1 00:00:01,160 --> 00:00:04,120 Speaker 1: Welcome to steph you missed in History Class from how 2 00:00:04,160 --> 00:00:14,160 Speaker 1: Stuff Works dot Com. Hello, and welcome to the podcast. 3 00:00:14,360 --> 00:00:19,959 Speaker 1: I'm Tracy B. Wilson and I'm Holly Fry. Today we 4 00:00:20,040 --> 00:00:23,960 Speaker 1: are talking about one of the modern world's most infamous 5 00:00:24,000 --> 00:00:29,120 Speaker 1: incidents of unethical medical research. It is the Tuskegee Syphilis Study, 6 00:00:29,120 --> 00:00:32,680 Speaker 1: which started in nineteen thirty two and ran until nineteen 7 00:00:32,920 --> 00:00:37,120 Speaker 1: seventy two. The studies researchers told its participants that they 8 00:00:37,120 --> 00:00:40,600 Speaker 1: were being treated for syphilis, but in reality they were not, 9 00:00:41,240 --> 00:00:44,080 Speaker 1: and the entire point of the study was actually to 10 00:00:44,200 --> 00:00:49,120 Speaker 1: observe how untreated syphilis progressed in black men. So this 11 00:00:49,280 --> 00:00:52,400 Speaker 1: study itself was part of a much greater pattern in 12 00:00:52,479 --> 00:00:57,640 Speaker 1: medical history of white doctors conducting unethical studies, experiments, and 13 00:00:57,720 --> 00:01:01,600 Speaker 1: procedures on minority patients. In terms of black patients, this 14 00:01:01,680 --> 00:01:04,880 Speaker 1: pattern includes the work of Jay Maryan Sims, who's known 15 00:01:04,920 --> 00:01:08,959 Speaker 1: as the Father of gynecology, who conducted surgeries on enslaved 16 00:01:08,959 --> 00:01:12,399 Speaker 1: women without anesthesia. You can hear more about that in 17 00:01:12,560 --> 00:01:15,440 Speaker 1: our sister podcast, Stuff Mom Never Told You in the 18 00:01:15,480 --> 00:01:19,720 Speaker 1: episode The Mothers of Gynecology. It also includes the use 19 00:01:19,720 --> 00:01:23,200 Speaker 1: of cancer cells taken from Henrietta Lax without her consent, 20 00:01:23,280 --> 00:01:26,160 Speaker 1: which you can learn about in Rebecca Sclute's exceptional book, 21 00:01:26,240 --> 00:01:29,600 Speaker 1: The Immortal Life of Henrietta Lax. But as we discussed 22 00:01:29,600 --> 00:01:32,559 Speaker 1: in our teen podcast on the Doctor's Riot of sevent 23 00:01:33,360 --> 00:01:38,240 Speaker 1: this pattern even continued after death, with grave robbers overwhelmingly 24 00:01:38,440 --> 00:01:43,240 Speaker 1: using black cemeteries as their source for medical cadavers. Apart 25 00:01:43,319 --> 00:01:47,119 Speaker 1: from its deeply unethical setup, the Tuskeee Study had real 26 00:01:47,319 --> 00:01:50,600 Speaker 1: and damaging effects that continued long after it was over 27 00:01:51,040 --> 00:01:55,080 Speaker 1: all of which we will talk about today. So to 28 00:01:55,240 --> 00:01:58,320 Speaker 1: give you a brief primer on syphilis, Syphilis is a 29 00:01:58,360 --> 00:02:02,640 Speaker 1: diseased caused by the bacteria um Treponema politum. And while 30 00:02:02,640 --> 00:02:05,520 Speaker 1: there are other similar diseases in the same family that 31 00:02:05,560 --> 00:02:10,120 Speaker 1: are spread through casual contact, syphilis is spread through sexual activity. 32 00:02:10,600 --> 00:02:13,880 Speaker 1: It can also move through the placenta during pregnancy, leading 33 00:02:13,880 --> 00:02:19,400 Speaker 1: to congenital syphilis in newborn babies. There are several hypotheses 34 00:02:19,480 --> 00:02:23,160 Speaker 1: about where this disease first originated. We know for sure 35 00:02:23,280 --> 00:02:26,200 Speaker 1: that it was present in the America's prior to Christopher 36 00:02:26,200 --> 00:02:29,880 Speaker 1: Columbus's first voyage, So the most popular explanation and it 37 00:02:29,960 --> 00:02:32,400 Speaker 1: was that it was carried back to Europe on Columbus's 38 00:02:32,480 --> 00:02:36,720 Speaker 1: ships in and then it spread really rapidly from there 39 00:02:36,760 --> 00:02:40,120 Speaker 1: because the population had no immunity to it. There are 40 00:02:40,160 --> 00:02:43,480 Speaker 1: also other theories that syphilis was already present outside the 41 00:02:43,480 --> 00:02:47,320 Speaker 1: America's at that point, but was more dike misdiagnosed as leprosy, 42 00:02:47,400 --> 00:02:50,720 Speaker 1: which is now known as Hanson's disease, and this second 43 00:02:50,840 --> 00:02:54,400 Speaker 1: theory the disease evolved to become more virulent in the 44 00:02:54,480 --> 00:02:59,040 Speaker 1: fifteenth century, and it was coincidentally after Columbus's first voyage. 45 00:02:59,720 --> 00:03:03,720 Speaker 1: In a first stage, syphilis presents as a sore on 46 00:03:03,760 --> 00:03:07,080 Speaker 1: the location where the bacteria entered the body. That sore 47 00:03:07,200 --> 00:03:09,600 Speaker 1: usually goes away within three to six weeks, even if 48 00:03:09,600 --> 00:03:12,800 Speaker 1: it's untreated, but the disease at that point is not cured. 49 00:03:13,440 --> 00:03:16,360 Speaker 1: It typically returns in a second stage, marked by a 50 00:03:16,480 --> 00:03:19,560 Speaker 1: rash that's sometimes the only symptom, but it can also 51 00:03:19,600 --> 00:03:24,520 Speaker 1: be accompanied by swollen lymph nodes, fever, fatigue, achiness, and 52 00:03:24,639 --> 00:03:30,040 Speaker 1: general symptoms of being unwell. Those symptoms also resolve without treatment. 53 00:03:31,480 --> 00:03:34,679 Speaker 1: From there, syphilis goes into a latent phase when it's 54 00:03:34,680 --> 00:03:37,440 Speaker 1: not treated and there are no symptoms at all. Sometimes 55 00:03:37,480 --> 00:03:40,320 Speaker 1: that lasts for the rest of the person's life, but 56 00:03:40,400 --> 00:03:43,720 Speaker 1: for up to thirty percent of people who don't receive treatment, 57 00:03:43,840 --> 00:03:48,320 Speaker 1: syphilis enters a very serious tertiary phase ten to thirty 58 00:03:48,400 --> 00:03:52,560 Speaker 1: years after the initial infection. This stage can affect multiple 59 00:03:52,600 --> 00:03:55,800 Speaker 1: parts of the body, including the heart and brain. Third 60 00:03:56,120 --> 00:04:00,360 Speaker 1: third stage syphilis can cause large sores on the body, blindness, 61 00:04:00,720 --> 00:04:06,440 Speaker 1: mental disorders, destruction of bone and soft tissue, paralysis, organ failure, 62 00:04:06,760 --> 00:04:12,760 Speaker 1: and death. It's primarily this third, debilitating, disfiguring, and deadly 63 00:04:12,840 --> 00:04:15,720 Speaker 1: phase that shows up in art and literature, as well 64 00:04:15,760 --> 00:04:19,279 Speaker 1: as in explanations for the brutal or erratic behaviors of 65 00:04:19,360 --> 00:04:25,120 Speaker 1: various monarchs, including even the Terrible. Regardless of whether syphilis 66 00:04:25,320 --> 00:04:29,440 Speaker 1: was really present outside the America's prior to free as 67 00:04:29,440 --> 00:04:32,359 Speaker 1: it spread through the fifteenth century and beyond, it became 68 00:04:32,640 --> 00:04:37,240 Speaker 1: really heavily stigmatized. People quickly understood that it was spread 69 00:04:37,240 --> 00:04:40,160 Speaker 1: through sexual contact, and that meant that in many cultures 70 00:04:40,200 --> 00:04:44,080 Speaker 1: and religions it was associated with sinfulness and immoral behavior. 71 00:04:44,960 --> 00:04:49,000 Speaker 1: Folklore about the origin of syphilis also frequently connected it 72 00:04:49,040 --> 00:04:53,760 Speaker 1: to Hanson's disease, and that disease is also heavily stigmatized 73 00:04:53,800 --> 00:04:57,880 Speaker 1: and then culturally associated with sin and with being quote unclean. 