settled the suit two years later for 10 million dollars and agreed to pay the medical treatments of all surviving participants and infected family members, the last of whom died in 2009.

Largely in response to the Tuskegee study, Congress passed the National Research Act in 1974, and the Office for Human Research Protections was established within the USPHS. Obtaining informed consent from all study participants became required for all research on humans, with this process overseen by Institutional Review Boards (IRBs) within academia and hospitals.

The Tuskegee study has had lasting effects on America . It’s estimated that the life expectancy of black men fell by up to 1.4 years when the study’s details came to light. Many also blame the study for impacting the willingness of black individuals to willingly participate in medical research today.

We know all about evil Nazis who experimented on prisoners. We condemn the scientists in Marvel movies who carry out tests on prisoners of war. But we’d do well to remember that America has also used its own people as lab rats . Yet to this day, no one has been prosecuted for their role in dooming 399 men to syphilis.

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What Newly Digitized Records Reveal About the Tuskegee Syphilis Study

The archival trove chronicles the extreme measures administrators took to ensure Black sharecroppers did not receive treatment for the venereal disease

Caitjan Gainty, The Conversation

In 1972, a whistleblower revealed that the United States Public Health Service (USPHS) had withheld syphilis treatment from hundreds of Black men as part of a 40-year study observing the natural course of the disease. The experiment’s subjects—the majority of whom were sharecroppers from rural Alabama—believed they were undergoing treatment for “bad blood,” a colloquial name then used for a host of conditions, including venereal diseases. Instead, they received placebos and inadequate medical care, even after penicillin emerged as an effective, readily available treatment for syphilis in the mid-1940s.

The Tuskegee syphilis study , as the experiment is often called today, began in 1932 with the recruitment of 600 Black men, 399 with syphilis and 201 without, to serve as the control group. Initially intended to run for six months, the study continued for decades. Unwitting participants lured in by the promise of free medical care, hot meals and burial insurance returned regularly for aspirin, tonics, blood draws and the occasional spinal tap. But none of these treatments does any good for syphilis, and 128 of the men ultimately died of the disease or complications related to it.

When news of the study broke, Chuck Stone , a journalist and former Tuskegee Airman , responded with an impassioned editorial, writing, “It either takes a tough constitution or a rancid morality to sit quietly by and watch 200 men die without doing anything about it. I call it genocide. Have you got a better name for it?”

Historians have had decades to pore over the study’s archives. Now, the National Library of Medicine has made a collection of those documents available for public viewing online . Anyone with an internet connection can read the primary source material—hundreds of pages of administrative records, letters and meeting minutes.

No one would expect the portrait this collection paints to be pretty or redemptive. Indeed, the study has gone down in the annals of American history as one of the most notorious, but by no means only, examples of medicine at its most prejudicial, virulent and unethical. Even with this knowledge, it is galling to read about the lengths USPHS doctors went to to ensure their patients were denied treatment.

Immobile and malleable

A 1948 history of the study makes it clear that the choice to set the experiment in the Deep South was deliberate. As the paper notes, the study followed a broader survey of syphilis in the still deeply segregated region. Sponsored by the Julius Rosenwald Fund , this earlier program aimed to assess the prevalence of the disease in several Southern counties and make sensible plans for its treatment—a starkly different goal than the Tuskegee experiment. The USPHS drew on this data to identify Macon County, Alabama, the surveyed area with the highest prevalence rate of syphilis, as the right place for a new study. Macon County also had high poverty rates and low education rates, ensuring the experiment’s subjects would be both immobile and malleable.

Another contributing factor was the presence of the venerable Tuskegee University, a historically Black college then known as the Tuskegee Institute, which had the facilities necessary to carry out the autopsies and lab work the study required.

Always a hurdle was a 1927 Alabama state statute that required medical personnel to report and treat all cases of syphilis. But enforcement of this statute was so lax that the experiment could have continued unimpeded had it not been for the 1942 draft, which led the local Selective Service Board to unmask the syphilitic status of the study’s subjects. The board’s charge was to evaluate individuals for military service, a process that required testing for venereal diseases and mandatory treatment for those affected.

R.A. Vonderlehr, the assistant surgeon general and one of the originators of the study, jumped into action to prevent the subjects from receiving treatment. He wrote urgently to local health officer Murray Smith, asking him to pull some strings to get the study subjects exempted.

“I would suggest that you confer with the chairman of the local Selective Service Board,” Vonderlehr wrote. “I believe he is an old friend of yours, and I would inform him of all the circumstances connected with the study. It is entirely probable that … he will cooperate with you in the completion of the investigation.”

Smith made good use of his social connections, managing to get the 256 remaining syphilitic subjects exempted from treatment. Likewise, when the same matter reached D.G. Gill, director of the Alabama Department of Health’s Bureau of Preventable Diseases, he requested Vonderlehr’s advice on whether to “make an exception of these few individuals” to avoid “encroaching on some of your study material.”

Effective treatment denied

Even in the postwar period, when penicillin became widely available, replacing the arguably ineffective and dangerous arsenic-based syphilis treatments that had preceded it, the study ploughed ahead , still more committed to documenting the disease than treating its sufferers. There was nothing unwitting about this denial of treatment.

Indeed, the archive shows that subjects were explicitly and repeatedly lied to for decades so they wouldn’t seek treatment for syphilis on their own. Even the form letters they received bore the hallmarks of a scam. They were invited to a “special examination” with government doctors waiting to give them “special attention” to “find out how you have been feeling and whether the treatment has improved your health.” Some of these notes were signed by Smith, who was designated just below his signature as a “special expert” to the USPHS.

And then there were the spinal taps , which were widely hated by the study subjects for the severe headaches they caused and because the men worried the procedure “robbed [them] of their procreative powers (regardless of the fact that I claim it stimulates them),” wrote physician Austin V. Deibert in a 1939 letter to Vonderlehr. 

Deibert told Vonderlehr the USPHS might have to  cancel the spinal taps  for the sake of the study’s continuation. “All in all and with no attempt at humor,” he said, he was the one with the real “headache.”

Neither World War II nor the early civil rights movement seemed to move the subsequent generations of study staff and administrators. The study was widely known in medical circles, thanks to the dozen or so articles on its findings published in prominent journals. Though outsiders started criticizing the experiment in the 1950s and ’60s, these dissenting voices were few and far between.

The first confirmed critique of the study from outside the USPHS arrived in a 1955 letter written by physician Count Gibson , who had heard a USPHS official explicitly state that the study’s subjects were not informed that treatment was being withheld.

Though Gibson was reportedly unsatisfied with the response he received, his colleagues urged him not to pursue the issue for fear that speaking out against these very powerful men might jeopardize his own career. He let it drop. In 1964, cardiologist Irwin Schatz voiced similar concerns, writing a letter that also questioned the study’s ethics. He never received a reply.

Concerns waved off

Indeed, the study directors continued to wave off concerns. As a set of meeting minutes from 1965 put it, “Racial issue was mentioned briefly. Will not affect the study. Any questions can be handled by saying these people were at the point that therapy would no longer help them. They are getting better medical care than they would under any other circumstances.”

In 1970, Anne R. Yobs, a co-author of one of the published papers, acknowledged that the research should come to an end. In a letter to the director of the Centers for Disease Control, she recommended closing the study, not because the charges of racism and unethical practice that had started to pour in were merited, but rather because “changes at the program level … in sensitivity to (potential) criticism” had forced administrators’ hands.

The study had become “an increasingly emotionally charged subject,” preventing “a rational appraisal of the situation,” wrote James B. Lucas, assistant chief of the USPHS’ Venereal Disease Branch, in a memo that same year.

By 1972, Peter Buxtun , a USPHS venereal disease officer who had spoken out against the study within the organization for years to no avail, had had enough. He went to the press.

Jean Heller, an Associated Press journalist, broke the story that July. A few months later, an ad hoc committee organized to evaluate the study finally ended it .

The Tuskegee study’s legacy has reverberated across the decades. In 1974, the NAACP successfully sued the federal government for $10 million, distributing the settlement money to the study subjects and their surviving family members. In 1997, President Bill Clinton publicly apologized to the men, acknowledging that what the USPHS had done was “deeply, profoundly, morally wrong.”

The study has had a material impact on medical outcomes within the African American community more broadly. Over the past several decades, researchers have connected the experiment to lower life expectancy among Black men due to broken trust in the health care system. More recently, the Covid-19 pandemic and subsequent vaccination efforts reignited discussions around Tuskegee’s impact on medical mistrust . Susan Reverby, the preeminent historian of the Tuskegee syphilis study, argues that the experiment’s legacy is far more complex than commonly stated, in no small part because of how it has been viewed historically. She notes that tying medical skepticism directly to Tuskegee erroneously suggests that the “reason for mistrust happened a long time ago,” thus turning attention away from the structural racism of today. As historian Alice Dreger succinctly puts it, “African Americans who distrust the health care system see plenty of reasons all around them to do so. They don’t have to look back 40 years.”

Perhaps, in this light, the most important takeaway from these digitized documents is not the starkly racist, unethical enterprise they so vividly record. It’s easy to condemn Vonderlehr, Smith, Yobs, Deibert and the countless others in the story whose actions are deeply troubling. But it’s more useful to observe how professional credentials and networks, philanthropic funding, warped notions of the greater good, and devotion to the scientific method provide cover to racism—and even prop it up. For it is often in these more quotidian spaces of life that racism in medicine persists .

This article is published in partnership with the Conversation under a Creative Commons license. Read the Conversation’s version .

