Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

“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.”

Washington argues that slavery and American medicine were deeply intertwined from the beginning of US history. Physicians played a key role in supporting slavery, as they worked with enslavers to ensure that enslaved people were healthy enough to work. Similarly, physicians relied on enslaved people as a population on which to experiment and develop new advances in medical science.

“Cartwright suggested that blacks’ physical and mental defects made it impossible for them to survive without white supervision and care, alleging that the cranium of blacks was 10 percent smaller than that of whites, preventing full development of the brain and causing a stunting of the intellect.”

Samuel A. Cartwright, a Louisiana doctor, was one of the foremost proponents of scientific racism. Despite its name, scientific racism relies on misapplications of science to create justifications for the institution of slavery. In the eyes of scientific racists such as Cartwright, Black people were inherently inferior both physically and mentally, requiring the benevolence of white people to assist in their survival.

“Informed consent is not a signed piece of paper but, rather, the fluid, continuous process by which a researcher informs the subject in detail of what he or she proposes to do, why it is being proposed, and what possible consequences the experiment carries.”

Informed consent is an important concept that recurs throughout Medical Apartheid. Crucially, informed consent cannot be granted through a simple “yes” before an experiment begins. Rather, experimenters have to continuously be in dialogue with their research subjects about the nature of the experiment and have to be forthcoming about all possible risks to the subject’s health.

“One of the most tenacious beliefs was that blacks did not feel pain or anxiety, which excused painful surgical explorations without anesthesia on blacks.”

One particularly pernicious tenet of scientific racism was that Black people were physically incapable of feeling pain. Such a myth paved the way for white doctors to perform lurid and painful experiments on Black people. Misconceptions that Black people have a higher pain tolerance than white people persist into the present day, affecting many physicians’ treatment of African Americans.

“On another, deeper level [a black person turning white] posed an implicit threat to civilization, because white skin was held to denote evolutionary advantage during this period, when most scientists insisted that whites were the superior humans or perhaps even the only true humans.”

In the 1850s, showman P. T. Barnum began mounting sideshow acts of Black people who, for a variety of reasons, possessed white-appearing skin. Washington argues that such white-passing Black people created a crisis for scientific racists, who believed white people were inherently superior to Black people.

“Curator W.J. McGee aimed for a panoply of evolution that was ‘exhaustively scientific’ from the highest to the lowest forms of man. Accordingly, the ‘darkest Blacks’ from the ‘lowest known culture’ were contrasted to the ‘dominant whites’ of man’s ‘highest culmination.’”

W. J. McGee was the curator of the World Congress of Races, an anthropological exhibition at the 1904 World’s Fair that arranged members of a variety of races according to their placement in a supposed racial hierarchy. Washington argues that popular displays such as this one played a crucial role in spreading the myths of scientific racism to the general American population.

“Because of the widespread use of blacks as teaching material, new physicians left their medical school training with a deeply ingrained habit of looking upon blacks as demonstration material and experimental subjects.”

In “The Surgical Theater,” Washington describes how Black people were frequently used as the “material” for training new doctors. Washington argues that such practices actively diminished white doctors’ capacity to feel empathy for Black patients, as they learned to view Black people as nothing more than objects for experimentation.

“For blacks, anatomical dissection meant even more: It was an extension of slavery into eternity, because it represented a profound level of white control over their bodies, illustrating that they were not free even in death.”

In the 19th century, the dissection of a human corpse became a standard educational practice for new doctors. Frequently, dissection relied on the use of Black cadavers, as Black people had fewer rights than whites. Black people, however, were particularly reticent to have their corpses used for such practices, as they saw it as yet another instance of white people wielding control over their bodies.

“Lynched bodies and grisly human souvenirs served as warnings to blacks that whites could torture them, murder them, and defile their bodies with impunity.”

Many doctors in the late 19th century documented their training on Black corpses through photographs posed next to dissections or through mummified body parts. Washington compares this evidence to photographs of lynchings that frequently circulated, arguing that both served to remind Black Americans of the lack of autonomy they possessed over their bodies.

“Life-insurance companies considered blacks uninsurable and black extinction was actually predicted for the year 2000.”

Following the Civil War, free Black people in the South received little governmental support and were trapped in cycles of intense poverty that led to an abundance of disease. Many white people saw such poor health as evidence that Black people were physically inferior rather than recognizing how a lack of social support was negatively impacting African Americans.

“PHS doctors portrayed black Alabamans as resistant to health measures, intellectually inferior, impetuous, degenerate, and, above all, at the mercy of frighteningly powerful sex drives.”

The racist beliefs of Public Health Service doctors—particularly their view of Black people as inherently promiscuous—impacted their attitude toward dealing with Black men infected with syphilis. Rather than attempting to treat and eradicate syphilis in Tuskegee, the PHS instead chose to allow the disease to develop unchecked and study the results.

