CDC and Tuskegee University recently took the next step in establishing a new ethics fellowship at CDC, which will serve the goals and missions of both institutions. This fellowship will be an important tool for developing expertise on ethical issues that impact the practice of public health. The two organizations discussed the fellowship's focus and needs at a meeting here at CDC in November 2007and will finalize them in early 2008. CDC anticipates accepting the program's first fellow in summer of 2008.
Partnership between CDC and Tuskegee University
During the, observance of the 10-year anniversary, May 18, 2007, of the Presidential apology for the US Public Health Service (USPHS) Syphilis Study at Tuskegee, CDC Director Julie Gerberding, MD, MPH, announced that CDC and Tuskegee would develop a visiting fellowship program designed to promote the study and application of ethics in public health practice and research, and foster collaborations between the University's faculty and students, and CDC staff.
"In 1997, CDC provided funding to Tuskegee University to create the first bioethics center at a historically black university," said Dixie Snider, Jr., MD, MPH (RADM (Ret.), USPHS). "The establishment of a CDC-Tuskegee Fellowship Program is a logical next step, in that it further strengthens the person-to-person and community-to-community bonds that currently exist between CDC and Tuskegee. Thus, in the past decade, we have journeyed from silence to dialogue," Snider concluded. "We have moved from isolation from one another to partnership with one another. This fellowship then takes us beyond reconciliation to working for a common purpose-improving the health of underserved and marginalized communities." The first step happened during the Presidential apology, when President Clinton announced a $200,000 grant to Tuskegee University to initiate the National Center for Bioethics in Research and Health Care. Two years later, CDC awarded the university a $10 million cooperative agreement to establish the Center, which focuses on bioethics, minority health, and public health policy. Since then, CDC has collaborated with the university to fulfill the Center's goal of transforming the negative legacy of the USPHS Study of Syphilis at Tuskegee. In 2005, CDC awarded the university a second cooperative agreement for $10 million.
"I am excited about the potential that the CDC-Tuskegee University Ethics Fellowship has to contribute to the field of public health ethics and to compliment the existing Tuskegee Health Programs," said Bryan K. Lindsey, PhD, NCHHSTP/OD/OHD, who manages Tuskegee Health Programs and serves as Project Officer for the Bioethics Center cooperative agreement.
Meeting between Representatives of Tuskegee University and CDC
The November meeting began with a look at the history and structure of CDC and CDC's fellowships, presented by Tanja Popovic, MD, PhD, chief science officer, and Stephen Thacker, MD, MSc (RADM (Ret.), USPHS), director, OWCD. A discussion about CDC's fellowship programs and an overview of CDC's public health ethics activities followed. Presentations focused on ethics activities within the NCIPC related to HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
Other highlights included a description of Tuskegee University's mission and an overview of the National Center for Bioethics in Research and Health Care, presented by university Provost Luther Williams, PhD, who leads the bioethics center project. "We could not have asked for a better partner in Tuskegee University," said Denise Koo, MD, MPH (CAPT, USPHS), director, Career Development Division, OWCD. "Williams is a visionary who seeks a mutually beneficial partnership. He also sees the possibilities for extending the reach of this program beyond Tuskegee and CDC." Koo went on to explain that the CDC-Tuskegee Fellowship Program presents an opportunity to learn more about how to integrate ethics into all CDC fellowships. "Having a fellowship in ethics can cement its incorporation into our daily decision-making, just as the Epidemic Intelligence Service program facilitated integration of epidemiology into the agency, and the prevention effectiveness and informatics fellowships have helped introduce these disciplines to CDC."
Participants agreed that the proposed CDC-Tuskegee University Ethics Fellowship should be practical, applied, and supportive of the missions of both CDC and Tuskegee. They also agreed that fellows should have opportunities to work on projects that are relevant to underserved communities. Finally, they agreed to meet at the bioethics center in early 2008 to finalize the fellowship's goals in anticipation of CDC's accepting the first fellow in fall 2008.
Recalling the Syphilis Study and the Presidential Apology
In 1932, USPHS began a study of the natural history of syphilis in rural Macon County, Alabama. The study involved 632 black men, of whom 399 had syphilis. These numbers vary based on different reports, because some of the men were moved to the syphilis group if they contracted the disease while enrolled in the study. Conducted without the benefit of patients' informed consent, the study offered participants free medical exams, free meals, and burial insurance. Although originally projected to last six months, the study continued for 40 years, and found that the men with syphilis had many more health complications and lived shorter lives than the men without syphilis. In July 1972, an Associated Press story about the study caused a public outcry that led the government to appoint an ad hoc advisory panel to review the study. The panel concluded that the study was "ethically unjustified"-the knowledge gained was sparse when compared with the risks the study posed to participants-and advised stopping the study immediately. A few months later, the study ended.
In 1997, at a formal White House ceremony in the East Room, with five of the then-living survivors of the study and many family members of study participants present, President Clinton said, "What was done can not be undone, but we can end the silence. We can stop turning our heads away. We can look you in the eye and finally say, on behalf of the American people, what the United States government did was shameful, and I am sorry."
CDC was represented on stage by then-Director David Satcher, MD, PhD (ADM (Ret.), USPHS). Following the event, the press interviewed Satcher on the White House lawn. The apology led every TV newscast and was on the front page of every major newspaper in the country.
Strengthening the Connection between CDC and Tuskegee University
Coordinating development of the CDC-Tuskegee University Ethics Fellowship is Mehran S. Massoudi, PhD, MPH (CAPT, USPHS), associate director for science, OWCD. Massoudi first learned about the USPHS Syphilis Study at Tuskegee while he was a graduate student in Pittsburgh, and was disturbed by the great injustice done to the African American community, not just in Alabama, but across the country. "When I was asked to work on this endeavor for developing an ethics fellowship," Massoudi said, "I took it as an honor to work with highly qualified and motivated professionals at Tuskegee University and CDC."
Massoudi explained that he hopes "that we can make this more than a fellowship...that our efforts further solidify the relationship between CDC and Tuskegee University that will make Tuskegee a leader in public health ethics among historically black colleges and universities, and other learning institutions."
Enthusiastic about progress made during the November meeting, CDC's Public Health Ethics Coordinator and Chair of the CDC Public Health Ethics Committee, Drue Barrett, PhD (CAPT, USPHS), said, "I look forward to the establishment of the fellowship and feel it will be an important collaboration that will benefit both CDC and Tuskegee University. This will be an important resource for development of future leaders in the field of public health ethics." Tuskegee University and CDC will continue to collaborate to craft a fellowship that leverages the strengths of both organizations while involving the community and other historically black colleges and universities.
- article attributed to CDC (Centers for Disease Control & Prevention)
