View source for Tuskegee Syphilis Study

{{Short description|1932–1972 human experiment in Alabama, United States}}
{{redirect|Tuskegee experiments|the album by Don Byron|Tuskegee Experiments (album)}}
{{Sprotected|small=yes}}
{{Use mdy dates|date=March 2024}}
{{infobox clinical trial
| name = Tuskegee Syphilis Study
| image = Tuskegee-syphilis-study doctor-injecting-subject.jpg
| image_size = 270px
| alt =
| caption = A doctor draws blood from one of the Tuskegee test subjects
| study_type =
| dates = 1932–1972
| locations = [[Tuskegee, Alabama]]
| lead_researcher =
| funding = [[United States Public Health Service|U.S. Public Health Service]] (PHS)
| protocol =
| published_year =
| published_article =
}}

The '''Tuskegee Study of Untreated Syphilis in the Negro Male'''<ref>
*{{Cite news |last1=Newkirk |first1=Vann R. II |title=A Generation of Bad Blood |url=https://www.theatlantic.com/politics/archive/2016/06/tuskegee-study-medical-distrust-research/487439/ |access-date=December 18, 2020 |work=[[The Atlantic]] |date=June 17, 2016 |quote=Known officially as the Tuskegee Study of Untreated Syphilis in the Negro Male ... |archive-date=December 18, 2020 |archive-url=https://web.archive.org/web/20201218121728/https://www.theatlantic.com/politics/archive/2016/06/tuskegee-study-medical-distrust-research/487439/ |url-status=live }}
*{{Cite journal |first1=Shamim M.|last1=Baker|first2=Otis W.|last2=Brawley|first3=Leonard S.|last3=Marks |title=Effects of untreated syphilis in the negro male, 1932 to 1972: a closure comes to the Tuskegee study, 2004 |journal=Urology |date=June 2005 |volume=65 |issue=6 |pages=1259–62 |doi=10.1016/j.urology.2004.10.023 |pmid=15922414 |url=https://www.usrf.org/uro-video/Tuskegee_2004/Tuskegee_study.pdf |access-date=December 18, 2020 |quote=The study was officially titled 'The Effects of Untreated Syphilis in the Negro Male.' |archive-date=September 15, 2012 |archive-url=https://web.archive.org/web/20120915180342/http://www.usrf.org/uro-video/Tuskegee_2004/Tuskegee_study.pdf |url-status=live }}
*{{cite web |title=The Tuskegee Timeline |url=https://www.cdc.gov/tuskegee/timeline.htm |department=U.S. Public Health Service Syphilis Study at Tuskegee |publisher=[[U.S. Centers for Disease Control and Prevention]] |access-date=December 18, 2020 |quote=It was called the 'Tuskegee Study of Untreated Syphilis in the Negro Male.' |archive-date=May 10, 2019 |archive-url=https://web.archive.org/web/20190510082812/https://www.cdc.gov/tuskegee/timeline.htm |url-status=live }}</ref> (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 Prevention]] (CDC) on a group of nearly 400 [[African American]] men with [[syphilis]] as well as a [[control group]] without.<ref name="Brandt-1978">{{Cite journal |last=Brandt |first=Allan M. |date=December 1978 |title=Racism and Research: The Case of the Tuskegee Syphilis Study |url=https://dash.harvard.edu/bitstream/1/3372911/1/Brandt_Racism.pdf |journal=The Hastings Center Report |publisher=[[Wiley-Blackwell]]|location=Garrison, New York|volume=8 |issue=6 |pages=21–29 |doi=10.2307/3561468 |jstor=3561468 |pmid=721302 |s2cid=215820823 |access-date=June 27, 2020 }}</ref><ref name="CDC-2020">{{Cite web |title=Tuskegee Study - Timeline |url=https://www.cdc.gov/tuskegee/timeline.htm |date=March 2, 2020 |publisher=CDC - NCHHSTP |language=en-us |access-date=May 14, 2020 |archive-date=May 10, 2019 |archive-url=https://web.archive.org/web/20190510082812/https://www.cdc.gov/tuskegee/timeline.htm |url-status=live }}</ref> The purpose of the study was to observe the effects of the disease when untreated, to the point of death and [[autopsy]].<ref name=":0">{{Cite journal |last=Tobin |first=Martin J. |date=2022-05-15 |title=Fiftieth Anniversary of Uncovering the Tuskegee Syphilis Study: The Story and Timeless Lessons |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC9872801/ |journal=American Journal of Respiratory and Critical Care Medicine |volume=205 |issue=10 |pages=1145–1158 |doi=10.1164/rccm.202201-0136SO |issn=1535-4970 |pmc=9872801 |pmid=35500908}}</ref> Although there had been effective treatments to reduce the severity of the disease since the 1920s, the use of [[penicillin]] for the treatment of syphilis was widespread as of 1945.<ref name=":0" /> The men were not informed of the nature of the study, proper treatment was withheld, and more than 100 died as a result.

The Public Health Service started the study in 1932 in collaboration with [[Tuskegee University]] (then the Tuskegee Institute), a [[Historically black colleges and universities|historically Black college]] in Alabama. In the study, investigators enrolled 600 impoverished African-American [[sharecropper]]s from [[Macon County, Alabama]].<ref name="Reverby-2009">{{cite book|last=Reverby|first=Susan|title=Examining Tuskegee: The Infamous Syphilis Study and its Legacy|publisher=[[The University of North Carolina Press]]|location=Chapel Hill, North Carolina|year=2009|page=30|isbn=9780807833100}}</ref> Of these men, 399 had [[latent syphilis]], with a [[control group]] of 201 men who were not infected.<ref name="CDC-2020" /> As an incentive for participation in the study, the men were promised free medical care and promised funeral expenses.<ref name=":0" /> While the men were provided with both medical and mental care that they otherwise would not have received,<ref>{{Cite journal|last=Reverby|first=S.M.|date=1999|title=Rethinking the Tuskegee Syphilis Study: Nurse Rivers, Silences, and the Meaning of Treatment|url=http://ftp.columbia.edu/itc/hs/pubhealth/p9740/readings/reverby.pdf|journal=[[Nursing History Review]]|volume=7|pages=3–28|doi=10.1891/1062-8061.7.1.3|pmid=10063364|s2cid=35965490}}</ref> they were deceived by the PHS, who never informed them of their syphilis diagnosis{{refn|<ref name="Reverby-2009" /><ref name="Brown-2017">{{Cite news|title='You've got bad blood': The horror of the Tuskegee syphilis experiment|url=https://www.washingtonpost.com/news/retropolis/wp/2017/05/16/youve-got-bad-blood-the-horror-of-the-tuskegee-syphilis-experiment/|last=Brown|first=DeNeen L.|newspaper=[[The Washington Post]]|language=en|date=May 16, 2017|access-date=May 14, 2020|archive-date=May 13, 2020|archive-url=https://web.archive.org/web/20200513010907/https://www.washingtonpost.com/news/retropolis/wp/2017/05/16/youve-got-bad-blood-the-horror-of-the-tuskegee-syphilis-experiment/|url-status=live}}</ref><ref name="Associated Press-2017">{{Cite web|title=Descendants of men in syphilis study emerging from shadows|url=https://www.al.com/news/2017/05/descendants_of_men_in_tuskegee.html|agency=[[Associated Press]]|date=May 10, 2017|publisher=[[al.com]] |language=en|access-date=May 14, 2020|archive-date=August 9, 2020|archive-url=https://web.archive.org/web/20200809131454/https://www.al.com/news/2017/05/descendants_of_men_in_tuskegee.html|url-status=live}}</ref><ref name="Heller-1972">{{Cite news|first=Jean|last=Heller|agency=[[Associated Press]]|date=July 26, 1972|title=Syphilis Victims in U.S. Study Went Untreated for 40 Years|language=en-US|work=[[The New York Times]]|url=https://www.nytimes.com/1972/07/26/archives/syphilis-victims-in-us-study-went-untreated-for-40-years-syphilis.html|access-date=May 14, 2020|issn=0362-4331|archive-date=February 9, 2014|archive-url=https://web.archive.org/web/20140209211124/http://select.nytimes.com/gst/abstract.html?res=F40616F6345A137B93C4AB178CD85F468785F9|url-status=live}}</ref><ref name="AP News-2017">{{Cite web|title=AP WAS THERE: Black men untreated in Tuskegee Syphilis Study|date=May 10, 2017 |url=https://apnews.com/e9dd07eaa4e74052878a68132cd3803a|publisher=[[AP News]]|access-date=May 14, 2020|archive-date=June 3, 2020|archive-url=https://web.archive.org/web/20200603104352/https://apnews.com/e9dd07eaa4e74052878a68132cd3803a|url-status=live}}</ref>}} and who provided disguised [[Placebo|placebos]], ineffective treatments, and [[diagnostic procedures]], such as [[Lumbar puncture|lumbar punctures]], as treatment for "bad blood".<ref name=":0" /><ref name="Gray-1998">{{Cite book|last=Gray|first=Fred D.|title=The Tuskegee Syphilis Study: The Real Story and Beyond|publisher=NewSouth Books|year=1998|location=Montgomery, Alabama|isbn=978-1579660123|page=76}}</ref>

