Elizabeth Reynolds
Writing 5
Essay One Assignment: The Tuskegee Study

Free at Last: the Center for Disease Control Ends and Ethical Research Practices Begin

During the forty year Tuskegee Study, the government overstepped its duties and infringed on innocent African American lives. Researchers in Macon County, Alabama started this study in 1932 in order to examine the effects of untreated syphilis in African American men. The study began with 399 subjects with the disease and 201 without it; by the time the research was halted in 1972, over one hundred of the men had died (Jones 2). One government organization involved in this experimentation acted particularly irrationally: the Center for Disease Control (CDC). The CDC knew exactly what was going on with the Tuskegee Experiment and understood that the subjects were being denied treatment. However, the CDC never questioned the morality of their experiment. Furthermore, the director at the time, Dr. David Sencer, was an advocate for continuing the research. Even when Dr. Irwin J. Schatz, staff member of the Henry Ford Hospital, first sent his letter to the CDC objecting to the Tuskegee study in 1964, Dr. Sencer allowed the CDC to set the letter aside and pretend it did not exist. When another opponent of the study, Peter Buxton, started his 1965 investigation of the study, Sencer’s first concern was not that the CDC was acting unethically, but that the CDC would get bad press (Jones 190). Clearly the CDC was not actually focused on the welfare of unhealthy Americans, but was instead corrupt and self-serving. This organization was primarily political and secondarily medical.
To prevent inhumane research experiments like the Tuskegee Study from occurring on American soil again, the CDC needs to be completely dissolved. The CDC’s main focus is medical research. However, it is redundant for the United States government to have two organizations, the CDC and the National Institutes of Health (NIH), both conducting research. Research projects previously performed by the CDC would simply transfer over to the NIH. If the CDC were eliminated, its responsibilities could also shift towards state health departments, under the supervision of the Association of State and Territorial Health Officials (ASTHO). As shown by its involvement with the Tuskegee Study and other inhumane experiments, the CDC is completely incompetent and it has disgraced itself. This is exemplified by the CDC’s website, which even today is still involved in a cover-up as it fails to portray accurate and unbiased information. The website’s official timeline of the Tuskegee study does not include events that reflect badly on the CDC; for example, the fact that the CDC coerced subjects into getting painful spinal taps in 1932 is not mentioned. Not only does the CDC engage in unethical human research projects, but the organization also struggles to fulfill its goals that could be successfully achieved in the private sector or with other organizations. Disbanding the CDC would be a step in the direction of eschewing unproductive government programs and limiting the entire scope of our federal government.
Unethical experimentation still takes place today at the hands of the CDC. Clinical trials for the drug tenofovir in Thailand is an example of a pending human subject research project, which the CDC is having trouble subduing. In these placebo-controlled clinics, half the subjects will be given tenofovir to prevent HIV spread through injection drug use, and half the patients will not be treated. Jintarkanon, of the Thai Drug Users Network, et al. explain that none of the subjects “will receive the most effective prevention tool that currently exists: clean needles and syringes” (par. 2). The CDC acknowledged that it is unethical to deny these Thai subjects the best available treatment. However, distributing clean needles and syringes is not an option for the CDC because it is against U.S. government policy. Therefore, their solution is to create an advisory board and have the final design for the study go through three U.S. government ethics boards. This solution provides no room for community involvement or say in whether or not these trials should be preformed (Jintarkanon et al., par. 6). While a private organization would have the option of sending syringes and needles, the CDC keeps all of the decision-making under government control and ignores public opinion. The fact that nongovernmental voices are left out of the evaluation of the trials leaves more room for corruption and unethical behavior.
In addition to not properly policing unethical research, the CDC also knowingly funds questionable studies. . It is important to note that the money the CDC puts towards controversial experimentation comes from American tax dollars. Marcia Angell M.D, the first woman to serve as editor-in-chief of the New England Journal of Medicine, describes an example of a CDC sponsored experiment that is very similar to the Tuskegee Experiment in her editorial, “The Ethics of Clinical Research in the Third World”. In 1997, the CDC sponsored a placebo test in third world countries to study HIV positive pregnant women. At the time, the drug zidovudine was known to be a successful means of preventing vertical transmission of HIV from infected mothers to their babies. However, the majority of the women in the study were denied antiretroviral treatment (Angell). Denying these pregnant women harms both the women and their babies. According to U.S. Sen. Carol Moseley Braun, because of this experiment, “at least, 1,000 children will suffer and may die unnecessarily from HIV” (Strausberg). The CDC knows the infected mothers will pass along HIV to their babies; yet, the organization is doing nothing productive to stop it. It is ironic that the CDC explicitly outlines on its website that one of its goals is to “Prevent infectious diseases and their consequences among infants and toddlers”. This is a perfect example of how the CDC goes against its principals and then cannot even recognize its own failings. Clearly the CDC could very likely continue to fund this kind of non-therapeutic human research, just as it did with the Tuskegee Syphilis Experiment. Once again, the CDC took advantage of average Americans for the sake of unprincipled scientific experimentation.
One could argue that eliminating the CDC would be an unwise decision, causing a decline in the general health of the American population and the world. Researchers, scholars, and students depend on the CDC and its detailed website for information on infectious diseases, emergency preparedness, and environmental health among other things. The elimination of the CDC would be sudden. This would force people to turn to new sources for health related information. As for research, it is possible that unethical research could still take place within the state governments, even with the CDC gone. While state governments are not as remote and bureaucratic as the federal government, there is still room for corruption and human subject research. In addition, the CDC partakes in many humanitarian efforts to improve health conditions in developing nations. For example, the CDC recently led a program in Patna, India that vaccinated impoverished children. There are now 650 vaccination centers set up around the Indian state of Bihar thanks to the CDC (World Wide Web site for The Center of Disease Control and Prevention). Without the CDC, major global health efforts could be more difficult to execute and fund.
Nevertheless, the CDC’s work is repetitive and could be carried out in other ways. In other words, the organization is obsolete. A major component of what the CDC does is research, and the United States already has another governmental organization entirely focused on medical research, the National Institutes of Health. Therefore, the research formally done by the CDC could be transferred over to the NIH. In addition, the NIH uses 80 percent of its funds for grants given to more than 325,000 researchers from the top universities, medical schools, and research institutes in the country (World Wide Web site for the National Institutes of Health); this means the CDC’s research could also be completed by independent researchers receiving government money.
A second objective that the CDC focuses on is promoting healthy living among Americans. This includes nutritious eating, good exercise habits, sexual health, smoking prevention, and other healthy lifestyle choices. This responsibility of informing the average American of how to stay healthy would shift towards doctors and teachers. Doctors could put more of an emphasis on basic health habits when treating patients. Health classes in elementary and high schools, which are mandatory for the public school system, would continue to supplement this.
State and county health officials would benefit from the elimination of the CDC. This would be an opportunity to redistribute the power and responsibility from the centralized federal government to the individual states. Each state’s department of health would perform the jobs of the CDC but at a smaller scale. This way, the state departments of health could focus on statewide issues and connect more with the people they serve. A nonprofit organization, The Association of State and Territorial Health Officials (ASTHO), would be the means of collaboration and consultation among the various state health department officials. ASTHO has had success in the past with the ProStep Rebate Program, a campaign for smoking prevention. In February of 1993, Lederle Laboratories donated two million of its ProStep nicotine patches to ASTHO to be distributed to heavy smokers (Starr). The spokeswoman for Lederle, Pat Fiaschetti, expresses her trust in ASTHO to address the issue of nicotine addiction by using this smoking-cessation product:
We have left the determination of who would get the free ProStep up to ASTHO and its state offices, because they know better than anybody else who in their areas need it and qualify for it. Some states will say that they are going to try to primarily target lower-income people who might not have access to it. Some might try to target mothers who have just given birth and who really should be getting off nicotine. (Starr)
Starr emphasizes how state health officials understand their constituents and the problems facing them much better than federal health officials do. The handoff of responsibility from the federal government to state governments would lead to more community involvement in health related decision-making. If the CDC were successfully eliminated, our country would reap many benefits. Our tax dollars could be used for other purposes, like helping relieve the deficit. Getting rid of the CDC would also give more responsibility to individual states. This would improve human relations between the government and average Americans. If states are in charge of government health research, then they can conduct experiments that their constituents request, and address the issues their constituents are worried about. The state government is more likely to care about their people than the federal government is. In addition, dissolving the CDC would help prevent sadistic experimentation, especially on human beings, from happening again. There would be more transparency and accountability when the decision-making is occurring close to home instead of in a distant governmental office at the CDC headquarters. Getting rid of the CDC would also lead to less lobbying of drug companies. Drug companies can greatly impact health care legislation and persuade government workers to put the company’s best interests first. However, it is a lot more difficult for large drug manufacturers to lobby individual state governments versus one overarching government organization. While it is not possible to control nongovernmental health studies, the risk of government-run experiments like the Tuskegee Experiment would be greatly reduced if the CDC were dissolved.

