Syphilis: Doc James on the Tuskegee Study

[Bezdomni]

Doing some research into the origin of the term "grande vérole" (as opposed to "petite vérole"), I happened to read the en.wp page on Syphilis (T-H-L), where I read the section on the Tuskegee study of the disease. It turns out that this page contains some quite misleading information about the Tuskegee study. This is what I found in researching the origin of the misinformation:

Study directors continued the study and did not offering (sic) patients treatment with penicillin. This however is debated and some have found that penicillin was given to many of the subjects.<ref>{{cite journal|last=White|first=RM|title=Unraveling the Tuskegee Study of Untreated Syphilis.|journal=Archives of internal medicine|date=2000 Mar 13|volume=160|issue=5|pages=585-98|pmid=10724044}}</ref>

source: original addition back in 2011. NB: as of the most recent edit today (by the same editor), the prose had been modified slightly -- though not substantially -- in the last 7 years to eliminate the grammatical infelicities and for flow.

As a result, I decided to track down the article referenced in order to see if perhaps I had misunderstood the furor about the study (I had always thought the problem was one of not obtaining informed consent and of misleading the subjects to believe they were receiving treatment.) The article confirmed (rather in spite of itself) that this was the major issue:

[T]he charge that medical officials lied to and deceived patients was not identifiable in the published reports but was uncovered years later in documents in the National Archives.

source, p. 11/14; orig. p. 595

Nowhere is this basic problem mentioned in the subsection on the Tuskegee study.

A 1956 study reported that 261 of 289 of the second cohort had received some treatment (heavy metals), but that less than 3% had received adequate penicillin treatment.

In the article by Schuman et al, the Sing Sing criteria for adequate therapy for syphilis were defined—no treatment: no treatment or less than 12 doses of arsenicals and/or bismuth injections; inadequate treatment: 12 doses of arsenicals and/or bismuth but less than adequate or less than 2.4 x 106 U of penicillin; and adequate treatment: 20 doses each of arsenicals and bismuth or 30 injections within 2 years or a rapid treatment schedule of 2.4 x 106 U or more of penicillin. According to the Sing Sing criteria for treatment, only 8 of the 299 subjects would have been considered to be adequately treated.

source, pp. 6-7; orig. pp. 590-1

So during the earlier stages of the study, over 97% of the subjects did not receive adequate penicillin treatment, though the author argues that this was not necessarily unusual at the time. Reading further, I discovered what probably inspired the Wikipedia editor in question to add the misinformation:

By 1952, 28% of the syphilitic patients examined in the TSUS had received penicillin therapy.

source, p. 11/14; orig. p. 595

Two things are particularly worth noting here in relation to the claim: first, the text does not state whether the penicillin therapy was adequate (though it may have been), and second (more importantly), the text does not suggest that the men received penicillin therapy because of their participation in the study as the "wiki-text" leads the reader to believe. Indeed, later in the paragraph, White makes clear that it was quite the contrary:

Although the USPHS may have deprived the men participating in the TSUS of penicillin therapy, it was unsuccessful in stopping the administration of “happenstance penicillin.”

source, p. 11/14; orig. p. 595

It is very strange that the contributor, having read the entire article, decided to include the claim that "penicillin was given to many of the subjects" because of their participation in the study, since this is repudiated in the same paragraph, while deciding to omit the more fundamental fact that the subjects had been misinformed.

(In reading this data, remember too that many of the men from the earlier stages of the study would have been dead by the later study. Indeed, much of the early research came from autopsies.)

Who was this editor? Well, if you click on the first "source" link, you will find they are a current trustee of the Wikimedia Foundation, the esteemed Doc James. Was the error deliberate or inadvertent? One can only assume the latter. Still, frankly, I find this #fakenews very strange. What is debated is not whether the subjects were offered penicillin through the study (they clearly were not), but whether they may have been treated with penicillin elsewhere (e.g. treatment for pneumonia, seeking treatment outside of the study, in compliance with Alabama state law concerning early-stage syphilis, etc.).

I have posted the full PDF (see sources above) in hope that someone will be able to dispute the accuracy of my re-reading of the evidence I believe has been misrepresented in the Wikipedia entry. I am also including a link to an article from 1976 that provides some damning correspondence from some of the administrators of the project. This article is heavily cited in the source mentioned above, but receives no mention in the Wikipedia entry despite being the established scholarship that White is arguing against in his critical/revisionist retrospective.

