Medical Apartheid: the Dark History of Medical Experimentation on Black Americans From Colonial Times To the Present (07 Edition)

From the era of slavery to the present day, the first full history of black America's shocking mistreatment as unwilling and unwitting experimental subjects at the hands of the medical establishment.

Medical Apartheid is the first and only comprehensive history of medical experimentation on African Americans. Starting with the earliest encounters between black Americans and Western medical researchers and the racist pseudoscience that resulted, it details the ways both slaves and freedmen were used in hospitals for experiments conducted without their knowledge — a tradition that continues today within some black populations. It reveals how blacks have historically been prey to grave-robbing as well as unauthorized autopsies and dissections. Moving into the twentieth century, it shows how the pseudoscience of eugenics and social Darwinism was used to justify experimental exploitation and shoddy medical treatment of blacks, and the view that they were biologically inferior, oversexed, and unfit for adult responsibilities. Shocking new details about the government's notorious Tuskegee experiment are revealed, as are similar, less-well-known medical atrocities conducted by the government, the armed forces, prisons, and private institutions.

The product of years of prodigious research into medical journals and experimental reports long undisturbed, Medical Apartheid reveals the hidden underbelly of scientific research and makes possible, for the first time, an understanding of the roots of the African American health deficit. At last, it provides the fullest possible context for comprehending the behavioral fallout that has caused black Americans to view researchers — and indeed the whole medical establishment — with such deep distrust. No one concerned with issues of public health and racial justice can afford not to read Medical Apartheid, a masterful book that will stir up both controversy and long-needed debate.

"This groundbreaking study documents that the infamous Tuskegee experiments, in which black syphilitic men were studied but not treated, was simply the most publicized in a long, and continuing, history of the American medical establishment using African-Americans as unwitting or unwilling human guinea pigs. Washington, a journalist and bioethicist who has worked at Harvard Medical School and Tuskegee University, has accumulated a wealth of documentation, beginning with Thomas Jefferson exposing hundreds of slaves to an untried smallpox vaccine before using it on whites, to the 1990s, when the New York State Psychiatric Institute and Columbia University ran drug experiments on African-American and black Dominican boys to determine a genetic predisposition for "disruptive behavior." Washington is a great storyteller, and in addition to giving us an abundance of information on "scientific racism," the book, even at its most distressing, is compulsively readable. It covers a wide range of topics — the history of hospitals not charging black patients so that, after death, their bodies could be used for anatomy classes; the exhaustive research done on black prisoners throughout the 20th century — and paints a powerful and disturbing portrait of medicine, race, sex and the abuse of power. (Dec. 26)" Publishers Weekly (Starred Review) (Copyright © Reed Business Information)

"This groundbreaking study documents that the infamous Tuskegee experiments, in which black syphilitic men were studied but not treated, was simply the most publicized in a long, and continuing, history of the American medical establishment using African-Americans as unwitting or unwilling human guinea pigs. Washington, a journalist and bioethicist who has worked at Harvard Medical School and Tuskegee University, has accumulated a wealth of documentation, beginning with Thomas Jefferson exposing hundreds of slaves to an untried smallpox vaccine before using it on whites, to the 1990s, when the New York State Psychiatric Institute and Columbia University ran drug experiments on African-American and black Dominican boys to determine a genetic predisposition for 'disruptive behavior.' Washington is a great storyteller, and in addition to giving us an abundance of information on 'scientific racism,' the book, even at its most distressing, is compulsively readable. It covers a wide range of topics — the history of hospitals not charging black patients so that, after death, their bodies could be used for anatomy classes; the exhaustive research done on black prisoners throughout the 20th century — and paints a powerful and disturbing portrait of medicine, race, sex and the abuse of power." Publishers Weekly (Starred Review) (Copyright Reed Business Information, Inc.)

