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Tuskegee, Alabama. EU 1932-1972.

"The United States government did something wrong-deeply and morally wrong. It was an atrocity to our commitment to integrity and equality for all our citizens ... clearly racist. "

- President Clinton's Apology to the 8 survivors of the Tuskegee Experiment, May 16, 1997 -

The Study of the Tuskegee Syphilis (1932-1972), also known as the study of syphilis Public Health Service, was a clinical study conducted around Tuskegee Alabama where 399 African Americans (over 200 people in a control group without syphilis) poor - and almost illiterate - participated in a study aimed at description of the natural history of syphilis. This study became notorious because it was conducted without due regard to the experimental subjects, and led to major changes in how patients should be protected in clinical studies. Individuals enrolled in the Tuskegee study did not give informed consent and were not informed of their diagnosis. Instead, they said they had "Bad Blood" and inviting them to free treatment at a clinic. It also offered a hot meal per day and $ 50 for death to cover the costs of his funeral.

By 1947, penicillin had become standard treatment for syphilis. Before its discovery, syphilis frequently led to the development of a multisystem disease, chronic, painful and fatal. Instead of treating syphilitic subjects with penicillin and cancel the study, the Tuskegee scientists refused to use penicillin or provide information about it, in order to continue the study on of how the disease progresses and kills the patient. Participants also were persuaded to go to other treatment programs were available to others in the area. The study continued until 1972, when a leak to the press - more than any other ethical or moral consideration - led to its cancellation. The Tuskegee study is frequently cited as one of the biggest breaches of ethics and trust between doctors and their patients, in conducting a clinical study in the United States. The study of the Tuskegee syphilis led to the development of the Belmont Report and the establishment of the National Council for Human Research and institutional review boards of Research Protocols.

The study group was formed as part of the venereal disease section of the Public Health Service of the United States (PHS). The beginning of the Tuskegee study is commonly attributed to Dr. Taliaferro Clark. Its initial purpose was to follow the natural process of untreated syphilis in a group of black men by 6 to 8 months, then continue to follow a stage in treatment. Later, Dr. Clark agreed to the deployment of deceptive practices suggested by other members of the study. Clark retired from the study one year after it began.

Dr. Eugene Dibble was the director of the John Andrew Hospital in Tuskegee Institute.

Dr Oliver C. Wenger was the director of the clinic for venereal diseases of PHS in Hot Springs, Arkansas. He was an enthusiastic promoter of the exhaustive exploration of syphilis and installation of treatment programs in the black community. At various stages of the Tuskegee experiment, Wenger was linked to the activities of Macon County, and played a critical role in the development of the first study protocols. Wenger continued to provide advice on the experiment when it entered a long period of study of the evolution of the disease without treatment. Also hide was a supporter of the experimental subjects, the study aids - feared that the disclosure may lead to uncooperative.

In 1932, Dr. Raymond H. Vonderlehr was the director of the Tuskegee experiment. He made several early physical examinations and medical procedures. Vonderlehr carried out the policies that shaped the next phase of the project. For example, it was he who decided to obtain the "consent" of subjects to perform lumbar punctures (for signs of neurosyphilis) by promoting diagnostic tests as a "special free treatment." On one occasion, Dr Wenger congratulated him for their "facilities to send letters to blacks." Vonderlehr retired as director of the Venereal Disease Section in 1943.

Dr. John R. Dr. Heller was Assistant Vonderlehr and replaced as director of the Venereal Disease Section of the PHS. The direction of the experiment by Heller coincided with the introduction of penicillin in other PHS clinics as a routine treatment for syphilis, as well as the formulation of the Nuremberg Code (With which sought to protect the rights of research subjects .) The study was exposed to the public in 1972, Heller defended the ethics of the experiment until the end.

Nurse Eunice Rivers was an African American woman who trained at Tuskegee and was recruited at the John Andrew Hospital when the study began. Dr. Vonderlehr became a strong advocate of their role. Nurse Rivers became the only person on the staff that remained in the study during the 40 years of its existence. For the decade of the 50, Rivers nurse had become a crucial element of the study-her personal knowledge of all subjects allowed the long-running monitoring is maintained.

During the Great Depression of the early 30's, were offered to the lower classes of African Americans - Who usually could not get adequate medical care, the opportunity to join the shelter of Miss Rivers. Here, patients receive free medical examinations at Tuskegee University as well as free transportation to and from the clinic, hot meals in the days of examination and treatment for minor ailments.

The experiment originally began as a study of the incidence of syphilis in Macon County's population. Subjects would be studied for a period of six to eight months, and then treated with contemporary treatments (including the salvarsan, mercury and bismuth ointments) that were moderately effective but very toxic. The initial intent of this study were public health benefit of the poor, as evidenced by the participation of Tuskegee Institute, the university founded by Booker T. African-American Washington. Its affiliated hospital gives the PHS medical facilities for study, and other predominantly African-American institutions as well as local physicians also participated. Was supposed to provide Rosenwald Philanthropic Foundation funds to pay for any treatment. The study recruited 400 black men suffering from syphilis, and 200 healthy Black men as controls.

