SYPHILIS AND HUMAN EXPERIMENTATION

12 May

In 1932, the United States Public Health Service initiated a study of the natural history of untreated syphilis, very loosely modeled on the Oslo Study, although the project was not motivated by therapeutic skep- ticism. Conducted in Macon County, Alabama, with the assistance of personnel at the Tuskegee Institute, the Veterans Administration Hospi- tal in Tuskegee, the Macon County Health Department, and so forth, the experiment became known as the Tuskegee Study, although in the 1970s, the Tuskegee Institute claimed to have had little or no contact with the experiment after the 1930s. Six hundred poor black men were recruited for the study with promises of free medical care and money for burial (after autopsy): four hundred were diagnosed as syphilitic and two hundred were selected to serve as uninfected controls. Published reports from the Tuskegee Study of Untreated Syphilis in the Negro Male appeared with some regularity from 1936 into the 1960s.

Various federal and local officials assisted the investigators when complications arose. For example, R. A. Vonderlehr, Assistant Surgeon General, exerted his influence to make sure that subjects of the Tuskegee Study of Untreated Syphilis did not receive effective treat- ments from nonparticipating physicians. In 1943, when Vonderlehr was told that the Selective Service Board might compel some of the subjects to be treated for venereal disease, he asked the Board to exclude study participants from the draft. Vonderlehr had no doubt that the Board would cooperate, if researchers described the ‘‘scientific importance’’ of completing the study. Throughout the course of the experiment, the physicians conducting the study deliberately withheld available therapy and deceived the participants by assuring them that they were In 1932, the United States Public Health Service initiated a study of the natural history of untreated syphilis, very loosely modeled on the Oslo Study, although the project was not motivated by therapeutic skep- ticism.

Conducted in Macon County, Alabama, with the assistance of personnel at the Tuskegee Institute, the Veterans Administration Hospi- tal in Tuskegee, the Macon County Health Department, and so forth, the experiment became known as the Tuskegee Study, although in the 1970s, the Tuskegee Institute claimed to have had little or no contact with the experiment after the 1930s. Six hundred poor black men were recruited for the study with promises of free medical care and money for burial (after autopsy): four hundred were diagnosed as syphilitic and two hundred were selected to serve as uninfected controls. Published reports from the Tuskegee Study of Untreated Syphilis in the Negro Male appeared with some regularity from 1936 into the 1960s. Various federal and local officials assisted the investigators when complications arose.

For example, R. A. Vonderlehr, Assistant Surgeon General, exerted his influence to make sure that subjects of the Tuskegee Study of Untreated Syphilis did not receive effective treat- ments from nonparticipating physicians. In 1943, when Vonderlehr was told that the Selective Service Board might compel some of the subjects to be treated for venereal disease, he asked the Board to exclude study participants from the draft. Vonderlehr had no doubt that the Board would cooperate, if researchers described the ‘‘scientific importance’’ of completing the study. Throughout the course of the experiment, the physicians conducting the study deliberately withheld available therapy and deceived the participants by assuring them that they were receiving appropriate medical care for ‘‘bad blood.’’ In 1970, an official of the Public Health Service declared that the Tuskegee Study was incompatible with the goal of controlling venereal disease because noth- ing had been learned in the course of this poorly planned and badly executed experiment that would ever ‘‘prevent, find, or cure’’ a single case of syphilis. But it was not until 1972, when investigative reporters brought the experiment to public attention, that the study was terminated. Eight survivors of the Tuskegee Study, including 95-year-old Mr. Shaw and Mr. Fred Simmons, who gave his age as about 110 years, were present in 1997 when President Clinton offered an official apology for the infamous Tuskegee Study. The President’s goal was to rebuild trust in the nation’s biomedical research system by establishing rules that would ensure that all medical research programs would conform to the highest ethical standards and that researchers would work more closely with com- munities. The Department of Health and Human Services announced plans to establish a Tuskegee center for bioethics training that would serve as a memorial to the victims of the Tuskegee study.

The President also extended the charter of the National Bioethics Advisory Commission. The Tuskegee Study revealed nothing of value about the natural history of syphilis, but told a disturbing story of racism, poverty, and ignorance. Historians who have analyzed the Tuskegee Study concluded that it ‘‘revealed more about the pathology of racism than it did about the pathology of syphilis.’’ Official investigations have generally focused on the question of why the study was allowed to continue after the 1940s, when penicillin became the drug of choice in treating the disease. The assumption was often made that withholding treatment during the 1930s was justifiable on the grounds that the treatments then available were both worse than the disease and ineffective. During the 1930s, physicians were no longer praising Salvarsan as a miracle cure for syphi- lis, but they were subjecting patients to long, expensive, painful treatment programs involving numerous intramuscular injections of Salvarsan in combination with applications of mercury or bismuth ointments.

Per- haps ethical questions about the treatment of the well-to-do, as well as the withholding of treatment from the poor are applicable to the time period preceding the introduction of penicillin. Both the Oslo and the Tuskegee Experiment involved studies of naturally acquired syphilis, but other research on the disease involved the deliberate infection of human subjects. While some researchers used themselves as guinea pigs, experiments carried out by Dr. Camille Gibert (d. 1866) and Dr. Joseph Alexandre Auzias-Turenne (d. 1870) in Paris in 1859 involved the use of hospital patients. Auzias-Turenne called himself the inventor of ‘‘syphilization,’’ that is, a series of inoculations with what were said to be successively weaker forms of the ‘‘syphilitic virus’’ taken from patients at different stages of the disease. Auzias-Turenne believed that his experiments would settle the contemporary debate about the symptoms and contagiousness of secondary syphilis. To prove that secondary syphilis was contagious, Auzias-Turenne inoculated four hospitalized patients—who were free of venereal disease—with ‘‘puru- lent matter’’ taken from a patient with syphilis in the secondary phase. All four patients contracted the disease. For the most part, the medical community condemned these experiments as unethical and unnecessary. In general, doctors and the public objected to experiments that might harm any patient—rich or poor. Nevertheless, Auzias-Turenne felt triumphant because his work forced Ricord to admit that secondary syphilis was contagious. Laboratory animals, such as rabbits, were eventually used for many studies of Treponema pallidum, but researchers argued that some questions could only be answered by experiments on human subjects. For example, in 1916, Udo J. Wile inoculated rabbits with treponemes taken from the brains of paretic patients.

hese studies were done in order to determine whether neurosyphilis was caused by a specific strain of the agent that causes syphilis. Wile obtained samples of brain tissue by trephining the skulls of patients hospitalized for forms of insanity associated with syphilis. Noguchi and other scientists had studied the relationship between T. pallidum in preserved brain sections of paretics or fresh autopsy material, but Wile argued that it was important to demonstrate the existence of active spirochetes in the brains of living paretics. Such findings, he warned, had important implications for the management of patients, because many physicians assumed that paretics could not transmit the disease.

Random Posts

Comments are closed.