When Evil Intrudes

Twenty years ago Peter Buxtun, a public health official working for the United States Public Health Service, complained to a reporter for the Associated Press that he was deeply concerned about the morality of an ongoing study being sponsored by the Public Health Service--a study compiling information about the course and effects of syphilis in human beings based upon medical examinations of poor black men in Macon County, Alabama. The men, or more accurately, those still living, had been coming in for annual examinations for forty years. They were not receiving standard therapy for syphilis. In late July of 1972 the Washington Star and the New York Times ran front-page stories based on Buxtun's concerns about what has been called the longest running "nontherapeutic experiment" on human beings in medical history and "the most notorious case of prolonged and knowing violation of subject's rights"--the Tuskegee study.[1] Buxtun went public with his ethical concerns after years of complaining to officials from the Centers for Disease Control and the Public Health Service with no apparent effect. His decision to blow the whistle led to a series of sensational congressional hearings chaired by Senator Edward Kennedy in February and March of 1973. Legislators and federal officials expressed outrage over the immorality of a study in which poor, illiterate men had been deceived and given placebo treatment rather than standard therapy so that more could be learned about syphilis. Americans found it hard to believe that the Public Health Service had intentionally and systematically duped men with a disease as serious as syphilis--contagious, disabling, and life-threatening--for more than forty years. The level of outrage about the Tuskegee study was enormous. One CDC official labeled the experiment akin to "genocide."[2] As a result of public anger over the immorality of the study, Congress created an ad hoc blue ribbon panel to review both the Tuskegee study and the adequacy of existing protections for subjects in all federally sponsored research. Even though the panel did not receive all the information about the study that the government had available,[3] they were still concerned enough about what had taken place to recommend the creation of a national board with the resources to reexamine all aspects of human experimentation in the United States. Congress, in 1974, created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research which, in its seventeen reports and numerous appendix volumes, laid the foundation for the ethical requirements that govern the conduct of research on human subjects in the United States to this day. Syphilis continues to challenge America's and the world's medical, public health, and moral resources. While there are a variety of antibiotics available to treat the disease, it has proven to be a stubborn and resilient foe. The Centers for Disease Control has found steady and alarming increases in the incidence of primary and secondary syphilis over the past decade. It is still a major public health problem in the United States today, especially among young black males. The rise in the incidence of the disease has ensured that writings about the diagnosis, management, and treatment of syphilis are prominently featured in the professional literature of public health and biomedicine as well as in standard textbooks about venereal and infectious diseases. Ongoing concern about syphilis has led physicians and public health officials to draw upon as much information as they can about the course of the disease. One of the bitter if generally unacknowledged ironies of the Tuskegee study is that, while it now occupies a special place of shame in the annals of human experimentation, its findings are still widely cited by the contemporary biomedical community. In looking at instances of scientific misconduct and moral malfeasance with respect to research it is quite common to find the position advanced that good science is incompatible with bad ethics. …