When Evil Intrudes

Abstract

Twenty years ago Peter Buxtun, a public health official working for United States Public Health Service, complained to a reporter for Associated Press that he was deeply concerned about morality of an ongoing study being sponsored by Public Health Service--a study compiling information about course and effects of syphilis in human beings based upon medical examinations of poor black men in Macon County, Alabama. The men, or more accurately, those still living, had been coming in for annual examinations for forty years. They were not receiving standard therapy for syphilis. In late July of 1972 Washington Star and New York Times ran front-page stories based on Buxtun's concerns about what has been called longest running nontherapeutic on human beings in medical history and the most notorious case of prolonged and knowing violation of subject's rights--the Tuskegee study.[1] Buxtun went public with his ethical concerns after years of complaining to officials from Centers for Disease Control and Public Health Service with no apparent effect. His decision to blow whistle led to a series of sensational congressional hearings chaired by Senator Edward Kennedy in February and March of 1973. Legislators and federal officials expressed outrage over immorality of a study in which poor, illiterate men had been deceived and given placebo treatment rather than standard therapy so that more could be learned about syphilis. Americans found it hard to believe that Public Health Service had intentionally and systematically duped men with a disease as serious as syphilis--contagious, disabling, and life-threatening--for more than forty years. The level of outrage about Tuskegee study was enormous. One CDC official labeled experiment akin to genocide.[2] As a result of public anger over immorality of study, Congress created an ad hoc blue ribbon panel to review both Tuskegee study and adequacy of existing protections for subjects in all federally sponsored research. Even though panel did not receive all information about study that government had available,[3] they were still concerned enough about what had taken place to recommend creation of a national board with resources to reexamine all aspects of human experimentation in United States. Congress, in 1974, created National Commission for Protection of Human Subjects of Biomedical and Behavioral Research which, in its seventeen reports and numerous appendix volumes, laid foundation for ethical requirements that govern conduct of research on human subjects in United States to this day. Syphilis continues to challenge America's and world's medical, public health, and moral resources. While there are a variety of antibiotics available to treat disease, it has proven to be a stubborn and resilient foe. The Centers for Disease Control has found steady and alarming increases in incidence of primary and secondary syphilis over past decade. It is still a major public health problem in United States today, especially among young black males. The rise in incidence of disease has ensured that writings about diagnosis, management, and treatment of syphilis are prominently featured in professional literature of public health and biomedicine as well as in standard textbooks about venereal and infectious diseases. Ongoing concern about syphilis has led physicians and public health officials to draw upon as much information as they can about course of disease. One of bitter if generally unacknowledged ironies of Tuskegee study is that, while it now occupies a special place of shame in annals of human experimentation, its findings are still widely cited by contemporary biomedical community. In looking at instances of scientific misconduct and moral malfeasance with respect to research it is quite common to find position advanced that good science is incompatible with bad ethics. …