The men were initially told that the experiment was only going to last six months, but it was extended to 40 years.<ref name="CDC-2020" /> After funding for treatment was lost, the study was continued without informing the men that they would never be treated. None of the infected men were treated with penicillin despite the fact that, by 1947, the antibiotic was widely available and had become the standard treatment for syphilis.<ref name="Duff-Brown-2017">{{Cite web|title=The shameful legacy of Tuskegee syphilis study still impacts African-American men today|url=https://healthpolicy.fsi.stanford.edu/news/researchers-and-students-run-pilot-project-oakland-test-whether-tuskegee-syphilis-trial-last|last=Duff-Brown|first=Beth|date=January 6, 2017|publisher=Stanford Health Policy|language=en|access-date=May 14, 2020|archive-date=June 17, 2020|archive-url=https://web.archive.org/web/20200617121756/https://healthpolicy.fsi.stanford.edu/news/researchers-and-students-run-pilot-project-oakland-test-whether-tuskegee-syphilis-trial-last|url-status=live}}</ref>

The study continued, under numerous Public Health Service supervisors, until 1972, when a leak to the press resulted in its termination on November 16 of that year.<ref>{{Cite web|title='I Didn't Want to Believe It': Lessons from Tuskegee 40 Years Later|url=http://advocatesaz.org/2012/11/15/i-didnt-want-to-believe-it-lessons-from-tuskegee-40-years-later/|last=Matt|date=November 15, 2012|publisher=Planned Parenthood Advocates of Arizona|language=en-US|access-date=May 14, 2020|archive-date=May 19, 2020|archive-url=https://web.archive.org/web/20200519123834/http://advocatesaz.org/2012/11/15/i-didnt-want-to-believe-it-lessons-from-tuskegee-40-years-later/|url-status=live}}</ref> By then, 28 patients had died directly from syphilis, 100 died from complications related to syphilis, 40 of the patients' wives were infected with syphilis, and 19 children were born with [[congenital syphilis]].<ref name="Kim-2018">{{Cite book |last1=Kim |first1=Oliver J. |title=A History of Medicine |last2=Magner |first2=Lois N. |publisher=[[Taylor & Francis]] |year=2018 |page=138}}</ref>

The 40-year Tuskegee Study was a major violation of [[Medical ethics|ethical standards]]<ref name="Duff-Brown-2017" /> and has been cited as "arguably the most infamous biomedical research study in U.S. history."<ref name="Katz-2008">{{Cite journal|last1=Katz|first1=Ralph V.|last2=Green|first2=B. Lee|last3=Kressin|first3=Nancy R.|last4=Kegeles|first4=S. Stephen|last5=Wang|first5=Min Qi|last6=James|first6=Sherman A.|last7=Russell|first7=Stefanie L.|last8=Claudio|first8=Cristina|last9=McCallum|first9=Jan M.|date=November 1, 2008|title=The legacy of the Tuskegee Syphilis Study: assessing its impact on willingness to participate in biomedical studies|journal=[[Journal of Health Care for the Poor and Underserved]] |volume=19|issue=4|pages=1168–1180|doi=10.1353/hpu.0.0067|issn=1049-2089|pmc=2702151|pmid=19029744}}</ref> Its revelation led to the 1979 [[Belmont Report]] and to the establishment of the [[Office for Human Research Protections]] (OHRP)<ref name="HHS-2008">{{Cite web|title=Office for Human Research Protections|url=https://www.hhs.gov/ohrp/index.html|date=September 28, 2008|publisher=Department of Health and Human Services|language=en|access-date=May 14, 2020|archive-date=January 18, 2021|archive-url=https://web.archive.org/web/20210118011337/https://www.hhs.gov/ohrp/|url-status=live}}</ref> and [[Human subject research legislation in the United States|federal laws and regulations]] requiring [[institutional review board]]s for the protection of [[Human subject research|human subjects]] in studies. The OHRP manages this responsibility within the [[United States Department of Health and Human Services]] (HHS).<ref name="HHS-2008" /> Its revelation has also been an important cause of distrust in medical science and the US government amongst African Americans.<ref name="Katz-2008"/>

In 1997, President [[Bill Clinton]] formally apologized on behalf of the United States to victims of the study, calling it shameful and racist.<ref name="CNN-1997">{{cite news |title=Clinton Apologizes To Tuskegee Experiment Victims |url=http://www.cnn.com/ALLPOLITICS/1997/05/16/tuskegee.apology/ |access-date=December 7, 2020 |publisher=[[CNN]] |date=May 16, 1997 |archive-date=June 18, 2015 |archive-url=https://web.archive.org/web/20150618161620/http://www.cnn.com/ALLPOLITICS/1997/05/16/tuskegee.apology/ |url-status=live }}</ref> "What was done cannot be undone, but we can end the silence," he said. "We can stop turning our heads away. We can look at you in the eye, and finally say, on behalf of the American people, what the United States government did was shameful, and I am sorry."<ref name="CNN-1997"/><ref>{{cite web|url=https://clintonwhitehouse4.archives.gov/textonly/New/Remarks/Fri/19970516-898.html|title=Remarks by the President Bill Clinton in Apology for the Study Done in Tuskegee}}</ref>

==History==

===Study details===
[[File:Tuskegee study.jpg|thumb|Subject blood draw, c. 1953]]

In 1928, the "[[The Oslo Study|Oslo Study of Untreated Syphilis]]" had reported on the [[Pathology|pathologic]] manifestations of untreated syphilis in several hundred white males. This study was a [[retrospective study]] since investigators pieced together information from the histories of patients who had already contracted syphilis but remained untreated for some time.<ref name="Whorley-2006" />

The U.S. Public Health Service Syphilis Study at Tuskegee group decided to build on the Oslo work and perform a [[prospective study]] to complement it.<ref name="Brandt-1978" /> The U.S. Public Health Service Syphilis Study at Tuskegee began as a 6-month [[Descriptive study|descriptive]] [[Epidemiology|epidemiological]] study of the range of pathology associated with syphilis in the population of Macon County. The researchers involved with the study reasoned that they were not harming the men involved in the study, under the presumption that they were unlikely to ever receive treatment.<ref name="Reverby-2009" /> At that time, it was believed that the effects of syphilis depended on the race of those affected. Physicians believed that syphilis had a more pronounced effect on African-Americans' [[cardiovascular system]]s than on their [[central nervous system]]s.<ref name="HHS-2008" />

Investigators enrolled in the study a total of 600 impoverished, African-American [[sharecropper]]s.<ref name="Reverby-2009" /> Of these men, 399 had latent syphilis, with a control group of 201 men who were not infected.<ref name="CDC-2020" /> As an incentive for participation in the study, the men were promised free medical care, but were deceived by the PHS, who never informed subjects of their diagnosis, despite the risk of infecting others, and the fact that the disease could lead to blindness, deafness, mental illness, heart disease, bone deterioration, the collapse of the central nervous system, and death.<ref name="Brown-2017"/><ref name="Associated Press-2017"/><ref name="Heller-1972"/><ref name="AP News-2017"/> Instead, the men were told that they were being treated for "bad blood", a [[colloquialism]] that described various conditions such as syphilis, [[anemia]], and fatigue. The collection of illnesses the term included was a leading cause of death within the southern African-American community.<ref name="CDC-2020" />

At the study's commencement, major medical textbooks had recommended that all syphilis be treated, as the consequences were quite severe. At that time, treatment included [[arsenic]]-based compounds such as [[arsphenamine]] (branded as the "606" formula).<ref name="Brandt-1978" /> Initially, subjects were studied for six to eight months and then treated with contemporary methods, including [[Arsphenamine|Salvarsan]] ("606"), [[Mercury (element)|mercurial]] ointments, and [[bismuth]], which were mildly effective and highly toxic.<ref name="Reverby-2009" /> Additionally, men in the study were administered disguised placebos, ineffective methods, and diagnostic procedures, which were misrepresented as treatments.<ref name="Gray-1998"/>

Throughout, participants remained ignorant of the study clinicians' true purpose, which was to observe the natural course of untreated syphilis.<ref name="Reverby-2009" /> Study clinicians could have chosen to treat all syphilitic subjects and close the study, or split off a [[control group]] for testing with penicillin. Instead, they continued the study without treating any participants; they withheld treatment and information about penicillin from the subjects. In addition, scientists prevented participants from accessing syphilis treatment programs available to other residents in the area.<ref>{{Cite book|last=Jones|first=James H.|url=https://archive.org/details/badbloodtuskegee00jone/page/161/|title=Bad Blood: The Tuskegee Syphilis Experiment|publisher=[[Free Press (publisher)|The Free Press]]|year=1981|isbn=978-0029166703|location=New York City|page=[https://archive.org/details/badbloodtuskegee00jone/page/161/ 161–62]}}</ref> The researchers reasoned that the knowledge gained would benefit humankind; however, it was determined afterward that the doctors did harm their subjects by depriving them of appropriate treatment once it had been discovered. The study was characterized as "the longest non-therapeutic experiment on human beings in medical history."<ref name="Jones-1981" />

To ensure that the men would show up for the possibly dangerous, painful, diagnostic, and non-therapeutic [[Lumbar puncture|spinal taps]], doctors sent participants a misleading letter titled "Last Chance for Special Free Treatment".<ref name="Brandt-1978" />

The U.S. Public Health Service Syphilis Study at Tuskegee published its first clinical data in 1934 and issued its first major report in 1936. This was before the discovery of penicillin as a safe and effective treatment for syphilis. The study was not secret, since reports and data sets were published to the medical community throughout its duration.<ref name="Reverby-2009" />

