Today in our History -November 30, 1929 - The Rosenwald Fund - funded a syphilis treatment pilot program in five Southern states.
GM – LIF – Today’s American Champion event was based on a Norwegian study in 1928 that reported on the pathologic manifestations of untreated syphilis in several hundred white males. This study is known as a retrospective study since investigators pieced together information from the histories of patients who had already contracted syphilis but remained untreated for some time.
The Tuskegee study group decided to build on the Oslo work and perform a prospective study to complement it. Researchers could study the natural progression of the disease as long as they did not harm their subjects. The researchers involved with the Tuskegee experiment reasoned that they were not harming the black men involved in the study because they were unlikely to get treatment for their syphilis and further education would not diminish their inherent sex drive. Even at the beginning of the study, major medical textbooks had recommended that all syphilis be treated, as the consequences were quite severe. At that time, treatment included arsenic therapy and the "606" formula. The researchers reasoned that the knowledge gained would benefit humankind; however, it was determined afterward that the doctors did harm their subjects by depriving them of appropriate treatment once it had been discovered. The study was characterized as "the longest non-therapeutic experiment on human beings in medical history."
Remember - "The United States government did something that was wrong—deeply, profoundly, morally wrong. It was an outrage to our commitment to integrity and equality for all our citizens... clearly racist."
—President Clinton's apology for the Tuskegee Syphilis
Today in our History -November 30, 1929 - The Rosenwald Fund - funded a syphilis treatment pilot program in five Southern states. The Rosenwald project emphasized locating people with syphilis and treating them, during a time when syphilis was widespread in poor African-American communities. The Fund ended its involvement in 1932, due to lack of matching state funds (the Fund required jurisdictions to contribute to efforts to increase collaboration on solving problems). After the Fund ceased its involvement, the federal government decided to take over the funding and changed its mission to being a non-therapeutic study. The infamous Tuskegee syphilis study began later that year, tracking the progress of untreated disease, and took advantage of poor participants by not informing them fully of its constraints. Even after penicillin became recognized as an approved treatment for this disease, researchers did not treat the study participants.
The US Public Health Study of Syphilis at Tuskegee began as a 6-month descriptive epidemiological study of the range of pathology associated with syphilis in the Macon County population. At that time, it was believed that the effects of syphilis depended on the race of those affected. For African Americans, physicians believed that their cardiovascular system was more affected than the central nervous system. Initially, subjects were studied for six to eight months and then treated with contemporary methods, including Salvarsan ("606,") mercurial ointments, and bismuth. These methods were, at best, mildly effective. The disadvantage was that these treatments were all highly toxic. The Tuskegee Institute participated in the study, as its representatives understood the intent was to benefit public health in the local poor population. The Tuskegee University-affiliated hospital effectively loaned the PHS its medical facilities, and other predominantly black institutions and local black doctors participated as well.
The Rosenwald Fund, major Chicago-based philanthropy devoted to black education and community development in the South, provided financial support to pay for the eventual treatment of the patients. They had previously collaborated with Public Health Services in a study of syphilis prevalence in over 2,000 black workers in Mississippi's Delta Pine and Land Company in 1928, and helped provide treatment for 25% of the workers who had tested positive for the disease. Study researchers initially recruited 399 syphilitic Black men, and 201 healthy Black men as controls.
Continuing effects of the Stock Market Crash of 1929 and the beginning of the Great Depression led the Rosenwald Fund to withdraw its offer of funding. Study directors issued a final report as they thought this might mean the end of the study once funding to buy medication for the treatment phase of the study was withdrawn.
Medical ethics considerations were limited from the start and rapidly deteriorated. The PHS asked black Tuskegee Institute physicians to participate in the study by offering funds, employment, and interns to encourage the ongoing participation of the patients. Additionally, the study intentionally employed Eunice Rivers, a black nurse from Macon County, to be a primary source of contact and build personal, trusting relationships with patients to promote their participation. To ensure that the men would show up for the possibly dangerous, painful, diagnostic, and non-therapeutic spinal taps, the doctors sent the 400 patients a misleading letter titled "Last Chance for Special Free Treatment". The study also required all participants to undergo an autopsy after death in order to receive funeral benefits. After penicillin was discovered as a cure, researchers continued to deny such treatment to many study participants. Many patients were lied to and given placebo treatments so that researchers could observe the full, long-term progression of the fatal disease.
The Tuskegee Study published its first clinical data in 1934 and issued its first major report in 1936. This was prior to the discovery of penicillin as a safe and effective treatment for syphilis. The study was not secret since reports and data sets were published to the medical community throughout its duration.
During World War II, 250 of the subject men registered for the draft. These men were consequently diagnosed as having syphilis at military induction centers and ordered to obtain treatment for syphilis before they could be taken into the armed services. PHS researchers attempted to prevent these men from getting treatment, thus depriving them of chances for a cure. A PHS representative was quoted at the time saying: "So far, we are keeping the known positive patients from getting treatment." Although some of the men in the study received arsenical or penicillin treatments elsewhere, for most of them this did not amount to "adequate therapy".
By 1947 penicillin had become standard therapy for syphilis. The US government-sponsored several public health programs to form "rapid treatment centers" to eradicate the disease. When campaigns to eradicate venereal disease came to Macon County, study researchers prevented their patients from participating.
By the end of the study in 1972, only 74 of the test subjects were alive. Of the original 399 men, 28 had died of syphilis, 100 were dead of related complications, 40 of their wives had been infected, and 19 of their children were born with congenital syphilis. The Tuskegee University Legacy Museum has on display a check issued by the United States government on behalf of Dan Carlis to Lloyd Clements, Jr., a descendant of one of the Tuskegee Syphilis Study participants. Lloyd Clements, Jr.'s great-grandfather Dan Carlis and two of his uncles, Ludie Clements and Sylvester Carlis, were in the study. Original legal paperwork for Sylvester Carlis related to the Tuskegee Syphilis Study is on display at the museum as well. Lloyd Clements, Jr. has worked with noted historian Susan Reverby concerning his family's involvement with the Tuskegee Syphilis Study. Research the other angles of what would be called The Tuskegee Study of Untreated Syphilis in the Negro Male and share it with your babies. Make it a champion day!