Examining Tuskegee: The Infamous Syphilis Study and Its Legacy (review)

Although James H. Jones put the Tuskegee syphilis-study debacle on the public’s radar screen with his book Bad Blood (New York, 1981), Reverby’s work about this deeply disturbing, experimental study of around 400 African-American men in the Black Belt of Alabama (largely Macon County) now stands as definitive. Her masterfully compiled and carefully edited collection of essays, Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study (Chapel Hill, 2000), remains one of the most comprehensive and thorough resources on the subject to date.

In Examining Tuskeegee, Reverby puts the reader on notice from the outset that she is not offering a tentative speculation about the Tuskegee syphilis study but the settled appraisal of a seasoned veteran whose investigations have lasted more than a decade. “Since the 1990s,” she explains, “I have tested my ideas out around the country at lectures, conferences, and public forums in places too numerous to mention” (x). No simple rendering of “the facts,” the author’s story centers on three fascinating tropes—testimony, the collected writings, formal and informal, of those involved in the study; testifying, a “speaking out loud about a set of truths and beliefs that are usually part of a self-revelatory experience” (7); and traveling, an examination of the sometimes competing narratives of Tuskegee by physicians, scientists, reporters, authors, and, most importantly, African Americans themselves. Reverby correctly points out that her aim is the deconstruction, construction, and reconstruction of images, expectations, relationships, and responsibilities.

Readers looking for answers to tough questions may not find final answers to all of them, but they will certainly find satisfying explanations for many of them. For example, how is it that an investigation of the long-term nature of syphilis could last from 1932 to 1972 (from treatment with mercury to treatment with penicillin) without ever explaining the nature of the study to the participants or (more egregiously) without treating them? The answer, as Reverby points out, is revealed in the attitude of Sidney Olansky, the physician in charge of the study in the 1950s: “The PHS [Public Health Service] needed time to stand still in the Study, and Olansky’s reports emphasized this understanding” (146). Macon County became frozen in time and captured within a Depression- era framework that refused to be moved by changing demographics or even modalities of care.

A central and recurrent question among jurists, bioethicists, and historians in Examining Tuskegee concerns whether the Tuskegee investigators should be judged as culpable for not treating their unwitting participants. A knee-jerk response would suggest an immediate “yes,” but opposition could counter that the rules and expectations for such human studies were inchoate in 1932 and that, after all, the project was designed to investigate the possibility that syphilis was a self-resolving disease. Reverby sorts through these issues and delivers an incontrovertible verdict:

The conflicting evidence in the autopsies, the lack of records for those who dropped out, the ways in which controls were switched to the syphilitic group, and the evidence that some of those in the syphilitic group probably never had the disease in the first place and should have been in the controls—all muddy the data. It is impossible to know if penicillin would have changed the health outcomes of those still alive in the antibiotic era and whether those who were decades out from their initial infections would have been helped. But even a syphilis study that used white patients at Stanford in 1948 and withheld treatment concluded: “Should penicillin prove effective, all arguments against the routine treatment of latent syphilis should vanish.” By the mid-1950s, penicillin became routine in medical practice, even for those in latency.

(232)

Fingers, it turns out, can be pointed and blame assessed. Thus, Reverby is anything but dismissive of President Clinton’s public apology on May 16, 1997. In the end, it “mattered because it acknowledged the pain and renewed the necessity for a discussion of...