Prejudice and the Medical Profession: A Five-Year Update

Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Institute of Medicine, Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Health Care (Washington, D.C.: National Academy Press, 2002).

Gifford A. Cunningham W. Heslin K. , “Participation in Research and Access to Experimental Treatments by HIV-Infected Patients,” New England Journal of Medicine 346, no. 18 (May 2, 2002): 1373–1382.

Corbie-Smith G. Thomas S. St. George D. , “Distrust, Race, and Research,” Archives of Internal Medicine 162, no. 21 (November 25, 2002): 2458–2463.

The term “medical profession” is a social construct and in this paper is being used in a broad sense. The medical profession is comprised of millions of individuals in which, many may be racist and insensitive, but there are many of whom are not racist. For lack of a better term, the term “medical profession” will be used to designate medical professionals in the United States knowing full well not all are being deemed racist.

See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 4.

United States Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ), 2007 National Healthcare Disparities Report, Washington, D.C., February 2008.

The Tuskegee Syphilis Study will be discussed in more depth later in this article. For a more detailed analysis of the Tuskegee Syphilis Study see, Jones J. H. , Bad Blood: The Tuskegee Syphilis Experiment — A Tragedy of Race and Medicine (New York: The Free Press, 1981).

Allport G. W. Postman L. , The Psychology of Rumor (New York: Henry Holt, 1947): At ix.

Turner P. , I Heard It Through the Grapevine: Rumor in African American Culture (Berkeley: University of California Press, 1993): at 4.

Id., at 5.

Allport and Postman make a case that legends are often little more than solidified rumors. See Allport Postman , supra note 8, at167.

Id., at xv and 108.

See Turner , supra note 9, at 138.

Gamble V. , “A Legacy of Distrust: African Americans and Medical Research,” American Journal of Preventative Medicine 9, no. 6, Supplement (1993): 35–38.

Id., at 35. See also, Weld T. D. , American Slavery As It Is: Testimony of a Thousand Witnesses (New York: 1939); Boone F. N. , Dr. Thomas Hamilton: Two Views of a Gentleman of the Old South (New York: Phylon, 1967); and Sims J. M. , The Story of My Life (New York: Appleton, 1998).

Id., at 35–36.

For a more detailed analysis of the influence of the Paris school on American medicine, see Ackerknecht E. , Medicine at the Paris Hospital, 1794–1848 (Baltimore: Johns Hopkins Press, 1967); Shryock R. , The Development of Modern Medicine: An Interpretation of the Social and Scientific Factors Involved (New York: Elsevier 1947); Foucault M. , The Birth of the Clinic: An Archeology of Medical Perception (New York: Routledge Classics, 1973); and Gerald G. , Edward Garvis and the Medical World of Nineteenth Century America (Knoxville: Turner, 1978).

Savitt T. , “The Use of Blacks for Medical Experimentation and Demonstration in the Old South,” Journal of Southern History 48, no. 3 (1972): 332–333.

Id., at 333.

Fry G.-M. , Night Riders in Black Folk History (Athens, GA: University of Georgia Press, 1991): At 174–176.

Id., at 174–178.

Id., at 176. See also Guttmacher , “Bootlegging Bodies,” Society of Medical History of Chicago 4, no. 2 (January 1935): 353–402.

Id. (Fry), at 171.

For a more detailed analysis of the black migration to industrial centers, see Henderson D. , “The Negro Migration of 1916–1918,” Journal of Negro History 6, no. 2 (January 1921): 383–498.

See Fry , supra note 20, at 171.

Id., at 172.

Humphrey D. C. , “Dissection and Discrimination: The Social Origins of Cadavers in America, 1760–1915,” Bulletin of the New York Academy of Medicine 44, no. 9 (1970): 819–827, at 822. Humphrey also cites Sozinsky T. S. , “Grave-Robbing and Dissection,” Penn Monthly 19 (1879): 216.

Id. (Humphrey), at 824.

Id., at 824–825.

See Gamble , supra note 14, at 36.

Id., at 36. See also, Murrell T. W. , “Syphilis and the American Negro,” Journal of the American Medical Association 54, no. 10 (1910): 846–849 at 847; and Hazen H. H. , “Syphilis in the American Negro,” Journal of the American Medical Association 63, no. 6 (1914): 463–468 at 463.

