As I have learned this year in United States History, the foundation of America is rooted in racist ideology that directly affects our lives centuries later, and medicinal science is no exception. For my catalyst research project, I chose to deep dive into the history of scientific racism and race-based medicine and how they have created a racially biased healthcare system in the United States against African American patients. What I discovered was centuries of injustice and medical racism that had current manifestations continuing to harm African Americans, with the COVID 19 pandemic only exemplifying these disparities.
I have always been drawn to having a medical career in the future. This year, I am taking a GOA Medical Problem Solving course, which has largely focused on medical ethics from healthcare professionals and systems. For example, we worked on case studies concerning patients without health insurance, transgender identifying patients, or patients suffering from opioid addiction. For every case, we considered bedside manner and the importance of treating patients with equitable care. I believe racial bias can be extremely harmful in healthcare since biased treatment or diagnosis has the potential to critically alter someone’s life, and it’s the responsibility of the individual medical professional as well as the larger systems to work against these biases. I hope to learn more so I can one day become a better physician, and make a difference within the U.S. healthcare system.
Since the first enslaved Africans arrived in America, they faced unending exploitation, including in the medical field. In 19th-century medical education, schools commonly relied on teaching by dissecting slaves’ bodies. They recruited “resurrectionists” to steal freshly buried bodies from segregated graveyards, and this practice lasted for many years (Nuriddin). Additionally, race has been defined as early as the 1830s to separate us by using false biological premises. Most educated people of the 19th century believed in a doctrine of “inheritance of acquired characteristics” and that environment influenced the physical nature of an organism. The belief that traits acquired from the environment were biologically inherited combined with white supremacy fostered what became known as scientific racism at the start of the 20th century (Jackson). The products of these illogical ideologies are centuries of race-based medicine that exposes the historical issue of the American healthcare system harming African Americans rather than providing them with proper care.
Scientific Racism in Gynecology
The history of American gynecology shows how closely associated medical discoveries were with slavery as an institution. The success of Dr. James Marion Sims, who was known as the “father of modern gynecology” for his breakthrough on treating vesicovaginal fistula was built upon terrorizing treatments 14 female slaves endured for multiple years. His dedication in creating this procedure converged directly with the interest of white society. In 1808 a ban on importing slaves from other countries to the US made slavery dependent on African American women giving birth. Slave owners and physicians now cared about these women having healthy births in their own economic interest. In his autobiography titled The Story of My Life, Sims described the arrangement of getting women for his experiments as, “I made this proposition to the owners of the [Black women]: If you will give me Anarcha and Betsey for the experiment, I agree to perform no experiment or operation on either of them to endanger their lives, and will not charge a cent for keeping them, but you must pay their taxes and clothe them. I will keep them at my own expense” (Sims, 236). As a doctor, Sims served slaveholders and slavery, not the enslaved women who needed medical care and clearly weren’t consenting to these experiments. These invasive treatments used silver wires and these women, one of which endured over 30 painful practices of his procedure, were never given anesthesia. Part of why Black women were seen as appropriate testing subjects and weren’t given pain relievers was, “based on the widespread belief that Black people experienced less pain than white people” (Bachynski). Scientific racism was very apparent in attempts to justify these operations as well as to dehumanize African Americans to make slavery appear as an ethical institution.
Post-Slavery Health Segregation
Even after the Civil War, the Reconstruction era failed in creating equality for Black Americans and reflected worsened living conditions as a result of slavery. A product of Jim Crow laws was healthcare segregation, and a majority of hospitals had separate wings and staff for Black patients. Educational segregation caused a deficit of trained Black healthcare workers, and Black patients couldn’t go to any medical facility without receiving drastically different treatment than white patients. The descendants of slaves lived in more disease-ridden and unhealthy environments, and “within the confines of a segregated health-care system, these factors became poor health outcomes that shaped Black America as if they were its genetic material” (Newkirk). Physicians of the time connected emancipation to the supposed physical and mental deterioration of African Americans and used common stereotypes against Black Americans, such as barbaric tendencies or sexual immorality to argue that the Black population was more susceptible to disease. Doctors didn’t think that poor health amongst the Black community was due to socioeconomic factors or that they needed better healthcare. Rather, due to assumed racial differences, they believed all Black people would refuse to get care, making proper treatment of this community impossible.
