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Certainly, the research conducted by Katz and colleagues has importance for biomedical researchers (including designers, recruiters, and investigators), public health workers, medical sociologists, and others, but it is interesting from a rhetorical standpoint, as well. Specifically, the wording of the TLP Questionnaire prompts and the manner in which the results are framed are ripe artifacts for rhetorical analysis. In this section, I will address the rhetorical dimensions of the survey and reports as well as the researchers’ decision to include myths about the TSS in their survey. My analysis illuminates the significant ways in which audiences continue to construct meaning from the TSS and Clinton’s speech. At face value, the findings by Katz and colleagues seem to indicate that the <Tuskegee> ideograph is fading, and Clinton’s apology had a minimal effect in contributing to this outcome. Yet, these conclusions are also subject to interpretation. Closer analysis of Katz and colleagues’ approach shows alternate interpretations of their data and reveals how their study design inflects meaning in their findings.

Based on the initial four-city study in 1999-2000, the Tuskegee Legacy Project researchers concluded that the plurality of those who were aware of the Tuskegee Syphilis Study

or the apology was less likely to participate in biomedical research but that this negative influence was more significant among Whites than Blacks.⁹² The researchers hypothesize that this “may reflect the daily cultural reality in the Black community, which has for a long time been accustomed to increased risks for Blacks in many activities,” whereas Whites may have found the TSS “more shocking and at odds with their daily expectations.”⁹³ These findings and their discussion in the published research article indicate that the researchers interpreted awareness of Clinton’s speech as a factor that negatively affected attitudes about participating in research. The researchers’ write-ups treat knowledge of the TSS and knowledge of Clinton’s speech as nearly interchangeable influences, as when they summarize that “Whites who had heard either of the study or of the presidential apology were more negatively influenced toward participation in biomedical research than were Blacks who had heard of either event.”⁹⁴ Likewise, in the introduction to an article about a follow-up study comparing Blacks’ and Whites’ knowledge of the TSS, the researchers summarized the “Awareness” article’s findings as: “Blacks were 2-3 times more likely than Whites to be willing to participate in biomedical studies despite having heard of the Tuskegee Syphilis Study or the Presidential Apology”

(emphasis added).⁹⁵

In this construction, the researchers frame awareness of the apology negatively—a factor that failed to have the TLP researchers’ expected negative impact upon the Blacks surveyed.

Once again, the apology is treated as comparable to the TSS itself as a reason why Americans may be wary of participating as biomedical research subjects, as though awareness of the

92 Katz and others, “Awareness of the Tuskegee Syphilis Study,” 1140-1141.

93 Ibid., 1140.

94 Ibid., 1141.

95 Katz and others, “Legacy: Assessing its Impact,” 1169.

apology is a stand-in for awareness of the wrongdoing that necessitated an apology. This interpretation is not immediately intuitive, considering the various potentially transformative and healing powers of apology discussed in Chapter 4. However, the treatment of Clinton’s speech as a negative influence on Americans’ attitudes about biomedical research—and the TLP findings that indicate the same—illuminate the limitations of institutional apology to perform the same healing functions as genuine interpersonal apology. Clinton’s apology for the Tuskegee Study likely would have been much more transformative if he had a more direct connection to the Study, just as it is more relevant and meaningful to the victims directly affected by the Study than other witnesses.

The phrasing of the apology awareness prompts in the TLP Questionnaire does not appear to be slanted toward the negative, however. Questions such as “Based upon what you heard about the apology, would it influence your decision to join a biomedical research study today?” and “Did that apology make you more or less likely to join a study?” allow respondents to respond positively or negatively without feeling as though they are giving a “wrong”

answer.⁹⁶ In the 2003 follow-up survey in New York City, Baltimore, and San Juan, the recognition prompts were similarly neutral: “Have you ever heard anything about the Tuskegee Syphilis Study?” and “What have you heard about the Tuskegee Syphilis Study?”⁹⁷