74 00:04:58,680 --> 00:05:02,000 Speaker 1: Syphilis was so rever vial that nations named it after 75 00:05:02,000 --> 00:05:06,240 Speaker 1: whichever country they thought it came from, so in Italy, Germany, 76 00:05:06,279 --> 00:05:08,880 Speaker 1: and the British Isles it was the French disease, but 77 00:05:09,000 --> 00:05:13,680 Speaker 1: in France it was the Neapolitan disease. Russia blamed Poland, 78 00:05:13,720 --> 00:05:18,200 Speaker 1: and Poland blamed Germany. In some places, different religions took 79 00:05:18,200 --> 00:05:21,400 Speaker 1: the blame, with Hindus and Muslims each blaming each other 80 00:05:21,480 --> 00:05:26,560 Speaker 1: in northern India. Compounding all of the layers of stigma 81 00:05:26,640 --> 00:05:29,240 Speaker 1: was the fact that there wasn't a very effective treatment 82 00:05:29,240 --> 00:05:33,520 Speaker 1: available for syphilis until the twentieth century. Physicians tried a 83 00:05:33,640 --> 00:05:37,640 Speaker 1: range of herbs, compounds, and practices, and by the sixteenth century, 84 00:05:37,720 --> 00:05:41,360 Speaker 1: the most common treatment was mercury, which was highly toxic 85 00:05:41,440 --> 00:05:46,000 Speaker 1: and not particularly effective. In eighteen eighty four, doctors started 86 00:05:46,080 --> 00:05:49,560 Speaker 1: using business salts, which were less toxic and somewhat more 87 00:05:49,600 --> 00:05:52,760 Speaker 1: effective than mercury, but still only offered a cure about 88 00:05:52,800 --> 00:05:55,799 Speaker 1: thirty percent of the time, and that was after months 89 00:05:55,839 --> 00:05:58,760 Speaker 1: of difficult treatment that had high rates of side effects, 90 00:05:58,800 --> 00:06:03,479 Speaker 1: including death and arsenic derivative known as compounds six oh six, 91 00:06:03,760 --> 00:06:07,200 Speaker 1: was developed in nineteen O nine and that was apparently effective, 92 00:06:07,560 --> 00:06:10,479 Speaker 1: although it was difficult to administer and it could cause 93 00:06:10,520 --> 00:06:14,200 Speaker 1: tissue damage and death if it were given improperly. I 94 00:06:14,200 --> 00:06:17,880 Speaker 1: try to find some real solid information about how effective 95 00:06:17,920 --> 00:06:21,720 Speaker 1: compounds six oh six was. It was apparently hailed as 96 00:06:22,120 --> 00:06:26,920 Speaker 1: a miracle, but since it was replaced relatively quickly and 97 00:06:27,000 --> 00:06:29,640 Speaker 1: far far enough in the past that we don't have 98 00:06:29,720 --> 00:06:32,839 Speaker 1: a lot of evidenced based medical data about it, I'm 99 00:06:32,839 --> 00:06:35,040 Speaker 1: not quite sure whether it was as effective as people 100 00:06:35,560 --> 00:06:38,360 Speaker 1: build it as at the time. The reason it was 101 00:06:38,440 --> 00:06:42,040 Speaker 1: replaced pretty quickly was that in ninety eight Alexander Fleming 102 00:06:42,120 --> 00:06:46,440 Speaker 1: discovered the antibiotic penicillin, which was far far safer for 103 00:06:46,520 --> 00:06:51,400 Speaker 1: treating anything, but particularly syphilis, than compounds made from toxic 104 00:06:51,440 --> 00:06:55,920 Speaker 1: metals are. It became a standard treatment for syphilis intree 105 00:06:56,160 --> 00:06:59,480 Speaker 1: and this synopsis we've given is really an overview. If 106 00:06:59,480 --> 00:07:02,640 Speaker 1: you weren't to know more about the history of syphilis treatment, 107 00:07:03,000 --> 00:07:05,560 Speaker 1: check out the saw Bones episode on syphilis from March 108 00:07:05,560 --> 00:07:09,960 Speaker 1: of In the mid nineteen twenties, in the United States, 109 00:07:10,240 --> 00:07:14,400 Speaker 1: syphilis was a public health crisis. Conservative estimates put the 110 00:07:14,480 --> 00:07:17,800 Speaker 1: rate of infection at ten to fifteen percent, but estimates 111 00:07:17,840 --> 00:07:20,640 Speaker 1: go as high as thirty five percent of those people 112 00:07:20,680 --> 00:07:25,120 Speaker 1: of reproductive age. A nine nine study of rural Alabama 113 00:07:25,160 --> 00:07:29,240 Speaker 1: counties had found that it was particularly high in Macon County, Alabama, 114 00:07:29,680 --> 00:07:34,400 Speaker 1: home of the Tuskegee Institute. The Tuskegee Institute, which is 115 00:07:34,440 --> 00:07:38,520 Speaker 1: now Tuskegee University, was founded on July fourth, eighty one 116 00:07:38,680 --> 00:07:43,080 Speaker 1: as Tuskegee Normal School for Colored Teachers. A normal school 117 00:07:43,160 --> 00:07:46,240 Speaker 1: was a teacher's college, and Tuskegee was established after the 118 00:07:46,280 --> 00:07:51,560 Speaker 1: state of Alabama passed legislation that authorized its creation. Tuskegee's 119 00:07:51,560 --> 00:07:55,200 Speaker 1: first teacher was Dr Booker T. Washington. It became an 120 00:07:55,200 --> 00:07:59,320 Speaker 1: independent institution of higher learning. The Tuskegee Normal and Industrial 121 00:07:59,360 --> 00:08:04,560 Speaker 1: Institute in Tuskegee became home to more than just the university. 122 00:08:04,920 --> 00:08:08,200 Speaker 1: In nine three, it opened the Tuskegee v A Hospital 123 00:08:08,280 --> 00:08:11,480 Speaker 1: to provide long term care for black veterans. It was 124 00:08:11,560 --> 00:08:14,800 Speaker 1: also home to the Tuskegee Airman's flight training program in 125 00:08:14,840 --> 00:08:17,600 Speaker 1: World War Two. There's actually an episode on them in 126 00:08:17,680 --> 00:08:23,120 Speaker 1: our archive from past hosts Candice and Jayne. The research 127 00:08:23,520 --> 00:08:26,960 Speaker 1: on untreated syphilis that we're talking about today was conducted 128 00:08:27,040 --> 00:08:30,119 Speaker 1: by the US Public Health Service, but it took place 129 00:08:30,200 --> 00:08:33,560 Speaker 1: at Tuskegee Institute, with the involvement of some of the 130 00:08:33,600 --> 00:08:35,760 Speaker 1: staff there, and we were going to talk about it 131 00:08:35,840 --> 00:08:44,400 Speaker 1: after a quick sponsor break. The Tuskegee study was not 132 00:08:44,480 --> 00:08:48,800 Speaker 1: the only one in history to observe untreated syphilis. For example, 133 00:08:48,880 --> 00:08:52,720 Speaker 1: a study at the Oslo Venereal Clinic in Norway withheld 134 00:08:52,760 --> 00:08:56,640 Speaker 1: treatment from nearly two thousand patients between eighteen ninety and 135 00:08:56,760 --> 00:09:02,320 Speaker 1: nineteen ten. That clinics chief doctor was convinced pretty understandably 136 00:09:02,360 --> 00:09:05,439 Speaker 1: so that the syphilis treatments available at the time were 137 00:09:05,480 --> 00:09:08,920 Speaker 1: actually worthless. To protect the rest of the community from 138 00:09:08,920 --> 00:09:11,880 Speaker 1: the spread of infection during the study, the Oslo team 139 00:09:12,000 --> 00:09:16,480 Speaker 1: kept the participants hospitalized until they were symptom free. The 140 00:09:16,520 --> 00:09:19,840 Speaker 1: Oslo study found that for about seventy of the patients, 141 00:09:19,920 --> 00:09:22,760 Speaker 1: once the disease reached a latent phase, they had no 142 00:09:22,880 --> 00:09:26,040 Speaker 1: further problems and they weren't contagious. But for the other 143 00:09:26,080 --> 00:09:29,920 Speaker 1: thirty percent, the tertiary stage followed and it was serious 144 00:09:30,040 --> 00:09:33,840 Speaker 1: and severe. Once compound six oh six was introduced. The 145 00:09:33,880 --> 00:09:37,920 Speaker 1: Oslo study was ended. The study had demonstrated that untreated 146 00:09:37,920 --> 00:09:41,720 Speaker 1: syphilis could be serious or deadly, making it unethical to 147 00:09:41,760 --> 00:09:46,320 Speaker 1: withhold and effective though risky treatment once it was available. Yeah, 148 00:09:46,320 --> 00:09:50,080 Speaker 1: there are plenty of other ethical questions about this study. 149 00:09:50,679 --> 00:09:54,640 Speaker 1: It's it's complicated by the fact that the doctor running 150 00:09:54,640 --> 00:09:56,880 Speaker 1: the study was correct and the fact that the treatments 151 00:09:56,880 --> 00:10:00,360 Speaker 1: that were available were not actually doing much. But study 152 00:10:00,440 --> 00:10:02,720 Speaker 1: did stop once there was a treatment that people did 153 00:10:02,720 --> 00:10:07,120 Speaker 1: think actually worked available to them. So this Oslo study 154 00:10:07,200 --> 00:10:10,559 Speaker 1: was one of two that informed the Tuskegee syphilis study. 155 00:10:10,720 --> 00:10:14,440 Speaker 1: The other was the study we referred to before the break. 