Editing Tuskegee Syphilis Study (section)

==Legacy==
[[File:Syphilis-poster-wpa-cure.jpg|upright|right|thumb|Depression-era U.S. poster advocating early syphilis treatment. Although treatments were available, participants in the study did not receive them.]]

===Scientific failings===
Aside from a study of racial differences, one of the main goals that researchers in the study wanted to accomplish was to determine the extent to which treatment for syphilis was necessary and at what point in the progression of the disease it should be treated. For this reason, the study emphasized observation of individuals with late latent syphilis.<ref name="Brandt-1978" /><ref name="Reverby-2009" /> However, despite clinicians' attempts to justify the study as necessary for science, the study itself was not conducted in a scientifically viable way. Because participants were treated with mercury rubs, injections of neoarsphenamine, protiodide, [[Arsphenamine|Salvarsan]], and bismuth, the study did not follow subjects whose syphilis was untreated, however minimally effective these treatments may have been.<ref name="Brandt-1978" /><ref name="Reverby-2009" />

Austin V. Deibert of the PHS recognized that since the study's main goal had been compromised in this way, the results would be meaningless and impossible to manipulate statistically. Even the toxic treatments that were available before the availability of penicillin, according to Deibert, could "greatly lower, if not prevent, late syphilitic cardiovascular disease ... [while] increas[ing] the incidence of neuro-recurrence and other forms of relapse."<ref name="Reverby-2009" /> Despite their effectiveness, these treatments were never prescribed to the participants.<ref name="Reverby-2009" />

===Racism===
{{Further|Medical racism in the United States}}
The conception which lay behind the U.S. Public Health Service Syphilis Study at Tuskegee in 1932, in which 100% of its participants were poor, rural African-American men with very limited access to health information, reflects the [[Racism in the United States|racial attitudes in the U.S. at that time]]. The clinicians who led the study assumed that African-Americans were particularly susceptible to [[Sexually transmitted infection|venereal diseases]] because of their race, and they assumed that the study's participants were not interested in receiving medical treatment.<ref name="Brandt-1978" /><ref name="Howell-2017">{{Cite journal|last=Howell|first=Joel|title=Race and U.S. Medical Experimentation: The Case of Tuskegee|journal=Reports in Public Health, University of Michigan|year=2017|volume=33Suppl 1|issue=Suppl 1|pages=e00168016|doi=10.1590/0102-311X00168016|pmid=28492710|doi-access=free}}</ref>

Taliaferro Clark said, "The rather low intelligence of the Negro population, depressed economic conditions, and the common promiscuous sex relations not only contribute to the spread of syphilis but the prevailing indifference with regards to treatment."<ref name="Howell-2017" /> In reality, the promise of medical treatment, usually reserved only for emergencies among the rural black population of Macon County, Alabama, was what secured subjects' cooperation in the study.<ref name="Brandt-1978" />

===Public trust===
The revelations of mistreatment under the U.S. Public Health Service Syphilis Study at Tuskegee are believed to have significantly damaged the trust of the black community toward public health efforts in the United States.<ref>{{Cite journal|last1=Thomas|first1=SB|last2=Quinn|first2=SC|date=November 1991|title=The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community|journal=Am J Public Health|volume=81|issue=11|pages=1498–505|doi=10.2105/AJPH.81.11.1498|pmid=1951814|pmc=1405662}}</ref><ref name="Alsan-2018">{{Cite journal|last1=Alsan|first1=Marcella|last2=Wanamaker|first2=Marianne|date=2018|title=Tuskegee and the Health of Black Men|journal=Quarterly Journal of Economics|volume=133|issue=1|pages=407–55|doi=10.1093/qje/qjx029|pmid=30505005|pmc=6258045}}</ref> Observers believe that the abuses of the study may have contributed to the reluctance of many poor black people to seek routine [[preventive care]].<ref name="Alsan-2018" /><ref>{{Cite web|title=Tuskegee's ghosts: Fear hinders black marrow donation - CNN.com|url=https://www.cnn.com/2007/HEALTH/02/07/bone.marrow/index.html|website=www.cnn.com|access-date=May 14, 2020|archive-date=August 17, 2020|archive-url=https://web.archive.org/web/20200817215518/https://www.cnn.com/2007/HEALTH/02/07/bone.marrow/index.html|url-status=live}}</ref> A 1999 survey showed that 80% of African-American men wrongly believed the men in the study had been injected with syphilis.<ref name="Katz-2008" />

