Community/Public Health Nursing 6th Edition by Mary Nies ,Melanie McEwen

Exercise 8

In 1932 the U.S. Public Health Service (PHS) began a longitudinalexperimental study of 600 African-American sharecroppers, 399 of whom had syphilis and 201 who did not. The study was conducted in one of the poorest counties of Alabama, and the subjects were unaware that they had syphilis; they were told they were being treated for "bad blood." Enticed by the promise of free medical care and meals, the subjects joined the study without knowledge of their disease, its treatment, or the study procedures. The experimental group was initially treated with ineffective doses of the treatments of the time, bismuth or mercury, and later with aspirin. Even when penicillin became available in the late 1940s, these subjects were actively denied treatment. For 40 years, these men were followed up by PHS investigators affiliated with the Tuskegee Institute and hospital, who claimed to be observing the differences in the progression of the disease in blacks in comparison with the control group. During the course of the study, many subjects died of syphilis or other causes, numerous wives became infected, and children were born with congenital syphilis.
In 1972, a former venereal disease interviewer, Peter Buxtun, "blew the whistle" on the study, and reports were published in newspapers. Only after the public became outraged about the unethical nature of the study did the Centers for Disease Control and Prevention and the PHS move to end it. In 1973, the National Association for the Advancement of Colored People (NAACP) won a $10 million class action suit on behalf of the subjects. In 1997, President Bill Clinton formally apologized to the few survivors and their families for the harm inflicted on these men and their families in the name of public health research.
The Tuskegee Study raises questions about how a study could proceed without informing and seeking consent of participants, how available treatment could be withheld, and how government researchers could pursue an unethical research plan without periodic review and questioning. Furthermore, the racial and discriminatory issues suggest disturbing questions for researchers and practicing nurses to contemplate, one being that the Tuskegee Study contributes to a legacy of distrust that minorities may harbor toward both the health care delivery system and research programs.