Quotes from Harriet A. Washington

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.

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.

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

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

Because race is not a biological reality, medications based upon group biological differences will work only for some African Americans. This will lead to a false sense of security, and will stymie the search for more inclusive, more efficacious, and, in a word, better treatments. We must recognize the powerful stigmatizing potential of genetic approaches to disease, especially when they are touted as the only approach.

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.

In fact, researchers who exploit African Americans were the norm for much of our nation's history, when black patients were commonly regarded as fit subjects for nonconsensual, nontherapeutic research. This book explores the many reasons that blacks are so vulnerable, but ultimately it is because American medical researchers remain a racially homogeneous group, and I show how the racial homogeneity of American medical researchers lies at the very heart of the problem.

Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.

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

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?

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

American university research centers have historically been located in inner-city areas, and accordingly, a disproportionate number of these abuses have involved experiments with African Americans.

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.

Geography, tradition, and culture intersect to make blacks likely research subjects for new technologies, but race and economics tend to place them outside the marketplace for these same technologies when they are perfected.

I challenge us to change, because as Charles Darwin once observed, "It is not the strongest species that will survive, nor the most intelligent, but the one most responsive to change.

The vaccine debate encapsulates more than a scientific disagreement; it also reflects the lingering iatrophobia from the exploitative abuse of African American children. This abuse has had a chilling effect on lifesaving research because parents are withholding their permission from positive as well as abusive research. History has shown them how difficult it is to distinguish between the two.

fact, the first legally proven fatality from domestic bioterrorism was the 1973 murder of West Oakland school superintendent Dr. Marcus A. Foster, an African American, who was felled by a cyanide-tipped bullet from the arsenal of the Symbionese Liberation Army.22

Two other slave women peer around a sheet, apparently hung for modesty's sake, in a childlike display of curiosity. This innocuous tableau could hardly differ more from the gruesome reality in which each surgical scene was a violent struggle between the slaves and physicians and each woman's body was a bloodied battleground.

Betsey's voice has been silenced by history, but as one reads Sims's biographers and his own memoirs, a haughty, self-absorbed researcher emerges, a man who bought black women slaves and addicted them to morphine in order to perform dozens of exquisitely painful, distressingly intimate vaginal surgeries. Not until he had experimented with his surgeries on Betsey and her fellow slaves for years did Sims essay to cure white women.

Three times as many African Americans were diagnosed with diabetes in 1993 as in 1963.

Mental ailments are destroying blacks, as well: Black women suffer the highest rates of stress and major depression in the nation and suicide rates soared 200 percent among young black men within just twenty years.

The health of thirty million African Americans is continually imperiled, partly because many eschew effective care rather than risk the tender mercies of government-sponsored medicine. Although many studies and abuses contributed to this iatrophobia, Tuskegee remains the iconic symbol of racialized medical abuse.