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

“Infection and Inequity” describes medical institutions’ present-day treatment of African Americans who have dangerous infectious diseases, such as tuberculosis and AIDS, which have historically occurred in greater proportion in Black people. Doctors frequently ignore privacy and other important patients’ rights in treating afflicted Black people. Washington argues that such a lack of respect for the rights of Black people stems from a cluster of racist beliefs, from imagining Black people as “vectors of disease” to assumptions that Black people infected with diseases such as AIDS are drug users and thus untrustworthy (326). In Washington’s view, such approaches toward infected African Americans focus on simply treating the disease after infection rather than tackling the socioeconomic inequalities that lead to the growth of disease in Black communities.

In the 1980s, tuberculosis re-emerged as a deadly killer in African American communities in the US, even though antibiotics had seemingly wiped out the disease decades before. Washington argues that a return of tuberculosis was due to an abandonment of preventative practices, such as a lack of regular testing for the disease and “wide-scale vaccination” (329). As a result, a deadlier, more drug-resistant form of tuberculosis emerged that disproportionately affected African Americans. Governmental responses to the outbreak were to involuntarily detain infected Black individuals and force them to undergo treatment—practices that often specifically impacted homeless African Americans and Black people with mental health conditions.

Washington also describes medical responses toward AIDS, which Washington argues have grown increasingly punitive as the disease has emerged in the public consciousness as a “black disease” (332). At the genesis of the AIDS crisis in the early 1980s, the disease was thought to only impact gay people. Although gay men were stigmatized by mainstream culture, Washington notes that the rights and privacy of infected gay patients were respected by doctors, and no gay men were forcibly quarantined or made to “divulge their HIV status” (331). In the 1990s, the demographics of AIDS patients began to shift, and Black patients with AIDS far outnumbered white patients. Some cities, such as New York, passed laws that required doctors to divulge an infected person’s HIV-positive status to all of that person’s sexual contacts, often failing to protect the patient’s privacy in the process. Such laws reinforced notions that only criminals contracted HIV, a “blame-the-victim approach” (339) that Washington argues further stigmatized the disease.

Medical centers such as New York’s Incarnation Children’s Center (ICC), associated with Columbia University, tested experimental AIDS drugs on young children infected with HIV. These children were orphans and were almost entirely “black or Hispanic” (334). Children were not asked whether they would like to participate in the trials, and the medication often caused serious side effects, such as “anemia, muscle wasting, [and] organ failure” (334). Although some of the children’s foster parents objected to the trials, the ICC overrode their objections and forced the children to continue to take the medication.

Washington’s focus in “The Machine Age” is on the ways in which Black bodies have been used by surgeons to test risky new medical technologies. Often, surgeons failed to fully explain the risks of such experimental devices to their Black subjects, and in some cases, they would implement medical technologies into unconscious patients without their prior consent. While Black people have played a crucial role in testing medical advances, such surgeries and technologies are often unaffordable for most Black people once they leave the testing phase and enter the general market.

Washington illustrates this form of abuse of African Americans largely through two examples: artificial hearts and artificial blood. In the early 2000s, the AbioCor Corporation began testing an artificial heart on “patients with end-stage heart failure whose chance of dying within thirty days [was] at least 70 percent” (350). The first two patients to test the heart, Robert Tools and James Quinn, were both Black. The heart was advertised to them as their only chance at prolonging their life, and the procedure was technically a success as both patients lived for several months longer than initially expected. However, they were unable to leave their hospital beds and had a series of strokes that ultimately killed them both. Irene Quinn, the wife of James Quinn, felt that both she and her husband were “deceived” into accepting the artificial heart, and she contended that the doctors did not fully explain the adverse effects that might occur.

PolyHeme is a form of artificial blood, a new medical device with potentially numerous benefits, such as eliminating the restrictions of blood types. However, PolyHeme was tested randomly in emergency rooms by being inserted into “severely injured, mostly unconscious ER patients” (352). As Black people make use of emergency rooms more frequently than white people, Washington argues that PolyHeme was much more likely to be tested on Black bodies. Such testing seems to flagrantly ignore standards of informed consent, as patients receiving the artificial blood were not consulted prior to the transfusion, and the blood runs the risk of harming or even killing patients.

