The legacy of the Tuskegee study

By Austin Frakt

In the United States, African American men have the worst health outcomes of any major demographic group. At age 45, their life expectancy is more than three years less than that of non-Hispanic Caucasian men and more than five years less than African American women. According to a 2017 study published in The Quarterly Journal of Economics, one-third and one-quarter, respectively, of these life expectancy gaps may be attributed to a single event in 1972 — the disclosure of the Tuskegee study.

From 1932 to 1972, the U.S. Public Health Service studied 600 hundred low-income, African American men in Tuskegee, Alabama. The study’s purported purpose was to better understand the natural course of syphilis, which two-thirds of the men had.

Deceived about the nature of the study, the syphilitic men were provided sham treatments and were discouraged from seeking additional medical care. Physicians leading the study even contacted other doctors in the area urging them not to treat study participants. For their participation, the men received hot meals and their families were compensated for their burial costs.

Under any circumstances, this now infamous study is plainly unethical, unjust, and in violation of common sense and decency. That it wasn’t even scientifically useful — the natural history of syphilis was already largely understood — betrayed the study’s racist motivation, as conveyed by Allan Brandt.

The doctors who devised and directed the Tuskegee Study accepted the mainstream assumptions regarding blacks and venereal disease. The premise that blacks, promiscuous and lustful, would not seek or continue treatment, shaped the study. […]

In retrospect the Tuskegee Study revealed more about the pathology of racism than it did about the pathology of syphilis.

The Associated Press broke the story of the study in 1972 and it was halted. But its damage did not end with the participating men and their families. Public health researchers have cited it as a source of distrust among African Americans of the medical establishment, challenging efforts to slow the spread of HIV, contain tuberculosis outbreaks, and broaden preventive care.

Marcella Aslan and Marianne Wanamaker conducted a quantitative study of the effect of the Tuskegee Study. They found that black men at least 10 years old in 1972 and living closer to Macon County (where Tuskegee is located) are more likely to mistrust the medical system.

Perhaps as a consequence of this distrust, black men living closer to Tuskegee study participants are less likely to receive medical care and die at younger ages. Aslan and Wanamaker estimated that the

decrease in the life expectancy of black men attributable to the Tuskegee revelation represents 35% of the racial gap in male life expectancy in 1980 and 25% of the gender gap in black life expectancy.

These are large effects. And these are from just one chapter in a long history of racial discrimination and race-based beliefs in medical care (and elsewhere) that continue to this day.