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Bad Blood: The Tuskegee Syphilis Experiment

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From 1932 to 1972, the United States Public Health Service conducted a non-therapeutic experiment involving over 400 black male sharecroppers infected with syphilis. The Tuskegee Study had nothing to do with treatment. Its purpose was to trace the spontaneous evolution of the disease in order to learn how syphilis affected black subjects.

The men were not told they had syphilis; they were not warned about what the disease might do to them; and, with the exception of a smattering of medication during the first few months, they were not given health care. Instead of the powerful drugs they required, they were given aspirin for their aches and pains. Health officials systematically deceived the men into believing they were patients in a government study of “bad blood”, a catch-all phrase black sharecroppers used to describe a host of illnesses. At the end of this 40 year deathwatch, more than 100 men had died from syphilis or related complications.

“Bad Blood” provides compelling answers to the question of how such a tragedy could have been allowed to occur. Tracing the evolution of medical ethics and the nature of decision making in bureaucracies, Jones attempted to show that the Tuskegee Study was not, in fact, an aberration, but a logical outgrowth of race relations and medical practice in the United States.

Now, in this revised edition of “Bad Blood”, Jones traces the tragic consequences of the Tuskegee Study over the last decade. A new introduction explains why the Tuskegee Study has become a symbol of black oppression and a metaphor for medical neglect, inspiring a prize-winning play, a Nova special, and a motion picture. A new concluding chapter shows how the black community's wide-spread anger and distrust caused by the Tuskegee Study has hampered efforts by health officials to combat AIDS in the black community. “Bad Blood” was nominated for the Pulitzer Prize and was one of the “N.Y. Times” 12 best books of the year.

297 pages, Paperback

First published January 1, 1981

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James H. Jones

39 books10 followers

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5 stars
289 (33%)
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341 (40%)
3 stars
172 (20%)
2 stars
37 (4%)
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13 (1%)
Displaying 1 - 30 of 81 reviews
Profile Image for Leah.
335 reviews
September 11, 2010
A must read for all aspiring biomedical and behavioral researchers. I couldn't write my dissertation without it.
Profile Image for Broodingferret.
341 reviews11 followers
August 18, 2014
Exhaustively researched and elegantly written, Bad Blood: The Tuskegee Syphilis Experiment is both a wonderfully detailed history of the infamous Tuskegee Syphilis Experiment and an incisive analysis of the effects of institutionalized discrimination on marginalized segments of a population. From the ingrained racism that led many early 20th century doctors to believe that blacks and whites respond differently to various diseases (despite a complete lack of supporting evidence) to the blind faith that many in the early- to mid-century had in medical researchers to police themselves responsibly and ethically to the tendency of the Tuskegee Experiment’s directors to willfully blind themselves to the ethically questionable nature of their endeavor, this book provides an excellent and chilling lesson both on how cultural environments and personal foibles can unknowingly influence something as ostensibly objective as scientific inquiry, and on the absolute necessity of the placement of ethics as the foremost consideration in all biomedical research. Jones follows his historical critique of the Experiment with a treatment on the effects of the Experiment’s legacy on the early years of the AIDS crises, which I found particularly eye opening. After reading the history of the experiment and seeing the disturbing parallels, in both cultural perceptions and in institutional reactions, between syphilis early in the century and AIDS later in the century, the fact that conspiracy theories popped up among many black and gay people in the wake of AIDS makes more sense to me now than it did before (not to say that the theories themselves make any sense, simply that the emotional impetus behind them is understandable). This book is a must-read for any burgeoning scientist and should be required reading in all research ethics classes.
Profile Image for Emma.
141 reviews3 followers
September 15, 2013
Proof that at least one historian did something useful once, rather than writing about things like Western movies. This was an informative, rage inducing case study of racist medical experimentation in America, whose research also went to support the class action legal action brought about by the victims and their descendants.
Profile Image for Timo Hagmaier.
56 reviews
July 7, 2021
Ausführliche und eindrückliche Aufarbeitung eines der bedeutendsten Skandale der Medizingeschichte.
Beängstigend mit welchen Mitteln Rassismus und Homophobie rationalisiert wird. Die immense Auswirkung des Experiments ist einer der vielen historischen Ereignisse, die das Verhältnis zwischen der amerikanischen Gesellschaft & Regierung, und den verschiedensten Minderheiten bis heute schädigt.
Als Kurzfassung einfach „Skegee“ von JID (2021) anhören
Danke James
6/10 📖
Profile Image for Nancy Oakes.
1,967 reviews793 followers
February 12, 2008
What a terrible story!! I don't mean terrible in the sense that the book was bad but in the sense that I can't believe this actually happened. For 40 years black men with syphilis in Alabama were a part of an experiment in which they were seen by doctors but not treated for their disease, even after penicillin became widely available as a treatment for syphilis. The worst part of the entire thing: no one ever told these men that they had the disease; they thought they were being monitored because they had "bad blood."

