Thursday, June 23, 2011

Book 50: Bad Blood

Bad Blood: The Tuskegee Syphilis Experiment by James Jones

I had heard of the Tuskegee Syphilis Experiment at some point in school, but only knew very broadly what had happened: white doctors experimented on black men and let them die of syphilis in the '30s. What I didn't know is that the experiment continued into the '70s, or how it even came to be.

Jones does a very good job of telling the story behind the experiment, and what led to it. He doesn't even necessarily judge the doctors himself, letting their actions speak for themselves and also demonstrates how they rationalized the experiment to themselves. Jones begins with the history of racism in medicine, and goes back to the times of slavery. At that point, many believed that diseases affected blacks and whites differently but despite this the doctors used the same treatments for slaves as for their masters. After the Civil War, many whites thought that blacks would die out due to their death rates which could be directly traced to their living conditions. Some used this to show that blacks were inferiors to whites, while others realized that anyone in these conditions would face similar challenges. As a result, public health officials focused on education within poor and black communities. In the early 1930s, public health officials were in Macon County, Alabama to test for syphilis and were surprised by the rather significant rates of syphilis among the population. It was around this time that their funding for treatment (which still involved mercury and a year long succession of shots) was cut due to the Depression. One of the doctors determined that since the population couldn't be treated and wouldn't look for treatment on their own anyway, it was the perfect setting to examine the affects of syphilis, intending to observe a group of men for a period of six months or so. It is easy to see the justification here: the money wasn't there, the patients wouldn't have been able to afford treatment on their own, and it would only be short term. However, the doctors didn't straight up tell the patients what was being done to them/what they were being used for. Many believed they were receiving treatment. The doctors may argue that they had told the patients they were being examined because they had bad blood, believing it to be local slang for syphilis, but that wasn't quite accurate. Bad blood could be used to refer to a number of conditions, basically boiling down to ill health.

Additionally, after the six months were up, other doctors wanted to continue the experiment, believing it to be a one time opportunity to view the affects of syphilis on blacks (they still believed it affected blacks and whites differently). In order to do this, they involved medical professionals throughout the community, and made them promise not to treat the men in the group. In fact in later years, others would come down to treat syphilis in the area (during WWII, for example), but these men were not given treatment. Even when penicillin, a more effective treatment was developed, the scientist continued to deny the men help or tell them what was really wrong with them. Additionally, the whole experiment was flawed to begin with: one of the organizations that agreed to sponsor the original six month experiment said that all the men must be treated. The doctors gave all the men at least a few shots of the mercury, not enough to actually cure the disease, but enough to make the argument that this was a study of completely untreated syphilis invalid.

When the story finally broke, it invited comparisons to the Nazis, and with a few other cases that were making news, really made people wonder about patient rights and consent. I had actually heard of this book in particular from the bibliography of The Immortal Life of Henrietta Lacks, and both of these books refer to a scientific experiment that involved people being injected with cancer cells (without their knowledge) to see what would happen. This is a later edition of the book, so it also includes a chapter about AIDS and the publics' reaction to HIV and AIDS. The book was educational, and very well researched. My one complaint is that the series of doctors really aren't that distinguished from each other, so there were basically a lot of names thrown out but I really couldn't say which one was involved in the experiment in which way at this point. Then again, that helps to show just how much bureaucracy there was in this whole process, and how a series of men who didn't see conflict between this experiment and their oaths as doctors.

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