Hippocrates Weeps: Institutional Racism within the American Medical Establishment
Johns Hopkins University
Kevin M. Bair
ABSTRACT
Institutional Racism within the American medical society promoted fear in oppressed and impoverished black communities. This fear was established through unethical medical procedures performed by unprincipled white doctors who used their image of respectability and healing to gain patients’ trust. I supported my argument by researching and reviewing scholarly articles, books, and internet research. The areas of concentration: the socially constructed view of the doctor, the Antebellum period, the Tuskegee Syphilis Study, Acquired Immune Deficiency Syndrome (AIDS) and the lack of black participants in the study, and the health disparities of blacks in the 1990’s.
Through this research I found overwhelming evidence in support of the historically long presence of Institutional Racism within the American medical establishment. How the culturally constructed image of the doctor, his prejudiced self-assured reasoning, and continuous medical clan reassurances all supported the racial myths of white superiority. These racial myths provided permission to the medical establishment to conduct horrid medical abuses on the race with the greatest disparities, the oppressed blacks. The result of these abuses obliterated the trust between blacks and the medical establishment, thus furthering the already oppressive disparities felt by the black communities.
The intent of this paper is to demonstrate how Institutional Racism within the American medical establishment promoted fear in oppressed and impoverished black communities. This fear was established through unethical medical procedures and performed by unprincipled white doctors, who used their image of respectability and healing to gain patients’ trust. The areas of concentration for this report are the Antebellum period, Tuskegee Syphilis Study, AIDS, and the lack of black participants in the study. Additionally, health disparities of blacks in the 1990’s will be covered. Through these examples, this author will pave a pathway for blacks’ justification in fearing the predominantly white medical establishment.
These unsuspecting patients were selected based on their race/ethnicity, economic, and social disparities. Furthermore, this paper will establish how medical exploitation eroded patient-doctor trust, resulting in many abused patients and their communities to mistrust the medical profession; thus, making any future medical studies or treatments nearly impossible within these maltreated societies.
Dr. J. Corey Williams, in her article Black Americans Don’t Trust Our Healthcare System — Here’s Why, suggests the medical institutes of the United States have an extensive history of “discriminating and exploiting black Americans” which is etched within the collective memory of the black community (Williams, 2017).
Some biased doctors, in the name of medical science, used patient’s health disparities to their advantage. Data indicates they sought out the poor, the sickly, and the uneducated, to conduct unethical procedures, thus, leaving behind their medical morals.
For those unfortunate patients, the shining image of the doctor and what he represents was shattered. He left a path of distrust and bewilderment between himself and his patients.
The image of the Doctor, is a culturally accepted constructed persona, which is based on trust. According to Karima Armstrong in her Racial/Ethnic Differences in Physician Distrust in the United States remarks, “In health care, trust in physicians is generally defined as the belief that the physician will act in your best interest and arises from perceptions of the physician’s values (including fidelity and honesty) and competence” (Armstrong, p. 1283). Dan Blumhagen explains in his article The Doctor’s White Coat: The Image of the Physician in Modern America, “The relationship between a physician and his patient is serious and purposeful, not social, casual or random” (Blumhagen, p. 111).
When we think of the “Doctor”, we have a vision of a middle aged man wearing the classic white coat. He may be wearing a stethoscope, a shiny head mirror, and carrying the iconic black bag. This portrait is symbolic of physicians, and it is this social stereotype which depicts a person of authority. Furthermore, Blumhagen states the white coat is an illustration of purity and innocence and is the polar opposite of black, the symbol of death and sorrow (p. 111). Society expects the person wearing the white coat to be a protector, flawless in character, who is impervious to his patients sexually.
Culturally, we have a belief that all doctors have sworn the Hippocratic Oath to higher powers, stating that they would first and foremost, do no harm – abstain from harming or wronging any man; present themselves as the friends of the sick (Porter, p. 63). However, history reveals how many white doctors felt about the black race, and how they used their thinking to justify unethical medical procedures on them.
Figure 1The unilinear scale of human races 1868 Nott and Gilddon (Gould, p. 65)
Stephen Jay Gould’s book The Mismeasure of Man, depicts an 1868 drawing (Figure 1) from the book Indigenous Races Of The Earth, by Dr. Josiah Clark Nott and Dr. George Robbins. This drawing supposedly represents a unilinear scale of human races. However, what this drawing does, is reveal their scientific racism, and their proposed racial hierarchy putting the intelligence of blacks between white Greeks and chimpanzees; solely based on their caricatures. Gould explains, “the chimpanzee skull is falsely inflated, and the Negro jaw extended, to give the impression that blacks might even rank lower than apes” (Gould, p. 65).
