Transcript Tuskeegee - Engineering

Tuskegee Syphilis Study
Leading Up To
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Antebellum Health Care
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Plantation owners valued employees
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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
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“Doctrine of innate racial differences” p12 LaVeist
Leading Up To
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After Civil War
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Federal Government set up the Freedman’s Bureau
in 1865
By 1868 all but one had closed
Night riders
No care for freed slaves
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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
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Restrict Black physician education
Limit community control over hospitals
Exclude Black physicians from practicing with White
physicians
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."
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Leading Up To
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1900-1920s
Physician education was reformed; upper
class, white, male profession
 1900 seven medical schools educated
Black physicians
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By 1920 on 2 remained; Howard and Meharry
 Main source of Black physicians until 1960
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Fear of Black physicians and encouraged
community to keep separation
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Flexner Report confirmed separation
Provident Hospital and Training
School, Chicago
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Leading Up To
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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
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Separate but equal facilities in Health Care
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
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1930s and Incidence of Syphilis
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1934 for Black Adults
17,700 deaths from syphilis
 500,000 new cases each year
 Predicted that 7 million would get the
disease
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Discrepancy between case in Blacks and
Whites so concluded
Dermatological Cause
 Hereditary
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Addressing the concerns
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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
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T88
Addressing the concerns
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Rosenwald Fund
1929 in conjunction with the United States
Public Health Service
 Three goals
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Provide health programs for southern Blacks
 Provide key positions for Black health
professionals
 Support medical education and training
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Addressing the concerns
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Rosenwald cont’d
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Established syphilis treatment programs for rural
blacks
One was in Macon County AL
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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 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 experiment by
Jones, J (1993)
The Players
Tuskegee Institute- medical facilities
 Eunice Rivers- nurse
 Macon County physicians
 USPH service, AMA and the medical
community
 Men of Macon County
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Tuskegee Institute
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Dr. Dibble agreed for the facility to
provide medical services
Blood Test
 Spinal Taps
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In return, the physicians at Tuskegee
involved, would be given co-authorship
on any publications as the result of the
research
Eunice Rivers
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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
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Asked all the physicians, both black and
white, not to treat those men involved in
the study
US Public Health Service
Precursor to the current CDC- Center for
Disease Control
 Money and personnel provided
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Men of Macon County
Selected 400 men with syphilis
 They were told that had “Bad Blood”
 They were given:
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NO medication
 Spinal taps
 Blood test
 $50 toward burial expenses
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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
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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
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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?
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Responses
Tuskegee Institute
 Nurse Rivers
 Medical Community
 PHS
 Lawyers
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National Apology
May 16, 1997
 President Bill Clinton offered a formal
apology—25 years after the conclusion
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After Tuskegee
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1989– vaccine on Black and Latino children;
parents not informed
 Polyheme Blood substitute
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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