[Poetlister]

This is pretty worrying. Doc James, whatever his faults, is a qualified medical doctor and has no excuse for not knowing better.

[Bezdomni]

I've contacted the author of the entry (51%) who has graciously cleaned up the mistake. What surprises me is that nobody found that howler during the GA assessment in August 2011 (only a couple months after it was added). I remember WRC saying a while back that the very first part of a GA review is meant to be verifying that the sources are accurately represented. Oh well, better 7 years later than never, I guess...

[Poetlister]

I've contacted the author of the entry (51%) who has graciously cleaned up the mistake. What surprises me is that nobody found that howler during the GA assessment in August 2011 (only a couple months after it was added). I remember WRC saying a while back that the very first part of a GA review is meant to be verifying that the sources are accurately represented. Oh well, better 7 years later than never, I guess...

Wikipedia ... always improving.

[Malik Shabazz]

I call bullshit. There was no study, because a study implies an effort to learn something. The effects of untreated syphilis were well-known, well-documented, and well understood decades before the men in Tuskegee were allowed to go untreated.

[Bezdomni]

I call bullshit.

Well the elephant in the room is probably: why is an infected black dick illustrating the just-glance-down-from-thelede of the syphilis "entry"?

As far as I know, you're not blocked, despite your evidence-free aspersions against Sandstein, so you can fix whatever isn't right. If you haven't (for whatever reason) when I've looked in next, I'll give you a few suggestions that you are free to adapt or ignore.

Thanks for breaking your silence in this thread MS. I think you're right to; there's something (per "haps" to be studied) here.

[Poetlister]

I call bullshit. There was no study, because a study implies an effort to learn something. The effects of untreated syphilis were well-known, well-documented, and well understood decades before the men in Tuskegee were allowed to go untreated.

Surely what was being studied was how much difference the treatments made. You need an untreated control group to do that properly.

[Bezdomni]

I call bullshit. There was no study, because a study implies an effort to learn something. The effects of untreated syphilis were well-known, well-documented, and well understood decades before the men in Tuskegee were allowed to go untreated.

Surely what was being studied was how much difference the treatments made. You need an untreated control group to do that properly.

I don't know if you're trying to suggest that Malik is incorrect or if you're just making an obvious point about scientific method, Poetlister. The last link in my first post mentions that the Tuskegee study was inspired by a Norwegian study conducted at the turn of the century by C. Boeck at the Oslo Venereal Hospital. Bruusgard continued the work after Boeck died, observing that while there were a surprising number of people (70%) who went on to lead lives untroubled by the disease, 30% of cases were quite malignant.

[E]very major textbook of syphilis at the time of the Tuskegee Study's inception strongly advocated treating syphilis even in its latent stages[.]

source, pp 22-23.

A page later, Brandt provides the text of the flyer the Macon County Health Department sent round to the subjects for their completely free therapeutic follow-up spinal tap:

Some time ago you were given a thorough examination and since that time we hope you have gotten a great deal of treatment for bad blood. You will now be given your last chance to to get a special treatment if it is believed you are in a condition to stand it. ...
Remember This is Your Last Chance For Special Free Treatment. Be Sure To Meet The Nurse.

Outside of BigScience, Malik is also just right. In BigLiterature, (Doc) Rabelais dedicated Gargantua to the Pox-Ridden in 1533/4. He was probably so moved by his proximity to the disease during the Italian Wars (François Ier / Henri II -- Charles Quint), where the disease is thought to have first appeared in Europe. Shakespeare, too, was obsessed with it (§). Post Gutenberg, the effects of syphilis were pretty widely known among the people who could read or be read to.

Speaking of the "syphilis in arts & literature" section of the Doc's GA... it's true that (Poet-Doc) Keats was progressively poisoning himself with mercury for some obscure reason around the time he revisited the medieval La Belle Dame sans mercy -- written in the 1420s, several generations before the post-1492 syphilis outbreaks in Europe, which, on French accounts at least, came through the port of Naples (while small pox was wiping out the Arawak).

I imagine that the gendry could find something to say about en.wp's survey of syphilis in literature only focusing on femmes fatales.

[Poetlister]

I don't know if you're trying to suggest that Malik is incorrect or if you're just making an obvious point about scientific method, Poetlister.

