In this essay I am neither endorsing nor dismissing the counter-narrative, but rather spelling it out and suggesting why it is plausible enough to warrant more public attention. It remains to be seen whether an impartial assessment of the evidence (and future research) will continue to lend support to the popular contemporary horror-story version of Tuskegee; or whether, alternatively, one will come to the conclusion that the Tuskegee project was neither racist nor in and of itself the cause of great harms. Perhaps the horror story will have to be revised and toned down because it has been too heavily influenced by post-1968 identity politics. Perhaps not - that remains to be seen.Racial justice matters, and social justice in general is a central value in our liberal democracy. But one must also remain open to the possibility that in this instance politics and generalised racial grievance have got in the way of critical analysis. That too remains to be seen, and debated. At the very least, the evidence suggests to me that in this instance the 'received wisdom' of the day deserves to be re-examined.
Don't let that "counter-narrative" phrasing put you off - it's an interesting and worthwhile essay. I was not so uninformed that I held the belief that the study subjects were deliberately infected with syphilis, but I certainly have accepted unquestioningly the prevailing "horror-story version" - I can vaguely recall becoming irate at an unrepentant old doctor who had been involved in the study, interviewed on some television special aired years ago. (The article also compels me to update corrupted or erroneous memory files re Ehrlich and salvarsan. I was under the impression that by the time of Tuskegee, the available arsenical compounds were a more effective - if not a more tolerable - remedy than Shweder's article suggests.)
Hmm. I've printed out the article for an in-depth read. Frankly, I bought the conventional "narrative" hook, line and sinker.
I agree with your point about the "sin of presentism." It seems like the current zeitgeist - which I own like everyone else - is willing to forgive any other culture for its imperfections, but will never attempt to understand our own, even if the "past is a different country."
Posted by: Peter Sean Bradley on January 25, 2004
Ok. I've read the article. I like what it says about presentism, but I do have this demurrer. While I can understand how paternalistic doctors in the era before "informed consent" might have conducted a passive watch and learn study on blacks in the South or White hardscrabble farmers in Appalachia, I just can't imagine such a study being done among middle class folk in Upstate New York or among Massachusett's farmers in the 1930s. My sense is that such a study in that context at that time would have been viewed as improper. I also think that a concern over equality and equal dignity is one reason why the idea of informed consent evolved. It's a very interesting article with points worth pondering.
Posted by: Peter Sean Bradley on January 26, 2004
Agree with your demurral - one of the first questions that would need to be asked in a re-evaluation would be "why was this particular population chosen for study?" Higher rates of syphilis? More likely compliance among people who otherwise couldn't afford access to health care? Why poor blacks not poor whites? Regarding the selection of the poor rather than the middle class, though, one has to ask if that isn't true for many types of medical studies done today (though with adherence to current standards of informed consent). That's just a speculation on my part - I recall that as an undergraduate in a research lab, the subjects for the studies I worked on were the "working poor". They could be bribed into participating with offers of regular medical care - something they couldn't usually get, unlike both middle-class and Medicaid parents.
Also, regarding informed consent, I wasn't able to make out if the author was trying to imply anything about the need, or lack of need, for ethical oversight committees, or whether he was simply relating the origin of intitutionalized ethical oversight as part of the Tuskegee story.
Posted by: Moira on January 26, 2004