Customer Reviews

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

5 star:		(48)
4 star:		(5)
3 star:		(3)
2 star:		(0)
1 star:		(0)

 

 

The opening salvo was the press reporting on the so called Tuskegee experiments, in which black syphilitic men were studied but not treated. This book gives the most complete description of the Tuskegee experiments I've seen as it makes this study the centerpiece of medical experimentation where one race was selectied out as the subjects.

From there, unfortunagely, it goes on to show that this was not an abberation but a practice that goes back to slave days. It gives the stories of experiment after experiment that were conducted the same way with predominately black subjects.

The book concentrates on experiments conducted on black Americans and goes on to describe the ongoing, perhaps everlasting suspicion that these experiments have left in the minds of black America towards the medical profession.

This is a fitting subject for a book, but while reading I was reminded of the other famous medical experimentation incidents such as the German experiments in their concentration camps or those performed by Japan's Unit 516. It seems that 'unter-people' or people viewed as some kind of sub-human are the favorites for experiments.

Harriet Washington has created an extensive investigative body of work that reveals the inhumane treatment of a people unprovenly regarded as less than by those who have proved themselves to be less than. One wonders why God would grant anyone dominion over the earth and all that dwells upon it, but Medical Apartheid indentifies those who take to heart that particular verse and chapter and illustrates how they consider no one and nothing exempt from the horrors of their demonic thinking. From surgical procedures with neither consent nor notification to the withholding of treatment for the sake of science, this book reveals the price so many African-Americans have paid in the name of medical advancement-without compensation or an acknowledgment of gratitude from the medical community.

This book should be mandatory reading for all.

RCP

Medical Apartheid is a must read for anyone interested in social justice issues. While Washington's work may be the catalyst for the long awaited national apology, the researched accounts of U.S. atrocities deserve and require far more. This book should become required reading in our educational institutions regardless of one's pursued field of study. The U.S. must tell the truth about its past and those it has ceremoniously honored and attempted to destroy. Harriet Washington has done just that.

I bought this book last year about this time because I was in the midst of writing a M.A. Thesis focused on racial differences in trust in the patient-physician relationship. I read the first and seventh chapters and put the book down because my stomach was deeply disturbed by the books' contents. I was disappointed that the terms, "trust," "distrust," or "mistrust" were not indexed in the back of the book. Nonetheless, I decided ind to put the book on the list for my qualifying exams--it was to my knowledge the most comprehensive assessment of race and medical experimentation written to date.

I finished reading the book from start to finish last week. I was deeply impressed that Washington was able to cover the breadth of history without shortchanging the respect due to the grave matters dealt within between the covers of Medical Apartheid. Some critics of the book have stated that they are unsure whether she is accurately portraying the truth of the history of medical research. Others suggest that her emotions may have guided the presentation of the material. My review will be directed to such responses of the book.

I myself had doubts initially. The things I began reading about last December were too grotesque for them to have actually happened and the dispassion characterizing the medical researchers who went about their work is at odds with the Hippocratic Oath that is supposedly the center of Western medicine. However, more recent work by Steven Epstein (2007) on the social movement that yielded the NIH Revitalization Act of 1994 and more dated work by Laurel Baldwin-Ragaven, Jeanelle de Gruchy, and Leslie London (1999) on the unethical behavior of South African doctors during this country's apartheid era confirm many of the facts and conclusions Washington herself puts forth in Medical Apartheid.

Even with the research I had done on the roots of medical mistrust among blacks, this book came as a shock to me. First, it demonstrates in a measured manner a persistent pattern of unethical behavior by American scientists and doctors in a wide range of activities (it's not just about graverobbing). This is a rebuttal to the over-reliance of those who perceive that the Tuskegee Syphilis Study is "the" reason for blacks' aversion to doctors and hospitals. Instead, the devaluation of the bodies of socially marginalized racial groups can be seen in every aspect of medicine, even into the roots of how medical knowledge was first formed.

