1900 10 20 30 40 50 60 70 80 90 2000

Eugenics Movement

Nuremberg Code - 1947

Declaration of Helsinki - 1964

Tuskegee Study – 1932-72

WWII – 1939-45

Time Line for Human Subject Research and Protection

Tuskegee Study of Untreated Syphilis

1932-1972

0

5

10

15

20

25

30

35

40

45

White Negro White Negro

CardiovascularCases

CardiovascularCases

Central NervousCases

Central NervousCases

Pe

rce

nt

Aff

ec

ted

Men

Women

From: Sowder WT. An interpretation of Bruusgaard’s paper on the fate of untreated syphilitics. American Journal of Syphilology 1940; 24:684-691

Gender and Race Related Manifestations in 6,420 Cases of Late Syphilis

Tuskegee Study Rationale - 1932

• Was there enough information to justify a cohort study of untreated Negro men?

• Were effective treatments available for managing syphilis?

Tuskegee Study of Untreated Syphilis

• Negro Men

• Infected with Syphilis

• 1932-1972

• Macon County, Alabama

Alabama

Russell Lee – Farm Security AdministrationLibrary of Congress - LC-USF33- 011671-M2

Cotton Pickers – 1938 - Arkansas

Incentives for Participation

• Burial costs

• Periodic Examinations

Cotton Field – Macon County, Alabama(Centers for Disease Control, Atlanta, GA)

Nurse Eunice Rivers and Unidentified Subject

Field Follow-up: Tuskegee Study - 1952

Mr. David Albritton, Dr. Walter Edmondson, Nurse Eunice Rivers, and Unidentified SubjectMacon County, Alabama

(Centers for Disease Control, Atlanta, GA)

Tuskegee Study: Press Reaction - 1972

“Believe nothing that yousee in the newspapers – they have done more to create dissatisfaction thanall other agencies. If yousee anything in them thatyou know is true, begin todoubt it at once.”

William Osler, M.D.

1900

Rudolf H. Kampmeier, M.D.

Editorials:

The Tuskegee Study of Untreated Syphilis.Southern Medical Journal1972; 65 (10): 1247-1251

Final Report on the “Tuskegee Syphilis Study.”Southern Medical Journal1974; 67 (11): 1349-1353

Argues that the Tuskegee study should be interpreted in the context of the times in which it was conducted.

The Shibboleth of Informed Consent

“…I have no intention of becoming entrapped in this topic since to me the interpretation of customs and mores of a generation or two ago in today’s terms is a tilting at windmills…. In the days of the Tuskegee Study we used to walk into a patient’s room and announce ‘We’re going to take out your gallbladder tomorrow morning,’ the answer commonly was, ‘OK’ and that was it – no ‘informed consent,’no signed paper of permission – ergo, Jenner, the Hunters, Pasteur, and hundreds of thousands of physicians and surgeons of the past have been unethical in terms of ‘informed consent.’”

Kampmeier, RH. Southern Medical Journal 1974; 67:1349-1353

Tuskegee Study - 1972

• What is the evidence that treatment of tertiary syphilis with penicillin changes outcomes?

• What proportion of cohort participants received antibiotics over the course of the study?

• How complete was the cohort follow-up?

White House Apology Ceremony – May 16, 1997

Front Row (left to right): Herman Shaw, Fred Simmons, Charles Pollard, Frederick Moss, Carter Howard.

Back Row (left to right): Surgeon General David Satcher, President William J. Clinton, Vice-President Albert Gore.