51 pages • 1 hour read
Harriet A. WashingtonMedical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
Nonfiction | Book | Adult | Published in 2007A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
Racist Dehumanization in Medical Science
Content Warning: The source material and this guide include discussions of racism, eugenics, and medical experimentation.
The major throughline in Medical Apartheid is how medical science has been characterized by the racist dehumanization of Black people. White doctors often fail to show the same compassion toward their Black patients as they do toward their white patients. Washington introduces this disparity in an anecdote in the Introduction, in which she stumbles upon the files of two different patients, one white and one Black. While the white patient was described compassionately, with the doctor describing his family personality, the Black patient was far less fully described, with the file frequently emphasizing that he was “Negro” (14). The differences extend beyond mere description into malpractice, as the white patient received a needed kidney transplant, but the Black person did not receive the organ donation they needed to survive. The extreme difference in the two files epitomizes a long-standing gap in the care received by white and Black medical patients, and it shows how viewing Black people as less human results in substandard care for Black patients.
Washington traces this dehumanization of Black patients back to slavery, which itself relied on the idea that Black people were less than human. Indeed, the motivations for treating an enslaved person’s illnesses were different than for treating white patients. Since enslaved people were viewed only as property, enslavers were only motivated to keep them alive if they could still perform labor. By contrast, white lives were viewed as intrinsically valuable. In some cases, doctors explicitly purchased enslaved Black people to perform medical experiments on them. Doctors such as James Marion Sims were able to perform barbaric experiments on enslaved women without anesthesia precisely because they were viewed as less than human.
This practice then extended to the teaching practices of 19th-century hospitals since Black people—enslaved or not—had fewer rights over their bodies than white people. Experiments were performed on Black patients without their consent, and doctors were incentivized to allow Black patients to die so their cadavers could be used in dissections. These practices further perpetuated the dehumanization of Black people by the medical establishment as doctors-in-training were taught that Black people felt less pain or were simply vessels for experimentation, not people in their own right.
Similar to other forms of racist discrimination, the dehumanization of Black people in science and medicine has endured long after emancipation. For example, the eugenics movement focused on reducing the populations of so-called undesirable populations, including Black Americans. Washington discusses how Margaret Sanger opened clinics that worked toward this goal by distributing birth control to Black women, often without their informed consent. In other instances, Black women were forcibly sterilized without their knowledge or consent by doctors performing other operations, a practice that endured into the mid-20th century.
Much of Medical Apartheid focuses on unethical 20th-century medical experiments conducted on Black subjects, most famously the Tuskegee Syphilis Experiment. This experiment is one of many examples of white doctors performing non-therapeutic medical research on Black people. In therapeutic research, the goal is to “help treat or cure a patient with a disorder” (5), and decisions by the doctor are always based primarily on the research subject’s health. In contrast, non-therapeutic research pays little regard for the patient’s well-being, instead viewing research subjects as a means for “investigat[ing] medical issues for the benefit of future patients or of medical knowledge” (5). Non-therapeutic medical research often deliberately places research subjects in harm’s way due to the potential discoveries that may result, and this sort of unethical practice is only possible when doctors dehumanize their patients. As such, Black people have been and continue to be at risk for exploitative medical practices by unscrupulous white doctors.
Science is not Morally Neutral
Throughout Medical Apartheid, Washington describes numerous individuals who attempted to paint their racist views of Black people as grounded in scientific fact. This appeal to science allowed them to portray their racism as grounded in objectivity rather than personal bias. While such uses of science were deeply hypocritical and illogical, they highlight the fact that science in and of itself is not objective or morally neutral; instead, it reflects the biases of those performing research and must be considered in this context.
One of the primary examples is the ideology of scientific racism, which became popular during slavery to justify the enslavement of Black people. Adherents of scientific racism such as Samuel A. Cartwright were obsessed with proving that Black people evolved differently than white people, justifying slavery by claiming they were less human. Dubious experiments and findings were used to inform policy in the Antebellum South, creating so-called evidence that proved the benevolence of slavery. Despite these scientists claiming Black people were inferior to white people, Washington notes the hypocrisy involved; the same enslavers who espoused the belief in the inherently poor mental capacities of Black people also trusted them to perform skilled labor, allowing them to serve as “nurses, cooks, herbalists, midwives” and other roles (42).
