One to One: Harriet A. Washington, author, Medical Apartheid

Summary

In this interview, Harriet Washington, author of 'Medical Apartheid,' discusses the dark history of medical experimentation on African Americans from colonial times to the present. She reveals how historical mistreatment, including enslavement and segregation, has led to a legacy of distrust in the medical community. Washington also addresses current issues such as the erosion of informed consent in medical research and the impact on minority communities. She emphasizes the importance of acknowledging this history to move forward and build trust in medical institutions.

Takeaways

• 📚 Harriet Washington's book 'Medical Apartheid' uncovers the dark history of medical experimentation on black Americans from colonial times to the present, highlighting the health disparities and distrust in medical institutions.
• 🏥 African-Americans face a higher incidence of certain diseases and earlier mortality rates, with health profiles resembling those of third-world countries, partly due to historical medical abuses.
• 🔬 During slavery, medical 'enslavement' was rampant, with enslaved Africans used for experiments and medical advancements, often without anesthesia or consent.
• 🌐 The pattern of medical mistreatment continued with medical segregation during the era of legal segregation in the United States, reinforcing racial health disparities.
• 🏥 Dr. Marion Sims, infamous for his gynecological experiments on enslaved women without anesthesia, became a celebrated medical figure, exemplifying the exploitation of black bodies for medical progress.
• 🧬 Black healers and medical practitioners contributed significantly to medical advancements, such as surgical techniques leading to cesarean sections, but were often uncredited for their work.
• 💀 The use of black bodies for dissections in medical schools led to widespread grave-robbing in black cemeteries due to the demand for cadavers and the lack of legal protection.
• 🚫 Presumed consent laws in many states allow for the harvesting of tissues and organs without explicit permission, potentially leading to abuses and a lack of informed consent.
• 🛑 The erosion of informed consent is a modern concern, with examples including the Department of Defense's waiver to test on soldiers without consent and the use of experimental drugs on unconscious or incapacitated individuals.
• ⚖️ To prevent historical abuses from recurring, it's crucial to reinforce informed consent, involve lay people in ethical review boards, and ensure that medical research adheres to strict ethical standards.

Q & A

What is the main theme of Harriet Washington's book 'Medical Apartheid'?

The main theme of 'Medical Apartheid' is the dark history of medical experimentation on black Americans from colonial times to the present, highlighting the health disparities and the atrocities committed under the guise of medical research.

How does the health profile of African-Americans compare to that of whites, as mentioned in the interview?

African-Americans have a much higher incidence of certain diseases, die earlier, and have a health profile resembling that of a third-world country, as noted by Dr. H Freeman, who compared the health of Harlem residents to those in Bangladesh.

What is the connection between medical experimentation and the historical context of slavery in the United States?

During slavery, medical researchers were not any better or worse than other societal groups, and thus medical research mirrored societal norms. Enslavement and segregation in society led to medical enslavement and segregation, where the health and rights of African-Americans were severely neglected.

Can you provide an example of medical experimentation on slaves mentioned in the interview?

One example is Thomas Jefferson experimenting with the live cowpox vaccine on his slaves before using it on his family. Another is Dr. Walter Jones pouring boiling water on a naked slave to test if it would treat typhoid and pneumonia.

What was Dr. J. Marion Sims known for, and how did his practices relate to medical experimentation on slaves?

Dr. J. Marion Sims was known for perfecting surgical treatments, particularly the repair of vesico-vaginal fistula, using enslaved black women as his subjects. His fame and surgical accomplishments were predicated on the abuse of these captive women without anesthesia.

How did the cesarean section procedure relate to medical practices on slaves?

The cesarean section procedure was perfected on female slaves, highlighting how medical advancements were often achieved through the exploitation of vulnerable populations, such as slaves, who were not given consent or considered as patients.

What was the impact of using black bodies for dissections in medical schools during the 19th century?

The use of black bodies for dissections led to widespread grave robbing, as medical schools required a large number of bodies for teaching. This practice was facilitated by the fact that black cemeteries were vulnerable and poor communities could not afford measures to protect their dead from being exhumed.

How have presumed consent laws potentially led to abuses in modern times?

Presumed consent laws, which allow for the harvesting of tissues and organs without explicit permission, have led to abuses such as the sale of tissues at high rates, use of tissues without consent for monetary exchange, and dangerous transplant schemes with tissues that were not safely procured or tested.

What is the significance of the Department of Defense's waiver from the FDA in 1990 regarding informed consent?

The waiver allowed the Department of Defense to subject soldiers to research without their consent, marking a significant erosion of informed consent. This set a precedent that has expanded to include other populations, often leading to the exploitation of those who are unable to give consent.

How did the Tuskegee study exemplify the historical mistreatment of African-Americans in medical research?

The Tuskegee study involved withholding treatment from black men with syphilis to observe the disease's progression, demonstrating a blatant disregard for the health and well-being of the subjects and a dark chapter in the history of medical ethics.

What steps does Harriet Washington suggest to prevent the repetition of historical medical abuses?

Harriet Washington suggests rolling back the erosion of informed consent, ensuring that people have the right to consent or refuse medical research. She also calls for stronger oversight by the FDA, more diverse and representative institutional review boards, and a commitment to ethical standards in both domestic and international research.