During [[World War II]], 256 of the infected subjects [[Selective Service Act of 1917|registered for the draft]] and were consequently diagnosed as having syphilis at military induction centers and ordered to obtain treatment for syphilis before they could be taken into the armed services.<ref name="CPH-2004">{{Cite book|title=Doctor of Public Health Student Handbook|publisher=University of Kentucky College of Public Health|location=Lexington, Kentucky|year=2004|page=17}}</ref><ref name="Reverby-2012">{{cite book |editor1-last=Reverby |editor1-first=Susan M. |title=Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study |year=2012 |publisher=[[UNC Press Books]] |location=Chapel Hill, North Carolina|isbn=978-1469608723 |pages=226–28 |url=https://books.google.com/books?id=f3q0CgAAQBAJ&pg=PA226 |access-date=December 22, 2020 |archive-date=January 18, 2021 |archive-url=https://web.archive.org/web/20210118011338/https://books.google.com/books?id=f3q0CgAAQBAJ&pg=PA226 |url-status=live }}</ref> PHS researchers prevented these men from getting treatment, thus depriving them of chances for a cure. Vonderlehr argued, "this study is of great importance from a scientific standpoint. It represents one of the last opportunities which the science of medicine will have to conduct an investigation of this kind. ... [Study] Doctor [Murray] Smith ... asked that these men be excluded from the list of draftees needing treatment. ... in order to make it possible to continue this study on an effective basis."<ref name="Reverby-2012"/>

Later, Smith, a local PHS representative involved in the study, wrote to Vonderlehr to ask what should be done with patients who had tested negative for syphilis at the time of enrollment in the study and were being used as control subjects but had later tested positive when registering for the draft: "So far, we are keeping the known positive patients from getting treatment. Is a control case of any value to the study, if he has contracted syphilis? Shall we withhold treatment from the control case who has developed syphilis?"<ref name="Reverby-2012"/> Vonderlehr replied that such cases "have lost their value to the study. There is no reason why these patients should not be given appropriate treatment unless you hear from Doctor Austin V. Deibert who is in direct charge of the study".<ref name="Reverby-2012"/>

By 1947, penicillin had become standard therapy for syphilis. The U.S. government sponsored several [[Public health program|public health programs]] to form "rapid treatment centers" to eradicate the disease. When campaigns to eradicate [[venereal disease]] came to Macon County, study researchers prevented their subjects from participating.<ref name="CPH-2004" /> Although some of the men in the study received arsenical or penicillin treatments elsewhere, for most of them this did not amount to "adequate therapy".<ref>{{Cite journal|last1=Benedek|first1=Thomas G.|journal=[[Perspectives in Biology and Medicine]]|last2=Erlen|first2=Jonathon|pages=24–25|title=The Scientific Environment of the Tuskegee Study of Syphilis, 1920–1960|year=1999|volume=43|issue=1|publisher=[[Johns Hopkins University Press]]|location=Baltimore, Maryland|doi=10.1353/pbm.1999.0034|pmid=10701219|s2cid=34614156}}</ref> [[File:Tuskegee-syphilis-study subjects-talking-to-nurse-eunice-rivers.jpg|thumb|Subjects talking with study coordinator, Nurse Eunice Rivers, c. 1970|alt=]]By the end of the study in 1972, only 74 of the test subjects were still alive.<ref name="AP News-2017" /> Of the original 399 men, 28 had died of syphilis, 100 died of related complications, 40 of their wives had been infected, and 19 of their children were born with congenital syphilis.<ref name="Kim-2018" />[[File:Tuskegee-syphilis-study doctor injects subject with placebo.gif|thumb|Researcher collecting a blood sample as part of the Tuskegee Syphilis Study|alt=]]

The revelation in 1972 of study failures by 29-year-old [[whistleblower]] [[Peter Buxtun]]<ref name=":0" /> led to major changes in U.S. law and regulation concerning the protection of participants in clinical studies. Studies since then require [[informed consent]],<ref name="HHS-2009">{{Cite web|title=Code of Federal Regulations Title 45 Part 46 Protections of Human Subjects 46.1.1 (i)|url=https://www.hhs.gov/ohrp/sites/default/files/ohrp/policy/ohrpregulations.pdf|date=January 15, 2009|website=[[U.S. Department of Health and Human Services]]|access-date=May 14, 2020|archive-date=March 28, 2016|archive-url=https://web.archive.org/web/20160328191725/http://www.hhs.gov/ohrp/policy/ohrpregulations.pdf|url-status=live}}</ref> communication of [[diagnosis]] and accurate reporting of test results.<ref name="UVA-1996a">{{Cite web|title=Final Report of the Tuskegee Syphilis Study Legacy Committee|url=http://www.hsl.viriginia.edu/historical/medical_history/bad_blood/report.cfm|date=May 20, 1996|website=Tuskegee Syphilis Study Legacy Committee|access-date=May 14, 2020}}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

===Study clinicians===
The [[venereal disease]] section of the [[U.S. Public Health Service]] (PHS) formed a study group in 1932 at its national headquarters in Washington, D.C. [[Taliaferro Clark]], head of the USPHS, is credited with founding it. His initial goal was to follow untreated syphilis in a group of African-American men for six months to one year, and then follow up with a treatment phase.<ref name="Reverby-2009" /><ref name="Jones-1981">{{cite book|first=James H.|last=Jones|url=https://archive.org/details/badbloodtuskegee00jone_0|title=Bad Blood: The Tuskegee Syphilis Experiment|publisher=[[Free Press (publisher)|Free Press]]|year=1981|isbn=978-0-02-916676-5|location=New York City|page=91}}</ref> When the [[Rosenwald Fund]] withdrew its financial support, a treatment program was deemed too expensive.<ref name="Whorley-2006">{{Cite thesis|last=Whorley|first=Tywanna Marie|date=2006|title=The Tuskegee Syphilis Study: Access and Control over Controversial Records|url=http://d-scholarship.pitt.edu/9244/1/Dissertation_Whorley_2006.pdf|publisher=[[University of Pittsburgh]]|journal=|access-date=May 14, 2020|archive-date=August 9, 2020|archive-url=https://web.archive.org/web/20200809113148/http://d-scholarship.pitt.edu/9244/1/Dissertation_Whorley_2006.pdf|url-status=live}}</ref> Clark, however, decided to continue the study, interested in determining whether syphilis had a different effect on African-Americans than it did on whites. A retrospective study of untreated syphilis in white males had been conducted in Oslo, Norway, and could provide the basis for comparison.<ref name="Whorley-2006" /><ref>{{Cite book|last=Jones|first=James H.|title=Bad Blood: The Tuskegee Syphilis Experiment|publisher=The Free Press|year=1981|isbn=978-0029166703|location=New York|pages=17–19}}</ref> The prevailing belief at the time was white people were more likely to develop neurosyphilis and that Black people were more likely to sustain cardiovascular damage. Clark resigned before the study was extended beyond its original length.<ref>{{Cite book|last1=Fregni|first1=Felipe|title=Critical Thinking in Clinical Research: Applied Theory and Practice Using Case Studies|last2=Illigens|first2=Ben M.W.|publisher=Oxford University Press|location=Oxford, England|isbn=9780199324507 |date=2018|page=11}}</ref>

Although Clark is usually assigned blame for conceiving the U.S. Public Health Service Syphilis Study at Tuskegee, [[Thomas Parran Jr.]] also helped develop a non-treatment study in Macon County, Alabama. As the Health Commissioner of New York State (and former head of the PHS Venereal Disease Division), Parran was asked by the Rosenwald Fund to assess their [[serological]] survey of syphilis and demonstration projects in five Southern states.<ref>Jones (1981), pp.52–90</ref> Among his conclusions was the recommendation that: "If one wished to study the natural history of syphilis in the African American race uninfluenced by treatment, this county (Macon) would be an ideal location for such a study."<ref>{{Cite web|title=Did a U.S. surgeon general come up with the idea of the notorious Tuskegee syphilis experiment?|url=https://www.inquirer.com/philly/news/thomas-parran-tuskegee-syphilis-hornblum-experiment-20170720.html|last=Bender|first=William|website=www.inquirer.com|date=July 20, 2017 |language=en-US|access-date=May 14, 2020|archive-date=June 18, 2020|archive-url=https://web.archive.org/web/20200618114758/https://www.inquirer.com/philly/news/thomas-parran-tuskegee-syphilis-hornblum-experiment-20170720.html|url-status=live}}</ref>

Oliver C. Wenger was the director of the regional PHS Venereal Disease Clinic in [[Hot Springs, Arkansas]]. He and his staff took the lead in developing study procedures. Wenger continued to advise and assist the study when it was adapted as a long-term, no-treatment observational study after funding for treatment was lost.<ref>{{Cite book|last1=Blumenthal|first1=Daniel S.|title=Community-Based Health Research: Issues and Methods|last2=DiClemente|first2=Ralph J.|publisher=[[Springer Publishing]]|date=2003|isbn=978-0-8261-2025-0|location=New York City|page=50}}</ref>

[[Raymond A. Vonderlehr]] was appointed on-site director of the research program and developed the policies that shaped the long-term follow-up section of the project. His method of gaining the "[[Informed consent|consent]]" of the subjects for [[Lumbar puncture|spinal taps]] (to look for signs of [[neurosyphilis]]) was by advertising this diagnostic test as a "special free treatment".<ref name="Reverby-2009" />  He also met with local black doctors and asked them to deny treatment to participants in the Tuskegee Study. Vonderlehr retired as head of the venereal disease section in 1943, shortly after [[penicillin]] was proven to cure syphilis.<ref name="Brandt-1978" /> After Vonderlehr's retirement, [[John R. Heller Jr.]], his mentee, succeeded him as head of the venereal disease section. Even with the discovery that penicillin served as an effective treatment for syphilis, Heller did not provide the drug to the participants of the study.<ref>{{cite web |title=Faces of Tuskegee |url=https://msu.edu/course/hm/546/tuskegee.htm |accessdate=December 5, 2015 |publisher=[[Michigan State University]]}}</ref> 