Likewise, the statements about the TSS in the Facts & Myth Quiz were presumably constructed as non-leading prompts, but may have more complex psychological influence than is initially apparent. Of the seven statements that respondents were to identify as true, false, or “I don’t know,” four were false and three were true. However, all the statements were phrased as

96 Katz and others, “Awareness of the Tuskegee Syphilis Study,” 1139.

97 Katz and others, “Identifying the Tuskegee Syphilis Study,” Additional File 1.

positive assertions (i.e., a total absence of “not,” “no,” and “none” in the phrases), which can be misinterpreted by those without confident knowledge as “true” assertions. For example, one false statement reads, “The subjects were injected with syphilis.”⁹⁸ A respondent who did not believe strongly that this was a false statement might interpret it, knowingly or not, as a statement of fact about the Study that can then circulate beyond the TLP Questionnaire as “truth” and inflect the ideograph of <Tuskegee>. In this way, the survey instrument has the potential to affect the beliefs and attitudes of the thousands of respondents who participated in the studies conducted by Katz and his research team. Since the influence of ideographs is largely subconscious, it is impossible to know just how much the respondents could be affected by hearing untrue statements professed as true assertions in the TLP Questionnaire.

Regardless of the particular phrasing of the Facts & Myth Quiz prompts, is important to recognize the TLP researchers’ inclusion of both factually correct statements and prominent myths about the TSS in their assessment of respondents’ awareness of the Study because both facts and myths circulate in salient ways as part of the contemporary cultural knowledge and understanding(s) of the TSS. McGee notes that ideographs are efficacious due to their usage rather than their specific “idea-content,” and the <Tuskegee> ideograph is an example of how the term still functions and circulates in predictable ways even though the connotations it carries may not be entirely factual or even consistent.⁹⁹ Additionally, trying to “correct” the ideograph’s associations to include only known facts about the Study is likely to meet with opposition by those who hold strongly their beliefs about what happened in the Study, as occurred during the

98 Katz and others, “Legacy: Assessing its Impact,” 1171.

99 McGee, “Ideograph,” 10.

focus group research by Corbie-Smith and colleagues.¹⁰⁰ The “legacy” of the Tuskegee Study and <Tuskegee> are bound up in the complexities of these intertwining and recalcitrant beliefs;

the myth-mixed-with-facts “knowledge” of the Tuskegee Study shapes how people think about

<Tuskegee>, the Study, and its repercussions even if it does not affect their actual research participation rates.

The analyses of the Tuskegee Legacy Project also belie the researchers’ assumptions that there is an objective truth to be known about the Study. They measure respondents’ accuracy in identifying historically correct details and common myths, but they stop short of interrogating the less “knowable” features of the Study that bear on present attitudes. For example, the government doctors’ complex and shifting motives, the indispensable involvement of African American nurse Eunice Rivers, and the constraints faced by the Study designers and investigators are each difficult to definitively assess but still bear on how we understand and interpret the Tuskegee Study in hindsight. These factors may not be consciously contemplated by the TLP respondents or systematically measured by the TLP Questionnaire, but they are examples of how we can never fully settle what the Tuskegee Study and <Tuskegee> mean.

Reverby cautions that the incomplete and conflicting records of the Study, the deaths of key figures, and the “what ifs” of alternative paths the Study trajectory could have taken all complicate how we are to understand the “facts” of the Study.¹⁰¹ Moreover, she writes, “The symbolic ‘Tuskegee’ and the historical Study […] feed on one another, as they did from the beginning. It is not possible to understand one without the other, to read the ‘facts’ without knowing the myths and tropes that shape them; nor is it possible to create the myths without

100 The focus group moderator gave “historically accurate information” about the Tuskegee Study during the discussion but was “aggressively challenged” by the participants who thought the moderator was perpetuating a biased and incorrect view of the Study. Corbie-Smith and others, “Attitudes and Beliefs,” 541.

101 Reverby, Examining, 232.