Review

Author(s): Francis Helminski

Review by: Francis Helminski
Source: Jurimetrics, Vol. 22, No. 4 (Summer 1982), pp. 451-454
Published by: American Bar Association
Stable URL: http://www.jstor.org/stable/29761806
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CURRENT LITERATURE

REVIEW AND CRITIQUE

BAD BLOOD.

THE TUSKEGEE SYPHILIS EXPERIMENT

James

H.

Jones

The Free Press, New York, 1981

xii + 272 pp., $14.95

Francis Helminski

This is a book foranyone who doubts the legitimacyof legal interventioninto

research.

medical

Bad

is not so much

Blood

and

about medicine

law, as what

happened tomedicine when no law would restrain it.The Tuskegee Syphilis

Study,

conducted

between

1932 and

a medical

1972, was

Scottsboro.

Like

that

blot on American legal history, theTuskegee study involved poor black vic?
tims, professional

hubris, and lack of due process

for those who

needed

itmost.

James Jones setsout thefactualand philosophical climatewhich made thestudy

possible. He points up its operation by deceit,
That
cratic inertia and its ultimate uselessness.

through bureau?
is also part of the Tuskegee
trag?
its continuance

edy; not onlywere human rightsviolated but "[njothing learnedwill prevent,

Not only did the study
find, or cure a single case of infectious syphilis . ..."1
violate ethical norms, but scientific norms as well.
Jones is a historian, not a lawyer, and readers searching for extended legal

discussion will be disappointed. Jones specializes rather inmedical history,

and has served several fellowships inbioethics. His approach is a telescoped
discussion ofmedical
chronology.Much of thebook isdevoted to introductory
of
attitudes toward blacks and syphilis, early efforts theU.S. Public Health
Service in theruralSouth, and events leadingup to thestudy.The study itselfis
dealt with in less thanhalf thebook. Final chaptersdiscuss itsabruptendwhen
brought topublic attention in 1972.
*Francis

Helminski

is a member

of the Section's

Committee

on Life

Sciences,

Subcommittee

on Legal Aspects ofMedical Experimentation, and is employed at theOffice of Legal Affairs,

Harper-Grace

Hospitals,

Detroit

]J.Jones, Bad Blood

SUMMER

Medical

Center.

202 (1981).

1982

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All use subject to JSTOR Terms and Conditions

451

The studywas conducted inMacon County, Alabama, location of theTus

kegee Institute.2Macon County was a poor area with a high incidence of ac?
quired and congenital syphilis among blacks. Sporadic treatmentprograms had
failed due to lack of funds and lack of effective therapy in thepre-penicillin age.
Officials at theU.S. Public Health Service took advantage of these conditions
tobegin a study of the effects of untreated syphilis inblack males over twenty
five. Ostensibly the studywas to complement earlier reports fromNorway on

theeffectsof thedisease inuntreatedwhites. American physicians socialized to

black "inferiority" had postulated that syphilis affected the two races differ?
ently. Public Health Officers seized theopportunity to contribute to this "sci?
entific"

debate.

Several hundred black men with and without thedisease were divided into
a study and a control group in 1932. Public Health personnel arrived for a short
period each year thereafterto conduct examinations and take blood samples to
chart theprogress of thedisease. A black nurse visited themen throughout the
year, to help ensure continued cooperation. Her role in the study reveals much
not only about male/female and white/black relations, but about doctor/nurse
authoritarianism. Local physicians helped by withholding syphilis treatment,
and by alerting officials when a subject died so thathis body could be secured
for autopsy. The men in turn enjoyed some freemedical care for other ail?
ments, prestige in the county's black community, and the assurance of a burial
stipend at death for their family. They were never told thattheyhad syphilis, or
that theywere subjects of a study. Rather theywere affirmatively deceived;
told that theyhad "bad blood,"

and that theiraspirin and placebos were genu?

ine remedies.

Jones faults thephysicians with a "moral astigmatism.'' In his view, itwas

not thecase thattheyconsidered ethical and unethical alternatives and chose the
unethical, but rather that they never experienced a moral crisis at all. They
could not even recognize the ethical issues, much less ponder them.
Behind the study, Jones argues, was a belief in themoral inferiorityof
blacks, a phenomenon noted by other commentators in other contexts.3 This
belief was intensifiedwhere venereal disease was concerned. Since a major
goal of the study was to discover whether syphilis affected the races
differently?a hypothesis possible only in a racistmilieu?the studywas scien?
tificallydishonest. This race-connected objective, combined with a sloppy pro?

tocol, invalidated any usefulness the studymay have had. Jacob Bronowski,
discussing the absurdity of Nazi race-connected "experiments," commented

2The Institute lent support to the study with facilities and personnel, and failed to object to the
deception of subjects. The Institute's principal at this time also failed, forwhatever reason, to take
a public position on the nearby Scottsboro trials. D. Carter,
Scottsboro
153 (1969).
3"The social history of racism clearly was predicated on a belief in themoral inferiority of
blacks, a belief thatwas necessary to justify the institution of chattel slavery, and a belief that per?
sisted to justify pervasive racial discrimination and victimization of blacks throughout American
society.'' Sedler, Racial Preference and theConstitution: The Societal Interest in theEqual Partic?
ipation Objective,

452

26 Wayne

L. Rev.

1227, 1237 (1980).

