The Ongoing Significance of Racism in American Medicine
Oxford University Press’s Academic Insights for the Thinking World
Tina K. Saks
February 24th, 2019

America’s healthcare system is considered by many the finest in the world, and the symbol of what America can achieve combining science and service. It’s also true that we spend 1/5 of our nation’s resources funding healthcare, so it’s certainly an institution that all Americans are deeply invested in. And still, the reality is that American medicine has never invested equally for black Americans and white Americans. Further, the medical system has always been fraught with outright abuse, experimentation, and neglect. Thanks to the groundbreaking work of scholars Harriet Washington and Susan Reverby, (among others) the long history of mistreatment of black, and other vulnerable, people in American hospitals and doctor’s offices is not a secret.

Consider Alex McNabb, an EMT who boasted about harming a pediatric patient, proclaiming on a podcast he hosts “So, guess who volunteered to take (his) blood?’ Dr. Narcan enjoyed great, immense satisfaction as he terrorized this youngster with a needle and stabbed him thusly in the arm with a large-gauge IV catheter.” His account of purposefully trying to hurt a black child is remarkable in its cruelty and wanton disregard for black people’s humanity. For some women encountering someone like McNabb was not just a passing fear. Rather, for Tammy (pseudonym), a 37 year old accountant in Chicago, people like McNabb represented a very real threat.

According to Tammy, she was taught from a young age that she could not receive medical treatment from a white person under any circumstances. She recalled,

“You can’t get a shot. I’ve never gotten a shot by a white person ever . . . they had me terrified [of being treated by a white doctor].” Her family’s concerns stemmed from their understanding that their great-grandfather died as a result of the Tuskegee Syphilis Study. The US Public Health Service began the “Study of Syphilis in the Untreated Negro Male” in 1932. Approximately 600 black men, primarily poor sharecroppers in Macon County, Alabama, were enrolled in the study. The men were told they would be treated for syphilis when in fact the purpose of the study was to learn whether syphilis progressed differently in blacks than whites. Although penicillin was available by 1943, the US Public Health Service never intended to provide treatment to the study respondents. The men were not treated and hundreds went on to infect their wives and children through congenital exposure. Although the record keeping was inconsistent, as many as 30% of the men may have died directly from untreated syphilis. The experiment continued for 40 years and ended in 1972.

Image credit: “Doctor drawing blood from a patient as part of the Tuskegee Syphilis Study” by National Archives. Public domain via Wikimedia Commons.

Although the details are fuzzy, Tammy’s family believed their great-grandfather died of a “broken back” possibly due to a botched spinal tap, a procedure commonly used to stage the progression of syphilis among men in the study. Her great-grandmother and grandmother were deeply affected by his death and absence of financial support he provided for the family. This is one of the implications of tragedies like the Tuskegee Syphilis Study that are all but overlooked: the wrongful death of a family member ripples across multiple generations. The families live with the dread of being mistreated when they are most vulnerable. Being sick or injured is scary enough without the suspicion you may not get what you need, or even worse, that your healthcare provider may hurt you on purpose.

To try to protect the family, Tammy’s grandmother, and later her own mother, insisted the children avoid care from white doctors believing the doctors would purposefully harm them. Tammy was so deeply affected by what happened to her that even as recently as 2011, she refused emergency care for her school age daughter until the hospital could find a black doctor to perform an appendectomy. Although her daughter’s life was in danger if she did not have the surgery, Tammy was paralyzed with the fear that a white doctor could not be trusted to save her child’s life. This is a profoundly painful predicament for any parent and Tammy’s agony should be thought of as a direct consequence of the syphilis study itself.

Although Tammy does not represent all black women and McNabb does not represent all healthcare providers, their stories illustrate deeply entrenched racism in the American healthcare system. Healthcare for black people seems to hover somewhere between willful neglect and overt malfeasance. We need only look to the ongoing lead poisoning disaster in Flint, Michigan, or the black maternal mortality crisis as examples.

Among all these tragedies, the Tuskegee Syphilis Study stands out as an archetype of racism in medicine. It functions as a collective rearview mirror: a guidepost to suggest we have turned the corner and are no longer capable of carrying out such cruelty under the guise of science. Yet, the conditions that gave rise to the Tuskegee Syphilis Study are the same ones that lead to the world’s McNabbs. Black people have always been viewed as less worthy of care and fundamentally less human than white people. This is an enduring or timeless condition of American life rather than a historic one. Only when we truly confront this reality can we begin to redress these historic and contemporary harms. To do so would ensure black children purposefully stabbed with big needles and made to drink poisoned water get the care they rightfully deserve.

Lastly, it is time to stop pretending that the “objective” training in the scientific method required in medical schools somehow cleanses would-be providers of racism, sexism, xenophobia, etc. This was not true in 1932 when the Tuskegee Syphilis Study began nor was it true in 2017 when an EMT decided to use a big needle on a little kid. Let’s stop telling ourselves lies about our past so we can get on with the work of cleaning up the future of American medicine.

Sacks, Tina K. | The Ongoing Significance of Racism in American Medicine | Oxford University Press’s Academic Insights for the Thinking World | February 24th, 2019 | https://blog.oup.com/2019/02/ongoing-significance-racism-american-medicine/