There were cultural sensitivity challenges with regard to methodology and the use of a single-word sound bite for the TSUS.

The authors made the points that “blacks were more likely to believe that a similar study could happen again regardless of their awareness of the Tuskegee study” and “we cannot be sure how knowledge of the Tuskegee study may be related to medical mistrust in other minority groups.” We learned from recalculation of the authors’ data that 25% of blacks, 74% of whites and 100% of “others” were aware of the TSUS. However, the authors’ survey measured a race difference in response to a medical event specific to only one racial group. The TSUS was a study that occurred in blacks and whose importance might be more specific to, and thus more meaningful, to blacks. The authors did not vary medical events specific for whites, i.e., linking a medical event, with actual or alleged challenges, that could either pose a potential barrier to participation or induce distrust in the medical care system or research. Because of this narrow view, one might consider this omission as culturally insensitive, i.e., assuming that an adverse medical event specific to blacks influenced behavior in subjects of another race. For example, specifically, “Being the greatest victims of the fairly recent racist Nazi ideology, Jews may have a heightened sensitivity to medical research and to genetic studies in particular.” There was no evidence to support the assumption that the TSUS influenced health beliefs and behaviors in the same manner in all ethnic groups; ethnic-specific aberrant medical events might be more important to members of a given ethnic group. In view that recalculation of the author’s results for awareness of the TSUS demonstrated nearly a three-fold greater awareness of the TSUS favoring whites over blacks, this type of control might have been useful.

Nevertheless, lack of a comparable medical event specific for whites appeared to be a common methodological flaw in this type of research (i.e., knowledge of the TSUS) in comparing blacks to whites (or other groups). Also, in discussions of sociocultural issues in research, only blacks linked to the TSUS as aberrant research were cited.
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For the record, there are examples of questionable medical events, which had other races or vulnerable groups, such as (medical event: race or vulnerable group): a) Mengele’s “twin experiments” at Auschwitz: Jews; b) Dachau artificial production of septicemia: Polish Catholic priests; c) Dachau induced malaria infections to investigate immunization and treatment: concentration-camp inmates;  Plasmodium falciparum infections to study development of immunity: black and white neurosyphilitics; e) Stateville Penitentiary induced P. vivax infections for antimalarial drug screening: white prisoners; f) radium implants into nasopharyngeal hyperplastic lymphoid tissue: white World War II Army Air Force pilots; g) Sing Sing Prison inoculations of syphilis: black, white and Puerto Rican prisoners; h) the first contraceptive pill experiment: Puerto Rican women; and i) the injection of live cancer cells at the Jewish Chronic Disease Hospital: whites. Dissimilar to the TSUS, in a number of the examples, the researchers injected the research participants with an infectious material—an event that did not happen in the TSUS. Similar to the TSUS, there was no evidence of informed consent in these cases.

Clearly, the medical events listed above are not reported to effect participation of the specific racial groups in clinical trials or fuel mistrust of the healthcare system similar to the alleged effect the TSUS has on blacks. Lack of interest by researchers and subjects about and/or citation of other aberrant medical events may occur because: a) these studies may not be as incendiary and/or as well-known by both researchers and participants; b) other racial or subject groups may be immune to or not interested in past events which included/targeted their group; c) these studies and/or events are protected by specific advocacy groups; d) their influence may not have been consistently studied or published; e) media sources (e.g., print and broadcast press, theater, movies) have not consistently focused on the events; and f) funding agencies may not have shown an interest because of similar reasons and/or other funding priorities.
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Finally, in the text the authors referred to the TSUS as the “Tuskegee Study of Untreated Syphilis in the Negro Male,” and “Tuskegee study,” in the title, header, tables, and at times in the Discussion they referred to the TSUS as “Tuskegee” [e.g., Legacy of Tuskegee (title); Tuskegee and Mistrust of Medical Care (header); Knowledge about Tuskegee (Table 2); Awareness of Tuskegee and Belief that a Similar Study Could Happen Today, Can Tuskegee Happen Again, Unaware or Aware of Tuskegee (Table 3); Knowledge of Tuskegee, Heard of Tuskegee, Tuskegee Summary (Table 4); move beyond Tuskegee and a Tuskegee-like experiment (Discussion)]. This type of “sound bite” and abbreviated labeling and language is inappropriate in scientific and research discourse because misuse of “Tuskegee” may fuel mistrust of medical care. Other authors have used “Tuskegee” in a similar manner, suggesting that this is a common practice. On the other hand, Carmichael and Hamilton associated “knowledge of Tuskegee” with several notables, such as: Tuskegee Institute (now University), Booker T. Washington, George Washington Carver, Tuskegee Veterans Hospital, Tuskegee Civic Association and black World War II Army Air Force pilots (now Tuskegee Airmen). Misrepresentation and misuse of the word “Tuskegee” distracts from the major positive impact of “Tuskegee” on the black experience, community and the nation during decades of severe racial subjugation, segregation and socioeconomic oppression.