On May 16, 1997, in the East Room of the White House, President Bill Clinton issued a formal apology for the Tuskegee Study of Untreated Syphilis in the Negro Male. Directing his words to the survivors, several of whom were over 90 years old, the President said, "...what was done cannot be undone, but we can end the silence. What the United States government did was shameful, and I am sorry." The President placed the burden of responsibility for the abuse on the medical research establishment when he stated, "the people who ran the study at Tuskegee diminished the stature of man by abandoning the most basic ethical precepts. They forgot their pledge to heal and repair."1 Almost 70 years after the study began in 1932, 26 years after it was stopped in 1972, and 1 year after the Presidential apology, there remains a legacy of mistrust among African Americans toward the medical research establishment.2-7 In this issue of The American Journal of the Medical Sciences, Giselle Corbie-Smith's essay argues that this mistrust is legitimate and she illustrates how the long shadow of Tuskegee is a barrier to increasing the participation of African Americans in clinical research. The Presidential apology and the Corbie-Smith essay both demonstrate the danger and the opportunity inherent in any attempt to draw lessons from the Tuskegee Study.