From The Times
Herman Shaw leans back in his rocking chair, takes off a greasy baseball cap, and scratches his head. “Nobody knew what we were being treated for, and I was with it from start to finish. I really don’t know what made them do it.” Shaw, a farmer who has spent his life scraping a living from a few acres of land in rural Alabama, is lucky. Now in his early nineties, he is a survivor of one of the most gruesome medical experiments in American history.
Sixty years ago, doctors from the United States Public Health Service (PHS) selected 400 men from around the small agricultural town of Tuskegee, in Macon County, Alabama. The men suffered from syphilis. Poverty-stricken and barely educated, they were enticed on to a course of “free treatment”. It was a sham. Without their knowledge, the men were used as guinea-pigs by doctors wanting to know how untreated syphilis affected the human body. By the time the experiment ended, 20 years ago this summer, scores of the men were dead.
Shaw, along with every other man on the experiment (there were no women), was black. The doctors who administered the project were white. On the surface, this is a classic tale of American racism. But it is more than that. By the standards of the day, the doctors were liberals. They began the study in the hope of finding a cure for syphilis, which had reached epidemic proportions in black areas of the South. How they came to be accused of genocide owes as much to scientific arrogance as racism. And there is a twist in the tale.
According to a recent survey, millions of black Americans think the federal government is exploiting the Aids virus to destroy their race. For them, what happened in Tuskegee is proof enough. But the syphilis experiment could never have been carried out without the collaboration of the local black medical establishment. As Aids becomes embroiled in the racial politics of contemporary America, the earlier story is one many in Tuskegee prefer to forget.
Driving down Interstate 85 from Atlanta, Georgia, it is easy to miss Tuskegee. Set deep in the pine forests that cover huge areas of Alabama, where tiny rural communities are still only linked by dirt roads, Tuskegee strives unsuccessfully to justify its motto as being The Heart of the Fast-Growing South.
Occasionally, a tail-finned Buick or Chevrolet crawls past the second-hand shops and the fried-chicken cafes. Incongruously, a statue of a Confederate soldier gazes on to the square. The grateful citizens who erected this monument to the Old South are long gone; there is barely a white face to be seen. Like many other black southern towns, Tuskegee relied for most of its history on the vagaries of the cotton trade. But in the Thirties, it faced a bigger problem than economic downturn. According to PHS figures, almost 35 per cent of the black population of Macon County suffered from the potentially fatal disease of syphilis.
“Syphilis was the Aids of the Thirties,” says Dr John Cutler, a former PHS employee who worked on the Tuskegee study. “The disease could strike at any part of the body. It could cause heart failure, paralysis, insanity or premature death.” In 1935, the PHS estimated that every year there were one million new cases of syphilis in the United States. There was a cure of sorts involving injections of arsenic and bismuth but treatment was time-consuming and expensive. It was also dangerous. The use of arsenicals meant that if the disease did not kill, the treatment might.
The urgency of finding a cure attracted some of the best minds in medical science to syphilology. “The doctors were at the cutting edge,” says William Watson, who worked on the venereal disease control programme between 1948 and 1957. “They regarded themselves as crusaders.” Two of these men were Dr Raymond Vonderlehr and Dr Taliaferro Clark. Vonderlehr was the rising star of the PHS. At the age of 35, he already had an impressive track record. Postgraduate work in Europe had been followed by two years lecturing at the Medical College of Virginia. Clark was one of the most senior officers in the service, and was approaching retirement. He had held several key posts with the PHS.
In their search for a cure for syphilis, Vonderlehr and Clark decided to conduct an experiment. Over a period of six months, the course of the disease would be followed in 400 men. Macon County, with its high rate of infection and a community tied to the land, seemed ideal. “They were so isolated down there,” says Dr Sidney Olansky, who worked on the study in the Fifties. ”They were suited for the type of follow-up we wanted.“ Only one person was lost,” he adds, “and that was because he got himself shot. He ruined our statistics.”
But rather than tell the local community what they intended, the doctors, fearing a reluctance to co-operate, began weaving an elaborate web of deceit.