The requisite stuff: would I recommend it? Yes, definitely. Who should read it? Well, personally I think anyone with a conscience, but it is at times very difficult going reading wise. It is a history, not only of the experiment at Tuskeegee, but the author sets it all up with a history of the disease & of the Public Health Service, and most interestingly, a history of medical care for African-Americans going back to slavery days. So it may not be everyone's cup of tea.

This would have been outrageous on a basic scale if the originators of this experiment were working alone, but as the author shows, it seems that the work was well known in medical circles. The work was documented over the 40-year period in medical journals, discussed at medical conferences and was not simply the product of the Public Health Service but had the backing of Tuskegee Institute (and you have to ask yourself WHY?, especially during the 1950s and 1960s when Alabama was a hot spot in the civil rights movement), the Veteran's Hospital, multiple medical practitioners (both African-American and White) throughout the state who signed death certficates and let the principals know when a certain subject was hospitalized or died, and the list goes on and on. The author also discusses the "ethical" question and shows clearly that beginning in the 1930s, physicians covered each other & basically made up their own ethics as they went along. Even after it was discovered that Nazi scientists were doing human experimentation at the concentration camps, and after the Trials at Nuremberg when human experimentation was brought into public view, the scientists conducting the Tuskegee experiment didn't have any qualms about continuing the project. Alabama passed several laws requiring the reporting of infectious disease and still somehow through all of the revisions of these laws, the Tuskegee people were not held accountable nor were they required to follow the law.

I would have to add that this study was completely racist: some of the justifications given in the course of the study just floored me. For example, on page 23, the author notes that physicians realized that it would be only natural for African-Americans to have the highest incidence of syphilis since "personal restraints on self-indulgence did not exist...the smaller brain of the Negro had failed to develop a center for inhibiting sexual behavior," and on 24, "the Negro man will not abstain from sexual intercourse if thre is the opportunity for indulgence." On page 48, re the white image of black sexuality: "Blacks suffered from venereal diseases because they would not, or could not, refrain from sexual promiscuity." One further justification for the experiment was as a comparison between untreated syphillis in African-American people and untreated syphilis in Whites; there had been some sort of experiment done prior to this in Norway with white people.

I could go on and on, but suffice it to say that I was totally outraged after reading this book. And I think that is a good thing.

If you want to add another chapter to your knowledge of African-American history, PICK UP THIS BOOK!

read: 2/01/2005
253 reviews1 follower
July 7, 2010
Educational but not overly academic. It definitely helps you understand how this could have happened, how people could justify participation and how to never let this kind of outrageousness ever happen again. Much more nuanced than expected.
Profile Image for Liberté.
249 reviews
February 24, 2020
I began reading this book for a seminar in January and finished it this month. Extremely well documented, this history tracks the events leading up to and during the Tuskegee Syphilis Study, along with the aftermath of public outrage. Jones also covers the impact of the study on perceptions during the height of the AIDS crisis, and the destruction of trust in government public health officials that stemmed from the study. A chilling chapter in American history, it is one with implications for how we think about public health, as well as the trust and authority granted to public health officials who may well not deserve it.
Profile Image for Alina Colleen.
215 reviews1 follower
October 13, 2020
As a public health student, this was maybe the 20th time I had heard of the Tuskegee Syphilis Experiment, so I was a little dismayed by the prospect of reading a whole book about it. If you’ve never come across the infamous Study before, this book is certainly a comprehensive overview and a good place to start. Published in the decade immediately after the Tuskegee Study came to light, “Bad Blood” was probably groundbreaking historical work at the time.