156 00:10:14,840 --> 00:10:17,320 Speaker 1: That one was a U S Public Health service study 157 00:10:17,360 --> 00:10:19,760 Speaker 1: as well, and it was paid for by the Rosenwald Fund. 158 00:10:20,360 --> 00:10:23,439 Speaker 1: It was undertaken with the goal of figuring out whether 159 00:10:23,520 --> 00:10:27,120 Speaker 1: a mass syphilis treatment program would be feasible or successful 160 00:10:27,200 --> 00:10:30,400 Speaker 1: in rural areas, and its findings suggested that yes, a 161 00:10:30,480 --> 00:10:35,920 Speaker 1: mass treatment program would. Unfortunately, also saw the start of 162 00:10:35,960 --> 00:10:39,480 Speaker 1: the Great Depression. Funding for a mass treatment program for 163 00:10:39,559 --> 00:10:42,720 Speaker 1: black patients with a sexually transmitted disease already would have 164 00:10:42,760 --> 00:10:45,800 Speaker 1: been incredibly difficult to find, but with the Great Depression 165 00:10:45,920 --> 00:10:50,720 Speaker 1: it became impossible. The Rosenwald study and its optimistic conclusions 166 00:10:50,760 --> 00:10:54,200 Speaker 1: about the success of a treatment program fell by the wayside, 167 00:10:54,920 --> 00:10:58,600 Speaker 1: But in nineteen thirty two, Dr Talia Faro Clark, chief 168 00:10:58,640 --> 00:11:01,520 Speaker 1: of the U s Public Health serve A Spunereal Disease Division, 169 00:11:01,600 --> 00:11:06,120 Speaker 1: who had actually authored that study, returned to those results 170 00:11:06,120 --> 00:11:09,120 Speaker 1: with an idea for another approach. This would be a 171 00:11:09,120 --> 00:11:12,200 Speaker 1: counterpoint to the previous OSLO study, which had been on 172 00:11:12,240 --> 00:11:17,400 Speaker 1: white subjects, Theorizing that syphilis progressed differently among black patients 173 00:11:17,440 --> 00:11:20,360 Speaker 1: than white patients, Clark decided to take advantage of the 174 00:11:20,440 --> 00:11:24,040 Speaker 1: high rate of syphilis infection in Making County and observe 175 00:11:24,120 --> 00:11:27,400 Speaker 1: how the disease progressed when left untreated in black men 176 00:11:27,720 --> 00:11:31,960 Speaker 1: over a period of six months. Underpinning this plan were 177 00:11:31,960 --> 00:11:36,200 Speaker 1: a set of racist stereotypes about black men, their sexual behavior, 178 00:11:36,320 --> 00:11:39,600 Speaker 1: and their supposed lack of interest in or compliance with 179 00:11:39,720 --> 00:11:43,800 Speaker 1: medical treatment. Basically was the idea was that if these 180 00:11:43,800 --> 00:11:46,840 Speaker 1: men weren't going to get treated anyway, the medical community 181 00:11:46,920 --> 00:11:50,080 Speaker 1: might as well observe what happened when they didn't. Clark 182 00:11:50,200 --> 00:11:53,920 Speaker 1: called this a quote ready made situation to conduct quote 183 00:11:53,960 --> 00:11:58,520 Speaker 1: a study in Nature. As a side note, the racism 184 00:11:58,679 --> 00:12:02,040 Speaker 1: threaded through this study did not end with the stereotypes 185 00:12:02,080 --> 00:12:05,839 Speaker 1: that were framing how the white medical establishment was approaching it. 186 00:12:06,120 --> 00:12:08,600 Speaker 1: It's not really a matter of a set of implicit 187 00:12:08,640 --> 00:12:12,000 Speaker 1: biases that were guiding them in such a strange and 188 00:12:12,040 --> 00:12:17,000 Speaker 1: horrifying direction. The correspondence of the studies white doctors with 189 00:12:17,040 --> 00:12:21,480 Speaker 1: one another are laced with incredibly racist attitudes and views. 190 00:12:22,280 --> 00:12:26,559 Speaker 1: They are gross. Every time I would find another quotation 191 00:12:26,640 --> 00:12:30,360 Speaker 1: from one of them, I would get angrier, because they 192 00:12:30,360 --> 00:12:36,760 Speaker 1: are really really offensive. US Surgeon General Hugh Smith Coming 193 00:12:36,880 --> 00:12:41,119 Speaker 1: then contacted our our Moten, director of the Tuskegee Institute, 194 00:12:41,160 --> 00:12:44,680 Speaker 1: to enlist the institute's help, calling the proposed study a 195 00:12:44,760 --> 00:12:48,480 Speaker 1: quote an unparalleled opportunity for carrying on this piece of 196 00:12:48,520 --> 00:12:52,560 Speaker 1: scientific research which probably cannot be duplicated anywhere else in 197 00:12:52,600 --> 00:12:56,320 Speaker 1: the world. In that same letter, Coming said the study 198 00:12:56,320 --> 00:13:00,200 Speaker 1: could have quote a marked bearing on the treatment or conversely, 199 00:13:00,280 --> 00:13:03,960 Speaker 1: the non necessity of treatment in cases of latent syphilis. 200 00:13:05,840 --> 00:13:09,600 Speaker 1: The Tuskegee Institute ultimately agreed to cooperate, and later in 201 00:13:09,679 --> 00:13:13,920 Speaker 1: ninety two, doctor Raymond Vanderler began trying to recruit black 202 00:13:13,960 --> 00:13:16,520 Speaker 1: men with syphilis who were between the ages of twenty 203 00:13:16,559 --> 00:13:20,199 Speaker 1: five and sixty for the study. He ran into difficulty 204 00:13:20,280 --> 00:13:23,720 Speaker 1: really quickly when he advertised the study was open to 205 00:13:23,800 --> 00:13:26,520 Speaker 1: men with a minimum age of twenty five people can 206 00:13:26,600 --> 00:13:30,520 Speaker 1: suspected that he was actually there conducting draft physicals, and 207 00:13:30,559 --> 00:13:33,680 Speaker 1: nobody came so. Even though the study was only to 208 00:13:33,720 --> 00:13:36,680 Speaker 1: be done on men, the initial physicals were conducted on 209 00:13:36,720 --> 00:13:40,480 Speaker 1: women as well. Another hiccup was that the prevalence of 210 00:13:40,520 --> 00:13:43,120 Speaker 1: syphilis in Macon County was not as high as the 211 00:13:43,240 --> 00:13:47,360 Speaker 1: Rosenwald study had suggested. The Public Health Service had expected 212 00:13:47,400 --> 00:13:50,880 Speaker 1: an infection rate of thirty five percent, but once Vonderler 213 00:13:51,080 --> 00:13:53,800 Speaker 1: was actually testing subjects, that rate turned out to be 214 00:13:53,880 --> 00:13:58,280 Speaker 1: more like and completely contrary to the stereotype that the 215 00:13:58,320 --> 00:14:01,480 Speaker 1: men being studied were innately unlikely to go to the doctor, 216 00:14:01,920 --> 00:14:04,240 Speaker 1: they found that a lot of Macon County residents had 217 00:14:04,280 --> 00:14:09,160 Speaker 1: already seen a doctor for syphilis and received treatment. Also 218 00:14:09,440 --> 00:14:14,000 Speaker 1: contrary to the prevailing stereotypes, overwhelmingly, the men that Wonderler 219 00:14:14,080 --> 00:14:17,960 Speaker 1: approached about this study were only willing to participate if 220 00:14:18,080 --> 00:14:22,120 Speaker 1: participating would result in their being treated, so this idea 221 00:14:22,520 --> 00:14:27,040 Speaker 1: that was guiding their entire study approach. This idea that 222 00:14:27,080 --> 00:14:30,960 Speaker 1: black men were unlikely to seek treatment was completely unfounded. 223 00:14:32,000 --> 00:14:34,760 Speaker 1: When faced with this dilemma, the doctors involved with the 224 00:14:34,800 --> 00:14:39,320 Speaker 1: study lied. They told participants they had bad blood and 225 00:14:39,320 --> 00:14:42,520 Speaker 1: that they were being treated for that then to keep 226 00:14:42,600 --> 00:14:46,320 Speaker 1: up the deception that participants were given ineffective quote treatments 227 00:14:46,920 --> 00:14:50,840 Speaker 1: like mercury, ointments, aspirin, and actual drugs that were at 228 00:14:50,880 --> 00:14:54,080 Speaker 1: too low a dose to be effective in any way. 229 00:14:54,120 --> 00:14:57,360 Speaker 1: Bad blood was used to describe syphilis, but was also 230 00:14:57,440 --> 00:15:03,400 Speaker 1: kind of a catch all term for other diseases as well. Regardless, 231 00:15:03,560 --> 00:15:06,080 Speaker 1: it was referred to pretty consistently as bad blood when 232 00:15:06,080 --> 00:15:08,760 Speaker 1: talking to the patients who were part of this study. 