The lost story of how a future surgeon general and revered medical figure inspired the most notorious and perhaps also the most unethical medical study in American history — one in which African Americans were infected with syphilis and left untreated so scientists could study the disease’s progression— has now been found.
It was while Gregory J. Dober was researching the history of using institutionalized children as subjects for human experimentation for our book, Against Their Will, that he came across the papers of Dr. Thomas Parran Jr. archived at the University of Pittsburgh. A significant stash of important documents totaling over 75 linear feet, they not only help us understand medical research during the last century and Parran’s zeal for conquering various social diseases, but also how U.S. Public Health Service (PHS) physicians could have annually examined hundreds of impoverished, syphilitic Alabama sharecroppers but never actually treat them.
It's important that this story be told—on this 85th anniversary of the start of the experiments, the 45th anniversary of their exposure by Jean Heller of the Associated Press, and 20th anniversary of President Clinton apologizing to the survivors—not only to correct the historical record, but also because it is far from the only example of scientists initiating and carrying out such troubling research on unknowing and defenseless citizens here.
A former U.S. Surgeon General, founder of Pitt’s Public Health Department, and iconic figure in the fight against venereal disease when many refused to even mention the word syphilis, Dr. Parran had enjoyed a stellar image as a thoughtful policy advocate and progressive administrator, though it had already begun to take some hits due to his association with two of the most ethically challenged experiments in medical history.
The documents Dober discovered clearly show that Parran was more than a distant government bystander of the racially centered experiment that began in 1932 and did not end until 40 years later. In fact, Dober and I argue in a forthcoming journal article that without Parran, there never would have been a syphilis study in Tuskegee.
Moreover, the documents support our contention that Dr. Taliaferro Clark, a competent but not particularly innovative PHS officer to whom historians have mistakenly attributed authorship of the study, would never have conceived such a radical medical experiment without his having conversations with Parran at the time and access to his official reports and memos.
The ramifications for science, and for Parran’s reputation, are important. No longer can blame for the study's creation be assigned to an unknown line officer (Clark). Beyond that, Dober’s discovery underscores how medical ethics has and remains an afterthought in research medicine. Solving medical conundrums, winning research grants, achieving fame all trump any competing interests such as concern over test subject safety and principles of ethical research. Dozens of doctors and administrators knew of the Tuskegee Study and never saw anything wrong with it. Incredible.
A graduate of St. John’s (Md.) and Georgetown Medical School, Parran was a precocious student who early on displayed academic brilliance, programmatic creativity, and a knack for public policy. He advanced quickly at the PHS during the 1920’s and became the head of the Venereal Disease Unit at an early age, only to be chosen by Gov. Franklin D. Roosevelt in 1930 as the Health Commissioner of New York.
It was around this time that he had become intrigued by the more scientific, less moralistic approach of Scandinavian medicine, particularly in regard to fighting syphilis and other venereal diseases. One Norwegian study Parran found especially intriguing was a retrospective investigation of an earlier non-treatment experiment performed on 2,000 patients at an Oslo Hospital between 1891 and 1910. Captivated by the idea of withholding treatment - which consisted of numerous injections of various arsenicals and heavy metals for victims of syphilis before the discovery of penicillin - Parran applauded the Oslo experiment as an example of “masterful inaction”—reflecting dominant thought at the time in medicine that human experimentation was often defensible.
Soon after, he would contemplate conducting a similar initiative in America, and suggested the African-American population of Macon County, Alabama as the perfect group for such a rare scientific exercise. “If one wished to study the natural history of syphilis in the Negro race uninfluenced by treatment,” Parran would write in January 1932, “this county would be an ideal location for such a study.” Later that year, the PHS would begin just such an experiment.
In addition to Parran providing the creative spark for the experiment, he would also play a critical role in obtaining foundation funds so that PHS doctors could offer black sharecroppers burial stipends, a key inducement in attracting volunteers for the study. Though he would go on to be named Surgeon General of the United States by President Roosevelt and have a long, distinguished career as the nation’s chief medical officer, he at no time considered ending the non-treatment study in Tuskegee or giving the men penicillin, a proven treatment by the late 1940’s.
Consistent with a research mien that can best be described as unrestrained was Parran’s oversight of an equally if not more ethically troubling series of venereal disease experiments in Guatemala between 1946 and 1948. Once again designed to advance scientific knowledge, Public Health physicians orchestrated a program that purposefully infected with syphilis, gonorrhea, and chancroid - through inoculation and the use of prostitutes - over 1,300 prisoners, soldiers, and mental patients.
