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Transcript of 19001020304050607080902000 Eugenics Movement Nuremberg Code - 1947 Declaration of Helsinki - 1964...
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Eugenics Movement
Nuremberg Code - 1947
Declaration of Helsinki - 1964
Tuskegee Study – 1932-72
WWII – 1939-45
Time Line for Human Subject Research and Protection
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Tuskegee Study of Untreated Syphilis
1932-1972
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White Negro White Negro
CardiovascularCases
CardiovascularCases
Central NervousCases
Central NervousCases
Pe
rce
nt
Aff
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ted
Men
Women
From: Sowder WT. An interpretation of Bruusgaard’s paper on the fate of untreated syphilitics. American Journal of Syphilology 1940; 24:684-691
Gender and Race Related Manifestations in 6,420 Cases of Late Syphilis
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Tuskegee Study Rationale - 1932
• Was there enough information to justify a cohort study of untreated Negro men?
• Were effective treatments available for managing syphilis?
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Tuskegee Study of Untreated Syphilis
• Negro Men
• Infected with Syphilis
• 1932-1972
• Macon County, Alabama
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Russell Lee – Farm Security AdministrationLibrary of Congress - LC-USF33- 011671-M2
Cotton Pickers – 1938 - Arkansas
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Incentives for Participation
• Burial costs
• Periodic Examinations
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Cotton Field – Macon County, Alabama(Centers for Disease Control, Atlanta, GA)
Nurse Eunice Rivers and Unidentified Subject
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Field Follow-up: Tuskegee Study - 1952
Mr. David Albritton, Dr. Walter Edmondson, Nurse Eunice Rivers, and Unidentified SubjectMacon County, Alabama
(Centers for Disease Control, Atlanta, GA)
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Tuskegee Study: Press Reaction - 1972
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“Believe nothing that yousee in the newspapers – they have done more to create dissatisfaction thanall other agencies. If yousee anything in them thatyou know is true, begin todoubt it at once.”
William Osler, M.D.
1900
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Rudolf H. Kampmeier, M.D.
Editorials:
The Tuskegee Study of Untreated Syphilis.Southern Medical Journal1972; 65 (10): 1247-1251
Final Report on the “Tuskegee Syphilis Study.”Southern Medical Journal1974; 67 (11): 1349-1353
Argues that the Tuskegee study should be interpreted in the context of the times in which it was conducted.
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The Shibboleth of Informed Consent
“…I have no intention of becoming entrapped in this topic since to me the interpretation of customs and mores of a generation or two ago in today’s terms is a tilting at windmills…. In the days of the Tuskegee Study we used to walk into a patient’s room and announce ‘We’re going to take out your gallbladder tomorrow morning,’ the answer commonly was, ‘OK’ and that was it – no ‘informed consent,’no signed paper of permission – ergo, Jenner, the Hunters, Pasteur, and hundreds of thousands of physicians and surgeons of the past have been unethical in terms of ‘informed consent.’”
Kampmeier, RH. Southern Medical Journal 1974; 67:1349-1353
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Tuskegee Study - 1972
• What is the evidence that treatment of tertiary syphilis with penicillin changes outcomes?
• What proportion of cohort participants received antibiotics over the course of the study?
• How complete was the cohort follow-up?
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White House Apology Ceremony – May 16, 1997
Front Row (left to right): Herman Shaw, Fred Simmons, Charles Pollard, Frederick Moss, Carter Howard.
Back Row (left to right): Surgeon General David Satcher, President William J. Clinton, Vice-President Albert Gore.