Tuskegee Syphilis Study

Between 1932 and 1972, the United States Public Health Service (PHS), later joined by the Centers for Disease Control and Prevention (CDC), conducted a study of untreated syphilis in Macon County, Alabama, in collaboration with the Tuskegee Institute (now Tuskegee University). Investigators enrolled 600 impoverished African American sharecroppers: 399 men with latent syphilis and a control group of 201 men who were not infected. The stated purpose was to observe the natural progression of untreated syphilis to the point of death and autopsy. Effective treatments to reduce the severity of syphilis had existed since the 1920s, and penicillin became a widely used cure by 1945, yet researchers withheld treatment from the men for the study's full 40-year duration. More than 100 of the men died as a result.

The men were never told they had syphilis. Instead, researchers described their condition using the local term bad blood, which covered several ailments, and offered free medical exams, meals, transportation, and funeral expense payments as incentives to stay in the study. In place of treatment, participants received disguised placebos, ineffective remedies, and invasive diagnostic procedures such as spinal taps, which were misrepresented to them as therapy. The study was originally planned to last six months but was extended indefinitely after funding for a treatment phase fell through. Even after penicillin became the standard cure for syphilis by 1947, and even when men were separately diagnosed with syphilis at military draft boards during World War II, study researchers intervened to keep them untreated and blocked their access to public health treatment campaigns that later came to the county. By the time the study ended in 1972, only 74 of the original participants were still alive: 28 had died directly of syphilis, 100 had died of related complications, 40 of their wives had been infected, and 19 of their children had been born with congenital syphilis.

Concerns about the study's ethics were raised internally and externally for years before it ended, including by a Public Health Service employee whose 1966 letter to federal officials was rebuffed. The study became public in 1972 after a leak to the press; a Washington Star report on July 25 of that year was followed by national front-page coverage and Congressional hearings. A federal advisory panel subsequently found the study medically unjustified, and it was terminated on November 16, 1972.

In 1974, the U.S. government settled a class-action lawsuit brought on behalf of participants and their families for $10 million and agreed to provide free medical care to survivors and infected family members. That year, Congress passed the National Research Act, creating a commission whose work led to the 1979 Belmont Report and the establishment of the Office for Human Research Protections, along with federal requirements for informed consent and institutional review boards in human-subjects research. In 1997, the President of the United States formally apologized on behalf of the federal government at a White House ceremony attended by five of the study's eight known surviving participants; the government later helped establish Tuskegee University's National Center for Bioethics in Research and Health Care in 1999.

The study has been described as one of the most infamous biomedical research studies in U.S. history and is widely cited as a major cause of enduring distrust of medical and public health institutions among African Americans. A 2016 economic analysis linked the study's 1972 disclosure to decreased physician visits and reduced life expectancy among older Black men, an effect compared in scale to eliminating smoking. The last known surviving participant died in 2004.