The logic goes, in 1932, when the study was started, there were no safe or effective treatments for syphilis. Therefore, things don't get ethically mushy until penicillin is introduced during WW2.pic.twitter.com/esn8au7BrA
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The logic goes, in 1932, when the study was started, there were no safe or effective treatments for syphilis. Therefore, things don't get ethically mushy until penicillin is introduced during WW2.pic.twitter.com/esn8au7BrA
The study was, after all, based on the Oslo syphilis study, starting in 1891 when Dr. Boeck withheld treatment from ~2000 patients based on that logic -- that the treatment was worse than the disease. Bruusgard's initial 1923 paper shown; here is 1955: https://www.sciencedirect.com/science/article/pii/0021968155901399 …pic.twitter.com/VH0yKqrv04
The problem? In 1891, standard of care was mercury, iodine, and (less commonly) bismuth. Boeck's hypothesis -- that the cure was worse than the disease -- was not unreasonable. And he stopped his experiment in 1910 -- the year that Salvarsan became commercially available.pic.twitter.com/ju8dJD0ZMi
In 1932, the standard of care was arsenicals (Neosalvarsan, or more commonly mapharsen) in addition to Bismuth. And they appeared to work! Take this follow up from a study done in the early 30s of mapharsen + bismuth in the early 1930s (https://jamanetwork.com/journals/jamadermatology/article-abstract/517894 …)
Follow up was not great, but ~80% of patients with 1o and 2o syphilis remained asymptomatic with neg serology. Doctors were also starting to experiment with mapharsen infusions, with allowed for a cure rate of 86.5% in a far shorter period of time (https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.31.6.545 …)
So even WHEN the Tuskegee syphilis study was launched, there was reasonably effective and reasonably well-tolerated therapy for primary and secondary syphilis (though obviously nothing like penicillin) that was being offered to patients across the world.
Even its very rationale was ethically damning.
Anyway, let me know your thoughts! I've been reading a lot about syphilis in preparation for the history of syphilis presentation I'm doing with @tony_breu.
I’d have to find source, but remember reading that there was a tx program that was defunded. The natural hx study was started to show the bad outcomes of untreated syphillis and to persuade whomever was making decision to refund the tx program. Will try to find ref.
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