Several African-American [[health workers]] and [[Health educators|educators]] associated with the [[Tuskegee Institute]] played a critical role in the study's progress. The extent to which they knew about the full scope of the study is not clear in all cases.<ref name="Reverby-2009" /> [[Robert Russa Moton]], then president of Tuskegee Institute, and [[Eugene Dibble]], head of the Institute's [[John A. Andrew Memorial Hospital]], both lent their endorsement and institutional resources to the government study.<ref>{{Cite book|last=Kaplan|first=Mary|title=The Tuskegee Veterans Hospital and Its Black Physicians: The Early Years|publisher=[[McFarland (publisher)|McFarland]]|location=Jefferson, North Carolina|date=2016|pages=90–91, 104|isbn=9781476662985}}</ref>

Nurse [[Eunice Rivers]], who had trained at Tuskegee Institute and worked at its hospital, was recruited at the start of the study to be the main point of contact with the participants.<ref name="Reverby-2009" /> Rivers played a crucial role in the study because she served as the direct link to the regional African-American community. Vonderlehr considered her participation to be the key to gaining the trust of the subjects and promoting their participation.<ref name="Thomas-2000">
{{cite journal|last1=Thomas|first1=Stephen B.|last2=Crouse Quinn|first2=Sandra|s2cid=68358316|year=2000|title=Light on the Shadow of the Syphilis Study at Tuskegee|url=http://health-equity.pitt.edu/658/1/Light_on_the_Shadow_of_the_Syphilis_Study_at_Tuskegee.pdf|url-status=dead|journal=[[Health Promotion Practice]]|publisher=[[SAGE Publications]]|location=Thousand Oaks, California|volume=1|issue=3|pages=234–37|doi=10.1177/152483990000100306|hdl=1903/22693|archive-url=https://web.archive.org/web/20160616213555/http://health-equity.pitt.edu/658/1/Light_on_the_Shadow_of_the_Syphilis_Study_at_Tuskegee.pdf|archive-date=June 16, 2016|access-date=December 12, 2014|hdl-access=free}}
</ref> As a part of "Miss Rivers' Lodge", participants would receive free physical examinations at [[Tuskegee University]], free rides to and from the clinic, hot meals on examination days, and free treatment for minor ailments. Rivers was also key in convincing families to sign autopsy agreements in return for funeral benefits. As the study became long-term, Rivers became the chief person who provided continuity to the participants. She was the only study staff person to work with participants for the full 40 years.<ref name="Reverby-2009" />

<gallery>
File:vonderle.gif|[[Raymond A. Vonderlehr]] (medical doctor)
File:Eugene Dibble.jpg|[[Eugene Dibble]] (medical doctor)
File:Eunice Rivers.jpg|[[Eunice Rivers Laurie|Eunice Rivers]] (nurse)
File:Oliver Wenger.jpg|Oliver Wenger
</gallery>
{{clear}}

==Study termination==
[[File:Peter Buxtun.jpg|thumb|200px|Peter Buxtun, a [[U.S. Public Health Service|PHS]] venereal disease investigator, the whistleblower]]
[[File:Tuskegee-syphilis-experiment-test-subjects.gif|thumb|right|250px|Group of Tuskegee Experiment test subjects]]

Several men employed by the PHS, namely Austin V. Deibert and Albert P. Iskrant, expressed criticism of the study, primarily on the grounds of poor scientific practice.<ref name="Reverby-2009" /> The first dissenter against the study who was not involved in the PHS was [[Count Gibson]], an associate professor at the [[Medical College of Virginia|Medical College of Virginia in Richmond.]] He expressed his ethical concerns to PHS's Sidney Olansky in 1955.<ref name="Reverby-2009" />

Another dissenter was Irwin Schatz, a young [[Chicago]] doctor only four years out of medical school. In 1965, Schatz read an article about the study in a [[medical journal]] and wrote a letter directly to the study's authors confronting them with a declaration of brazen unethical practice.<ref>{{Cite news|title=Dr. Irwin Schatz, the first, lonely voice against infamous Tuskegee study, dies at 83|url=https://www.washingtonpost.com/news/morning-mix/wp/2015/04/20/dr-irwin-schatz-the-first-lonely-voice-against-infamous-tuskegee-study-dies-at-83/|last=Kaplan|first=Sarah|newspaper=Washington Post|language=en|access-date=May 14, 2020|archive-date=May 14, 2016|archive-url=https://web.archive.org/web/20160514160812/https://www.washingtonpost.com/news/morning-mix/wp/2015/04/20/dr-irwin-schatz-the-first-lonely-voice-against-infamous-tuskegee-study-dies-at-83/|url-status=live}}</ref> His letter, read by Anne R. Yobs, one of the study's authors, was immediately ignored and filed away with a brief memo that no reply would be sent.<ref name="Reverby-2009" />

In 1966, [[Peter Buxtun]], a PHS venereal-disease investigator in [[San Francisco]], sent a letter to the national director of the Division of Venereal Diseases expressing his concerns about the ethics and morality of the extended U.S. Public Health Service Syphilis Study at Tuskegee.<ref>{{Cite web|title=Tuskegee Truth Teller|url=https://theamericanscholar.org/tuskegee-truth-teller/|date=December 4, 2017|website=[[The American Scholar (magazine)|The American Scholar]]|language=en-US|access-date=May 14, 2020|archive-date=April 25, 2020|archive-url=https://web.archive.org/web/20200425055753/https://theamericanscholar.org/tuskegee-truth-teller/|url-status=live}}</ref> The CDC, which by then controlled the study, reaffirmed the need to continue the study until completion; i.e. until all subjects had died and been autopsied. To bolster its position, the CDC received unequivocal support for the continuation of the study, both from local chapters of the [[National Medical Association]] (representing African-American physicians) and the [[American Medical Association]] (AMA).<ref name="Reverby-2009" />

In 1968, [[William Carter Jenkins]], an African-American [[statistician]] in the [[U.S. Public Health Service|PHS]] and part of the [[Department of Health, Education, and Welfare]] (HEW), founded and edited ''The Drum'', a newsletter devoted to ending [[racial discrimination]] in HEW. In ''The Drum'', Jenkins called for an end to the study.<ref>{{Cite news|title=Bill Jenkins, epidemiologist who tried to end Tuskegee syphilis study, dies at 73|url=https://www.washingtonpost.com/local/obituaries/bill-jenkins-epidemiologist-who-tried-to-end-tuskegee-syphilis-study-dies-at-73/2019/02/27/2319e142-3aa2-11e9-a06c-3ec8ed509d15_story.html|last=Smith|first=Harrison|date=February 27, 2019|newspaper=Washington Post|language=en|access-date=May 14, 2020|archive-date=June 18, 2020|archive-url=https://web.archive.org/web/20200618001310/https://www.washingtonpost.com/local/obituaries/bill-jenkins-epidemiologist-who-tried-to-end-tuskegee-syphilis-study-dies-at-73/2019/02/27/2319e142-3aa2-11e9-a06c-3ec8ed509d15_story.html|url-status=live}}</ref> He did not succeed; it is not clear who read his work.

Buxtun finally went to the press in the early 1970s. The story broke first in the ''[[Washington Star]]'' on July 25, 1972, reported by [[Jean Heller]] of the [[Associated Press]].<ref name="Heller-1972" /> It became front-page news in the ''[[New York Times]]'' the following day. Senator [[Ted Kennedy|Edward Kennedy]] called [[Congressional hearings]], at which Buxtun and HEW officials testified. As a result of public outcry, the CDC and PHS appointed an ad hoc advisory panel to review the study.<ref name="Brown-2017" /> The panel found that the men agreed to certain terms of the experiment, such as examination and treatment. However, they were not informed of the study's actual purpose.<ref name="CDC-2020" /> The panel then determined that the study was medically unjustified and ordered its termination.{{citation needed|date=January 2021}}

In 1974, as part of the settlement of a [[class action|class action lawsuit]] filed by the [[NAACP]] on behalf of study participants and their descendants, the U.S. government paid the plaintiffs $10 million {{USDCY|10000000|1974}} and agreed to provide free medical treatment to surviving participants and surviving family members infected as a consequence of the study. Congress created a commission empowered to write regulations to deter such abuses from occurring in the future.<ref name="CDC-2020" />

A collection of materials compiled to investigate the study is held at the [[National Library of Medicine]] in [[Bethesda, Maryland]].<ref>{{Cite web|title=Documents on the origin and development of the Tuskegee syphilis study 1921-1973|url=https://oculus.nlm.nih.gov/cgi/f/findaid/findaid-idx?c=nlmfindaid;idno=tuskegee264|website=oculus.nlm.nih.gov|access-date=May 14, 2020|archive-date=August 9, 2020|archive-url=https://web.archive.org/web/20200809155256/https://oculus.nlm.nih.gov/cgi/f/findaid/findaid-idx?c=nlmfindaid;idno=tuskegee264|url-status=live}}</ref>
{{clear}}

==Aftermath==
In 1974, Congress passed the [[National Research Act]] and created a [[National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research|commission]] to study and write regulations governing studies involving human participants. Within the [[United States Department of Health and Human Services]], the [[Office for Human Research Protections]] (OHRP) was established to oversee [[Clinical trial|clinical trials]]. As a result, new studies require [[informed consent]],<ref name="HHS-2009" /> communication of diagnosis and accurate reporting of test results.<ref name="UVA-1996a" /> Institutional review boards (IRBs), including laypeople, are established in scientific research groups and hospitals to review study protocols, protect patient interests, and ensure that participants are fully informed.

