Renowned pulmonologist Martin J. Tobin, MD, recounted the horrors and moral failings of the Tuskegee Experiment on Monday, May 16. His presentation on the notoriously racist and unethical experiment was part of the scientific symposium, Publishing the Best Science: The Comprehensive Spectrum Provided by the ATS Family of Journals.
Dr. Tobin, Edward Hines Jr. VA Hospital, and a professor at Loyola Medicine in Chicago, authored “Fiftieth Anniversary of Uncovering the Tuskegee Syphilis Study: The Story and Timeless Lessons,” published in the May 15, 2022, issue of the American Journal of Respiratory and Critical Care Medicine. His aim, he said, was to further shed light on the historic study, how it happened, and the lessons learned from it.
He discussed how investigators intentionally withheld effective treatments from nearly 400 African American men with syphilis for 40 years, allowing between 28 and 100 men to die as a direct result of the disease by 1969.
The Public Health Service, precursor to the Centers for Disease Control and Prevention, conducted the experiment. The U.S. Surgeon General at the time, Dr. Hugh Cumming, had solicited the help of the Tuskegee Institute by stating that the study would offer a rare chance for carrying on “this piece of scientific research which probably cannot be duplicated anywhere else in the world.”
Most of the men studied by the Tuskegee Experiment were poor, uneducated sharecroppers, who had been promised free medical care and burial insurance. They were also deceived into thinking they’d be treated with medications that were effective against the disease. German investigators had already discovered effective treatments for syphilis, including an arsenic compound known as Salvarsan, by the time the experiment began.
Dr. Tobin noted how the African American men were further deceived about the reason for receiving painful lumbar punctures. Dr. Raymond Vonderlehr sent letters to his collaborators instructing them to give as few details of the puncture techniques as possible so the men would think they were therapeutic when, in fact, they were used to determine if the men had neurosyphilis.
The racism and lack of ethics within the study was so unchecked that Dr. Cumming wrote in a letter to the director of Andrew Hospital where the experiment was conducted that it was the PHS’s desire to continue observation of the men and, if possible, bring a percentage of them to autopsy so that pathological confirmation could be made of the disease processes.
Several reports on the Tuskegee Experiment had been published in medical journals over the years, yet despite the obvious devastation of untreated syphilis, Dr. Tobin noted, no one was compelled to criticize the ethics of the experiment. That is until December 1965, when the PHS hired a young psychiatric social worker, Peter Buxtun, to interview patients with venereal disease.
After raising his concerns about the ethics of the study with the PHS, Buxtun contacted a journalist, who broke the story in the Washington Star on July 25, 1972. Another story about it subsequently ran as front-page news in The New York Times the following day.
Dr. Tobin explained how everyone assumed that this chapter in American medicine was an anomaly. But in 2010, it was revealed that the same group of researchers had infected hundreds of Guatemalans with syphilis and gonorrhea in the 1940s to study treatments for the infections. Investigators intentionally infected Guatemalan prisoners, psychiatric patients, and orphans by swabbing pus from STD patients into their eyes, urethra, and rectums so they could study progression of the diseases. One woman died four days after being infected, Dr. Tobin noted.
Sen. Edward Kennedy conducted congressional hearings into the Tuskegee Experiment in 1973, resulting in the passage of the National Research Act and establishment of institutional review boards, principles of informed consent, and protection of vulnerable populations. Physician-scientists who participated in the Tuskegee Experiment, however, were never submitted to any legal proceedings.
“The reason people fail to take steps to halt behavior that in retrospect everyone judges reprehensible is complex,” Dr. Tobin said. “Lack of imagination, rationalization, and institutional constraints are formidable obstacles.”
The central lessons from the study, he said, are the need for those in the medical community to examine their conscience and then speak up when they see something is wrong.
“There is a common perception that moral judgment is linked to education,” Dr. Tobin said. “Yet Peter Buxtun had far less education than the future director of the National Cancer Institute who led the study for years, and many surgeon generals who had intimate knowledge of it.”
There is also a tendency to believe that the actions of groups are more effective than those of individuals, Dr. Tobin said.
“But correction of the great ills of society has always started in the heart of one individual,” he said.