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Medical Apartheid

In Books, medicine on June 20, 2011 at 8:30 am

I just finished reading “Medical Apartheid: the dark history of medical experimentation on Black Americans from colonial times to present” – Wow, what a read!  Major kudos to Harriet A. Washington for having the courage and gusto to pursue such an expansive project in the face of such resistance.  Our nation’s ability to bury, in an attempt to erase, undesirable history is something else.  I hope that one day (sooner rather than later), someone will turn this work into a documentary. I was searching a few months ago for a documentary our SNMA chapter could show on the historical basis for the mistrust of the medical community observed in the African American community – none exist that don’t focus solely on Tuskegee, shame. Spike Lee, where you at?

I would urge any medical student to read this book – not just African Americans and not just those interested in medical research.  Why?  Well, as can be easily observed, many of our nation’s medical schools are situated in predominantly minority communities.  As such, the population medical students will be honing their skills on are minorities, and since we are underrepresented in medicine, I question the knowledge the majority has about these communities. Personally, I have found my own formal education on minorities’ plight in our nation’s history lacking…  Furthermore, logic tells us that by having an appreciation for the history of the community we serve can better inform our communication with said community.  In other words, if the Black community is untrusting of the medical community (Washington uses the term iatrophobia = fear of medicine), there might be ways we adjust our delivery to make them more receptive to our message so that we can help eradicate those fears instilled from decades of abuse and exploitation from…well, us. Makes sense to me.  How can you possibly expect to slay a dragon if you don’t know what it looks like?  You have to have some idea of the beast you’re going to face to adequately prepare to beat it… And let it be known that this beast of distrust has a very sound basis and is contributing to the vast health disparities observed in our nation.

I think what surprised me most in this 400 odd-some pages of this book is a 3-way tie:

  1. How many other atrocious studies of similar duration were conducted while the notorious Tuskegee syphilis experiment was occurring.  From XYY experiments with young Black boys to government-engineered disease-ridden mosquitos bred and released, en masse, on certain Black communities in the South, leading to illness and death.
  2. How many of these breaches of trust occurred up North, where I was raised to believe that we were “more liberal and socially advanced than the antiquated South” – false. I do think, overall, the North tended to treat Black populations a bit better than the South (ex: “The Mississippi Appendectomy“).  Actually, I take that back – it seems that the North initially left Blacks alone (or were more prone to use them as a last resort vs the cheap lab rats physicians of the South described Blacks as), but something happened where post-1960/70 it seemed that Northern medical schools and researchers found it ok to conduct experiments that were largely non-therapeutic, without consent and/or informing of participants, and maybe even coerced when involving children and inmates.
  3. The modern-day exploitations of Black Americans by the medical community. So, I went into this book knowing that I’d be a little nauseous reading about experimentation on slaves, but didn’t expect to be so blown by the exploitations in the past few decades (by prominent medical institutions), both in the US and in Africa.  I mistakenly thought “we” had learned and grown from “our” past, and were better than that.  Granted, the US is doing a much better job than they were in the ’70s at shutting down such projects, but 1) unethical projects are still arising and 2) the culprits (White male doctors) are still making a name for themselves and getting off relatively scotch-free.

But, I think my biggest take-home was how much the medical community truly owes the Black community. And I do mean truly owes.  Oh so many institutions and “Fathers of Medicine” have built their name and fame by abusing the trust and vulnerable position of the Black community.  Prime example – many of the “Fathers of Medicine” that built their fortune on using slaves for experimental surgeries…without anesthesia, dehumanizing and over-sexualizing Blacks, and then addicting them to morphine post-surgery. Ex: Dr. J. Marion Sims, Father of American Gynaecology, who ironically has a statue erected in his honor in an area of Central Park in Harlem. (not going to lie, I was reading this book when I was back home in Jersey and it took every fiber of self-control to not march over to that statue with a sledgehammer or spray can and go.to.town.! or at the very least, spit on it)  Some argue that it’s ok because it was common practice, and thus ethically sound at the time to use slaves for medical research…regardless, it’s still disgusting and many physicians unnecessarily went beyond what was even accepted by their medical peers for treatment of slaves.  When were move past the slave era, the same abuses of power can be observed.  Honestly, I feel that had similar medical experiments been conducted on concentration camp victims, there would have been an enormous outrage…oh wait, that’s right – there was! (i.e. the Nuremberg Trials and Code). aside: I find it interesting that medical researchers in these trials used in their defense that they based their practices on American physicians’ treatment of Blacks in America…hmmm.  And yet, no outcry, just perpetuation of the same stripping of dignity and metamorphosis into other forms of exploitation.

The uniting thread of this book is the abuse of a population of people who are least likely to benefit from the results of the experiments conducted on them, with little-to-no admission of guilt by and repercussions for those conducting such projects (mostly White men, and sometimes the government).  So much of what we know medically is based on this, and Blacks, throughout generations have passed down their “iatrophobia” (or witnessed these patterns of abuse first-hand in recent years and arrived at the same conclusions) and thus are reluctant now to enroll in research studies that are so desperately needed to be conducted to bring our health status to the levels of the majority.  It is a shame what has transgressed and persisted in this nation, and the consequences of such sins.

For me, the book lost it’s wind in the third section (on the complex relationship between racism and research), but all-in-all it is a stripped down chronology of a disgraceful history of American medical research that has been excluded from every history book I have ever looked at, and something that should be incorporated into medical training.  That being said, I attend a med school that was repeatedly mentioned throughout this book, so I have my doubts of this change coming to fruition :/

Remaining on My Summer Reading List:

Feel free to leave any book recommendations…I need some non-medically-related texts!!

***Note: Washington has a new book coming out that I’m looking to read…Deadly Monopolies: The Shocking Corporate Takeover of Life Itself – and the Consequences for Your Health and Our Medical Future. Look for it soon…***

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