In 1994, a multi-disciplinary symposium was held on the U.S. Public Health Service Syphilis Study at Tuskegee, ''Doing Bad in the Name of Good?: The Tuskegee Syphilis Study and Its Legacy'' at the [[University of Virginia]]. Following that, interested parties formed the Tuskegee Syphilis Study Legacy Committee to develop ideas that had arisen at the symposium, chaired by [[Vanessa Northington Gamble]]. It issued its final report in May 1996, having been established at a meeting on January 18–19 of that year.<ref name="UVA-1996b">{{Cite web|title=Final Report of the Tuskegee Syphilis Study Legacy Committee – May 1996|url=http://exhibits.hsl.virginia.edu/badblood/report/|website=Bad Blood: The Tuskegee Syphilis Study|language=en-US|access-date=May 14, 2020|archive-date=July 5, 2017|archive-url=https://web.archive.org/web/20170705123612/http://exhibits.hsl.virginia.edu/badblood/report|url-status=dead}}</ref> The Committee had two related goals:<ref name="UVA-1996b" />
# President [[Bill Clinton]] should publicly apologize to the survivors and their community for past government wrongdoing related to the study due to the harm done to the Macon County community and Tuskegee University, and the fears of government and medical abuse the study created among African Americans. No apology had yet been issued at the time.<ref name="UVA-1996b" />
# The Committee and relevant federal agencies should develop a strategy to redress the damages, specifically recommending the creation of a center at Tuskegee University for public education about the study, "training programs for [[Health professional|health care providers]]", and a center for the study of [[research ethics|ethics in scientific research]].<ref name="UVA-1996b" />

A year later on May 16, 1997, Bill Clinton formally apologized and held a ceremony at the [[White House]] for surviving Tuskegee study participants. He said:

{{blockquote|What was done cannot be undone. But we can end the silence. We can stop turning our heads away. We can look at you in the eye and finally say on behalf of the American people, what the United States government did was shameful, and I am sorry... To our African American citizens, I am sorry that your federal government orchestrated a study so clearly racist.<ref>{{Cite web|title=Apology For Study Done in Tuskegee|url=http://clinton4.nara.gov/textonly/New/Remarks/Fri/19970516-898.html|archive-url=https://web.archive.org/web/20141011090548/http://clinton4.nara.gov/textonly/New/Remarks/Fri/19970516-898.html|url-status=dead|archive-date=October 11, 2014|date=2014-10-11|access-date=2020-05-14}}</ref>}}

Five of the eight study survivors attended the White House ceremony.<ref name="Banisky-1997">{{Cite web|title=A Survivor's Grace At 95, Tuskegee study participant Herman Shaw prefers reconciliation to recrimination, forgiveness to bitterness.|url=https://www.baltimoresun.com/news/bs-xpm-1997-08-24-1997236123-story.html|last=Banisky|first=Sandy|website=baltimoresun.com|date=August 24, 1997 |language=en-US|access-date=May 14, 2020|archive-date=September 24, 2020|archive-url=https://web.archive.org/web/20200924015212/https://www.baltimoresun.com/news/bs-xpm-1997-08-24-1997236123-story.html|url-status=live}}</ref>

The presidential apology led to progress in addressing the second goal of the Legacy Committee. The federal government contributed to establishing the National Center for Bioethics in Research and Health Care at Tuskegee, which officially opened in 1999 to explore issues that underlie research and medical care of African Americans and other under-served people.<ref>{{Cite web |title=About the Center {{!}} Tuskegee University |url=https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-center |url-status=live |archive-url=https://web.archive.org/web/20210311014629/https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-center |archive-date=March 11, 2021 |access-date=March 11, 2021 |website=www.tuskegee.edu |language=en-US}}</ref>

In 2009, the Legacy Museum opened in the Bioethics Center, to honor the hundreds of participants of the ''Tuskegee Study of Untreated Syphilis in the African American Male.''<ref name="UVA-1996b" /><ref>{{Cite web|title=Legacy Museum {{!}} Tuskegee University|url=http://www.tuskegee.edu/libraries/legacy_museum.aspx|archive-url=https://web.archive.org/web/20170514231236/http://www.tuskegee.edu/libraries/legacy_museum.aspx|url-status=dead|archive-date=May 14, 2017|date=May 14, 2017|access-date=May 14, 2020}}</ref>

In June 2022, the [[Milbank Memorial Fund]] apologized to descendants of the study's victims for its the role in the study.<ref>{{cite news |last1=Reeves |first1=Jay |title=New York fund apologizes for role in Tuskegee syphilis study |url=https://apnews.com/article/politics-health-syphilis-race-and-ethnicity-business-0a393357b7014707cf2dd18454a3cce4 |access-date=June 21, 2022 |work=[[AP News]] |date=June 11, 2022 |language=en}}</ref>

=== Study participants ===
[[File:Charlie Pollard.jpg|thumb|right|100px|Charlie Pollard, survivor]]The five survivors who attended the White House ceremony in 1997 were Charlie Pollard, Herman Shaw, Carter Howard, Fred Simmons, and Frederick Moss. The remaining three survivors had family members attend the ceremony in their name. Sam Doner was represented by his daughter, Gwendolyn Cox; Ernest Hendon by his brother, North Hendon; and George Key by his grandson, Christopher Monroe.<ref name="Banisky-1997" /> The last man who was a participant in the study died in 2004.[[File:Herman Shaw.jpg|thumb|right|100px|Herman Shaw, survivor]]

Charlie Pollard appealed to civil rights attorney [[Fred Gray (attorney)|Fred D. Gray]], who also attended the White House ceremony, for help when he learned the true nature of the study he had been participating in for years. In 1973, ''Pollard v. United States'' resulted in a $10 million settlement.<ref name="Reverby-2009" />

Another participant of the study was Freddie Lee Tyson, a sharecropper who helped build [[Moton Field]], where the legendary "[[Tuskegee Airmen]]" learned to fly during World War II.<ref name="Associated Press-2017" />

==Legacy==
[[File:Syphilis-poster-wpa-cure.jpg|upright|right|thumb|[[Great Depression in the United States|Depression]]-era U.S. poster advocating early syphilis treatment. Although treatments were available, participants in the study did not receive them.]]

===Scientific failings===
Aside from a study of racial differences, one of the main goals that researchers in the study wanted to accomplish was to determine the extent to which treatment for syphilis was necessary and at what point in the progression of the disease it should be treated. For this reason, the study emphasized observation of individuals with late latent syphilis.<ref name="Brandt-1978" /><ref name="Reverby-2009" /> However, despite clinicians' attempts to justify the study as necessary for science, the study itself was not conducted in a scientifically viable way. Because participants were treated with mercury rubs, injections of neoarsphenamine, protiodide, [[Arsphenamine|Salvarsan]], and bismuth, the study did not follow subjects whose syphilis was untreated, however minimally effective these treatments may have been.<ref name="Brandt-1978" /><ref name="Reverby-2009" />

Austin V. Deibert of the PHS recognized that since the study's main goal had been compromised in this way, the results would be meaningless and impossible to manipulate statistically. Even the toxic treatments that were available before the availability of penicillin, according to Deibert, could "greatly lower, if not prevent, late syphilitic cardiovascular disease ... [while] increas[ing] the incidence of neuro-recurrence and other forms of relapse."<ref name="Reverby-2009" /> Despite their effectiveness, these treatments were never prescribed to the participants.<ref name="Reverby-2009" />

===Racism===
{{Further|Medical racism in the United States}}
The conception which lay behind the U.S. Public Health Service Syphilis Study at Tuskegee in 1932, in which 100% of its participants were poor, rural African-American men with very limited access to health information, reflects the [[Racism in the United States|racial attitudes in the U.S. at that time]]. The clinicians who led the study assumed that African-Americans were particularly susceptible to [[Sexually transmitted infection|venereal diseases]] because of their race, and they assumed that the study's participants were not interested in receiving medical treatment.<ref name="Brandt-1978" /><ref name="Howell-2017">{{Cite journal|last=Howell|first=Joel|title=Race and U.S. Medical Experimentation: The Case of Tuskegee|journal=Reports in Public Health, University of Michigan|year=2017|volume=33Suppl 1|issue=Suppl 1|pages=e00168016|doi=10.1590/0102-311X00168016|pmid=28492710|doi-access=free}}</ref>

Taliaferro Clark said, "The rather low intelligence of the Negro population, depressed economic conditions, and the common promiscuous sex relations not only contribute to the spread of syphilis but the prevailing indifference with regards to treatment."<ref name="Howell-2017" /> In reality, the promise of medical treatment, usually reserved only for emergencies among the rural black population of Macon County, Alabama, was what secured subjects' cooperation in the study.<ref name="Brandt-1978" />

===Public trust===
The revelations of mistreatment under the U.S. Public Health Service Syphilis Study at Tuskegee are believed to have significantly damaged the trust of the black community toward public health efforts in the United States.<ref>{{Cite journal|last1=Thomas|first1=SB|last2=Quinn|first2=SC|date=November 1991|title=The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community|journal=Am J Public Health|volume=81|issue=11|pages=1498–505|doi=10.2105/AJPH.81.11.1498|pmid=1951814|pmc=1405662}}</ref><ref name="Alsan-2018">{{Cite journal|last1=Alsan|first1=Marcella|last2=Wanamaker|first2=Marianne|date=2018|title=Tuskegee and the Health of Black Men|journal=Quarterly Journal of Economics|volume=133|issue=1|pages=407–55|doi=10.1093/qje/qjx029|pmid=30505005|pmc=6258045}}</ref> Observers believe that the abuses of the study may have contributed to the reluctance of many poor black people to seek routine [[preventive care]].<ref name="Alsan-2018" /><ref>{{Cite web|title=Tuskegee's ghosts: Fear hinders black marrow donation - CNN.com|url=https://www.cnn.com/2007/HEALTH/02/07/bone.marrow/index.html|website=www.cnn.com|access-date=May 14, 2020|archive-date=August 17, 2020|archive-url=https://web.archive.org/web/20200817215518/https://www.cnn.com/2007/HEALTH/02/07/bone.marrow/index.html|url-status=live}}</ref> A 1999 survey showed that 80% of African-American men wrongly believed the men in the study had been injected with syphilis.<ref name="Katz-2008" />