For those unfamiliar with the Tuskegee Study, it started out as a Public Health Service initiative in 1932. A previous prevalence survey, also conducted by the Public Health Service, revealed that syphilis rates in Macon County, Alabama were as high as 35%. Public health officials sensed an opportunity. A study of untreated syphilis among white men in Oslo, Norway had recently been concluded in 1910 with the results published in 1929. Never mind that the Oslo Study was a retrospective one, or that the study was halted after the discovery of Salvarsan, the first effective treatment for syphilis. No. The public health officials in the United States were determined that syphilis was distinctly different across races. This insistence, as author James H. Jones shows, was born out a racist belief that white people and Black people were significantly biologically distinct, to the extent that several common illnesses affected the races differently. With a prevalence rate of 35%, how could physicians and public health workers resist the temptation to see how syphilis destroyed poor, rural,
uneducated and untreated Black men over time?

It goes without saying that this book is difficult to read at times - the atrocities just keep coming. First they single out illiterate and indigent Black men. Then they never tell them they had syphilis, saying only they had “bad blood.” They never obtain consent from anyone. Indeed, later in the book a health official justifies continuing the study by saying it would be practically impossible to obtain consent from such ignorant people. They tell the men they should be grateful to receive medical treatment that most people can’t afford. That “treatment,” by the way, is often aspirin pills that of course do absolutely nothing for syphilis. They trick the men into getting lumbar punctures that they advertise with a flyer labeled “special free treatment.” At the time the study began, treatments for syphilis did exist - a noxious combination of arsenic and mercury - but they were expensive, lengthy, and riddled with side effects. Initially required by their donor to provide some treatment to the participants, the men in the study received short courses of arsenic and mercury, but far below the threshold deemed therapeutic. When the study was continued past the original 8 months, officials justifying withholding treatment because, they reasoned, the men would never be able to afford it on their own anyway. They didn’t want any of the men to die without the chance to perform autopsies, so a list of all the men in the study was circulated to private physicians, local hospitals, and clinics - if any of the men showed up seeking treatment for syphilis, the study organizers were to be contacted. Many attempts at seeking treatment were blocked. There was literally a conspiracy against these men. All of this happened long before penicillin was discovered as a cure for syphilis - a cure that was, of course, systematically denied to the men for several more decades.

I happened to look up the Tuskegee Study FAQ on the CDC’s website, and I was shocked. It reads:
“Q. When did the U.S. Public Health Service Syphilis Study at Tuskegee become unethical?
A. The study became unethical in the 1940s when penicillin became the recommended drug for treatment of syphilis and researchers did not offer it to the subjects.”
Is this a joke? Is the CDC trying to save face? The study was ALWAYS unethical. It was unethical from the very beginning. It was based on racist medicalization of Black men. It took advantage of poverty, race, and lack of education. There was never consent. There was duplicity at every stage. That FAQ is shameful.

“Bad Blood” is very much the work of a historian. Although James H. Jones makes it clear that the Tuskegee Study was unethical from the start, he relays events in a relatively emotionless manner. Indeed, many of the racist quotes are shocking enough to speak for themselves, but I was a little surprised that he didn’t do more editorializing. The most interesting chapter by far was on Nurse Rivers, the Black nurse who was largely responsible for keeping the men in the study over the years. Even though she knew the men were denied treatment even after the discovery of penicillin, she denied any wrongdoing. Jones must contend with this frankly baffling historical figure with some of his own reasoning, instead of merely relying on documents to tell the story for him. Indeed, I thought a NYT review of the book put it well: “If anything, Mr. Jones is far too evenhanded, far too dispassionate, in making this point. He renounces heavyhanded moral indignation.” Considering the subject matter, the book is surprisingly dry and, at times, hard to follow. It’s certainly detailed and well-researched, but it lacks heart.
Profile Image for Reginald Allen.
61 reviews1 follower
July 4, 2021
“Bad Blood” altered a long running myth, in my mind, that the government deliberately inoculating syphilis into Black male sharecroppers, during the 1930s as part of the Tuskegee Study. In this book, by author James H. Jones, it’s delineated how the Public Health Service (PHS), in Macon County, Alabama, [in & around the county seat of Tuskegee] wanted to study “effects” of untreated syphilis and its consequence on cardiovascular & neurological trauma, in Black bodies. The nontherapeutic experiment was aimed at compiling data on the effects of the spontaneous evolution of syphilis in Black males, without informed consent. The subjects involved in this human experimentational study were poor, uneducated, and mostly illiterate.

