Ghosts of Tuskegee

Ghosts of Tuskegee: THE GOVERNMENT IS STILL LIVING DOWN ITS INFAMOUS STUDY OF UNTREATED: SYPHILLIS IN ALABAMA, BUT TO DOCTORS WHO TOOK PART, THERE'S NOTHING TO APOLOGIZE FOR

BYLINE: By Jim Auchmutey STAFF WRITER
DATE: 09-06-1992
PUBLICATION: The Atlanta Journal and Constitution
EDITION:
SECTION: Newspapers_&_Newswires
PAGE: M/01

Susan Krane was watching TV one night when a familiar face unexpectedly popped on the screen. It was her dermatologist, Sidney Olansky. In several visits to his Peachtree Street office, Ms. Krane had found "Dr. Sid," as the staff called him, to be as cheerful as the colorful bow ties he wore. With his silver hair and long lab coat, he seemed the very picture of doctorly trust.

The picture was about to change.

Years before, as a laboratory researcher with the U.S. Public Health Service, Dr. Olansky had taken part in the Tuskegee Study, a 40-year project in which scientists observed - but did not adequately treat - syphilis among 412 black men in rural Alabama. The disease killed at least 28 of them, a federal investigation concluded.

Now this friendly Marcus Welby figure was on ABC's "PrimeTime Live" defending a study that Louis Sullivan, secretary of Health and Human Services, has branded "an outrage."

Ms. Krane, a curator at the High Museum of Art, was so appalled that she changed doctors. "I cannot fathom," she wrote Dr. Olansky "that you have no second thoughts about your participation in this horrifying chapter in American medical research."

Twenty years after it collapsed in scandal, the Tuskegee Study is a ghost that won't go away. The nation's most notorious medical ethics case, its legacy haunts public health as never before.

A play about the project, "Miss Evers' Boys," is being widely staged. "Nova," a public TV science show, plans a documentary this season. Schools and health agencies are beginning to discuss the lessons of Tuskegee at seminars such as one held recently at the Centers for Disease Control.

The main reason for the renewed attention? AIDS.

The fatal virus strikes minorities disproportionately, yet public health authorities have found many black people reluctant to heed government warnings on AIDS prevention. Louis Farrakhan, the Nation of Islam leader, sums up that attitude by saying you can't trust a medical establishment that was willing to experiment with black men's lives. Some people believe the government actually injected syphilis into the Tuskegee subjects, the way they believe AIDS was created to control non- white populations.

"Tuskegee has never been exorcised, and it's definitely hampering our efforts against AIDS," says Robert Rolfs, an epidemiologist in the CDC's division of sexually transmitted diseases.

That's where the Tuskegee doctors come in. Watching this debate about the toxic afterlife of Tuskegee, a few of the researchers who were involved in the study have spoken up in an effort to defend the syphilis project - and themselves. Against all conventional wisdom, they argue that the study was ethical. They feel wronged by history.

"We're dying off, and we've borne this burden for years," says John Cutler, 77, a former assistant surgeon general who worked on the study during the 1940s and '50s. "We have an obligation to tell our story. Tuskegee was undertaken for the highest ethical reasons."

Dozens of doctors participated in the Tuskegee Study from 1932 to 1972. Most were young Public Health Service officers who visited Alabama, conducted some physicals, drew some blood and soon got on with careers in private medicine. The officials who conceived the experiment 60 years ago are dead. So are the ones who decided not to give the subjects penicillin when it became available 45 years ago.

More than anyone, the person who has been left to shoulder the blame - the only living defendant in the lawsuit that Tuskegee survivors filed in 1973 - is Dr. Olansky.

Distinguished career

He is not a likely villain. Now 78 and hobbled by hip replacement surgery, the Atlanta dermatologist can look back on a long resume of medical accomplishment: service with the PHS, years of training physicians with the venereal disease clinic at Grady Hospital and two decades of teaching at Emory University, where the dermatology library was named for him.

Dr. Olansky retired to private practice with two sons in 1981. Then, last winter, his past came calling. "PrimeTime Live" wanted to interview him about Tuskegee and its implications for AIDS education. Galled by the way the study was depicted in the media, Dr.Olansky consented.

He was the star of the show, appearing in one nervous close-up after another, comparing the patients to sheep, saying syphilis isn't such a bad disease.

"They made me look like a mad scientist and a bigot," he says.

Many viewers apparently agreed. Since the February broadcast, Dr. Olansky has gotten hate mail, a bomb threat and angry phone calls from people such as a California woman ranting that he was "a murderer." And it hasn't stopped. One day this summer he went to his office in the Doctors Building downtown and found fliers asking patients to "stop Olansky " by joining something called the Tuskegee Action Group.

