Medicine: A Matter of Morality

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For the past 40 years, the U.S. Public Health Service has conducted a study in which people with syphilis were induced to go without treatment so that science could determine the disease's effects on the human body. For the past 25 years, the service has had a proven remedy available and neglected to use it on its select test cases—in the name of science.

The study was started in 1932 by the service's venereal-disease section. It involved 625 black men, mostly poor and uneducated, from the county surrounding Tuskegee, Ala., which then had the highest syphilis rate in the nation. Two hundred of the men did not have syphilis and served as a control group for comparison purposes; 425 had latent (and therefore noncommunicable) syphilis and received little, if any treatment for it. As an incentive to participate in the study, they were offered free treatment for any other illnesses, free hot lunches and free burial after autopsies were performed.

At the time the test began, treatment for syphilis was uncertain at best, and involved a lifelong series of risky injections of such toxic substances as bismuth, arsenic and mercury. But in the years following World War II, the PHS's test became a matter of medical morality. Penicillin had been found to be almost totally effective against syphilis, and by war's end it had become generally available. But the PHS did not use the drug on those participating in the study unless the patients asked for it.

Such a failure seems almost beyond belief, or human compassion. Recent reviews of 125 cases by the PHS'S Center for Disease Control in Atlanta found that half had syphilitic heart valve damage. Twenty-eight had died of cardiovascular or central nervous system problems that were complications of syphilis.

The study's findings on the effects of untreated syphilis have been reported periodically in medical journals for years. Last week's shock came when an alert A.P. correspondent noticed and reported that the lack of treatment was intentional. Senator William Proxmire of Wisconsin, a member of the subcommittee that oversees PHS's budgets, called the study "a moral and ethical nightmare." Dr. Merlin K. DuVal Jr., Assistant Secretary of Health, Education and Welfare for Health and Scientific Affairs, expressed dismay and launched an investigation.

The probe may not help much, for the damage has already been done. The officials responsible for the study have long since retired. Present CDC officials agree with DuVal that such a study could not be conducted today. Their solicitude, however, is small consolation for the 74 of the original 425 syphilitics still surviving. The agency is treating them for whatever other diseases or physical problems they might have, but it can do little for their syphilis. The average age of the survivors is 74, and the massive penicillin therapy necessary to arrest their long-ignored affliction could do more harm than good. For them, the PHS reversal has come too late.