Table 1

A comparison of two experiments: Tuskegee and the 100 KPH experiment in Israel

Tuskegee experimentThe 100 kph experiment
PathogenTreponema pallidum - spirocheteKinetic energy
Source-mode of transmissionPerson-to-person, sexual contact or placental transmissionVehicle-person impact, first, second and third collision
Exposure voluntary-involuntaryVoluntary - sexual intercourseInvoluntary: most victims passively exposed
Addictive effects from exposureNoYes
Forewarning/prior consent to exposure to pathogenProbably notSometimes yes, mostly no
Ethical issueWithholding effective treatment and total cure from sick victimsReduction of severity of exposure to population already at excess risk for death and injury from road crashes
Public health impactSlow progression of disease in all victims; PYL <10 y (non-stochastic)Stochastic for event: all or nothing: increase in risk in entire population
Degree of compulsion/power relationshipsOne powerless, voiceless subgroup: Black, poor, southern in 1950s, passive acquiesence of uninformed black communityMany powerless subgroups at excess risk: occupants of motor vehicles struck by trucks; pedestrians (aged, children, infirm); children in fast vehicles; soldiers; truck drivers working under incentive premiums
Role of “establishment”, “power elites” (mandarins, consultants, academics, senior scientists)Initiated “experiment”; no known falsification of data within study; withholding information from powerless subgroupEncouraged and endorsed “experiment”; misinformation to entire society; repression of information on adverse effects, including high-risk subgroups
ScopeRestricted to one group; experiment terminatedEntire population; experiment expanded
Motivations“Science”, “knowledge”, fame, prestige, bureaucratic inertia“Cost-benefit”, “rational policy”, “EEC”; consultant contracts, new highways
Adequacy of current standards for best practicePenicillin: good to excellent“Best” standards: outcome criteria not explicitly defined
Attitude of publicApproval in early years; instant repudiation following exposure in 1970sPolls: majority supports 100 kph; majority opposes when told it causes increased death and injury
Institutional safeguardsNone at time (1945–1970)None at time (1993–1999)