Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study (review)

Susan M. Reverby, ed. Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. Studies in Social Medicine. Chapel Hill: University of North Carolina Press, 2000. xviii + 630 pp. Ill. $69.95 (cloth, 0-8078-2539-5), $27.50 (paperbound, 0-8078-4852-2).

From 1932 until 1972, the United States Public Health Service conducted a study in which some four hundred poor black men infected with syphilis were monitored to determine the natural history of that disease. Their health was assessed regularly, but effective treatment was intentionally withheld for the duration of the study. Official reports in the medical literature repeatedly described the project as an investigation of "Untreated Syphilis in the Male Negro," but it was more commonly known simply as the "Tuskegee Study." ¹ That phrase is now used to characterize the most infamous research scandal in American history. The Tuskegee Study entered popular consciousness following a journalistic exposé and a congressional investigation in the early 1970s. Dramatic details of the Study's methods, including the inexplicable denial of penicillin therapy to infected participants after it became available in the 1940s, fueled the momentum toward adoption of extensive federal regulations designed to protect human subjects of research.

For the past twenty years, James H. Jones's classic Bad Blood: The Tuskegee Syphilis Experiment (1981) has provided most readers with a thorough and accessible analysis of the Study. Pursuing Tuskegee beyond Jones's treatment required forays into a multidimensional morass of medical periodicals, government documents, and archival materials--many of which were not easily available to scholars or the general public. By assembling this volume, Susan M. Reverby has taken some of the heavy lifting out of the task of studying Tuskegee. Tuskegee's Truths is a compendium of diverse materials that shed different kinds of light on the notorious research project. The toxic entanglement of race and science, professional prerogative and governmental power, that characterizes our memories of Tuskegee is portrayed in primary documents and scholarly commentary drawn from a myriad of disciplines. Historical analysis is found alongside records from governmental archives; journalistic reportage accompanies congressional testimony. There is drama and even poetry about Tuskegee. Reverby's selections show, as James Jones notes in his foreword, how "other people's sensibilities . . . broaden the scope of the inquiry" (p. xi).

The book is divided into ten parts. "Contemporary Background" provides an analysis of the Tuskegee community excerpted from black sociologist Charles Spurgeon Johnson's 1934 book, The Shadow of the Plantation. Johnson's title echoes in former Surgeon General Thomas Parran's 1937 study, Shadow on the Land: Syphilis describing Tuskegee's beginnings from the white, medical perspective. Other parts of the book contain academic commentaries ranging from early to very recent assessments of the study by historians Allan Brandt, Susan Lederer, Susan Smith, and Vanessa Northington Gamble; bioethicists John Fletcher and Arthur Caplan; and law professors Patricia King and Harold Edgar. Essays survey the impact of Tuskegee on the participation of blacks in the health-care system, and contemporary reverberations of the study appear in the ethical debate surrounding research on AIDS pharmaceuticals, where commentators draw parallels between drug studies in underdeveloped countries and the Tuskegee experience.

Other materials allow us to see the Tuskegee story unfold both in public and in private. In matter-of-fact, medical-journal prose a detached third-person narrator describes the role of "the nurse" as the study progressed; Eunice Rivers, both author and subject of that article, speaks in a very different voice in an interview recorded years later. We listen to Tuskegee participants in previously unpublished letters between Public Health Service officials, local physicians, and study "patients." Interviews and transcripts of Senate hearings convey the testimony of people who witnessed Tuskegee firsthand; an aged Herman Shaw articulates a survivor's view at the Tuskegee Apology ceremony.

As a result of Reverby's judicious editing, the reader is treated to prime examples of "the...