Such abuses of scientific theory continued throughout the 20th century, especially in the eugenics movement in the early 1900s. Scientists such as Francis Galton deliberately manipulated the theory of natural selection to their racist ends. He and other eugenicists argued that society should carefully monitor reproductive practices and encourage “selective procreation” to ensure the birth of more genetically fit offspring. However, such ideas of genetic fitness have little to do with actual science and instead are based on racist assumptions that Black people are “genetically inferior to whites. Despite having no scientific proof for white supremacy (or using bogus practices like phrenology to manufacture evidence), eugenicists influenced medical practices and harmed Black populations. Along with the aforementioned Tuskegee Syphilis Experiments and unethical birth control practices, Washington cites the practice of doctors citing racist ideas of the natural aggression or primitiveness of Black people to support performing extremely violent lobotomies on Black children and urban rioters.
As Washington makes clear, the supposed objectivity of science can often be twisted to support ideological and racist ends. While she points to more recent ethical codes and practices that offer greater patient protection, she also highlights the way that medical racism persists outside of American scientific rules. In particular, she cites how scientists will pursue unethical experiments in Africa, purposely seeking out Black research subjects in places where the rules are more lax. By illuminating the history of biased medical experimentation on Black Americans, Washington raises the alarm about these 21st-century experiments, insisting that Black people worldwide should be protected by the same ethical standards that reduce instances of bias in American medical science.
The Legacy of Medical Racism
In creating this history of medical racism in the US, one of Washington’s chief goals is to show that the individual horrors inflicted on Black patients do not exist in a vacuum. Instead, they exist in a long history of dehumanization, and even after certain practices are outlawed, they have lasting effects on later generations.
The most obvious of these effects is on Black people, who still suffer from centuries-old stereotypes and misinformation about Black bodies. For example, Washington cites 19th-century beliefs that Black people feel pain less than white people do. This inaccurate view guided centuries of medical experiments on Black people, including irradiating Black patients at higher degrees than white patients. Recent studies show that to this day, doctors still tend not to believe Black patients when they complain of pain, and they harbor false beliefs, such as the idea that Black people have thicker skin than white people (Sabin, Janice A. “How we fail black patients in pain” AAMC, 6 Jan 2020). Along with mistreatment from doctors, this history of medical malpractice has led to iatrophobia, a mistrust of doctors in Black communities. Due to both family histories of medical abuse and infamous stories like those of the Tuskegee Syphilis Experiments, Washington asserts that Black Americans have a justified fear of seeking medical help. This has its own legacy, leading to adverse health outcomes due to a lack of treatment.
Meanwhile, the medical racism that emerged in the 19th century has had a lasting impact on white doctors’ beliefs about their Black patients. As mentioned above, some doctors still harbor biases and false ideas about the physicality of Black people. Alongside this, the dehumanization of Black patients in the 19th century led to doctors being trained to not empathize with Black patients. In one instance cited in Medical Apartheid, a doctor tells his students that the “decision to amputate should be weighed differently according to the person’s race and class” (109). Likewise, Washington uses the memoirs of Dr. Pray to illustrate how teaching hospitals “blunted physicians’ compassion” (112). While one entry describes Pray’s unease with performing a dissection on a young Black girl, an entry a year later describes Pray using a piece of an African American corpse to play a prank. Washington argues that such a “sad psychological transformation” can only be understood as a result of teaching practices that emphasized Black bodies as nothing more than material to be exploited for experimentation (113). Such attitudes toward Black people then persisted into the 20th century. For example, when Dr. Kligman visits the Holmesburg Prison, he perceives the Black inmates as “acres of skin” rather than people (249), ripe for use to test experimental and dangerous skin products. From 20th-century medical experimentation to 21st-century issues such as a disproportionately high maternal mortality rate among Black women, Washington asserts that 19th-century medical and scientific racism have enduring consequences, with each historic violation informing new ones.