While the final report of the Tuskegee Syphilis Study Legacy Committee noted that the study had contributed to fears among the African American community of abuse and exploitation by government officials and medical professionals,<ref name="UVA-1996b" /> medical mistreatment of African Americans and resulting mistrust predates the Tuskegee Syphilis Study.<ref name="Gamble-1997" /> [[Vanessa Northington Gamble]], who had chaired the committee, addressed this in a seminal article published in 1997<ref>{{Cite news |last=Yuko |first=Elizabeth |date=March 9, 2021 |title=Why Are Black Communities Being Singled Out as Vaccine Hesitant? |language=en-US |magazine=Rolling Stone |url=https://www.rollingstone.com/culture/culture-features/covid-19-vaccine-hesitant-black-communities-singled-out-1137750/ |access-date=March 11, 2021 |archive-url=https://web.archive.org/web/20210309201001/https://www.rollingstone.com/culture/culture-features/covid-19-vaccine-hesitant-black-communities-singled-out-1137750/ |archive-date=March 9, 2021}}</ref> after President Clinton's apology. She argued that while the Tuskegee Syphilis Study contributed to African Americans' continuing mistrust of the biomedical community, the study was not the most important reason. She called attention to a broader historical and social context that had already negatively influenced community attitudes, including countless prior medical injustices before the study's start in 1932. These dated back to the [[antebellum period]], when slaves had been used for [[Unethical human experimentation|unethical and harmful experiments]] including tests of endurance against and remedies for [[heatstroke]] and experimental [[Gynecological surgery|gynecological surgeries]] without [[anesthesia]]. African Americans' [[Body snatching|graves were robbed]] to provide cadavers for dissection, a practice that continued, along with other abuses, after the [[American Civil War]].<ref name="Gamble-1997">{{Cite journal|last=Gamble|first=V N|date=November 1, 1997|title=Under the shadow of Tuskegee: African Americans and health care.|journal=American Journal of Public Health|volume=87|issue=11|pages=1773–78|doi=10.2105/AJPH.87.11.1773|pmid=9366634|pmc=1381160|issn=0090-0036}}</ref>

A 2016 paper by [[Marcella Alsan]] and Marianne Wanamaker found "that the historical disclosure of the [Tuskegee experiment] in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men. Our estimates imply life expectancy at age 45 for black men fell by up to 1.4 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men." The authors further observed that the decline also represented 25% of the gender gap in Black life expectancy at that time. The authors noted that the extent of this effect was comparable to major public health benchmarks, such as eliminating smoking or the impact of the [[Great Migration (African American)|Great Migration]] on life expectancy. Aslan's and Wanamaker's study provided evidence that reduced trust in medical institutions, fueled by the Tuskegee disclosure, had measurable effects on health attitudes and outcomes in the black community. Aslan and Wanamaker's study provides evidence that reduced trust in medical institutions was fueled by the Tuskegee disclosure, having measurable effects on health attitudes and outcomes on the Black community.<ref>{{Cite journal |last=Alsan |first=Marcella |last2=Wanamaker |first2=Marianne |date=2018-02-01 |title=Tuskegee and the Health of Black Men* |url=http://www.nber.org/papers/w22323.pdf |journal=The Quarterly Journal of Economics |volume=133 |issue=1 |pages=407–455 |doi=10.1093/qje/qjx029 |issn=0033-5533}}</ref> 

Studies that have investigated the willingness of black Americans to participate in medical studies have not drawn consistent conclusions related to the willingness and participation in studies by racial minorities.<ref>{{Cite journal|last=Crenner|first=Christopher|s2cid=5484282|date=February 12, 2011|title=The Tuskegee Syphilis Study and the Scientific Concept of Racial Nervous Resistance|journal=Journal of the History of Medicine and Allied Sciences|volume=67|issue=2|pages=244–80|doi=10.1093/jhmas/jrr003|pmid=21317423}}</ref> The Tuskegee Legacy Project Questionnaire found that, even though black Americans are four times more likely to know about the syphilis trials than are whites, they are two to three times more willing to participate in biomedical studies.<ref name="AJPH-2008">{{cite journal |author1=Katz, R. |author2=Kegeles, S. |author3=Kressin, N. R. |author4=Green, B. |author5=James, S.A. |author6=Wang, M. |author7=James, J. |author8=Russel, S. |author9=Claudio, C. |date=2008 |title=Awareness of the Tuskegee Syphilis Study and the US Presidential Apology and Their Influence on Minority Participation in Biomedical Research |journal=American Journal of Public Health |volume=98 |issue=6 |pages=1137–42|doi=10.2105/AJPH.2006.100131 |pmid=17901437 |pmc=2377291 }}</ref><ref name="Reverby-2009" /> Some of the factors that continue to limit the credibility of these few studies is how awareness differs significantly across studies. For instance, it appears that the rates of awareness differ as a function of the method of assessment. Study participants who reported awareness of the Tuskegee syphilis study are often misinformed about the results and issues, and awareness of the study is not reliably associated with unwillingness to participate in scientific research.<ref name="Katz-2008" /><ref name="AJPH-2008" /><ref>{{Cite journal|last1=Poythress|first1=N.|last2=Epstein|first2=M.|last3=Stiles|first3=P.|last4=Edens|first4=J.|date=October 9, 2011|title=Awareness of the Tuskegee Syphilis Study: Impact on Offenders' Decisions to Decline Research Participation|journal=Behavioral Sciences and the Law|volume=29|issue=6|pages=821–28|doi=10.1002/bsl.1012|pmid=21984035}}</ref><ref>{{Cite journal|last1=Brandon|first1=D.T.|last2=Isaac|first2=L.A.|last3=LaVeist|first3=T.A.|date=2005|title=The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care?|journal=J. Natl. Med. Assoc.|volume=97|issue=7|pages=951–60|pmid=16080664|pmc=2569322}}</ref>

Distrust of the government, in part formed through the study, contributed to persistent rumors during the 1980s in the black community that the government was responsible for the HIV/AIDS crisis by having deliberately introduced the virus to the black community as some kind of experiment.<ref>{{Cite book|last=Jones|first=James H.|title=Bad Blood: New and Expanded Edition|publisher=Simon & Schuster|year=1993|isbn=978-0-02-916676-5|pages=220–41}}</ref> In February 1992 on ABC's ''[[Prime Time Live]]'', journalist [[Jay Schadler]] interviewed Dr. Sidney Olansky, Public Health Services director of the study from 1950 to 1957. When asked about the lies that were told to the study subjects, Olansky said, "The fact that they were illiterate was helpful, too, because they couldn't read the newspapers. If they were not, as things moved on they might have been reading newspapers and seen what was going on."<ref name="Thomas-2000" />

On January 3, 2019, a United States federal judge stated that [[Johns Hopkins University]], [[Bristol-Myers Squibb]] and the [[Rockefeller Foundation]] must face a $1 billion lawsuit for their roles in a [[Guatemala syphilis experiments|similar experiment affecting Guatemalans]].<ref>{{Cite news|date=January 4, 2019|title=Johns Hopkins, Bristol-Myers must face $1 billion syphilis infections suit|language=en|work=Reuters|url=https://www.reuters.com/article/us-maryland-lawsuit-infections-idUSKCN1OY1N3|access-date=May 14, 2020|archive-date=January 18, 2021|archive-url=https://web.archive.org/web/20210118011339/https://www.reuters.com/article/us-maryland-lawsuit-infections-idUSKCN1OY1N3|url-status=live}}</ref> In 2001, a court compared the [[Kennedy Krieger Institute's Lead-Based Paint Abatement and Repair and Maintenance Study]] to the Tuskegee experiments.<ref>{{Cite web |last=Cohn |first=Meredith |date=November 15, 2019 |title=Court orders Kennedy Krieger to pay woman harmed in 1990s-era lead paint study $1.84 million |url=https://www.baltimoresun.com/health/bs-hs-kennedy-krieger-lead-paint-judgment-20191114-fxlxecyzg5hvnojmyy5onpwriy-story.html |access-date=December 30, 2022 |website=Baltimore Sun}}</ref>

Some African Americans have been hesitant to get [[COVID-19 vaccine|vaccinated against COVID-19]] due to the Tuskegee experiments.<ref>{{Cite news|last=Elliott|first=Debbie|date=February 16, 2021|title=In Tuskegee, Painful History Shadows Efforts To Vaccinate African Americans|url=https://www.npr.org/2021/02/16/967011614/in-tuskegee-painful-history-shadows-efforts-to-vaccinate-african-americans|access-date=August 19, 2021|website=[[NPR]]|language=en}}</ref> In September 2021, the right-wing group [[America's Frontline Doctors]], which has promoted [[COVID-19 misinformation|COVID-19 conspiracy theories and misinformation]], filed a lawsuit against New York City, claiming that its [[Vaccine passports during the COVID-19 pandemic|vaccine passport]] health orders were inherently discriminatory against African Americans due to the "historical context".<ref>{{Cite web |last=Mencimer |first=Stephanie |title=Pro-Trump doctors invoke civil rights in bid to overturn New York's vaccine mandate |url=https://www.motherjones.com/politics/2021/09/simone-gold-new-york-vaccine-lawsuit/ |access-date=January 3, 2022 |website=Mother Jones |language=en-US}}</ref>

