5/25/2022 0 Comments the deadly deceptionSyphilis was a disease that garnered much attention at various points in history, especially in the 1930s and 1940s. The attention faded after penicillin was pushed as a viable treatment for this infectious disease. Syphilis is unfortunately another example of the “panic and neglect” (Chen 2021) cycle that the United States rotates through. Currently, the United States is experiencing another resurgence of syphilis, when formerly, health officials were certain that it could be eradicated. In 2019, 129,813 cases of all stages of syphilis were reported in the United States (CDC). This is a significant jump from previous years and a cause for concern especially in populations that are disproportionately being impacted, such as men compared to women, Hispanics, and Native American communities. Left untreated this spiral-shaped bacteria that is the causative agent of syphilis can live in the body for decades and cause blindness, mental illness, heart issues, and nervous tissue and brain damage. It is largely spread through intimate contact in the first weeks and months of contracting the infection. Early infection symptoms include rashes, headaches, flu-like symptoms, and chancres on genitalia can occur. In light of the current resurgence, it is important to take a look at the spotted history of syphilis in the United States.
In the first few decades of the twentieth century, syphilis was known as “bad blood.” Despite the poor euphemism, public health scientists and medical professionals saw syphilis as something they could potentially have an impact on. There was a clear cause of syphilis and they knew how it could spread, but they wanted to know more especially as it pertained to the disease progression and how it might impact people differently. Some proposed to study whether it was the same disease in Blacks and Whites, based on the assumption that Blacks were more genetically susceptible. It was also assumed not to be deadly for Black people. In Alabama, the Tuskegee Study of Untreated Syphilis in the Negro Male began in 1932. Of the 600 black men that were involved in the study, 399 had syphilis. Of significance was the fact that the men involved had no idea that they were a part of a research study. Informed consent was not obtained by public health officials, who lured test subjects with the promise of free treatment by government doctors. Instead of treating the men, government doctors and researchers proceeded to study how syphilis attacks the body by withholding treatment. The inhumane and discriminatory study was conducted in an area of Alabama in which 80% of the population consisted of Black sharecroppers only two generations removed from slavery. The promise of free treatment of this highly stigmatized disease appealed to an impoverished populus with high numbers of infant mortality. Vulnerable populations were not at liberty to question government officials. “Treatment” began with a blood draw to confirm syphilis infection and revealed 30% of black men in the region had contracted the disease. Test subjects were given placebo treatments and even spinal taps under the guise of treatment, when in reality they were being monitored for progression of the disease. A study that was intended to last 6 months lasted for years, retaining subjects with the help of nurse liaison Eunice Rivers. She solicited the test subjects for ‘treatment’ and coordinated further visits. Dozens of men died and were autopsied to determine the extent of the internal pathology of the disease. Test subjects were offered a $50 life insurance policy as an incentive to stay with the “treatment” program. This meant a proper burial for an individual whose family would not likely have the resources to provide. Government employees went to great lengths to prevent the men in the study from getting real treatment. They went as far as appealing to the draft board to exclude their patients from treatment by the military during the war effort. Consequently, the men involved in the study lived with syphilis untreated unknowingly for decades with untold pain and suffering all while penicillin was proven to be a highly effective treatment. Eventually, certain individuals in the medical community spoke out and proposed that the men in the study should be treated and reveal the true nature of the study. This occurred 30 years after the study began. The story broke out in the media and the government launched an investigation. The men discovered their role and lawsuits were filed. Each participant was given a $30k settlement, meager consolation for what they had endured. Despite the the adoption of the Nuremberg code in 1947 and the discovery of the horrendous experimental studies performed on the Jewish community by German Nazis, the Tuskegee scientists, doctors, and government employees did not see their research as unethical. Doctors such as John Cutler would defend their actions claiming a contribution to the greater health of the Black community. John Cutler and others defended their actions even though nothing of scientific value was discovered through the duration of the study. There was also no evidence suggesting that syphilis differs in humans from race to race. Perhaps we have made some progress from the days of the Tuskegee study. The Hippocratic Oath to Do No Harm is brought to the forefront of our minds and extended to maximize good. Since then, more regulations are in place and enforced for the protection of experimental subjects, particularly with regards to informed consent. The Tuskegee study demonstrates the dangers of prejudice, racism, and bias in scientific studies. The distrust that this study fueled for White medical professionals still lives on today in the Black community. The lasting impacts have not yet healed. Perhaps the resurgence presents an opportunity to provide thorough, reliable, health care, especially to vulnerable communities experiencing outbreaks. Building new trust with impoverished communities will require populations to experience positive outcomes in the treatment of their illnesses and good will from their health professionals.
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