“Aberrant Wars” finds Washington investigating the role that experimentation on Black bodies has played in developing weapons capable of what she calls “bioterrorism.” Washington succinctly defines terrorism as:

a threat or the use of violence (including kidnapping, extortion, assault, and murder) by an individual or organization that targets innocent civilians. In contrast to mere criminality, terrorism is employed to further ideological, political, or religious goals (365).

The 20th century has seen the development of “bioterrorism”—a form of terrorism that specifically aims to use biological warfare weapons to poison communities or spread diseases. Although the development of biological warfare has been outlawed by the 1963 Geneva Convention, Washington describes how both extremist fringe groups and mainstream governments have continued to develop and make use of biological warfare, typically with the aim of committing racial genocide.

In the 1950s, the CIA’s MK-NAOMI program explicitly sought to develop weapons of biological warfare that could be used against the Soviets. In particular, the CIA was interested in using mosquitos as a form of organic weaponry by infecting mosquitos with diseases and unleashing them to spread the disease to humans. To test this idea, the CIA bred diseased mosquitos and unleashed them on the Black community of Carver Village in Florida, causing an outbreak of whooping cough that affected thousands. Although the CIA later sought to erase any trace of MK-NAOMI, a group of Scientologists known as the American Citizens for Honesty in Government publicized proof of the experiment, leading to a public outcry.

Much of “Aberrant Wars” focuses on the development of biological warfare in apartheid South Africa, where a group of white scientists, led by Dr. Wouter Bassoon, used biological weapons to poison Black anti-apartheid activists. Washington deems Bassoon’s activities to be a “science of genocide” and argues that such acts of murder could never have occurred without close collaboration from US scientists. One American governmental researcher, Larry Ford, played a particularly significant role in assisting Bassoon’s research and made frequent trips to consult with Bassoon and other South African scientists. Project Coast, a subset of Bassoon’s Chemical and Biological Warfare Programme, specifically aimed to create poison agents that only afflicted individuals with Black skin. Washington cautions that the existence of such weapons is not a mere conspiracy theory, and research indicates that “weapons could be tailored to the genetic vulnerabilities of specific ethnic groups” (375).

In the Epilogue, Washington addresses the state of medical research in the present day. Although the potential for abuse still lingers, Washington writes that standards of ethics for medical research have generally increased, and most contemporary research is safe and ethically sound. While Washington warns African Americans to remain cautious about entering any medical experiment, she also encourages Black participation in research, as she feels that therapeutic research on Black populations is a necessity for closing the gap between the health profiles of Black and white Americans.

However, Washington describes a number of problems that continue to plague contemporary medical research. Many of the abusive and unethical practices that characterize the historical experiments in Medical Apartheid have been transplanted to research conducted in Africa, where standards of ethical conduct are lower than those in the US. Western researchers in Africa frequently ignore the need to obtain informed consent, and the FDA allows American scientists to follow a more relaxed standard of ethics when conducting research abroad.

In the US, Washington argues that recent years have seen an “erosion” of informed consent practices. Doctors are no longer required to ask for informed consent when caring for certain emergency room patients, resulting in patients receiving experimental treatments without their knowledge. Likewise, the US military no longer requires informed consent in testing experimental drugs on its soldiers. In one case, the military administered an experimental anthrax vaccine to upwards of 1 million troops. Some soldiers who refused the vaccine were discharged from service.

Washington concludes the Epilogue with several suggestions for changes that could make medical experiments safer, especially for African Americans. Washington suggests that Institutional Review Boards should include “laypeople” as a check on the scientists evaluating the ethics of experiments. Informed consent, Washington argues, should be required for all medical experiments, as any exceptions might result in harmful, nontherapeutic treatments. Washington further advises that attending a course on medical ethics should be required of potential research subjects so that they can better evaluate whether an experiment matches ethical standards. Finally, Washington suggests that the same standard of medical ethics must be matched by US scientists whether conducting experiments in domestic or international contexts.