Evils in Medicine Have Bred Distrust in Black America

How the virus spread …

“Let the compromising expedient of the Constitution be mutually adopted, which regards them as inhabitants, but as debased by servitude below the equal level of free inhabitants, which regards the SLAVE as divested of two fifths of the MAN.” This is a direct quote from Article 54 of The Federalist Papers, a collection of 85 essays and papers published in 1788 meant to promote the ratification of the Constitution.

“The Founding Fathers” were charged with determining representation for each state in the House of Representatives. Because a higher population meant a greater advantage, the Southern states wanted to be able to count their slaves, but then, slaves were considered property not people. James Madison, the article’s likely author, argued that slaves, while not persons, were elevated slightly above, say, a mule.

The resulting compromise set forth in the Constitution: “Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their Respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons.” Succinctly, enslaved blacks were to be counted in the subsequent censuses as three-fifths of a person. There. Everyone’s happy.

When we talk of slavery, abolitionism and the Civil War, the sound bite often goes, “We were fighting for freedom.” Sure, freedom from chains and back-breaking labor was a goal, but the situation was even more dire than that – the fight was for humanity. We were not considered to be full human beings. It’s no wonder, then, that J. Marion Sims thought it OK to use black slave women as guinea pigs in a bloody, torturous quest that would eventually lead to the doctor being dubbed “The Father of Modern Gynecology.”

Sims made a name for himself in the 19^th century as the go-to physician for rich plantation owners; they called upon him to tend to their part-human slaves. Sims originally had no interest in treating female patients, and he had no gynecological training, as was customary at the time. Examining and treating female organs was thought to be seedy and distasteful.

But, when Sims was called on to treat a patient with pelvic and back pain, he realized he’d need to look inside her vagina. He used his fingers to open her up and look inside, diagnosing her with vesicovaginal fistula, a tear between the uterus and bladder, a common after-effect of childbirth in the 1800s that caused persistent pain and urinary incontinence.

This caused Sims to invent what has become the modern-day speculum, and he was determined to develop a repair method for vesicovaginal fistula. A fine aspiration, except, to establish a successful surgical method for vesicovaginal fistula took years and numerous experimental surgeries, and female slaves were his test dummies. Sims operated on these nameless, voiceless black women without consent – and without anesthesia. He, like many others, didn’t believe that black people felt pain like white people. We do know the names of a few of his victims by way of Sims’ notes. Anarcha was 17 years old and endured 30 surgeries over four years.

Atrocities like Sims’ are not artifacts of the slave era; no, instances of unethical torture treatment of black people in the name of medical advancement transcend the Emancipation Proclamation. Certainly, the most infamous of these is the Tuskegee Experiment, or the Tuskegee Study of Untreated Syphilis in the Negro Male, to be official. From 1932 to 1972, the Tuskegee Institute (now Tuskegee University) backed by the U.S. Public Health Service allowed syphilis to ravage the bodies and minds of hundreds of poor, black sharecroppers.

The men were not told they had syphilis – they thought they were being treated for “bad blood” – nor were they administered penicillin when it became the recommended treatment for syphilis in 1947. Instead, experimenters watched as the men went insane and blind, passed the disease to their wives and children, and died. The study only stopped when a whistleblower leaked the story to the Associated Press.

But, we’re past such evils, right?

The symptoms …

In Wanda Sykes’ recent Netflix special Not Normal, the comedian has a bit that’s meant to poke fun at the Trump administration’s thinly veiled justification for the border wall by claiming that it’s being built, in part, to help stop the opioid crisis. Sykes says, “That’s a message to white people, that’s for white people – opioid crisis. Because of racism, black people, we don’t even get our hands on opioids. They don’t even give ’em to us. White people, they get opioids like they’re Tic Tacs.”

Of course, this speaks to an epidemic of overprescribing addictive drugs like oxycodone, but also to a racist medical system that’s less likely to take black patients’ pain seriously and more prone to empathize with white patients. Sykes says, “I had a double mastectomy, and you know what they sent my black ass home with? I-bu-fucking-profen. To get some opioids, a black person would have to show up to the emergency room holding their own head detached from the body.”

Funny – but sadly, not far from the truth. The University of Virginia published a study in April 2016 that documented racial disparities within the medical system. Lead researcher Kelly Hoffman, then UVA psychology Ph.D. candidate, told UVA Today, “Many previous studies have shown that black Americans are undertreated for pain compared to white Americans, because physicians might assume black patients might abuse the medications or because they might not recognize the pain of their black patients in the first place. Our findings show that beliefs about black-white differences in biology may contribute to this disparity.”

