My Continued Education in American Racism
December 10, 2020
by Robert E. Cranston, MD, MA (Ethics)
In my most recent blog, I wrote of some of my personal efforts to educate myself about racism in America, as well as improve my service for Christ to His world. While I do not ascribe to the tenets of critical theory, and I believe America has made significant progress in combatting its racist tendencies, I affirm the work of Dr. Omari Hodge and the new R2ED Committee he is leading for CMDA. I think it is important and necessary for our moral growth as a nation and our spiritual growth as Christians that we examine these issues and act appropriately.
One could discuss discrimination in multiple areas of society, but as healthcare professionals, we should be particularly aware of and concerned about racism within healthcare. Many of us white Christians are unaware of the full roots of some of the distrust of medical science among many African Americans. We likely have heard of the Tuskegee Syphilis trials—in which a large U.S. government-funded study recruited men of color with syphilis and researchers observed and documented their decline, while leaving them untreated. The study began when good syphilis treatments were unavailable, but it continued long after penicillin and other effective treatments were the standards of medical care. This immoral debacle not only affected the men involved, but it also had an impact on their spouses, their children and the entire African American community.
It would be sad enough to report this as a distant, single outlier, but, unfortunately, people of color have been subjected to numerous explicitly and implicitly biased medical research trials and treatments. Some of these have included male and female penitentiary residents, who have served and in some cases are still serving, as research subjects in major university studies. Studies from the 1960s through the 1990s often enrolled prisoners for studies via financial inducements with little or no truly informed consent. Researchers executed poorly designed studies. Recordkeeping was abysmal, and many of the case evaluations were mysteriously “lost.” (The issue of massive racial incarceration is another topic for another day.)
In one study in New York, researchers from Columbia University and New York City’s New York State Psychiatric Institute approached families of juvenile detainees in order to perform psychiatric and pharmacological experimentation on the younger brothers and sisters of the detainees to determine if there was a biological basis for the behavior of the older siblings. Researchers gave financial incentives to the typically poor parents, and they gave gift certificates to ToysRUs to the young children. Informed consent was deceptive, as the researchers themselves knew little about the potential effects of the pharmaceuticals used. The language of the consent forms was essentially indecipherable by the medically unsophisticated parents. In some cases, these pharmaceuticals irreparably damaged the brain function of the children’s.
Dr. Marion Sims, sometimes referred to as the “Father of American Gynecology,” developed many of his surgical techniques for rectovaginal and vesicovaginal fistulas while operating on slaves without anesthesia or ethical consent, essentially torturing his patients. Many others in the medical community were aware of his behavior and did nothing to stop it.
Cadavers used for education in medical schools throughout the nation were largely African American. Major southern hospitals obtained many of these through deceptive means and then sold them to schools throughout the nation. Grave robbing from African American cemeteries was another means of obtaining these bodies, and, in some cases, they enrolled the assistance of other poor African Americans.
These are just a few of the egregious examples described by Harriet Washington, a writer and medical ethicist. Her classic book Medical Apartheid received the 2007 National Book Critics Circle Award for non-fiction. The book is well researched and clearly written. I commend it to you. She begins with a historical review of racism in America, beginning with multiple experiments performed on slaves, whose masters “consented” for them, see above, and brings us up to the present.
Dr. Washington outlines many unethical surgical, radiological and pharmacological research trials performed on poorly informed, poorly consented individuals, throughout the last four centuries, but concludes with identifying current areas of research abroad—primarily in sub-Saharan Africa on primarily black patients. Institutional review boards in other countries are typically not as restrictive as in the U.S. Additionally, in the U.S., we use “standard of practice” options to compare with new drugs or therapies. When these studies are performed internationally, the comparator is the local standards of practice, which are often less efficacious than those used in U.S. studies. Instead of comparing the research drug to cutting-edge therapies in the U.S., pharmaceutical companies often compare to whatever local options are available, many of which are inferior to standard U.S. therapies.
In medical school, and even into my recent past, I have heard healthcare professionals say disparagingly that African Americans are reluctant to participate in new research trials—as if they were being selfish and unnecessarily paranoid about established medicine today. This is wrong on several counts.
First, reluctance, which may be present, is not unreasonable or selfish, and it is not based on superstition. Paranoia is fear based on inordinate, inappropriate perceptions. Clearly, any reluctance present today is not paranoia. Good memory and documented history inform this reluctance. Unfortunately, poor representation in relevant clinical trials may delay or impede discoveries that might benefit or even preferentially help people of color.
Additionally, though we have made many advances in combatting racism, the battle is not over. We need to continue to be careful and persistent in protecting all of our patients, but ethnic healthcare disparities remain an ongoing concern, and we must pay particular attention to these with our patients of color.
Proverbs 18:19 says, “A brother offended is more unyielding than a strong city, and quarreling is like the bars of a castle” (ESV). We have harmed our brothers and sisters, and we must work hard to correct our past and future errors.
The point of this essay is not to heap guilt on white Americans of the 21st century, but to increase vigilance regarding research here and abroad. We should continue to closely monitor U.S. institutional review boards in their efforts here in America, and we should investigate research trials conducted by U.S. pharmaceutical companies abroad, particularly in sub-Saharan Africa. These are our Christian and ethical responsibilities.
Only by doing so will we improve confidence in the belief that we can conduct medically ethical research, and that we will do so in an ethical manner here and abroad. Medical and pharmaceutical innovations save lives, but we must pursue these with the full realization that God has created all humans in His image, and we must treat all humans as such.