1.+Tuskeege

General History of The Tuskegee Syphilis Study

The Tuskegee Syphilis Study, formally known as The Tuskegee Study of Untreated Syphilis in the Negro Male,took place in an era very different from today. Participants were recruited and treated in a way that current laws and codes of ethics would not allow for. The Tuskegee Syphilis Study, which consisted of persuasive incentives and procedures that led to the deaths of many innocent African American men, went relatively unnoticed for several decades until a news article went public and killed the study. Today, codes of ethics and social media platforms makes such treatment of study volunteers illegal and publicly unacceptable. In the era of the Tuskegee Syphilis Study, the racial climate bore such tension that legal maltreatment of blacks was justified by emphasizing physical features in order to portray blacks as inferior ( Daugherty-Brownrigg, 2013).

The study began in 1932 and the intended duration was six months. Public health initiatives were growing which led the US Public Health Service to fund a study on syphilis led by the Tuskegee Institute ( Cottrell & McKenzie, 2011. p. 97),. At this time the standard of care for syphilis was to administer injections of arsenic and mercury for a year, which had proven largely ineffective ( [|Daugherty-Brownrigg], 2013). There were 600 total participants, 400 of whom had syphilis at the time of the study, and 200 who did not have syphilis. All participants were poor, semi-literate African American male sharecroppers from Macon County, Alabama ( Daugherty-Brownrigg, 2013). The men were persuaded to participate by being offered free physical examinations, free treatment for minor health problems, free meals, transportation to and from the clinic, and a burial stipend ( Cottrell & McKenzie, 2011. p. 97, [|Daugherty-Brownrigg] 2013). These incentives were very persuasive because these men were very poor and sick. The men were also told that they were being treated for “bad blood”. The researchers knew that this meant that they had syphilis, but the participants were not aware that they were being treated for syphilis at all ( Cottrell & McKenzie, 2011. p. 97 ). Though penicillin was discovered as the treatment for syphilis in the 1940s the researchers allowed the men with syphilis to suffer without providing any real treatment. Though the study was supposed to last six months, it continued for over 40 years until a newspaper article exposed the conditions and ended it in 1972 (Cottrell & McKenzie, 2011, p. 97).

How did this influence research ethics?

 The unethical practices during the Tuskegee Syphilis Study resulted in many changes in research ethics concerning human participants. The federal investigation into the study resulted in policy changes and a shift in ethical principles (Reverby, 2009).

 The National Research Act (Public Law 93-348) of 1974 was passed in reaction to unethical practices like those at Tuskegee. This mandated the creation of institutional review boards (IRB) which served to approve and oversee research studies. The law also formed the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research which developed a set of standards or “basic ethical principles” (Cottrell & McKenzie, 2011. p. 98). This commission published the Belmont Report which stated the three fundamental ethical principles: “respect for persons, beneficence, and justice – the founding beliefs for modern American bioethics” (Cottrell & McKenzie, 2011. Reverby, 2009. p 191-192).

 The Belmont Report is often seen as encouraging protectionism for vulnerable populations (Reverby, 2009). This perspectivism runs its own risks. According to Reverby (2009), the protectionism instituted by The Belmont Report “might also leave a community //out// of clinical trials [which] became a political issue during the beginning of the AIDS epidemic” (p. 194). The commissioners behind The Belmont Report struggled “to strike a good balance between inclusion and protection, and it was easier to protect” (Reverby, 2009. p 194).

Though consent was technically required before and during Tuskegee, this breach of ethics forced a deeper look at the meaning of informed consent and the ethical means of obtaining it (Hardicre, 2014).

 While the practices at Tuskegee were outrageous, they did result in meaningful conversations and legislation that continue to impact research methods today.

References

Cottrell, R. R. & McKenzie, J. M. (2011). //Health Promotion & Education Research Methods Using the Five-Chapter Thesis/Dissertation Model//. 2nd Ed. Salisbury, MA: Jones & Bartlett.

Daugherty-Brownrigg, B (2013). Tuskegee Syphilis Study. Loue, S. (Eds.), Mental Health Practitioner’s Guide to HIV/AIDS(423-426). New York: Springer.

Hardicre, J. (2014). An overview of research ethics and learning from the past. //British Journal Of Nursing//, //23(9),// 483-486. Retrieved from http://0-search.ebscohost.com.libcat.widener.edu/login.aspx?direct=true&db=aph&AN=96014879&site=ehost-live.

Reverby, S. (2009). //Examining Tuskegee: The infamous syphilis study and its legacy//. Chapel Hill: University of North Carolina Press.