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Medical Apartheid [Book Review]

Summary

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington charts the history of unethical medical experiments that have been conducted on Black people. The book largely focuses on discussing examples of the lack of respect or even lack of recognition of Black personhood within the medical field. But the book also tells the story of the development of medical ethical standards.

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Yet, Medical Apartheid is also about much more as it uses the medical studies as a jumping-off point for exploring more wide-ranging issues that are also often attributed to stereotypes about the Black pathology. The idea is approached from several angles that instead of focusing on implementing solutions to address issues of poverty, violence, poor nutrition, inadequate housing, etc. studies and initiatives focus on trying to establish these problems as genetic or the nature of Black people.

Overall, diseases kill Blacks at higher rates but we are not dying from rare or hereditary diseases. Instead, the vast majority of illnesses that cause significant death amongst Black people are diseases that are more likely to be proactively defended against and treated in other races. Serious illnesses are diagnosed later in Black people and we are less likely to receive aggressive treatment or transplants. Screenings occur at the same rate for Black and White people but the quality varies which means illnesses such as cancer may not be detected until it has progressed to later stages. Black women suffer from high rates of stress and depression while the past few decades have seen an increase in suicide rates for Black males. Health disparities are a result of a combination of complex factors as well as a lack of access to care.

Yet, historically research centers have been primarily based in urban areas. And the subjects of studies, especially those that have been abusive/dangerous have been Black people. There’s a history of subjects being exposed to vaccines, medications, and procedures that are potentially lethal. Often, without their permission or full understanding of what exactly would take place and the risks. To make matters worse the oversight and governing bodies that should be moderating these studies often fall short. They fail to be diligent, become accomplices in executing experiments, or help to cover up wrongdoings. While the media has been a key figure in publicizing medical abuse, coverage is more of the breaking news type rather than ongoing oversight and reporting.

I appreciated the way Medical Apartheid is organized. It went back in history and began with the injustices faced by enslaved Black people in America and used that as a foundation for explaining how we go to the present state of things.

During slavery, slave owners would deny enslaved people access to medical care. Junk science and quack medicine like other aspects of society were finagled to fit the narrative of Black inferiority which supported the enslavement of Black people. It was interesting to see how racist ideas about the biology of Black people in the past carries forward to the present.

The long promoted idea that the pathology of disease would vary based on the race of the patient is explored in great detail. This flawed belief has led to Black people being exposed to illnesses and kept from treatment to study how diseases specifically affect Black people. Multiple examples are given of Black people being regarded as inferior but perfect subjects for experiments that could potentially improve the health of White people. Even back then the health of a slave was based on their physical ability to work while their mental health was disregarded. I think in some ways this carries over to the present with mental health still having a stigma that prevents people from talking about their issues and seeking treatment.

The enslaved distrusted and thus avoided Western medicine because those who provided or procured it didn’t necessarily have their best interest in mind. Some free and enslaved Black people still relied on traditional African spiritual medicine and healing. Yet, traditional African medicine was looked down upon although Western medicine at the time was arguably equally primitive.

Southern physicians exercised the unethical practice of owning slaves for experimentation. And the lack of acknowledgment of Black people’s rights meant that even “free” Black people could be pulled into studies without their consent or knowledge.

Washington asks the question of how info gained from Black subjects could be used in the care of White patients if the biology of the two races were viewed as being incredibly different. This isn’t illogical when you consider animal trials. Racist medical professionals would certainly try experiments on Black people deemed too risky for White people. It’s like how studies are conducted on mice and other animals before being conducted on humans. These animals are regarded as being lower life-forms and thus okay for experimentation. In the past and even the present, Black people are still viewed along those lines. Even in northern states, the enrollment of Black people in studies was out of proportion with their representation within the population.

Due to Black people being viewed as a different species than White people, we were also put on display in zoos and circuses to feed racists’ curiosity about Black people and Black bodies. It’s always interesting to read about the racist history of institutions that still exist today. For example, I’d previously heard the name Ota Benga but didn’t know his story. It was shocking to read that he was held captive in the monkey house at the Bronx Zoo. Black people protested but they were ignored. And the now venerable New York Times even joined in on the nonsense with ridiculous articles that supported the racist theories of the time.

Scientists believed in Darwin’s theory of evolution but viewed Black people as the missing link between ancestral apes and modern man. They went to Africa in search of examples that would support their theories. World’s Fairs stood as testaments to Western colonization and racism as people of color from around the world were brought to America and put on display.

Washington provides an overview of the theories of Benjamin Rush, an abolitionist who believed Black people suffered from a form of leprosy. Lots of nonsense abounds and I was struck by what seemed to be the author’s attempt to prevent the reader from thinking Rush was a racist. He certainly held complex and conflicting views but a person believing that slavery is wrong does not mean that they aren’t also racist. It’s completely possible to be right on some things and wrong on others. To hold prejudiced views on one topic and be fair-minded on another.

