Lessons from Tuskegee

A Cautionary Tale about Misplaced Trust

In the early 1930s, the black population of Macon County, Alabama, had the highest rate of syphilis in America, somewhere around 35 percent. While some physicians argued this was the result of sexual promiscuity, the prevailing view among the intelligentsia explained it according to the postulates of Charles Darwin. They took it as evidence that blacks were inferior to whites biologically, and thus more susceptible to disease.

So, in 1932, the U.S. Public Health Service (PHS) partnered with the Tuskegee Institute to study syphilis in black men in Macon County. At first, it seems the primary goal was containment. There was no cure for syphilis at the time, or even any real effective treatment, but the study was funded by the Chicago-based Rosenwald Fund to explore possibilities for mass treatment.

As it turned out, the study subjects were never treated for syphilis until after the study ended in 1972. Why was that? Today, shallow thinkers attribute it all to racism, and there’s no doubt racism played a role, but there’s more to it than fits into the default, America-is-racist construct.

The 1997 HBO movie, Miss Evers’ Boys recounts the study through the eyes of Nurse Eunice Evers, who worked with it from the beginning. She was the men’s primary point of contact, and the narrative of the movie is reconstructed from her 1973 testimony before the U.S. Senate subcommittee on health. (Her name was Eunice Rivers, but HBO changed it, perhaps because Mrs. Rivers was deceased when the “based on a true story” film was made. I’ll refer to her as Nurse Evers since I’m recounting the story according to the film.)

The principal operators of the study were Dr. John Douglas, a physician from out of state who had been appointed by the PHS, Dr. Sam Brodus, a physician at the Tuskegee Institute, and Nurse Evers. (For those who keep track according to skin color, Douglas was white, and Brodus and Evers were black.)

At the outset, Evers was nearly euphoric. Brodus was optimistic as well, but the men of Macon County were skeptical. Why should they trust the government to do anything for them? Nurse Evers’s first order of business was to convince them to come in for testing. She went out to their homes and the fields where they were working. “It’s the dawn of a new day!” she said. The government’s treating the sick colords free. “Ain’t that something? We got us a whole new deal here! They have a whole new view of things, and it’s coming straight down from President Roosevelt.” And so, they came. She also promised free medical care, free meals, and rides in her government car, but mainly they came because they trusted her.

Six months later, the funding ran out. The idea had been to get the program started and then turn it over to the state, but the state didn’t have the money to continue it. This was still the depression, and Alabama had been hit hard.

After several more months passed, Dr. Brodus was invited to Washington to hear a proposal about a new study. A study of all-white syphilitics had been done several decades prior in Oslo, Norway. That meant they now had a chance to compare the progression of syphilis in white men with that of black men. If the disease progression in the Tuskegee men proved to be no different from that of the Oslo men, they could lay to rest this notion of biological inferiority. The catch was, the Tuskegee men would have to go untreated.

Brodus was indignant. The DC officials put it to him as a way to help the Negro people advance medical science. “It’ll wipe out centuries of ignorance about the Negro man and disease being related to race,” Douglas said. “This is science!” a DC official added. “The stamping out of disease. That’s what this office is dedicated to, for all the people.”

Brodus was reluctant, but Douglas persisted. “It’ll make medical history,” he said. “We’ll do it for six months or a year, let them get their facts, then we’ll get federal money for treatment.” After that, Brodus could build Tuskegee into a major medical research center. “Think of what good you can do with a program like that.” Besides, the men were already going untreated. This would put them first in line for treatment after the PHS got their data.

Ultimately Douglas persuaded him to sign on, primarily, it seems, because of the promise of treatment to come, and he returned to Tuskegee with new funding. Nurse Evers was equally hesitant at first, but Brodus persuaded her with the same reasoning Douglas had given him. The treatment money will come, he promised, but first they had to get the data.

And so, the men came back in for “treatment” in the form of placebos. The 1930s turned into the 1940s, and a new drug called penicillin began showing promise as a cure for syphilis. Nurse Evers wanted to know when their men were going to get it. The PHS already had ten years of data. When would the Tuskegee men get treatment? she demanded to know.

“The study needs to go to the end point,” Douglas answered.

And what was that?

“We have to validate our facts - through autopsy, Nurse Evers. That is the end point. That will make it science, not guesswork.”

Evers was appalled, as a new realization dawned on her. “We’re gonna wait for them to die?”

“Science is sometimes a hard taskmaster, Nurse Evers. You think I like not treating them? No, but we have to finish the study. We have a chance to make history, here.”

All this time, she had believed the treatments would come. But that had never been part of the plan. She had signed onto this project in good faith. And the men had gone in for it because they trusted her. What was she to do now?

Dr. Brodus waxed philosophical. “We’re showing, once and for all, through the nobility of scientific proof, that when it comes to disease, ironically, we’re all the same. You are doing good for those men, and you are doing good for the Negro people.” He said staying with the project was her “calling.”

And so, she stayed and tended to the men as best she could. But there would be no penicillin for them. They were told there could be very dangerous side effects if they received it, and their names were distributed to area clinics to prevent them from getting it elsewhere. The study went on until an investigative journalist wrote about it and the PHS terminated it in 1972.

As it turned out, it did make history, but not for the reasons that had been put to anyone who participated in it. Today the whole 40-year episode is cast as evidence of American racism, but it’s more than that. It’s a cautionary tale about misplaced trust – misplaced trust in government, misplaced trust in science, and the error of violating one’s conscience. There’s never anything noble about maintaining a lie for a “greater good,” and you can see through the course of the story the effect on both doctors and especially Nurse Evers of violating their conscience.

None of those things have anything to do with race, but they have a lot to do with humanistic hubris. It’s perverse that the study was put to Dr. Brodus as a way of using “science” to prove human equality, when it was the “science” of Darwinian evolution that had created the notion of racial inequalities in the first place. It’s even more perverse that Evers was encouraged to violate her conscience because of some noble “calling.” Perhaps the uneducated men who were skeptical at the prospect of government “help” possessed a wisdom that went beyond that of all the educated helpers.