Alicia Newton, a secretary, helped organize the small group after learning about Tuskegee in a black studies class. "We don't think he should be practicing medicine," she says. "We want people to know that he's still out there sucking our blood."

While it's true that Dr. Olansky drew plasma in Tuskegee, he never set policy for the study. He oversaw its execution from 1950 to 1955 as head of the PHS's Venereal Disease Research Laboratory, which later became part of the CDC. Working out of a complex of Quonset huts in Chamblee, he and his assistants monitored the subjects and their health. Once a year, a doctor or two would visit Tuskegee to examine the men in what came to be known as "roundups."

There was nothing secret about this. Indeed, PHS doctors published 13 articles about Tuskegee in medical journals over the years. Dr. Olansky's name appears on more of them than any other researcher. He found the work fascinating.

Precursor of AIDS

It's difficult to appreciate today - when pencillin has long since curbed the disease - but syphilis control was once considered a high calling for public health clinicians. By the time Dr. Olansky attended medical school in the 1930s, VD had become a highly publicized government crusade, like the war on AIDS half a century later.

"The present generation could not begin to understand the extent of the veneral disease problem we faced," says James K. Shafer, 78, who directed the Tuskegee Study during the early '50s.

The project that would one day draw charges of racism has roots in a public health initiative that was considered progressive and racially enlightened for its time. The PHS wanted to show that syphilis could be controlled, even in the most backward areas of the South. With a grant from the Rosenwald Fund, a Northern philanthropy concerned with black welfare, the government in 1930 launched test treatment programs in six Southern counties with large black populations. One of them was Macon County, Ala. - then, as now, one of the nation's poorest places.

The programs were successful, but the Rosenwald Fund couldn't afford them and pulled out after two years. Rather than abandon its groundwork, the PHS decided to continue studying syphilis in Macon County, where an astounding 36 percent of all black men were infected. The doctors wanted to test a widely held suspicion that the disease affected black people's cardiovascular systems more than white people's. No one envisioned the study lasting more than a year or two.

State and local health authorities agreed to cooperate. So did the county's famous black college, Tuskegee Institute, which volunteered office space and the use of its hospital.

Now all that was needed were some syphilitics.

Handbills promising "special free treatment" went up around the county in the fall of 1932.

"It sounded like a good deal," remembers Charles Pollard, 84, one of 25 survivors of the study. The retired farmer still lives down the road from the white frame schoolhouse where he and scores of others first met the government doctors 60 years ago.

In several such gatherings, the physicians gave blood tests to hundreds of potential subjects, all of them black, most of them poorly educated sharecroppers. The doctors selected 399 men with syphilis (others were added later) and a control group of 200 who tested negative. They were given physicals and spinal taps that left some in pain for days. The only treatment they received was less than half the recommended dosage of mercury and neoarsphenamine, the heavy metal therapies then prescribed for syphilis.

The men were not told why they were being poked and probed. They were informed only that they had "bad blood," which the doctors assumed to be a black synonym for venereal disease. To local folk, however, the term denoted a variety of ailments, from VD to anemia to indigestion.

"I didn't know what they meant or what they wanted," says Carter Howard, 90, who was part of the non-syphilitic control group.

Year after year, the doctors came - an ever-changing procession of earnest white faces asking how the farming was going and whether there were any new aches and pains. The limited treatment stopped. Eventually, the only relief the physicians offered was a little pink pill, which the men really seemed to appreciate. Some of them had never taken aspirin.

"They didn't resent us at all," says Dr. Olansky, who went to Tuskegee twice. "It was a picnic atmosphere. We did the bloods, then we'd eat sandwiches, and they'd all sit around and sing. We had fun."

The mood was more serious back in Atlanta, where Dr. Olansky pored over the data to make scientific sense of it all. Writing in the Journal of Chronic Diseases, he summarized the project as it stood on its 20th anniversary in 1952: "As all previous works in this study have found, the most striking feature distinguishing the syphilitic group from the non- syphilitic is that the death rate is higher among the syphilitic men."

Death, after all, was the most important part of the study. The educated guesswork of clinical diagnosis could be confirmed only when a cadaver was cut open at autopsy. To make sure that deaths were reported and bodies harvested, the government offered each family a $100 funeral stipend. In a poor county where many couldn't afford a decent burial, it was a powerful incentive.

"I think it kept them coming," Dr. Olansky says. "Burial is very important to those people."

Penicillin withheld

The Tuskegee Study had become a public health tradition by the time Dr. Olansky signed on. As the PHS officers who had pioneered the project moved up the ranks, the wisdom of Tuskegee went unchallenged. Nothing threatened it, not even the emergence of a cure.