Second, it demonstrates that blacks have been routinely (ab)used in medical research and are overrepresented in clinical studies that have no therapeutic value. This is in direct contradiction to the predominant public narratives of the 70s and 80s which led to the NIH Revitalization Act--narratives that claimed women and minorities had been excluded from medical research. Washington's analysis gives life to Otis Brawley's warnings that the mandatory inclusion of minorities in federally-sponsored research would lead to "an incentive to give minorities the 'hard sell' when offering enrollment in a clinical trial" (Brawley quoted in Epstein 2007: 95). Simply put, informed consent--an ethical standard that Washington shows has already been treated as a technicality by medical scientists with regards to blacks involved in non-therapeutic research--is truly in danger of becoming an endangered species.

Third, and last, it demonstrates the many ways in which patient attitudes towards the medical institution (typically measured by distrust in medicine, refusal of robust treatments, unwillingness to seek a doctor for a problematic symptom, etc) can and have been shaped by unethical practices that prey on a lack of knowledge on the behalf of the patient and an imbalance of power within the therapeutic alliance. According to the 2003 IOM report on racial health care disparities, attitudes, or "patient preferences," are only a source of racial disparities in medical treatment IF these preferences are "not based on a full and accurate understanding of treatment options" (Smedley, Stith, and Nelson 2003: 4,32). While the contribution of patient preferences to racial disparities in medical treatment is minimized (and, I believe, under-theorized) in the seminal IOM report, Washington's analysis puts a whole new perspective on "patient preferences" as a legitimate source of racial disparities in health care and begs us to develop creative ways to measure it besides our trite attitudinal measures.

In all, I still am disappointed that variants of "trust" were not indexed. However, to be honest, every chapter provides a different (and, at times, new) way to understand the role that trust plays in the clinical encounter. Thanks for this invaluable piece of work.

The facts are disturbing but well documented. Ms. Washington's anaylsis is evenhanded, thorough, and scholarly. I am enjoying the book immensley.

We talk about freedom, freedom to pursue happiness, the oath doctors take. Yet we still have those who find it ok to use people without regard to life, liberty...I could be reading about Hilter's Germany.

At times this book made me cry. There are no words to express some of the horrors that African Americans have gone through in this country and around the world. If you would like to read true un-sugar coated history then this is the book for you. I think that this is a book that should be read by African Americans and others alike. It is so amazing how some (so called) human beings had so much hate for other human beings that they justified such horrible events such as these. I say that it is a must read.

As its title states, this book examines the history of medically "justified" and pseudo-science backed abuses of black Americans from colonial to modern times.
Harriet Washington traces American racism from a medical standpoint from the early days, when science was more curious than anything else, to the days of slavery, when religion and science went hand in hand to justify by divine sanction, on the one hand, and by scientific reason, on the other, that black slaves were inferior to their white masters - morally, physically and mentally; after the end of slavery, when that brand of religious racism held less sway, Darwinism was pulled into the mix; and, now, when words such as "inferior" are never used in a racial context, expect in a discussion of historical viewpoints, or by the most ardent racists, other, more insidious terms pop up - for the same purposes of exploitation and abuse. While the evolution of racism in the US is not the main topic of this book, it is inevitably linked; this book is an interesting look at how the two, racism and racist abuse of minorities, have worked together throughout American history. This book is easy to read language-wise, although the content is very difficult at times.

Some of the highlights of Washington's work:

- She examines how the slave-holders wielded faulty - and, sometimes, simultaneously contradictory - scientific theories to justify the harshest abuses of black slaves, as well as the institution of slavery itself. African-Americans were both extremely susceptible to disease and incapable of living on their own (thusly in need of their masters' gracious benevolence), yet at the same immune to diseases white people could contract in the fields, doing the same labor.
- She touches on the pseudo-scientific/medical "justifications" for the sexual exploitation of female slaves. As black people were (according to the prevailing racial ideas of the day) morally as well as physically and intellectually inferior, it was the wanton female slave, and not the virtuous white master, who was to blame when rape occurred. This went hand in hand with the wholly accepted exploitation of female slaves as breeders of new slaves (Washington quotes Thomas Jefferson as declaring, "I consider a slave woman who breeds once every two years as profitable as the best worker on the farm.")
- She follows medical abuses of blacks as they morphed from the era of slavery (when the health of blacks was regarded only insomuch as it brought profit to a slave owner, and blacks often fell victim to the ownership of doctors who preyed upon their legal status of "property" to conduct all manner of horrendous experiments) to freedom (where black health was still considered of no account, and blacks still found themselves the unwitting victims of abuse - including body snatching, experimentation, etc.).
- She examines the era of eugenics, when abuse morphed into a desire to exterminate - all for the purpose of creating a genetically perfect group of people, of course.
- She includes a lengthy examination of some of the more recent experimental abuses, ranging from studies performed with out consent, without the hint of therapeutic benefit, etc.
- She also includes an examination of abusive "research" conducted on prison populations, which, proportional to the "outside" population, were considerably skewed to include far more black victims than representative of the overall population.

