Medical Apartheid

Harriet Washington’s book tells the dark history of medical experimentation on black Americans. It also reveals broader problems of inequality, poor science, and human failures.

Harriet Washington

In a recent post, Clay Jones reminded us that “the unconscious need to avoid cognitive dissonance serves as a powerful motivation to rationalize even the most horrific beliefs and behaviors.” I recently wrote about the horrific Tuskegee syphilis experiment, an unethical and racist study that denied treatment to black men with syphilis. I don’t condone or excuse what those experimenters did, but I do want to understand how good people can come to do bad things. To learn more, I read a book by the black journalist and ethicist Harriet Washington: Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Comprehensive and meticulously researched, it shows that the Tuskegee experiment was not an anomaly; researchers who exploit African Americans have been the norm throughout our nation’s history. Longstanding problems of racism, misguided thinking, and poor science continue to plague our society today.

The racial health divide is undeniable. African Americans don’t live as long. Their infant mortality is twice that of whites. Twice as many develop diabetes. They have the highest rate of cancer and cancer deaths. The reasons for these discrepancies are complex and are largely due to socioeconomic and historical factors rather than racial characteristics.

The belief that blacks were an inferior race was built into our Constitution. It failed to abolish slavery and compromised by counting slaves as three-fifths of a person for the purpose of apportioning representation. Slaves were not citizens and were not permitted to testify in court. Religion was used to justify slavery; the churches quoted Bible verses and preached that slavery was part of God’s plan and was a benign establishment that protected those inferior beings who were incapable of managing their own lives.

Perversion of science

Pro-slavery scientists portrayed blacks as inherently and immutably debased. “No amount of training, education, or good treatment could make him the equal of a white man.” Blacks were believed to have a cranium 10% smaller than whites (not true). A Louisiana doctor asserted (with no evidence) that blacks had a very different breathing apparatus and skeletal structure from that of whites. Blacks were believed to sleep more, have thicker skin, feel less pain, be sexually precocious, and be intellectually retarded. They were thought to be more susceptible to some infections and less susceptible to others. Diseases were said to manifest differently in blacks. Blacks were said to suffer from made-up black diseases like drapetomania, a type of insanity that made slaves inexplicably (?!) want to run away from their owners, and hebetude, a singular laziness and shiftlessness that caused slaves to mishandle and abuse their owners’ property. The recommended treatment for these bogus psychiatric conditions was corporal punishment (which I would think would just make them want to run away that much more). Blacks were said to be a different species; mulattos a separate race. Black characteristics were said to demonstrate a mass of imperfections. The scientists did not notice the logical inconsistencies in their reasoning, and they violated the most basic principle of science: the need to test their beliefs to find out which (if any) were true.

Logical flaws

The scientists who made pronouncements about racial characteristics failed to notice the glaring logical inconsistencies in their arguments. They said blacks were physically inferior, riddled with imperfections from head to toe. And at the same time, they said blacks were hardy laborers who were impervious to most illness. These “inferior” beings were alleged to be resistant to malaria and to be far better suited to working in hot climates in conditions that would kill whites. They thought blacks were so different from whites that a treatment that cured a white man might kill a black man; yet they preferred to study diseases in black subjects and applied their findings to whites. Blacks’ typically thick lips were said to be a primitive, ape-like trait; but apes and chimpanzees have the thinnest of lips! They never did any controlled studies to test their beliefs.

Experiments on slaves

James Marion Sims is revered in medical history as a benefactor of women, the “father of modern gynecology”. He developed a surgical technique to repair vesicovaginal fistulas, a devastating complication of childbirth. White women would not have allowed him to experiment on them, so he acquired eleven slaves with vesicovaginal fistulas from their masters by promising to lodge, board, and treat them. He operated without anesthesia, claiming that blacks didn’t feel pain. They obviously did. Other doctors were recruited to restrain the women, but soon quit because they couldn’t stand the bone-chilling shrieks. He did as many as 30 operations on a single patient. Only one of his patients seems to have benefited.

As a plantation doctor, Sims used black infants for dangerous experiments in tetany. Tetany is a disease of malnutrition, but Sims thought it was caused by displaced skull bones. He believed the myth that black infants’ skull bones fused prematurely, leading to low intelligence. Washington provides this chilling description: “He took a sick black baby from its mother, made incisions in its scalp, then wielded a cobbler’s tool to pry the skull bones into new positions.” When the infants died, he blamed the sloth and ignorance of the mothers.

