On the Father’s day Sunday this year, I was at the Salem Baptist Church, south side mega church, for prostate specific antigen (PSA) screening and PSA study recruitment event. We offered PSA screening for prostate cancer several occasions at this church and this church has an annual health event to encourage African American church members to have healthier lifestyle. Five out of eight people who were working in the screening event that day were African Americans, including the PI of the project, who is African American male urologist at Northwestern medical school. The first African American man who came in for PSA screening jokingly said, “Ok, I will be the first guinea pig. What do I have to do?”
African American men have poorer health conditions compared to African American women or European American men and women, but African American men are usually underrepresented in many medical research projects, most likely due to difficulty recruiting them for medical research projects or clinical trials. Why is it so difficult to recruit African American men? Why do they refuse to participate in medical research?
This book, “Medical Apartheid,” illustrates the reasons why it is difficult to recruit African Americans for medical research and why they mistrust physicians or medical institutions rooted in the American history beginning the enslavement of Africans. The author, Harriet A. Washington, illustrates history of injustice in health, not from the victors’ perspective. The advance in medical science was achieved some way through exploitation of African Americans, but was hindered at the same time because of flaws in their research designs, scientific methods, and reasoning.
Considering the history of slavery and racial segregation, it was not surprising to read that White doctors did not treat the slaves like they would for white patients. Slave owners, physicians’ real clients, did not want to spend much money to treat their slave, if treatment cost more than they could make a profit from their slaves. African Americans knew that white doctors’ treatments did not work well or worsened the problems, and preferred their traditional healing methods (p.48). Even after the slavery ended, African Americans suffered with poor health conditions because they did not have access to good health care due to low income, no health insurance, and poor living environments (p. 152). Medical racism continued until recently, and medical procedures, such as hysterectomy, were done to African Americans and they were recruited to medical research without them fully understanding medical procedures, experiments, or research.
It was very surprising to read that a various painful and dangerous medical experiments were done to African Americans either poorly informed or without consent, without anesthesia during the slavery. Tuskegee Syphilis Study that followed untreated African American men with syphilis over 40 years and performed autopsy for hundred subjects is well known, but there are many more. For example, James Marion Sims, father of American gynecology, developed a surgical treatment for vesicovaginal fistula using slave women as experimental subjects (p.61-68).
Even after 1950s, medical experimentation targeted vulnerable segments of American society, low-income African Americans, prisoners, and children. Between 1944 and 1994, nontherapeutic radiation was injected to study subjects, and African American had higher risk of being the subject of the experiments. African Americans were targeted to experiment of biological weapon as well (p. 361-363). Washington states that many African American subjects who went through medical experiments and African American patients who received medical procedures involuntary thought that physicians were really caring them (p. 219). Washington further states that medical abuse is far from over and medical experimentations are still performed on people of African descent in this country as well as in Africa (p. 386-396).
Scientific racism was a major paradigm in the 19th century in the U.S. and Europe to show that African Americans and African as inferior subspecies of human. Scientists and physicians tried to show scientifically that there are anatomical and physiological differences, such brain size, immune system, and skin color, and the body of African Americans were displayed in St. Louis World’s Fair in 1906, a zoo in New York City, and a saloon in New York City transformed into an operation room, to prove that African Americans and Africans were inferior.
Washington sees the contradictions. Even though White physicians believed that African Americans were physically different from European Americans, African Americans were treated as a ‘clinical material’ in medical schools for instruction and experiment (p.106-108). Unnecessary surgeries were performed to demonstrate clinical procedure to the medical students. After death, their bodies were used for dissection, even in Georgia where anatomical dissection was illegal until 1887 and in northern states, using stolen bodies from graves (p.120). Northern states imported African American bodies for dissection from southern states (p.123).
Today, clinical trial is one way to receive the best treatment available, especial for the people with an advanced disease condition and traditional established treatment methods failed to cure or improve their health. However, African Africans are more likely to be recruited for high risk clinical trials for a newly developed HIV drag or an implantation of artificial heart than European Americans, but poor minority populations are less likely to be able to receive the expensive treatments after they are developed. African Americans who have been subjected to experiments as a ‘clinical material’ may see clinical trial differently. Washington quotes the Richmond Daily Dispatch published in 1854 saying that African Americans believed if they entered medical school hospital, they would not come out alive (p.108).
Having read this book, it is understandable if African Americans do not want to participate in clinical trial or medical research. African American patients are feeling anxious about their medical conditions, when they come to a clinic in a hospital, an institutions that have similar social structure as in slavery. Many physicians, high-rank nurses and administrative stuffs are European Americans, while lower-rank hospital stuffs are minorities. Some hospital and medical school buildings have architectural styles and motives that symbolize the power of European civilization.