A campaign was started in Macon County, promising “special free treatment” from “government doctors”. Thousands came for check-ups and blood tests. But there was no treatment: the tests were a means of screening 400 likely subjects for the study. Once selected, further lies quickly followed. The men were in the latent stage of syphilis, a period when there are no symptoms. They were not told that they had the disease, but that they were suffering from “bad blood”, a catch-all phrase used to cover many different ailments, such as anaemia and malaria.
“They didn’t tell you nothin’,” says Anderson Sinclair, now aged 87, who joined the study at the beginning: “Just, ‘come and roll your sleeve up and give some blood’.”
Being misled about their disease was bad enough, but far worse was the fact that the men were denied treatment. “The doctors did prescribe for the men,” Eunice Rivers, a local black nurse, says. “But it wasn’t for syphilis. If a man had a terrible cold, he would get something. And we always carried aspirin and vitamin pills. They just loved munching them vitamin pills.”
Many of the doctors involved still defend their actions. “The vocabulary of the men was limited,” says Dr Arnold Schroeter, who worked on the project in its final years. “I can remember talking to them and seeing my colleague shake his head and say: ‘You’re wasting your time.’ He did not doubt, however, the probity of proceeding with an experiment he could not explain to its subjects.”
Some doctors argue that human experimentation was acceptable in the Thirties. “Informed consent was not the vogue in those days,” Olansky says. Other doctors are more brutal, citing the principle of the greater good. “We have no compunction about sending our youth to war in the national interest,” Cutler says. “And it was in the national interest to know as much about syphilis as quickly as possible.”
All of them dismissed the possibility that the study might be racist. “The doctors were liberal; ultra-liberal,” Watson says. “They just wanted to find out about syphilis.”
No long-term damage might have been done to the men if the study had not been extended beyond its original six-month period. In 1933, Clark retired as head of the VD division and was replaced by Vonderlehr. Earlier, Clark had resisted Vonderlehr’s suggestion of continuing the study. Now the men would be part of the experiment until they died.
The first autopsies upset Rivers. “I wasn’t sold on autopsy”, she says, “so I had a problem selling it to other people.” Rivers was the linchpin of the experiment. She was born in Georgia in 1899. Her mother died when she was very young, and her father was the dominant influence in her early life. Albert Rivers, the son of a slave, was ambitious for his daughter. Working day and night, he scraped enough money together to send her to Tuskegee Institute, the leading black college in the South, where she took a nursing course. Most of the training was done at the John Andrew Hospital, another all-black institution. In addition to basic medicine, Eunice Rivers learnt the principle that guided her through her years on the project: a nurse must follow the doctors’ orders unequivocally, and to the letter.
The humble background she shared with the subjects of the project immediately won their trust. “We loved her,” Shaw says. “Every time you met her, you met her with a smile.” She bridged the world of the sharecroppers and the doctors, loyally translating their orders into language the men understood. “The study could not have been done without her,” Olansky says. “She was the link that kept it going.”
The study was extended in order to bring the men to autopsy, which, Vonderlehr believed, was essential to discover the damage caused by syphilis. The role of persuading the families of the deceased to donate the bodies fell to Rivers. Pride in her ability to carry out orders overcame her feelings of distaste. “It’s just like an operation”, she told the families, “except the person is dead.” In addition, $50 was offered for burial expenses.
Rivers insisted that great care be taken not to mar the bodies, in case the families objected. “If you mess up that body, you won’t get another,” she told one young doctor. In the first 20 years of the experiment, she asked 145 families to consent to an autopsy. Only one refused.
For Vonderlehr, the autopsies were the proof he was seeking. In 1936, in his first paper on the study, he noted with excitement the “very striking” fact that syphilis “shortened the lives of its hosts by almost 20 per cent”. Nowhere in the paper was the possibility of treatment considered.
In fact, steps were taken to prevent any likelihood of treatment. On one occasion, Shaw was sent by a doctor who was ignorant of the experiment to a VD clinic in Birmingham. Waiting for treatment, Shaw was recognised by a nurse. “She said, ‘What are you doin’ here? You’re not supposed to be here’, and she put me in a taxi and sent me home.”
