Author of ‘Medical Apartheid’ Harriet Washington Explains Why African Americans, after 400 Years, Are Justly Suspicious of U.S. Medicine 

ST. JOSEPH, Mich. — Why are many African Americans suspicious of health care professionals and institutions? What explains this lack of trust, this disconnect?

The disturbing answer, according to Harriet Washington, goes back a long time — in fact, all the way back to America’s colonial days. It is a story whose chapters include medical torture in the guise of noble experimentation, documented “proof” of the inferiority of Black bodies, and the amputation of limbs when not medically necessary but only as a way to teach White medical students. Among many other episodes on this grand and long-term scale of degradation, the story also includes the exhibition of naked African-American bodies in spectacle fashion before curious white audiences. 

Until as recently as the 1970s, one sordid chapter was the infamous study in Tuskegee, Ala., of hundreds of Black male sharecroppers suffering from syphilis. The U.S. Public Health Service began the study in 1932, calling it the “Study of Syphilis in the Untreated Negro Male.” Researchers allowed the disease to run its course for decades in these men, who were lied to and thought they were getting treated. “The whole intent was to bring them to autopsy,” Washington said.

Even today, research consistently shows physicians think Black people don’t feel pain the way White people do, and Black and Hispanic people are not prescribed pain medications to the same degree and for the same symptoms as Whites, Washington said.

‘Notes from History, Ethics’

Washington, a renowned medical writer and editor who has taught at the Harvard School of Public Health, gave a historical overview of the U.S. medical establishment’s treatment of African Americans during an online presentation in late September 2020. Her presentation was titled “Building a Trustworthy Health Care System: Notes from History, Ethics and Contemporary Crises.” She was speaking primarily to people who work in the Spectrum Health Lakeland health system in Berrien County in southwest Michigan, and to people in the communities it serves. Watch the Harriet Washington Event here.

Her presentation was sponsored by an ongoing project, now in its third year, Community Grand Rounds: Healing the Trauma of Racism. Lay and medical people alike were invited to watch and send questions online to Washington. Earlier in the day, Washington provided a continuing medical education presentation to Lakeland’s medical staff and was interviewed by a local doctor.

Why Southwest Michigan?

Lynn Todman, who conceived of and is leading Community Grand Rounds, introduced Washington. Todman said African Americans’ lack of trust in health care providers and the systems they work for is a major obstacle for Spectrum Health Lakeland as it seeks to reduce huge gaps in death rates and life expectancies between Blacks and Whites in Berrien County and improve the overall health of Blacks. Washington was invited to help the health system begin to earn the trust of Black residents. (See “How a Health System Can Earn the Trust of African-Americans)

Todman, the health system’s vice president of health equity, said trust has been “repeatedly and deeply eroded among African Americans.” This distrust shows up in many ways, from avoiding health care altogether to treating medical advice with skepticism and suspicion, she said. “This distrust is a perfectly logical response to the pervasive and institutionalized medical maltreatment of Black people in this country.”

Becoming what local African Americans consider trustworthy will help the SHL system “make meaningful improvements in population health to achieve health equity,” she said.

A Separate ‘Species’

Washington’s historical overview sometimes paralleled revelations in her 2007 book, “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.” Sales of the book have escalated in the last year. She finds this heartening. “There’s a lot more attention to it,” Washington said in apparent reference to the effects of racism. “I think people are ready for this history, and they’re ready to address these questions now in a way that they weren’t in 2007.”

From the time Africans were enslaved and transported to America, the relationship between Blacks and the White medical establishment has been testy. “From the beginning there was contention, rather than cooperation, between African Americans and doctors,” she said.

From the time Africans were enslaved and transported to America, the relationship between Blacks and the White medical establishment has been testy. “From the beginning there was contention, rather than cooperation, between African Americans and doctors,” she said.

To White doctors and researchers, Blacks were often little more than bodies to experiment on. Such experimentation was a natural outgrowth of a culture, and a medical establishment, that viewed Black people as inferior—even a separate species. Because they supposedly didn’t feel pain or die of heat illness, African Americans were “the ideal beings to work long, hard hours in the hot subtropical southern sun,” Washington said.

The Legacy from 1619 on

“There is no sphere of American medicine that has not been touched by its maltreatment of African Americans and by its mischaracterization of African Americans as people who are inherently less healthy and whose bodies are inherently inferior, and whose minds as well are inherently inferior,” Washington said. For a long time in this country, the best physicians and scientists were united by this belief of the profoundly inferior Black body and mind.

From 1619, when the first Africans were brought to this continent, to 1865, the year the Civil War ended, Blacks were forced to give up body parts in research settings and to serve as anatomical specimens and teaching material in hospitals, she said. 