233 00:15:10,000 --> 00:15:14,880 Speaker 1: The doctors also described spinal taps more accurately called lumbar 234 00:15:14,960 --> 00:15:18,600 Speaker 1: punctures as treatment, even though a spinal tap is not 235 00:15:18,640 --> 00:15:21,400 Speaker 1: a treatment. Uh they were they were being used to 236 00:15:21,480 --> 00:15:24,640 Speaker 1: diagnose whether the men had neuro syphilis, whether they had 237 00:15:24,680 --> 00:15:28,760 Speaker 1: the syphilis infection in their their brain and their nervous 238 00:15:28,760 --> 00:15:33,800 Speaker 1: system tissue. Because spinal taps are uncomfortable and they carry 239 00:15:33,880 --> 00:15:37,680 Speaker 1: risks of complications and side effects, these were scheduled last 240 00:15:37,760 --> 00:15:40,320 Speaker 1: in the physical exams with the hope that word of 241 00:15:40,360 --> 00:15:43,920 Speaker 1: their unpleasantness would not spread and lead people to drop 242 00:15:43,920 --> 00:15:45,240 Speaker 1: out of the study because they were going to have 243 00:15:45,320 --> 00:15:47,920 Speaker 1: to have a spinal tap. When it was time for 244 00:15:47,960 --> 00:15:50,640 Speaker 1: the spinal taps, the participants got a letter that read 245 00:15:50,720 --> 00:15:54,360 Speaker 1: quote some time ago, you were given a thorough examination, 246 00:15:54,960 --> 00:15:57,680 Speaker 1: and since that time, we hope you've gotten a great 247 00:15:57,760 --> 00:16:00,840 Speaker 1: deal of treatment for bad blood. You will now be 248 00:16:00,880 --> 00:16:04,080 Speaker 1: given your last chance to get a second examination. This 249 00:16:04,200 --> 00:16:07,760 Speaker 1: examination is a very special one, and after it is finished, 250 00:16:08,320 --> 00:16:10,960 Speaker 1: you will be given a special treatment if it is 251 00:16:11,000 --> 00:16:14,600 Speaker 1: believed you're in a condition to stand it. This language 252 00:16:14,680 --> 00:16:18,280 Speaker 1: makes me so angry. I've never had a spinal tap, 253 00:16:19,480 --> 00:16:22,360 Speaker 1: but I drove my mom, my mom back and forth 254 00:16:22,480 --> 00:16:24,720 Speaker 1: to the doctor for at least one, because she has 255 00:16:24,760 --> 00:16:30,960 Speaker 1: a neurological condition. They're rough, unpleasant, is like, that's the 256 00:16:31,040 --> 00:16:33,520 Speaker 1: nice word the doctor will say to you. Yeah, I 257 00:16:33,560 --> 00:16:36,160 Speaker 1: have not had one either. I have had both friends 258 00:16:36,160 --> 00:16:40,080 Speaker 1: and relatives that have had them. I witnessed one of them. 259 00:16:40,120 --> 00:16:44,800 Speaker 1: It was horrifying. Um. Once the study reached the end 260 00:16:44,800 --> 00:16:48,440 Speaker 1: of its original planned six months, the United States Public 261 00:16:48,480 --> 00:16:52,680 Speaker 1: Health Service decided to continue it indefinitely. In spite of 262 00:16:52,680 --> 00:16:55,600 Speaker 1: the fact that the subjects had defied their expectations regarding 263 00:16:55,600 --> 00:16:58,160 Speaker 1: whether they would seek treatment, they still believed that it 264 00:16:58,240 --> 00:17:02,240 Speaker 1: was quote natural to keep this study going. The researchers 265 00:17:02,240 --> 00:17:04,879 Speaker 1: came to believe that they would need to conduct autopsies, 266 00:17:05,280 --> 00:17:08,479 Speaker 1: not just examine living patients in order to get a 267 00:17:08,480 --> 00:17:13,359 Speaker 1: clear picture of how untreated syphilis progressed. This changed the 268 00:17:13,400 --> 00:17:16,359 Speaker 1: scope of a study added a further layer of deception. 269 00:17:17,280 --> 00:17:19,760 Speaker 1: In addition to keeping secret the fact that the men 270 00:17:19,800 --> 00:17:22,679 Speaker 1: were not being treated for syphilis, the doctors had to 271 00:17:22,840 --> 00:17:26,520 Speaker 1: also keep secret that they never would be and the 272 00:17:26,600 --> 00:17:30,000 Speaker 1: autopsies were kept secret as well, because they were concerned 273 00:17:30,040 --> 00:17:32,680 Speaker 1: that subjects would leave the study if they found out 274 00:17:32,680 --> 00:17:36,679 Speaker 1: they would have to be autopsied after they died. Only 275 00:17:36,800 --> 00:17:40,720 Speaker 1: after the US Public Health Service approved this indefinite extension 276 00:17:40,760 --> 00:17:43,440 Speaker 1: to the study did the team decide it should also 277 00:17:43,520 --> 00:17:46,560 Speaker 1: have a control group, and they recruited men who were 278 00:17:46,560 --> 00:17:50,760 Speaker 1: syphilis free. If any contracted syphilis during the course of 279 00:17:50,760 --> 00:17:53,000 Speaker 1: the study, they were then moved to the test group. 280 00:17:53,760 --> 00:17:56,159 Speaker 1: In the end, there were three hundred and ninety nine 281 00:17:56,240 --> 00:17:58,720 Speaker 1: men in the test group and two hundred and one 282 00:17:58,760 --> 00:18:02,200 Speaker 1: men in the control group. This is the least of 283 00:18:02,240 --> 00:18:05,159 Speaker 1: the problems with the study. But moving somebody from your 284 00:18:05,200 --> 00:18:07,480 Speaker 1: control group into your test group is not That's not 285 00:18:07,520 --> 00:18:10,440 Speaker 1: how it's supposed to happen. That's not good science. That's 286 00:18:10,440 --> 00:18:15,480 Speaker 1: a bad methodology. Like I said, that is the tiniest 287 00:18:15,520 --> 00:18:20,879 Speaker 1: of the problems here. So, like we said earlier, a 288 00:18:21,000 --> 00:18:23,399 Speaker 1: person has who has a latent syphilis infection can be 289 00:18:23,440 --> 00:18:26,720 Speaker 1: symptom free for their whole life. And suspecting that the 290 00:18:26,760 --> 00:18:29,240 Speaker 1: men would probably drop out of the study after for 291 00:18:29,280 --> 00:18:31,760 Speaker 1: a while if they continued to be symptom free and 292 00:18:31,760 --> 00:18:34,879 Speaker 1: they weren't seeing any benefit to this treatment, the Public 293 00:18:34,920 --> 00:18:37,800 Speaker 1: Health Service also offered a number of incentives to keep 294 00:18:37,840 --> 00:18:42,359 Speaker 1: people involved. Subjects received transportation to and from the Tuskegee 295 00:18:42,400 --> 00:18:44,880 Speaker 1: Institute for their medical exams, as well as a hot 296 00:18:44,920 --> 00:18:47,399 Speaker 1: meal on a day. They were allowed to stop in 297 00:18:47,480 --> 00:18:50,760 Speaker 1: town to run errands or visit friends. Afterward, if they 298 00:18:50,800 --> 00:18:53,760 Speaker 1: got sick with something besides syphilis, they got medical care 299 00:18:53,880 --> 00:18:57,760 Speaker 1: for free. Uh, the area where this was taking place 300 00:18:57,920 --> 00:19:00,520 Speaker 1: was pretty impoverished. A lot of the people in the 301 00:19:00,560 --> 00:19:03,919 Speaker 1: study where sharecroppers and people who had a very subsistence 302 00:19:04,040 --> 00:19:06,320 Speaker 1: level of living. So all of these incentives did make 303 00:19:06,359 --> 00:19:10,399 Speaker 1: the study really appealing for people to participate in. But 304 00:19:10,480 --> 00:19:14,399 Speaker 1: that still had the complicated question of the autopsy. Knowing 305 00:19:14,440 --> 00:19:17,320 Speaker 1: that it would be unlikely to secure permission to have 306 00:19:17,400 --> 00:19:21,200 Speaker 1: an autopsy done if the subject died somewhere other than 307 00:19:21,240 --> 00:19:25,160 Speaker 1: the hospital, the Public Health Service offered about fifty dollars 308 00:19:25,200 --> 00:19:28,840 Speaker 1: per person and burial expenses to encourage people to come 309 00:19:28,880 --> 00:19:31,359 Speaker 1: into the hospital and be admitted. If they became ill 310 00:19:31,480 --> 00:19:33,840 Speaker 1: that way, they would pass away in the hospital and 311 00:19:33,840 --> 00:19:37,399 Speaker 1: it would make it easier to conduct their autopsy. Keeping 312 00:19:37,400 --> 00:19:40,920 Speaker 1: the study going also required the Tuskegee team to collude 313 00:19:40,960 --> 00:19:45,240 Speaker 1: with health professionals elsewhere and for incoming directors and officers 314 00:19:45,280 --> 00:19:48,600 Speaker 1: in the public health service to maintain this deception through 315 00:19:48,680 --> 00:19:53,159 Speaker 1: multiple changes in administration. They gave lists of participants to 316 00:19:53,320 --> 00:19:56,760 