U.S. Public Health Doctors Withheld Penicillin From Syphilitic Black Men for 25 Years After It Worked

In 1932, the U.S. Public Health Service began a study in Macon County, Alabama, to track the natural progression of untreated syphilis. The Public Health Service enrolled 600 Black men — almost all of them poor sharecroppers — at the Tuskegee Institute. Of the 600, 399 were diagnosed with latent syphilis; the remaining 201 served as a control group. The men were not told they had syphilis. They were told they were being treated for "bad blood," a common rural euphemism that could mean anything from anemia to fatigue. The study's incentives were free medical exams, free meals on examination days, and burial insurance.

The original protocol was supposed to run six months. It ran for forty years. In 1947 penicillin became the established cure for syphilis. The Public Health Service decided not to interrupt the study to treat the participants and explicitly worked through local doctors and the Macon County draft board to ensure that subjects who tried to get penicillin from other providers were turned away. By the time the study was exposed in 1972, of the 399 syphilitic men, 28 had died directly of syphilis and roughly 100 from complications; about 40 of their wives had been infected, and 19 of their children were born with congenital syphilis.

The ending came from a 29-year-old PHS venereal-disease investigator named Peter Buxtun, who had argued internally for years that the study was indefensible and was repeatedly told to stand down. He leaked the documents to a journalist friend at the Associated Press. The story broke in the Washington Star on July 25, 1972, and the New York Times the next day. The study was halted within months. Federal regulations on informed consent in human-subjects research — the IRB system, the Common Rule — are direct legacies of it. President Clinton issued a formal apology to the survivors and their families in 1997.