Caitjan Gainty is a historian of 20th-century medicine and technology at King’s College London. She initially trained in public health and worked for several years in health care research before returning to academia to pursue a PhD in the history of medicine, which she received in 2012.

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How the Public Learned About the Infamous Tuskegee Syphilis Study

A s the fight over reforms to the American health-care system continues this week, Tuesday marks the 45th anniversary of a grim milestone in the history of health care in the U.S.

On July 25, 1972, the public learned that, over the course of the previous 40 years, a government medical experiment conducted in the Tuskegee, Ala., area had allowed hundreds of African-American men with syphilis to go untreated so that scientists could study the effects of the disease.

“Of about 600 Alabama black men who originally took part in the study, 200 or so were allowed to suffer the disease and its side effects without treatment, even after penicillin was discovered as a cure for syphilis,” the Associated Press reported , breaking the story. “[U.S. Public Health Service officials] contend that survivors of the experiment are now too old to treat for syphilis, but add that PHS doctors are giving the men thorough physical examinations every two years and are treating them for whatever other ailments and diseases they have developed.”

By the time the bombshell report came out, seven men involved had died of syphilis and more than 150 of heart failure that may or may not have been linked to syphilis. Seventy-four participants were still alive, but the government health officials who started the study had already retired. And, because of the study’s length and the way treatment options had evolved in the intervening years, it was hard to pin the blame on an individual — though easy to see that it was wrong, as TIME explained in the Aug. 7, 1972, issue:

At the time the test began, treatment for syphilis was uncertain at best, and involved a lifelong series of risky injections of such toxic substances as bismuth, arsenic and mercury. But in the years following World War II, the PHS’s test became a matter of medical morality. Penicillin had been found to be almost totally effective against syphilis, and by war’s end it had become generally available. But the PHS did not use the drug on those participating in the study unless the patients asked for it. Such a failure seems almost beyond belief, or human compassion. Recent reviews of 125 cases by the PHS’S Center for Disease Control in Atlanta found that half had syphilitic heart valve damage. Twenty-eight had died of cardiovascular or central nervous system problems that were complications of syphilis. The study’s findings on the effects of untreated syphilis have been reported periodically in medical journals for years. Last week’s shock came when an alert A.P. correspondent noticed and reported that the lack of treatment was intentional.

About three months later, the study was terminated, and the families of victims reached a $10 million settlement in 1974 (the terms of which are still being negotiated today by descendants). The last study participant passed away in 2004.

Tuskegee was chosen because it had the highest syphilis rate in the country at the time the study was started. As TIME made clear with a 1940 profile of government efforts to improve the health of African Americans, concern about that statistic had drawn the attention of the federal government and the national media. Surgeon General Thomas Parran boasted that in Macon County, Ala., where Tuskegee is located, the syphilis rate among the African-American population had been nearly 40% in 1929 but had shrunk to 10% by 1939. Serious efforts were being devoted to the cause, the story explained, though the magazine clearly missed the full story of what was going on:

In three years, experts predict, the disease will be wiped out. To root syphilis out of Macon County, the U. S. Public Health Service, the Rosenwald Fund and Booker T. Washington’s Tuskegee Institute all joined forces. Leader of the campaign is a white man, the county health officer, a former Georgia farm boy who drove a flivver through fields of mud, 36 miles a day to medical school. Last month, deep-eyed, sunburned Dr. Murray Smith began his tenth year in Macon County. “There’s not much in this job,” said he, “but the love and thanks of the people.” At first the Negroes used to gather in the gloomy courthouse in Tuskegee, while Dr. Smith in the judge’s chambers gave them tests and treatment. Later he set up weekly clinics in old churches or schoolhouses, deep in the parched cotton fields. Last fall the U. S. Public Health Service gave him a streamlined clinic truck. The truck, which has a laboratory with sink and sterilizer, a treatment nook with table and couch, is manned by two young Negro doctors and two nurses. Five days a week it rumbles over the red loam roads. At every crossroads it stops. At the toot of its horn, through the fields come men on muleback, women carrying infants, eager to be first, proud to have a blood test. Some young boys even sneak in to get a second or third test, and many come around to the truck long after they have been cured. One woman who had had six miscarriages got her syphilis cured by Dr. Smith with neoarsphenamine. Proudly she named her first plump baby Neo.

In the years following the disclosure, the Tuskegee study became a byword for the long and complicated history of medical research of African Americans without their consent. In 1997, President Bill Clinton apologized to eight of the survivors. “You did nothing wrong, but you were grievously wronged,” he said. “I apologize and I am sorry that this apology has been so long in coming.” As Clinton noted, African-American participation in medical research and organ donation remained low decades after the 1972 news broke, a fact that has often been attributed to post-Tuskegee wariness.

In 2016, a National Bureau of Economic Research paper argued that after the disclosure of the 1972 study, “life expectancy at age 45 for black men fell by up to 1.5 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men and 25% of the gap between black men and women.” However, many experts argue that the discrepancy has more to do with racial bias in the medical profession.

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What was the Tuskegee Syphilis Experiment

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.

Who was studied during the Tuskegee Syphilis Experiment?

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 a member of the control group contracted syphilis, they were 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 Tuskegee's city is the county seat—had “the highest syphilis rate of the six counties surveyed.” [1]

In the early 20th century, other clinics and physicians had studied syphilis treatment options. Like mercurial ointments, some treatment options 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 the 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.” [2]

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. 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.” [3]

Why was it controversial?

In 1934, Vonderlehr advised individual physicians in the area not to treat the men in their study. USPHS advised a mobile VD unit not to 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.” [5]

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 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. [6] Thankfully, Heller’s expose brought this study to an end. Still, it is possible that this experiment taught us about racist medical discourse than it did about latent syphilis in Black men.

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 .

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AP exposes the Tuskegee Syphilis Study: The 50th Anniversary

This 1950’s photo made available by the National Archives shows a man included in a syphilis study in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

In this 1950’s photo made available by the National Archives, a man included in a syphilis study has blood drawn in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

This image made available by the U.S. National Archives shows part of a 1940-dated document describing procedures for the distribution of autopsy results from subjects of the Tuskegee Syphilis Study conducted by the U.S. government. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP)

FILE - In this 1950’s photo made available by the National Archives, men included in a syphilis study stand for a photo in Alabama. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. (National Archives via AP, File)

FILE - In this 1950’s photo released by the National Archives, a man included in a syphilis study has blood drawn by a doctor in Tuskegee, Ala. For 40 years starting in 1932, medical workers in the segregated South withheld treatment for Black men who were unaware they had syphilis, so doctors could track the ravages of the illness and dissect their bodies afterward. Finally exposed in 1972, the study ended and the men sued, resulting in a $9 million settlement. (National Archives via AP)

Lillie Tyson Head holds a photograph of her late parents, Freddie Lee and Johnnie Mae Neal Tyson, at her home in Wirtz, Va., on Saturday, July 23, 2022. Freddie Tyson was part of the infamous “Tuskegee Study,” in which hundreds of Black men in Alabama went untreated for syphilis for decades so federal government researchers could record the disease’s affects on the body. Head says her mother was later tested, and did not have the disease. (AP Photo/Allen G. Breed)

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WASHINGTON (AP) — EDITOR’S NOTE — On July 25, 1972, Jean Heller, a reporter on The Associated Press investigative team, then called the Special Assignment Team, broke news that rocked the nation. Based on documents leaked by Peter Buxtun, a whistleblower at the U.S. Public Health Service, the then 29-year-old journalist and the only woman on the team, reported that the federal government let hundreds of Black men in rural Alabama go untreated for syphilis for 40 years in order to study the impact of the disease on the human body. Most of the men were denied access to penicillin, even when it became widely available as a cure. A public outcry ensued, and nearly four months later, the “Tuskegee Study of Untreated Syphilis in the Negro Male” came to an end. The investigation would have far-reaching implications: The men in the study filed a lawsuit that resulted in a $10 million settlement , Congress passed laws governing how subjects in research studies were treated , and more than two decades later President Bill Clinton formally apologized for the study, calling it “shameful.”

Today, the effects of the study still linger — it is often blamed for the unwillingness of some African Americans to participate in medical research.

In observance of the 50th anniversary of Heller’s groundbreaking investigation, the AP is republishing the original report and a recent interview with her and others on how the story came together.

For 40 years the U.S. Public Health Service has conducted a study in which human guinea pigs, denied proper medical treatment, have died of syphilis and its side effects.

The study was conducted to determine from autopsies what the disease does to the human body.

PHS officials responsible for initiating the experiment have long since retired. Current PHS officials, who say they have serious doubts about the morality of the study, also say that it is too late to treat syphilis in any of the study’s surviving participants.

But PHS doctors say they are rendering whatever other medical services they can now give to the survivors while the study of the disease’s effects continues.

The experiment, called the Tuskegee Study began in 1932 with about 600 black men mostly poor and uneducated, from Tuskegee, Ala., an area that had the highest syphilis rate in the nation at the time.

One-third of the group was free of syphilis; two-thirds showed evidence of the disease. In the syphilitic group, half were given the best treatment known at the time, but the other half, about 200 men, received no treatment at all for syphilis, PHS officials say.

As incentives to enter the program, the men were promised free transportation to and from hospitals, free hot lunches, free medicine for any disease other than syphilis and free burial after autopsies were performed.

The Tuskegee Study began 10 years before penicillin was discovered to be a cure for syphilis and 15 years before the drug became widely available. Yet, even after penicillin became common, and while its use probably could have helped or saved a number of the experiment subjects, the drug was denied them, Dr. J.D. Millar says.

