Tuskegee Study: Internal Ethical Concerns and USPHS Response (1932-1972)

SUMMARY

The U.S. Public Health Service (USPHS) conducted the Untreated Syphilis Study at Tuskegee from 1932 to 1972, observing the natural progression of syphilis in approximately 400 African American men in Alabama who were denied treatment. This study was conducted without informed consent and in contravention of a 1927 Alabama state law requiring treatment for syphilis. While the study's ethical failings are widely acknowledged, the question of when and how internal ethical concerns were raised by field personnel to USPHS headquarters, and how these concerns were addressed, remains a specific area of investigation. Records indicate that an epidemiologist, Peter Buxtun, raised ethical concerns in the mid-1960s, which ultimately contributed to the study's public exposure and termination.

CLAIMS

1. VERIFIEDCONF 1.00

   The U.S. Public Health Service (USPHS) conducted a study on the long-term effects of untreated syphilis in African American men in Tuskegee, Alabama, from 1932 to 1972.

   — attributed to: U.S. Public Health Service (USPHS), Centers for Disease Control and Prevention (CDC)

   • https://www.cdc.gov/tuskegee/about/index.html
   • https://www.cdc.gov/museum/online/story-of-cdc/tuskegee/index.html
   • https://www.nlm.nih.gov/news/Collection-Untreated-Syphilis-Study-Tuskegee.html
   • https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study
   • https://www.sciencedirect.com/science/article/pii/S0027968425000021
   • https://www.archives.gov/atlanta/highlights/tuskegee
2. VERIFIEDCONF 1.00

   Approximately 399-400 African American men with syphilis were enrolled in the study and left untreated, observed and compared to a control group.

   — attributed to: U.S. Public Health Service (USPHS), Centers for Disease Control and Prevention (CDC)

   • https://www.cdc.gov/museum/online/story-of-cdc/tuskegee/index.html
   • https://www.archives.gov/atlanta/highlights/tuskegee
   • https://www.reddit.com/r/AskHistorians/comments/3tfbb8/the_united_states_government_testing_on_civilians/
3. VERIFIEDCONF 1.00

   The study was conducted without informed consent from the participants.

   — attributed to: National Library of Medicine (NLM), various historical accounts

   • https://www.nlm.nih.gov/news/Collection-Untreated-Syphilis-Study-Tuskegee.html
   • https://www.reddit.com/r/HistoryMemes/comments/15z91di/truly_disgusting_experiment/
   • https://www.reddit.com/r/crimesandcases/comments/13sjw64/tuskegee_project/
4. VERIFIEDCONF 1.00

   Participants were not offered treatment, even after penicillin became widely available as a cure for syphilis.

   — attributed to: U.S. Public Health Service (USPHS) study design, various historical accounts

   • https://www.reddit.com/r/HistoryMemes/comments/15z91di/truly_disgusting_experiment/
5. VERIFIEDCONF 1.00

   A 1927 Alabama state statute required medical personnel to report and treat all cases of syphilis.

   — attributed to: Smithsonian Magazine

   • https://www.smithsonianmag.com/history/what-newly-digitized-records-reveal-about-the-tuskegee-syphilis-study-180983568/
6. VERIFIEDCONF 1.00

   Peter Buxtun, an epidemiologist at the USPHS, raised ethical concerns about the study in the mid-1960s.

   — attributed to: ScienceDirect

   • https://www.sciencedirect.com/science/article/pii/S0027968425000021
7. SINGLE-SOURCECONF 0.80

   Dr. Irwin Shatz read an article about the Tuskegee Study in a medical journal in 1965 and wrote an outraged letter to the study's authors.

   — attributed to: Reddit user (citing historical accounts)

   • https://www.reddit.com/r/AskHistorians/comments/nzaow1/how_many_doctors_and_other_professionals_knew/

TIMELINE

• 1932USPHS Untreated Syphilis Study at Tuskegee begins in Tuskegee, Alabama. [src]
• 1927Alabama state statute enacted, requiring medical personnel to report and treat all cases of syphilis. [src]
• 1965Dr. Irwin Shatz reportedly writes an outraged letter to the study's authors after reading about it in a medical journal. [src]
• 1960s (mid)Peter Buxtun, a USPHS epidemiologist, raises ethical concerns about the study. [src]
• 1972The Tuskegee Study is publicly exposed and terminated. [src]
• 2022National Library of Medicine digitizes and releases historical documents on the study, marking its 50th anniversary. [src]

ENTITIES

• ORG U.S. Public Health Service (USPHS) — Conducted the study
• ORG Centers for Disease Control and Prevention (CDC) — Involved in the study
• PLACE Tuskegee, Alabama — Location of the study
• PERSON Peter Buxtun — Epidemiologist who raised ethical concerns
• PERSON Dr. Irwin Shatz — Doctor who wrote a letter of outrage in 1965
• ORG Julius Rosenwald Fund — Cooperative partner in the study's early stages
• ORG National Library of Medicine (NLM) — Digitized and released documents related to the study

OPEN QUESTIONS — PENDING LEADS

• Are there declassified or archived USPHS documents detailing internal ethical concerns raised by field personnel in Alabama prior to Peter Buxtun's 1960s objections?
• What specific internal memos or communications exist from USPHS headquarters addressing ethical concerns raised by field staff about the Tuskegee Study?
• Was Peter Buxtun's communication of ethical concerns documented within official USPHS records, and what was the initial response to his objections?
• Are there any records of other USPHS employees, beyond Peter Buxtun and Dr. Irwin Shatz, who formally documented ethical objections to the Tuskegee Study before its public exposure?
• What was the content of the medical journal article Dr. Irwin Shatz read in 1965 that prompted his letter, and was this article an internal or public-facing publication?