I believe Nott and Gliddon were categorizing humans based on phenotypes. Matthew Desmond in his book Race in America, explained early science categorizing humans based on phenotypes, that is, race is based on a person’s physical composition and appearance: skin tone, hair texture, skeletal structure, etc. (Desmond, p. 34). Additionally, Judith Leavitt in her book, Sickness And Health In America, explains how some doctors further rationalized oppression of blacks. In her book, she mentions Dr. W. T. English who wrote: “Cranial structures, wide nasal apertures, receding chins, projecting jaws, all typed the Negro as the lowest species in the Darwinian hierarchy” (Leavitt, p. 393). These racially biased doctors and their thinking was standard beliefs with the 1860’s white medical professionals.
During the Antebellum Period (1789 -1861), Dr. J. Marion Sims (1813-1883) practiced medicine in Alabama on slaves between 1835 and 1849. During this time, he solved a medical problem that plagued doctors for generations. He perfected a surgical technique to repair rectovaginal and vesicovaginal fistulas; which can tear while giving birth. Unfortunately, to achieve this success, he operated repeatedly on several slave women, and on one woman named Anarcha, he operated at least thirty times. None of them were given anesthesia (Brown, 2017).
Sims operations were taking place in inhospitable, unsterile environments, the women were naked, positioned on all fours, and in the presence of several men observing the surgeries. According to the Minnesota Wellness Publication, “He put her up on his examination table, on her hands and knees and, [used] a modified pewter spoon to expand the walls of her vagina” (Minnesota Wellness Publications, 2017).
Theses slaves may not have not understood the medical procedures, but their friends and family would see, hear, and care for these women during and after the operations. I believe these patients suffered medical trauma from the repeated painful surgeries, which in turn would be felt within their community, thus spreading fear of the white doctor and the pain he caused.
The fear of surgery by the white doctor was not the only fear blacks had of the white medical institution, as white doctors and students of medicine needed bodies to examine. Many slaves were forced to exhume the dead bodies of blacks, and to participate in helping a white doctor perform dissections and examinations on the deceased. This grisly task prompted many slaves to flee or run away. Dr. Samuel Adolphus Cartwright (1793–1863), a white doctor from the University of Louisiana, stated that there was something medically wrong with a slave that would run away. He coined the condition of a slave fleeing Drapetomania, and his medical treatment for an afflicted slave was usually amputation of some body part (Williams, 2017).
For over 200 years, black chattel had the poorest health care, the vilest health status, and the foulest health outcome of any racial or ethnic group in the U.S.; combined with the public belief of their racial inferiority, it is not surprising they were generally abused and experimented on by the white medical society (Byrd, p. 11s).
According to Dr. Vanessa Northington Gamble, in her article, Under the Shadow of Tuskegee: African Americans and Health Care, African American folklore in the 19th Century clearly indicates blacks believe white doctors and hospitals were experimenting on them. Gamble explains that folktales are full of references to night doctors, also called Ku Klux doctors, who would ride out at night seeking victims to capture for nearby hospitals to experiment on and kill (Gamble, p. 1774). And Dr. J. Corey Williams states, “Historically, medicine has used black bodies, without consent, for its own advancement; while, medical theories, technologies, and institutions were used to reinforce systems of oppression” (Williams). As much as blacks worried about night riders, they did trust white doctors who acted sincere.
1930’s Macon County Alabama, home of the Tuskegee syphilis experiment, was the poorest county in Alabama. It was mostly black sharecroppers and their families. This economically poor state spent $65 annually for each white student but only seven dollars for each black student on education (MSUs Center for Ethics and Humanities ). The budget suggests that the state was making sure that blacks were not educated and remained ignorant. It is this ignorance that led to many oppressed and desperate black men to blindly trust the white doctors who conducted the Tuskegee Syphilis Study.
The men in the study were not told what the experiment was for, just that they were being treated for “bad blood”, which was local slang for any medical ailment (Sundararajan, 2014). To the blacks, that meant they would get medical care for any type of illness.
Dr. J. W. Williams, intern at St. Andrews Hospital in the Tuskegee Institute said, “The people who came in were not told what was being done. We didn’t tell them we were looking for syphilis. I don’t think they would have known what that was” (Sundararajan, 2014).