He is chief of the venereal disease branch of the PHS’s Center for Disease Control in Atlanta and is now in charge of what remains of the Tuskegee Study. Dr. Millar said in an interview that he has serious doubts about the program.

“I think a definite serious moral problem existed when the study was undertaken, a more serious moral problem was overlooked in the post-war years when penicillin became available but was not given to these men and a moral problem still exists,” Dr. Millar said.

“But the study began when attitudes were much different on treatment and experimentation. At this point in time, with our current knowledge of treatment and the disease and the revolutionary change in approach to human experimentation, I don’t believe the program would be undertaken,” he said.

Syphilis, a highly contagious infection spread by sexual contact, can cause if untreated, bone and dental deformations, deafness, blindness, heart disease and central nervous system deterioration.

No figures were available on when the last death occurred in the program. And one official said that apparently no conscious effort was made to halt the program after it got under way.

A 1969 CDC study of 276 treated and untreated syphilitics who participated in the Tuskegee Study showed that seven had died as a direct result of syphilis. Another 154 died of heart disease.

CDC officials say they cannot determine at this late date how many of the heart disease deaths were caused by syphilis or how many additional deaths could be linked to the disease.

However, several years ago an American Medical Association study determined that untreated syphilis reduces life expectancy by 17 per cent in black men between the ages of 25 and 50, a precise description of the Tuskegee Study subjects.

Don Prince, another official in the venereal disease branch of CDC, said the Tuskegee Study had contributed some knowledge about syphilis, particularly that the morbidity and mortality rate among untreated syphilitics were not as high as previously believed.

Like Dr. Millar, Prince said he thought the study should have been halted with penicillin treatment for participants after World War II.

“I don’t know why the decision was made in 1946 not to stop the program,” Prince said. “I was unpleasantly surprised when I first came here and found out about it. It really puzzles me.”

At the beginning of 1972, according to CDC data, 74 of the untreated syphilitics were still living. All of them, Dr. Millar said, were men who did not suffer any potentially fatal side effects from their bouts with the disease.

Some of them received penicillin and antibiotics in past years for other aliments, Prince said, but none has ever received treatment for syphilis. Now, both men agree, it’s too late

Recent reviews of the Tuskegee Study by the CDC indicate that treatment now for survivors is medically questionable, Dr. Millar said. Their average age is 74 and massive penicillin therapy, with possible ill side effects, is deemed too great a risk to individuals, particularly for those whose syphilis is now dormant.

However, Dr. Millar, added there was a point in time when survivors could have been treated with at least some measure of success.

“The most critical moral issue about this experiment arises in the post-war era, the years after the end of World War II when penicillin became widely available.

“I know some were treated with penicillin for other diseases and then dropped from the program because the drug had some positive effect on the primary disease (syphilis). Looking at it now, one cannot see any reason they could not have been treated at that time.”

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Tuskegee Syphilis Experiment

The official title was “The Tuskegee Study of Untreated Syphilis in the Negro Male.” It is commonly called the Infamous Tuskegee Syphilis Experiment. Beginning in 1932 and continuing to 1972 the United States Public Health Services lured over 600 Black men, mostly sharecroppers in Tuskegee, Alabama, into this diabolical medical experiment with the promise of free health care. For 40 years, hundreds of African American men with syphilis went untreated, given placebos and other ineffective treatments, so that scientists could study the effects of the disease, even after there was a cure. None of the men who had syphilis were ever told they had it. Instead they were only told that they had “bad blood.” They were also never given penicillin, despite the fact that it had become a standard treatment by 1947.

The last survivor of the study died in 2004. This was not that long ago.

The Hippocratic Oath is used as a symbolic gesture that binds physicians to their patient’s well-being. Those who choose to take the oath makes an affirmation about treatment of those entrusted in their care, “I will do no harm or injustice to them.” It is commonly simply rephrased as, "First, do no harm." That was not the case with healthcare providers in Tuskegee, AL.

Below is an excerpt from an official admission of systematic racial discrimination issued by the United States President in 1997:

The President’s words confirmed the institutionally and racially discriminatory practices that have spanned not just decades as in this case, but centuries. Medical malfeasance is nothing new. Currently, amends are being made symbolically. In 2018, New York City finally removed an offensive statue from high atop a pedestal in Central Park. The statue depicted an infamous 19th-century gynecologist who experimented on enslaved women named Anarcha, Lucy and Betsey. He was part of a medical apartheid system that treated Black subjects as sub-human. He inflicted unimaginable torture because he operated under the ridiculous notion that Black people did not feel pain.

Remarkably, present day studies reveal that a frightening number of healthcare providers believe the myth that Black people have thicker skin and therefore need less pain management. The University of Virginia reported that racial bias partially explains research documenting how Black Americans are systemically undertreated for pain.

The Tuskegee Experiment was relatively recent and at least partially impacts the reactions to the current Novel Coronavirus pandemic. Black Americans have this recent example, in addition to a long history of other examples, explaining why it is reasonable to be suspicious of governmental medical information.

BlackPast is dedicated to providing a global audience with reliable and accurate information on the history of African America and of people of African ancestry around the world. We aim to promote greater understanding through this knowledge to generate constructive change in our society.

Tuskegee syphilis experiment (1932-1972).

Acting on the presumption that rural southern blacks were generally more promiscuous and syphilitic than whites, and without sufficient funding to establish an effective treatment program for them, doctors working with the Public Health Service (PHS) commenced a multi-year experiment in 1932. Their actions deprived 400 largely uneducated and poor African Americans in Tuskegee, Alabama of proper and reasonable treatment for syphilis, a disease whose symptoms could easily have been relieved with the application of penicillin which became available in the 1940s.  Patients were not told they had syphilis nor were they provided sufficient medication to cure them.  More than 100 men died due to lack of treatment while others suffered insanity, blindness and chronic maladies related to the disease.

The original experiment took on a life of its own as physicians, intrigued by the prospect of gathering scientific data, ignored human rights and ethical considerations and managed to extend it until 1972 when a PHS researcher Peter Buxtun revealed its history to the press.  Public exposure embarrassed the scientific community and the government and the experiment was quickly shut down.  Attorney Fred Gray initiated a lawsuit on behalf of the patients.  In an out-of-court settlement each surviving patient received medical treatment and $40,000 in compensation.  In the wake of the scandal Congress passed the National Research Act of 1974 which required more stringent oversight of studies employing human subjects.  In 1997, on behalf of the federal government, President Bill Clinton issued a formal apology to the victims of the Tuskegee Syphilis Experiment.

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Cite this entry in APA format:

Source of the author's information:.

James H. Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1993); Carol A. Heintzelman, “The Tuskegee Syphilis Study and Its Implications for the 21st Century,” at:  http://www.socialworker.com/tuskegee.htm

The Tuskegee Syphilis Experiment

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. . . . clearly racist. —President Clinton's apology for the Tuskegee Syphilis Experiment to the eight remaining survivors, May 16, 1997

For forty years between 1932 and 1972, the U.S. Public Health Service (PHS) conducted an experiment on 399 Black men in the late stages of syphilis. These men, for the most part illiterate sharecroppers from 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 at all. 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 like Laboratory Animals

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 Black people as opposed to whites—the theory being that whites experienced more neurological complications from syphilis whereas Black people 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 3 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 1940s—the first real cure for syphilis—the 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 experiment 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, 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 that—Black 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 Black people, 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. 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: The Tuskegee Syphilis Experiment, James H. Jones, expanded edition (New York: Free Press, 1993).

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The Lasting Fallout of the Tuskegee Syphilis Study

A recent paper provides evidence that the Tuskegee Syphilis Study reduced the life expectancy of African-American men.

A new paper provides evidence that the Tuskegee Syphilis Study reduced the life expectancy of African-American men —though the Tuskegee Syphilis Study ended decades ago. What was the Tuskegee Syphilis Study and why did it have lasting reverberations?

The now-infamous 1932 Tuskegee Syphilis Study  was conducted by the U.S. Public Health Service in Macon County, Alabama. During the experiment 600 impoverished black men were studied, 399 of whom had syphilis that went untreated although the health care practitioners knew of their illness. The men were never educated about syphilis, were never told of their status or treated, although treatments did exist; they were merely told they were being seen for “bad blood.” The men underwent painful procedures like spinal taps under the guise of “free healthcare,” and were “compensated” with meals and burial insurance. The intent of the study was never even to actually help the patients, but rather to examine the course of untreated dormant syphilis in black men.

Men in the study were not allowed to access other treatment services in the area. Not only did the syphilis harm the men, many of their wives and even some of their children contracted the disease. Despite the fact that codes like the Nuremberg Code of ethics was created during the Tuskegee study, and that by 1947 penicillin had become a standard, effective treatment for syphilis, the experiment continued. The study was initially intended to be six months but continued until 1972.  It did not provide as much insight on syphilis research as it did about racism in health research.

Decades after the Tuskegee Syphilis study health statistics continue to illustrate the lack of trust black Americans have for healthcare professionals. Looking at the context and history of the beliefs can help us make sense of the trends. In the 1990s a notable chunk of the African American community believed that the government created AIDS . A 1997 study illustrated cited 32.1% of the black women surveyed agreed with a statement that scientists were not trustworthy . This significantly deviates from the 4.1 % of white women in the study who agreed with the aforementioned statement. This was despite the fact that over 80% of women surveyed recognized the benefits of medical research for society. The newer findings  delve specifically into how this mistrust of the health profession has had negative impacts on black people’s health.