During the second world war, the PHS persuaded the army not to draft the men in case they then re-ceived treatment. By 1955, according to the PHS’s own figures, 28 out of 92 patients examined at autopsy had died as a direct result of syphilis.
By the Fifties, what little justification there had been for the study had evaporated. The immorality of human experimentation without the consent of the subjects had been demonstrated at the Nuremberg trials. And penicillin had been discovered. A few shots of this drug cleared up syphilis for good without the side-effects associated with arsenic and bismuth.
The PHS launched a nationwide anti-syphilis campaign which, within months, resulted in a dramatic drop in the rate of infection across the United States except in Tuskegee, where the men were denied the new drug. When asked why, Olansky, then the deputy director of the study, replies: “Well, if we’d given them penicillin, there’d have been no Tuskegee study.”
It was a chance encounter in 1966 that signalled the beginning of the end for the experiment. Peter Buxtun was a young researcher with the PHS in San Francisco. “A colleague told me about the study over coffee,” Buxtun, now an antiques dealer on the West Coast, says. Buxtun, who had studied the Nuremberg trials as a graduate student, was struck by the similarities. He began bombarding his superiors with questions.
After months of silence he was summoned to Atlanta to meet some of the doctors who administered the study. “It was very much, ‘Now look here, young man’,” he says. Buxtun, though, was not intimidated and continued to press for a review. In February, 1969 he got his way, when a panel of top PHS officials met in Atlanta to discuss the study.
Nearly three years had passed since Buxtun had first spoken out. In that time, several American cities had been the scene of race riots. Incredibly, the panel decided the study should carry on. It was not until Buxtun told the story to a journalist three years later that it finally came to an end. By that time, according to estimates based on the PHS’s own figures, more than 100 of the men had died, prematurely, of syphilis.
The story of the experiment broke in the Washington Star on July 25, 1972. Bowing to the inevitable outcry, the American government appointed a panel to investigate and, following its recommendations, the study ended.
Meanwhile, in Tuskegee, Fred Gray, a local black attorney who had acted for Martin Luther King, launched a civil action against the government, the PHS, several of the doctors and various other health bodies. The case never came to trial.
In December 1974, the government agreed to pay about $10 million in an out-of-court settlement. Shaw and the other plaintiffs received compensation of up to $32,500 each. In addition, the government would meet all medical bills for them and their families until death.
But that is not the full story. Gray did not name a single black institution or individual in the suit. Yet without black involvement, the study could not have been maintained for so long. The town of Tuskegee occupies a proud place in black American history. The Tuskegee Institute (now a university), founded in 1881 by Booker T. Washington, was known as the Harvard of the South. Tuskegee, says Johnny Ford, the mayor, “was the centre of African-American intelligence and sophistication”.
For Vonderlehr and Clark, this was the final piece in the jigsaw. Not only did Macon County have an ideal study group, but in the Tuskegee Institute and the John Andrew Hospital it had the best medical facilities and the most highly trained black staff in the South. It was there that many of the examinations and all the autopsies took place. The enthusiasm of the emerging local black intelligentsia to participate in a government-sponsored study, on equal terms with their white colleagues, overcame any reservations about the civil rights of poorly educated sharecroppers. Today, neither Tuskegee University, the John Andrew Hospital, nor any of the black personnel who took part will admit to any involvement.
They were not the only ones to get off lightly. None of the doctors was ever disciplined or prosecuted. Indeed, for most of them the Tuskegee study was a launching pad to a lucrative career in private medicine; Olansky, now in his late seventies, is a successful dermatologist in Atlanta.
It has been a different outcome for the experiment’s subjects. The few survivors still live as they have always done, eking out an existence on their plots of land in Alabama. For Shaw, who is deeply religious, like most of the people who live in this area, there is little alternative but to forgive. “The doctors were evil men,” he says. “But you can’t go around hating for ever. You can’t go around hating and expect eternity.”