Winning The War: Tuskegee and the Biotech Arms Race

Part 4: The end?

On September 1, 1939, Adolf Hitler and the Nazis invaded Poland. The bloody quest to expand Germany’s territory had begun before this date, but this particular invasion was the one that drew the French and British Allies right into the middle of the war. Two days after the invasion, France and England declared war on Germany. The Nazis were determined to create an ethnostate that was self-sufficient from other countries on multiple fronts. The Allies arrived to stop them.

One of those theaters of war? Aside from physical land, there was an intellectual fight in Biotechnology. Two years before the invasion, in 1936 and 1938 two American acts were passed to take on the German economic pressure that was bearing down on Americans as the Germans made breakthroughs in various therapeutic medicines. There was a nationwide desire to have U.S.-based, efficient testing for diseases like Syphilis made and supplied right from home. Dependency on a power you had just fought and might go right back to war with again was something Americans wanted to eliminate as fast as possible. Containing the spread of Syphilis was also a major priority, so time was of the essence.

The Public Health Service utilized those two aforementioned acts - the Social Security Act and Venereal Disease Research Act - to expand both their financial and regulatory powers. The men within the control and infected groups from the Tuskegee Syphilis Study were even allowed to be totally exempt from the WWII draft to protect the study’s access to the men.

In 1942 American scientists advanced, making possible the rise of the successful VDRL test. Improvements in detecting Syphilis were finally starting to pick up steam. That same year, Hitler ordered Greece to be fortified by the Nazis and began conducting sterilization experiments on Jewish women in Auschwitz. In 1948, Johns Hopkins University experienced a win, with Robert Nelson figuring out a way to isolate a strain of rabbit syphilis for several days. In 1949, Germany split itself in two and Robert Nelson discovers that he can introduce antibodies from syphilitic human serums to immobilize and kill a kind of Syphilis (T Pallidum). The T Pallidum Immobilization Test is born. Compared to everything else available, it was highly sensitive and had an incredibly low rate of false positives. While difficult and expensive to deploy due to the sheer number of rabbit colonies needed to deploy it, it became the standard to measure all other developing tests. In 1952, the PHS clocked just how important this test would be and called a meeting of all their laboratories that fell under the Division of Venereal Disease to standardize the TPI. They started with some rabbit antibodies and then switched to humans. Then came what is known as the most important diagnostic test since the TPI: The Fluorescent Treponemal Antibody Absorption Test (FTA-ABS). It is still used today. Other nations, leaning on the national work of the network of clinics from the PHS, came to use two U.S.-created tests (VDRL and the FTA-ABS) all over the world. The successful commercialization and standardization of this incredibly useful biotechnology rested on steady access to property that the PHS had claimed: the blood of the infected Tuskegee patients.

One of the major assumptions and myths in our collective memory -when we do call to mind the experiment- is that the Tuskegee Syphilis study occurred in isolation. That the ethical missteps occurred in some kind of backwater, unsupervised situation. That could not be further from the case. PHS had a constellation of clinics that were interlocked together. Tuskegee provided what the state desperately needed, which was a standard against which to measure the value of any therapeutic innovations¹. The patients in Tuskegee were the human reservoirs of untreated syphilis, generating lots of human serum/sera (the blood fluid freed of cells and clotting proteins). Developing lucrative biotechnology like the VDRL test and the FTA-ABS (and more) required what would otherwise be an ever-decreasing supply as year after year more treatments started to go mainstream. "The Tuskegee Syphilis Experiment: Biotechnology and the Administrative State” by Dr. Benjamin Roy (which I have been referencing for this and which is touched upon in Harriet Washington’s Medical Apartheid) lays out in greater detail the historic chain through which the men’s sera was passed, and how legally the PHS covered this “indirect” use of the human fluids. By filing the Tuskegee Syphilis Study as a clinical study, the PHS could make a distinction between documentation of what was being used directly and what was being used indirectly. The sera from the men was filed under the indirect category. This meant that the fact that the PHS was harvesting without permission the bodily property of these men and sending it out for development was never reviewed or included in any later investigations of the Tuskegee Syphilis Study. In slavery, enslaved people did not have legal cover to physically leave medical development projects. But now they did. There was no way the PHS could convince people to freely donate and consent to remaining sick for a lifetime so they could have perfect Syphilis cultures. The deceptive practices weren’t localized to just the clinic, because doctors at the clinics connected to it had to have known what was going on and also wrote about how helpful the Tuskegee supply was! And the fact that upon closer inspection there was no clinical protocol for what was registered as a clinical study is another massive red flag. The clinical protocol lays out the proposed plan and aim of the study and experiment. But the usefulness of Tuskegee for decades was not in watching how the disease progressed but in the supply of syphilitic sera! The absence of the protocol and documented deception and fear that the patients would be treated and the supply would be jeopardized betray the commercial aims of the study.

The access to this supply is what helped the PHS and the USA climb to a monopoly on state-of-the-art tests and gain more power and prominence within the World Health Organization. To remain competitive, the experiment had to keep going. The sting is that the PHS technically did all of this legally. It is a glaring warning that the administrative state (or any agency) can be handed regulatory and financial power through acts that are poorly understood or not reviewed, and that can lead to legally permitted theft or abuse. If a group of people historically (or presently ) lack the power to meaningfully participate in the democratic process or to give their informed consent within an administrative system, they are at risk of being legally abused by their own state. This final look at the horrors of Tuskegee and the hidden, utilitarian justification should really be just the beginning of digging deeper into the ways other marginalized groups find themselves exploited for economic and technological gain. And as we begin the second part of Medical Apartheid, this exact lesson that was not learned from Tuskegee’s Syphilis Study will continue to come back over and over again.

1. Roy, Benjamin, MD “The Tuskegee Syphilis Experiment: Biotechnology And The Administrative State”