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

A closer look at the troubling numbers reveals that blacks are dying not of exotic, incurable, poorly understood illnesses nor of genetic diseases that target only them, but rather from common ailments that are more often prevented and treated among whites than among blacks. Three

Almost no effective treatments existed for prevalent diseases until the eighteenth century. Until the late 1830s, the lack of effective anesthesia made the few common surgical procedures horribly painful and all others impossible. Between

At the same time, medical experts of every persuasion agree that African Americans share the most deplorable health profile in the nation by far, one that resembles that of Third World countries. When Dr. Harold Freedman observed that the health status of Harlem men resembles that of Bangladeshis more closely than that of their Manhattan neighbors, he did not exaggerate. Twice as many African American babies as babies of other ethnic groups die before their first birthday. One and half times as many African American adults as white adults die every year. Blacks have dramatically higher rates of nearly every cancer, of AIDS, of heart disease, of diabetes, of liver disease, of infectious diseases, and they even suffer from higher rates of accidental death, homicide, and mental illness. Before they die young in droves from eminently preventable diseases, African Americans also suffer far more devastating but equally preventable disease complications, such as blindness, confinement to wheelchairs, and limb loss.

But in dissecting this shameful medical apartheid, an important cause is usually neglected: the history of ethically flawed medical experimentation with African Americans. Such research has played a pivotal role in forging the fear of medicine that helps perpetuate our nation’s racial health gulf. Historically, African Americans have been subjected to exploitative, abusive involuntary experimentation at a rate far higher than other ethnic groups.

Despite its image as a disease that affects middle-aged white men, heart disease claims 50 percent more African Americans than whites and African Americans die from heart attacks at a higher rate than whites. African Americans are more likely to develop serious liver ailments such as hepatitis C, the chief cause of liver transplants. They are also more likely to die from liver disease, not because of any inherent racial susceptibility, but because blacks are less likely to receive aggressive treatment with drugs such as interferon or lifesaving liver transplants. Even

Enslavement could not have existed and certainly could not have persisted without medical science. However, physicians were also dependent upon slavery, both for economic security and for the enslaved “clinical material” that fed the American medical research and medical training that bolstered physicians’ professional advancement.

far from sharing in the bounty of American medical technology, African Americans are often bereft of high-technology care, even for life-threatening conditions such as heart disease. The

Infant mortality of African Americans is twice that of whites, and black babies born in more racially segregated cities have higher rates of mortality. The life expectancy of African Americans is as much as six years less than that of whites.

In the early 1700s, this mirrored the situation in England and the rest of Europe, but medicine on the Continent began to undergo modernizing changes, although these were very slow to cross the Atlantic. Europe began to embrace public-health measures and medical advances such as widespread vaccination, scientific medical education, and the rise of the hospital, but American progress lagged behind, especially in the insular South. The

involved experiments with African Americans. These subjects were given experimental vaccines known to have unacceptably high lethality, were enrolled in experiments without their consent or knowledge, were subjected to surreptitious surgical and medical procedures while unconscious, injected with toxic substances, deliberately monitored rather than treated for deadly ailments, excluded from lifesaving treatments, or secretly farmed for sera or tissues that were used to perfect technologies such as infectious-disease tests.

Old measures of health not only have failed to improve significantly but have stayed the same: some have even worsened. Mainstream newspapers and magazines often report disease in an ethnocentric manner that shrouds its true cost among African Americans. For example, despite the heavy emphasis on genetic ailments among blacks, fewer than 0.5 percent of black deaths—that’s less than one death in two hundred—can be attributed to hereditary disorders such as sickle-cell anemia. A closer look at the troubling numbers reveals that blacks are dying not of exotic, incurable, poorly understood illnesses nor of genetic diseases that target only them, but rather from common ailments that are more often prevented and treated among whites than among blacks.

Physicians, patients, and ethicists must also understand that acknowledging abuse and encouraging African Americans to participate in research are compatible goals. History and today's deplorable African American health profile tell us clearly that black Americans need both more research and more vigilance.

The point of this chapter’s unflattering précis of nascent American medicine is not to castigate it for its primitivism, but to put blacks’ historical aversion to medical care into context, for most antebellum blacks were subjected to southern medicine. The

The South was a particularly unhealthy region and was home to 90 percent of American blacks, the majority of whom were enslaved until 1865.

Why Research Issues Still Matter Why do centuries of mutual distrust over medical research matter today? What does the sad history of exploitative experimentation augur for black health?