There’s mention of the belief that Black people don’t feel pain or at least not in the same way or to the same degree as White people. Outside of reading Medical Apartheid, I’ve read articles about recent studies of healthcare providers that show some of these beliefs still exist even today. Some of the experiments described are so ridiculous and nonsensical that they seem to be thinly-veiled disguises for torture.

Poor living conditions, inadequate nutrition, and physical exhaustion caused many of the illnesses found amongst the slaves. But the actions required to combat these things were considered cost-prohibitive. As an alternative, slaves were dismissively regarded as lazy or being inherently weak and sickly. Sound familiar?

Sometimes my brain hurts when trying to understand the ridiculous ideas that I’ve come across when reading about the history of racism. Weirdly, many people who claim to be pious and puritanical are completely absorbed with sex and sexuality. They have no regard for the humanity of Black people but are incredibly curious about their physical traits and sexual habits. Projecting their licentious interests and fantasies onto others while making unfounded claims. There’s a discussion of the fact that many prominent Southerners loudly proclaimed their negative views on and detestation of the Black body. Yet, evidence also exists of their lust for and carnal knowledge of those very same bodies.

Sexual assault on Black bodies was blamed on the uncontrolled sexuality of Black people rather than the individuals violating them. Here we see the beginning of the nonsense of young girls being referred to as “hot in the pants” rather than victims of (statutory) rape. And Black men being viewed as lust filled bucks. As well as the blame game of rapists using the excuse of their victims having seduced and caused their loss of self-control as an explanation for their being violated. Black women were pushed to have many children (often beginning at a young age) but their health would be disregarded as they were forced to keep working for as long as possible and might still be whipped while pregnant.

Artists as well denigrated Black bodies and viewed them as being inferior. Yet, they saw no issue with using them in art. Often posing them suggestively with breasts and genitals exposed. They implied and created conditions that represented Black people (women in particular) as oversexed. This stood in direct contrast to how White women were portrayed at the time with multiple layers of clothing to project chastity.

Enslaved people who could no longer provide traditional labor or service were loaned out or transferred to hospitals and researchers for participation in experiments. The loss of such a slave to progressing illness or malpractice was not deemed too great to risk because slave owners were often compensated. Also, slaves who recovered could be returned to the slave owner without them having to pay for medical care.

Something to note is that while blatant legal segregation existed in the South, a more subtle form of segregation existed in the North. This meant that regardless of location, quite often Black people could only obtain care at select hospitals. Therefore it was easier for researchers to create or focus on these facilities for their studies as they would have a reliable idea of the subject pool. They could also more easily pressure patients to participate in studies in exchange for receiving treatment as quite often patients had no other options for obtaining care. Black people who were forced to seek care at charity hospitals were not treated as regular patients. Instead, their care and improvement was a secondary priority to experimentation and treatment.

Some Black doctors protested these ethical abuses on behalf of patients but there weren’t enough to have a substantial impact. Many faced obstacles to obtaining the training needed to practice. Not all but a lot of the ethical violations that were taking place occurred in the South. MDs would have been facing various facets of institutional racism as well as the strategic limitation of opportunities for Black people in the South. They would have likely had the ability to speak out but not necessarily the power to bring about change at that time.

There are some interesting though morbid tidbits throughout Medical Apartheid. For example, I think most people who are familiar with the bombing of the Birmingham 16th Street Baptist Church know of the four girls who were murdered in the blast. But I was unaware that when the family of one of the girls, Addie Mae, moved her coffin decades later it was found to be empty. That’s a huge violation. Some people have no respect for others during life so I guess the joke’s on me for expecting that they would have some respect after someone’s death.

Medical Apartheid’s fifth chapter is short but very engrossing as it discusses the theft and use of Black dead bodies for dissection. The book’s content made my interest ebb and flow at some points. But this chapter had my complete attention. Much of the chapter focuses on the discovery of human bones beneath an old building that was once the Medical College of Georgia. It could be a whole other book that would seem so crazy and unbelievable but unfortunately true. The ethical transgression of grave robbing for medical training and research is one of the most widespread issues discussed in the book as evidence of cadaver sites have been found across the country.

There’s the backstory of the school’s resident bodysnatcher Grandison Harris, a Black man who seemed to proudly steal corpses from a nearby Black burial ground, the Cedar Grove Cemetery. Each page I read seemed more disgusting and unbelievable than the last. And to think Harris and the school were so bold as to have him give lectures on his body-snatching techniques. It’s disappointing but not surprising to learn about Black people playing a part in these violations against other Black people. But individuals have been known to put aside any expectations of loyalty or solidarity for the sake of their best interest.