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While tenets of equity in healthcare research appear to be universal , there is a long history of disparity when it comes to the distribution and quality of healthcare amongst individual people. The Hippocratic oath  compels new doctors to make blanket commitments to ethics and accountability while serving humanity regardless of gender, race, religion, political affiliation, sexual orientation, nationality, or social standing . And yet this oath belies a legacy of racism in medicine.

Communities that have experienced such painful histories of being used as lab rats understandably may not be inclined to engage with healthcare providers. Beneficence and non-maleficence are cornerstones of health care provision, at least if you look at codes we like to think all healthcare providers adhere to. But fidelity was not upheld with Tuskegee and the ripple effect is evident today. Oaths do not guarantee an obligation to morality or veracity in healthcare, people do.

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You, Me And Them: Experiencing Discrimination In America

Troubling history in medical research still fresh for black americans.

Kolbi Brown (left), a program manager at Harlem Hospital in New York, helps Karen Phillips sign up to receive more information about the All of Us medical research program, during a block party outside the Abyssinian Baptist Church in Harlem. Elias Williams for NPR hide caption

Kolbi Brown (left), a program manager at Harlem Hospital in New York, helps Karen Phillips sign up to receive more information about the All of Us medical research program, during a block party outside the Abyssinian Baptist Church in Harlem.

It's a Sunday morning at the Abyssinian Baptist Church , a famous African-American church in the Harlem area of New York City. The organist plays as hundreds of worshippers stream into the pews. The Rev. Calvin O. Butts III steps to the pulpit.

"Now may we stand for our call to worship," says Butts, as he begins a powerful three-hour service filed with music, dancing, prayers and preaching. "How good and pleasant it is when all of God's children get together."

Then, about an hour into the service, Butts does something he has never done before. "I would like to introduce the Precision Medicine Initiative," he says, referring to a huge new project sponsored by the National Institutes of Health. It's now called All of Us .

"It is a landmark longitudinal research effort that aims to engage 1 million participants of all ethnicities to improve our ability to prevent and treat disease based on individual differences in lifestyle, environment and genetic makeup," Butts says.

Code Switch

How black americans see discrimination.

Why is this famous preacher at this famous African-American church talking about a big government medical study in the middle of Sunday service?

To understand that, I visit a clinic more than 30 blocks away at Columbia University. That's where I meet Anne and Steve Halliwell of Irvington, N.Y., who just volunteered for the study.

Steve Halliwell (left), a volunteer in the study, has his height measured for a second time by Dan Nguyen, a research assistant involved in the All of Us research initiative. Elias Williams for NPR hide caption

Steve Halliwell (left), a volunteer in the study, has his height measured for a second time by Dan Nguyen, a research assistant involved in the All of Us research initiative.

"Sorting out the huge variation in the human race is very, very important — and is the future of good medicine," Steve Halliwell says.

The Halliwells spend the next hour learning about the project and answering detailed questions about their lifestyles, medical history and health. They also get their blood pressure, height, weight and waists measured and have blood drawn so scientists can get a sample of their DNA.

Anne Halliwell is 67; Steve is 74. They're white. And that's the problem: White people like the Halliwells are much more likely than black people to volunteer for medical studies.

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Poll: most americans think their own group faces discrimination.

The reasons are complicated. One is that African-Americans may not get the chance as often — they just aren't asked by their doctors or don't have the time or resources to volunteer.

But another is that medical research has a long, troubled racial history. One example is the Tuskegee study , which involved doctors letting black men die from syphilis. Another example is the case of Henrietta Lacks . She was a poor African-American woman whose cancer cells scientists and drug companies used for decades without her permission. But the list of abuses is long. So the National Institutes of Health and others have been trying to overcome all that, in part by working with groups like the Abyssinian Baptist Church.

"This research is not like the Tuskegee experiment," Butts tells his congregation. "And it is supported by some members of the Henrietta Lacks family."

"It's for all ethnicities," he says. "And you can bet your life that white folk are in this. They want to know what's gonna keep 'em alive. And we ought to know what's going to keep us alive."

The Abyssinian Baptist Church partnered with researchers on the All of Us project, allowing them to set up an information table at a block party following a Sunday church service. Elias Williams for NPR hide caption

The Abyssinian Baptist Church partnered with researchers on the All of Us project, allowing them to set up an information table at a block party following a Sunday church service.

As the service ends and the parishioners file out of the church, they find a block party starting outside. At one of the folding tables lining the block, researchers from the NIH, Columbia and two other New York hospitals are answering questions.

"So what is this?" one parishioner asks. "So you're doing research — tell me about this."

"It's really a unique program," says Kolbi Brown, the project's program manager at the Harlem Hospital. "Our goal is to get participants — a diverse range of participants. So we want women. We want minorities. We want everybody. But we really want women and minorities to participate in this community, of course."

Many people at the block party are enthusiastic. "I can't wait for this program to start," says Joanne Thigpen, who lives in Harlem. "I'm very excited about it for myself and my children." But some are wary. Deborah Fleming listens patiently but then declines an invitation to sign up.

"As an African-American, I know that sometimes these things are used against us — not to our advantage," says Fleming, who lives in Dutchess County, N.Y. "So that's why I'm reticent about joining."

Deborah Fleming declined to provide her contact information during the block party. She says she hesitated because of abuses of African-Americans that have occurred during medical research in the past. Elias Williams for NPR hide caption

Deborah Fleming declined to provide her contact information during the block party. She says she hesitated because of abuses of African-Americans that have occurred during medical research in the past.

Benjamin Vines Jr., 64, who was enjoying the party down the street, has similar feelings.

"It reminds me of the Tuskegee-type thing," he says. "And in my culture, African-Americans are scared of the doctor. They don't go to the doctor until the last minute — until we're almost on our deathbed — simply because of that."

A new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that about a third of African-Americans say they have experienced discrimination at a doctor's office or health clinic. The poll also found that 1 in 5 African-Americans avoids medical care because of concern about discrimination.

At first, I thought it was only older parishioners who feel that way. Hortensia Gooding, a 45-year-old graduate student who lives in Harlem, set me straight.

"I see my friends mentioning Tuskegee all the time on Facebook," Gooding says. "There's a lot of deep, deep-seated fear and concern that black lives don't matter and that the medical community really will harm people of African descent on purpose — just for profit or just to help someone from another race."

And some people's reluctance has nothing to do with Tuskegee or Lacks. Don't forget: The study is asking volunteers to give up a sample of their DNA.

"No. Not my DNA — I can't," says 51-year-old Clerance Johnson Jr., who also lives in Harlem. "I don't know what they might use it for," he says. "It might link me to something I don't want to be linked to — any criminal activities."

So the question remains: Will the help of the Abyssinian Baptist Church — and others — be enough to overcome these deep suspicions and other obstacles that prevent minorities from participating in medical research?

This story is part of our ongoing series , "You, Me and Them: Experiencing Discrimination in America." The series is based in part on a poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. We will be releasing results from other groups — including Latinos, whites, Asian-Americans, Native Americans and LGBTQ adults — over the next several weeks.

Correction Oct. 25, 2017

A previous version of this story misspelled Dutchess County as Duchess and a reference to Abyssinian Baptist Church as Abyssian.

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Medical racism didn’t begin or end with the syphilis study at tuskegee.

The study is often blamed for distrust of the U.S. health care system. It’s not that simple.

By Aimee Cunningham

Biomedical Writer

December 20, 2022 at 9:00 am

The U.S. Public Health Service deceived the men in the syphilis study at Tuskegee (several participants shown here) and withheld treatment from those with the disease. “The wounds that were inflicted upon us cannot be undone,” Herman Shaw said in 1997.

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“We were all hard-working men … and citizens of the United States.” Herman Shaw, 1997

Born in Alabama in 1902, Herman Shaw was a farmer and a cotton mill worker. He and his wife, Fannie Mae, were married for 62 years and had two children and six grandchildren.

Shaw was also a survivor of a 40-year medical experiment.

From 1932 until the Associated Press broke the story in 1972, the U.S. Public Health Service conducted a study of more than 600 Black men in Macon County, Ala., without their informed consent. The men were told they were being tested and receiving free therapies for “bad blood,” a local term for several ailments. Instead, it was a study of untreated syphilis. Roughly two-thirds of the men had the transmissible disease. The Public Health Service did not disclose to the men their diagnoses and withheld available treatments.

The experiment tracked the damage the disease inflicted on the men. The endpoint was death.

In the 50 years since its end, the U.S. Public Health Service Study of Untreated Syphilis at Tuskegee in Alabama has often been held up as a primary driver of distrust of the U.S. health care system in Black communities. Yet medical abuse of Black people has occurred throughout U.S. history.

White people have long justified abuse and mistreatment of Black people by describing them, explicitly and implicitly, as inferior. There have been “four hundred years of active decisions to dehumanize Black people and Black bodies,” says Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota School of Public Health in Minneapolis.

As John Heller, chief of the Division of Venereal Diseases at the U.S. Public Health Service from 1943 to 1948, did. Heller said in an interview with historian James Jones for his book on the syphilis study, “Bad Blood,” that “the men’s status did not warrant ethical debate. They were subjects, not patients; clinical material, not sick people.” 

Half a century later, this racist experiment can look like a product of a long-gone era, even as it gets outsize credit for distrust today. In reality, the racism that fueled the syphilis study has existed for centuries and still permeates the U.S. health care system, causing racial disparities in access to medical care and measures of health. While there are a variety of efforts to address these disparities, including medical training to bring awareness of racial biases, there is far to go.