"The Tuskegee Syphilis Study remains an ignominious milestone in the intertwined histories of race and medical science in U.S. society. Initiated in 1932, this tragic 40-year long public health project resulted in almost 400 impoverished and unwitting African-American men in Macon County, Ala., being left untreated for syphilis. Researchers wanted to observe how the disease progressed differently in... Washington Post Book Review (read the entire Washington Post review) blacks in its late stages and to examine its devastating effects with postmortem dissection.

A fresh account of the Tuskegee study, including new information about the internal politics of the panel charged by the Department of Health, Education and Welfare with investigating it in 1972, lies at the center of Harriet A. Washington's courageous and poignant book. The balance of 'Medical Apartheid' reveals, with arresting detail, that this scandal was neither the first chapter nor the last in the exploitation of black subjects in U.S. medical research. Tuskegee was, in the author's words, 'the longest and most infamous — but hardly the worst — experimental abuse of African Americans. It has been eclipsed in both numbers and egregiousness by other abusive medical studies.'

Although medical experimentation with human subjects has historically involved vulnerable groups, including children, the poor and the institutionalized, Washington enumerates how black Americans have disproportionately borne the burden of the most invasive, inhumane and perilous medical investigations, from the era of slavery to the present day. (This burden has become global in the last few decades.) In 1855, John 'Fed' Brown, an escaped slave, recalled that the doctor to whom he was indentured produced painful blisters on his body in order to observe 'how deep my black skin went.' This study had no therapeutic value. Rather, fascination with the outward appearance of African-Americans, whose differences from whites were thought to be more than skin deep, was a significant impulse driving such medical trials.

Shielding whites from excruciating experimental procedures also proved a powerful motivation. J. Marion Sims, a leading 19th-century physician and former president of the American Medical Association, developed many of his gynecological treatments through experiments on slave women who were not granted the comfort of anesthesia. Sims' legacy is Janus-faced; he was pitiless with non-consenting research subjects, yet he was among the first doctors of the modern era to emphasize women's health. Other researchers were more guilty of blind ambition than racist intent. Several African-Americans, including such as Eunice Rivers, the nurse-steward of the Tuskegee study, served as liaisons between scientists and research subjects.

The infringement of black Americans' rights to their own bodies in the name of medical science continued throughout the 20th century. In 1945, Ebb Cade, an African-American trucker being treated for injuries received in an accident in Tennessee, was surreptitiously placed without his consent into a radiation experiment sponsored by the U.S. Atomic Energy Commission. Black Floridians were deliberately exposed to swarms of mosquitoes carrying yellow fever and other diseases in experiments conducted by the Army and the CIA in the early 1950s. Throughout the 1950s and "60s, black inmates at Philadelphia's Holmesburg Prison were used as research subjects by a University of Pennsylvania dermatologist testing pharmaceuticals and personal hygiene products; some of these subjects report pain and disfiguration even now. During the 1960s and "70s, black boys were subjected to sometimes paralyzing neurosurgery by a University of Mississippi researcher who believed brain pathology to be the root of the children's supposed hyperactive behavior. In the 1990s, African-American youths in New York were injected with Fenfluramine — half of the deadly, discontinued weight loss drug Fen-Phen — by Columbia researchers investigating a hypothesis about the genetic origins of violence.

Washington's litany of experimental misdeeds done to African-Americans is more extensive than can be described here. With such damning evidence, one wonders why she felt it necessary to include examples that, while clearly offensive, do not rise to the threshold of medical experimentation. For instance, supporters of slavery, to justify the peculiar institution, cited data from the 1840 census showing that free African-Americans had poorer mental and physical health than enslaved blacks. Nonetheless, taking ideological liberties with questionable statistics is not, in and of itself, an example of medical experimentation, nor was circus impresario P.T. Barnum's display of black Americans as entertainment. While demonstrating the widespread exploitation of blacks, it confuses the thrust of Washington's argument.