Caldwell J. G. Price E. V. , “Aortic Regurgitation in the Tuskegee Study of Untreated Syphilis,” Journal of Chronic Diseases 26, no. 3 (1973): 187–94; Hiltner S. , “The Tuskegee Syphilis Study under Review,” Christ Century 90, no. 43 (1973): 1174–1176; Kampmeier R. H. , “The Tuskegee Study of Untreated Syphilis,” South Medical Journal 65, no. 10 (1972): 1247–1251; Kampmeier R. H. , “Final Report on the ‘Tuskegee Syphilis Study,’” South Medical Journal 67, no. 11 (1974): 1349–1353; Olansky S. Simpson L. , “Environmental Factors in the Tuskegee Study of Untreated Syphilis,” Public Health Report 69, no. 7 (1954): 691–698; Rockwell D. H. Yobs A. R. , “The Tuskegee Study of Untreated Syphilis: The 30th Year of Observation,” Archives of Internal Medicine 114 (1964): 792–798; Schuman S. H. Olansky S. , “Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study,” Journal of Chronic Diseases 2, no. 5 (1955): 543–58.

In August, 1972, HEW appointed an investigatory panel which issued a report the following year. The panel found the study to have been “ethically unjustified” and argued that penicillin should have been provided. See Brandt A. , “Racism and Research: The Case of the Tuskegee Syphilis Study,” Hastings Center Report 8, no. 6 (December 1978): 21–29 at 21; and Ad Hoc Advisory Panel, Department of Health, Education and Welfare, Final Report of the Tuskegee Syphilis Study (Washington, D.C.: Government Printing Office, 1973). For a more detailed analysis of the Tuskegee Syphilis Study see, Caplan A. , “When Evil Intrudes,” Hastings Center Report 22, no. 2 (November-December 1992): 29–32; Edgar H. , “Outside the Community,” Hastings Center Report 22, no. 6 (November-December 1992): 32–35; King P. A. , “The Dangers of Difference,” Hastings Center Report 22, no. 6 (November-December 1992): 35–38; and Jones J. H. , “The Tuskegee Legacy: AIDS and the Black Community,” Hastings Center Report 22, no. 6 (November-December 1992): 38–40.

For a more detailed analysis of the impact of birth control on the African American community, see Weisbord R. G. , “Birth Control and the Black American: A Matter of Genocide?” Demography 10, no. 3 (1973): 571–590.

Norplant is the trade name for a birth control product consisting of six thin capsules that, upon being implanted in the woman's arm, releases an ovulation-inhibiting hormone. See Turner , supra note 9, at 221.

Id., at 222. See also, Editor, “One Well-Read Editorial,” Newsweek 31, December 1990, at 65–66; and Kimelman D. , “Poverty and Norplant,” Philadelphia Inquirer 12, December 1990, at A-18.

Abate T. , “Brave New World of Genetics Explored at Academy of Science Meeting,” San Francisco Chronicle, February 25, 2002, E-1.

Id., at E-1.

For a more detailed analysis of the effects of race on medical care see, Geiger J. H. , “Race and Health Care: An American Dilemma,” New England Journal of Medicine 335, no. 12 (1996): 815–816; Gornick M. E. Eggers P. W. Reilly T. W. , “Effects of Race and Income on Mortality and Use of Services among Medicare Beneficiaries,” New England Journal of Medicine 335, no. 11 (1996): 791–799.

Wilkenson D. Y. , “For Whose Benefit?: Politics and Sickle Cell Anemia,” The Black Scholar 5, no. 8 (1974): 26–31. See also King , supra note 33, at 37.

Id. ( Wilkenson ), at 30.

See Curtis C. , Vaccines Are Dangerous: A Warning to the Black Community (Brooklyn: A&B Books, 1991).

O'Connor B. , “Foundations of African-American Mistrust of the Medical Establishment,” unpublished manuscript, Hahnemann University Medical School, Philadelphia, Pennsylvania, at 10–11.

