Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

A notoriously syphilis-soaked race

In 1932, the United States Public Health Service (PHS) inaugurated its “Tuskegee Study of Untreated Syphilis in the Negro Male” (Tuskegee Syphilis Study), which promised free medical care to about 600 sick, desperately poor sharecroppers in Macon County, Alabama. The study was designed, the PHS explained, to study the progression of syphilis in black men. Scientists had long claimed that the venereal disease manifested differently in blacks than in whites, and PHS scientists decided to document this by finding a pool of infected black men, withholding treatment from them, and then charting the progression of symptoms and disorders. But the PHS lied to the subjects, convincing them that they were being treated, not just studied. Among other things, the PHS expected to validate its belief in a specific type of racial dimorphism of syphilis: Whereas the disease was thought to do its worst damage to the neurologic systems and brains of whites, it was thought to wreak its worst havoc on the cardiovascular system of blacks, sparing their “relatively primitive and underdeveloped” brains.

After the first clinics enabled doctors to identify syphilitics, they selected study participants. They wanted only men, whose signs and symptoms were on the exterior genitalia and therefore easier to identify than lesions hidden behind the genitalia of women. They also wanted to exclude men whose syphilis was the result of recent infection, because doctors could be surer of choosing infected men if they chose those in the secondary or later stages of infection. Identifying such study candidates entailed taking painstaking medical histories and performing painful, medically risky spinal taps, ostensibly to determine the extent of syphilis’s neurologic involvement.

When a crowd appeared seeking the second examination, the PHS ran the spinal taps and selected 399 men with syphilis as subjects to observe. Doctors dispensed inadequate medications such as aspirin, which was craved as a miracle drug by the overworked, sickly men, who marveled at how it assuaged their omnipresent aches and pains. Raymond Vonderlehr, MD, chief of the PHS Venereal Disease Division, later added a control group of 200 uninfected men, who also were wooed with medications. When a dozen of these men developed syphilis over the 40-year course of the experiment, they were simply transferred to the infected group, a blatant violation of experimental design.

No treatment

Vonderlehr confessed in a letter to Clark, “It is my desire to keep the main purpose of the work from the negroes in the county and to continue their interest in treatment.” But there was no treatment. The next year, 1933, the PHS doctors went on to write of “bringing these cases to autopsy.” If any doubts lingered about the PHS physicians’ intention to withhold treatment, O. C. Wenger, the PHS senior officer for its syphilis program, swept them aside in 1933: “As I see it, we have no further interest in these patients until they die.”

“As I see it, we have no further interest in these patients until they die.”
— O. C. Wenger, PHS (1933)

The syphilitic men were monitored so well that most received no treatment for 40 years, despite the myriad dramatic changes in the medical landscape between 1932 and 1972. In 1934, PHS doctors met with local black doctors and asked them not to treat the men who were receiving care in the research study; the black doctors agreed. When World War II was declared, Tuskegee Syphilis Study subjects were exempted from the draft because the PHS feared that they would be treated for syphilis in the military.

As men began to die, the PHS performed autopsies and regularly published the results in medical journals. They even shared study results at a 1936 AMA meeting, which means many white physicians were informed of the study’s details—but not African American physicians, who were barred from AMA membership.

PHS documents that the sera of the infected Tuskegee subjects was used to develop more reliable tests for syphilis, including the fluorescent treponemal antibody absorption (FTA-ABS) test and the Venereal Disease Research Laboratory (VDRL) test. In 1970, Dr. James B. Lucas, of the PHS Venereal Disease branch, conceded, “Probably the greatest contribution that the Tuskegee Study has made and can continue to provide has been documented sera for study in our laboratory … In a great measure the development and our endorsement of the FTA-ABS test rested on Tuskegee sera.”

The decision not to treat the sick men of the Tuskegee Syphilis Study is a crime of omission, and it illustrates several of the important patterns explored in Medical Apartheid. These include the selection of blacks for the riskiest studies; their disproportionate selection for nontherapeutic experimentation; the myth of medical distinctiveness (which held that syphilis was manifested differently in blacks); and the myth of hypersexed blacks as “incorrigible” vectors of sexual disease and dysfunction. The use of men as reservoirs of syphilis reinforced the familiar use of black bodies to generate the profitable wonders of new disease approaches (to which the subjects are rarely privy) and the clinical display of disease in the clinic and in medical journals.