“It is never too late to work to restore faith and trust,” Herman Shaw said in 1997 when the United States apologized for the study.  U.S. President Joe Biden echoed these words during a November 30 event acknowledging the  50th anniversary of the end of the study : “Restoring faith and trust is the work of our time.”

Experimentation during slavery

“A slave is not a human being in the eye of the law, and the slaveholder looks upon him just as what the law makes him; nothing more, and perhaps even something less.” John Brown, 1855

In his 1855 memoir, John Brown wrote about his enslavement in Georgia and his escape to England. He described being experimented on to test therapies for heat stroke . Brown was forced to sit in a fire-heated pit with only his head exposed.

“In about half an hour I fainted. I was then lifted out and revived, the doctor taking a note of the degree of heat when I left the pit,” Brown wrote. The experiments continued as the doctor investigated which medicine “enabled me to withstand the greatest degree of heat.”

The enslavement and abuse of Black Americans were sanctioned by prevailing medical theories. Antebellum doctors claimed that Black people “ possessed peculiar physiological and anatomical features that justified their enslavement ,” Vanessa Northington Gamble wrote in the American Journal of Preventive Medicine in 1993. “This medical distinctiveness, [the physicians] argued, made Africans not only inferior but inherently suited for slavery.” And for medical experimentation.

That included excruciatingly painful gynecological surgeries performed on enslaved Black women by white doctors, experiments that advanced the field. Thought of as biologically inferior to white women, while also deemed to have a high tolerance for pain, enslaved women were considered “perfect medical subjects” for experimentation, Deirdre Cooper Owens, a historian at the University of Nebraska–Lincoln, wrote in her 2017 book Medical Bondage: Race, Gender, and the Origins of American Gynecology .

Anarcha, Betsy and Lucy were among about a dozen enslaved women who surgeon J. Marion Sims experimented on. He performed surgeries on the women, without anesthesia, to develop a repair for an abnormal opening between the bladder and the vagina. Held on Sims’ property from 1844 to 1849, the women were trained by Sims to assist with the procedure and became his surgical nurses, Cooper Owens wrote.

The work brought Sims renown as a gynecological surgeon. But, she wrote, “the central role that enslaved women played in these advances — by providing doctors the bodies and sometimes labor needed for experimentation, treatment, and repair — went unacknowledged.”

Embedded racism

“The Alabama community offered an unparalleled opportunity for the study of the effect of untreated syphilis.” Taliaferro Clark, Public Health Service, 1932

In the early 20th century, white physicians attributed the high rates of syphilis among Black people to their supposed immorality and excessive sexual desire. White doctors alleged that the disease was difficult to treat in Black people, because they wouldn’t reliably seek out or follow a therapeutic regimen , Northington Gamble wrote in the American Journal of Preventive Medicine .

Another prevailing theory that motivated the experiment was “the belief that syphilis was a different disease in African Americans than it was in white people,” says Northington Gamble, a medical historian and physician at George Washington University in Washington, D.C. “This whole theory of Black bodies being fundamentally different was a foundation not only of the syphilis study, but also the foundation of medical practice.”

The idea persists today. Race is a social concept , but using race as though it designates biological differences informs treatment decisions about the kidneys, the lungs, pregnancy and more .

For example, an equation that estimates kidney function long included a race-based adjustment, despite a lack of evidence for its use. The adjustment could mask the kidneys’ true condition in Black people.

Without the adjustment, 3.3 million more Black Americans met a threshold for stage 3 chronic kidney disease , researchers reported in eClinicalMedicine in 2021. At this stage, complications from kidney disease start to occur, meaning Black Americans could be missing out on needed care, the researchers wrote. A new equation to estimate kidney function without a race adjustment is starting to be used in clinical practice.

In contrast, the belief that Black people experience less pain than white people hasn’t been extinguished. Today, Black people often report their pain is not taken seriously and evidence shows their pain is undertreated .  

“Racism has been baked into health care,” Hardeman says. It’s embedded in the system : in therapeutic protocols, in the distribution of health care resources , in how a physician treats a patient ( SN: 4/5/22 ).

Black people are nearly twice as likely as white people to have procedures during perinatal care and birth done without their consent , researchers reported in Birth in June. Hardeman has talked to Black people whose doctors sent their urine samples for toxicological screens in prenatal visits without their consent. “There’s this underlying assumption that there is likely drug use and that a tox screen is necessary,” she says.

Unequal outcomes

The maternal mortality rate for Black women is about three times the rate for white women and for Hispanic women, according to the U.S. Centers for Disease Control and Prevention. The latest data, from 2020, reports 55 deaths per 100,000 live births for Black women, compared with 19 per 100,000 for white women and 18 per 100,000 for Hispanic women.

U.S. maternal mortality rates by race and ethnicity, 2018–2020

This embedded, structural racism is a risk to health , and underlies health disparities at birth and throughout life in the United States. Black newborns are more likely to die than white newborns ( SN: 8/25/20 ). The rate of maternal mortality for Black women is nearly three times that of white women. Black people are more likely than white people to die early from diseases that are treatable with access to care.

Singling out the syphilis study when discussing African Americans’ attitudes towards the medical system is “overly simplistic and historically inaccurate,” Northington Gamble says. The view that “the medical profession did not always have the best interest of African Americans at heart predated the syphilis study.” And the burden shouldn’t be on African Americans to change their attitudes, she says. “Trust should be earned.”

Along with past examples, there are plenty of modern-day instances of medical racism that contribute to distrust , says Fatima Cody Stanford, an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School in Boston. “Every single day it’s still going on,” she says.

Beyond the syphilis study

“What the United States government did was shameful, and I am sorry.” President Bill Clinton, 1997

Twenty-five years after the end of the syphilis study, the U.S. government apologized. Northington Gamble was part of the committee that helped to make the apology happen . She spoke about the event during the November 30 remembrance of the syphilis study, hosted by the U.S. Centers for Disease Control and Prevention in Atlanta.

“When President Clinton said, ‘and I am sorry,’ … there were sobs around the room,” Northington Gamble said. “And it wasn’t sobs just about the syphilis study, but it was sobs about how Black people have been treated in this country.”

Addressing and dismantling the racism behind that unequal treatment “will require changing systems, laws, policies and practices ,” researchers wrote in Health Affairs in February. Those changes should include mandating standards for health care systems to achieve equitable results for patients, and medical training in the health effects of structural racism , knowledge that would be required for professional licensing, Hardeman and colleagues wrote in 2020.

Some medical schools are bolstering their curriculum with more extensive instruction on racism and health inequities .

Doriane Miller, a primary care physician at the University of Chicago Pritzker School of Medicine and director of the institution’s Center for Community Health and Vitality, leads doctors in training on tours of the surrounding area, in the south side of Chicago. People often see the area as defined by poverty and violence, Miller says. The tour offers a different story.

Miller talks about “how people came to this city looking for opportunities from the Deep South, in order to escape racism and segregation, and formed thriving businesses and communities.” She takes the new doctors by Provident Hospital, founded by the Black surgeon Daniel Hale Williams in 1891. The first Black-owned and -operated hospital in the nation, it also provided training for Black doctors and nurses. Williams performed the first successful open-heart surgery in the United States in 1893 and helped establish the National Medical Association, the first national organization of medical professionals open to African Americans.

The historical tour is a way to give new doctors “a sense of, not just physical place, but the people they will be serving,” Miller says. People “want to have you understand their circumstances, so that you can respond to them as individuals,” she says, “rather than making presumptions about who they are and where they come from.”

Like the presumptions many made about the men included in the syphilis study. “What happens is that the humanity and the individuality and the life experiences and history of the men themselves, and their families, are erased,” Northington Gamble says. “People forget the fact that these were men with lives and families and stories.”

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Historical Origins of the Tuskegee Experiment: The Dilemma of Public Health in the United States

• PMID: 29311536
• PMCID: PMC10565021
• DOI: 10.13081/kjmh.2017.26.545

The Tuskegee Study of Untreated Syphilis in the Negro Male was an observational study on African-American males in Tuskegee, Alabama between 1932 and 1972. The U. S. Public Health Service ran this study on more than 300 people without notifying the participants about their disease nor treating them even after the introduction of penicillin. The study included recording the progress of disease and performing an autopsy on the deaths. This paper explores historical backgrounds enabled this infamous study, and discusses three driving forces behind the Tuskegee Study. First, it is important to understand that the Public Health Service was established in the U. S. Surgeon General's office and was operated as a military organization. Amidst the development of an imperial agenda of the U.S. in the late 19th and early 20th centuries, the PHS was responsible for protecting hygiene and the superiority of "the American race" against infectious foreign elements from the borders. The U.S. Army's experience of medical experiments in colonies and abroad was imported back to the country and formed a crucial part of the attitude and philosophy on public health. Secondly, the growing influence of eugenics and racial pathology at the time reinforced discriminative views on minorities. Progressivism was realized in the form of domestic reform and imperial pursuit at the same time. Major medical journals argued that blacks were inclined to have certain defects, especially sexually transmitted diseases like syphilis, because of their prodigal behavior and lack of hygiene. This kind of racial ideas were shared by the PHS officials who were in charge of the Tuskegee Study. Lastly, the PHS officials believed in continuing the experiment regardless of various social changes. They considered that black participants were not only poor but also ignorant of and even unwilling to undergo the treatment. When the exposure of the experiment led to the Senate investigation in 1973, the participating doctors of the PHS maintained that their study offered valuable contribution to the medical research. This paper argues that the combination of the efficiency of military medicine, progressive and imperial racial ideology, and discrimination on African-Americans resulted in the Tuskegee Syphilis Experiment.

