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Two studies, widely condemned in the 1970s and 1980s-the Tuskegee study of men with untreated syphilis and the New Zealand study of women with untreated carcinoma in situ of the cervix-received new defenses in the 21st century.
We noted remarkable similarities in both the studies and their defenses. Here we evaluate the scientific, political, and moral claims of the defenders.
The scientific claims are largely based on incomplete or misinterpreted evidence and exaggeration of the uncertainties of science. The defenders' political arguments mistakenly claim that identity politics clouded the original critiques; in fact such politics opened the eyes of the public to exploitation. The moral defenses demonstrate an overreliance on codes of conductandhaveimplications for research ethics today. (Am JPublicHealth. 2015;105: e12-e19. doi:10.2105/AJPH. 2015.302720)
IN DARK MEDICINE: Rationalizing Unethical Medical Research, William LaFleur describes how rationalizations initially masquerade as reasons-but they are insufficient or invalid.1 Even Nazi physicians experimenting in the concentration camps rationalized their actions. These acts were grossly immoral, yet behind them were moral justifications. Those involved used these justifications to suppress and subdue their moral intuitions.2 These were rationalizations offered at the time, but such justifications can also be made in the present for the past actions of others, though the motives for doing so are different. We use the idea of rationalization to explore recent revisionist accounts of what have been widely regarded as unethical medical studies.
The Tuskegee syphilis study in Macon Country, Alabama, has been described as an egregious case of blatant racism.3 Nevertheless, it has always had its defenders, such as those who rushed to justify it when the study first came to public attention in the 1970s.4 In the 21st century, physician Robert White and cultural anthropologist Richard Shweder have proffered a fresh defense, suggesting that the study was neither unethical nor racist.5 Similarly, by the late 1980s a cervical precancer study in Auckland, New Zealand, was widely considered to be emblematic of unethical research and of the failures of professional self-regulation.6 This "unfortunate experiment"7 at the National Women's Hospital had many similarities to the Tuskegee study. Defense of the unfortunate experiment is not new,8 but the established accounts of the study, that women with carcinoma in situ (CIS) of the cervix9 were followed but not treated,...