By Doug Wojcieszak.
Recent racial unrest has made many Americans — including the medical community — reflect on our nation’s racial history. The pandemic and our hopes for the COVID-19 vaccines, however, should make the medical community reflect deeper on the history of Black Americans and American medicine and how the future can be different.
Recent surveys show Black Americans have expressed the most hesitancy about taking the COVID vaccines, yet the Black community has suffered disproportionally during this pandemic. Indeed, the vaccine is the way out of this crisis for Black Americans and the rest of us. Some commentators attribute the vaccine reluctance of Black people to the legacy of the Tuskegee syphilis research program, but this is a historical oversimplification no different than high school history books that boil down the civil rights movement to Rosa Parks and Martin Luther King, Jr. Ironically, many Black Americans have little understanding of the Tuskegee experiments, yet they are leery of American medicine, especially medical research.
Harriet Washington’s “Medical Apartheid,” published 14 years before George Floyd’s death and the pandemic, details the tragic history of the Black community’s interface with American medicine, starting with slavery. Countless physicians profited handsomely from the South’s peculiar institution, and American medical publications provided a scientific rationale for slavery by claiming Black people had inferior intelligence, yet they were uniquely fit for hard manual labor. Physicians also experimented on slaves, including Dr. James Marion Sims who used un-anesthetized Black female slaves to perfect surgical repairs for vesicovaginal fistulas. Unfortunately, the medical horrors did not stop with Emancipation. The racist medical abuse continued for the next 100+ years and ranged from American medical colleges routinely robbing Black cemeteries for unethical research projects, to radiation experiments and the infamous Tuskegee syphilis study. These historical facts are not widely distributed in print, yet they have been passed down through the oral history of the Black community. Any wonder Black Americans are afraid of American medicine, including the COVID vaccines?
Harriet Washington states that modern medicine, including present-day medical research, should not be considered a risk for the Black community, however, the emotional damage persists. Trusting modern medicine is a major leap for many Black Americans. American medicine needs to build trust with Black Americans.
In my work in the disclosure and apology movement, I have seen the medical community break trust with countless patients and families due to undisclosed and unresolved medical errors. Though medical errors are always unintentional acts (no doctor or nurse wants to hurt patients), honest mistakes have historically been compounded by intentional unethical acts including lies and cover ups. These deny and defend tactics are a unique form of evil that has ruined the lives of countless consumers. Fortunately, the disclosure and apology movement has grown in popularity. Clinicians are now encouraged apologize to patients and families, which includes sharing details of errors, proposed safety fixes, and upfront compensation. Trust has been rebuilt between clinicians and consumers in some of the worst cases of medical errors, including crippling injuries and deaths. I believe the disclosure and apology movement is instructive not only for patient safety but also concerning the historical medical injustices suffered by Black Americans.
Some may worry that revisiting this history will create more fear, but Washington argues that a complete telling of this story is necessary:
“The challenge is to prepare the way for a new openness to medical research on the part of African Americans…I do not see how this can be accomplished without candor, because the traditional strategy of ostrichlike denial merely heights mistrust….physicians, patients, and ethicists must also understand that acknowledging abuse and encouraging African Americans to participate in medical research are compatible goals.” (pages 386, 388).
Washington makes a strong argument that historical disclosure and apology will unlock the “bounty of the American health-care system” (page 15) for the Black community.
There have been attempts at apology to the Black community, including President Clinton apologizing for the Tuskegee syphilis study and unethical radiation experiments (pages 189, 240-241). The Medical College of Georgia was candid and cooperative concerning the 9,800 human skeletal remains – many of them from Black Americans – found in their basement during a construction project (pages 121-123). Even the American Medical Association apologized to the National Medical Association for racist acts. These apologies, however, have been isolated events quickly forgotten by most. More comprehensive, sustained candor is needed.
This history needs to be told and acknowledged. Black Americans need to hear that the American medical community and the American public understand this history and appreciate their legitimate fears. Black Americans need to be shown how things have changed, including the protections now in place for consumers and research participants. Finally, Black Americans need to hear the same words desired by every family who has experienced medical errors: “I am sorry.”
Author: Doug Wojcieszak
Affiliation: Founder and President, Sorry Works!
Social media account of post author: @sorryworks