The sacred Hippocratic Oath held by physicians [to treat the ill to the best of one’s ability] was clearly ignored!
71 reviews
August 17, 2014
This book was boring when Dr. Jones assigned it in his history class years ago at UH, and (I am grieved to report) it is precisely as boring as I remember it to be. How anyone could made such an inherently dramatic subject such a chore to read about is anyone's guess, but I just couldn't make myself continue past page 2. Too bad. I know it's a worthy subject.
51 reviews1 follower
December 7, 2015
This is a very interesting read, it can be a little difficult and dry at times but it was not what I was expecting. This was a documented and publicized experiment that continued for 40 years. An eye opening read on the treatment and protection of people participating in medical science experiments.
Profile Image for Aja.
756 reviews
November 30, 2016
Used this book for the graduate level community health course. Excellent for discussion. By looking at this book as a case study for learning from mistakes, it gives great examples of how community health initiatives could/should be done to improve trust (and in the end health) between providers/researchers and the community.
Profile Image for DeeReads.
2,282 reviews
June 18, 2023
The Tuskegee experiment was a horrible way for the government to treat Black men. No humanity whatsoever!!!
14 reviews
May 17, 2019
great story, not told in a gripping fashion. AIDS chapter seems forced, no real transition there for me.
Profile Image for Gina.
Author 5 books27 followers
May 14, 2012
Although a bit slow-moving at times, this is a very important book with a lot of humanity for all the difficulty of its subject matter. It makes it more comprehensible, without ever justifying, how it could happen that human beings were willingly kept untreated, and able to spread, a horrible disease. Some of those conditions are human pride of course, and a tendency to continue down a path once it has started, but it is also clear that it is poverty and a lack of education that makes these kinds of abuses possible, and the book does a nice job of conveying the broader problems to society, without forgetting the impact on the individual.

The other interesting fact from the book, which is missed in a lot of information about the experiment, is that of the original test pool, all of the men had received some treatment for syphilis, so even though the stated purpose was to study untreated syphilis, that never happened--it only prevented treatment from happening, including after better treatments became available. It is amazing and awful.
Profile Image for Patrice.
1,389 reviews11 followers
June 25, 2013
This book surprised me. I didn't know as much as I thought about the experiment, a victim of modern misconceptions. I didn't realized that it had started out as a humanitarian relief program that transformed under changed leadership and lack of funding. The callous reactions of modern doctors involved in the program surprised me too. As late as the 1970s, despite the blatant deception, rationalized science and obvious uselessness of the experiment, they still didn't believe that they did anything wrong. That boggles my mind. I was also surprised to learn that the sharecroppers in Macon Alabama were still as poor in the seventies as they were int he thirties. It reads a little dry, but the content is afascinating look at why marginalized groups are justifiably distrustful of government health institutions and a detailed examination of racsim and medical ethics in twentieth century America.
Profile Image for Ley Stanton.
365 reviews27 followers
February 3, 2016
I normally don't add books that I have to read for school but after a chapter of the book, I knew I was going to have a lot of feelings about this whole thing. While it isn't something I would have picked for myself to read, I think it was an important book for me to read because its on a subject that I would normally ignore. The book was extremely well-written and opened my eyes to suffering and experimentation I didn't even know existed in the United States. This is about an experiment that lasted nearly 50 years where doctors watched about 500 black men die of syphilis while denying them treatment. Its something that I really need to hear about because, like many of the people in the book, I'm quick to turn away from things that make me uncomfortable or difficult subjects. This book was extremely informative but left me just feeling very icky about the government and kind of world that we live in.
96 reviews1 follower
March 6, 2015
This is a compelling history of a terrible blight on science and the country. I had heard the broad outlines of this experiment before, but Jones lays out the development of it in a way that makes you see how each horrifying step seemed reasonable and almost inevitable to the people responsible. It's disturbing to see how people of sharp minds and good intentions could, for such a long time, conduct a study that was so flawed, both morally and scientifically. The last chapter on AIDS was added for later additions, and is the only part of the book that is not effective -- I see why he made the connection, but the addition feels too ad hoc after the rich description and development of the other chapters.
Profile Image for Lauren.
101 reviews4 followers
March 3, 2015
Really fascinating and horrifying. Jones does a good job of making some logical sense of the fact that this "study" could continue for nearly 40 years without anyone ever questioning what was going on and why. He gives short shrift to discussion of the effects on the subjects' wives and children--I think that deserved more discussion as part of the criminal neglect of the whole project.

