The Tragic Legacy of the Tuskegee Study

African-American men have the worst health outcomes of all major ethnic, racial and demographic groups in the United States. New research by SHP’s Marcella Alsan explores how the Tuskegee Study carried out by the U.S. government from 1932–1972 still impacts the health of black men today.

For 40 years, the “Tuskegee Study of Untreated Syphilis in the Negro Male” passively monitored hundreds of adult black males with syphilis despite the availability of effective treatment. The study’s methods have become synonymous with exploitation and mistreatment by the medical community. In a new working paper published this month by the National Bureau of Economic Research, Stanford Health Policy’s Marcella Alsan and Marianne Wanamaker of the University of Tennessee, find that the historical disclosure of the study in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men. Their estimates imply life expectancy at age 45 for black men fell by up to 1.4 years in response to the disclosure, accounting for approximately 35 percent of the 1980 life expectancy gap between black and white men.

“The Tuskegee Study was one of the most egregious examples of medical exploitation in U.S. history,” Alsan and her colleage Marianne Wanamaker at the University of Tennessee write in their paper. “Our estimates indicate that the years following disclosure of the study’s tactics brought significantly lower utilizationof both outpatient and inpatient medical care by older black men in closer geographic and culturalproximity to the study’s subjects. This reduction in healthcare utilization paralleled a significant increasein the probability that such men died before the age of 75. The data indicate no corresponding effects for younger black males or for white males or black women. These results are robust to accounting for a widerange of policies, economic forces, and individual characteristics thought to shape health behaviors.”

The research has led to extensive media coverage, such as this piece in The Atlantic by VANN R. NEWKIRK II, a staff writer.

To figure this out, the duo crunched a bunch of data from the General Social Survey (a big, comprehensive survey of Americans’ attitudes and behaviors that has been administered for decades), “health seeking behavior reported in the National Health Interview Survey,” and “detailed annual mortality data available by race, age group, gender and cause from the Centers for Disease Control and Prevention.” — New York Magazine

The results of the research imply that Tuskegee and its revelation reduced black life expectancy at age 45 by 1.4 years, accounting for 35% of the black to white-male life expectancy gap in 1980.

National History Day video on the Tuskegee Study

"The men were denied highly effective treatment for their condition (most egregiously, penicillin, which became standard of care by the mid-1940s) and were actively discouraged from seeking medical advice from practitioners outside the study,” the authors wrote. “Participants were subjected to blood draws, spinal taps, and, eventually, autopsies, by the study’s primarily white medical staff. Survivors later reported that study doctors diagnosed them with "bad blood" for which they believed they were being treated. Compensation for participation included hot meals, the guise of treatment, and burial payments. News of the Tuskegee study became public in 1972 in an exposé by Jean Heller of the Associated Press. By that point, the majority of the study’s victims were deceased, many from syphilis-related causes.”

Presidential Apology

THE WHITE HOUSE Office of the Press Secretary For Immediate Release May 16, 1997 REMARKS BY THE PRESIDENT IN APOLOGY FOR STUDY DONE IN TUSKEGEE The East Room 2:26 P.M. EDT THE PRESIDENT: Ladies and gentlemen, on Sunday, Mr. Shaw will celebrate his 95th birthday.