Being from New York City I’d previously heard of the African burial site that was found in lower Manhattan and the protest of construction taking place at such sites. But I was unaware of the belief that Columbia University and New York University had a history of spiriting away bodies from such Black burial grounds for use by their medical schools. It says a lot that there was no uproar when these injustices were being committed in Black cemeteries. But people protested when body snatchers extended their operations to White cemeteries.

I remember reading about resurrection men in fictional books such as “A Tale of Two Cities”. I’d also read about executed criminals being dissected. But I never realized or at least never considered that this practice was often performed on the corpses of Black convicts but rarely if ever on the bodies of White convicts.

Because of racism at the time there was a huge disparity in the number of Black corpses being used for research and teaching. But as Washington explains, it is difficult to know if things are more equal now because there is no federal governing body that tracks demographic statistics of cadavers.

It was good to read that things have changed for the better to a degree as some medical schools now hold memorial services and burials for cadavers. Understandably, medical professionals would need cadavers to practice autopsies and other facets of medical training. So the issue is not with the use of cadavers but rather the disregard of an individuals’ wishes for what should happen to their body after death. As well as the disrespectful disposal of the remains once they are no longer needed.

It’s telling that in healthcare as with other facets of society, environmental, and social issues are not regarded as a matter of circumstance but rather a factor of what’s deemed Black pathology. Thus providing an excuse for inaction against issues that could be addressed and curtailed if not completely resolved with intervention. It’s easier and cheaper to say this is a problem that is endemic to Black people or found in Black populations rather than having to identify and implement resolutions.

For example, I’ve been under the impression since childhood that sickle cell is a disease that only or primarily affects Black people. But Washington explains that the prevalence of the gene that causes sickle cell is not a matter of race but rather having ancestors who originated from parts of the world where malaria is common. Yet while Black people are not the only people who can have the sickle cell trait or sickle cell disease, Black people have become the poster child of the illness.

You might have seen such films as Miss Evers Boys which is about the Tuskegee Syphilis Study but the movie takes some creative liberties. The chapter in Medical Apartheid that covers the study is a good jumping-off point for a fact-based understanding of the study. It details the initial good intentions of the Rosenwald Foundation and Booker T. Washington. There’s also context about the living conditions for Black people in Tuskegee and the lack of medical care. It goes on to explain how the involvement of the US Public Health Services changed the direction of the program.

The medical aspect of the Tuskegee experiment is harrowing and unbelievable on its own. But Medical Apartheid also details the community / public relations maneuvering in the aftermath of the experiment. It’s mind-blowing when you realize that the health and lives of the unwitting subjects of the Tuskegee Study were sacrificed in exchange for a payday and racist curiosity. There’s also discussion of another deeply troubling syphilis study funded by the Rockefeller Institute. At Tuskegee researchers left subjects untreated but in this less well-known study subjects were infected with a deadly strain of malaria as part of the experiment.

Though I’ve learned quite a bit so far, I don’t think I’m at the point of really being able to thoroughly explain the experiment. After listening to a podcast series and reading this chapter I plan to read the book Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones for a more thorough understanding. I’d recommend starting with the chapter in Medical Apartheid and then reading Bad Blood for a more thorough explanation of what took place and then making judgments and inferences on your own.

I always feel a sense of frustration when I read books like this which discuss injustices against Black people and then there are Black people within the story participating in or making excuses for the mistreatment of Black people. At some point, there has to be a reckoning or at least a serious discussion about the willingness of some Black “leaders” to serve as agents and mouthpieces for organizations and entities that seek to introduce detrimental initiatives into the Black community. There are several examples of Black people holding what would be considered racist views if expressed by a White person which shows that inequality is not just based on race but also heavily influenced by class and gender.

I support women’s rights to choose with regards to birth control and abortion as I believe in responsible family planning. I take issue with a person being deemed of sound mind but having others decide for them based on their income level and/or race whether or not they are fit to have children. This would only be fair if the mental and emotional suitability of potential parents was judged across all races and income levels.

I’ve had a soft spot in my heart for Fannie Lou Hamer since learning about how she came to be active in the Civil Rights Movement. Washington’s telling of the story of Fannie Lou Hamer is heartbreaking but incredibly well written. It is one of the best parts of Medical Apartheid as it captures the true sense that these are human beings against whom great travesties have been committed.

Medical Apartheid also dives into details about the racist origins and history of family planning centers. Yet, I believe that Planned Parenthood clinics regardless of their original intention are not on par with some of the other medical injustices discussed in the book. The reason being that those who obtain their services consent to treatment and can stop taking birth control pills whenever they please.

A great deal of the anti-birth control rhetoric discussed comes across as being grounded in sexism. It operates from a perspective that seems to imply that Black women’s purpose is to serve as baby-making machines. That control over Black women’s bodies should be wrested from the control of White people and establishments and handed over to the Black community at large.

