 Unethical human experimentation can conjure up the images of horror and pain inflicted by Unit 731 or Dachau or Auschwitz during the Second World War. But although Germany and Japan were the most well known for their inhumane experimentation during the early to mid 20th century, they were most certainly not the only perpetrators of suffering in the name of scientific discovery. Other experiments on humans have taken a much more subtle route than that of the Axis powers, running in democratic western countries, preying on the poor, racial minorities and or prisoners. The experiment orchestrators would draw in potential subjects by offering free medical help and or financial incentives. Such an experiment between the 1930s and 1970s would cross the line well into an unethical study. And although not as blatantly gruesome as a vivisection on a subject, would actively hide the diagnosis of a debilitating disease and withhold treatment from its victims all to find out how a person would succumb to said illness. The experiment orchestrators would draw in potential subjects by offering free medical help and or financial incentives. Not only that, but the disease in this study, syphilis, which not only can be deadly, is also easily transmissible from sexual contact with an infected person, even being able to be passed on from mother to unborn child. Today we are looking at a truly dark page in infectious disease study, the Tuskegee syphilis experiment. As such I'm going to rate it here 9 on my ethical scale, although it didn't have as many victims, this is most certainly up there with the lobotomy. It is 1932, an enrolment has begun on a new study. The participants are all African American males from impoverished backgrounds. They have been convinced to become participants by the promise of free lunches, transportation and medical care. The initial groundwork for this enrolment came from an earlier study funded by the Julius Rosenwald Fund and conducted by the US Public Health Service during 1928. It took place over 6 counties in Alabama USA and highlighted hotspots of syphilis infections in Macon County in the town of Tuskegee. The aim of the Rosenwald study was to find a population perfect for an attempt of mass treatment for the debilitating disease, and the largely African American inhabitants of Tuskegee seemed like the ideal test bed. It was estimated that around 36% of the 27,000 residents in Macon County were infected with syphilis. Giving the area a syphilis prevalence among the greatest in the United States. The funding for mass treatment would never come, as it was widely thought at the time that syphilis affected different races in different ways and could often remain dormant in African Americans. Most bizarrely it was also thought that at the time African Americans would not even want to seek treatment even if offered. Needless to say these assumptions were wrong, this distorted view was influenced by the racial segregation laws of the time which made African Americans essentially second class citizens in the southern states. Mass treatment was also not considered due to a lack of funding, as by 1929, Post-Wall Street Crash, money was not available, especially for a largely impoverished African American population. With no state matching funding, the Rosenwall Fund also withdrew its money for the treatment program. The report into the findings of the 1928 investigation was written by Public Health Service Officer Dr. Talefero Clark, but with no government funding, the project found itself at a dead end. With no funding to treat the ill, Dr. Clark found that the results provided an unusual opportunity for observation of the disease. By 1932, Clark thought that the results of the Rosenwall study merited a revisit and he began preparing to find test subjects for a long-term observation into the progression of syphilis in African American males. The new study would be considered by the Public Health Service as a classic study in nature rather than an experiment. So either way you looked at it, the participants would be observed and actively not treated for the disease. The key for the experiment to work was that the subjects would not know that they are infected and thus not seek treatment, as this would affect the results. The justification for this again was in the racist theory of that the African Americans wouldn't seek medical help anyway, so misdiagnosing wouldn't make any difference to the participants. Dr. Clark sent a Raymond H. Vondler to Tuskegee to act as the on-site director. The plan was to find syphilic males between the ages of 25 and 60 and was to initially last for around 6 months. Initially low, Vondler found it hard going trying to find test subjects. Amongst the men, screened only 20% had been infected and an even lower number still who had not sought out any kind of treatment. Those who had not received treatment were initially unwilling to volunteer for the study, but Vondler discovered that if free medical care was offered then the subjects would be more than willing for participation. As part of Vondler's plan to win the trust of the local community, employed Tuskegee Institute nurse Eunice Rivers. Tuskegee would become a vital point of contact for the US public health service and the local population. This ironically went against the original thinking that African American males would not seek out treatment. Kind of scuppering the justification for the study. But that didn't get in the way for the US public health service. Unaware that it was an experiment, many of the participants thought it was a mass treatment program linked to the earlier Rosenwald study of 1928. This misunderstanding was not corrected, helping Dr. Vondler gain the trust of many subjects. In total around 4,000 men were lured in to be screened for tertiary syphilis, resulting in 399 positive test subjects being convinced to take part in the study. 