A national survey, conducted by the Roper Starch Worldwide polling company, found that out of 500 blacks, 18% said they believed AIDS was a man-made virus; 9% in the general population agreed. When asked more specifically whether HIV and AIDS were part of a plot to kill blacks, 9% of the all-black group said it was definitely true; compared to 1% in the general group. See Richardson L. , “An Old Experiment's Legacy: Distrust of AIDS Treatment,” New York Times, April 21, 1997, at A-9.

See Gamble , supra note 14, at 37. See also, Thomas S. B. Quinn S. C. , “The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community,” New York Times, April 21, 1997, at A-9.

See Turner , supra note 9, at 158. See also Kloniff E. A. Landrine H. , “Do Blacks Believe That HIV/AIDS Is a Government Conspiracy against Them?” Preventative Medicine 28, no. 4 (1998): 451–457; Corbie-Smith G. Thomas S. B. Williams M. V. Moody-Ayers S. , “Attitudes and Beliefs of African Americans toward Participation in Medical Research,” Journal of General Internal Medicine 14, no. 9 (1999): 537–546.

Cneters for Disease Control, “HIV/AIDS in the United States-Fact Sheet,” March 2008, at 1–5, available at <http://www.cdc.gov/hiv/resources/factsheets/print/us.htm> (last visited January 9, 2009).

It should be noted that “age, sex, diet, underlying disease, and the concomitant use of other medications, race and genetic factors may play pivotal parts in the variability of subjects' responses to a medication.” See King T. , “Racial Disparities in Clinical Trials,” New England Journal of Medicine 346, no. 18 (May 2, 2002): 1400–1402.

See Gifford , supra 2, at 1373–1382.

Id., at 1376–1379. The NIH and the FDA both established guidelines encouraging inclusion of more women and minority groups in clinical trials. See, National Institutes of Health, “Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Trials,” Federal Register 59 (1994): 14508–14513; and Food and Drug Administration, Modernization Act of 1997 (FDAMA or the Act), Public Law No. 105–115 (November 21, 1997). It should be noted that experts at the NIH challenged the findings of Gifford , saying that because the study was based on patient interviews in 1996–1998, it was therefore out of date.

See Gifford , supra note 2, at 1379.

See Corbie-Smith , supra note 3, at 2458–2463.

See King , supra note 49, at 1402.

Id., at 1402. See also Fogarty L. Roter D. Larson S. , “Patient Adherence to HIV Medication Regimens: A Review of Published and Abstract Reports,” Patient Education Council 46, no. 2 (2002): 93–108.

See King , supra note 49, at 1401.

Merz J. , “Report Claims Clinical Trials Miss Many Populations,” Washington Post, April 3, 2008, available at <http://www.irbforum.org/forum/read/2/167/167Vt?PHPSESSID=656c640dfe552e73efb2e3877c277473> (last visited December 11, 2008).

See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 2.

Id., at 3–4.

United States Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ), supra note 6, at 5–6.

Id., at 6.

Id., at 7.

Williams D. Gonzalez H. Neighbors H. , “Prevalence and Distribution of Major Depressive Disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites,” Archives of General Psychiatry 64, no. 3 (March 2007): 305–315.

Halpern M. Ward E. Pavluck A. , “Association of Insurance Status and Ethnicity with Cancer Stage at Diagnosis for 12 Cancer Sites: A Retrospective Analysis,” Lancet Oncology 9, no. 3 (March 2008): 222–231.

Powe N. , “Black Americans Still Wary of Clinical Trials,” Medicine Online (January 14, 2008), available at <http://www.medicineonline.com/news/12/10849/Black-Americans-Still-Wary-0f-clinical> (last visited December 11, 2008).

Editor, “Did Tuskegee Damage Trust On Clinical Trials?” CNN.com, March 19, 2008, available at <http://www.cnn.com/2008/HEALTH/03/17/clinical.trials.ap/index.html> (last visited December 11, 2008).

Sequist T. Fitzmaurice G. M. Marshall R. , “Physician Performance and Racial Disparities in Diabetes Mellitus Care,” Archives of Internal Medicine 168, no. 11 (June 9, 2008): 1145–1151; and Minnema L. “Race May Limit Care,” Washington Post, June 17, 2008, available at <http://www.washingtonpost.com/wp-dyn/content/article/2008/06/13/AR2008061303263> (last visited December 22, 2008).