But Washington also sheds light on how our understanding of what constitutes medical research requires broadening in the face of new developments in genetic science. Federal and state forensic DNA databases contain a disproportionate number of samples from African-Americans, for example. Because genetic samples collected for this purpose carry information about a subject's health, blacks are particularly vulnerable to the exposure of sensitive medical information. And although experimentation with human subjects is less invasive than it once was, Washington cautions that it is no less injurious. Researchers still need to be mindful of the rights of their subjects.

Given the history presented in 'Medical Apartheid,' it is no surprise that some African-Americans continue to regard the medical system with apprehension, despite more stringent safeguards enacted by the federal government in the 1970s. Washington attributes this outlook, which she calls iatrophobia, to the seeds of distrust sown in black communities by the Tuskegee scandal and a history of lesser-known mistreatment.

Washington, a visiting professor at Chicago's DePaul University, intends that 'Medical Apartheid' serve a socially therapeutic — if not cathartic — function. Laying bare these atrocities, her logic goes, will foster healing and frank but necessary conversation. Clearing the air may encourage a better informed African-American public to participate in clinical trials.

Despite the author's best intentions, the scale and persistence of the 'dark history' she delineates may well preclude such a development. Precisely because Washington's account of racially stratified medical exploitation is so gripping, it may be difficult for the public to muster enthusiasm to enter clinical trials, no matter their cultural background. And with the experimental research burden shifting from Americans of African descent to Africa itself (which Washington calls a 'continent of subjects'), Asia, and Latin America, where some cavalier researchers are seeking more plentiful and pliant subjects, readers may be more convinced than ever of the durability of the medical color line.

Alondra Nelson, an assistant professor of African-American studies and sociology at Yale University, is writing a book, 'Body and Soul: The Black Panther Party and the Politics of Health and Race.'

" Reviewed by Alondra Nelson, Washington Post Book World (Copyright 2006 Washington Post Book World Service/Washington Post Writers Group)
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"[A] stunning work, broad in scope and well documented, revealing a history that reverberates in African Americans' continued distrust of the medical profession." Booklist (Starred Review)

"Sweeping and powerful." Kirkus Reviews

"Harriet Washington persuasively shows in her compelling Medical Apartheid that Tuskegee is only one chapter in a long history of physicians and scientists' mistreating African Americans..." Hartford Courant

"[A]n important book. Intellectually, I am pleased that I read it. Emotionally, I cannot drive the ugliness of its findings from my mind." Dallas Morning News

"This is an important book. The disgraceful history it details is a reminder that people in power have always been capable of exploiting those they regard as other,'..." New York Times

"[A] comprehensive account of the exploitation of black Americans in medical education and research...." Boston Globe

"[A] fascinating, chilling and important book." San Francisco Chronicle

Medical Apartheid is the first and only comprehensive history of the medical experimentation on African Americans. Starting with the earliest encounters between Africans and Western medical researchers and the racist pseudoscience that resulted, it details the way both slaves and freedmen were used in hospitals for experiments conducted without a hint of informed consent — a tradition that continues today within some black populations. It shows how blacks have historically been prey to grave-robbing as well as unauthorized autopsies and dissections. Moving into the twentieth century, it shows how the pseudoscience of eugenics and social Darwinism was used to justify experimental exploitation and shoddy medical treatment of blacks and a view that they were biologically inferior, oversexed, and unfit for adult responsibilities. Shocking new details about the government's Tuskegee experiment are revealed, as are similar, less well-known medical atrocities conducted by the government, the armed forces, and private institutions. Medical Apartheid reveals the hidden underbelly of scientific research and makes possible, for the first time, an understanding of the roots of the African American health deficit.

Harriet A. Washington has been a fellow in ethics at the Harvard Medical School, a fellow at the Harvard School of Public Health, and a senior research scholar at the National Center for Bioethics at Tuskegee University. As a journalist and editor, she has worked for USA Today and several other publications, been a Knight Fellow at Stanford University and has written for such academic forums as the Harvard Public Health Review and the New England Journal of Medicine. She is the recipient of several prestigious awards for her work. Washington lives in New York City.