I'm doing both. Malik is wrong because of this obvious point.

Of course, in practice i this sort of case it would be quite unethical to leave people deliberately untreated, so a proper double-blind study with some people given only a placebo would not be done.

[Malik Shabazz]

I don't know if you're trying to suggest that Malik is incorrect or if you're just making an obvious point about scientific method, Poetlister.

I'm doing both. Malik is wrong because of this obvious point.

Of course, in practice i this sort of case it would be quite unethical to leave people deliberately untreated, so a proper double-blind study with some people given only a placebo would not be done.

You're right, of course, but niggers in Alabama weren't people.

[Malik Shabazz]

I call bullshit. There was no study, because a study implies an effort to learn something. The effects of untreated syphilis were well-known, well-documented, and well understood decades before the men in Tuskegee were allowed to go untreated.

Surely what was being studied was how much difference the treatments made. You need an untreated control group to do that properly.

That's simply not true. First, the effects of untreated syphilis were sufficiently well-understood that no control was necessary. Second, there was no group being treated that was being compared to the untreated group. It was about as "scientific" an experiment as anything dreamed up by Dr. Mengele.

[Malik Shabazz]

As far as I know, you're not blocked, despite your evidence-free aspersions against Sandstein

I don't want to hijack this discussion, but Sandstein topic banned me from Israel-Palestine topics on May 23. In late May or early June, he received an e-mail message about me from an editor who needs to be perma-blocked. He bought every accusation against me in that message and "let me off with a warning" for violating the topic ban.

Unfortunately for the incompetent and corrupt piece of shit, those violations included (a) warning another editor about an Israel-Palestine 1RR violation on May 12, (b) asking for a better source than the Lonely Planet tourist guide for the assertion that there had been a Jewish temple or two in Jerusalem, and (c) editing a sentence about Judaism in article about religion in Israel. As I wrote, corrupt and incompetent. I've been told that he is a lawyer in meat-space. Had he made these accusations in a court of law, he would have been laughed out of court and possibly disbarred. On Wikipedia, the administrative corps just look the other way at his incompetence. Except for the dipshit who blocked me for telling the truth.

[Poetlister]

(b) asking for a better source than the Lonely Planet tourist guide for the assertion that there had been a Jewish temple or two in Jerusalem

I don't know whether the Lonely Planet guide is reliable or not, but how on earth can you query that there were two temples in Jerusalem?

I won't comment further on your understanding of designed experiments.

[Bezdomni]

It's an interesting case. I've been thinking of writing this up for TheWikiCabal or another publication. Unfortunately, since I am blocked for having questioned why a guy socking was being allowed to evade scrutiny and to call people checking out his embroidery propagandists, I can't include this information on the talk page of the "encyclopedia" article without myself violating en.wp rules.

Efforts to contact the principal author of the article to explain the problem have led to very minimal improvements. It is true that the article Mr. James added is no longer misrepresented as it had been for the past seven years. (The Doc has indeed chosen to focus on what is -- IMO -- the only reasonably strong counterargument against the established scholarship in White's article).

Doctor J was very quick to: delete a reference I pointed out which he deemed to be "spammy"; and, to correct what was blatantly false... yet he still seems reticent to include even a passing reference to the established scholarship (written by Harvard historian Allan M. Brandt (T-H-L)) that his preferred author is responding to. Strange, since I provided him with the ref all dressed up in its Template:Cite finest.

Off-wiki, we assume nothing, so I guess it will remain an open question what Doc J's motivation is. I gather that some suspect that it could be just pride unrelated to a desire to rewrite history.

[Malik Shabazz]

(b) asking for a better source than the Lonely Planet tourist guide for the assertion that there had been a Jewish temple or two in Jerusalem

I don't know whether the Lonely Planet guide is reliable or not, but how on earth can you query that there were two temples in Jerusalem?

I don't question the existence of two Temples in Jerusalem, but if Wikipedia is going to cite a "reliable source" for such a statement, it shouldn't be a travel guide, which may be one of the least reliable classes of published works.

[Poetlister]

I don't question the existence of two Temples in Jerusalem, but if Wikipedia is going to cite a "reliable source" for such a statement, it shouldn't be a travel guide, which may be one of the least reliable classes of published works.