Speaker 1: doctors in Making County, to the Alabama Health Department, and 317 00:19:56,800 --> 00:19:58,840 Speaker 1: to the Draft Board to make sure none of them 318 00:19:58,880 --> 00:20:03,800 Speaker 1: treated or reckon ended treatment to the participants. Apart from 319 00:20:03,800 --> 00:20:06,840 Speaker 1: the fact that they were literally convincing other doctors to 320 00:20:06,920 --> 00:20:11,400 Speaker 1: withhold appropriate care, they were also violating participants privacy by 321 00:20:11,440 --> 00:20:14,760 Speaker 1: disclosing to a whole lot of other doctors that they 322 00:20:14,760 --> 00:20:20,080 Speaker 1: had syphilis. Now conceived as a lifelong effort, the Tuskegee 323 00:20:20,119 --> 00:20:23,439 Speaker 1: study also needed a liaison between its medical team and 324 00:20:23,480 --> 00:20:26,840 Speaker 1: its subjects, and someone to basically ensure the continuity of 325 00:20:26,920 --> 00:20:30,800 Speaker 1: care for as long as the study lasted. That liaison 326 00:20:30,960 --> 00:20:34,359 Speaker 1: was Nurse Unice Rivers Laurie, known as Nurse Rivers for 327 00:20:34,480 --> 00:20:36,879 Speaker 1: nearly all of the studies duration because she got married 328 00:20:37,000 --> 00:20:40,399 Speaker 1: later on in her life. A graduate of the Tuskegee 329 00:20:40,440 --> 00:20:45,040 Speaker 1: Institute's nursing program, Nurse Laurie was an experienced public health nurse. 330 00:20:46,160 --> 00:20:50,080 Speaker 1: There are a number of contradictory truths about Nurse Laurie's work, 331 00:20:50,359 --> 00:20:54,320 Speaker 1: which lasted until the study ended, even after she officially retired. 332 00:20:55,119 --> 00:20:57,960 Speaker 1: She was an active participant in the medical team's deception 333 00:20:58,040 --> 00:21:01,439 Speaker 1: of the studies subjects. As liaison between the doctors and 334 00:21:01,440 --> 00:21:05,159 Speaker 1: the community, she was possibly the most instrumental in getting 335 00:21:05,160 --> 00:21:07,280 Speaker 1: the men to stick with the study and follow the 336 00:21:07,320 --> 00:21:11,560 Speaker 1: doctor's instructions. The more social community aspects of the study 337 00:21:11,640 --> 00:21:15,359 Speaker 1: became known as MS. Rivers Lodge. At the same time, 338 00:21:15,440 --> 00:21:17,920 Speaker 1: she was caring for men she knew who were part 339 00:21:17,960 --> 00:21:22,040 Speaker 1: of her community, including as they became ill, suffered, and 340 00:21:22,080 --> 00:21:26,360 Speaker 1: died as a result of their untreated syphilis. A lot 341 00:21:26,400 --> 00:21:32,080 Speaker 1: of the depictions of of Unice River's larry are either 342 00:21:32,680 --> 00:21:37,399 Speaker 1: that she was basically a helpless victim of a Jim 343 00:21:37,480 --> 00:21:42,760 Speaker 1: Crow era South herself uh or that she was like 344 00:21:42,800 --> 00:21:48,959 Speaker 1: an evil participant in this completely racist and unethical study. 345 00:21:50,240 --> 00:21:52,400 Speaker 1: These are all things that are multiple, Like the things 346 00:21:52,440 --> 00:21:55,760 Speaker 1: we just said are all true at the same time. Right. 347 00:21:55,840 --> 00:21:59,399 Speaker 1: It's rarely as as simple and easy to quantify in 348 00:21:59,440 --> 00:22:01,760 Speaker 1: one statement when you're dealing with a situation like this 349 00:22:01,960 --> 00:22:07,560 Speaker 1: as hero or villain, good or bad, there are there 350 00:22:07,600 --> 00:22:11,520 Speaker 1: are layers and layers to the whole thing. Yeah, there's 351 00:22:11,560 --> 00:22:17,560 Speaker 1: actually a hbo Um movie called Miss Evers Boys that 352 00:22:17,640 --> 00:22:21,560 Speaker 1: is a fictionalized account of this. That's basically a fictionalized 353 00:22:21,640 --> 00:22:24,199 Speaker 1: version of her story. One of the things that we 354 00:22:24,280 --> 00:22:28,520 Speaker 1: don't have much of it much of is uh documentation 355 00:22:28,720 --> 00:22:34,159 Speaker 1: from her about how she framed this for herself, or 356 00:22:34,160 --> 00:22:38,280 Speaker 1: about how she approached a lot of the huge ethical 357 00:22:38,640 --> 00:22:42,800 Speaker 1: concerns that were part of her work. Um So, I 358 00:22:42,840 --> 00:22:45,000 Speaker 1: think a lot of the things that portray her as 359 00:22:45,080 --> 00:22:52,639 Speaker 1: either a total unwilling person with no agency or a 360 00:22:52,640 --> 00:22:55,920 Speaker 1: complete villain like neither of those seems like a an 361 00:22:55,920 --> 00:23:01,560 Speaker 1: accurate picture. Unlike in the Oslo study, which ended when 362 00:23:01,600 --> 00:23:05,240 Speaker 1: compound six or six became available, the Tuskegee Study started 363 00:23:05,320 --> 00:23:08,919 Speaker 1: after compound six or six was already out. It continued 364 00:23:09,000 --> 00:23:13,400 Speaker 1: for another twenty nine years after penicillin became the standard 365 00:23:13,400 --> 00:23:17,080 Speaker 1: treatment for syphilis. When the study ended, only seventy four 366 00:23:17,119 --> 00:23:19,600 Speaker 1: of its subjects were still living, and the number who 367 00:23:19,640 --> 00:23:23,720 Speaker 1: had died as a consequence of their untreated syphilis is unclear. 368 00:23:24,359 --> 00:23:27,359 Speaker 1: It was at least twenty eight but possibly more than 369 00:23:27,400 --> 00:23:31,640 Speaker 1: a hundred. The number of people who contracted syphilis as 370 00:23:31,640 --> 00:23:35,240 Speaker 1: the result of this study, which was telling them that 371 00:23:35,280 --> 00:23:38,400 Speaker 1: they were being treated when they really were not, is unknown, 372 00:23:39,560 --> 00:23:42,760 Speaker 1: and the damaging effects of the study didn't stop when 373 00:23:42,800 --> 00:23:47,280 Speaker 1: the study stopped. In July of a National Bureau of 374 00:23:47,320 --> 00:23:51,320 Speaker 1: Economic Research working paper reported that when the study became 375 00:23:51,359 --> 00:23:55,600 Speaker 1: publicly known in nine two, it led to increases in 376 00:23:55,680 --> 00:23:59,600 Speaker 1: both mistrust of the medical community and immortality within the 377 00:23:59,640 --> 00:24:03,359 Speaker 1: black community. The paper estimates that for black men at 378 00:24:03,359 --> 00:24:05,719 Speaker 1: the age of forty five when the study was exposed, 379 00:24:06,280 --> 00:24:09,359 Speaker 1: life expectancy dropped by almost a year and a half, 380 00:24:09,680 --> 00:24:14,080 Speaker 1: contributing to up tot of the disparity in life expectancy 381 00:24:14,160 --> 00:24:17,600 Speaker 1: between black and white men as of nineteen eighty. And 382 00:24:17,720 --> 00:24:21,440 Speaker 1: to be clear, that is everywhere in the United States, 383 00:24:21,440 --> 00:24:25,199 Speaker 1: not just in Tuskegee, Alabama. Like that's that. This this, 384 00:24:25,600 --> 00:24:31,480 Speaker 1: the fact that the study existed ah appears to have 385 00:24:31,720 --> 00:24:37,879 Speaker 1: led to bad health outcomes, especially for black men, ongoing 386 00:24:37,920 --> 00:24:41,400 Speaker 1: for decades after the study was over. We will talk 387 00:24:41,400 --> 00:24:43,479 Speaker 1: about how this study came to light and what happened 388 00:24:43,520 --> 00:24:52,920 Speaker 1: afterward after another quick sponsor break. Although this study, which 389 00:24:53,000 --> 00:24:56,639 Speaker 1: was ultimately known as the Tuskegee Study of Untreated Syphilis 390 00:24:56,680 --> 00:25:00,760 Speaker 1: and the Negro Mail, was highly deceptive, was not in 391 00:25:00,840 --> 00:25:06,040 Speaker 1: any way secret findings were published and presented repeatedly, beginning 392 00:25:06,080 --> 00:25:10,119 Speaker 1: at the American Medical Association annual meeting in nineteen thirty six. 393 00:25:10,680 --> 00:25:15,600 Speaker 1: At least fifteen different papers on it were published out 394 00:25:15,640 --> 00:25:20,400 Speaker 1: in public for people to see over the duration. Even 395 00:25:20,400 --> 00:25:25,600 Speaker 1: though these reports consistently detailed serious and damaging consequences of 396 00:25:25,680 --> 00:25:30,200 Speaker 1: untreated syphilis, that alone was never enough to stop the study. 