This Week in Behavioral #7

At Frank we talk a lot about the importance of trust. This week we take a sobering look at one of the worst examples of medical exploitation the US has ever seen, the mistrust that followed, and the ensuing fallout.


The Tuskegee Study: A Breakdown of Trust

Starting in 1932, for forty years, the Public Health Service of the US Government studied the progression of syphilis in 600 poor, black male sharecroppers in Alabama. The study perhaps started with good intentions -- there was no known cure in 1932 -- however the study continued without treating sick participants for about thirty years after penicillin was shown to be an effective treatment.

In the sordid history of medical experiments, the Tuskegee Study shares the terror of the Nazi experiments, and radiation experiments done in the US.

In 1972, the US Government disclosed its dark secret. Censure was widespread, from the press to politicians. Reforms were passed, including new policies guiding the ethics of using human subjects in experiments.

But perhaps the most important fallout has only just now come to light: the impact of a massive breakdown in trust.

In a new paper, Marcela Alsan from Stanford and Marianne Wanamaker from the University of Tennessee, show that the horrible treatment of black males by these medical researchers lead to a dramatic and ubiquitous mistrust by black males of the medical community. And this mistrust lead to less use of health services. And this decrease lead to worse health and shorter lifespans.

The authors estimate that the post-1972 mistrust resulted in older black men dying up to 1.4 years earlier.

When an Industry Loses Trust

In other industries, when mistrust is high, there are often other places to turn, or perhaps this leads to a disruption of the industry. When the taxi industry couldn’t get worse, Uber came around and changed everything.

Recently, the questionable behavior of banks and financial institutions has lead to a complete breakdown of trust between them and their customers. One doesn’t need to look far to see that financial institutions are amongst the most hated brands, especially amongst millennials. That distrust will has lead to an entire generation of companies -- including Frank -- offering a better way forward.

But the mistrust of the medical industry was for an entire industry, and one where there was nowhere else to turn. It has taken decades to heal.

Reports of the Tuskegee Study typically cite 600 as the number of victims. But it’s clear when they lost the trust of that community, the number was tragically far greater.

Frank - Luke Coffman

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