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Tuskegee Syphilis Study. Leading Up To. Antebellum Health Care Plantation owners valued employees 1860 estimated value of 4 million slaves was 2 billion dollars Some hospitals for slaves, usually in places like New Orleans or Natchez, MS Slaves used in medical experiments

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leading up to
Leading Up To
  • Antebellum Health Care
    • Plantation owners valued employees
      • 1860 estimated value of 4 million slaves was 2 billion dollars
    • Some hospitals for slaves, usually in places like New Orleans or Natchez, MS
    • Slaves used in medical experiments
    • No healthcare choices– particularly reproductively
    • Science used as a means justify inequality
      • “Doctrine of innate racial differences” p12 LaVeist
leading up to1
Leading Up To
  • After Civil War
    • Federal Government set up the Freedman’s Bureau in 1865
    • By 1868 all but one had closed
    • Night riders
    • No care for freed slaves
      • Charities provided care to “the deserving poor, not as a service to all people in the community”; socially worthy
    • 1896 Plessy v Ferguson rule paved the way for segregation of healthcare
      • Restrict Black physician education
      • Limit community control over hospitals
      • Exclude Black physicians from practicing with White physicians
provident hospital annual report 1895 1896
Provident Hospital Annual Report 1895-1896

"The hospital is intended to fulfill three purposes: - To be an institution where people of color may be attended by physicians of their own race, and secondly, that colored physicians may have an opportunity to develop themselves along the lines of specialties, and thereby, become thoroughly proficient in them, at the same time no distinction is made in regard to color and all races of people are treated promptly, and properly and Third, to establish in the near future a well organized training school for nurses where young ladies may obtain special instruction pertaining to their calling."

www.nlm.nih.gov/.../images/hubbard.jpg

leading up to2
Leading Up To
  • 1900-1920s
    • Physician education was reformed; upper class, white, male profession
    • 1900 seven medical schools educated Black physicians
      • By 1920 on 2 remained; Howard and Meharry
      • Main source of Black physicians until 1960
    • Fear of Black physicians and encouraged community to keep separation
      • Flexner Report confirmed separation
provident hospital and training school chicago
Provident Hospital and Training School, Chicago

www.nlm.nih.gov/.../images/hubbard.jpg

leading up to3
Leading Up To
  • 1920-1940
    • Black physicians practiced only in Black hospitals with Black patients
    • Poorest care and inferior facilities
    • 1946 Hill Burton Construction Act- proposed by Lister Hill of Alabama
      • Separate but equal facilities in Health Care
prevailing medical assumptions
Prevailing Medical Assumptions
  • Diseases affected Black differently than Whites
  • Some kind of Health Care is better than what they had which often was nothing
  • Blacks were so poorly educated that they did not understand health care and being health anyway
1930s and incidence of syphilis
1930s and Incidence of Syphilis
  • 1934 for Black Adults
    • 17,700 deaths from syphilis
    • 500,000 new cases each year
    • Predicted that 7 million would get the disease
  • Discrepancy between case in Blacks and Whites so concluded
    • Dermatological Cause
    • Hereditary
addressing the concerns
Addressing the concerns
  • State of Alabama
    • 14 clinics
    • 175 private physicians donate a few hours each week
    • $2/visit
    • Syphilis required as many as 20 visits
    • Very rural area had nothing

T88

addressing the concerns1
Addressing the concerns
  • Rosenwald Fund
    • 1929 in conjunction with the United States Public Health Service
    • Three goals
      • Provide health programs for southern Blacks
      • Provide key positions for Black health professionals
      • Support medical education and training
addressing the concerns2
Addressing the concerns
  • Rosenwald cont’d
    • Established syphilis treatment programs for rural blacks
    • One was in Macon County AL
      • Very poor
      • Diet salt pork, hominy grits, cornbread and molasses and rarely meat, veggies or milk
    • Rosenwald fund oversaw and sent Dr. Harris, a black to physician to assess the project

T90

addressing the concerns3
Addressing the concerns

Dr. Taliaferro Clark had an “aha” moment!

  • 1400 negroes admitted to treatment but only a small number had previous treatment
  • Near a hospital– Tuskegee Institute
  • “In short, Macon County offered thousands of infected Negroes who lived outside the world of modern medicine yet close to a well equipped teaching hospital that could easily double as a scientific laboratory” Clark from Bad blood : the Tuskegee syphilis experimentby Jones, J (1993)
the players
The Players
  • Tuskegee Institute- medical facilities
  • Eunice Rivers- nurse
  • Macon County physicians
  • USPH service, AMA and the medical community
  • Men of Macon County
tuskegee institute
Tuskegee Institute
  • Dr. Dibble agreed for the facility to provide medical services
    • Blood Test
    • Spinal Taps
  • In return, the physicians at Tuskegee involved, would be given co-authorship on any publications as the result of the research
eunice rivers
Eunice Rivers
  • Grew up in Macon County
  • Oldest daughter of a poor man who could barely write his name
  • Went to Tuskegee and became a nurse
  • 1931 offered a job with the project
  • She took the job and enjoyed it-”Oh, we had a good time, We had a good time, Really and truly, when we were working with those people…….. That was the joy of my life” (Jones, Bad Blood p161)
  • Why did they want her?
macon county physicians
Macon County Physicians
  • Asked all the physicians, both black and white, not to treat those men involved in the study
us public health service
US Public Health Service
  • Precursor to the current CDC- Center for Disease Control
  • Money and personnel provided
men of macon county
Men of Macon County
  • Selected 400 men with syphilis
  • They were told that had “Bad Blood”
  • They were given:
    • NO medication
    • Spinal taps
    • Blood test
    • $50 toward burial expenses
so began 1932
So Began-1932
  • “The Tuskegee Study of Untreated Syphilis in the Negro Male”
  • The “longest know non-therapeutic experiment on humans in medical history” (Breaking the Fine Rain of Death byTownes(1998), p91
  • The study would end with the death of all of the participants
the players why did they
The Players—Why did they?
  • Tuskegee Institute- medical facilities
  • Eunice Rivers- nurse
  • Macon County physicians
  • USPH service, AMA and the medical community
  • Men of Macon County
the beginning of the end
The Beginning of the END
  • Dr. Irwin Schatz- first medical practicioner to question the study
  • Peter Buxton- worked for PHS
  • 1972 Edith Lederer wrote an article
  • 1973 $1.8 billion class action suit against the PHS, HEW (HHS), & State of Alabama; settled for $10 million
  • Who not named?
responses
Responses
  • Tuskegee Institute
  • Nurse Rivers
  • Medical Community
  • PHS
  • Lawyers
national apology
National Apology
  • May 16, 1997
  • President Bill Clinton offered a formal apology—25 years after the conclusion
after tuskegee
After Tuskegee
  • 1989– vaccine on Black and Latino children; parents not informed
  • Polyheme Blood substitute
    • Because the patients eligible for the study are unlikely to be able to provide consent due to the extent and nature of their injuries, the trial will be conducted under federal regulations that allow clinical research in emergency settings using an exception from the requirement for informed consent (21 CFR 50.24). http://www.northfieldlabs.com/facts.html
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