The Tuskegee Study was the most unorthodox and the longest nontherapeutic research study in the history of United States (Thomas, 2000). Initially Dr. Talliaferro Clark wanted to conduct a study that would study syphilis in black men for 6 to 9 months, a year at the most (Gray, 1998). Then do a follow up with treatment. Others involved in the study had a different idea. They wanted to study the natural history of syphilis, and so they did for 40 years, 1932 - 1972. Syphilis is an infectious disease (CDC, 2009) that is caused by bacterium, Treponema palladium a spirochete capable of infecting almost any organ or tissue in the body and causing protean clinical manifestations (CDC, 2009). Transmission occurs most frequently during sexual contact, including oral sex, through minor skin or mucosal lesions; sites of inoculations are usually genitals but may be extragential (CDC, 2009). The risk of developing syphilis after unprotected sex is 30-50% (Engineering, 2006). If left untreated it causes death. Before death occurs the individual infected suffers tremendously. The Tuskegee Study was initiated by the Public Health Service of Macon County, Alabama. It took place on the campus of Tuskegee Institute at John A. Andrews Memorial Hospital.
The incidence of syphilis was 36% among the 27,000 residents of Macon County, Alabama were infected with syphilis, giving this place syphilis prevalence among the greatest in the United States (Gray, 1998). Tuskegee residents were 82% black. This is the reason why Macon County was chosen to study the natural history of syphilis; it had the highest incidence of syphilis in the nation. Subjects were recruited through announcements that were made in churches and cotton fields about a way to receive free medical care. This was a community based approach, black leaders, elders in the community and owners of former plantations were enlisted to recruit subjects for the study (Thomas, 2000). Macon County where whites’ rule over blacks was virtually absolute, where blacks lived in extreme poverty and with a total lack of access to healthcare, there was no shortage of volunteers to participate in the study (Thomas, 2000).
A black public health service nurse, Eunice River was hired to monitor the men, and did so for forty years. Ms. Rivers played a major role in keeping the men in the study. The men trusted her, she was black. The word syphilis was never mentioned. As incentives the subjects were given free medical exams, free medical care for minor ailments, free meals on the days they saw the doctor, and rides back and forth to see the doctor.
The subjects that participated in the study were 600 black men, 399 with syphilis, and 201 who did not have the disease (Li, 1997). The number of subjects varies depending on the literature of reference. According to the CDC’s final count in 1974, based on medical records, is 427 with the disease and 185 controls, plus 12 controls switched to the syphilitic arm for a total of 624(CDC, 2009). Participants were the sons and grandsons of slaves, poor, black, uneducated sharecroppers from Macon County, Alabama. Most of them had never seen a doctor. Their ages ranged from 25 years and over. The men agreed freely to be examined and treated. However, there was no evidence that researchers had informed them of the study or its real purpose, and no informed consent was obtained (CDC, 2009). In 1929 the U. S. Public Health Service entered into a cooperative demonstration study with the Julius Rosenwald Fund, state and local department of health in a control of venereal disease is six southern states, Macon County Georgia being one of them (U.S. Department of Health, 1973). The study disclosed a high prevalence of syphilis 35% in the Macon County survey (U.S. Department of Health, 1973). A report issued in 1932 indicated a satisfactory clinical outcome in 35% of untreated latent syphilitics (U.S. Department of Health, 1973). After these studies little was known regarding the latent stages of the disease especially pertaining to its natural course and the epidemiology of late and latent syphilis (U.S. Department of Health, 1973). Thus the Tuskegee Study was born.
This was a combination case control study; there was a diseased and a non-diseased group and looked back at possible risk factors (Jekel, 2007). It was also a prospective cohort study; they followed the men to see what would happen with the progression of the disease, as well as looking at new cases during the study (Jekel, 2007). The Tuskegee Study was meant to understand the spread of syphilis and better examine its effects on the human body. To best examine this, government researchers found it most desirable to not only have a high concentration of syphilis in a given area; they wanted a high concentration of untreated syphilis (Maze, n.d.). Macon County met the criteria.
It was thought that white men suffered from neurological damage and black men suffered from cardiovascular disease as a result of syphilis (Maze, n.d.). At the time of the study there was no cure for syphilis. There was never any intention of curing the subjects of the disease. The information that researchers wanted to examine could only be gathered during an autopsy.
During the initial study subjects were crudely treated with arsenic, bismuth, neoarsphenamine, and mercury in small amounts that made no difference (Maze, n.d.). This treatment stopped due to lack of funding. They were given pink aspirin and an iron tonic thereafter (Maze, n.d.). Even after penicillin became the standard cure in 1947 the subjects were not treated. Some men went blind and insane from advanced syphilis, the doctors withheld treatment, remaining committed to observing their subjects through to the predetermined end point, autopsy (Thomas, 2000). To ensure that their families would agree to this final procedure, the government offered burial insurance, the most was $50.00 to cover the cost of a casket and grave (Thomas, 2000).
The results of the study was the natural history of the disease was studied, 28 men died from syphilis, and 100 were dead due to complications from syphilis (Engineering, 2006). No comprehensive report was ever published, although the study was published in medical journals for 40 years without protest from the medical community (Gray, 1998). The final report concludes that, due to a shuffling of subjects between the control and syphilitic groups and the fact that most subjects received treatment for their disease outside of the study, the study was worthless scientifically (Maze, n.d.). It was concluded that black and white men responded the same when infected with syphilis (Maze, n.d.). Without letting anybody affected know what was going on, the U.S. government effectively agreed to let the residents of Macon County die (Maze, n.d.). The study should have adhered to the original design by Dr. T. Clark and the men would have received the treatment that was being used for syphilis during that time. In 1947 all of the men should have received treatment for syphilis. The study subjects should not have been moved from one group to another to maintain the integrity of the study. These men should have been treated and released from the study. The integrity of the entire study must be questioned.

References
CDC. (2009, February 12). Retrieved September 19, 2010, from http://www.cdc.gov/tuskegee/timeline.htm
Engineering, N. A. (2006, July 20). Case Study 3: The Tuskegee Syphilis Study. Retrieved September 21, 2010, from
Gray, F. (1998). The Tuskegee Syphilis Study. Retrieved September 20, 2010, from http://www.history.ucsb.edu/faculty/marcuse/classes/33d/projects/medicine/The%20Tuskegee%20Syphilis%20Study.htm Jekel, J. F. (2007). Epidemiology, Biostatistics, and Preventative Medicine (3rd ed.). Philadelphia: Saunders Elsevier.
Li, A. Z. (1997, December 8). Tuskegee Study. Retrieved September 20, 2010, from http://www1.umn.edu/scitech/tuskegee.htm.
Maze, D. (n.d.). Human Experimentation on the Web. Retrieved September 24, 2010, from http://www.mit.edu/~dmaze/human_experimentation.html McCalmont, T. M. (2009, September 2). eMedicine. Retrieved September 20, 2010, from medicine: http://emedicine.medscape.com/article/1053426-overview
National Archives. (n.d.). The National Archives. Retrieved September 26, 2010, from http://www.archives.gov/
Thomas, S. B. (2000, February). The Body. Retrieved September 19, 2010, from http://www.thebody.com/content/art30946.html U.S. Department of Health, E. a. (1973, April 24). Final Report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel. Retrieved September 24, 2010, from http://biotech.law.lsu.edu/cphl/history/reports/tuskegee/re port1.pdf