Medical Apartheid

Title: Medical Apartheid – The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

Author: Harriet A Washington

Publisher:  Anchor Books, 2008 (First published 2006)

ISBN: 978-0-7679-1547-2

Pages: 405

Modern medicine has rescued more people from certain death than any other benefactor, be it factual or fictitious. Several maladies which plagued humanity from prehistoric times, like smallpox, leprosy, tuberculosis and others have been eradicated for most practical purposes with the help of wonder drugs brought out by the fruits reaped of the efforts of researchers and pharmaceutical companies. However, for any new drug to hit stores, it need to be tested to ascertain its effectiveness and to evaluate it for the harmful side effects it may generate. Medical testing and experimentation is essential before releasing the drug for public consumption. Those subjects which undergo such testing invariably run the risk of crippling physiological conditions that may arise from unintended consequences of taking the experimental medicine. Naturally, most people would object to submit themselves to studies, and researchers would be forced to find less privileged subjects to undergo their trials. Harriet A Washington, who is a fellow in ethics at Harvard Medical School and is a prominent research scholar in related fields presents the scary story of how black Americans have been subjected to frequent and often damaging experiments without obtaining their consent first.

Slavery was an institution which demoralized the slave as the master, yet continued till 1865 in the U.S. Denied of personal freedom, the black slaves were forced to toil in farms and plantations of rich, white owners in the South. Physicians played a significant part in propagating slavery as they physically inspected before they were bought. Such examinations were often indecent and humiliating as the physicians made no distinction of sex. Racist theories like the blacks had inherent immunity against tropical diseases made them exposed to pathogens commonly found in open spaces. The treatment given to ill slaves were inadequate and only such as to keep him alive so that the master’s money spent in purchasing him was not wasted. Ever since insurance companies started covering the lives of slaves, the medication became more precarious. If it was cheaper for the master to let the slave die as he would then receive the insurance money, physicians colluded with them to ensure a quick demise.

Conducting unproven, hazardous medical experiments on blacks was another occupational hazard for slaves. Not only therapeutic experiments which sought to test the efficacy of specific drugs, even sadistic procedures were also employed. James Marion Sims, the physician considered to be the ‘father of American gynaecology’ and the ‘great benefactor of women’, sharpened his skills by performing surgeries on unfortunate black women who were not anesthetized and subjected to brutal treatment without any vestige of ‘informed consent’ which makes the heart and soul of medical trials today. Even outside medical research, the black human body continued to attract researchers. A pygmy man was brought from Congo and displayed in the New York Zoo in 1905 in a cage which housed a gorilla and orang utan. Visitors came in droves to see him, howling, jeering and yelling at him. He at last attacked some of them, at which point the zoo ejected him. He continued education thereafter and found work, but later committed suicide when it became clear that he couldn’t save enough for the passage back home to Africa.

By mid-19^th century, medical education shifted from isolated centres of healing to attached hospitals. Teaching clinics, as they were called, needed larger and larger numbers of cadavers for the burgeoning student base. However, dissection on human bodies was socially frowned upon. Criminals committing gravest crimes were sentenced for execution and dissection! As the demand grew, medical schools resorted to stealing bodies from graveyards. Here too, blacks were specifically targeted as their neighbourhoods were poor and cemeteries unguarded at night. Diseases were also supposed to be racial in origin. Pellagra, a deficiency disease caused by shortage of the aminoacid niacin in corn frequently afflicted the slaves as they could afford only such food that was available to them. Economic downturn around 1906 forced whites also to eat less nutritious diet and pellagra appeared among them too, convincing racial superiority theorists about the fallacy of their ideas.

The most gruesome case of apartheid is the Tuskegee Syphilis Study, conducted from 1932-1972 in which 400 black syphilitics were given vitamin tablets and aspirin to convince them that they were receiving treatment when in fact the study was instituted solely to trace the progress of the deadly disease. The physicians were careful that the patients were not given treatment which available 11 years into the onset of the study, in 1943, when penicillin was invented as an antibiotic to fight the bacterium that caused syphilis. The study was dropped in 1972 after public outrage at the discriminatory and unethical manner in which it was conducted forced the government to do so.

Drug trials are conducted in three phases, Phase 1 for testing whether the drug is safe, Phase 2 for testing its effectiveness and Phase 3 which compares the results of treatment with the new drug against standard available therapy. Phase 1 is naturally the most dangerous and requires extensive followup checks. Prison inmates are thought to be ideal for this and they were widely used for medical trials in many countries. This fact also proved to be against blacks as they are overly represented in American prisons. One such experiment was the heating of blood to remove cancerous cells. Volunteers’ blood was removed via venous and cervical tubes, heated and returned at a temperature of 108.5 F, at a time when even a person taken to a hospital with 105 F is considered an emergency case.

Genome-based clinical trials pose a double edged sword. While it has undoubtedly secured the release of several blacks from prisons based on DNA fingerprinting, genetic factors which contribute to diseases have been poorly understood. Though sickle-cell anemia is known to afflict a portion of whites too, it is still hailed as a black disease, adding stigma to mental duress. Also, therapeutic research going into eradication of the disease is very meagre when compared to cystic fibrosis, which affects whites more. Even medicines tested on blacks are out of their reach when they come out as the final product. Eflornithine, a drug developed by Avantis was found to be very effective against sleeping sickness, commonly found in sub-Saharan Africa but was marketed as Vaniqa, for the removal of facial hair from women. The company found it more profitable as the white women could afford $50 a month for a cosmetic while the blacks could not manage the same amount to save their own lives.

Washington ends the discussion with a pragmatic note to blacks not to let the shadows of the past darken their future. Abuse of African Americans are rare today and those people should come forward now to participate in medical trials which may provide genuine cure to humanity. She also lists several suggestions which should be incorporated in any ethical medical research. They are, 1) repair the system of Institutional Review Boards (IRB), 2) stop the erosion of consent, 3) institute a coordinated system of mandatory subject education and 4) embrace single standard of research ethics across all countries.

Washington’s book, though appealing, is hampered by the fact that she is often biased with a trait that finds fault even where there is none. Her criticism of the medical establishment oversteps the boundary between objective analysis and scaremongering. An example which can be made out is her opposition to birth control initiatives undertaken among black women. Such measures would naturally targeted more on the economically weaker sections in any country, which happened to blacks in America as they had the highest birth rates though the factors leading to it were purely economical and not racial. But the author imagines this to be a purported move to eliminate blacks altogether from the country as advocated by some right-wing groups whose ideas often shared a fine line with lunacy. The book is also somewhat bulky. Washington could definitely have conveyed the same ideas in the same detail without inflicting so much damage on the environment.

The book is recommended.

Rating: 3 Star