Keywords: Bad Blood; Eugenics; Progressive Empire; Racial Pathology; the Public Health Service; the U.S. Surgeon General; Tuskegee Syphilis Experiment.

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• Eugenics, medical education, and the Public Health Service: Another perspective on the Tuskegee syphilis experiment. Lombardo PA, Dorr GM. Lombardo PA, et al. Bull Hist Med. 2006 Summer;80(2):291-316. doi: 10.1353/bhm.2006.0066. Bull Hist Med. 2006. PMID: 16809865
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The Crazy True Story Of The Tuskegee Syphilis Experiment

In 1932, the US Public Health Service began conducting a study on the African-American men of Macon County, Alabama. While the men volunteered to be treated for "bad blood," they were never informed of the true nature or the risks of the Tuskegee syphilis experiment.

For 40 years, public health officials engaged in unethical testing of Black sharecroppers, under the guise of offering them free medical treatment. But the men were never really given treatment. Instead, they were given placebos while researchers documented the long-term effects of syphilis on Black men, basing the foundation of their research largely on pseudoscience and eugenics. The medical mistrust sowed by the Tuskegee study would have lasting negative impacts on the African-American community for years to come. 

According to Jean Heller, the reporter who eventually broke the Tuskegee experiment story, the men of Macon County were "strictly targets of opportunity. There was no humanity in this whatsoever. [...] They were just targets. They were just convenient guinea pigs," via "Bad Blood": The Tuskegee Syphilis Study .

"Tuskegee Study of Untreated Syphilis in the Negro Male"

In the 1920s and 1930s, public health was seeped in racial prejudice, and nowhere was it more apparent than in matters of sexual health. Dating back to the Civil War , scientists posited the idea that African Americans were a different species, and the negative effects of this harmful theory continued to influence scientific studies in America throughout the 19th century. By the turn of the 20th century, eugenics had surged in popularity in America, and scientists began presenting a series of pseudoscientific theories regarding the African-American population. Scientific and public health officials claimed that they had larger genitals and a higher sex drive than white people and were more prone to contracting sexually transmitted diseases, like syphilis, according to  McGill University . Most crucially, scientists also believed that African-American men would not seek out or accept treatment for STIs even if they were available.

It was out of this climate of prejudice and racial bias that the infamously unethical "Tuskegee Study of Untreated Syphilis in the Negro Male" was conceived.

Goal of the Tuskegee syphilis experiment

In 1932, Taliaferro Clark, the head of the venereal disease department of the US Public Health Service, designed an experiment that would study the course of untreated syphilis on Black men. While Clark is credited with founding the study, another doctor, Thomas Parran Jr., also played a significant role in beginning the experiment. The sixth US Surgeon General and a prominent Public Health Service official, Parran was a driving force behind the development and implementation of the study, per  The Philadelphia Inquirer .

Parran was influenced by a similar study that had been conducted in Norway over 20 years earlier. "The Oslo study of the natural history of untreated syphilis," conducted between 1891 and 1910, was one of the largest studies on the effects of syphilis. Two thousand patients, both men and women, who had contracted syphilis were left untreated for nearly 20 years in Oslo, per  Science Direct , to understand the natural effects the course of the disease would have on the human body.

The plan for the Tuskegee syphilis experiment was to build on that work, while also comparing the different effects syphilis might have on subjects of different races. Scientists believed that the cardiovascular systems of African Americans would be more significantly impacted by the disease. The initial purpose of the study was to examine the pathology of syphilis in African-American males for six to nine months, according to  Britannica .

"Black Belt"

US Public Health Service officials needed a location to conduct their study, and they found the perfect place in Macon County, Alabama. It was known as the "Black Belt" of the region, both because of the thick, dark soil that made land so fertile for agriculture and because of the large population of Black sharecroppers who made their living working the land, according to Tuskegee University . According to the US Census, 82 percent of Macon County's population was Black in 1930, per " Bad Blood ." The region was very rural, and most sharecroppers were not well-educated. In Macon County, 227 out of every 1,000 African Americans could not read.

A predominantly rural, Black, and illiterate population was ideal for the purposes of the Tuskegee experiment. In January 1932, after seeing Macon Country, Dr. Parran declared, "If one wished to study the natural history of syphilis in the Negro race uninfluenced by treatment, this county would be an ideal location for such a study," via  The Philadelphia Inquirer . Dr. Clark echoed a similar sentiment, saying: "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."

Almost 40 percent of Tuskegee's Black population had syphilis

Tuskegee also had one other major factor that made it the perfect location for the experiment: Almost 40 percent of the Black population of Tuskegee had syphilis by 1929, making it the city with the highest syphilis infection rate in the country, according to  Time .

The US Public Health Service enlisted the help of the Tuskegee Institute, now known as Tuskegee University, and its affiliated hospital to conduct the study. They also enlisted Eunice Rivers, a local nurse, to help establish trust within the community, according to  The Washington Post . Rivers (pictured above) was charged with helping pick up subjects and bring them to their appointments, deliver hot meals, and drop off medicine, but behind the scenes, she was also in charge of keeping records on the men. She also reached out to surviving family members after a subject had passed to encourage them to consent to autopsies. Rivers served as a critical point of connection between the researchers and Macon County's African-American population for the entire 40 years of the study.

Tuskegee subjects were compensated with free food and medical exams

Health officials initially recruited subjects to the study by offering them free medical care. Macon County was not a wealthy region, and health care was not always easy to come by for Black agricultural workers, so it was an enticing offer. However, some men were initially skeptical, suspecting that they were really being examined for military recruitment. To quell these fears, officials began including women and children in their examinations while still adding any eligible men they encountered to the study, according to  McGill University .

In the 1930s, as the Great Depression worsened, the promise of free medical care was an exceptionally temping offer, particularly for an economically impoverished area. However, even the promise of free health care was not enough to entice some of the men to continue the treatments. So as the study went on, the subjects were offered more benefits, including extended medical treatment, free rides to appointments, hot meals on appointment days, medical exams, and even burial stipends, per Tuskegee University .

For some of the treatments, like the painful and ultimately unnecessary spinal taps, Public Health Service officials used a psychological tactic. Enticing them with the offer of a "special free treatment" for their "bad blood," officials convinced many of the men to undergo the dangerous spinal procedure, according to The New Social Worker .

The Tuskegee syphilis experiment went on for 40 years

The original experiment was only supposed to last six to nine months. Initially, the patients were left untreated for around six months and then treated with heavy metals, like arsenic, bismuth, and mercury, per  Britannica , which were commonly used therapies at the time. However, the study subjects were largely only given treatment in order to abide by Alabama guidelines and assuage any fears on the part of the participants.

Researchers released their initial findings in 1934 and published their major paper on the experiment in 1936. However, that same year, researchers declared that they hadn't received enough data and decided to extend the study. Rather than treat the subjects, they chose to follow the infected patients throughout the rest of their lives, documenting the long-term effects of the disease, according to the  CDC .

Initially, they'd recruited 600 Black men to the study, of whom 399 had syphilis. The remaining 201 African-American men who didn't have the disease served as the control group. All of them were then given placebos to continue the ruse that they were being treated, while in reality, none of them were receiving proper medical care. The study went on for 40 years, and when it finally came to an end in 1972, only 74 of the subjects were still alive, per  The New Social Worker .

Informed Consent

One of the main reasons the Tuskegee experiment was so unethical was because the study participants were never provided enough information to be able to give their informed consent. In fact, researchers deliberately withheld information about their disease and the true purpose of the experiment. An intern at the Tuskegee Institute's hospital admitted, "The people who came in were not told what was being done. We told them we wanted to test them. They were not told, so far as I know, what they were being treated for or what they were not being treated for. [The subjects] thought they were being treated for rheumatism or bad stomachs. We didn't tell them we were looking for syphilis. I don't think they would have known what that was," via " Bad Blood ."

The subjects were told only that they were being treated for "bad blood," which could include any number of illnesses, from syphilis to anemia to simple fatigue. None of the subjects were told they were being treated for an STD, and as a result, many unknowingly passed it on to their wives or girlfriends. Because they were not aware what illness they were being treated for, subjects were also not given the option to leave when penicillin became readily available as a syphilis treatment, per the  CDC . None of the patients were informed of the potential dangers, and none ever gave informed consent, making the Tuskegee syphilis experiment one of the most notorious and unethical studies in American history.

Researchers withheld treatment from Tuskegee subjects

When the study began in 1932, there was no known cure for syphilis. However, the study's subjects were repeatedly denied even the minorly effective treatments that were commonly used at the time, like mercury or arsenic.

In 1947, it was determined that penicillin was an effective cure for syphilis, and by the 1950s, it had become the standard treatment and was widely used. Despite knowing this, officials never gave the study subjects penicillin to treat the disease. As a result, 128 of the men died from syphilis or its complications, 40 of their wives were infected, and 19 of their children had the disease passed down to them over the course of the study, according to  McGill University

Study officials went out of their way to ensure that subjects were not treated. In 1934, officials provided all doctors in Macon County a list of study participants, telling them not to treat the subjects. In 1940, they expanded the distribution of the list to the Alabama Health Department. The following year, when some of the subjects were drafted to the Army, their medical entrance exam revealed the disease. Researchers, instead of allowing the men to be treated by Army doctors, pulled the men from the Army. The staff nurse, Eunice Rivers, even once followed a study subject to his personal doctor to ensure that he was not treated for syphilis, per  The Washington Post .

