Medical Apartheid

EZEKIEL EMANUEL, "Unequal treatment" in NY Times

In April 1721, sailors arriving from Barbados set off a smallpox epidemic that raged in Boston for a year. Cotton Mather, the powerful Puritan minister, advocated using pus from a smallpox scab to infect another person, producing a mild case and long-term immunity to the “speckled monster.” Mather first learned about inoculation from an African slave and from reports of the practice in Turkey. For years, he had repeatedly failed to persuade any physician to try it. But on June 26, 1721, Zabdiel Boylston, a physician, administered pus to his 6-year-old son and two of his slaves, an adult and child. All three experienced mild cases and quickly recovered. By the time the epidemic subsided, Boylston had inoculated 244 people, six of whom died — a death rate of 2.4 percent, compared with 14 percent for the nearly 6,000 Bostonians who acquired smallpox naturally.

As Boylston’s use of slaves highlights, African-Americans have participated in biomedical research from the outset. In “Medical Apartheid,” Harriet Washington charges that they have also too often been abused and exploited by a racist medical establishment. This history, she argues, goes far beyond the infamous Tuskegee syphilis study, in which African-American sharecroppers, under the sponsorship of the United States Public Health Service, were for 40 years subjected to various procedures and prevented from getting penicillin treatment — despite the fact that determining the course of the disease, the putative goal of the study, had already been accomplished. “Researchers who exploit African-Americans,” Washington writes, “were the norm for much of our nation’s history, when black patients were commonly regarded as fit subjects for nonconsensual, nontherapeutic research.” (read entire article)