While the final report of the Tuskegee Syphilis Study Legacy Committee noted that the study had contributed to fears among the African American community of abuse and exploitation by government officials and medical professionals,<ref name="UVA-1996b" /> medical mistreatment of African Americans and resulting mistrust predates the Tuskegee Syphilis Study.<ref name="Gamble-1997" /> [[Vanessa Northington Gamble]], who had chaired the committee, addressed this in a seminal article published in 1997<ref>{{Cite news |last=Yuko |first=Elizabeth |date=March 9, 2021 |title=Why Are Black Communities Being Singled Out as Vaccine Hesitant? |language=en-US |magazine=Rolling Stone |url=https://www.rollingstone.com/culture/culture-features/covid-19-vaccine-hesitant-black-communities-singled-out-1137750/ |access-date=March 11, 2021 |archive-url=https://web.archive.org/web/20210309201001/https://www.rollingstone.com/culture/culture-features/covid-19-vaccine-hesitant-black-communities-singled-out-1137750/ |archive-date=March 9, 2021}}</ref> after President Clinton's apology. She argued that while the Tuskegee Syphilis Study contributed to African Americans' continuing mistrust of the biomedical community, the study was not the most important reason. She called attention to a broader historical and social context that had already negatively influenced community attitudes, including countless prior medical injustices before the study's start in 1932. These dated back to the [[antebellum period]], when slaves had been used for [[Unethical human experimentation|unethical and harmful experiments]] including tests of endurance against and remedies for [[heatstroke]] and experimental [[Gynecological surgery|gynecological surgeries]] without [[anesthesia]]. African Americans' [[Body snatching|graves were robbed]] to provide cadavers for dissection, a practice that continued, along with other abuses, after the [[American Civil War]].<ref name="Gamble-1997">{{Cite journal|last=Gamble|first=V N|date=November 1, 1997|title=Under the shadow of Tuskegee: African Americans and health care.|journal=American Journal of Public Health|volume=87|issue=11|pages=1773–78|doi=10.2105/AJPH.87.11.1773|pmid=9366634|pmc=1381160|issn=0090-0036}}</ref>

A 2016 paper by [[Marcella Alsan]] and Marianne Wanamaker found "that the historical disclosure of the [Tuskegee experiment] in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men. Our estimates imply life expectancy at age 45 for black men fell by up to 1.4 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men." The authors further observed that the decline also represented 25% of the gender gap in Black life expectancy at that time. The authors noted that the extent of this effect was comparable to major public health benchmarks, such as eliminating smoking or the impact of the [[Great Migration (African American)|Great Migration]] on life expectancy. Aslan's and Wanamaker's study provided evidence that reduced trust in medical institutions, fueled by the Tuskegee disclosure, had measurable effects on health attitudes and outcomes in the black community. Aslan and Wanamaker's study provides evidence that reduced trust in medical institutions was fueled by the Tuskegee disclosure, having measurable effects on health attitudes and outcomes on the Black community.<ref>{{Cite journal |last=Alsan |first=Marcella |last2=Wanamaker |first2=Marianne |date=2018-02-01 |title=Tuskegee and the Health of Black Men* |url=http://www.nber.org/papers/w22323.pdf |journal=The Quarterly Journal of Economics |volume=133 |issue=1 |pages=407–455 |doi=10.1093/qje/qjx029 |issn=0033-5533}}</ref> 

Studies that have investigated the willingness of black Americans to participate in medical studies have not drawn consistent conclusions related to the willingness and participation in studies by racial minorities.<ref>{{Cite journal|last=Crenner|first=Christopher|s2cid=5484282|date=February 12, 2011|title=The Tuskegee Syphilis Study and the Scientific Concept of Racial Nervous Resistance|journal=Journal of the History of Medicine and Allied Sciences|volume=67|issue=2|pages=244–80|doi=10.1093/jhmas/jrr003|pmid=21317423}}</ref> The Tuskegee Legacy Project Questionnaire found that, even though black Americans are four times more likely to know about the syphilis trials than are whites, they are two to three times more willing to participate in biomedical studies.<ref name="AJPH-2008">{{cite journal |author1=Katz, R. |author2=Kegeles, S. |author3=Kressin, N. R. |author4=Green, B. |author5=James, S.A. |author6=Wang, M. |author7=James, J. |author8=Russel, S. |author9=Claudio, C. |date=2008 |title=Awareness of the Tuskegee Syphilis Study and the US Presidential Apology and Their Influence on Minority Participation in Biomedical Research |journal=American Journal of Public Health |volume=98 |issue=6 |pages=1137–42|doi=10.2105/AJPH.2006.100131 |pmid=17901437 |pmc=2377291 }}</ref><ref name="Reverby-2009" /> Some of the factors that continue to limit the credibility of these few studies is how awareness differs significantly across studies. For instance, it appears that the rates of awareness differ as a function of the method of assessment. Study participants who reported awareness of the Tuskegee syphilis study are often misinformed about the results and issues, and awareness of the study is not reliably associated with unwillingness to participate in scientific research.<ref name="Katz-2008" /><ref name="AJPH-2008" /><ref>{{Cite journal|last1=Poythress|first1=N.|last2=Epstein|first2=M.|last3=Stiles|first3=P.|last4=Edens|first4=J.|date=October 9, 2011|title=Awareness of the Tuskegee Syphilis Study: Impact on Offenders' Decisions to Decline Research Participation|journal=Behavioral Sciences and the Law|volume=29|issue=6|pages=821–28|doi=10.1002/bsl.1012|pmid=21984035}}</ref><ref>{{Cite journal|last1=Brandon|first1=D.T.|last2=Isaac|first2=L.A.|last3=LaVeist|first3=T.A.|date=2005|title=The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care?|journal=J. Natl. Med. Assoc.|volume=97|issue=7|pages=951–60|pmid=16080664|pmc=2569322}}</ref>