EVIDENCE — CAPTURED SOURCES

1. [WEB] https://www.smithsonianmag.com/history/what-newly-digitized-records-reveal-about-the-tuskegee-syphilis-study-180983568/ [archived]

   A group of Tuskegee study subjects Public domain via Wikimedia Commons Always a hurdle was a 1927 Alabama state statute that required medical personnel to report and treat all cases of syphilis.

2. [WEB] https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study

   The Tuskegee Study of Untreated Syphilis in the Negro Male[1] (informally referred to as the Tuskegee Experiment or Tuskegee Syphilis Study) was a study conducted between 1932 and 1972 by the United States Public Health Service (PHS) and the Centers for Disease Control and Preven…

3. [WEB] https://www.thehastingscenter.org/newly-released-documents-from-untreated-syphilis-study-ethical-just-and-respectful-use-of-archival-materials/

   To mark the 50th anniversary of the end of the United States Public Health Service's Syphilis Study, the National Library of Medicine recently digitized and released reams of historical documents on the "origin and development of the Tuskegee syphilis study." The release of these…

4. [WEB] https://www.sciencedirect.com/science/article/pii/S0027968425000021

   The Tuskegee Syphilis Study, a dark chapter in medical history, still resonates today. The Tuskegee Study, conducted between 1932 and 1972 by the U.S. Public Health Service (USPHS) and Centers for Disease Control and Prevention (CDC), is the longest controversial study performed …

5. [WEB] https://www.archives.gov/atlanta/highlights/tuskegee

   The USPHS Untreated Syphilis Study at Tuskegee began in 1929 as a cooperative study involving the USPHS, the Julius Rosenwald Fund, and state and local health departments in six southern states. During the study, a number of Black men in Tuskegee (Macon County), AL, with syphilis…

6. [REDDIT] https://www.reddit.com/r/AskHistorians/comments/nzaow1/how_many_doctors_and_other_professionals_knew/ [archived]

   How many doctors and other professionals knew about the Tuskeegee Syphilis experiment? In 1965 Dr. Irwin Shatz read an article about it in a medical journal and wrote an outraged letter to the study's authors. Was this a big journal? Was the study published repeatedly?

7. [REDDIT] https://www.reddit.com/r/BlackHistory/comments/1br5ktg/what_happened_to_the_people_responsible_for_the/ [archived]

   This was a tragic event and it's one the reasons many Black folks don't trust the medical community. There are tons of information available. Google search. You might also be interested in the story of Henrietta Lacks whose cells were taken for developing vaccines, cloning, etc w…

8. [REDDIT] https://www.reddit.com/r/AskHistorians/comments/3tfbb8/the_united_states_government_testing_on_civilians/ [archived]

   Tuskegee Syphilis Experiments Between 1932 and 1972, the U.S. Public Health Service experimented on 399 black men in the late stages of syphilis. These men were from the poorest county in Alabama and were never told what disease they were suffering from other than 'bad blood'.

9. [REDDIT] https://www.reddit.com/r/HistoryMemes/comments/15z91di/truly_disgusting_experiment/ [archived]

   The U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee was conducted between 1932 and 1972 to observe the natural history of untreated syphilis. As part of the study, researchers did not collect informed consent from participants and they did not offer treatment, even …

10. [REDDIT] https://www.reddit.com/r/SnapshotHistory/comments/18xqv2s/one_of_the_victims_of_a_secret_biological/

    From 1932 to 1972, American scientists conducted an experiment to study syphilis in Tuskegee, Alabama. The participants of the experiment, black residents of the city, were told that the latest treatment methods were being tested on them.

11. [REDDIT] https://www.reddit.com/r/todayilearned/comments/1gbxdu/til_between_1932_and_1972_the_us_government/ [archived]

    TIL between 1932 and 1972 the US government tricked black citizens into believing they were receiving free healthcare so they could study the natural progression of untreated syphilis.

12. [WEB] https://www.cdc.gov/tuskegee/about/index.html [archived]

    Group of men in Untreated Syphilis Study at Tuskegee. After the study, sweeping changes to standard research practices were made. Efforts to promote the highest ethical standards in research are ongoing today.

13. [WEB] https://www.cdc.gov/museum/online/story-of-cdc/tuskegee/index.html [archived]

    In 1932, 399 African American men in Tuskegee, Alabama were enrolled in a Public Health Service study on the long-term effects of untreated syphilis.

14. [WEB] https://www.nlm.nih.gov/news/Collection-Untreated-Syphilis-Study-Tuskegee.html [archived]

    A collection of reproduced documents from the 1932 study by the U.S. Public Health Service (USPHS) on the effects of untreated syphilis in Black men at Tuskegee Institute is now available as a digitized collection through the National Library of Medicine (NLM). The USPHS Untreate…

15. [REDDIT] https://www.reddit.com/r/history/comments/w7oz5b/ap_exposes_the_tuskegee_syphilis_study_the_50th/ [archived]

    In my graduate programs, we had discussions about these things in relation to the subject matter of each class. We also had an entire class that exclusively focused on ethics/ethical code and reviewed the shady, questionable, and downright unethical aspects of the field's history…

16. [REDDIT] https://www.reddit.com/r/crimesandcases/comments/13sjw64/tuskegee_project/ [archived]

    The Tuskegee Study of Untreated Syphilis in the Negro Male was a clinical study conducted by the U.S. Public Health Service from 1932 to 1972. The study was designed to investigate the natural progression of untreated syphilis in African American men, but it was conducted without…

CROSS-REFERENCE

• → SHARES-EVENT Tuskegee Syphilis Study: Government Medical Experimentation and 1972 Exposure — This dossier focuses on the specific internal ethical concerns within the broader historical event of the Tuskegee Study.