The first critical point in the direction that would take the Tuskegee experiment in 1929, when the arrival of the Great Depression would leave the Rosenwald Foundation without the ability to afford the treatments that had initially promised. Initially, the directors of the study thought that this would be the end of the study, considering that the Foundation would no longer be able to buy medicines for the treatment phase of the study. He even prepared a final report.

In 1928, the Oslo Study had reported the pathologic manifestations of untreated syphilis in several hundred white men. This study was retrospective; The researchers collected data of patients who had contracted syphilis and had remained untreated for a while. The Tuskegee Study Group decided to save his experiment and continue, to make a prospective study equivalent to Oslo. This was not inherently wrong in itself, taking into consideration that there was nothing the investigators could do therapeutically, they could study the natural history of the disease, not cause harm to their patients. That would benefit humanity. Either way, the researchers left the marks of fair trial, when his study eventually became the longest nontherapeutic experiment performed in humans in the history of medicine.

Ethical considerations, poor from the start, began to deteriorate rapidly. Taking an example, half of the study, as a means of ensuring that the men agreed to perform a potentially dangerous diagnostic procedure (not therapeutic) as lumbar puncture, doctors sent 400 letters to patients entitled "Last chance to receive special free treatment. " The study also required that an autopsy on all subjects after his death, even when participants were never informed from this requirement. Treatment for patients was intentionally denied. Many were lied to and given placebo treatments in order to observe the fatal progression of the disease. In 1934, the first medical information was disclosed, published the first report being higher in 1936. It is important to note that this was not a secret study, as had numerous articles published throughout its history.

The second critical point in the direction of the experiment would come in 1947, at which time, penicillin had become standard treatment for syphilis. Several programs of the Public Health Service of the U.S. government were implemented to form "rapid treatment centers" in order to eradicate the disease. When several national health campaigns to eradicate venereal disease came to Macon County, Tuskegee study investigators discouraged their experimental subjects to participate in them. During the Second World War, 250 of the experimental subjects were recorded Tuskegee study in these campaigns, and were subsequently diagnosed and scheduled for treatment. Either way, the PHS was charged with discarding. The PHS representative at that time said: "So far, we are ensuring that all patients diagnosed not receive treatment. "

the end of the study, only 74 of the experimental subjects were still alive. 28 of the men had died directly because of syphilis, 100 died from complications arising from it, 40 of his wives were infected and 19 children were born suffering from congenital syphilis.

In 1966, Peter Buxtun, a PHS investigator in San Francisco, sent a letter to the director of the Division of venereal diseases to express their concerns about the morality of the experiment. The Centers for Disease Control (CDC) reaffirmed the need to continue the study until completion (until subjects died and the autopsies could be performed.)

With their claims ignored Buxtun Peter went to the press. The story first appeared in the Washington Star on July 25, 1972. Then he appeared on the front page of the New York Times the next day. As a result of public outcry in 1972, an advisory committee was appointed to determine whether the study was medically unjustified and ordered a halt to the experiment. As part of the adjudication that resulted from the scandal, the surviving participants who had been affected as a result of the study and their families received $ 9 million and the promise free medical treatment.

In 1974, the National Research Act became law. It also created a commission to study and draft regulations to be met by experiments involving human participants.

The May 16, 1997, five of the eight survivors of the experiment attended a White House ceremony in which President Clinton requested a formal apology to the Tuskegee experiment participants:

"We can not remedy what is already done, but we
end the silence ... We can stop turning our eyes to another part
. We watch in the eye and finally say, on behalf of the American
people that what made the United States Government
was embarrassing and I'm sorry. "

In 1932, treatments for syphilis were relatively ineffective and had severe side effects. It was known that syphilis was particularly prevalent in poor black communities. Initially, the intention of the study was to measure the prevalence of the disease, its natural history and the true effectiveness of treatment. Medical ethics prevalent at the time, had yet to exacting standards to develop an informed consent, and doctors routinely withheld information on their health status to participants. A clinical study to evaluate the effectiveness of treatment of this terrible disease was not inherently wrong. Either way, this study exploited a vulnerable sobpoblación to answer a question that would have been beneficial to the entire population. Some argue that this was an example of racism on the part of the organizers of the study.

However, with the development of an effective and simple method for the treatment of syphilis (penicillin), and changing ethical standards, ethical and moral judgments of the experiment became absolutely indefensible. By the time the study was canceled hundreds of men had died of syphilis and many of their wives had been infected. Many children also suffered the ravages of congenital syphilis. This study has become a byword for exploitation in clinical trials and has been often compared with experiments conducted by Nazi doctor Josef Mengele.

Some sociological studies have shown that the study of the Tuskegee Syphilis has predisposed many African Americans distrust the medical authorities. The study itself is a significant factor in the low participation of African Americans in clinical studies and organ donation programs. No one could blame them.