Somehow it was even more horrifying and sad to read about the black medical professionals who saw nothing wrong with what was happening--even the Macon County doctors consulted in the 1970s. Still agreeing, decades later, to deliberately withhold treatment from these syphilitic men. Jesus.
Profile Image for Mark Oconnor.
28 reviews10 followers
January 5, 2014
Insightful and appalling, this thorough history of the notorious Tuskegee Study in rural Alabama gives a comprehensive view of the background, origins, implementation, discovery and fall out of one of the darkest chapters in the countries public health history. Through a combination of cultural, bureaucratic and dogmatic precepts the study begins and moves along, gaining momentum from 1932 until 1972 when a dogged critic breaks the story to the Associated Press. The final chapter addresses the AID epidemic and the tragic and unfortunate effects of Tuskegee on inner-city African Americans along with the culture of mistrust, suspicion, fear and anger that is it's legacy.
Profile Image for Ashley.
501 reviews19 followers
October 26, 2010
Jones' book is an excellent overview of the Tuskegee study's "protocol," the personalities involved, and a little of the scandal and aftermath. The book includes a lot of quotes from primary sources and individuals directly involved in the study-- which is great.

"Bad Blood" was initially published about 10 years after the AP brought the study to light, so it is a little light on discussing the ramifications of the study. The introduction and conclusion touched on this, but I would love to see a new edition that talks about the legacy of Tuskegee in public health and medicine.
Profile Image for Max.
67 reviews2 followers
December 5, 2014
Wonderfully-written with much detail, this book describes the study and the efforts made to bring it to light. The author, an attorney from the area, took up the cause at the behest of one of the victims. Culminating in an apology from President of the United States Bill Clinton, the book describes the process that was used to lure the men into the study and keep them there for 40+ years. Sadly, many of the men who were involved in the study had died by the time the formal apology and restitution were made, but attention must be paid so that this never happens again.
This entire review has been hidden because of spoilers.
Profile Image for Catherine Cook.
1 review7 followers
November 14, 2013
Very informative. I especially found the final chapter interesting where conclusions were drawn on how the Tuskegee Experiment effected the AIDS crisis. Even more fascinating were the theories regarding how the AIDS virus came about and started to spread. There's a specific theory that encourage everyone to research for themselves because it truly is plausible. I'll let you figure out which one it is.
Profile Image for Roger.
558 reviews
April 5, 2018
As a white person, I didn’t know this story. The study started innocently enough in the 1930’s when medical ethics were just assumed and not really considered. But they missed several opportunities stop the study and consider the racist theme of only monitoring and not treating the deadly disease of syphilis. It was hard to read about blatant racism and lying to program “participants” over decades of time.
Profile Image for treehugger.
502 reviews96 followers
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October 2, 2009
I'm pretty excited about this - this book is required reading for my Pharmacy law and ethics course, so I think it's going to be an eye opener...and it'll be nice to get away from so many of the scientific journals I have to read all the time!

I'm never going to finish this book, so I'm just going to be honest with myself right now, and take it off my "currently-reading" shelf.
Profile Image for Lora.
67 reviews3 followers
February 5, 2010
I chose this to write a book review about something concerning medical ethics... We'll see!

In the end, I never finished the book before returning it, but it brought up some serious issues. For instance - race, health distributions, lots of medical ethics, AND I got to learn how syphilis works. Yes, I am a nerd, and it was fascinating.
7 reviews
August 26, 2014
Must Read for everyone! This book is an important reminder of what Americans have done in the name of Science. It is so easy to think that these kinds of things could only happen in Hitler's Germany. But the fact is they happened here, and we are talking about our history. The Tuskegee Experiment lasted into the 1970's!
Profile Image for Ty G.
16 reviews9 followers
August 6, 2013
Don't know if this book was written deliberately to confuse people to who the real perpetrators in this experiment was. And confusing the point of the experiments in all. which was to enhance white genetic survival. The record shows this is always the purpose of European misconduct toward non-Europeans human beings
Profile Image for Judy.
634 reviews1 follower
December 29, 2014
This was fascinating and well researched. It explained how the experiment came to be and how bureaucracy can keep a so-so idea running until long after it becomes a very bad idea. It also cleared up some misconceptions I had about the study. I had a hard time getting into it though and reading it for more than a little bit at a time. Once I finally got up and running with it the story was over.
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