==Ethical implications==
The U.S. Public Health Service Syphilis Study at Tuskegee highlighted issues in race and science.<ref>{{Cite news|last=Chadwick|first=A.|date=July 25, 2002|title=Remembering the Tuskegee Experiment|work=NPR}}</ref> The aftershocks of this study, and other [[Human experimentation in the United States|human experiments in the United States]], led to the establishment of the [[National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research]] and the [[National Research Act]].<ref name="HHS-2008" /> The latter requires the establishment of institutional review boards (IRBs) at institutions receiving federal support (such as grants, cooperative agreements, or contracts). Foreign consent procedures can be substituted which offer similar protections and must be submitted to the ''[[Federal Register]]'' unless a statute or Executive Order requires otherwise.<ref name="HHS-2008" />

In the period following World War II, the revelation of [[the Holocaust]] and related [[Nazi human experimentation|Nazi medical abuses]] brought about changes in international law. Western allies formulated the [[Nuremberg Code]] to protect the rights of research subjects. In 1964, the [[World Medical Association]]'s [[Declaration of Helsinki]] specified that experiments involving human beings needed the "informed consent" of participants.<ref>{{Cite journal|last=Fischer|first=Bernard A. IV.|date=October 2005|title=A Summary of Important Documents in the Field of Research Ethics|journal=Schizophrenia Bulletin|volume=32|issue=1|pages=69–80|doi=10.1093/schbul/sbj005|pmid=16192409|pmc=2632196}}</ref> In spite of these events, the protocols of the study were not re-evaluated according to the new standards, even though whether or not the study should continue was re-evaluated several times (including in 1969 by the CDC). U.S. government officials and medical professionals kept silent and the study did not end until 1972, nearly three decades after the Nuremberg trials.<ref name="Gray-1998" />

Writer James Jones said that the physicians were fixated on African-American sexuality. They believed that African-Americans willingly had sexual relations with infected persons (although no one had been told his diagnosis).<ref>{{Cite book|last=Jones|first=James H.|title=Bad Blood: The Tuskegee Syphilis Experiment|publisher=Free Press|year=1993|location=New York|pages=22–23|chapter=A Notoriously Syphilis-Soaked Race}}</ref> Due to the lack of information, the participants were manipulated into continuing the study without full knowledge of their role or their choices.<ref>{{Cite book|last1=Katz|first1=Ralph|title=The Search for the Legacy of the USPHS Syphilis Study at Tuskegee|last2=Warren|first2=Rueben|publisher=Lexington Books|year=2011|location=Lanham}}</ref> Since the late 20th century, IRBs established in association with clinical studies requirements that all involved in the study be willing and voluntary participants.<ref>{{Cite journal|last=Perkiss|first=Abigail|date=2008|title=Public Accountability And The Tuskegee Syphilis Experiments: A Restorative Justice Approach|journal=Berkeley Journal of African-American Law & Policy|pages=70}}</ref>

The Tuskegee University Legacy Museum has on display a check issued by the United States government on behalf of Dan Carlis to Lloyd Clements, Jr., a descendant of one of the U.S. Public Health Service Syphilis Study at Tuskegee participants.<ref name="Clements-2009">{{Cite news|last=Clements|first=Lloyd Jr. |date=August 20, 2009|title=Need commission to address Black health care needs|work=The Tuskegee News}}</ref> Lloyd Clements, Jr.'s great-grandfather Dan Carlis and two of his uncles, Ludie Clements and Sylvester Carlis, were in the study. Original legal paperwork for Sylvester Carlis related to the study is on display at the museum as well. Lloyd Clements, Jr. has worked with noted historian Susan Reverby concerning his family's involvement with the U.S. Public Health Service Syphilis Study at Tuskegee.<ref name="Clements-2009" />

==Society and culture==
;Comics
* ''[[Truth: Red, White, and Black]]'' (published January–July 2003) is a seven-issue [[Marvel Comics|Marvel]] comic book series inspired by the Tuskegee trials. Written as a prequel to the ''[[Captain America]]'' series, ''Truth: Red, White, and Black'' explores the exploitation of certain races for scientific research, as in the Tuskegee syphilis trials.<ref name="AJPH-2008"/>

;Theater
* [[David Feldshuh]]'s stage play ''Miss Evers' Boys'' (1992), based on the history of the U.S. Public Health Service Syphilis Study at Tuskegee, was a runner-up for the 1992 [[Pulitzer Prize]] in drama.<ref>{{cite web
|url = http://www.pulitzer.org/bycat/Drama
|title = The Pulitzer Prizes: Drama
|website = The Pulitzer Prizes
|publisher = Columbia University
|access-date = November 20, 2008
|archive-date = August 13, 2010
|archive-url = https://web.archive.org/web/20100813115701/http://www.pulitzer.org/bycat/Drama
|url-status = live
}}</ref>

;Music
* The lyrics of [[Gil Scott-Heron]]'s 33-second song, "Tuskeegee #626", featured on the ''[[Bridges (Gil Scott-Heron and Brian Jackson album)|Bridges]]'' (1977) LP, details and condemns the U.S. Public Health Service Syphilis Study at Tuskegee.
* [[Frank Zappa]]'s 1984 album ''[[Thing Fish]]'' was heavily inspired by the events of the Tuskegee Syphilis Study.
* Avant-garde metal band [[Zeal & Ardor]]'s song  "Tuskegee", from the 2020 EP ''Wake of a Nation'', is about the Tuskegee Syphilis Study.
* Jazz musician [[Don Byron]]'s 1992 album ''[[Tuskegee Experiments]]'' was inspired by the study.
*[[Atlanta]]-based rapper [[JID]] juxtaposes his life to the Tuskegee Experiment in his 2021 song "Skegee".<ref>{{Cite web|title=J.I.D pays homage to the historical Tuskegee experiments in Alabama in "Skegee" video – Music News|url=http://abcnewsradioonline.com/music-news/2021/2/25/jid-pays-homage-to-the-historical-tuskegee-experiments-in-al.html|url-status=live|access-date=February 26, 2021|website=ABC News Radio|language=en|archive-date=February 25, 2021|archive-url=https://web.archive.org/web/20210225221955/http://abcnewsradioonline.com/music-news/2021/2/25/jid-pays-homage-to-the-historical-tuskegee-experiments-in-al.html}}</ref>

;Television
* The 1992 ''[[Secret History (TV series)|Secret History]]'' series documentary "Bad Blood" is about the experiment.<ref>{{Cite web |url=https://www.imdb.com/title/tt1417763/ |title=Bad Blood |website=[[IMDb]] |access-date=July 12, 2020 |archive-date=February 11, 2017 |archive-url=https://web.archive.org/web/20170211080416/http://www.imdb.com/title/tt1417763/ |url-status=live }}</ref>
* ''[[Miss Evers' Boys]]'' (1997), a TV adaptation of David Feldshuh's eponymous 1992 stage play, was nominated for 11 [[Emmy Award]]s<ref>{{cite news
|url = http://www.news.cornell.edu/Chronicle/97/9.11.97/Emmys.html
|title = HBO's adaptation of Feldshuh's play Miss Evers' Boys is up for 12 Emmys
|first = Darryl
|last = Geddes
|date = September 11, 1997
|work = Cornell Chronicle
|access-date = August 4, 2005
|archive-date = September 10, 2005
|archive-url = https://web.archive.org/web/20050910174011/http://www.news.cornell.edu/Chronicle/97/9.11.97/Emmys.html
|url-status = live
}}</ref> and won in four categories.<ref>{{cite web
|url = https://www.imdb.com/title/tt0119679/awards
|title = Awards for Miss Evers' Boys
|publisher = Cornell University
|access-date = July 1, 2018
|archive-date = March 14, 2016
|archive-url = https://web.archive.org/web/20160314040520/http://www.imdb.com/title/tt0119679/awards
|url-status = live
}}</ref>

;Video production
*''[[Medical Racism: The New Apartheid]]'' (2021) exploits the Tuskegee trials to promote [[COVID-19 misinformation]].<ref>{{Cite news|last1=Zadrozny|first1=Brandy|author-link1=Brandy Zadrozny|last2=Adams|first2=Char|date=March 11, 2021|title=Covid's devastation of Black community used as 'marketing' in new anti-vaccine film|work=NBC News|url=https://www.nbcnews.com/news/nbcblk/covid-s-devastation-black-community-used-marketing-new-anti-vaxxer-n1260724|url-status=live|access-date=March 18, 2021|archive-url=https://web.archive.org/web/20210318224620/https://www.nbcnews.com/news/nbcblk/covid-s-devastation-black-community-used-marketing-new-anti-vaxxer-n1260724|archive-date=March 18, 2021}}</ref><ref>{{Cite news|last1=Zadrozny|first1=Brandy|author-link1=Brandy Zadrozny|last2=Adams|first2=Char|date=March 11, 2021|title=Covid's devastation of Black community used as 'marketing' in new anti-vaccine film|work=NBC News|url=https://www.nbcnews.com/news/nbcblk/covid-s-devastation-black-community-used-marketing-new-anti-vaxxer-n1260724|url-status=live|access-date=March 15, 2021|archive-url=https://web.archive.org/web/20210314022034/https://www.nbcnews.com/news/nbcblk/covid-s-devastation-black-community-used-marketing-new-anti-vaxxer-n1260724|archive-date=March 14, 2021}}</ref><ref>{{Cite news|last=Guynn|first=Jessica|date=March 10, 2021|title='We are going to have to save ourselves,' Black community fights deadly COVID vaccine conspiracy theories|work=USA Today|url=https://www.usatoday.com/story/tech/2021/03/10/covid-vaccine-facebook-youtube-instagram-black-misinformation-fight/6943180002/|url-status=live|access-date=March 21, 2021|archive-url=https://web.archive.org/web/20210319014116/https://www.usatoday.com/story/tech/2021/03/10/covid-vaccine-facebook-youtube-instagram-black-misinformation-fight/6943180002/|archive-date=March 19, 2021}}</ref><ref>{{Cite web|last1=Hale Spencer|first1=Saranac|last2=Fichera|first2=Angelo|date=March 11, 2021|title=RFK Jr. Video Pushes Known Vaccine Misrepresentations|url=https://www.factcheck.org/2021/03/scicheck-rfk-jr-video-pushes-known-vaccine-misrepresentations/|url-status=live|archive-url=https://web.archive.org/web/20210312005215/https://www.factcheck.org/2021/03/scicheck-rfk-jr-video-pushes-known-vaccine-misrepresentations/|archive-date=March 12, 2021|access-date=March 21, 2021|website=Factcheck.org|publisher=Annenberg Public Policy Center}}</ref>

