Racism in Medicine: A Legacy of Non-Autonomy
Written by
Samantha Melia
July 13, 2024
Via Health Affairs
Medical knowledge is a transcendent compendium as old as the human race. It is the amalgam of millions who are long-dead, and their blood, sweat, and tears. Most of what we know now is the result of a potent, human desire to see loved ones live long and happy lives.
However, at some point along the way, something in that guiding principle of medicine changed. The best treatment available at any given time is largely reserved for the white and wealthy, and much of the “research” that allowed for the development of medical science came at the cost of experimentation on enslaved or colonized communities. Those subjected to this experimentation often died as a result of invasive procedures, sicknesses from unsterilized medical equipment, or an intentional exposure. In death, even their bones remain a spectacle, and the remains of enslaved people can be found in European museums to this day. The Vrolik Museum in the Netherlands, for example, boasts a collection of 25,000 human specimens.
In its infancy, accepted practices of accumulating information took the form of experimentation on the bodies of enslaved Africans, and displaced Native Americans, in the instance of the United States. These experiments effectively made them into wards of the state through an assortment of oppressive assimilation programs. Older nations, also bearing responsibility for countless human rights violations in the name of development and progress, such as Belgium, France, the Netherlands, the United Kingdom, and Spain, have obtained a wealth of information from the illegitimate coercion of oppressed peoples.
Stanford historian, Londa Schiebinger, has conducted extensive research for numerous publications on the nature of colonial experimentation on black and brown bodies. In England, 1721, the first smallpox inoculations were performed on a group of six inmates incarcerated at Newgate Prison. While speaking to the Stanford Review, Schiebinger discusses the log of English-born plantation physician John Quier. His log begins in the year 1768 in Jamaica and details his smallpox vaccine experiments on 850 enslaved Black people. In addition to exposing pregnant women and infants to the fatal smallpox in an attempt to create a vaccine for “polite society”, Quier would expose some enslaved people to multiple rounds of the same infection in order to measure the strength of their health.
Through his experimentation, Quier concluded that the harsh treatment and conditions reserved for enslaved people were likely not suitable for those “of fashion and of delicate constitutions”— namely women. It was for justifications like these that early medical experimentation was largely done on enslaved or incarcerated bodies.
The driving justification for instances of “necessary” exploratory research on unwilling participants in the colonial context can largely be attributed to the theories of phrenology, eugenics, and social Darwinism, interpreted and proliferated in a context of their own that is skewed to yield to ideas of inherent racial superiority. There are few scenes in contemporary media as apt in depicting the insidiousness of this perspective in its heyday – the entirety of the 1800s, 1820-1880 in particular (Bank, 1996) – as Leonardo Dicaprio’s chilling performance with his skull in Django. A purely empirical evaluation of the medical field over time is incomplete without recognition of the fact that those at the height of “progress” were complicit, and often devoted, to these pervasive and self-serving narratives as they applied illegitimately to a real science.
An adequate evaluation of the state of medical understanding at the time would, additionally, be remiss without the inclusion of the fact that during early industrialism, women were warned against riding in trains. This was done for fear that their uterus would be compromised. Both The Lancet, formed in 1823, and the New England Medical Gazette, published in 1863, voiced these concerns surrounding uterine dislocation and even the possibility of complete ejection from the body if subjected to high-speed travel. More often, it is women who face the results of a legacy of gender-exclusionary medical decision-making, and the spirit of sterilization campaigns included in many colonial projects persists today. These take shape in the prison system and are more prevalent along the poverty line.
In 2021, Bill Chapel revealed that 148 women were forcibly or coercively medically sterilized while in California prisons from 2006 to 2010, a fact he uncovered while researching prison sterilizations for NPR. Officially, sterilization practices made legal by eugenics laws were banned in 1979 for California state hospitals and in 2010 for California state prisons. Hundreds of women were found to have been sterilized under coercive or forcible circumstances in California, both leading up to and during 2010. Largely, those sterilized were women of Latin American descent.
The practice of forced sterilization in contemporary America (and the limited calls to justify it) yields to social Darwinism, and even an ancient, Platonic conception of inherent superiority of one “class” of people over another —as found in the philosopher’s “Myth of the Metals,” – leaves circumstances of a pre-constructed class-system aside and settles comfortably into the notion that some people are just born more deserving than others.