The discovery in 2010 of the long-secret Guatemala study that occurred during Parran’s tenure as Surgeon General caused the American Sexual Transmitted Disease Association to remove the doctor’s name from their prestigious Lifetime Achievement Award in 2013. The new revelation of Parran’s key role in formulating and funding the infamous Tuskegee Syphilis Study will once again foster debate as to whether Pitt’s block-long, nine-story Public Health building should continue to have the Surgeon General’s name on it?
Parran’s brilliance and ardor in the fight against syphilis cannot be questioned, but his impressive resume and long list of accomplishments - including the cover of Time magazine and numerous New Deal initiatives - masks a serious flaw. He suffered from a moral blind spot that allowed him to view the weak and socially ostracized as throw-away people; raw material for experimentation. In that regard he was not unlike other mid-twentieth century scientific explorers who accomplished great things, but at some cost to the disadvantaged who were often used as human guinea pigs.
It is not difficult to believe that Parran - like so many other young men attracted to a career in medicine in the 1920’s - was motivated by the glowing accounts of scientific triumph emanating from the works of Sinclair Lewis and Paul de Kruif. Arrowsmith, Microbe Hunters, and Harvey Cushing’s biography of famed surgeon William Osler (who helped found Johns Hopkins Hospital) became best sellers, won numerous awards, and helped usher in the era of heroic medicine.
Scientists like Louis Pasteur, Theobald Smith, and Paul Ehrlich, who tackled age old diseases with a religious-like fervor, became national celebrities at the dawn of a hero-worshiping age. But accounts of their triumphs usually sugar-coated the risks endured by those they used as test subjects. “To make any kind of experiment,” Walter Reed, the intrepid conquerer of yellow fever admitted to de Kruif, “you must have experimental animals, and that meant nothing more nor less than human animals.”
De Kruif, who was a microbiologist as well as a journalist, would make Reed a centerpiece of his popular book about dedicated medical sleuths working to solve deadly riddles. He would go on to describe scientific research on humans as “an immoral business.” How else, de Kruif would argue, does one explain Reed’s belief that to successfully fight tropical disease one had “to risk human lives,” and accept the cruel calculus that “you must kill men to save them.”
More than a half-century later that cavalier, roll-of-the-dice research mentality that underscored Tuskegee not only still existed, but in some ways had been put on an industrial scale. When I walked into Philadelphia’s Holmesburg Prison in 1971, I was shocked to see that a big city jail had been transformed into a large, human experimentation laboratory. Hundreds of inmates adorned in gauze pads and medical tape had been incorporated in an array of clinical trials that tested everything from deodorants, detergents, and hair dye to wart virus, ringworm, and herpes zoster.
The inmates, overwhelmingly unschooled and African-American, were paid - usually a dollar a day - to become human guinea pigs, but rarely knew what they were being exposed to. None were aware they had been injected with radioactive isotopes and slathered with dioxin. Dr. Albert M. Kligman, the Ivy League dermatologist who created and directed the prison research operation for a quarter-century, admitted the ethics-free postwar era was “a wonderful time“ to do research: “No one asked me what I was doing.”
Dr. James Ketchum, an Army psychopharmacologist conducting chemical warfare experiments at Holmesburg, told me he had doubts about Kligman’s ethically loose and shoddy practices. However, the fear of the Soviet Union during the height of the Cold War caused researchers to skirt moral strictures, presuming there were some in the first place. Research ethics courses, many doctors informed me, were never a cornerstone of medical school educational programs. In fact, very few recall something as important as the Nuremberg Code ever being mentioned.
Dr. Chester Southam, a noted cancer researcher, told me much the same when I interviewed him. Notorious for injecting two dozen elderly patients with live cancer virus at the Jewish Chronic Disease Hospital in New York City in 1963, he would remain convinced - even decades later - that the negative publicity surrounding his hospital experiment was undeserved. Convinced none of his subjects would contract cancer from the injections, I inquired of him, what if they had? “Oh,” he cavalierly replied, “we’d just cut it out.”
Dr. Hilary Koprowski, a well-known virologist and longtime head of the Wister Institute, had an equally casual attitude about research ethics and the treatment of test subjects. His shocking display of research chutzpah was put on display when he inoculated 20 children with an unproven live-polio vaccine in 1950. When questioned by horrified colleagues about this audacious act, Koprowski dismissively relied, “Somebody had to take this step.” And not unlike Parran two decades earlier, throwaway people were used as test subjects: developmentally-challenged children at the Letchworth Village School in New York.
Though the Tuskegee Syphilis Study will probably remain the best-known example of unethical medical research in American history, it is unique only in its duration. The medical culture that that enabled Surgeon General Parran as well as Drs. Kligman, Ketchum, Southam, and Koprowski to utilize vulnerable populations as test subjects is a part of history puts the anniversary of one of the nation’s most sordid medical events in a grim context and should cause us to reflect and make sure that it never happen again.