Furthermore, according to Jean Heller in her article Black Men Untreated In Tuskegee Syphilis Study, the men were convinced to join the study by promises of a free round trip ride to the hospital, free medical treatment for non-syphilis problems, free hot lunches, and when needed, cash for a burial (Heller, 2017).
It is obvious, the doctors took advantage of the disparities in which these poor rural blacks lived. Susan M. Reverby, in her book, Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study explains how the Tuskegee experiment “helped to lay the foundation for Blacks’ pervasive sense of distrust of public health authorities today” (Reverby, p. 405).
I believe the most damming case of Institutional Racism by the white doctors at the Tuskegee Study comes from their own words. Dr. Taliaferro Clark, head of the study, remarks the causation of Syphilis in Macon County is based on the patients’ living in “depressed economic conditions” and with “rather low intelligence”. He also states they are “very ignorant and easily influenced” and very “promiscuous in their sex relations” (Brandt, p. 23).
Dr. O. C. Wenger, chief of the federally operated venereal disease clinic at Hot Springs, Arkansas, writes, “We must remember we are dealing with a group of people who are illiterate, have no conception of time, and whose personal history is always indefinite” (23). Additionally, he states, “The only way we are going to get post mortems is to have the demise take place in [Dr.] Dibble’s hospital and when these colored folks are told that Doctor Dibble is now a Government doctor too they will have more confidence” (Brandt, p. 23).
Dr. Wenger also remarks, “We have no further interest in these patients until they die” (p. 24). U.S. Surgeon General Hugh Smith Cumming (1920-1936) explains, “it is our desire to continue observation… [of Tuskegee patients]. to bring a percentage of these cases to autopsy so that pathological confirmation may be made of the disease processes” (p. 24). To conduct their needed autopsy research, these doctors purposely let the Tuskegee Syphilis patients die.
According to Allen M. Brandt in his article Racism and Research: The Case of the Tuskegee Syphilis Study, he states, “the Tuskegee Study revealed more about the pathology of racism than it did about the pathology of syphilis” (Brandt, p. 27).
These unethical medical procedures give us insight into the vast bigotry practiced in the medical field, promoted distrust and caused abused parties and their communities to no longer trust doctors. This lack of trust could stifle any additional future medical research conducted within the black communities.
According to Dr. Stephen B. Thomas’ article The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community, the doctors at Tuskegee who failed to inform their patients, or provide adequate medical care for them, created a pathway for blacks to further “distrust” public health authorities (Thomas, p. 1499). Thomas also notes, there are now fears within black communities of a black genocide performed by the white medical establishment working within their communities (Thomas, p. 1499).
Mark Smith, MD, from the School of Medicine at Johns Hopkins University in Baltimore, described the African American community as “already alienated from the health care system and the government and are somewhat cynical about the motives of those who arrive in their communities to help them” (Thomas, p. 1499).
Harlon Dalton, associate professor of law at Yale University and member of the National Commission on AIDS, remarks how the Tuskegee Syphilis Study is a reflection of societies long-term indifference to the lives of blacks, “The government purposefully exposed black men to syphilis so as to study the natural course of the disease” (Thomas, p. 1499). Thomas believes the AIDS outbreak within the black communities, and their reluctances to receive treatment, is a significant indicator of the impact the Tuskegee Study had on black mentality towards the health care system. (Thomas, p. 1504).
According to Deborah Kong’s article Blacks Mistrust AIDS Study, “Blacks have been hit harder by AIDS than any other racial or ethnic group in America” (Kong, 2003). In 2003, advocates and educators told medical researchers trying to learn more about AIDS in the black communities, that they may have trouble finding willing people for their studies (Kong, 2003). Additionally, Kong suggests blacks had developed such a fear and distrust of the white medical establishment and the U.S. government, that some believed HIV was designed to kill them. This mistrust is also known as “Tuskegee mentality”, a term used by J. Lawrence Miller, Executive Director of the Black Educational AIDS Project in Baltimore.
According to Dr. Katrina Armstrong’s 2007 report Racial/Ethnic Differences in Physician Distrust in the United States, due to the history of adverse medical treatment to the black population, from slavery through to the Tuskegee Syphilis Study, a great distrust towards the medical field is particularly prevalent among many racial and ethnic minority groups. (Armstrong, p. 1283).