In another anecdote, Washington describes how a black man refused to consent to surgery on his jaw, so Sims had him forcibly restrained so he could demonstrate the surgery to students. He operated without anesthesia.

Illogical, dangerous, and torturous treatments were commonly tried on slaves. Doctors wantonly tested ideas that had no scientific rationale. For example, one doctor repeatedly poured boiling water on naked slave patients suffering from typhoid pneumonia. The only possible rationale: maybe it would increase circulation!

Race is scientifically meaningless, but discrimination persists

Racial prejudices and abuses persisted even as the science of genetics discovered that the concept of race has no genetic or scientific basis. It is a made-up label, not a scientifically meaningful term.

As we saw in the case of Tuskegee, the end of slavery didn’t mean the end of experimentation on blacks and other powerless people. The practice was well-established and was simply used on any available victims: the poor, the uneducated, prisoners, etc. Other minority groups (Jews, gypsies, the mentally defective) were the research victims of Nazi doctors. Racism was rampant in America. African natives were exhibited at the World’s Fair. The Bronx Zoo exhibited human pygmies as if they were just another exotic animal species. Sideshows exploited humans with anomalies such as the “white Negroes” who suffered from vitiligo.

Where slavery existed, slaves were deliberately used to test treatments, but where it didn’t exist, blacks still bore the brunt of experimentation. Thomas Jefferson used cowpox on 200 slaves before he would allow its use on his white family. In predominately white Brookline, Massachusetts, Dr. Zabadiel Boylston gave 251 experimental smallpox inoculations; all but one of the subjects were black.

Errors in book

Harriet Washington is a skilled reporter, but there are some flaws in the book that might make readers question her ability. She says the word “experiment” is derived from the Latin for “ex” (out of) and “periculum” (dangerous trial). All the sources I found said it is derived from the Latin “experimentum”. She mis-states Heisenberg’s uncertainty principle. She calls Oveta Culp “Oveta Gulp”. While she gets the facts right about the Tuskegee trial in most of the book, in one section she erroneously says the participants included women and children. Only men participated in the study.

Surprising revelations

The book added to my knowledge of the Tuskegee experiment. She pointed out that it wasn’t just white prejudice: black doctors who knew about the experiment approved of it. Some people wrongly believed the men were injected with syphilis. That misunderstanding was not surprising, since there were at least 40 other experiments where doctors deliberately infected healthy black patients with various diseases including syphilis and gonorrhea. She says there was one good scientific result of the study. Public Health Service (PHS) documents show that blood from the Tuskegee subjects was instrumental in developing more accurate blood tests for syphilis, including the FTA-ABS and VDRL tests that are used today.

I did not know that blacks were barred from some chapters of the American Medical Association (AMA) until well into the 1960’s. I did not know that the first successful open-heart surgery was done by a black doctor, Daniel Hale Williams, in 1893. He sutured the pericardium to repair a wound. I was surprised to learn that a bill to abolish slavery was introduced in the Virginia legislature by Thomas Jefferson’s grandson in 1831, and it was defeated by only seven votes.

The Tuskegee Study was not the worst

The Tuskegee experiment is the most famous, but it has been “eclipsed in both numbers and egregiousness by other abusive medical studies” which the book goes on to describe. In the interest of eugenics, black babies with congenital defects were allowed to die, hysterectomies were done without consent, and the government encouraged and funded involuntary sterilization.

Grave robbing provided an excess of black corpses to medical schools. Birth control measures were disproportionately tested on black women; some called it intended genocide. Norplant was selectively marketed to poor black women and young girls. Drug abuse in black women was ten times more likely to be reported to law enforcement although it was no more common in black women than in white women. The “crack baby” epidemic was a myth.

Radiation experiments

A truck driver with multiple broken bones was not expected to survive, so without permission, the Atomic Energy Commission (AEC) took the opportunity to inject him with 41 times the normal lifetime dose of plutonium to see what would happen. They pulled his teeth and extracted bone chips to measure the plutonium levels, and five days later they finally got around to setting his broken bones. He not only survived, but he unexpectedly walked out of the hospital and disappeared, dying at home eight years later of unrelated heart disease.

The government did all kinds of radiation experiments to bleach skin, remove hair, treat ringworm, etc. There were a total of 435 human radiation experiments, some resulting in cancer and disfigurement. They gave blacks a higher dose of radiation because they believed they were more tolerant; there was no evidence to support that belief. The AEC used some of the same justifications used by Nazi doctors. They established informed consent policies but then proceeded to ignore them.