Past Medical Exploitation and Unethical Research
These misconceptions perpetuated unethical medical experimentation. An infamous example is the U.S. Public Health Service Tuskegee Study of Untreated Syphilis, which began in 1932. The experiment’s subjects were 600 Black men living in Macon County, 400 of the subjects had syphilis, while 200 didn’t and served as a control. They lived in Macon County, one of the most impoverished counties of Alabama where many Black people in that area had never visited a doctor. The doctors grossly misinformed them, and those who were syphilitic were instead told they simply had “bad blood”. They were also never asked whether they consented to the study since none of them were aware of its true purpose. The researchers tracked the natural course of how syphilis infected their minds and bodies, but even once penicillin became the known cure for syphilis, they didn’t receive it and instead got purposefully ineffective medicine. This caused syphilis to spread to the subjects’ wives and children and some of the men to die preventable deaths at the hands of the American government (Nuriddin). These unethical experiments carried on for 40 years, and The Tuskegee Syphilis Study quickly became a well-known example of malpractice amongst black patients and showed the horrific injustice our country was capable of.
Over the years, progress was made to eradicate the level of disparities African Americans face. During times of healthcare segregation, those at the forefront of solving these issues were Black medical professionals who advocated for better care for their community. For example, African Americans physicians formed the National Medical Association in 1895 when the American Medical Association excluded them. Black medical schools and colleges were crucial for training Black physicians when they couldn’t attend other schools (Nuriddin). The Tuskegee Study also caused major changes in research practices. 1974 regulations required researchers to get informed consent and a new National Research Act was passed into law, all to ensure that the grave mistakes of the Syphilis Study never occur again (Tuskegee Study Research Implications). However, current disparities are embedded within medical practices, institutions, and medical professionals, creating a harmful system of race-based medicine.
Present Day Issue
Race-based medicine is a normalized practice within American healthcare and can be defined as, “the system by which research characterizing race as an essential, biological variable translates into clinical practice, leading to inequitable care” (Roth). The history of medical racism in the United States continues in the present day, with the COVID 19 pandemic exemplifying these disparities. With a renewed focus on racial injustice in America, local to national change could create a more equitable medical system for African American patients.
Throughout all aspects of healthcare, Black Americans are continually disadvantaged. Compared to White people in the U.S., Black Americans are more susceptible to strokes, cancer, diabetes, HIV, AIDS, and many other diseases. They’re more likely to die at earlier ages for all causes since young African Americans are getting conditions commonly found in older people of other racial groups (Health Disparities Among African-Americans). African American women have a two to six times higher maternal mortality rate than white women depending on location (April 11 –17 Is Black Maternal Health Week). But instead of helping these issues, medical racism fosters “a system of belief and practice that allowed doctors to place blame on Black people for not having the same health outcomes as White people” (Medical racism has shaped U.S. policies for centuries).
Current Race-based medical practices
Outdated medical practices further perpetuate the problem. A standard test for kidney function, known as estimated glomerular filtration rate (eGFR), measures creatine levels. High levels of this waste product accurately indicate kidney damage unless you’re Black since race is a “correction factor” where slightly higher levels are perceived as normal for self-identified African American patients. Considering that Black Americans are almost four times more likely to suffer from kidney failure and eGFR overestimates kidney filtration rates for Black patients, this “race adjustment” potentially delays care, having grave impacts (Godoy). Additionally, BiDil, a hybrid compound of 2 drugs, became the first and only FDA-approved race-based medication. It’s being marketed as a heart failure medication specifically to African Americans. The drug is problematic because there’s no evidence-based medicine that race specification is valid, and it labels race as a relevant biomedical construct (Bachynski).