As Zulema Valdez states in her book, Beyond Black and White, “Racial disparities in health may reflect racial disparities in health care since limited access to and poorer quality of care results in worse health outcomes” (Valdez, 2017).
The evidence in this paper demonstrates a long history of Institutional Racism within the American medical establishment, providing evidence that blacks are justified in their distrust. In the cases discussed, racially biased doctors played significant roles in providing further racial hatred based on culturally constructed images, prejudiced self-assured reasoning, and continuous clan support of racial myths of white superiority. These racial myths provided permission to the medical establishment to conduct horrid medical abuses on the race with the greatest disparities, the oppressed blacks. The result of these abuses obliterated the trust between blacks and the medical establishment, thus furthering the already oppressive disparities felt by the black communities.
Works Cited
Armstrong, K. M. (2007). Racial/Ethnic Differences in Physician Distrust in the United States. American Journal of Public Health (97)7, 1283-1289.
Blumhagen, D. W. (1979). The Doctor’s White Coat:The Image of the Physician in Modern America. Annals at Internal Medican (91), 111-116.
Brandt, M. A. (1978). Racism and Research: The Case of the Tuskegee Syphilis Study. The Hastings Center Report 8(6), 21-29.
Brown, D. L. (2017, Aug 29). A surgeon experimented on slave women without anesthesia. Now his statues are under attack. Retrieved from The Washington Post: https://www.washingtonpost.com/news/retropolis/wp/2017/08/29/a-surgeon-experimented-on-slave-women-without-anesthesia-now-his-statues-are-under-attack/?utm_term=.55a8fa761526
Byrd, W. M. (2001). Race, Medicine, and Health Care in the United States: A Historical Survey. Journal of the National Medical Association 93.3, 11S–34S. Print.
Desmond, M. (2016). Race in America. New York, London: W. W. Norton & Company, Inc.,.
Gamble, V. N. (1997). Under the Shadow of Tuskegee: African Americans and Health Care. American Journal of Public Health (87) 11, 1773-1778.
Gould, S. J. (1996). The Mismeasure of Man. New York Londan: W.W. Norton and Company.
Heller, J. (2017, May 10). AP WAS THERE: Black men untreated in Tuskegee Syphilis Study. Retrieved from Associated Press: https://www.apnews.com/e9dd07eaa4e74052878a68132cd3803a
Kong, D. (2003, Feb 26). Blacks mistrust AIDS study. Retrieved from Ocala.com: http://www.ocala.com/article/LK/20030226/news/604231419/OS/
Leavitt, J. W. (1997). Sickness and health in America. Madison,: The University of Wisconsin Press.
Minnesota Wellness Publications. (2017, Nov 15). Anarcha The Mother of Gynecology. Retrieved from http://www.mnwelldir.org/docs/history/biographies/anarcha.htm: http://www.mnwelldir.org/docs/history/biographies/anarcha.htm
MSUs Center for Ethics and Humanities . (2005). Faces of Tuskegee. Retrieved from https://msu.edu/course: https://msu.edu/course/hm/546/tuskegee.htm#Dr. Taliaferro Clark
Porter, R. (2013 ). The Greatest Benefit to Mankind: A Medical History of Humanity. New York, London: W. W. Norton & Company; Kendle Edition .
Reverby, S. M. (2000). Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study. Chapel Hill and London: The University of North Carolina Press; 1 edition.
Sebring, S. (2007, Dec 06). mississippi appendectomy. Retrieved from mississippiappendectomy.wordpress.com: https://mississippiappendectomy.wordpress.com/2007/12/06/fannie-lou-hamer/
Sundararajan, N. A. (2014). “BAD BLOOD”: The Tuskegee Syphilis Study . Retrieved from http://tuskegeestudy.weebly.com: http://tuskegeestudy.weebly.com/the-study-is-born.html
Thomas, S. B. (1991 (81)11). The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community. American Journal of Public Health, 1498-1505.
Valdez, Z. e. (2017). Beyond Black & White. Thousand Oaks: SAGE Publications, Inc.
Wall, L. L. (2006). The medical ethics of Dr J Marion Sims: a fresh look at the historical record. J Med Ethics (32), 346-350.
Williams, J. C. (2017, Aug 24). Black Americans don’t trust our healthcare system — here’s why. Retrieved from The Hill: http://thehill.com/blogs/pundits-blog/healthcare/347780-black-americans-dont-have-trust-in-our-healthcare-system
Figure 1. The unilinear scale of human races 1868 Nott and Gilddon (Gould, p. 65)5