Prisoners

For a long time, prisoners were recruited for experiments. The ethics were questioned: they volunteered, but there was thought to be an element of coercion. Blacks were not specifically targeted, but they might as well have been since prison inmates were 40-61% black. They were often deceived and injured. In one study, cancer cells were injected into 396 inmates; more than 180 of them were black. Experiments were flawed. They involved psychosurgery, mind control, burns to the cornea that often caused blindness, and plasma transfusions that inadvertently infected 28% of subjects with hepatitis. The CIA funded drug experiments with LSD and other drugs. One drug to control violence was tested exclusively on black prisoners because they were thought to have “a weak type of nervous system.” Prison research largely died out in the 1970s but is enjoying a quiet renaissance. The laws enacted to protect prisoners have consistently failed to do so, and there’s no guarantee that they will in the future.

Children

Research on children has been problematic. Recruiting from lower socioeconomic populations selected a preponderance of black children. Some experiments recruited black children exclusively, stigmatized black children, or had racial agendas. To study violent behavior in black children, younger brothers of boys in the probation system were given fenfluramine. That drug had never been tested on children under twelve, and it was known to produce side effects in 90% of adults and to cause heart valve damage in 30%. The rationale for testing it was a presumed correlation between violence and serotonin levels, but there was no such correlation. The study was junk science with many scientific errors. Parents were lured with payments of $100 and children were baited with $25 toy certificates. A study looking for the prevalence of the XYY karyotype (falsely believed to be associated with violence) among black boys lied to participants and suffered from the same glaring logical flaws as the fenfluramine study. Newborns were tested for HIV and positive results were not divulged to the parents, depriving both mother and child of the opportunity for lifesaving treatment. Other experiments bypassed parental consent and got around federal legislation.

Other problems

Washington’s book reveals more problems. The drug BiDil was not approved for general use, so the company used a marketing ploy to get it approved as a special drug for black patients with high blood pressure. AIDS research has jeopardized the health and rights of HIV-positive children in the interests of completing research protocols. A researcher who needed live lice specimens for typhus research got a Boston policeman to arrest a homeless black man and hold him until the researcher could collect his lice. The CIA released infected mosquitoes. Documents were destroyed. Researchers in South Africa sought a deadly virus that would infect only blacks, as well as a virus that would make blacks sterile. There are examples of government-mediated bioterrorism.

Parallels with women

As I read the book, I was constantly reminded of similar prejudices against women. Religious teaching supported discrimination against women; preachers quoted Bible verses as evidence that women were inferior and meant to be subjugated to men. Scientists claimed that women were inherently weaker, less intelligent, less capable of math and science, less ambitious, more neurotic, unsuited to many occupations, etc.

In the Victorian era, women endured a type of slavery. They had no rights, and were considered the property of their husbands. Some Muslim women today are still subjugated to men and have fewer rights; they don’t even have the right to travel without a male guardian. Today, women are still under-represented in many occupations and are often paid less than men.

I am acutely aware of discrimination against women since I experienced it in person in my career as an Air Force doctor and flight surgeon. Because of my sex, I was denied jobs I wanted. I was paid less, because back then women were not authorized to get a dependent allowance for their spouse. I was not authorized to live in base housing. And I worked for a hospital commander who publicly announced that women are not motivated to pursue a career and don’t care about their jobs. I explained all this and more in my book Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon.

Lessons learned

Washington’s book aimed to reveal the dark history of medical experimentation on black Americans. It did that, but it accomplished much more. It revealed broader problems of racial and socioeconomic inequalities, of poor science, of science pandering to prejudice, of superstitions falsely represented as scientific fact, of failure to submit beliefs to controlled scientific testing, of failures of critical thinking, and of failure of common human decency when it comes to the health and welfare of powerless minorities. We can learn a lot from the book, but will we? My understanding of human nature suggests we will not.

This article was originally published in the Science-Based Medicine Blog

Dr. Hall is a contributing editor to both Skeptic magazine and the Skeptical Inquirer. She is a weekly contributor to the Science-Based Medicine blog and is one of its editors. She has also contributed to Quackwatch and to a number of other respected journals and publications. She is the author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon and co-author of the textbook, Consumer Health: A Guide to Intelligent Decisions.