Washington covers far more than these points, and each of these points is examined at length, in detail. Her sources are many, and her writing - even when discussing the most horrendous abuses, the most offensive racism, etc. - is easy to follow.
There are times, I think, that Washington assumes a racial motive for what is not necessarily racially motivated - such as HIV/AIDS experimental pediatric treatments that target primarily black orphans/foster kids. Is this really a racially motivated abuse, or are these kids just the most vulnerable and easiest to get at for the researchers? In other words, are the researchers targeting them because they are black, or are they targeting them because they are powerless and friendless, and therefore easy subjects for research? I'd be inclined to believe the latter. Not that that makes it right, by any stretch of the imagination; I'm just not convinced that skin color is a deciding (or motivating) factor. Unscrupulous people will target vulnerable populations, period. If Washington could show that the same researchers bypassed similar white populations to prey on black ones, I could more easily believe that race was a deciding factor. Of course, this discussion is made less straightforward by the abandonment of racist terminology...a hundred - even fifty - years ago, there would be no need to wonder; racially motivated experimentation, as Washington shows, was openly labeled as such by the researchers involved. Now, words are chosen more carefully...so racist intent, if it exists, is masked behind non-racial language. Regardless, whether the intent of such studies is racist or not, the outcome is that, by design or no, blacks still face exploitative studies and disproportionate risks.
All in all, this is a very well researched, thought-provoking book. This is one more piece, often overlooked, in the discussion of American racism, and one that we cannot afford to overlook. We've all read the religious justifications for murder, slavery, and all sorts of other evils, that mankind has thought up through the ages. We know, too, from the abuses of the Nazis, that the scientific and medical justifications, when science and medicine abandon their true purposes, can be just as terrible. But it was not the Nazis, Mengele, etc., who exemplified this for us; American doctors, researchers and scientists have a terrible history of their own. It is intellectually dishonest, and morally dangerous, to ignore the wrongs committed by those on "our shores"; it may be comforting to think of forced sterilization programs as a Nazi-Germany thing, and so distance ourselves from that savagery. But forced sterilization, the "one drop" rule, Pocahontas exception, etc., etc., etc. were all American things; there is no distance between our culture and a culture that could produce such wrongs. Ours did, a relatively short time ago; pretending it did not happen will not prevent it from happening again. We need to see more books like this one - books that confront America's racist past, rather than ignoring it or pretending it vanished when black kids could go to the same schools as white kids, or African-Americans could ride anywhere they wanted in a bus. Washington's honest look at the brutal reality of racism in medicine is exactly the sort of discussion we need to be having - about all aspects of racism.

5/5 stars

Although I would like to think that I couldn't be tempted (as a medical researcher) to break the rules and to impair human dignity, it was a very disturbing eye-opener to read this book! It made me remember a few events in my medical education when I saw my teachers cross the line, not as dramatically as most of what Washington portrays, but nevertheless the start of the slippery slope, and I know the temptations to "cut corners" in pursuing your goal of completing your research project. Once you give in to that, much worse can follow. I agree with other reviewers that this book has rendered a great service and should be required reading.

This is a book not just for blacks so as to be aware of what the medical field may still do to you at any given time, but for everyone that may visit a physician, surgeon and so on. We must remember that they are not gods, but doctors in practice, they don't know everything. We know our own bodies better than they do and if one isn't ready to listen then we must find ones that will. A pill doesn't make it go away, nor does ignoring the patient or worse yet, because of the color, class, race or religion they have mutilated, purposely given people diseases (HIV, Syphilis, Gonorrhea and so on). When I read this book I was disgusted with the medical field and thus made me do more research before I take any medication, surgery and so on. It makes you wonder what goes through their minds while you are completely under and can do whatever they please, this is not to say that there are not good doctors out here. We will have to just be cautious and do more research.