A whistleblower brought the Tuskegee syphilis experiment down

No one raised any concerns about the unethical nature of the study until 1966, when Peter Buxtun, a Public Health Service employee, became suspicious after hearing that a colleague in the venereal disease section had scolded a doctor for treating a Tuskegee study subject with penicillin.

Upon further investigation, Buxtun was shocked to discover the similarities between the syphilis experiment and the crimes that had been brought to court during the 1947 Nuremberg Doctors' Trial. The subsequent Nuremberg Code had been established to prevent unethical experimentation on human subjects, but these ethical guidelines were being steadfastly ignored in the Tuskegee study.

Buxtun wrote a report detailing his concerns about the unethical nature of the experiment, but his report was dismissed by his superiors, who insisted the subjects were all "volunteers." Buxtun argued they were "nothing more than dupes ... being used as human guinea pigs" and were "quite ignorant of the effects of untreated syphilis," via the  Government Accountability Project . When the US Public Health Service chose to continue on with the study, Buxtun decided to go public. He leaked information about the experiment to Jean Heller, a reporter at the Washington Star, who broke the story July 25, 1972. The ensuing public outcry over the unethical nature of the study led to its eventual end in October 1972.

Public outcry

After the Tuskegee story broke, public outcry was immediate. Massachusetts Senator Edward Kennedy called the experiment "outrageous and intolerable," according to the  Government Accountability Project , and held congressional hearings on the matter. An advisory panel was also established to review the study, and in October 1972, the panel ruled that the study was unethical and should be stopped immediately, officially bringing the 40-year experiment to an end.

The study's surviving participants, represented by attorney Fred Gray, filed a class-action lawsuit against the US Public Health Service in the summer of 1973, per  Tuskegee University . The study's remaining subjects were awarded a $9 million settlement. They were also granted lifetime medical benefits and burial services. In 1975, the benefits were extended to include not just the surviving subjects, but all participants' wives and children, as well. In 1995, it was extended one final time, to include health as well as medical benefits for all participants and their families. The Tuskegee Health Benefit Program was established to disperse the benefits, according to the  CDC . 

Congress also passed additional protections for human subjects, including the National Research Act, which required the approval of institutional review boards for all experiments using human test subjects, according to  Britannica . The outcry following the Tuskegee syphilis experiment helped establish many of the modern medical ethical standards that are in place today.

The Tuskegee Syphilis Study Legacy Committee

In 1994, a symposium called "Doing Bad in the Name of Good?: The Tuskegee Syphilis Study and Its Legacy" was held at the Claude Moore Health Sciences Library in Charlottesville, Virginia. The goal of the symposium was twofold: First, they wanted a public apology from the president on behalf of the government for the experiment, according to  Tuskegee University . They achieved this goal on May 16, 1997, when Bill Clinton publicly apologized for the Tuskegee syphilis experiment, saying, "You did nothing wrong, but you were grievously wronged. I apologize and I am sorry that this apology has been so long in coming, " via  Time .

Their second goal was a little more complicated. They hoped to address the lasing damage of the study and set up strategies to address unethical government studies while restoring the reputation of Tuskegee University. The result was the creation of the Tuskegee Syphilis Study Legacy Committee, which first convened in January 1996 and focused on establishing scientific ethics, as well as the founding of Tuskegee University's National Center for Bioethics in Research and Health Care.

Lasting public health effects of the Tuskegee syphilis experiment

In the aftermath of the tests, African-American communities developed a mistrust of public health initiatives that still lingers today. As a result, Black men are less likely to seek health care and treatment than their white counterparts, per  The Atlantic .

According to the  National Bureau of Economic Research , a study "comparing older black men to other demographic groups, before and after the Tuskegee revelation, in varying proximity to the study's victims" found "that the disclosure of the study in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men."

After the experiment had been made public, life expectancy for Black men at age 45 fell up to 1.5 years. The Tuskegee syphilis experiment continued to cause harm to the Black community even years after it officially ended.

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Dr. Charlotte P. Morris Says Farewell; Welcomes 10th President, Dr. Mark Brown ‘86

June 26, 2024.

Contact: Thonnia Lee , Office of Communications, Public Relations and Marketing    

Las t fall I told you of my intention to retire after almost 40 years at this illustrious institution. Now that the time has come, I have a few thoughts to share as we welcome the 10th president, Dr. Mark Brown ‘86.

I have met him and his wife, Gwen, several times and talked about my experience as president. Unlike our nation’s tradition around the transfer of power, I didn’t leave a secret note on his desk to wish him well. He is an honored serviceman with decades of experience leading thousands of Air Force servicemen and women and an accomplished scholar returning to the place where he first grew into a leader. He will do well here. 

The history of this university is unlike any other. As Dr. Brown steps back on campus and into that history, my wish is that the campus community support him as fervently as you have me. My time at Tuskegee has been more than I ever could have imagined when I accepted that first teaching assignment years ago.

I have celebrated successes with you all, talked through challenges and made tough decisions. With each decision, the long-term success of the university remained at the forefront. The student experience, our innovative programs, world-class professors – all of that requires a vision and in some cases compromise.

Thank you for your support all of these years and particularly during my time as the ninth president. It has meant the world to me to work with you – to serve with you. Now I turn my focus to enjoying my family, serving the community through my sorority and deciding on a travel itinerary for my next big trip.

I will never be too far away. So don’t be surprised when you see me at Homecoming – it will be our 100th and I wouldn’t dare miss it. For now, I will say so long with gratitude and high expectations for the university’s continued success.

Best regards,

Charlotte P. Morris Tuskegee University 9th President

© 2024 Tuskegee University

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Frequently Asked Questions

No. According to a journal article  about the study, published in 1936, the 399 men in the syphilitic group were initially recruited because they already had late-latent syphilis. The 201 men in the control group did not have the disease.

Tuskegee community members were aware of the study but understood it to be a special government health care program.  1

According to the Assistant Secretary for Health and Scientific Affairs’ Ad Hoc Advisory Panel’s  published report , “…the Macon County Health Department and Tuskegee Institute were cognizant of the study.”

There is no evidence that researchers obtained informed consent from participants, and participants were not offered available treatments, even after penicillin became widely available.

You can learn more about changes made to standard research practices after Tuskegee in Research Implications .

No women were included in the study. The study was limited to Black men 25 years of age or older. However, as a result of lack of treatment, some women contracted syphilis from men who participated in the study’s syphilitic group.

The National Archives, Southeastern Region, maintains a list of  Tuskegee patient medical files.

The National Archives maintains  photos related to the study.

The $10-million settlement was divided into four categories:

• Living syphilitic group participants received $37,500.
• Heirs of deceased syphilitic group participants received $15,000.
• Living control group participants received $16,000.
• Heirs of deceased control group participants received $5,000. 2

1 Vonderlehr to Clark, October 20, 1932, Records of the USPHS Venereal Disease Division, Record Group 90, National Archives, Washington National Record Center, Suitland, Maryland.

2 Gray, Fred D. The Tuskegee Syphilis Study: An Insider’s Account of the Shocking Medical Experiment Conducted by Government Doctors against African American Men. Montgomery: Fred D. Gray, 2013.

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Dr Fitzroy Dawkins’ love letter to African Americans

Ja-born oncologist says fear, distrust of health system preventing early detection, treatment of cancers in black communities.

The history of racially motivated experimentation on black Americans within the United States health system – often conducted without their knowledge or consent – has had a detrimental impact on black healthcare in the country, asserts Jamaican-American oncologist Dr Fitzroy Dawkins.

In an interview with The Sunday Gleaner last week, he said denial, distrust and fear – of the disease itself and of being used as guinea pigs – looms large in the cancer culture in African Americans, and during active practice, he tried to change the deep-seated positions.

“So much has changed in medical protocols over the last half century that these fears are no longer valid. Yet, African American cancer patients have essentially sidelined themselves from finding a cure. There’s no doubt that medicine has made incredible strides in treating and even curing cancers. But there’s a portion of the population that’s missing out on these medical advances. Despite the advances, the African American history in the health sector is still very poignant today,” he said.

In his book, Fighting for Survival – Conquering Cancer and the African American Experience , he said black Americans are not only haunted by the Tuskegee experiment, but also that of Henrietta Lacks.

Lacks, during treatment for cervical cancer at Johns Hopkins Hospital in Maryland in 1951, had her cells cultured to create a cell line called HeLa without informed consent, and which is still being used for medical research.

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But the ghost looming largest is the Tuskegee experiment, which went on for 40 years in the US using hundreds of black men as part of an experiment to observe the natural progression of syphilis, without treatment, until a whistleblower blew the lid. The men, impoverished sharecroppers from racially curdled Alabama, were part of a research that should have been six months, but which lasted four decades. They never gave consent to be part of the experiment, and were never offered treatment, though antibiotics became widely available 15 years after the experiment started. Untreated, they experienced severe health issues, including blindness, mental impairment and death.

Dawkins says experimentation using black people was taking place for years before Tuskegee, and Lacks, but the two exposed the evil of institutional racism.

The deep-seated distrust of the sector and its offerings have left African Americans disproportionately excluded from research that could detect and treat, all cancers in the early stages, and, especially prostate cancer, according to Dr Dawkins.

The book, which he says is his love letter to African American cancer patients and his plea is for them to fully embrace all that research and medicine has to offer, so they can fight and cure their cancers.

“It (the distrust) is still with us, when we see the whole COVID-19 experience and what people talked about and it’s ‘I don’t trust the government’. ‘If they say this is the case, I don’t trust them.’ ‘They just want to use me for their purposes.’ There are African Americans who disagree with me on this so I don’t think it’s a monolithic response, but in my view, in my practice at Howard University, Tuskegee was forever present when I talked about clinical trials,” he told The Sunday Gleaner .