Id. ( Sequist ), at 1145. See also Schulman K. A. Berlin J. A. Halrell W. , “The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization,” New England Journal of Medicine 340, no. 8 (1999): 618–626; Abreu J. M. , “Conscious and Nonconscious African American Stereotypes: Impact on First Impression and Diagnostic Ratings by Therapists,” Journal of Consulting and Clinical Psychology 67, no. 3 (1999): 387–393; and Van Ryn M. Burke J. , “The Effect of Patient Race and Socio-Economic Status on Physician's Perceptions of Patients,” Social Science and Medicine 50, no. 6 (2000): 813–828.

Satcher D. , “Our Commitment to Eliminate Racial and Ethnic Health Disparities,” Yale Journal of Health Policy, Law, and Ethics 1, no. 1 (2001): 1–14.

Id., at 1.

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelinesfor the Protection of Human Subjects of Research (Washington, D.C.: U. S. Government Printing Office, 1979): At B-1.

Pellegrino E. D. Thomasma D. C. , A Philosophical Basis of Medical Practice (New York: Oxford University Press, 1981): at 213.

See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 2.

See Corbie-Smith , supra note 3, at 2460.

See Powe , supra note 65, at 2.

See Gifford , supra 2, at 1373–1375.

Id., at 1373.

See King , supra note 28, at 1402. See also, Svensson C. K. , “Representation of American Blacks in Clinical Trials of New Drugs,” Journal of the American Medical Association 261, no. 1 (1989): 263–265.

Centers for Disease Control and Prevention, “United States HIV/AIDS Statistics,” HIV/AIDS Surveillance Report 13, no. 2 (June 2001): 1–4.

See Powe , supra note 65. Gardner A. , “Black Americans Still Wary of Clinical Trials,” U.S. News and World Report (January 20, 2008), available at <http://health.usnews.com/usnews/health/healthday/080114/black-americanstill-wary-of-clinical-trials> (last visited December 22, 2008).

Barrett G. , “Deadly Delay,” Newsweek Web Exclusive (February 17, 2008), available at <http://www.newsweek.com/id/112952/output/print> (last visited December 11, 2008).

See United States Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ), supra note 6, at Chapter 4, “Priority Populations,” at 1–10.

Gilliam M. , “Health Care Inequality Is Key in Abortion Rates,” Philadelphia Inquirer, August 10, 2008, available at <http://www.philly.com/inquirer/currents/20080811_health-care_inequality_is_key_in_abortion_rates.html?adString=ing.currents/currents;!category=currents;&randomOrd=081308104817> (last visited December 22, 2008).

Id., at 2.

U.S. Department of Health and Human Services, “Key Themes and Highlights from the National Healthcare Disparities Report,” 2007, at 1–11, available at <http://www.ahrq.gov/qual/nhdr07/Key.htm> (last visited December 11, 2008).

See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 5–6.

Council on Ethical and Judicial Affairs, Code of Medical Ethics: Current Opinions with Annotations, American Medical Association, Chicago, 1998, at 9.121.

See Corbie-Smith , supra note 3, at 2462.

Id., at 2462.

See U.S. Department of Health and Human Services, supra note 74, at 10.

Angell M. , “The Forgotten Domestic Crisis,” New York Times, October 13, 2002, at Wk-13.

Stolberg S. G. , “Race Gap Seen in Health Care of Equally Insured Patients,” New York Times, March 21, 2002, at A-1, A-34.

See Gardner , supra note 80, at 3.

Cohen E. , “Tuskegee's Ghosts: Fear Hinders Black Marrow Donation,” CNN.Com, February 7, 2007, at 1–2, available at <http://www.cnn.com/2007/HEALTH/02/07/bone.marrow/index.html> (last visited January 9, 2009).

See Barrett , supra note 81, at 2–3.

Mozes A. , “Report Claims Clinical Trials Miss Many Populations,” U.S. News & World Report, April 1, 2008, available at <http://health.usnews.com/usnews/health/healthday/080401/report-claims-clinical-trials-miss-many-populations.html> (last visited April 3, 2008).