397 00:25:30,800 --> 00:25:33,680 Speaker 1: A meeting at the Centers for Disease Control about whether 398 00:25:33,760 --> 00:25:36,880 Speaker 1: to continue the study, at which some of the participants 399 00:25:36,880 --> 00:25:40,880 Speaker 1: of that of that meeting did criticize it as being 400 00:25:40,920 --> 00:25:44,000 Speaker 1: an ethical they ultimately approved the study to go on, 401 00:25:44,080 --> 00:25:48,080 Speaker 1: and that was in nineteen sixty nine. Then in July 402 00:25:48,280 --> 00:25:50,919 Speaker 1: of nineteen seventy two, The New York Times in the 403 00:25:50,960 --> 00:25:55,920 Speaker 1: Washington Post published an associated Press article called Syphilis Victims 404 00:25:55,960 --> 00:26:00,520 Speaker 1: in US Study went Untreated for forty Years by Gan Heller. 405 00:26:01,200 --> 00:26:03,880 Speaker 1: And it was this report and the outrage that followed 406 00:26:03,920 --> 00:26:07,119 Speaker 1: that finally brought about the end of the study. That 407 00:26:07,200 --> 00:26:11,040 Speaker 1: report was possible thanks to a whistleblower. Also following the 408 00:26:11,040 --> 00:26:14,879 Speaker 1: studies end, uh We're congressional hearings and a class action 409 00:26:14,960 --> 00:26:18,520 Speaker 1: lawsuit filed by civil rights attorney Fred Gray that ended 410 00:26:18,520 --> 00:26:21,639 Speaker 1: in a ten million dollar out of court settlement. The 411 00:26:21,720 --> 00:26:25,359 Speaker 1: United States government established the Tuskegee Health Benefit Program to 412 00:26:25,400 --> 00:26:28,960 Speaker 1: pay for medical care and burials of the participants, whose 413 00:26:29,000 --> 00:26:31,879 Speaker 1: wives and children were later added to the program as well. 414 00:26:32,680 --> 00:26:35,800 Speaker 1: The Department of Health, Education, and Welfare also formed an 415 00:26:35,800 --> 00:26:39,520 Speaker 1: advisory panel to evaluate the study, eventually ruling that it 416 00:26:39,600 --> 00:26:45,320 Speaker 1: was quote ethically unjustified. Seventy one of the survivor's medical 417 00:26:45,400 --> 00:26:48,679 Speaker 1: records were released in the nineties seventies. That's less than 418 00:26:48,720 --> 00:26:51,400 Speaker 1: twenty of those who had been part of the studies 419 00:26:51,440 --> 00:26:54,879 Speaker 1: infected group. At that point. It was discovered that at 420 00:26:54,920 --> 00:26:57,960 Speaker 1: least a portion of the participants did wind up receiving 421 00:26:58,320 --> 00:27:01,760 Speaker 1: at least some penicillin sometime between when it became the 422 00:27:01,800 --> 00:27:04,920 Speaker 1: standard treatment for syphilis and the end of the study. 423 00:27:06,359 --> 00:27:09,119 Speaker 1: A lot of the people who did wind up getting 424 00:27:09,160 --> 00:27:12,440 Speaker 1: some penicillin during the course the study were treated by 425 00:27:12,520 --> 00:27:15,320 Speaker 1: two doctors, Dr Murray Smith, of the Making County Health 426 00:27:15,400 --> 00:27:19,320 Speaker 1: Department and doctor Eugene Dibble at the Tuskegee Institute's Johnny 427 00:27:19,320 --> 00:27:24,200 Speaker 1: Andrew Hospital. They both prescribed penicillin to people who were 428 00:27:24,200 --> 00:27:27,120 Speaker 1: in the test group as a treatment for other conditions, 429 00:27:27,160 --> 00:27:31,359 Speaker 1: including colds, flu, and back pain. It's completely unclear whether 430 00:27:31,400 --> 00:27:33,960 Speaker 1: this was an accidental oversight of the fact that these 431 00:27:34,000 --> 00:27:37,240 Speaker 1: men were in the studies test group, or if it 432 00:27:37,320 --> 00:27:40,320 Speaker 1: was an intentional and covert way to treat them for 433 00:27:40,400 --> 00:27:43,879 Speaker 1: syphilis without raising the red flag from the people running 434 00:27:43,880 --> 00:27:48,200 Speaker 1: the study. Others were able to receive treatment after moving 435 00:27:48,240 --> 00:27:51,120 Speaker 1: away from Tuskegee, at which point either the Public Health 436 00:27:51,119 --> 00:27:54,280 Speaker 1: Service lost track of them or the doctors at their 437 00:27:54,320 --> 00:27:57,159 Speaker 1: new home refused to withhold treatment from them in spite 438 00:27:57,200 --> 00:28:00,199 Speaker 1: of the study staff's attempts to convince them otherwise. Is 439 00:28:01,760 --> 00:28:06,840 Speaker 1: On May sixteenth, President Bill Clinton issued an apology for 440 00:28:06,880 --> 00:28:10,280 Speaker 1: the study on the behalf of the government, specifically naming 441 00:28:10,359 --> 00:28:12,399 Speaker 1: the eight men in the study who were at that 442 00:28:12,440 --> 00:28:18,080 Speaker 1: point still living Carter Howard, Frederick Moss, Charlie Pollard, Herman Shaw, 443 00:28:18,560 --> 00:28:23,920 Speaker 1: Fred Simmons, Sam Donner, Ernest Hendon, and George Key. Five 444 00:28:23,960 --> 00:28:26,359 Speaker 1: of the men were present at this apology and the 445 00:28:26,359 --> 00:28:29,800 Speaker 1: three who could not attend were represented by members of 446 00:28:29,840 --> 00:28:33,600 Speaker 1: their family. The last surviving participant of the study died 447 00:28:33,600 --> 00:28:38,120 Speaker 1: in two thousand four. There's a widespread and very persistent 448 00:28:38,200 --> 00:28:41,200 Speaker 1: piece of misinformation that the men in the study were 449 00:28:41,240 --> 00:28:46,200 Speaker 1: deliberately infected with syphilis. This, based on all the information available, 450 00:28:46,360 --> 00:28:51,120 Speaker 1: is completely untrue. There was, however, a completely different US 451 00:28:51,200 --> 00:28:54,600 Speaker 1: Public Health Service study conducted in Guatemala in the nineteen 452 00:28:54,640 --> 00:28:59,600 Speaker 1: forties which did indeed infected subjects with sexually transmitted infections 453 00:28:59,640 --> 00:29:04,920 Speaker 1: on purpose. That was actually uncovered while the researcher was 454 00:29:05,720 --> 00:29:08,920 Speaker 1: looking for information about the Tuskegee study, and they happened 455 00:29:09,000 --> 00:29:11,160 Speaker 1: to find this isn't like two thousand and five, not 456 00:29:11,240 --> 00:29:14,280 Speaker 1: that long ago, happened to find documents about this Guatemala 457 00:29:14,320 --> 00:29:19,520 Speaker 1: study um that definitely did infect people with sexually transmitted diseases. 458 00:29:20,360 --> 00:29:23,680 Speaker 1: Another piece of misinformation that's followed the study and is 459 00:29:23,960 --> 00:29:27,200 Speaker 1: it's a piece of misinformation and yet it's responsible for 460 00:29:27,560 --> 00:29:32,440 Speaker 1: important work. Is that its main flaws where it's failure 461 00:29:32,480 --> 00:29:36,959 Speaker 1: to get participants informed consents, and that the withholding of 462 00:29:37,000 --> 00:29:40,280 Speaker 1: the penicillin once it was available it was an ethical 463 00:29:40,400 --> 00:29:44,000 Speaker 1: But these are really kind of beside the point, compound 464 00:29:44,000 --> 00:29:47,200 Speaker 1: six oh six was available as a syphilis treatment before 465 00:29:47,400 --> 00:29:50,640 Speaker 1: the study even started. So even though penicillin was a 466 00:29:50,640 --> 00:29:53,000 Speaker 1: lot safer and had a lot fewer side effects and 467 00:29:53,040 --> 00:29:56,320 Speaker 1: I think probably a lot more effective, had trouble answering 468 00:29:56,320 --> 00:30:00,320 Speaker 1: that question specifically. It wasn't like there was no treatment 469 00:30:00,360 --> 00:30:04,240 Speaker 1: and then they continued the study after treatment was available, 470 00:30:04,280 --> 00:30:06,560 Speaker 1: Like there was a treatment available from the beginning, from 471 00:30:06,600 --> 00:30:10,880 Speaker 1: the very start, and the point was always to withhold treatment. Uh, 472 00:30:10,920 --> 00:30:15,320 Speaker 1: the failure to get informed consent from the participants, it's 473 00:30:15,360 --> 00:30:18,600 Speaker 1: also really secondary to the fact that the study every 474 00:30:18,600 --> 00:30:22,560 Speaker 1: step of the way was intentionally about deceiving people into 475 00:30:22,600 --> 00:30:26,800 Speaker 1: participating and then withholding a treatment for a treatable illness 476 00:30:26,840 --> 00:30:31,880 Speaker 1: without their knowledge for decades. Yeah, the idea of informed consent, Yes, 477 00:30:31,880 --> 00:30:35,640 Speaker 1: that is really important. I am glad that such, uh, 478 00:30:36,000 --> 00:30:41,440 Speaker 1: such a focus on informed consent followed this particular study. 