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Journal of General Internal Medicine

, Volume 35, Issue 1, pp 322–325 | Cite as

The Tuskegee Study of Untreated Syphilis: A Case Study in Peripheral Trauma with Implications for Health Professionals

  • Marcella Alsan
  • Marianne WanamakerEmail author
  • Rachel R. Hardeman
Perspective

Abstract

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 

Notes

Authors’ Contributions

Marcella Alsan, Marianne Wanamaker, and Rachel Hardeman take responsibility for the integrity of the data and the accuracy of the data analysis, as well as the manuscript submission.

Funding Information

Drs. Alsan and Wanamaker recognize funding from the National Institute on Minority Health and Health Disparities (1R03MD011449).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

References

  1. 1.
    Bor J, Venkataramani AS, Williams DR, Tsai AC. Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. Lancet. 2018;392:302–10.CrossRefGoogle Scholar
  2. 2.
    Novac NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46(3):839–49.Google Scholar
  3. 3.
    Alsan M, Yang CS. Fear and the Safety Net: Evidence from Secure Communities. NBER Working Paper No. 24731. 2018.Google Scholar
  4. 4.
    Hatzenbuehler ML, Keyes K, Hamilton A, Uddin M, Galea S. The Collateral Damage of Mass Incarceration: Risk of Psychiatric Morbidity Among Nonincarcerated Residents of High-Incarceration Neighborhoods. Research and Practice. 2015;105(1):138–43.Google Scholar
  5. 5.
    Hoynes H, Schanzenbach DW, Almond D. Long-Run Impacts of Childhood Access to the Safety Net. Am Econ Revie. 2016;106(4):903–34.CrossRefGoogle Scholar
  6. 6.
    Herd P, Schoeni RF, House JS. Upstream Solutions: Does the Supplemental Security Income Program Reduce Disability in the Elderly? Milbank Q. 2008;86(1):5–45.CrossRefGoogle Scholar
  7. 7.
    Smolak A. White slavery, whorehouse riots, venereal disease and saving women: historical context of prostitution interventions and harm reduction in New York City during the Progressive Era. Soc Work Public Heal. 2014;28(5):496–508.CrossRefGoogle Scholar
  8. 8.
    Pierce CC. Venereal disease control in civilian communities. Am J Public Health. 1919;9(5):340–5.CrossRefGoogle Scholar
  9. 9.
    Roy B. The Julius Rosenwald Fund syphilis seroprevalance studies. J Natl Med Assoc. 1996;88(5):315–22.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention [Internet]. Atlanta: CDC. U.S. Public Health Service syphilis study at Tuskegee timeline; 2017 [cited 2018 October 4]. Available from: https://www.cdc.gov/tuskegee/timeline.htm.
  11. 11.
    Alsan M, Wanamaker M. Tuskegee and the Health of Black Men. Qtrly J of Econ. 2018;133(1):407–55.Google Scholar
  12. 12.
    Hardeman RR, Medina EM, and Kozhimannil KB. Structural racism and supporting black lives—the role of health professionals. N Engl J Med. 2016;375(22): 2113–5.CrossRefGoogle Scholar
  13. 13.
    Tsai J, Crawford-Roberts A. A call for critical race theory in medical education. Acad Med. 2017;92(8):1072–3.CrossRefGoogle Scholar
  14. 14.
    Tsai J. A Critique of Cultural Competency in Health Care [Internet]. in-Training: the agora of the medical student community. 2016 [cited 2019 Apr 10]. Available from: https://in-training.org/critique-cultural-competency-10456.
  15. 15.
    Carpenter R, Estrada CA, Medrano M, Smith A, Massie FS. A web-based cultural competency training for medical students: a randomized trial. Am J Med Sci. 2015;349(5):442–6.CrossRefGoogle Scholar
  16. 16.
    Lie DA, Lee-Rey E, Bereknyei S, Braddock CH 3rd. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Intern Med. 2011;26(3):317–25.CrossRefGoogle Scholar
  17. 17.
    Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals. Cochrane Database Syst Rev. 2014;(5):CD009405.Google Scholar
  18. 18.
    Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Serv Res. 2014;14:99.CrossRefGoogle Scholar
  19. 19.
    Ludolph R, Schulz RJ. Debiasing Health-Related Judgments and Decision Making: A Systematic Review. Med Decis Making. 2018;38(1):3–13.CrossRefGoogle Scholar
  20. 20.
    Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–25.CrossRefGoogle Scholar
  21. 21.
    Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med. 2009;84(6):782–7.CrossRefGoogle Scholar
  22. 22.
    Spevick J. The case for racial concordance between patients and physicians. Virtual Mentor 2003;5(6):163-165.Google Scholar
  23. 23.
    Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. (Smedley BD, Stith AY, Nelson AR, eds.). National Academies Press, Washington D.C.; 2002.Google Scholar
  24. 24.
    LaVeist TA., Amani N-J, Jones KE. The association of doctor-patient race concordance with health services. J Public Health Policy. 2003;24(3–4):312–23.CrossRefGoogle Scholar
  25. 25.
    Saha S, Komaromy M, Koepsell T, Bindman A. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004.CrossRefGoogle Scholar
  26. 26.
    Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA. Patient-provider race-concordance: does it matter in improving minority patients health outcomes? Ethn Health. 2009;14(1):107–130.CrossRefGoogle Scholar
  27. 27.
    Alsan M, Garrick O, Graziani GC. Does Diversity Matter for Health? Experimental Evidence from Oakland. NBER Working Paper No. 24787. 2018.Google Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Marcella Alsan
    • 1
    • 2
  • Marianne Wanamaker
    • 2
    • 3
    Email author
  • Rachel R. Hardeman
    • 4
  1. 1.John F. Kennedy School of GovernmentHarvard UniversityCambridgeUSA
  2. 2.National Bureau of Economic ResearchCambridgeUSA
  3. 3.Department of EconomicsUniversity of TennesseeKnoxvilleUSA
  4. 4.Division of Health Policy & ManagementUniversity of Minnesota School of Public HealthMinneapolisUSA

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