Throughout all of my years of schooling thus far, and despite every science and pre-med course I’ve taken in college, not once have I ever heard of the concept called “medical racism.” That’s why I’m taking this course, because simply the name, “Literature, Medicine, and Racism,” made me curious about what topics we would learn about. Since reading a few chapters of Harriet Washington’s Medical Apartheid, the content she wrote about not only shocked me but also worried me. I couldn’t help but think, how is it that I’m just now coming across this knowledge? How many Americans know this version of the history of medicine from Washington’s perspective; or maybe the more important question is how many Americans don’t know this history? Throughout the last several classes I’ve been curious about how many more “isolated incidents” of medical racism have been surreptitiously silenced, hidden, or ignored during the history of medicine and healthcare in the United States. Furthermore, I’ve been wondering if the current institutions that produce healthcare workers and researchers have made students aware of the people who had suffered and never got recognition for their, usually uninformed and nonconsensual, dedication to science and research. I would argue that simply the acknowledgment of medical atrocities towards African Americans and other minority groups by the medical population in America could greatly change the relationship between doctors and their patients as well as the way medicine is practiced.
One aspect of early American medicine that surprised me was how progress in this field of science was often due to the slave trade and the physician-and-planter relationship. Due to the mass importation of enslaved people to one general region of the U.S., Southern American medicine boomed for nearly two and a half centuries. Immense progress in medicine was due to, as Washington puts it, “clinical material” (Washington, 2006). Enslaved people were viewed as clinical material by planters in the South. Enslaved people served as training material for many physicians and researchers, which caused physicians to foster a strong relationship with planters. This relationship seemed to be mutually beneficial; physicians could practice and experiment with medicine without moral conduct, and the planters could keep their enslaved people alive in order to continue working for them. The usage of Black people during this time period objectified them and denied them of having any bodily autonomy. Out of everything I’d ever learned about slavery, the involvement of enslaved people in medicine was never mentioned. It’s disappointing to learn how little care physicians and researchers had for enslaved people but instead saw them as objects and projects. Perspectives like Washington’s help to provide crucial context to the bigger picture. The fact that doctors across the country saw Black people as “clinical material” clearly shows that these were not even close to isolated incidents.
Looking deeper into the physician-and-planter relationship, Washington describes instances where owners of enslaved persons restricted medical care due to accusing sick Blacks of malingering. On the other hand, owners of enslaved persons would bring in medical professionals to examine their slaves to figure out if they malingering. According to the definition from Oxford Languages, to malinger or malingering means to pretend to be ill, or feign illness in order to escape duty or work. Physicians and planters doubted the legitimacy of the claims their enslaved people made and were more concerned with putting them back to work. Planters often didn’t believe them and didn’t put forth any effort to take care of their mental well-being, but only cared about their physical, and mechanical well-being. In many cases, enslaved people did not receive medical care until it was too late, the medicine given made their conditions worse, and they often noticed physicians would provide the same “cures” for multiple different ailments. These patterns caused a lot of distrust in Western medicine. Soon, slaves began to conceal their illnesses out of their distrust of Western medicine. As Washington describes this trend, “In short, enslaved Blacks often eschewed Western medicine because they suspected their owners of a greater interest in them as capital than in their welfare” (Washington, 2006). These examples of neglectful medical practices resonate with the iatrophobia African Americans have experienced for centuries and into the present day. Again, for millions of Black Americans, across many regions of the country, these were not isolated incidents. As time moved forward, communities of enslaved people saw how they were objectified by White physicians; for many African Americans today, African Americans are less likely to seek treatment and overall have more restrictions to access healthcare (Armstrong, 2007). So statistically, in America, we see some diseases that are killing African Americans at higher rates than White Americans. For example, Black Americans have a 25 percent higher cancer death rate than their white counterparts. Black American women have a 20 percent higher cancer death rate than White women (National Cancer Institute, 2022). The reason why is not really biologically related, but rather is due to social constructs. The distrust between African Americans and doctors in the present day, while it is completely justified, is negatively affecting the health of this group of Americans overall.
I was curious about how much distrust still exists among African Americans and doctors today, and I found many recent publications online about how American doctors are failing Black mothers. During pregnancy, Black American mothers-to-be often don’t receive enough communication from their doctors about all the risks they’re susceptible to while pregnant or simply aren’t listened to when describing health concerns. Several African-American women have spoken out about the injustices Black mothers have been subjected to by medical professionals. The lack of communication is similar to telling the truth but not the whole truth. This creates inequities in treatment between expecting mothers of different ethnicities. For example, American sprinter Allyson Felix spoke to Time Magazine in June of 2023 about her own experience and other women’s experiences of being neglected by their doctors while pregnant. She stated that many Black women like herself were not aware of health risks while being pregnant. To name a few, Serena Williams experienced a pulmonary embolism shortly after giving birth to her daughter via cesarean section, but her doctors initially dismissed her concerns for her health when she expressed them. Beyonce developed and was diagnosed with preeclampsia, a high blood pressure disorder that can occur during pregnancy and could later cause seizures. Felix herself developed preeclampsia too just days before giving birth. Sadly, in April of 2023, a former teammate of Felix’s, American sprinter Tori Bowie passed away while 8 months pregnant due to respiratory distress and eclampsia (Felix, 2023). A common trend across the experiences of the 4 women mentioned by Felix is the neglect in care by medical professionals, and their dismissive nature when health concerns are brought into the conversation. Whether those doctors realize it or not, the medical system in America has not trained healthcare workers to value the lives of Black women equally to White women, and furthermore, there are still racial disparities in maternal and infant health.
Personally, I believe education on the history of these racial inequities should be mandatory for medical students. To be fair to themselves and to their patients, it’s important to understand the reality of America’s dark medical history. The way Americans practice medicine may even improve due to these acknowledgments. I wonder if every student was aware of the events Washington describes in Medical Apartheid, would their approach to patient care be different? Would it be enough to restore some trust in the American healthcare system?
References
Armstrong, K., Ravenell, K. L., McMurphy, S., & Putt, M. (2007). Racial/Ethnic Differences in Physician Distrust in the United States. American Journal of Public Health, 97(7), 1283–1289. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913079/
Felix, A. (2023). Allyson Felix: Tori Bowie Can’t Die in Vain. Time. https://time.com/6287392/tori-bowie-allyson-felix-black-maternal-health/
National Cancer Insitiute (2022). Cancer Disparities. https://www.cancer.gov/about-cancer/understanding/disparities#top
Washington, H. A. (2006). Medical Apartheid The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Anchor Books.