==See also==
{{columns-list|colwidth=30em|
* [[John Charles Cutler]]
* [[Declaration of Geneva]]
* [[Eugenics in the United States]]
* [[Kennedy Krieger Institute's Lead-Based Paint Abatement and Repair and Maintenance Study]]
* [[Guatemala syphilis experiments]]
* [[Human experimentation in North Korea]]
* [[Human subject research]]
* [[International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use]]
* [[Bill Jenkins (epidemiologist)]]
* ''[[Medical Apartheid]]''
* [[Operation Whitecoat]]
* [[Project 4.1]]
* [[Race and health in the United States]]
* [[Shiloh Missionary Baptist Church]]
* [[Unethical human experimentation]]
* [[Unit 731]]
* [[World Medical Association]]
}}

==References==
{{Reflist|30em}}

==Further reading==
* {{cite news|url=http://www.socialworker.com/feature-articles/ethics-articles/The_Tuskegee_Syphilis_Study_and_Its_Implications_for_the_21st_Century/ |title=The Tuskegee Syphilis Study and Its Implications for the 21st Century|work=socialworker.com}}

===Primary sources===
* {{Cite journal
 | last = Caldwell | first = J. G |author2=E. V. Price | year = 1973
 | title = Aortic regurgitation in the Tuskegee study of untreated syphilis
 | journal = J Chronic Dis | volume = 26 | issue = 3 | pages = 187–94
 | doi = 10.1016/0021-9681(73)90089-1
 | pmid = 4695031 |display-authors=etal}}
* {{Cite journal
 | last = Hiltner | first = S. | year = 1973
 | title = The Tuskegee Syphilis Study under review
 | journal = Christ Century | volume = 90 | issue = 43 | pages = 1174–76
 | pmid = 11662609 }}
* {{Cite journal
 | last = Kampmeier | first = R. H. | year = 1972
 | title = The Tuskegee study of untreated syphilis
 | journal = South Med J | volume = 65 | issue = 10 | pages = 1247–51
 | pmid = 5074095 | doi=10.1097/00007611-197210000-00016}}
* {{Cite journal
 | last = Kampmeier | first = R. H. | year = 1974
 | title = Final report on the "Tuskegee syphilis study
 | journal = South Med J | volume = 67 | issue = 11 | pages = 1349–53
 | pmid = 4610772 | doi=10.1097/00007611-197411000-00019}}
* {{Cite journal
 | last = Olansky | first = S. |author2=L. Simpson | year =1954
 | title = Environmental factors in the Tuskegee study of untreated syphilis
 | journal = Public Health Rep | volume = 69 | issue = 7 | pages = 691–98
 | pmid = 13177831
 | pmc = 2024316 | doi=10.2307/4588864|display-authors=etal| jstor = 4588864 }}
* {{Cite journal
 | last = Rockwell | first = D. H. |author2=A. R. Yobs | year = 1964
 | title = The Tuskegee Study of Untreated Syphilis; the 30th Year of Observation
 | journal = Arch Intern Med | volume = 114 | issue = 6 | pages = 792–98
 | pmid = 14211593 | doi=10.1001/archinte.1964.03860120104011|display-authors=etal}}
* {{Cite journal
 | last = Schuman | first = S. H. |author2=S. Olansky | year = 1955
 | title = Untreated syphilis in the male African American; background and current status of patients in the Tuskegee study.
 | journal = J Chronic Dis | volume = 2 | issue = 5 | pages = 543–58
 | doi = 10.1016/0021-9681(55)90153-3
 | pmid = 13263393 |display-authors=etal}}

<gallery caption="Photocopied documents from the study">
File:Tuskegeeletter.jpg|The Tuskegee Study Group Letter inviting subjects to receive "special treatment", actually a diagnostic lumbar puncture
File:Tuskegee-syphilis-study autopsy-request.gif|Document from Tuskegee Syphilis Study, requesting that after test subjects die, an autopsy be performed, and the results sent to the [[National Institutes of Health]]
File:Tuskegee-syphilis-experiment draft report 1.gif|Draft report of study results up to 1949, page 1
File:Tuskegee-syphilis-experiment draft report 2.gif|Draft report of study results up to 1949, page 2
File:Tuskegee-syphilis-experiment table-subjects.gif|Table depicting number of subjects with syphilis and number of controlled non-syphilitic patients, and how many of the subjects have died during the experiments, 1969
File:Tuskegee-syphilis-study termination-memo.gif|Memo ordering the termination of the study
</gallery>

===Secondary sources===

* {{Cite book | first = Elof Axel | last = Carlson | title = Times of triumph, times of doubt : science and the battle for the public trust | publisher = Cold Spring Harbor Press | year = 2006 | isbn = 978-0-87969-805-8 | url = https://archive.org/details/timesoftriumphti00carl }}
* {{cite journal | author = Gjestland T | year = 1955 | title = The Oslo study of untreated syphilis: an epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material | journal = Acta Derm Venereol | volume = 35 | issue = Suppl 34| pages = 3–368 }}
* {{Cite book
 | first = Fred D. | last = Gray
 | author-link = Fred Gray (attorney)
 | title = The Tuskegee Syphilis Study: The Real Story and Beyond
 | location = Montgomery, Alabama | publisher = NewSouth Books | year = 1998 }}
* {{Cite book
 | first = James H. | last = Jones
 | title = Bad Blood: The Tuskegee Syphilis Experiment
 | location = New York | publisher = Free Press | year = 1981 }}
* DiAnni, Denisce (1993). [https://catalog.lib.unc.edu/catalog/UNCb2482491 ''The Deadly Deception'', PBS/WGBH Nova documentary video.]
* {{Cite journal
 | author-link= Susan M. Reverby
|first= Susan M. | last = Reverby
 | title = History of an Apology: From Tuskegee to the White House | journal = Research Nurse | year = 1998 }}
* {{Cite book
 | first = Susan M. | last = Reverby
 | title = Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study
 | publisher = University of North Carolina Press | year = 2000 }}
* {{Cite book
 | first = Susan M. | last = Reverby
 | title = Examining Tuskegee: The Infamous Syphilis Study and its Legacy
 | publisher = University of North Carolina Press | year = 2009 }}

* Sherrod, K. Lynn.  "Nurse Eunice Rivers in the Tuskegee Syphilis Study: In the Jim Crow south" (Thesis, Sarah Lawrence College; ProQuest Dissertations & Theses,  2014. 1525437).

* {{Cite journal
 | last = Thomas | first = Stephen B |author2=Sandra Crouse Quinn
  | title = The Tuskegee Syphilis Study, 1932–1972: Implications for HIV Education and AIDS Risk Programs in the Black Community
 | journal = American Journal of Public Health | year = 1991 | volume = 81 | issue = 1503 | pmid=1951814 | doi=10.2105/AJPH.81.11.1498 | pmc=1405662 | pages=1498–1505}}

* {{Cite book
 | first = Harriet A. | last = Washington | year = 2007
 | title = Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present
| title-link = Medical Apartheid }}

==External links==
{{Commons category}}

* {{cite web|url=http://tuskegeestudy.weebly.com/|title=Bad Blood: The Tuskegee Syphilis Study|publisher=Claude Moore Health Sciences Library, [[University of Virginia]]}} (Archived.)
* {{cite web|title=Patient medical files |url=https://www.archives.gov/southeast/finding-aids/tuskegee.html|website= National Archives and Records Administration Southeast Region|location= Morrow, GA|date=August 15, 2016}}
* {{cite web|publisher=Michigan State University|url=http://www.msu.edu/course/hm/546/tuskegee.htm |archive-url=https://wayback.archive-it.org/all/20001027222606/http://www.msu.edu/course/hm/546/tuskegee.htm |url-status=dead |archive-date=October 27, 2000 |title=Review of the TSS}}
* {{cite web|url=https://www.cdc.gov/tuskegee/ |title=U.S. Public Health Service Syphilis Study at Tuskegee|publisher= [[Centers for Disease Control]]|date=October 3, 2018}}

{{Medical ethics cases}}
{{Tuskegee University}}
{{Authority control}}

{{DEFAULTSORT:Tuskegee Study Of Untreated Syphilis In The African American Male}}
[[Category:1932 establishments in Alabama]]
[[Category:1972 disestablishments in Alabama]]
[[Category:African-American history of Alabama]]
[[Category:Clinical trials]]
[[Category:Health disasters in the United States]]
[[Category:History of racism in Alabama]]
[[Category:Human rights abuses in the United States]]
[[Category:Human subject research in the United States]]
[[Category:Medical ethics]]
[[Category:Medical scandals in the United States]]
[[Category:African-American health]]
[[Category:Social problems in medicine]]
[[Category:Syphilis]]
[[Category:Tuskegee University]]
[[Category:United States Public Health Service]]