Distrust of the government, in part formed through the study, contributed to persistent rumors during the 1980s in the black community that the government was responsible for the HIV/AIDS crisis by having deliberately introduced the virus to the black community as some kind of experiment.<ref>{{Cite book|last=Jones|first=James H.|title=Bad Blood: New and Expanded Edition|publisher=Simon & Schuster|year=1993|isbn=978-0-02-916676-5|pages=220–41}}</ref> In February 1992 on ABC's ''[[Prime Time Live]]'', journalist [[Jay Schadler]] interviewed Dr. Sidney Olansky, Public Health Services director of the study from 1950 to 1957. When asked about the lies that were told to the study subjects, Olansky said, "The fact that they were illiterate was helpful, too, because they couldn't read the newspapers. If they were not, as things moved on they might have been reading newspapers and seen what was going on."<ref name="Thomas-2000" />

On January 3, 2019, a United States federal judge stated that [[Johns Hopkins University]], [[Bristol-Myers Squibb]] and the [[Rockefeller Foundation]] must face a $1 billion lawsuit for their roles in a [[Guatemala syphilis experiments|similar experiment affecting Guatemalans]].<ref>{{Cite news|date=January 4, 2019|title=Johns Hopkins, Bristol-Myers must face $1 billion syphilis infections suit|language=en|work=Reuters|url=https://www.reuters.com/article/us-maryland-lawsuit-infections-idUSKCN1OY1N3|access-date=May 14, 2020|archive-date=January 18, 2021|archive-url=https://web.archive.org/web/20210118011339/https://www.reuters.com/article/us-maryland-lawsuit-infections-idUSKCN1OY1N3|url-status=live}}</ref> In 2001, a court compared the [[Kennedy Krieger Institute's Lead-Based Paint Abatement and Repair and Maintenance Study]] to the Tuskegee experiments.<ref>{{Cite web |last=Cohn |first=Meredith |date=November 15, 2019 |title=Court orders Kennedy Krieger to pay woman harmed in 1990s-era lead paint study $1.84 million |url=https://www.baltimoresun.com/health/bs-hs-kennedy-krieger-lead-paint-judgment-20191114-fxlxecyzg5hvnojmyy5onpwriy-story.html |access-date=December 30, 2022 |website=Baltimore Sun}}</ref>

Some African Americans have been hesitant to get [[COVID-19 vaccine|vaccinated against COVID-19]] due to the Tuskegee experiments.<ref>{{Cite news|last=Elliott|first=Debbie|date=February 16, 2021|title=In Tuskegee, Painful History Shadows Efforts To Vaccinate African Americans|url=https://www.npr.org/2021/02/16/967011614/in-tuskegee-painful-history-shadows-efforts-to-vaccinate-african-americans|access-date=August 19, 2021|website=[[NPR]]|language=en}}</ref> In September 2021, the right-wing group [[America's Frontline Doctors]], which has promoted [[COVID-19 misinformation|COVID-19 conspiracy theories and misinformation]], filed a lawsuit against New York City, claiming that its [[Vaccine passports during the COVID-19 pandemic|vaccine passport]] health orders were inherently discriminatory against African Americans due to the "historical context".<ref>{{Cite web |last=Mencimer |first=Stephanie |title=Pro-Trump doctors invoke civil rights in bid to overturn New York's vaccine mandate |url=https://www.motherjones.com/politics/2021/09/simone-gold-new-york-vaccine-lawsuit/ |access-date=January 3, 2022 |website=Mother Jones |language=en-US}}</ref>