Implicit bias from physicians also affects the quality of care African American patients receive. A 2016 survey found, “around half of white medical students and residents…endorsed false beliefs about biological differences between black and white patients. For example, 25 percent of medical residents agreed that blacks have thicker skin than whites” (Bachynski). Many medical professionals believe Black people feel less pain than White people due to fewer nerve endings, a baseless claim that causes Black patients to receive less pain medication or even none at all. This causes harmful biases and medical schools need to educate medical students better so they unlearn these fallacious beliefs.
Racial Health Disparities Amidst the COVID Pandemic
COVID 19 has only affirmed these issues and made disparities more apparent. Even though they are a minority population, African Americans have double the mortality rate than White people (Neuman). Even with higher infection rates, there’s vaccine hesitancy from some African Americans. This could be partly due to past exploitation of Black Americans such as in the Tuskegee Syphilis Study, but present-day systemic racism is the larger reason with pharmacy deserts, poverty, unemployment, and access to transportation to vaccination sites also as factors. The dismissiveness and lack of proper treatment Black patients receive due to a biased system add to the mistrust many feel when deciding whether to get the COVID vaccine (Dembosky).
For Now Response
Individual hospitals and physicians need to consider how they contribute to race-based medicine. Many healthcare centers have recently eliminated the eGFR race-based kidney damage diagnosis at the city level, but every hospital needs to get rid of this practice. On the national level, an inclusive approach should become the standard of care for this medical test. Additionally, hospitals’ implicit bias training helps remove barriers and increase provider performance, which will cause unbiased diagnosis and treatment. As of a couple of weeks ago, US Kidney-Group Presidents are calling for ending the eGFR race modification nationally (Zoler). As renowned nephrology groups, they have the influence to create a larger scale end to this inequitable practice, and I hope their call to action creates national change.
Larger solutions for the United States are needed to change larger-scale perceptions of race in American medical care. We must get rid of the belief that race is a factor that causes differing health needs, and instead, treat it as a social determinant of health to better treat historically and currently marginalized populations. As found by the Human Genome Project, humans are all 99.9% the same (Dorr). Race isn’t genetic and cannot be biologically defined. By allowing pseudoscientific beliefs to persist, our healthcare system continues stereotyping, a racial bias that favors white patients, and race-based medicine. It also needs to be required for medical schools to have a well-defined social justice curriculum. As expressed by pathologist Rudolf Virchow, “physicians are the natural attorneys of the poor, and social problems fall largely within their jurisdiction” (Coria). Medical education is responsible for training physicians, and teaching race as a social determinant rather than a biological one will create better doctors. A school implementing this is the Geisel School of Medicine at Dartmouth, which made the Social Justice Vertical Integration Group. This group defined core competencies medical students need related to social determinants of health, key topics needed in curricula nationally, how these teachings will be translated into service work, and integrating social justice topics into the basic science lessons (Coria). Using social justice in medicine for rethinking how medical schools teach would make more empathetic and ultimately better medical professionals.
America has a long way to go towards creating equal health conditions and medical experiences for all patients regardless of racial identity. It’s crucial to understand that historical figures, including in the medical field, who made groundbreaking achievements still used in current medicinal practice commonly profited off systems like slavery or segregation and contributed to medical racism. The effects and health disparities we see today are contemporary manifestations of issues that, although we may believe are gone, still persist in some way. The racist treatment and biases, increased disease and mortality rates, and overall lack of adequate medical care experienced by African American communities are no coincidence; they are deliberate and long-lasting issues.
What can you do?
- Where do you see racism or racial bias in healthcare in current events?
- How do you see racial health disparities in your local community (food deserts, healthcare deserts, policies, etc.)
- Comment any additional thoughts or questions you have!