Department Tactics Remind of Tuskegee

The infamous Tuskegee Syphilis Study took place between 1932 and 1972 in Macon County Alabama. In that study, a group of poor Macon County black men with syphilis were left untreated by government health care officials so researchers could monitor the effects of untreated syphilis in a human population. The study continued long after the discovery of penicillin, a successful treatment for the disease.

In 1997, President Clinton invited the survivors of the Tuskegee Syphilis Study to Washington. The President used that occasion to make a national apology for the government’s misconduct in conducting such a study.

Today, a lawsuit pending in the Circuit Court of Lowndes County reminds us of that government misconduct. Because this case is still pending before the court, I will not discuss the legal issues involved. Here, I want to discuss public health policy and the use of a health care strategy known as “Blitz,” which is at the core of this lawsuit.

According to one public health official, “The Blitz is a time honored public health technique that’s been around for a long time in infectious disease control to try to deal with an epidemic situation.” This official, along with other Blitz supporters, credits use of Blitz tactics in controlling outbreaks of disease.

Blitz tactics also have some detractors, who claim the program violates individual privacy rights. Others claim that allowing anonymous naming of sexual contacts invites abuse by individuals seeking to disgrace or discredit someone else’s reputation.

The Lowndes lawsuit stems from 1991, when State Health Department officials determined that there was a syphilis epidemic in Montgomery County. They authorized a Blitz. The operation took place between June 17 and November 7, 1991. Using the Center for Disease Control (CDC) guidelines, and assisted by personnel from the U.S. Public Health service, the Health Department brought the syphilis epidemic in Montgomery County under control.

According to CDC guidelines, during Blitz conditions the goal is treatment of as many “contacts” as possible. A Contact is anyone identified through case-partner notification (sexual partner) or by Cluster investigation. Cluster investigations are designed to identify persons other than sex partners at high risk for syphilis (High Risk Associates). This method, Contacts naming Contacts, is effective. However, the policy results in the interview and treatment of many individuals who do not have the disease.

During the Montgomery Blitz, based on CDC information, 373 case-patients identified 984 sex partners. Of these, 696 (71%) were examined: 113 (11%) had syphilis and were treated, 547 (56%) were given prophylactic antibiotic treatment. In addition, case-patients provided information that identified 1,446 high-risk associates. Of these, 1,153 (80%) were examined, 41 (3%) had syphilis and were treated, and 836 (58%) were treated prophylactically.

Using Blitz tactics, CDC statistics chart an impressive decrease in syphilis cases in the United States beginning in the 1940s. This trend continued until about 1985 when the number of syphilis cases had been reduced by nearly a half million total cases to approximately 70,000 nationwide. In the late eighties, the downward trend suddenly reversed. This upturn peaked in 1990 when the number of cases exceeded 120,000.

In addition to the privacy issue, a close scrutiny of the CDC’s syphilis data exposes a troublesome racial component. When the government categorized the new cases, (1985 to 1990) nationally by race, all the new cases were statistically classified black, while syphilis rates among all other ethnic groups continued to decline. Inexplicably, between 1985 and 1990, reported syphilis cases among black Americans increased 50%. Then, just as unexplainably, from 1990 to 1995, the rate decreased the same amount, back to 1985 levels.

These statistics are disturbing, and while there might be a perfectly innocent and reasonable answer, citizens require a full explanation for this demographic dissimilarity in the data. Race-based research often focuses on social pathologies in minority populations. Then, when the research is published, unenlightened majorities use the results to stereotype minority individuals with these negative data.

In light of past “official” wrongdoings, Public Health administrators must exercise extra diligence in defining, characterizing, and publishing disease research data by race. In this post civil rights era, all Americans must remain mindful of our past. Society has not yet maturated into Martin Luther King’s idealized state, where an individual is judged by character instead of skin-color.

It must be the solemn covenant of each American to never again tolerate the kind of overt institutional racism perpetrated upon victims of the Tuskegee Syphilis Study.

Originally Published: 5 June 1998, Montgomery Advertiser

1 comment to Department Tactics Remind of Tuskegee

  • Efrain Messan

    Syphilis is caused by the treponema pallidum sprichete. Even if it is considered a sexually transmitted disease, it isn’t always acquired through sexual contact. There are rare cases where the infectious organism is passed on through open wounds or lesions as point of entry. Syphilis may also be passed on from mother to fetus during pregnancy and childbirth. It is a sad fact, though, that 25 percent of fetuses born of syphilitic mothers end up in stillbirths, while the remaining 75 percent develop congenital syphilis which may aggravate into another medical complication if left untreated. Also, people with syphilitic sores who remain sexually active are at higher risk of acquiring HIV or AIDS.”

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