Medical Apartheid

I recently finished reading Harriet Washington’s haunting and devastating account of America’s history of racism in medical treatment and research, Medical Apartheid. I came across this book on several anti-racism reading lists and assigned the introduction in my health policy seminar this semester. The topic of this book has come up over and over again throughout the pandemic. Much has been written about the disproportionate impact of COVID-19 on communities of color, as well as resistance in black and latino communities to participating in vaccine trials and getting the eventual vaccine. This book lays out the deep history of medical abuse that undergirds that resistance and suspicion. It is to the American healthcare system what Michelle Alexander’s The New Jim Crow has been to the American criminal justice system.

Washington’s history traces a throughline of the abuse of black bodies in America; from excruciating experiments on slaves through displays of the “exotic,” government testing of the effects of radiation exposure and biological weapons (Carver Village), prison experiments, drug studies on children, genetics research, AIDS research, and much more. A major aspect of this throughline is the lack of informed consent and voluntary participation, up through the present. She spends some time in the epilogue making recommendations for further improving research practices – including paying more attention to upholding human subjects protections and therapeutic treatment for participants in studies conducted in Africa (e.g., ANTICOV), mandatory participant education, participants serving on institutional review boards, and protecting participants who cannot consent to research (e.g., studies done in emergency rooms). Washington balances these recommendations with encouragement for African Americans to engage in clinical research, though doing so after warily evaluating it for necessary research protections. The current vaccine push and evaluation of therapeutics for COVID-19 are good examples of the societal cost for low participation.

This book is a must read for doctors and researchers in training. It could be a powerful tool for discussing human subjects protections in research courses. It is also vital background for understanding the understandable reticence of communities of color to participate in needed medical research.