In 1932, the United States Public Health Service (USPHS) initiated an experiment entitled “Study of Untreated Syphilis in the Negro Male of Macon County, Alabama,” also called the Tuskegee Study, to determine the natural course of untreated latent syphilis in African-American males.

The trial included 399 syphilitic men, as well as 201 uninfected men who served as control population. The first published report on the study appeared in 1936, and subsequent articles were published every four to six years until the 1960s. In the early 1950s, when penicillin became widespread as the preferred treatment for syphilis, the men participating in the study did not receive therapy. In fact, on several occasions, the USPHS attempted to prevent treatment by other sources. In addition, a committee of the Center for Disease Control, operated by the U.S. federal government, decided in 1969 that the study should continue.

The prevailing scientific thinking about race and heredity in the early 20th century is crucial to understanding the Tuskegee Study. This particular configuration of ideas, assimilated to social Darwinism, formed the core of medical opinion about African Americans, sex, and disease in the early 20th century: it was argued that essentially “primitive” peoples could not assimilate into a complex white civilization. Under this conception, the African-American population was especially prone to disease, vice and crime. Their sexual desire was considered excessive and their brains underdeveloped. The medical profession supported these conclusions of the anthropologists, ethnologists and biologists of the late 19th and early 20th centuries. According to these physicians, lust and immorality, unstable families, and “barbaric tendencies” made African Americans especially prone to sexually transmitted diseases.

The USPHS determined that Macon County, Alabama, in which the city of Tuskegee is located, had the highest rate of syphilis of the six counties surveyed for this purpose. The assumptions that the conditions in Tuskegee existed “naturally” and that men would not receive treatment anyway provided the rationale for the experiment: these two assumptions were based on prevailing medical attitudes toward African Americans, sex, and disease.

Modern medicine has always considered it a principle never to perform an experiment on a human being that could be unnecessarily harmful in any way to his/her integrity, no matter how valuable it may be for science (at least without the informed consent of the subject). This principle and others were typified in the Nuremberg Code (1947), when the military tribunals that judged the crimes against humanity perpetrated by Nazism exposed the atrocities of the medical experiments carried out by the Nazis on human beings. In the United States v. Karl Brandt et al. trial, whose intervening court articulated the Nuremberg Code as part of the verdicts, official representatives of the American Medical Association (AMA) clearly suggested that experiments such as the Tuskegee Study were unacceptable practices in the United States and throughout the world. However, the study continued even after the Code and its provisions had become widely disseminated in the scientific community and the general population. Other codes of ethics for scientific research that arose out of the need to expand and complement the Nuremberg Code include the Declaration of Helsinki (1964), the AMA’s Ethical Guidelines for Clinical Research (1966), and the American Psychological Association’s code (1972), all of which were developed and disseminated while the Tuskegee Study was still active.

A July 26, 1972 article in the New York Times reported nationally and for the first time on the study, citing it as “the longest non-therapeutic experiment on human subjects in the history of medicine.” At that time, seventy-four of the test subjects were still alive and at least twenty-eight (although there is speculation that the actual number would be over one hundred) had died directly from advanced syphilitic lesions. On August 28 of that year, following press reports, the Department of Health, Education and Welfare (DHEW) formed the Tuskegee Syphilis Study Ad Hoc Advisory Panel in response to criticism provoked by press descriptions of the experiment. The nine-member panel (five of whom were African American) focused on two issues: first, whether the study was justified in 1932 and whether the men had given informed consent, and second, whether they should have been given penicillin when it became available in the early 1950s. The group was also tasked with determining whether the study should be terminated and to evaluate current policies on human experimentation. The Department of Health, Education and Welfare did not stop the experiment until November 19, 1972, and even then it did only due to adverse reaction among the public. The Advisory Panel published its report seven months later: it found that the study had been “ethically unjustified” and argued that the men should have been given penicillin. However, the DHEW investigation failed to mention a crucial fact: that the men participated in the study under the impression that they were or would be treated. Moreover, during the forty years of the experiment, the USPHS attempted on several occasions to ensure that the subjects did not receive treatment from other sources.

In 1974, as part of the settlement of a class action lawsuit filed by the National Association for the Advancement of Colored People (NAACP) on behalf of study participants and their descendants, the U.S. government paid $10 million and agreed to provide free medical treatment to surviving participants and surviving family members infected as a result of the study. The US Congress also created a commission empowered to draft regulations in order to prevent similar abuses from occurring in the future.