50 Years After the Tuskegee Revelations: Why Does the Mistrust Linger?

The COVID-19 pandemic proved that mistrust of the government's public health efforts stems not only from manipulated political anger toward federal policies but also from personal and collective memories of medical and public health experiences.1Fifty years ago this past July, media outlets across the country reported that between 1932 and 1972 the US Public Health Service had been conducting an experiment in and around Tuskegee, Alabama, to study, but not treat, hundreds of African American men who had the noncontagious stage of latent syphilis.2 Throughout its 40year history, the government doctors lied to the men, telling them over and over again they were being treated for an unspecified sickness called "bad blood" that might or might not be syphilis. Many of the men had their lives shortened, and scores died from not being treated. Although they were supposed to be at the noncontagious stage, many passed the dangerous disease on to their sexual partners, wives, and children.3 After 1972, "Tuskegee" entered our public health and medical vocabulary as a metaphor for racism in medical research and public health practices.After the Tuskegee Study was disclosed to the broader public, the efforts to acknowledge it and provide reparations began.4 The case demanded litigation. Fred Gray, the iconic Alabama civil rights lawyer who represented Rosa Parks and Martin Luther King during the Montgomery bus boycott, filed and settled a lawsuit that gave modest sums to the surviving subjects, controls, and the families of the deceased. In addition, the Center for Disease Control (later renamed Centers for Disease Control and Prevention) provided medical care, then health care, for any issues to the remaining men and any of their wives and children who had contracted syphilis. A badly flawed federal report followed, evaluating some of the research malpractice embedded in the Tuskegee Study. Several years later, knowledge of the Tuskegee Study was instrumental in pushing the government to establish guidelines that require the principles of justice, beneficence, and respect for persons in federally funded human participants' research.