The Tuskegee Study of Untreated Syphilis: A Case Study in Peripheral Trauma with Implications for Health Professionals
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John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA; 2National Bureau of Economic Research, Cambridge, MA, USA; Department of Economics, University of Tennessee, Knoxville, TN, USA; 4Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA. 3
Racially or ethnically targeted events may have adverse health implications for members of the group not directly targeted, a phenomenon known as peripheral trauma. Recent evidence suggests that mass incarceration, police brutality, and immigration actions all have such effects, as did medical exploitation by the US government during the Tuskegee Study of Untreated Syphilis in the Negro Male. We summarize recent findings in the economics literature on population-level effects of the Tuskegee study, including a decline in health-seeking behavior and a rise of both mortality and medical mistrust among African-American men not enrolled in the study. We highlight the relevance of our findings for present-day racial health disparities. Practitioner awareness of peripheral trauma is an important element of cultural competency. But among options to substantially improve minority trust in the healthcare system, the diversification of medical practitioners may hold greatest promise. KEY WORDS: racial disparities; mistrust in institutions; population health. J Gen Intern Med DOI: 10.1007/s11606-019-05309-8 © Society of General Internal Medicine 2019
INTRODUCTION
A nascent body of research suggests exposure to racially or ethnically targeted events predicts adverse physical and mental health outcomes among minority groups, even among members not directly targeted, a phenomenon known as peripheral trauma. In cases where the medical profession is the perpetrator of such actions, health effects may be even more pronounced as targeted groups experience both the stress of targeting and heightened mistrust of the medical profession. In this Perspectives piece, we summarize recent research on peripheral trauma, including the population-level effects of police killings of unarmed black men, immigration enforcement actions, and mass incarceration.1–4 We then discuss new evidence that the racially targeted Tuskegee Study of Untreated Received October 5, 2018 Revised May 30, 2019 Accepted August 13, 2019
Syphilis in the Negro Male (TSUS) affected more than just the study’s direct victims; lower healthcare utilization and higher mortality extended to the generation of black men who identified with those victims. To the extent ongoing medical mistrust among black Americans is rooted in this historical exploitation, the peripheral trauma of TSUS spans generations. We conclude by outlining the implications of peripheral trauma for the medical profession and discuss potential mitigating strategies to counter its effects.
EVIDENCE ON PERIPHERAL TRAUMA
Several recent studies document the effect of peripheral trauma on population health. Bor and colleagues (2018) examine whether police killings affect the mental health of b
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