479 00:30:41,520 --> 00:30:44,600 Speaker 1: Like there's even a bioethics center at Tuskegee Institute now 480 00:30:44,920 --> 00:30:46,960 Speaker 1: in part as a response to the study. All of 481 00:30:46,960 --> 00:30:51,560 Speaker 1: that is super duper important, But like, informed consent not 482 00:30:51,920 --> 00:30:55,480 Speaker 1: really the biggest problem in a study that was literally, 483 00:30:56,040 --> 00:30:59,160 Speaker 1: we're going to lie to people and withhold an available 484 00:30:59,200 --> 00:31:02,920 Speaker 1: treatment for decades until they die, and then we will 485 00:31:02,960 --> 00:31:05,240 Speaker 1: conduct an autopsy on their body and see what happened 486 00:31:05,360 --> 00:31:08,360 Speaker 1: when like we already knew, we already knew what happened, 487 00:31:09,240 --> 00:31:12,280 Speaker 1: which was that untreated syphilis can kill you, Like we 488 00:31:12,360 --> 00:31:16,040 Speaker 1: knew that stuff already. So well, I always wonder when 489 00:31:16,040 --> 00:31:20,720 Speaker 1: we're any time we're talking about things like this, this 490 00:31:20,760 --> 00:31:23,120 Speaker 1: one in particular, because it's recent enough and it's in 491 00:31:23,160 --> 00:31:25,200 Speaker 1: the South, that I feel like, you know, I know 492 00:31:25,280 --> 00:31:28,040 Speaker 1: the kinds of people who may have been employed in 493 00:31:28,040 --> 00:31:30,040 Speaker 1: in a place like that, And I'm like, what kind 494 00:31:30,080 --> 00:31:32,880 Speaker 1: of mental gymnastics were some of these people having to 495 00:31:32,960 --> 00:31:34,680 Speaker 1: do with themselves to be like, no, no, we have 496 00:31:34,760 --> 00:31:38,840 Speaker 1: to keep doing this, yeah, because at some point your 497 00:31:38,840 --> 00:31:41,479 Speaker 1: brain raises a flag and goes, hey, this is not okay, 498 00:31:41,720 --> 00:31:45,720 Speaker 1: this is maybe bad. Well, and that's especially like from 499 00:31:45,800 --> 00:31:50,080 Speaker 1: the first publications there were people who could kind of went, hey, uh, 500 00:31:50,200 --> 00:31:54,440 Speaker 1: this seems wrong, and the study continued in spite of 501 00:31:54,480 --> 00:31:58,200 Speaker 1: the criticism saying, hey, this seems wrong. Um, in spite 502 00:31:58,200 --> 00:32:01,440 Speaker 1: of the you know, for the whole time. Um. There 503 00:32:01,440 --> 00:32:05,160 Speaker 1: are also people who will bring up the fact that, like, uh, 504 00:32:05,320 --> 00:32:08,520 Speaker 1: Eunice River's Larie was black, and some of the doctors 505 00:32:08,560 --> 00:32:11,680 Speaker 1: at the Tusky Institute who were participating in like allowing 506 00:32:11,720 --> 00:32:16,080 Speaker 1: this to happen on the Tusky Institute campus. We're also black, 507 00:32:16,080 --> 00:32:19,360 Speaker 1: and like people will try to wrap their mind around 508 00:32:19,400 --> 00:32:20,960 Speaker 1: that in such a way of being like, well, it 509 00:32:21,040 --> 00:32:23,320 Speaker 1: must have been okay if there were black people involved 510 00:32:23,320 --> 00:32:26,560 Speaker 1: in this treatment on black No, that's not that's not 511 00:32:26,760 --> 00:32:31,960 Speaker 1: correct at all. Uh, And that is really every time 512 00:32:31,960 --> 00:32:34,720 Speaker 1: I've seen that argument, it's been basically an attempt to 513 00:32:34,800 --> 00:32:38,680 Speaker 1: derail that Yes, this was awful, it was wrong, and 514 00:32:38,720 --> 00:32:43,360 Speaker 1: it was racist, and it has continued to have damaging 515 00:32:43,400 --> 00:32:50,160 Speaker 1: effects continuing probably until today. Yeah, I mean, like you said, 516 00:32:50,200 --> 00:32:53,800 Speaker 1: the thing is right, Like, you can't track really the 517 00:32:54,000 --> 00:32:58,760 Speaker 1: depth and resonance of what this created. Because these are 518 00:32:58,760 --> 00:33:01,560 Speaker 1: people that we're getting treated, some of whom were presumably 519 00:33:01,680 --> 00:33:04,960 Speaker 1: sexually active that probably passed it on to other people. 520 00:33:06,240 --> 00:33:08,400 Speaker 1: We don't know where the ripples go from there, you 521 00:33:08,400 --> 00:33:10,480 Speaker 1: know what I mean. There's so many lives that can 522 00:33:10,480 --> 00:33:15,720 Speaker 1: be affected in this sort of echoing horrible nous that well, 523 00:33:15,760 --> 00:33:18,000 Speaker 1: and then then when the news came out about it, 524 00:33:18,080 --> 00:33:20,480 Speaker 1: everything was compounded with the fact of, like, these were 525 00:33:20,560 --> 00:33:23,959 Speaker 1: doctors who people knew and trusted and in some cases 526 00:33:24,000 --> 00:33:26,480 Speaker 1: had been seeing for years and people had been seeing 527 00:33:27,080 --> 00:33:31,760 Speaker 1: uh Nurse Rivers later known as Nurse Larry, like they 528 00:33:31,800 --> 00:33:33,800 Speaker 1: had been seeing her for years, she had been taking 529 00:33:33,800 --> 00:33:35,760 Speaker 1: care of them for years, and people were like, how 530 00:33:35,800 --> 00:33:38,360 Speaker 1: can I ever trust another doctor ever again? And how 531 00:33:38,360 --> 00:33:41,240 Speaker 1: can I trust the government ever again? Like there was 532 00:33:42,400 --> 00:33:45,560 Speaker 1: there were definitely causes to mistrust the medical establishment and 533 00:33:45,600 --> 00:33:48,240 Speaker 1: the government before that point, but this was such an 534 00:33:48,280 --> 00:33:53,440 Speaker 1: immediate and visceral response that I think it has carried 535 00:33:53,520 --> 00:33:57,960 Speaker 1: through for generations. Yeah, and you you can't fault someone 536 00:33:58,000 --> 00:34:02,600 Speaker 1: at that point for having no faith in in uh, 537 00:34:02,960 --> 00:34:05,680 Speaker 1: you know, the medical treatments available to them or the 538 00:34:05,720 --> 00:34:08,560 Speaker 1: medical professionals available to them, which stinks. It's such a 539 00:34:08,600 --> 00:34:11,239 Speaker 1: disservice to the rest of the medical community. Like in 540 00:34:11,280 --> 00:34:15,520 Speaker 1: addition to the people that were being victimized by this 541 00:34:15,560 --> 00:34:20,359 Speaker 1: horrible study, obviously we feel ways about this, uh And 542 00:34:20,400 --> 00:34:22,279 Speaker 1: I laugh, not not to make light of it, but 543 00:34:22,360 --> 00:34:26,440 Speaker 1: just to uh, to to laugh at how embroiled in 544 00:34:26,440 --> 00:34:29,560 Speaker 1: our hearts it becomes. Yeah, I've researched a lot of 545 00:34:30,560 --> 00:34:36,040 Speaker 1: really horrible, horrifying, horrifying episodes on this show, and like 546 00:34:36,120 --> 00:34:42,399 Speaker 1: this is one of the hardest ones to me. Yeah, uh, 547 00:34:42,440 --> 00:34:45,000 Speaker 1: what's the listener male situation? It's not a much lighter 548 00:34:45,560 --> 00:34:48,160 Speaker 1: a much lighter note than this. It's also a throwback 549 00:34:48,200 --> 00:34:50,799 Speaker 1: to an episode that was from a while ago. This 550 00:34:50,880 --> 00:34:53,480 Speaker 1: is from Shelley. Shelley says, Hi, Holly and Tracy. She 551 00:34:53,520 --> 00:34:56,040 Speaker 1: has introduction to us and some thank you, and then 552 00:34:56,040 --> 00:34:58,719 Speaker 1: she says, I recently listened to the podcast about Hildegarde 553 00:34:58,760 --> 00:35:01,160 Speaker 1: up being in how Over. I quickly realized that I 554 00:35:01,239 --> 00:35:03,680 Speaker 1: must have mistaken this Hilleguard for a different of the 555 00:35:03,719 --> 00:35:06,239 Speaker 1: same name that I'm familiar with. No worries, I'm game 556 00:35:06,280 --> 00:35:08,719 Speaker 1: for an adventure in learning. I learned from the two 557 00:35:08,719 --> 00:35:10,680 Speaker 1: of you about her church training and her choice to 558 00:35:10,719 --> 00:35:12,800 Speaker 1: be an anchorous and then I hear it her musical 559 00:35:12,840 --> 00:35:15,640 Speaker 1: training again. You mentioned her lyric poems and hymns and 560 00:35:15,640 --> 00:35:18,040 Speaker 1: the musical lines ago with them. This is why I 561 00:35:18,040 --> 00:35:20,880 Speaker 1: tuned into the podcast. So this podcast really made me 562 00:35:20,920 --> 00:35:23,200 Speaker 1: scratch my head. I have a master's degree in music 563 00:35:23,280 --> 00:35:26,360 Speaker 1: and Hildegard is a huge part of our music history courses. 