Hoffman and her team asked 222 white medical students and residents to rate, on a scale of zero to 10, the pain levels they’d associate with two mock cases, a leg fracture and a kidney stone, for a white patient and for a black one. Then the doctors-in-training were told to recommend a course of treatment. The group was also asked whether they believed racist myths about biological differences between blacks and whites: black peoples’ nerve endings are less sensitive than whites – sound familiar? – our blood coagulates more quickly than whites, our skin is thicker, black people age slower.

All of these are false – yes, even the part about us aging slower. But half of the subject samples believed at least one of these and that mix of med students and residents, in turn, were more likely to give a lower pain rating, and less likely to recommend appropriate treatment – students that will one day become masters.

The conversation as of late has circled around the fact that black women are almost 400 percent more likely to die from complications related to pregnancy than white mothers, even when income, education and other socioeconomic factors are similar. That’s 42.8 black women dying per 100,000 live births compared to 13 deaths per 100,000 live births for white women, according to the Centers for Disease Control and Prevention. Black mothers die bringing forth life more often than white, Asian and Hispanic women combined.

Black people, as a whole, are less likely to visit the doctor’s office in the first place. We’re more apt to ignore a problem until it becomes glaring. These, like most societal issues, have more than one cause. We’d be remiss not to consider that factors like transportation and income influence why blacks are less likely to visit the doctor regularly, and that pre-existing health issues like hypertension and diabetes – common in the black community – contribute to why the maternal mortality rate is so high amongst black women.

Still, it’d be foolish not to recognize that black women’s cries of concern often go ignored or dismissed and that deep seeds of mistrust stemming from past and current mistreatment certainly play a role in why a doctor in a lab coat can feel as scary as a hothead in a policeman’s uniform.

The antidote …

When we interviewed Judge Denise Page Hood for BLAC’s June issue, the chief federal judge talked thoughtfully about the significance of black boys and men walking into her courtroom and seeing a black face staring down at them from the bench. Hood said while it doesn’t necessarily mean the outcome will be different – though we know negative bias can be measured – there’s a comfort in knowing, in a vulnerable situation, that the person that holds your life in his or her hands gets you and that you’ll be handled with compassion and based on facts, not perceptions.

Less than 6 percent of practicing U.S. physicians and surgeons are black, according to Census data. Detroit Medical Center is partnering with Meharry Medical College to help train its medical students with hands-on experience at Sinai-Grace Hospital. The Nashville, Tennessee institution is the nation’s largest private, historically black academic health sciences center, admitting 60 dental students and 115 medical students per year. “We’ve been piloting this for the past two years, and we’re now really, at this point, moving into a more structured program,” says Dr. Patricia Wilkerson-Uddyback, DMC’s vice president of graduate education.

DMC had been bringing on board 10 students per month; that’ll start to be ramped up and students will have more opportunities to do core rotations. Typically, medical students spend their first two years studying cases, anatomy, pathology and the like; the next two years are spent gaining real-world experience. “The long-term hope,” Dr. Wilkerson-Uddyback says, “will be that these students will come up here, they’ll do their rotations, they’ll have a great experience, and then when it comes time for them to apply for residency, they’ll put our program higher on the list. And then, hopefully, because we’ve had experience with them and exposure to them, we’ll rank them higher so that we can start to improve the diversity amongst our residency program.”

She goes on: “And if they have a good resident experience here, then, hopefully, they’ll then decide to stay in Detroit, set up practice and begin serving the community, which is what has traditionally happened in Detroit. I think at one point, we had the largest number of Meharry graduates practicing medicine in the city of Detroit.” Black doctors practicing in the city means easier access to care and untangled lines of communication.

“You’ve got to speak the same language, and it goes even deeper than saying the words. There’s a connection, and that happens in all cultures,” Wilkerson-Uddyback says. “There’s always a language that’s right underneath the surface, and that’s where I think we have to start connecting with our patients. When you have people that look like you, you’re going to listen a little bit harder. When I tell patients, ‘I know you made your greens with some ham hocks, and that’s why your blood pressure is through the roof today,’ they look at you and they don’t even try to tell you a different story because they know you know.”

If anything is going to change with regard to black people’s access to health care and the ways in which we’re cared for when we walk through the door, we must graduate more black doctors – it’s a matter of life or death. Wilkerson-Uddback says the few black doctors that we do have must engage children of color early and often, taking their little hands and showing them the way. “If we have more doctors who are from the community, they’re going to choose to practice in the community, and that improves access at a whole other level.”