JURIMETRICS JOURNAL

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that"we have seen theprodigious success of science as an activity because it is

based on perfect trust in the truthof statements."4 Tuskegee sprang from dec?
ades of pseudo-Darwinian hypothesizing about racial distinctions in physiol?
ogy, pathology, mentality. There was no scientific honesty in thedesign, even
if the data

were

accurate.

This is not to suggest that the studywas invalidper se because therights of

its subjects were violated. William Beaumont, ina remarkably parallel case not

mentioned by Jones, made serendipitous discoveries of great value about di?

gestion when a young patient's wound would not heal over. Beaumont hounded
his reluctant subject, but he did not startout by theorizing on racial grounds.
Tuskegee was taintedbecause itcategorized its subjects as ignorantblacks, in?
stead of as human beings with a withering affliction.
Tuskegee was a model of uninformed consent. Fearing that uneducated
candidates would refuse to participate in this "ready-made opportunity,"5 the
Public Health Service fraudulentlymaneuvered themen into cooperating. The
illegalitywas compounded by thewithholding of treatment,even afterpenicil?

lin became available.

Blackstone recognized in 1768 thata trespass on the case could comprise
an iatrogenic injury "whether . . . [made by] curiosity and experiment, or by
neglect, because itbreaks the trustwhich theparty had placed inhis physician
and tends to the patient's destruction."6 But the law has usually entered after
the fact. "As inmost areas ofmedicine, the law [affectingexperimentation] has
been reactive rather thanprospective; reaction has been to atrocities rather than
"7
to 'standardmedical activity.'
The Nuremberg Code is an example. Handed
down in 1947, itpurported to codify pre-war medical ethics concerning experi?
mentation. Itsmeaning was lost on thedirectors of theTuskegee study, despite
theirprogram's continuing violation of virtually each of the code's ten provi?
sions. Ironically, defendants at theNuremberg medical trial could point to
questionable American experiments. Tuskegee was not cited, but only through
the oversight of German defense counsel. There were at least three articles in
themedical literaturedescribing the study by 1946.8
Jones's most disturbing findingwas thewidespread professional indiffer?
ence to the ethics of the study. This continued through 1969, when a blue
ribbon panel of physicians approved continuation both of the study and of de?
nial of treatment. There was only one dissenter. The rest "perceived no
conflict between theirown scientific interest in the experiment and attempting
'9
todecide what was best for their subjects.' The studymay have stemmed from
racism, but thisdecision was wholly professional inorigin. The now nearly all
and Imagination
The Origins of Knowledge
4J.Bronowski,
137 (1978).
5Jones at 94.
Commentaries
122 (1768); [emphasis added].
63W. Blackstone,
and Allied
& B. Katz, The Rights of Doctors,
7G. Annas, L. Glantz
Nurses,
Professionals
130(1981).
%See Jones at 257.
9Id. at 196.

SUMMER 1982

Health

453

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black Macon County Medical Society concurred, even agreeing not togive the
men antibiotics for any reason. The doctors were carried off in a pathology
wonderland of aortic insufficiencies, capillary pulsations, and eroded cardiac
valves. By 1969 themen had become too interestingas baskets of symptoms to
end the experiment. These physicians were not evil, but ethically illiterate.
Dedication to their craft overrode inchoate concerns with morality.
Tuskegee and similar domestic shames10 have brought about legal inter?
vention in the once private relation between subject and investigator. As a
result,medicine is no longer "wiser than the laws,"" butmust tolerate a rea?
sonable balance between public intrusionand professional independence. Bad
Blood shows theethical vacuity of thosewho sacrificed vulnerable subjects for
a perceived scientific good. Those who question the need for regulation of

medical research should be disabused by thiswork.

of Clinical
Research
n)See, e.g., R. Levine, Ethics and Regulation
1
]See Gold, Wiser Than theLaws?: The Legal Accountability of theMedical
j. L. & Med.
145(1981).

454

51-53

(1981).
7 Am.

Profession,

JURIMETRICS JOURNAL

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