Road to medicine

But how did this Jamaican become so influential in the US black health community?

Dawkins told the story of a mystery illness, which prevented him from doing his high-school placement exams at the same time with hundreds of other pupils, and left him spending months in a cast from chest to toe at the University Hospital of the West Indies. He was not told about the cause of his illness, but he recalled multiple surgeries and procedures and countless trips to the hospital. Years later, he believes he had an infection of the hip bone.

After about six months, he was discharged to his aunt in Newport, Manchester.

But years before his illness, Dawkins had decided that he wanted to be a doctor and during his hospitalisation, the medical intervention involving orthopaedic surgeon Professor Sir John Golding solidified his choice. Dawkins regaled Golding for “his care in treating the patient as a whole, both mind and body” and intervening so he could do his exams.

Dawkins recalled the weight on his shoulders to ace the exams, which he sat alone at the Ministry of Education, doing well enough to secure a place at Manchester High. He would later transfer to Wolmer’s Boys’ School at the end of the first term of third form to complete high school.

Born and raised in St James, he grew up in different parts of Jamaica, moving among relatives, including his mother, who was a registered nurse/midwife, but functioned in several capacities in the communities where she served.

Dawkins recalled how his mother would disappear for days when called to deliver babies in the hilly terrain of the rural areas as sometimes, the babies would take days to make their appearance. His mother would have to wait until their birth before returning to her children.

“My mother’s dedication as a nurse, working in remote areas had a tremendous impact on me. The fact that I became a Christian at 14 years old had a tremendous impact on my worldview. Dr Golding to me was more than just an orthopaedic surgeon. I remember distinctly him in my room at the hospital with his team and asking someone if I shouldn’t be taking Common Entrance Exam. They said yes, but the time had passed. And he told someone to see what they could do so I could sit the exams before the results were published,” said Dawkins, recounting the event as something for which he is forever grateful.

Golding, he said, epitomised all he wanted to be in a doctor and was his motivation while in active practice in the United States.

The immigrant story

After leaving Wolmer’s, Dawkins’ mother told him of the life-changing decision made for him that would see him boarding an airplane for the first time, travelling solo to New York. He was only given an address – that he dared not misplace – as he went to live with strangers and was told to “figure out” his quest to become a doctor.

His experience was common to thousands of immigrants in the US – unwelcome in their communities and places of study.

The young Dawkins worked multiple odd jobs – in the fashion industry, in a factory making plastic utensils, washing pots, and serving food. He was also being tempted into criminality, but found strength in the values ingrained in him in Jamaica.

Nearly a year after landing, he saved enough to pay for part of his college education and applied to City University of New York to read for a degree in biology. This he saw as a step to opening the door to medicine.

He rode his bicycle daily as the 35-cent train ride was too expensive and after work, he went home to study, sleep, then head back to school – a routine he maintained for four years.

After graduating in 1979, he spent a year working with an insurance company before heading to medical school and began working as a janitor cleaning a bank.

Medical school was brutal as he came face to face with racism, which was openly displayed by students and some faculty.

“I went to school upstate New York in a city called Buffalo. The city itself was hostile to black folks. You were seen as ‘the other’. And it wasn’t just black folks. If you were not from the area – even if you came from New York and especially if you came from New York City – they were not particularly enamoured with your presence.

“So here comes this black kid in a class of 145, ten of us being black, and with the sense of ‘we don’t want you here; you don’t belong here, and we don’t want you in our neighbourhood, and we really don’t care for you’. This was the city and the medical school was equally hostile,” he recounted.

Dawkins said the camaraderie he expected was not forthcoming, especially as it was made clear he did not come from generations of physicians, unlike other students.

The memories remain painful and he would rather not dwell on them, but they are included in the book as learning experience, and, hopefully, will serve as a lighthouse for others facing oppression and exclusion.

“I have been through the deep waters. I have been called names. My car has been painted [with racial slurs]. I have been held up and threatened with death, and I survived. So I went through this, you are going through this, so take a page out of my book to realise that you don’t have to accept the status quo and despite the perceptions there are of you,” he said.

Cancer diagnosis, treatment

Dawkins not only beat the odds, but devoted his active years to research and treatment of cancers among African Americans. He admitted some bias, but said in the oncology space, there is a huge disparity. He wants them to push for what’s rightfully theirs.

“Part of what holds us back, I think, is fear. Not just distrust of the system, but fear to even say the word cancer. Some people will not even share the information with their families … . So much of cancers is about genetics. We don’t like talk about it because we hope it will go away; we hope that God will heal us, and if we pray hard enough everything is going to be okay. The push that I have is, ‘You should do what you can. The system may be against you, but you should do what you can’,” he pleaded.

Addressing the issue of prostate cancers in black men, he said that there are significant issues, including homosexual innuendoes from having a finger inserted in the rectum to screen for an enlarged prostate.

“The thought of someone putting a finger in your rectum, I mean, who would allow that? There are crass jokes told among patients about not putting things in your behind, so that having a colonoscopy or sigmoidoscopy – the minimally invasive medical examination of the large intestine from the rectum through the nearest part of the sigmoid colon – [is shunned] because it might imply this or that … ,” he explained.

Much of the fear, he said, is that it would impact their sexual prowess if part of the treatment is removing parts of their rectum. Manhood, he said, is largely defined in the black community as the ability to have sex, a mindset that is to the detriment of many.

Locally, oncologists have expressed the same concerns for men.

Dawkins said many discoveries have been made in the treatment of cancers, and while not asking black people to forget Tuskegee, he wants them to use the experience to get treatment. He stressed that many are missing out on opportunities in clinical trials that could change the trajectory of their lives for the better as too many only show up with third-stage and endstage cancers, when early detection could have made a difference.

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FAMU joins Tuskegee University, U.S. Sugar to study sugarcane farming in the Glades

'we are committed to strengthening partnerships and highlighting the role we play in our communities and our environmental stewardship,' u.s. sugar said in a statement..

Florida A&M University is partnering with Tuskegee University and U.S. Sugar to study the impacts of sugarcane farming across the Glades region in Florida.

The joint partnership with the HBCUs (historically Black colleges and universities) will launch an environmental study that assesses the impacts of farming methods — such as sugarcane burning — and will also allow FAMU to help analyze more sustainable practices throughout the project.

“We’re always looking to make sure that agricultural processes are environmentally safe while trying to come up with ways to make them even safer,” FAMU’s interim dean for the College of Agriculture and Food Sciences Garlen Dale Wesson told the Tallahassee Democrat this week.

U.S. Sugar is a Clewiston-based farming company that grows sugarcane, citrus and fresh vegetables to provide locally grown food to individuals across the country. Its main business, however, revolves around sugarcane.

“We are committed to strengthening partnerships and highlighting the role we play in our communities and our environmental stewardship,” U.S. Sugar Community Relations Director Brannan Thomas said in a statement. “This collaboration marks a significant step toward a more comprehensive and inclusive understanding of our rural communities and sustainable agricultural practices.”

The project comes as Florida's pre-harvest sugar cane burning season , which typically lasts from October to March every year, remains an issue in the Glades — a region anchored by the cities of South Bay, Belle Glade and Pahokee.

Sugarcane undergrowth such as weeds are burned to make the harvesting process easier, but the method leads to billows of smoke rising into the air. Critics say the aftermath contributes to climate change and harms the health of workers and residents.

The burning of sugarcane fields has been challenged in South Florida — where the soot and pollution it produces predominantly affect Palm Beach County’s most impoverished communities — and it continues to be a topic of concern as the impacted communities are largely made up of residents of color, according to The Palm Beach Post .

More from The Palm Beach Post: Sugar companies said our investigation is flawed, biased. Let’s dive into why that’s not true.

Tuskegee University, a private HBCU in Alabama, had an initial partnership with U.S. Sugar to work on the project before FAMU.

“With its long history and legacy of promoting environmental stewardship, Tuskegee University is committed to promoting sustainable agricultural practices as we work together to feed a growing population,” Tuskegee University’s College of Agriculture, Environment and Nutrition Sciences (CAENS) Dean Olga Bolden-Tiller said in a prepared statement.

Wesson says FAMU joined the initiative after discussions with Bolden-Tiller during a recent conference, where Bolden-Tiller thought FAMU would be a great addition to the project because of its similar agriculture school.

U.S. Sugar gave the HBCUs a $100,000 grant — which is being managed by Tuskegee University — to cover travel costs and instrumentation purchases for the purpose of the project.

The grant will not be spread over a certain amount of time, but Wesson predicts that the project could last up to two years.

In April, a few faculty members from FAMU and Tuskegee University placed air monitors around sugar farms in the Glades to measure particulates in the air before, during and after the burning process as a part of the joint project. The information will then be used to predict where the smoky particulates will go based on different weather conditions.

“We’re mostly interested in monitoring the effects on the surrounding communities of concern,” Wesson said. “A lot of our African American or minority communities don’t get these kinds of studies done, so we’re placing an emphasis on supporting minority communities.”

The initiative is also expected to lead to the assessment of the agriculture industry’s economic and ecological impacts in the Glades region.

A FAMU faculty member is currently working on the U.S. Sugar initiative in the Glades along with three faculty members from Tuskegee University, and the plan is to also get students involved in the project in the future, Wesson said.

In addition, the collaboration places emphasis on community engagement to listen to and integrate local perspectives in order to address community concerns, according to a project summary report.

Contact Tarah Jean at  [email protected]  or follow her on X:  @tarahjean_ .