Research Methods & Ethics · 1972
Tuskegee Syphilis Study Exposed
The study began in 1932 in Macon County, Alabama, one of the poorest counties in the United States. The U.S. Public Health Service enrolled 399 Black men with latent syphilis and 201 uninfected controls, recruited through churches and schools with promises of free meals, transportation, and burial insurance. The stated research purpose was to observe the natural history of untreated syphilis in Black men, premised on the assumption, common among Public Health Service physicians of the era, that the disease manifested differently by race. The men were not told they had syphilis; most were told they were being treated for bad blood.
When penicillin became the standard treatment for syphilis in 1947, PHS researchers made a deliberate decision not to offer it to the study participants. They also worked through the Macon County draft board during World War II to prevent participants from being treated for syphilis when they were called up for military service. Peter Buxtun, a PHS venereal disease investigator, raised ethical objections internally in 1966 and again in 1968; both times the PHS reviewed the matter and decided to continue the study.
Buxtun eventually passed documents to journalist Jean Heller of the Associated Press. Her story ran on July 25, 1972, and was front-page news in newspapers across the country. The PHS terminated the study within weeks of publication. By that point, 28 participants had died of syphilis, 100 more had died of related complications, 40 wives had been infected, and 19 children had been born with congenital syphilis.
Senator Edward Kennedy held hearings, and the resulting investigation found that no participant had signed an informed consent document and that researchers had systematically obstructed access to treatment. Congress passed the National Research Act in 1974, creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The commission's deliberations produced the Belmont Report in 1979, which articulated three foundational principles for ethical research involving human subjects: respect for persons, beneficence, and justice.
Institutional review board oversight for all federally funded human research became mandatory under the regulations that followed. The study's legacy extended beyond regulatory reform: surveys conducted in subsequent decades found that Black Americans cited Tuskegee as a reason for distrust of the medical and research establishment, a distrust that influenced participation in clinical trials and uptake of preventive care. President Clinton delivered a formal government apology in 1997 to five surviving participants. Buxtun received no formal recognition from the government for more than three decades after his disclosure.
Key People
- Jean Heller — AP journalist whose 1972 report exposed the study and ended it.
- Peter Buxtun — PHS venereal disease investigator who first raised ethical objections internally in 1966.
- Edward Kennedy — U.S. Senator who chaired hearings leading to the National Research Act of 1974.
Jean Heller, Associated Press, July 1972; Ad Hoc Advisory Panel Final Report, 1973
Related landmarks
- 1972 · Cochrane, 'Effectiveness and Efficiency' (Research Methods & Ethics)
- 1976 · Large simple trials and trial overviews (Peto and colleagues) (Research Methods & Ethics)
- 1964 · Declaration of Helsinki (Research Methods & Ethics)
- 1962 · Kefauver-Harris Drug Amendments (Research Methods & Ethics)