Penicillin was first tested on humans in 1941. Within three years, the drug was known to kill treponema pallidum, the bacterium that causes syphilis. Doctors administered penicillin to thousands of GIs during World War II, but they never administered it to the Tuskegee men. In fact, the PHS arranged for almost 50 of the subjects to be exempted from the draft so they wouldn't receive the new wonder drug.

To critics, the denial of penicillin therapy is the most sinister aspect of Tuskegee. To Dr. Olansky, it was a practical diagnosis. "Penicillin was not considered," he says, "because it would not have helped these men."

There's an old saying that syphilis occurs in three stages - "get it, forget it, regret it." In the first phase, a few weeks after infection, a chancre usually appears on the genitals. In the secondary phase, two to six months later, rashes appear, patches of hair fall out and flulike aches spread through the joints. Then, mysteriously, the disease seems to vanish during a period of latency that may last five years or a lifetime.

In two-thirds of the cases, syphilis remains benign (hence the Tuskegee survivors). But in the other third, the bacteria can bore into the brain or heart and cause blindness, insanity and sudden death, often when a weakened aortic wall blows out.

Pencillin wouldn't have reversed damage already done to the men by 1950. It might have stopped further damage, however. That's why the CDC long has recommended that all phases of syphilis be treated with the drug, if only to kill the syphilis bacteria that might remain deep in the body.

"It's clear to me that this knowledge existed back then and that these men should have been treated," says Dr. Rolfs of the CDC's sexually transmitted diseases division.

Dr. Cutler, who was with the VD division when penicillin became widely available, suggests a different rationale for not treating the men: "It would have rendered the study invalid."

Even if withholding the drug led to deaths - which he doubts - Dr. Cutler considers it a sensible trade. "If I may make an analogy, it's like sending men off to war and knowing some will die. It's in the interest of the total society. These men in Tuskegee helped us learn how to treat syphilis among blacks. They were serving their race."

Dr.Olansky says these ethical questions never came up during his time with the study. Actually, they were raised at least once.

In 1955, shortly before he left the PHS to start his teaching career at Duke University, Dr. Olansky conducted a seminar on Tuskegee at the Medical College of Virginia. The presentation included autopsy slides graphically showing the devestating effects of untreated syphilis on brains and hearts.

"My jaw dropped," recalls Count D. Gibson Jr., who was then a professor at the school and has since retired from Stanford University. "I ran up to him afterwards and asked whether the people were getting penicillin and whether they were being kept in ignorance. He couldn't talk; he had to catch a plane."

Dr. Gibson detailed his objections in a letter. Dr. Olansky's reply betrayed at least a flicker of doubt.

"I got involved in this study in 1950, and all the things that bothered you bothered me at that time. After seeing these people, knowing them and studying them and the record, I honestly feel that we have done them no real harm and probably have helped them in many ways."

Dr. Gibson wishes he had taken the story to the press the day he opened that letter.

Instead, the study ran another 17 years. The end came in 1972 when a former PHS fieldworker tipped off an Associated Press reporter. The CDC, which had decided to continue the experiment during an internal review in 1969, soon closed it down. The ethical and racial climate had changed so much that Donald Printz, an officer with the CDC branch that had kept Tuskegee going, didn't even try to defend the study. It was, he said, "almost like genocide."

A question of ego?

If Dr. Olansky suffers any remorse over Tuskegee, it's for his soiled reputation. He still considers it good science (although he admits little was learned). And like other doctors who took part in the study, he remains angry that the government settled out of court rather than fight the lawsuit on its merits.

"These are very proud men," says Alan Olansky, his son and medical partner. "They know that their intentions were good, and they can't accept people questioning that. There's so much ego involved in medicine. They just can't admit that their methods, in retrospect, might have been wrong."

James H. Jones, a University of Houston historian, interviewed numerous Tuskegee doctors during the 1970s for his book on the study, "Bad Blood." Not one expressed reservations about the morality of the enterprise. Indeed, he found only one medical professional connected with Tuskegee who admitted any ethical qualms.

She was Eunice Rivers, a black Macon County nurse hired by the PHS to keep track of the subjects and make sure they appeared for roundups - or autopsies. Miss Rivers attended to the Tuskegee Study all of its 40 years. She said it was the joy of her life, the men her only real family. "She was the Mother Teresa of Tuskegee," Dr. Olansky says.

Miss Rivers met Dr. Jones five years after the study was halted. She reminisced non-stop for two days as they drove around the countryside past the farm shacks she had visited so many times. At one point, he asked her point-blank whether there was anything that should have been done differently.

"We should have told them they had syphilis," she replied. "And we should have given them penicillin."

Miss Rivers reached a moral reckoning that eluded her higher-ranking colleagues, and Dr. Jones believes he understands why.

"She was the only person with the study who lived with these men. She came to see them as people, not data."