Scientists believed Blacks suffered diseases that nobody else did. One such phantom illness was drapetomania (from the Greek words for flight and insanity), which applied to slaves who ran away. Other “disease” symptoms included refusing to follow the orders of one’s master, talking back to a White man, and striking or harming an owner. “They all reflected something in common: a lack of enthusiasm for enslavement,” Washington said.

Horrors on the Operating Table

Doctors during the era of slavery often conflated violence and treatment. They shared successful techniques they used to force Black people to get back to work when they were ill. “It might be medical treatment, but also could as easily be some kind of torture designed to get him (the slave) back to work,” she said.

Washington told the story of Dr. James Marion Sims, who in 1875 became president of the American Medical Association. He was revered as “an American medial hero and the father of gynecology.”

But the ugly truth was Sims, in a search for a technique to cure vesicovaginal fistula, “a horrible complication of childbirth,” made female slaves strip naked. He even invited an audience, including local businessmen and his friends, to the shack where he did the operations. He sliced into the women’s genitalia as they emitted bloodcurdling screams. The women had no anesthesia, although doctors were using it at the time. Other people attending the surgeries held the women down.

This article can only begin to suggest the scope of instances and types of mistreatment Washington mentioned in her presentation. Similarly, as she wrote in “Medical Apartheid,” her book, full as it is of horrors, only partially tells the story and is no complete encyclopedia of all the horrors the American medical system has done to Black citizens. 

Black Doctors Were Excluded

During the era of segregation, from 1865 to the 1960s, African Americans could find few places to receive medical care. Hospitals and health care systems that were started by Blacks were dismantled or sabotaged. The “very poor care” they did receive tended to be in “subterranean, rodent-ridden areas in hospitals,” Washington said.

Black physicians didn’t fare so well, either. They were excluded from specialized training and residency programs and from practicing in hospitals. Many people began to see them as inferior. The Black doctors turned to civil protests to fight their exclusion. Washington showed a slide of Black doctors picketing a meeting of the AMA, to which they were finally fully admitted in 1968. 

Very Bad ‘Science’

A major theme Washington weaved through her wide-ranging presentation was how White doctors and scientists believed in racial dimorphism, that Black and White people had profoundly different bodies. This once-pervasive belief “has never completely died out,” she said.

These biases against African Americans preceded the scientific method. When science did begin to dominate medicine, doctors and scientists simply overlaid theories on their pre-existing beliefs. They saw what they expected to see — including one doctor’s insistence that he found an extra rib in all the Black cadavers he dissected. “It shows something about human nature,” Washington said of this doctor’s “discovery.”

“We see what we want to see. It (the extra rib) didn’t exist.”

The researchers who devised the Tuskegee Syphilis Study were, as late as 1973, trying to prove one particular theory—“a holdover from the Victorian era”— that African Americans with syphilis would manifest the disease in very different ways from White people. They believed subjects would suffer no brain or neurological damage, as White people do, but only muscle damage, because — so their belief went — Blacks’ neurological systems were primitive and kept them from feeling anxiety and pain.

Very often, researchers doing such work did not state what they were trying to prove, Washington said.

Creatures of Time & Place

Washington also made it clear that medical people are the products of their time and place. “It’s not that medical workers are especially unfeeling or racist or uncaring—not at all. The problem is that the American medical milieu reflects what’s happening in the larger American culture.”

Although things have improved, they are still not equitable. African Americans are less likely to have a private doctor, less likely to have health care insurance and less likely to live in places free of environmental contaminants. Health inequities result from inequities in the larger culture.

Jarring News Stories

Even today, Washington said, Black Americans encounter many experiences and risks to which whites aren’t exposed. “It makes it difficult sometimes for White people to understand African Americans’ wariness.” 

Even today, Washington said, Black Americans encounter many experiences and risks to which whites aren’t exposed. “It makes it difficult sometimes for White people to understand African Americans’ wariness.” 

She cited the news story from early 2019 that Virginia Gov. Ralph Northam admitted posing in blackface, alongside a companion dressed in a Ku Klux Klan outfit, in a 1984 yearbook to celebrate his graduation from medical school. (The next day, Northam retracted his confession, saying he was not in the picture. And a three-month investigation could not prove who the men were in the photo.)

A similar story Washington mentioned was from 2008 in New Jersey. Three paramedics were fired after allegedly hazing two paramedic trainees by forcing them to wear white sheets over their heads. One of the trainees held a cross. The incident came to light after cellphone camera images surfaced. Washington said she wouldn’t want to call an ambulance staffed by one of these guys. She said hearing such stories can keep Black people away from the medical system.

How a Health System Can Earn the Trust of African Americans