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Book Review: Bad Blood — The Tuskegee Syphillis Experiment
by Bertram Bruce
‘Science for the People’ Vol. 14, No. 2, March-April 1982, p. 29
Bertram Bruce is a member of the Sociobiology Study Group.
Bad Blood: The Tuskegee Syphillis Experiment
by James Jones, The Free Press, New York, 1981.
In 1932 the United States Public Health Service (PHS) began deliberately withholding treatment for syphilis from 400 black men. For forty years, until 1972, government scientists and private physicians in and around Macon County, Alabama carefully recorded the effects produced by untreated infestations of the spirochete, Treponema pallidum. These effects included gummas (rubbery tumors), crusty ulcers on the skin, bone deterioration, liver deformity, lesions of the aorta, blindness, paresis (a softening of the brain that produces paralysis and insanity), and death. The stages of the disease’s development and the consequences of not treating it were all known in 1932. And so was a cure.
Bad Blood: The Tuskegee Syphilis Experiment, by James Jones, is a chronicle of the appalling cruelty that turned people into “subjects” for the sake of science. The men in the study were told that they had “bad blood”—but the “treatment” they received was only aspirin and iron tonic. The PHS worked with local doctors to ensure that no antibiotics or other treatments would be given that might alter the progression of the disease.
Letting the principals tell the story in their own words, from journal articles, newspapers, PHS memos, letters, and interviews, Jones shows in frightening detail how a racist society can betray even the lowest standards of decency. To this day there has been no apology from the PHS officers directly involved in the experiment and the only outcome of a suit against the US, the Department of Health Education and Welfare, the PHS, the Center for Disease Control, the state of Alabama and others was a cash payment of $37,500 (less lawyers’ fees) to the survivors, and lesser payments to the heirs of those who did not survive.
The first mention of the infamous syphilis experiment usually raises the question of how it could have gone on for so long without being exposed. Jones shows that there was no coverup; the experiment was regularly reported in medical journals and at medical conferences. It involved not only the PHS but also the Tuskegee Institute, the Veterans’ Hospital in Tuskegee, and both white and black doctors in Macon County. Over the years, the study became a training ground for young physicians. Where else could one go to see prime examples of the debilitations of syphilis?
The study was not the product of a mad scientist working alone in a secret laboratory. Nor was it the playing out of some gruesome fantasy of people who hated blacks and poor people. The doctors involved were in fact among the progressives of their day. They were the first to conduct large-scale syphilis treatment programs for blacks. As Jones says, their “argument that social class had a direct bearing on health attacked the very foundations of the racist belief that the high black mortality was due to racial inferiority.” These doctors worked hard to draw national attention and support for improving the health and economic conditions of blacks. When money for treatment ran out during the Depression, the study was proposed as an alternative preferable to doing nothing at all. Jones shows, however, that the relatively liberal attitudes of these PHS doctors were rooted in prevailing attitudes about race and class. Blacks were to be helped because they were a “weaker race”; if they were not treated, their “degeneracies” might spread to the rest of society.
Jones lets the syphilis experiment tell itself, only stopping to point out numerous ironies along the way. Despite the sacrifice of people for the glory of science, virtually nothing was learned—the study was bad science on methodological as well as political and moral grounds. Yet nothing seemed capable of stopping it. For example, a PHS staff member, Peter Buxtun, insisted in 1967 that the patients in the study were not volunteers— “they were nothing more than dupes and were being used as human guinea pigs.” But his objections were essentially ignored. Even the discovery that penicillin was an inexpensive, safe and effective cure for syphilis only prolonged the study—never again would scientists have the opportunity to study “uncontaminated” subjects.
Bad Blood is a focused and well-researched account. But as valuable as the book is, I was left with frustrations at the end, unanswered questions and issues that Jones seemed to skirt. I wanted to know more about what other studies the PHS (and other agencies, such as the National Cancer Institute) were, and are, conducting. I wanted to know more about the country that failed to notice and then, despite the newspaper accounts and the 1973 Kennedy hearings, practically condoned the study. It took eight months after the story broke in the Washington Star for the surviving “subjects” to receive treatment. I wanted to read more about the development of racist beliefs of scientists and the logic that governed the progression of the study. And I wanted to know more about how that logic operates in less obvious circumstances. These questions are clearly beyond what the book sets out to do.
On its own terms, however, the book is difficult to fault. It is a gripping story that reads like a novel in which any ending would be good, as long as there is one. It is also a good reference on medical care for blacks, and on the relationships among medicine, theories of race and the economic roles and conditions of blacks in 19th and 20th century United States.
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