564 00:35:26,640 --> 00:35:30,080 Speaker 1: That you only mentioned her musical contributions in passing and 565 00:35:30,080 --> 00:35:32,520 Speaker 1: then in all capital letters with an exclamation point. This 566 00:35:32,640 --> 00:35:35,680 Speaker 1: is crazy. I had no idea about any of her 567 00:35:35,719 --> 00:35:38,320 Speaker 1: journeys in life. Sure I knew she was a religious 568 00:35:38,320 --> 00:35:41,040 Speaker 1: gal as most Western music of the Middle Ages of 569 00:35:41,120 --> 00:35:43,480 Speaker 1: liturgical in origin, but I had no clue of the 570 00:35:43,520 --> 00:35:46,279 Speaker 1: extent of her religious commitments. I was inspired to go 571 00:35:46,400 --> 00:35:48,680 Speaker 1: through some of my old music history books and brush 572 00:35:48,719 --> 00:35:50,920 Speaker 1: up on Hildegard, and sure enough, the extent of her 573 00:35:50,920 --> 00:35:55,320 Speaker 1: religious involvements are not mentioned much. There are two sentences 574 00:35:55,320 --> 00:35:58,600 Speaker 1: that describe her visions. Quote, during moments that we might 575 00:35:58,600 --> 00:36:02,200 Speaker 1: today identify as severe migraine headaches, she heard voices and 576 00:36:02,239 --> 00:36:05,719 Speaker 1: saw visions accompanying accompanied by great fashion flashes of light, 577 00:36:05,960 --> 00:36:08,759 Speaker 1: a serpent like Satan devouring pedals of a scarlet rose, 578 00:36:08,840 --> 00:36:12,280 Speaker 1: or the blood of Christ streaming in the heavens, for example. 579 00:36:12,360 --> 00:36:17,080 Speaker 1: And that was from right sims Uh music and Western civilization. 580 00:36:18,360 --> 00:36:21,920 Speaker 1: They later credit those visions with her quote extremely colorful 581 00:36:22,040 --> 00:36:24,719 Speaker 1: visions in her music. The music industry is a male 582 00:36:24,760 --> 00:36:28,200 Speaker 1: dominated arena, but Hildegard was crashing through the glass ceilings 583 00:36:28,200 --> 00:36:31,279 Speaker 1: in the eleventh century. She left many chants preserved in 584 00:36:31,320 --> 00:36:34,920 Speaker 1: her symphonia, as well as her liturgical drama Ordo virtue Um, 585 00:36:34,920 --> 00:36:38,000 Speaker 1: the first religious opera I recently recommended your podcast to 586 00:36:38,000 --> 00:36:39,560 Speaker 1: a friend of mine. I got her hooked with the 587 00:36:39,600 --> 00:36:42,279 Speaker 1: Haunted Management episodes and being a musician a college music 588 00:36:42,360 --> 00:36:45,000 Speaker 1: professor on her own, she also picked up Hildegard to 589 00:36:45,040 --> 00:36:47,200 Speaker 1: Being In for a listen. She almost turned the episode 590 00:36:47,239 --> 00:36:49,920 Speaker 1: off because she thought it was the wrong Hildegard. Hildegarden 591 00:36:49,920 --> 00:36:52,880 Speaker 1: to Being In is a staple and every trained musician's curriculum, 592 00:36:53,200 --> 00:36:56,520 Speaker 1: every conservatory school and Department of music student has had 593 00:36:56,560 --> 00:36:59,239 Speaker 1: a listening and content test on her. She's a really 594 00:36:59,280 --> 00:37:02,800 Speaker 1: big deal in bold with an exclamation point. After discussing 595 00:37:02,800 --> 00:37:05,440 Speaker 1: this and being truly astonished the lack of music mentioned 596 00:37:05,440 --> 00:37:08,040 Speaker 1: in your episode, we laughed it off. I'm inspired by 597 00:37:08,040 --> 00:37:11,240 Speaker 1: what an astonished, astonishing woman she was. Thank you, ladies 598 00:37:11,280 --> 00:37:13,560 Speaker 1: for this was truly something I missed in history class. 599 00:37:13,640 --> 00:37:17,360 Speaker 1: Keep up the great work, Shelly. Thank you for the note. Shelly. 600 00:37:17,760 --> 00:37:22,879 Speaker 1: I had an interesting response to this email, which is that, uh, 601 00:37:23,160 --> 00:37:26,680 Speaker 1: what seems weird to me is to have um a 602 00:37:26,760 --> 00:37:29,799 Speaker 1: focus on Hilly Guard Hildy Guard that is solely on 603 00:37:29,840 --> 00:37:35,239 Speaker 1: her music because her religious instruction and upbringing and the 604 00:37:35,280 --> 00:37:38,080 Speaker 1: fact that she was able able I mean I say 605 00:37:38,080 --> 00:37:40,600 Speaker 1: able and quotation marks. Her parents literally gave her to 606 00:37:40,640 --> 00:37:44,040 Speaker 1: the church, possibly as part of the tithe Like all 607 00:37:44,080 --> 00:37:46,719 Speaker 1: of those things are how she was even able to 608 00:37:47,760 --> 00:37:50,520 Speaker 1: have a body of music as part of her work 609 00:37:51,520 --> 00:37:55,320 Speaker 1: because she was devoting her life to God and living 610 00:37:55,600 --> 00:38:01,000 Speaker 1: in a monastic setting. So it is strange to me, Like, 611 00:38:01,040 --> 00:38:03,960 Speaker 1: it doesn't surprise me that people who have a music 612 00:38:04,040 --> 00:38:08,560 Speaker 1: history degree would know about Hildegard primarily through her music, 613 00:38:08,920 --> 00:38:13,200 Speaker 1: But she did a lot of other things besides right music. Um, 614 00:38:13,280 --> 00:38:16,760 Speaker 1: she was also shattering glass ceilings in terms of her writing, 615 00:38:16,840 --> 00:38:19,400 Speaker 1: and in terms of her religious instructions of other people, 616 00:38:19,640 --> 00:38:26,000 Speaker 1: and in terms of like uh founding, um, like founding 617 00:38:26,040 --> 00:38:30,200 Speaker 1: a religious community of women. So uh, yeah, it doesn't 618 00:38:30,200 --> 00:38:34,480 Speaker 1: surprise me that music instruction would focus primarily on her music, 619 00:38:34,520 --> 00:38:37,000 Speaker 1: but like that's definitely not the only thing, or I 620 00:38:37,040 --> 00:38:39,560 Speaker 1: would even argue the core thing about Hildegard in her 621 00:38:39,600 --> 00:38:42,560 Speaker 1: life and work. Yeah, if you would like to write 622 00:38:42,560 --> 00:38:45,240 Speaker 1: to us about this or any other podcast or history 623 00:38:45,239 --> 00:38:48,520 Speaker 1: podcasts at how stuff works dot com, russo on Facebook, 624 00:38:48,680 --> 00:38:51,200 Speaker 1: Facebook dot com slash mss in history, and on Twitter 625 00:38:51,239 --> 00:38:53,760 Speaker 1: at miss in history basically all of our social media 626 00:38:54,120 --> 00:38:56,759 Speaker 1: or at the user name miss in history. You can 627 00:38:56,840 --> 00:38:59,000 Speaker 1: have to our parent company's website, which is how stuff 628 00:38:59,000 --> 00:39:01,440 Speaker 1: Works dot com and find all kinds of information about 629 00:39:01,520 --> 00:39:03,719 Speaker 1: cool stuff. You can come to our website, which is 630 00:39:03,800 --> 00:39:06,160 Speaker 1: missed in History dot com, and you will find show 631 00:39:06,239 --> 00:39:08,520 Speaker 1: notes to the episodes Holly and I have done in 632 00:39:08,560 --> 00:39:11,839 Speaker 1: an archive of every episode. Ever. We also have four 633 00:39:12,120 --> 00:39:14,680 Speaker 1: videos we made and those are all on our website too, 634 00:39:15,080 --> 00:39:16,399 Speaker 1: So we can do all that and a whole lot 635 00:39:16,400 --> 00:39:18,560 Speaker 1: more at how stuff works dot com or missed in 636 00:39:18,640 --> 00:39:25,759 Speaker 1: History dot com. For more on this and thousands of 637 00:39:25,760 --> 00:39:40,320 Speaker 1: other topics, is it how stuff works dot com