201 males were also enrolled as a control group who had not contracted the illness. To not raise suspicion of the infected participants, the control group was also administered useless medications and if any later contracted syphilis they would be transferred to the study group or just secretly dropped. All involved were told that they had bad blood, a local colloquialism for a multitude of conditions and common ailments. Eventually subjects were found and in order to be entered into the study a comprehensive examination had to take place, culminating in a spinal tap biopsy to find if any of the subjects had neurosyphilis. This was dressed up as a form of treatment for the subject's bad blood. The reason for the spinal puncture being last was twofold. One was to have the subject leaving feeling like they had received a treatment and two is that neurosyphilis can be one of the final stages of the illness. Once infected persons were found the intention was to not tell them of their condition and instead only offer placebo or other useless treatments for the symptoms caused by the syphilis. This allowed the doctors to concede that the participants were ill, all without actually making them aware of their real diagnosis. In 1933 and with contradicted assumptions on whether African Americans would seek out treatment the study was allowed to continue past its initial six months. The participants were given a small dose of mercury as a way to make them feel like they had received some kind of treatment. Clark and Vondela now looking at the long term wanted to see what would happen over a 5-10 year period but this would eventually last for over 40 years. But this came with a problem. You see the only need for the subjects was for a few blood tests every few years but ultimately it would be their bodies post death that would provide the most scientific value. The issue being how do you convince someone to donate their body after death to you if you are the one that is meant to be treating them. To offer an incentive for continued participation and eventual access to their body a $50 stipend was offered for their burial costs and yearly cash payments of $25 were made for any man who stayed in the study. And this continued participation was when Nurse Eunice came to be very handy. Because she was made the middleman she kept in regular contact with the participants and administered fake treatment tonics as well as arranged for transport to the Tuskegee Institute when too ill to travel. At the time, syphilis was incurable but as the 1930s drew to a close the study would take a darker turn from withholding information and effective symptom treatment to actively withholding cure. But before this I think we need to have a quick look at the disease itself and what it does to the human body. Syphilis is a sexually transmitted infection caused by the bacterium, trepanina, pallidum and subspecies pallidum. Its origin is largely unknown but its first written records of an outbreak of syphilis in Europe occurred in 1494 or 1495 in Naples Italy. The disease presents itself in four stages. Between two and six weeks after exposure, bisexual contact with an infected person a lesion is formed called a chancra. Syphilis occurs on a person's genitals but can appear on any part of the body that has come into contact with another chancra. After a few weeks if left untreated the chancra will disappear on its own and this is known as the primary stage. The next secondary stage comes along around four to six weeks after the first signs of symptoms and this part of the progression of the disease shows itself in many different ways. The most commonly manifests itself in rashes on any part of the body and other symptoms include fever, sore throat, malaise, weight loss, hair loss and headache. These acute symptoms usually resolve after three to six weeks leading to the next stage. Latent syphilis develops after secondary syphilis and it is itself divided into early latent and late latent stages. This stage develops two years after exposure, the infected person can then after a number of years develop into the fourth and final period of the disease and that is tertiary stage. The final stage can occur between three and fifteen years post initial exposure and can manifest itself in one of several ways. Gometus syphilis which is benign tumours that can appear on the body which can lead to physical disfigurement, cardiovascular syphilis which can cause heart problems, neuro syphilis which is an infection involving the central nervous system and can result in dementia, mania, psychosis, depression and even brain damage and finally meningovascular syphilis which involves inflammation of the small and medium arteries of the central nervous system. Roughly 30% of people who have contracted syphilis reach the tertiary stage. This part of the disease progression is largely not infectious to other people. The things in the 1940s would change dramatically for sufferers and like nearly everything 20th century links into the Second World War. In 1942 Alexandra Fleming successfully treated Harry Lambert's streptococcal meningitis originally thought to be a fatal condition with a new drug called penicillin. The potential use of the fungus for medicinal purposes was known as early as the late 19th century but growing enough for the fungus to actually be useful was one of its biggest hurdles. Before Fleming's use of pure penicillin Australian scientist Howard Flory later Baron Flory and a team of researchers at Oxford University had treated a policeman for an infection on his face in 1940. Sadly though the participant died when stocks of the fungus ran out. This would lead to Flory to travel to the USA to seek out a mass production which in the early 1940s was backed by the US government and by June 1942 just enough penicillin was available to treat 10 patients. With USA now involved in the Second World War the usefulness of a drug that could kill many different infections was clearly an obviously useful thing and one of these infections that were easily wiped out by the new wonder drug was the age old blight on humanity syphilis. Over 2.3 million doses were ordered for the D-Day landings in 1944. But how does this tie back into Tuskegee you might ask? Well with the country in a state of war from 1941 the US needed soldiers and as such the draft was implemented as the country's pre-war professional career military wasn't big enough to fight in the Pacific, Atlantic, Asia, Africa and Europe. Now many of these test subjects for the Tuskegee study by 1941 were well within the age range for military service and with the introduction of the draft in 1940 the study was at risk of losing some of its participants. But again you might think what is the problem? Well part of enlistment is a full medical including testing for STDs as