The Legacy of Racism in Modern Medicine

BY AHMAD NISAR – Medicine should be the ‘great equalizer.’ At the morphological level, the human body has remained remarkably constant in form and function despite the enormous geographic spread of mankind from our evolutionary cradle in Eastern Africa. The history of medicine itself is complex and variegated, with various civilizations — ancient Egypt, Rome, China, India and the Islamic world — contributing everything from the Hippocratic oath to surgical instruments to clinical pharmacology to the very notion of a public hospital that we take for granted in modern, Western medicine. However, particularly in the American context, medical practice has a nefarious past as well. Some medical contributions, like the study of syphilis and gynecological conditions, have only been determined via experimentation on African-American slaves (and freemen) without their knowledge or consent, as in the cases of the infamous Tuskegee Study, or in the 19th-century experiments of the ‘father of gynecology,’ J. Marion Sims, as enslaved and impoverished peoples provided to researchers an abundant source of desperate, easily-accessible subjects with little agency of their own. Such cruel techniques have since gone out of vogue in much of the nation (aside from cases of forced sterilization and lethal intrauterine devices being provided to indigenous and African-American women), but the influence of  ‘scientific racism’ on the development of modern medicine still reverberates in medical study and practice. This article will explore the outdated beliefs and stereotypes that still affect us today, and how, as students pursuing careers in healthcare, we can learn to avoid them.

A common belief among both medical students and practicing physicians rooted in experiments on enslaved subjects is that African-Americans have a higher ‘pain threshold’ than other ethnicities due to ‘thicker skin,’ although according to surveys, this stereotype is now being manifested in different forms — that blacks have ‘shorter nerve endings,’ ‘denser bone mass,’ and other rationales that have no actual anatomical basis. This has had an outsized impact not only on vulnerable populations like African-American and indigenous women, who suffer from three times the rate of pregnancy-related deaths compared to white women (primarily to the prejudices reinforced by J. Marion Sims’ vaginal operations on enslaved subjects without any anesthesia), but also on the general African-Amerian population: a recent study has revealed that, at a national level, opioids and pain-medicines are prescribed to black patients at a far lower quantity than their Caucasian counterparts (which may actually be positive due to the American opioid epidemic), revealing the depth and reach with which this stereotype pervades modern practices. As medicine is a field in which empathy and patient welfare is the prime directive for any decision, we must correct this false notion when we consider the trauma that may be afflicted on African-American patients who do not receive the proper attention to their pain. 

Another common medical racial bias steeped in the legacy of American slavery is the notion that African-Americans have a lower lung capacity than other ethnicities. Proposed by figures like Thomas Jefferson and physician Samuel Cartwright as a justification for forced labor and the ‘inability’ of African-Americans for liberation or military service due to their ‘inferior physicality’ (it was thought that slaves would need to be brutally over-worked to ‘correct’ this supposed lower lung capacity and to reduce African-Americans’ perceived promiscuity and laziness), this seemingly-antiquated theory has modern ramifications. Samuel Cartwright’s invention of the spirometer (a tool that gauges pulmonary volume) was accompanied by his false qualification that “the deficiency in the Negro may be safely estimated at 20 percent,” which has been so pervasive that modern spirometers, which are digitally operable, have “race correction” embedded into their software that ‘corrects’ lung capacity measurement for broadly ‘black’ patients, despite the complex web of environmental and socioeconomic factors that determine the analysis of this measurement and the highly variable physical differences within different African ethnicities. The racial bias of spirometry may actually lead to severe ramifications in healthcare as black patients must have a significantly lower lung-capacity measurement than those of other ethnicities to be diagnosed with respiratory illnesses. This is but one example of how modern technology, without proper context or oversight, is not immune to the biases and sociopolitical frameworks of the past. 

There are many more examples of outdated racial biases masquerading as objective truth in medicine, from debunked theories about the ‘genetic origin’ of higher blood pressure in African-American populations to racially charged discussions on IQ and intelligence. As students of medicine, however, we must navigate all of these debates with caution, open-mindedness, and tact, especially in a world as diverse and interconnected as ours. Despite all the categories we can sort patients into — race, sex, socioeconomic status or otherwise — the patient is always a living, feeling human deserving of the same standard of care and dignity as any other. 

Editor: Sherry Luo

Photography Source: http://theconversation.com/why-we-keep-playing-the-generation-blame-game-and-why-we-need-to-stop-82219