I read with great interest Roberts et al’s report on the natural history of syphilitic aortitis. With regard to their information about the Tuskegee Study of Untreated Syphilis (TSUS), 3 areas of comment are in order. First, in contrast to the Oslo study, the TSUS participants were not hospitalized, were not in the primary stage, and thus were not infectious. In general, at inception, the TSUS was an outpatient study, and the patients were ≥3 to 5 years from their primary infection and considered in the latent stage by the United States Public Health Service.

Second, with regard to the TSUS participants, Roberts et al stated that “None were treated with penicillin, which had become available in the United States in 1943.” Although the study was called “untreated,” numerous participants received treatments early in the study (i.e., younger participants, aged <50 years, received treatments to render them noninfectious) and later in the 1940s and 1950s. The latter was in response to Alabama mandatory syphilis testing, for symptomatic syphilis and for other illnesses. These treatments included arsenicals, heavy metals, and penicillin. The Public Health Service documented some of these treatments in reports written from the study. In fact, Schuman et al wrote, “It is the practice of Public Health Service officers to refer men who develop syphilitic or nonsyphilitic conditions requiring therapy to the proper sources of treatment. Nevertheless, a few of the men have, on their own, sought and received antisyphilitic treatment in varying amounts. Some were treated by private physicians, a few had been inadvertently rounded up and sent to rapid treatment centers by health department workers who were unaware of the research project. Some of the patients were given therapy because of positive serologic tests for syphilis … or because of a history of infection; some even were treated for unrelated symptoms, rather than for specific complications of syphilis.” That none of men in the TSUS ever received penicillin is not supported by published research.

Third, Roberts et al referred to the TSUS as “controversial (i.e., unethical),” while the Oslo study (of the natural history of untreated syphilis) has not been reported using such terms. There was no indication that any of the patients in the Oslo study received treatment. Dr. Boeck, who was at the University of Oslo, started the Oslo study. One TSUS report stated that Dr. Boeck “did not use arsenicals when they became available, nor did he use even mercury, so that his patients were allowed to run the normal course of syphilis essentially uninfluenced by therapy.” Also, the TSUS accrued only men, but the Oslo study accrued men and women. The TSUS investigators limited the study population to men because of concern about congenital syphilis.

Readers of The American Journal of Cardiology may be interested in a reanalysis and challenges to the misrepresentations and misinformation about the TSUS. This work is important because it focuses attention to numerous distortions and errors about the TSUS. The goal is ending problems such as patient mistrust, ineffective doctor-patient and researcher-participant relationships, poor recruitment of blacks in clinical trials and as organ transplantation donors, and risky health behaviors.