According to Aisha Nnoli, M.D., four events dictated the course of the American medical sphere overtime in its relation to treating patients of color: The conceptualization of race into limited standards by Western society, the proliferation of slavery, the legal doctrine “partus sequitur ventrem” (making the children of enslaved women automatic inheritors of her enslavement status), and the American Eugenics movement (1907-1963). Many contemporary examples of racial bias in medicine push the fallacy that the skin of people of color is somehow thicker or more durable than that of white people. It has also been incorrectly suggested that pain tolerances vary between the two groups, as well as the speed of blood coagulation.
In a study published by the Association of American Medical Colleges in 2020, Janice A. Sabin, Ph.D., reveals that 40% of first and second-year medical students surveyed endorsed the notion that black people have thicker skin than white people. These false statements were historically used as justification for experimental procedures on incarcerated and colonized peoples; this has shifted into an accepted form of misinformation that stands as yet another barrier between disenfranchised people of color and quality healthcare.
Commonly, we see manifestations of medical inequality appear in terms of access: Access to maternity care, emergency services, and life-saving medications, – the best of these services are reserved for private hospitals and expensive insurance plans. Even in diversely populated urban settings, such as Providence, Rhode Island, which houses the highest concentration of hospitals in the entire state, the city has the highest level of delayed or foregone maternity care of any other Rhode Island residence. The Rhode Island Women’s Wellbeing Index, published with statistics collected by the Women's Fund of Rhode Island, shows that between 18-20.6% of women in Pawtucket, Providence, and Woonsocket received delayed natal care. These areas are more densely populated by minority populations. This number didn’t break 13% in more suburban or affluent areas.
Nationwide, 1 in 5 Black women die from birth and labor complications. This figure on maternal mortality, both during and after childbirth, is five times higher than it is for white women. There is an unfortunate irony behind the inability of women of color to obtain quality natal care and the perversion of the gynecological practice to coercively perform hysterectomies and other sterilization procedures on incarcerated women of color well into the 20th century. The way non-autonomy manifests itself in the present day medical sphere lends to the legacy of experimentation on the bodies of more persecuted women of color that began hundreds of years ago.
When given a theoretical framework and historical timeline, it is much easier to make the connection between the atrocities of colonialism and the apathy toward medical rights violations seen today. That is not to say there is a dearth of examples in between that can work to assist in filling in any conceptual gaps, such as the ugly blot of time in American history taken up by the Tuskegee Syphilis experiment from 1932 to 1972. In this experiment, the test subjects were all Black men exposed to syphilis under the impression that they were being treated for it. In reality, they were being incrementally given the equivalent of sugar capsules under the guise of treatment as the disease progressed, destroying their health and spreading to friends, lovers, and family members.
In 1921, Sweden established the Institute for Racial Biology, which would house numerous collaborations with Nazi scientists. In the 1940s, similar phrenological experiments that amounted to inhumane torture (as determined by the Nuremberg trials) would be conducted by Nazi scientists in concentration camps across Europe. Under CIA Operation Paperclip, America contracted and relocated over 1,600 scientists and engineers previously affiliated with the Nazi Party after the war had ended. These “former” Nazis would go on to contribute to medical literature and conduct further research.
All this supposedly “justified” sacrifice for life-saving and live-giving procedures, and those most impacted (as is revealed by countless studies on colonial experimentation and genealogical trauma) rarely reap the benefits. This can be attributed to a lack of financial means to acquire healthcare or a general distrust in medical institutions that, evidently, have long been guided by misinformed standards of biological realities regarding the treatment of black and brown bodies. It is no longer a question of whether the ends justify the means when the ends are, thus far, so inadequate. The ends have become continually weaponized, just as the means once were, in service of the false idol of white superiority. Until the quality of accessible public services (including and beyond the medical industry) is equalized along all communities, until the forced sterilization phenomenon has ended in the West, and in all Western prisons, we cannot begin to approach a commiseration for our past.
At the very least, we can start by ensuring that our state-funded institutions dedicated to medical practice have materials representing bodily science in its actuality and not according to an outdated pseudo-science. Mante, Greenridge, and Amutah argue that “race is not a biologic category,” in their scathing evaluation of outdated class materials in medical schools for The New England Medical Journal. The way racial differences have been categorized in literature, supposedly to better represent the phenomena of genealogical pre-disposition, have since been proven inefficient in contemporary breakthrough research. Inequity in medicine manifests itself between patients and providers on the interpersonal level and through the system as a whole. Issues of race in modern medicine will not be resolved until medical institutions across the United States and Europe acknowledge the violations of human rights and dignity committed for the expansion of their practice.
Written By: Samantha Mejia
Racism in Healthcare, Medical Ethics, Health Equity
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