Works Cited
Angell, Marcia. "The Ethics of Clinical Research in the Third World." The New England Journal of Medicine 337.12 (1997): 847-49. The New England Journal of Medicine. Massacusetts Medical Society. Web. 6 Oct. 2009.
Jintarkanon, Seree, Supatra Nakapiew, Nimit Tienudom, Paisan Suwannawong, and David Wilson. "Unethical clinical trials in Thailand: a community response." The Lancet 365.9471 (2005). Science Direct. Web. 6 Oct. 2009. <http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4G4F8Y7-M&_user=4257664&_coverDate=05%2F13%2F2005&_alid=1037285173&_rdoc=2&_fmt=high&_orig=search&_qd=1&_cdi=4886&_docanchor=&view=c&_ct=3&_acct=C000022698&_version=1&_urlVersion=0&_userid=4257664&md5=457fe5f1aa312432b5d14602566d7e63>.
Jones, James H. Bad Blood. 2nd ed. New York: The Free, 1993. Print.
Starr, Cynthia. "ProStep rebate program dashes smokers' last excuse." Drug Topics 3 May 1993. ProQuest. Web. 7 Oct. 2009. <http://proquest.umi.com/pqdlink?Ver=1&Exp=10-06-2014&FMT=7&DID=779581&RQT=309>.
Strausberg, Chinta. "U.S. Funded Experiment Unethical." New York Beacon 15 Oct. 1997. ProQuest. Web. 6 Oct. 2009. <http://proquest.umi.com/pqdweb?index=0&did=482668571&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1254863831&clientId=4347>.
United States. Center for Disease Control and Prevention. Department of Health. Health Protection Goals. Atlanta, 2009. Web. 6 Oct. 2009. <http://www.cdc.gov/osi/goals/>.
United States. Center for Disease Control and Prevention. Department of Health. Healthy Living. Atlanta, 2009. Web. 7 Oct. 2009. <http://www.cdc.gov/HealthyLiving/>.
United States. Center for Disease Control and Prevention. Department of Health. Tool Helps Vaccinate India's Urban Poor. Atlanta, 2009. Web. 7 Oct. 2009. http://www.cdc.gov/news/2009/08/india_vaccination/.
United States. National Institutes of Health. Department of Health. NIH Budget. Bethesda, 2009. National Institutes of Health. Web. 6 Oct. 2009. <http://www.nih.gov/about/budget.htm>.