I understand being worried about offers of help when those offers have often proven detrimental in the past. But Black women choosing to use birth control is not at all the same thing as Black people who were sterilized without their consent. Though reading about the prevalence of elective hysterectomies in New York teaching hospitals for no other reason beyond training students was eye-opening. I found myself thinking of the number of Black women who undergo hysterectomies as a treatment for fibroids. I couldn’t help but wonder how many of those cases might have been unnecessary.

Adult Black women consenting to the use of birth control is one thing. But it’s completely different for underage Black girls to be given contraceptives by school-based clinics without the knowledge or consent of their parents. I appreciated the context that Washington uses to explain how troubling it is for Black teen girls to be judged “fast” rather than provided with help and protection from men who would seek to prey on them. In such examples, schools are overstepping and taking on the role of a parent without there being evidence of negligence. It’s another instance of Black parents having control over raising their children taken away by entities that assume they know better. It might seem like a reach but this strikes me as a holdover from slavery where Black parents’ authority over their kids was fickle.

I have a strong interest in the justice system and also an appreciation for analytics and data so the sections of Medical Apartheid about disparities within the justice system were very engrossing for me. The chapter on drug use in general and with regards to pregnant mothers was eye-opening. It helped to show through data the bias of media coverage and how it skews the perception of the number of Black drug addicts as well as how much more harshly Black addicts are punished versus White addicts.

Medical Apartheid is a great source of information about medical ethical violations but also for refuting junk science and inaccurate information. I grew up hearing about crack babies and the idea that they were born addicted to cocaine. It was surprising to learn that being deemed a crack baby is based on the mother’s testing positive for the drug rather than the baby being born addicted. There are examples of how Black mothers are judged harshly and unfairly labeled with stereotypes related to crack use and Welfare. There’s a history of judging Black people and assigning negative behavior to being Black even when such behavior is found across racial groups.

Quite often discussions of government experiments can venture into an area of seeming fit for people who wear tinfoil hats. But there are several examples of government-sponsored, if not orchestrated experiments, that make complete sense from a logical standpoint. The final chapters in Medical Apartheid that focus on the use of chemical and biological weapons against Black people are terrifying.

Individuals who are both Black and incarcerated are especially vulnerable to being pressured into experiments. It’s unsettling to read about men being threatened with having their release denied for choosing to not participate in research studies. And then being further sucked into studies because visits to research labs offer a rare opportunity to get away from the hardships of prison and ironically be treated more humanely. Some participants joined studies to gain access to medical care that might have otherwise been unattainable. Also, inmates are often paid pennies to a few dollars for prison jobs but could earn comparatively more as participants in research studies. Various circumstances surrounding being in prison combine to make taking the chance to participate in a research study seem like a great opportunity. Especially if you don’t understand and aren’t told about all the risks.

Unfortunately, as Medical Apartheid transitions to modern times, it becomes apparent that with globalization and stricter research guidelines in America more research studies are now being conducted abroad. It’s no surprise that they aren’t being moved to Europe but rather countries that are home to people of color.

Black-on-Black violence is a misleading term as most violence is intra-racial. But for a while, the phrase made news headlines. Mass shootings are most often carried out by White men, with several in recent years caused by White males in their teens to early twenties. But studies about violence continue to focus heavily on Black males while comparable studies are rarely if ever conducted on White males. Not to mention as with their older counterparts Black boys are disciplined far more harshly within the legal system than White boys and White men. Medical Apartheid also branches out to discuss the prevalence of wrongful convictions in Black defendants and the role of DNA in exonerations.

In light of the current COVID pandemic, it was interesting to read about an ongoing tuberculosis epidemic that occurred on New York’s Rikers Island as well as attempts to slow the spread of HIV. These are great chapters to read and learn about past efforts to contain epidemics in the United States.

I understood Washington’s explanation of her mission as writing the book to address past abuses while showing the importance of Black people participating in current research studies. But I don’t think a clear enough line was drawn to show how things have become safer for Black people participating in studies. Especially given that some of the examples of unethical studies occurred recently.

The history of Black people being mistreated and taken advantage of plays a part in the apprehension that some Black people have with regards to seeking medical care. In studying Black history I find that every time there’s some kind of reform or protective rule put in place to protect Black people and other vulnerable populations shortly thereafter some new practice or initiative is developed to circumvent the changes.

I don’t remember how I first learned about Medical Apartheid but I was looking forward to reading it for quite some time. The book didn’t disappoint with the data presented. But, as I’ve found with several wide-ranging books such as this is that without the story of a specific person (or persons) serving as anchor the book can easily veer into feeling overly cold and academic. Don’t get me wrong, the book has peaks and valleys but is still a solid four stars.

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