What we (don’t) discuss in my MPH program

Three of my professors have mentioned the Tuskegee Syphilis Study. By mentioned, I mean just that: they’ve either said the words ‘Tuskegee Syphilis Study’ or painted some oversimplified, less severe, version of what actually happened. One professor said that the problems with this ‘incident’ were these doctors (no specification of their race) didn’t practice informed consent, and that the participants were “mainly low-income, uneducated minorities from rural Alabama.”

First of all, the US Public Health Service was involved in this study, and other professional groups and services (AMA and NMA) continued to support the study (design flaws and all) well into the 1960s. The “mainly low-income, uneducated minorities from rural Alabama” were ALL BLACK MEN, all 600 of them. Not only was there no informed consent, there were outright lies. These men were told that they were being treated for what they called “bad blood” but physicians who joined the study were told specifically NOT to treat the men for their syphilis, which could have been treated with penicillin. ALSO, these researchers actually prevented the men from getting treatment on more than one occasion. Yes, there were black health professionals involved in the study, but this was by and large WHITE doctors who purposefully targeted BLACK men in order to study the progression of syphilis until these men DIED from it. And they were targeted BECAUSE of their race. A clearly unethical study like that could only have been performed on black people, who, for all intents and purposes, they considered subhuman. It wasn’t an accidental oversight in design like my professor would have made it sound.

What he also failed to mention were the effects of untreated syphilis (which is particularly ridiculous for a professor who is also a medical doctor). According to the CDC:

In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

Moreover, because these men went about their lives thinking they were getting treatment, they didn’t think twice about passing on the infection. Many of their wives contracted syphilis, got pregnant, and passed on congenital syphilis to their children. There is hardly anything written on the long term effects that their families faced as a result of this “study.” How does syphilis affect pregnant women?

The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.

The lack of critical discussions in these classes is unacceptable. There are so many students who had no basis for what the Tuskegee Syphilis Study was that these cursory overviews means that the future public health workforce won’t even know what they don’t know. We’re getting a masters degree! We discuss theories, theoretical situations, policies (almost only from the perspective of what the laws say and what their intended to do as opposed to what they ACTUALLY do), some psychology, and a little bit of behavioral analysis. But the social indicators, the issues in multicultural health, the issues in LGBTQ health, are either completely passed over or talked about in some oversimplified, glossed-over, manner. Health disparities are only discussed as statistics. No history. No context. Like we just happened upon these problem. Like someone didn’t actively contribute to their existence. Like that someone to perform one of the most heinous studies (that we know of) in this country wasn’t the US Public Health Service, that we as the future workforce aren’t connected to.

After all of that, come to find out another syphilis study took place in Guatemala, RECENTLY! A couple of months ago. Not a single one of my professors even bothered to throw out a mention of this in class. They probably don’t even know.

This is bullshit.

What we (don’t) discuss in my MPH program