Running head: UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

Unethical Principles Used in the Tuskegee Syphilis Study

Angela Long and Myrian Diatta
Coppin State University Helene Fuld School of Nursing
Ethics
Nursing 500
Dr. Emmanuel Obiako
July 15, 2014
Unethical Principles used in The Tuskegee Syphilis Study
Introduction
Syphilis is a sexual transmitted infection that first appeared in Europe in the late 15 th century that
was considered a horrible painful epidemic according to the literature (Karamanou, Kyriakis, Tsoucalas,
& Androutsos, 2013, p. 317). It has taken the medical world a long time to learn and treat Syphilis. A
study that was used by the medical community called the Tuskegee Syphilis Study has had negative
lasting effects on the entire world population especial African American people. Unethical treatment of
the study participants helped put in place rules and regulations that we currently follow based on what
was learned from the wrongs of the Tuskegee Syphilis Study and other unethical studies.

UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

This paper will focus on defining Syphilis, explaining treatments used in the past and current day
treatment, giving general historical information on the Tuskegee Syphilis Study and what the
consequences were from the unethically treatment of these participates. This paper will also discuss three
basic ethical principles that were violated by the Tuskegee study and the laws that were put in place to
protect people after this and several other studys that broke ethical principles and hurt their study
participants. The Tuskegee Syphilis study has made Americans today feel that racism, experimentation,
deception of the federal government, paternalism and devaluing of the African American race are all still
happening and possible (Mays, 2012, p. 411), this study gives validity to the fears that many African
American feel. This study has also helped shaped change by bringing into light and to the forefront that
transforming health care reform, health research, working on elimination health disparities in racial and
ethnic minorities is very important (Mays, 2012, p. 411).
Literature Review
Syphilis
Syphilis is a sexually transmitted disease meaning transmitted by sexual contact of the anal,
vaginal or oral cavities or mother to fetus ("Syphilis," 2014, p. 1). Syphilis is caused by a bacterium called
Treponem Palladium (Karamanou et al., 2013, p. 317). Syphilis can be divided into stages and some of
the signs and symptoms can be over looked or confused with other things. The first stage is called the
primary stage in which a small single sore may appear where the syphilis bacteria entered the body
("Syphilis," 2014, p. 1). The sore can be round, firm and painless, which can easily go unnoticed
("Syphilis," 2014, p. 1). The single sore or multiple sores will last from 3 to 6 weeks and then the disease
progresses into the secondary stage if untreated.
In the secondary stage sores develop in the mouth, vagina, anus and skin rashes develop on one
or more areas or the entire body ("Syphilis," 2014, p. 1). This rash can be faint rough, red or reddish
brown spots, which commonly appear on the palms of the hands and soles of the feet ("Syphilis," 2014, p.
1). Some common symptoms during this stage are fever sore throat, hair loss, headaches, muscles aches,

UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

swollen lymph nodes, weight loss and fatigue ("Syphilis," 2014, p. 1). If this is left untreated they the
disease will progress into the latent stage or late stage of the disease process. All of the symptoms from
the secondary stage disappear at this point in the disease ("Syphilis," 2014, p. 2).
According to the CDC, ("Syphilis," 2014, p. 2) late or latent syphilis can develop 10 -30 years
after the initial infection in the body. At this stage of the disease the internal organs are several damaged
by the disease and death can occur ("Syphilis," 2014, p. 2). Some symptoms in this late stage are
paralysis, or difficulty coordinating muscle movement, blindness or numbness, a mental disorder called
dementia are just a few of the more serious symptoms ("Syphilis," 2014, p. 2).
Treatment
According to the Journal of Medicine and Life, (Tampa, Sarbu, Matei, Benea, & Georgescu,
2014, p. 4) the first treatment was from the guaiac tree brought from the New World in the late 1400s to
early 1500s. This plant was known as a blood cleaner and was boiled, and consumed for 30 days. This
treatment was unsuccessful and later Mercury treatment was used (Tampa et al., 2014, p. 4). The mercury
treatment was thought to eliminate the virus by causing sweat, salivation and dieresis, but in fact it was
causing toxicity, pneumonia and eventually death (Tampa et al., 2014, p. 4). In 1884 bismuth salts were
introduce as a replacement for mercury treatments (Tampa et al., 2014, p. 4). A German scientist won a
Nobel Prize for the discovery of Salvarsan which was an arsenic compound (Tampa et al., 2014, p. 4). All
of these drugs were unsafe and none of them cured or controlled Syphilis.
In 1943 penicillin became the main treatment of Syphilis and still is to this very day (Tampa et
al., 2014, p. 4).
The current treatment for syphilis is penicillin G benzathine 2.4 million units intramuscular times one for
primary or secondary stage less than one year. If in the latent stage or greater than one year or unknown
duration then the dose is 2.4 million units intramuscular every week for three weeks.
Tuskegee Study of Untreated Syphilis

UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

In 1932 The Tuskegee Institute and the Public Health Service began a study called the Tuskegee
Study of Untreated Syphilis in the Negro Male ("Tuskegee Timeline," 2014, p. 1). The study was original
slated to justify the treatment program of syphilis in blacks ("Tuskegee Timeline," 2014, p. 1). The study
recruited 600 black men from Macon, Alabama, 400 men with syphilis and 200 without the disease
("Tuskegee Timeline," 2014, p. 1). The participants did not give informed consent, they were never told
what or why the study was being conducted. The researchers that conducted the study told the participants
that they were being treated for bad blood ("Tuskegee Timeline," 2014, p. 1). The participants were told
that the study would last six months and they would receive free medical exams, free meals, and free
burial insurance ("Tuskegee Timeline," 2014, p. 2). The study actual lasted 40 years, until it was brought
to light by a reporter, which caused a public outcry ("Tuskegee Timeline," 2014, p. 2)?
The participants were never given an option to quit the study at any time even after treatment of
penicillin was started to be used in1947. Wives and children become affected because of the untreated
participates that have syphilis ("Tuskegee Timeline," 2014, p. 2). According to the Center for Disease
Control and Prevention, after the July 1972 Associated Press story an advisory panel was form, in
October 1972 the panel found that the study was ethically unjustified and stopped at once ("Tuskegee
Timeline," 2014, p. 2).
In 1973 a class action lawsuit was filed and in 1974 $10 million dollars was awarded to the
participants and families ("Tuskegee Timeline," 2014, p. 2). The government promised to give lifetime
medical benefits and burial services to all living participants as part of the settlement ("Tuskegee
Timeline," 2014, p. 2).
The last Tuskegee Study participant dies in January of 2004 and last widow died in January of
2009 ("Tuskegee Timeline," 2014, p. 2). Today there are 15 offspring currently receiving health and
medical benefits according to the CDC ("Tuskegee Timeline," 2014, p. 2).

Unethical Principles

UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

Some major terms that are related to ethics or ethical principle are autonomy,

nonmalefience and beneficence. Autonomy gives a person the chance and ability to act freely,
without limitation that stop informed consent and limited the ability to choose ones own plans
(Beauchamp & Childress, 2013, p. 103). Some general principle of nonmalefiences are one shall
not kill, one shall not bring pain or suffering, one shall not incapacitate, one should not inflict
offense and thou shall not deny others of the goods of life (Beauchamp & Childress, 2013, p.
151). Beneficence means that agents or people must take positive steps to help other just as long
as their lives are not put in danger (Beauchamp & Childress, 2013, p. 202). Every one of these
three simple principles was violated by the Tuskegee Syphilis Study.

Exploration and Analysis

Researchers still struggle with ethical complexities of conducting research today, especial in
developing countries, according to Vamus & Satcher 2014 (Varmus & Satcher, 2014, p. 337). After the
Tuskegee study was made public a national commission was established to put in place principles and
guidelines to protect research participants (Varmus & Satcher, 2014, p. 337). This system was described
and documented in the Belmont report, which has three basic principles (Varmus & Satcher, 2014, p.
337). The first principle being respect for the persons which means the person has the right to exercise
their own autonomy (Varmus & Satcher, 2014, p. 337). The second being beneficence or the
minimization of risks incurred by the participants and the maximization of the benefits to them and others
(Varmus & Satcher, 2014, p. 337). The third principle is justice, where researchers shouldnt unduly
involve participants from groups that would not benefit from applications of the research (Varmus &
Satcher, 2014, p. 337). Many researchers today struggle with the same question over and over again; do
the benefits outweigh the risks? (Varmus & Satcher, 2014, p. 338)

UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

In the Tuskegee study these three principals were not even considered. The 600 men that were
evolved never were given the opportunity to exercise their own autonomy, or beneficence. The Tuskegee
Study did not produce any information or research that benefited any poor African American men, or any
men with syphilis in a rural area such as Alabama. The Tuskegee study did not benefit any women or
children that are married to a man with syphilis, it did not change the way we treat this sexually
transmitted disease and it did not help come up with an effective treatment.
Manipulation was used in the Tuskegee Study to stimulate and sustain the participants interest in
participation according to Beauchamp& Childress 2014 (Beauchamp & Childress, 2013, p. 139). The
researchers offered burial assistance and insurance to these very poor African American men who had no
extra money for burial and didnt want to burden their families (Beauchamp & Childress, 2013, p. 139).
They offer them free transportation to and from the examinations and offered to give them a free trip into
town of which most of them didnt have vehicles (Beauchamp & Childress, 2013, p. 139). Participants
were offered free hot meals on the day of exams and free medications (but not medications to treat their
syphilis) (Beauchamp & Childress, 2013, p. 140). The participants socioeconomic class made them
extremely vulnerable to these forms of manipulations and bribery (Beauchamp & Childress, 2013, p.
140).
Mistrust and the underreprestation of African Americans in research is largely blamed on the
infamous Tuskegee Syphilis Study , however this mistrust of medicine and research did not start with this
study and doesnt end with this study. Some of these other questionable unethical studies are the EZ
measles vaccine, the Kennedy Krieger lead paint abatement and the polyheme synthetic blood study
(Rencher & Wolf, 2013, p. 2136). There currently are policies and laws to help mandate women and
minorities be properly represented, the NIH Revitalization Act is one sure law but has had limited success
(Rencher & Wolf, 2013, p. 2136). The US Department of Health and Human Service 2011 Advanced
Notice of Proposed Rule Making was to offer and address regulations for governing human participants in
research but failed to address the important use of Alabama did not receive any benefits from this study

UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

which lasted 40 years. The cost of life was greater than the benefit of the information. These participants
were denied health care that was the standard treatment for syphilis.
Current laws
The Food and Drug Administration held hearing in August 1979 to regulate protection of human
subjects and informed consent and in Janurary of 1981 the final rules were passed by congress ("FDA,"
2014, p. 1). Any agency or institiution must make an application to the FDA for permission to conduct
any research where human subjects are involved ("FDA," 2014, p. 1). The laws and regulates are aligned
up with the same regulations and actions of the Department of Health and Human Services ("FDA," 2014,
p. 1).

Demonstration of the significance of these events to the evolution of current laws and regulations guiding
the use of human subjects in research.

UNETHICAL PRINCIPLES USED IN THE TUSKEGEE SYPHILIS

References

Beauchamp, T., & Childress, J. (2013). Principles of Biomedical Ethics (7th ed.). New York:
Oxford University Press.
Karamanou, M., Kyriakis, K., Tsoucalas, G., & Androutsos, G. (2013). Hallmarks in history of
syphilis therapeutics. Le Infezioni in Medicina, 4(1), 317-319. Retrieved from
www.pubmed.com
Mays, V. M. (2012, November 1). The legacy of the us public health service study of untreated
syphilis in african american men at Tuskegee on affordable care act and health care
reform fifteen years after president Clintons apology. Ethics Behavior, 22(6), 411-418.
http://dx.doi.org/10.1080/10508422.2012.730808
Protection of human subjects and informed consent. (2014). Retrieved from
http://www.fda.gov/science research
Rancher, W., & Wolf, L. (2013, December). Redressing past wrongs: changing the common rule
to increase minority voices in research. American Journal of Public Health, 2136-2140.
http://dx.doi.org/10.2105%fajph.2013.301356
Syphilis CDC fact sheet. (2014). Retrieved from http://www.cdc.gov/std
Tampa, M., Sarbu, I., Matei, C., Benea, V., & Georgescu, S. (2014, March 15). Brief history of
syphilis. Journal of Medicine and Life, 7(1), 4-10. Retrieved from www.ncbi.nlm.nih.gov
The Tuskegge timeline. (2014). Retrieved from www.cdc.gov/tuskegee/timeline.htm
Varmus, H., & Snatcher, D. (2014, October 2). Ethical complexities of conducting research in
developing countries. The New England Journal of Medicine, 337-348.
http://dx.doi.org/10.1056/NELM201410023371411