well as the other side effect of being in the army of risking getting killed in a war. As such United States Public Health Service convinced Macron County of the scientific importance of the experiment and thus declined conscription of men who were enrolled in the study. In total some 256 of the men had their draft blocked by the Tuskegee study, not before some of them being diagnosed by the army until to get treatment which again was duty blocked locally by the study. Post-war the US government now wanted to stamp out the disease with the large availability of penicillin which was a standard treatment from 1947. Many of the men had now sought out treatment outside of the study, however an estimated 7% of the men received what would be considered an adequate dose. To keep the deception going in 1959 certificates were issued to the participants congratulating them for 25 years of service in the Tuskegee Medical Research Study. Many kept this certificate as a source of pride in taking part in a government project but even as late as 25 years post-study beginning they were kept ignorant of the true reason of their participation. The 1950s rolled into the 1960s and Nurse Eunice continued visiting the men, medicating them with use as tonics. In 1969 a CDC panel met to discuss the continuation of the study and although one doctor pushed for the ceasing and actually treating the men the experiment was allowed to continue, collecting samples from the living and autopsying the dead. But the end was on the horizon, but not from the powers at B but instead by whistleblower Peter Buxton, an epidemiologist and public health employee. He was hired in 1965 to interview STD sufferers and as part of his duties he discovered the Tuskegee study. Disgusted by this in 1966 he made an official protest to his superiors only to be instantly shut down. Again he opposed the study in 1968 and again he was shut down. With no options left in 1972 Buxton leaked the information to June Heller. This led to publication first appearing in the Washington Star. The public outrage forced the public health service to form an ad hoc advisory panel comprising nine members, via whom were African American. The panel focused on two main issues, penicillin therapy and informed consent, both of which were not present in the study and very rightly they concluded the Tuskegee syphilis experiment was ethically unjustified. Buxton's study was officially ended in 1973, however only 74 of the original participants had survived the experiment. Of the original 399 test subjects, 28 had died of syphilis, 100 died of related complications and 40 of their wives had been infected, with 19 of their children born with congenital syphilis. Needless to say this was a disgusting result and this is only an estimate as many other infections could have been spread within the community. 13 peer reviewed publications were made during the study with Nurse Eunice Rivers co-authoring many. The nurse had worked with the subjects all throughout the 40 year lifespan of the experiment, leaving her to be the longest serving member of the clinicians involved. The study failed not only on ethical grounds but also scientific ones. Participants were treated with mercury rubs, injections and bismuth, however minimally effective these treatments may have been, this completely contradicted the purpose of the experiment to track completely untreated syphilis. This led to the results completely being unreliable and essentially a complete waste of time, money and most importantly quality of life, resulting ultimately in life itself. On July 23rd 1973, Fred Gray, a civil rights lawyer filed a $1.8 billion class action lawsuit in the US District Court for the Middle District of Alabama. The lawsuit alleged multiple violations of participants constitutional rights. Unsurprisingly, this never went to trial and resulted in an out of court settlement for $10 million, netting many of the victims from between under $20,000 and over $40,000 each, free medical care for themselves and any affected family members as well as new regulations to be set out to prevent further abusive studies but nowhere near what should have been given. The racial part of the study is unavoidable and the race and social economic backgrounds of the participants were preyed upon for their continuation in the experiment. Much of the language in correspondences between the clinicians is pretty hard to read due to the way they talk about the human beings that they were actively refusing treatment for. Because of the study, trust in medical studies have been erased, especially in the African American community and many parts of the United States, which has a knock on effect in a critical underrepresentation of African American men in studies, for example, in understanding the pathology of prostate cancer, sickle cell anemia, as well as many other diseases. In an attempt to try and mend the bridge for clinical studies with different racial backgrounds, President Clinton in 1997 called survivors and descendants to the White House for a formal apology for the United States role in the study, but the legacy casts a very long shadow over clinical trials, one that will take a long time to erase, even 90 years after its beginning. The study leaves a bitter taste in the mouth as it resulted in unnecessary suffering due to the manipulation of its subjects and this is why it has a nine on my scale. But more importantly, where would you rate this study? Thank you for watching, I'm not going to lie, this one made me very sad. If you want to read more about the study, there is a great book called Tuskegee Truths rethinking the Tuskegee syphilis experiment, it's well worth a read and this video really is only a scratch of the surface for the dumpster fire that was this experiment. This is a plenty of good production, all videos on the channel are created by the Commons attribution share alike licensed, many of the videos are produced by me John in the currently average southeastern corner of London UK, help channel grow by liking commenting and subscribing, check out my Twitter for all sorts of photos and odds and sods as well as hints on future videos, I've got Patreon and YouTube membership as well so if you fancy checking them out and helping out the channel financially, you can go there. And all that's left to say is thank you for watching.