The core findings of the Brandon, Isaac and LaVeist article made believing their case difficult. It was not true that “approximately two-fifths of both black and white participants” indicated that they had heard of the TSUS, but it was 25% and 74%, respectively—results markedly different than what others have reported. Miscalculations similar to the ones described, if applied to other areas, could cause numerous health disparities to vanish literally on paper when they still exist to the disadvantage of the black community. It was true that there was little dif ference between these black and white respondents in detailed knowledge about TSUS—most answered incorrectly the author-selected questions. The authors exaggerated that “nearly twice as many black respondents believed that Tuskegee study research investigators infected the study participants with syphilis” (75.3% vs. 52.8%)—not supported by the data. It was not an exaggeration that nearly twice the proportion of white respondents believed that TSUS research participants already had syphilis (24.7% vs. 47.2%)—supported by the data.

The reason for awareness of the TSUS favoring whites might be due to: a) a random event; b) demographics, such as educational status [e.g., high school, college or advanced college degrees or socioeconomic status (e.g., high, middle, low)]; c) an event occurring in Baltimore that drew selective attention to whites; or d) differences in an individual’s reality and perceptions of community experiences. The authors gave a rationale for selection of blacks from Baltimore, but no rationale for whites was provided. No demographic analysis by race was provided. At least in blacks, media attention directed to the TSUS or some other event might have influenced, in part, the proportions of who knew about the TSUS or any racial difference in response to queries about the TSUS. Corbie-Smith and co-authors suggested this possibility in their report on focus group interviews about clinical research. They wrote that”… all focus group interviews were completed before national media attention focused on the February release of the Home Box Office special ‘Miss Evers’ Boys’… Current interviews may reveal a higher level of awareness of the Tuskegee Syphilis Study …” In a monograph by Brown and Herskovitz, knowledge of the TSUS in blacks increased from 40% in 1996 to 53% in 1998. The authors of the monograph wrote, “This finding is not surprising in that President William J. Clinton issued a national apology to the remaining experiment survivors and their families in 1997.” A similar analysis in whites was not performed because the 1996 survey focused primarily on blacks.
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Among subjects who were aware of the TSUS, blacks and whites diverged with regard to the belief that a similar study could happen today—87% of blacks vs. 38%) of whites believed that it could happen today. Both blacks and whites who were unaware of the TSUS but who received author-selected information about the TSUS similarly believed that it could happen today—77% vs. 64%, respectively. For those who did not have prestudy awareness about the TSUS, education with possibly questionable information about the TSUS might have impacted their trust of the medical care. In other words, blacks and whites who did not know about the TSUS and who were read the same information about the TSUS responded similarly to a question regarding whether a similar study could happen today. This belief appeared to be induced in whites compared to whites with prestudy awareness of the TSUS but not read information from the CDC website. The duration of this induced mistrust of medical care (“The belief that a similar study could happen again”) in whites by what might be questionable information about the TSUS is unknown. From a human subjects perspective, there was no indication that an intervention was available for subjects who were provided information about the TSUS and who now had mistrust of medical care and might suffer harm in their future interactions with medical care. The respondents who were aware of the TSUS at baseline were different than the respondents who were not aware of the TSUS at baseline because the latter group was provided with author-selected information about the TSUS. It was not clear whether only the former group was entered into the authors’ medical care mistrust model or whether both groups were used. The fact remains that the latter group was biased. Viagra Super Active

Whether the TSUS was a predictor of mistrust of the healthcare system was inconclusive based on the results in the authors’ article. However, as Brandon, Isaac and Laveist concluded, other researchers also suggested that knowledge of the TSUS might not have the impact on health-related decisions as often alleged. In the Shavers and coauthors article, 49% of blacks who reported that their knowledge about the TSUS would affect their participation in a clinical trial indicated that they would not be willing to participate; 17% of whites indicated the same. Conversely, 51% of blacks and 83% of whites may be willing to participate in a clinical trial. Green and coauthors reported that 22% of blacks compared to 10% of whites indicated less interest in participation in health research or promotions because of the TSUS. This might mean that 78% of blacks compared to 90% of whites were interested in participation. In the Brown and Topcu article, 60% of blacks who had knowledge of the TSUS compared to 64% who had no knowledge were willing to participate in clinical cancer treatment trials; 76% of whites who had knowledge of the TSUS compared to 68% who had no knowledge were willing to participate in clinical cancer treatment trials. Similar to the Brandon, Isaac, LaVeist article, knowledge of the TSUS alone did not appear to influence negatively the willingness to participate in a clinical trial or health promotion. With regard to a difference in an individual’s reality and perceptions of community experience, Green and coauthors in their telephone survey reported that 23% of blacks felt unfairly treated because of ethnicity while pursuing help for a health problem, in comparison to 12% of whites. This might indicate their individual experience with the healthcare system. Over two-thirds of blacks believed that people were treated poorly in research studies, people were sometimes treated poorly by doctors and African Americans were treated poorly in health research studies; the responses for whites were 55%, 76%) and 37%, respectively. This may be an indication of their perception of what others are experiencing in the healthcare system. Corbie-Smith and coauthors’ study of distrust and the healthcare system reported that 25% of blacks believed that physicians have given them treatment as part of an experiment without their permission, in comparison to 8% of whites, indicating their individual experience with the healthcare system. Sixty-three percent and 79% of blacks thought that physicians prescribed medication as a way of experimenting on people without their knowledge or consent and thought they or people like them might be used as “guinea pigs” without their consent, respectively; the responses for whites were 38% and 52%, respectively. For both races, this may be an indication of their perception of what others are experiencing in the healthcare system. Thus, the perception of abuse in the community—”people” and “African Americans”—was higher than the individual’s actual reported experience with abuse in the healthcare setting.
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In conclusion, it is a laudable goal to attempt to provide evidence that the TSUS does not have an impact on alleged mistrust, but the Brandon, Isaac and LaVeist article has serious challenges in calculations, demographic analysis by race, knowledge of TSUS, cultural sensitivity and methodology. Although these challenges do not minimize the concern that blacks may be making health-related decisions based on medical events or some other event(s), these challenges suggest caution with regard to any change in research direction or policy debate based on the results reported in the article.