It depends on whether a statement is controversial. If everyone agrees that it's true, nobody will quibble about the reference. If people with a POV wish to deny it, then a dozen impeccable sources might not suffice. My favourite example is whether Georg Cantor (T-H-L)'s father was Jewish. Cantor himself says clearly "Er ist aber in Kopenhagen geboren, von israelitischen Eltern, die der dortigen portugisischen Judengemeinde" ("However, he was born in Copenhagen of Jewish parents from the Portuguese-Jewish community") but that does not seem to be enough proof.

[Eric Corbett]

I don't question the existence of two Temples in Jerusalem, but if Wikipedia is going to cite a "reliable source" for such a statement, it shouldn't be a travel guide, which may be one of the least reliable classes of published works.

It depends on whether a statement is controversial. If everyone agrees that it's true, nobody will quibble about the reference. If people with a POV wish to deny it, then a dozen impeccable sources might not suffice. My favourite example is whether Georg Cantor (T-H-L)'s father was Jewish. Cantor himself says clearly "Er ist aber in Kopenhagen geboren, von israelitischen Eltern, die der dortigen portugisischen Judengemeinde" ("However, he was born in Copenhagen of Jewish parents from the Portuguese-Jewish community") but that does not seem to be enough proof.

All that proves is that his parents were Jewish, not that he was.

[Poetlister]

All that proves is that his parents were Jewish, not that he was.

Yes, obviously it's original research to assume that if your parents are both not just Jewish but members of the local Jewish community, then you were born Jewish.

[Eric Corbett]

All that proves is that his parents were Jewish, not that he was.

Yes, obviously it's original research to assume that if your parents are both not just Jewish but members of the local Jewish community, then you were born Jewish.

My parents were both Roman Catholics, but I'm not.

[Ming]

The issue of what constitutes Jewish identity has become controversial of late, though in Cantor's father's day the answer was straightforward enough. The long discussion in the article makes it clear, however, that his father was at least a convert to Lutheranism if not so baptized at birth, and there are plenty of inconsistencies to where Cantor's own recollection of something he wasn't around to see for himself ought not to be taken to trump all other sources. The unanswered (and for that matter unasked) question is why everyone cares so much: given the effort put into researching his background before WP came on the scene, it was obviously important to someone-- given the mention of the 1930s, presumably the Nazis, but it doesn't say.

[Poetlister]

All that proves is that his parents were Jewish, not that he was.

Yes, obviously it's original research to assume that if your parents are both not just Jewish but members of the local Jewish community, then you were born Jewish.

My parents were both Roman Catholics, but I'm not.

But you were born Roman Catholic and presumably baptised as such.

[Eric Corbett]

All that proves is that his parents were Jewish, not that he was.

Yes, obviously it's original research to assume that if your parents are both not just Jewish but members of the local Jewish community, then you were born Jewish.

My parents were both Roman Catholics, but I'm not.

But you were born Roman Catholic and presumably baptised as such.

Nobody is born any religion, and I was baptised in the Church of England. Admittedly I was baptised again eight or nine years later, that time as a Roman Catholic. I'm just saying that even from my limited experience one shouldn't make assumptions that connect the religious faith of the parents with the religious faith of the child.

[Poetlister]

I wasn't talking just about religion. Judaism is an ethnicity and is specifically protected as such under the UK Race Relations Act and similar legislation in other countries. But all this is way .

[Eric Corbett]

I wasn't talking just about religion. Judaism is an ethnicity and is specifically protected as such under the UK Race Relations Act and similar legislation in other countries. But all this is way .

Then why do you persist in prolonging an argument which you do not understand? Seems to be something of a modus operandi with you.

[Poetlister]

Then why do you persist in prolonging an argument which you do not understand?

Why do you assume that I don't understand it?

Seems to be something of a modus operandi with you.

Are you referring to your vastly greater knowledge of statistics and experimental design?

[Eric Corbett]

Then why do you persist in prolonging an argument which you do not understand?

Why do you assume that I don't understand it?

Seems to be something of a modus operandi with you.

Are you referring to your vastly greater knowledge of statistics and experimental design?

My knowledge is considerably greater than your own. Live with it.

[Poetlister]

Are you referring to your vastly greater knowledge of statistics and experimental design?

My knowledge is considerably greater than your own. Live with it.

I certainly intend to go on living.