The Price of Mistrust

Black Americans have plenty of good reasons to mistrust the police. The Tuskegee scandal also gave them good reason to mistrust doctors. But this mistrust has cost them millions of years of their lives.

How can you trust your country? Sadly, it is a question that black Americans have had a great many reasons to ask themselves. Keith Scott in Charlotte on Sept. 20, Terence Crutcher in Tulsa four days earlier, Sylville Smith in Milwaukee in August, Philando Castile in Falcon Heights and Alton Sterling in Baton Rouge in July. All of these African-Americans were killed by the police, further prolonging a terrible litany of victims. Trust in government institutions is threatened by this. But this trust has already been undermined many times in the past, in many different ways. This undermining has formidable effects on abstract ideas such as democracy and on more concrete realities such as health and life expectancy. A recent study has shown the shadow cast by a horrifying history that began nearly a century ago, the effects of which can still be seen today: the Tuskegee scandal.

Tuskegee is a large city in Alabama. Rosa Parks—the black woman who dared to refuse to give up her seat to a white person on a bus in 1955, thus becoming a symbol of the fight against racial segregation—was born there. A famous study into syphilis was also conducted there, beginning in 1932. One of the many victims of this venereal disease was the writer Guy de Maupassant, who was delighted to have contracted it (“I have syphilis, therefore I am not afraid of catching it”) before dying 15 years later. In 1932, a medical team decided to conduct a six-month epidemiological study in Macon County, where Tuskegee is the county seat. They enlisted 399 black men who were suffering from the illness, mainly illiterate agricultural workers. In exchange for meals and burial payments (with permission to perform an autopsy on their bodies before the funeral), the sufferers agreed to regularly undergo medical tests and painful lumbar punctures. This study was then renewed…indefinitely. When a number of sufferers were conscripted into the army during Word War II, the medical team ordered them not to follow the treatments prescribed by the recruitment centers. When penicillin was systematically introduced in 1947 to successfully treat the disease, that same team decided not to give it to their guinea pigs, so that they could observe the evolution of the disease at leisure.

In 1966, Peter Buxtun, a social worker who had heard word of this strange study, raised it with the medical authorities. They told him that the study would continue until its end—that is to say, the death of the last sufferer. In 1972, Buxtun ended up passing the report on to Jean Heller, a journalist working for the Associated Press. It made the front page of The New York Times. The experiment was finally stopped. Only 74 survivors remained; 28 sufferers had died of syphilis directly and 100 others had died from related complications; 40 wives had been infected and 19 children were born with the disease. The scandal was massive. Sen. Ted Kennedy called for congressional hearings into the study. The medical team’s procedures were completely revised, and the obligation to obtain the informed consent of all patients for any experiment was introduced. Bill Clinton welcomed the last survivors to the White House in 1997 to offer them the nation’s apologies.

But, just when the Tuskegee drama seemed to be at an end, it had in fact only just begun. This is demonstrated in a fascinating academic article published this summer by Marcella Alsan, a professor at Stanford medical school, and Marianne Wanamaker, an economist at the University of Tennessee.* The two researchers demonstrate that the scandal had an immediate effect; black men suddenly stopped trusting doctors. They said so in a survey regularly carried out by the Health Department (incidentally, it was not known whether or not the color of their skin featured in the questionnaire). They have demonstrated this effect by going to the doctor less often.

The legitimate mistrust toward medical professionals has led to a healthcare catastrophe. Among black men over the age of 45, who identify most readily with the Tuskegee victims, the rate of life expectancy dramatically ceased to coincide with that of whites as of 1972. In the United States, the two researchers estimate that “Tuskegee and its revelation reduced black life expectancy at age 45 by 1.4 years, accounting for 35 percent of the black to white-male life expectancy gap in 1980.” They go on to show that the impact has been even stronger among blacks living near Tuskegee, and that the proportion of the population that comes from Alabama is high. An event that affected hundreds of people has resulted in a final bill that amounts to years of millions of lives lost. The multiplying effect of a loss of confidence can be terrible.

This lesson does not only apply to black Americans. It is well known among businesses also. Perrier almost disappeared after traces of benzene were found in some of its bottles. Cattle farmers and their industry struggled to survive the mad cow crisis. And no one can tell just how many tens of billions of dollars Volkswagen’s rigged vehicles will cost them. Politicians all too often seem to ignore it. The current French president was elected under a promise of “change now.” His predecessor had won by announcing a “shake up.” Neither of them kept their promises. Mistrust toward politicians seems to be rising inexorably. It is democracy that will pay the bill, a bill that is infinitely higher than the price of a few lies during the election campaign.

*Editor’s note: The article, “Tuskegee and the Health of Black Men,” was published by the National Bureau of Economic Research, and is cited as Working Paper No. 22323, NBER, June 2016.