“[Surgeon General Thomas Parran] explained that the availability of penicillin meant the ‘opportunity’ represented by the Tuskegee Syphilis Study’s pool of syphilitic patients would never come again, and must be exploited.”

In 1943, more than 10 years into the Tuskegee Syphilis Study, penicillin was discovered to be incredibly effective against syphilis. Rather than therapeutically treat the study’s infected subjects, the PHS chose to withhold the medication, inflicting needless harm upon the research subjects.

“The sexual irrepressibility and the bad mothering were biologically located in the hereditary apparatus, [eugenicists] contended.”

The theory of eugenics emerged in the early 1900s and contended that human breeding should be controlled to produce the most evolutionarily fit offspring. However, eugenicists' appeals to science were often a means of covering up deeply racist beliefs. For instance, eugenicists claimed that Black women were genetically prone to be bad mothers to support their belief that Black people’s reproduction should be limited.

“The 1967 Black Power Conference in Newark, New Jersey, passed a resolution that equated birth control with ‘black genocide,’ and that year, a crowd of blacks chanted ‘Genocide!’ as they burned down a Cleveland, Ohio contraceptive clinic.”

After the development of the birth control pill, US governmental agencies actively promoted the pill to Black women. Many Black people, however, could not separate this supposedly benevolent program from historical attempts to reduce the Black population. As such, they claimed that the birth control pill was a means for the US government to eradicate African Americans.

“All [X-ray radiation programs] invoked the cutting-edge technology of ‘scientific light’ to efface the dark disability of racial difference, and by every account, the black experimental subjects were not only willing but eager.”

In the years following the discovery of X-rays, some clinics opened that claimed to be able to lighten skin with radiation. Such clinics relied on the metaphor of scientific knowledge as “light” to make their claims that new technological advancements eliminated the need for racial difference. In reality, the treatments failed to work and burned the patients’ skin.

“‘All I saw before me were acres of skin. It was like a farmer seeing a fertile field for the first time.’”

These are the words of Dr. Albert M. Kligman, a dermatologist who tested experimental skin products on a Black prison population. Such a quote exemplifies the attitude of many white medical researchers who have seen Black people not as human beings but as mere organic material ripe for experimentation.

“You’re important: we need you.”

In a lecture, Dr. Kligman explained to his medical students the importance of making statements such as this one to Black prisoners when convincing them to participate in experiments. Kligman recognized the loneliness and despair of many prisoners, and he advised appealing to their emotional needs to manipulate them into volunteering consent.

“[B]rain destruction was employed not only for misbehaving black boys but to ensure the docility of prisoners and, in the 1960s, as a government-funded cure for urban rioters.”

In the 1950s and 1960s, some neurosurgeons performed destructive lobotomies on Black boys with behavioral issues, as they believed Black people to have natural aggressive tendencies. These neurosurgeons believed that lobotomies could help tame the supposed aggression of Black adults, proposing to the US government that lobotomies be performed on rioters protesting against racist governmental policies.

“‘If you look, for example, at male monkeys, especially in the wild, roughly half of them survive to adulthood. The other half die by violence. That is the natural way of it for males, to knock each other off.’”

This quote comes from a speech by Dr. Frederick Goodwin to the National Health Advisory Council in 1992 when seeking funding for studies on urban violence. In the speech, Goodwin compared the behavior of Black men in poor neighborhoods to the aggressive tendencies of monkeys. Rather than consider the effects of poverty on Black men’s psyches, Goodwin relied on racist tropes that portray Black people as naturally animalistic and primitive.

“However, the Human Genome Project has erased any lingering doubts: Biological race does not exist, because all humans share the same genes.”

In Medical Apartheid, Washington distinguishes between two conceptions of race: biological and social. According to Washington, studies such as the Human Genome Project have shown that biological race does not exist, as genetic differences between human beings do not match racial groupings.

“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.”

Black people play a crucial role in the development of new medical devices, as medical experiments continue to rely on marginalized populations as sources for research subjects. However, Washington notes that many of these technologies that are developed through the use of Black subjects are often extraordinarily expensive when they reach the marketplace, making them unaffordable and inaccessible for most African Americans.

“The researchers must also tell the subject that he can quit the experiment at any time, but such a guarantee is meaningless in an all-or-nothing experimental venture such as the AbioCor tests: Quitting the experiment means dying.”

The process of informed consent was especially difficult to fulfill in tests of the AbioCor artificial heart. Although patients agreeing to test the artificial heart were told they could quit the experiment at any point, it was impossible to remove the heart once it was implanted. Experiments such as this one complicate the question of whether informed consent is always attainable.

“The Third World has become the laboratory of the West, and Africans have become the subjects of novel dangerous therapeutics.”

In the Epilogue, Washington writes that medical research has largely improved from the historical abuses that she uncovers in the rest of her book. However, she argues that medical institutions have merely transplanted their abusive techniques onto Africa, where they frequently use Africa’s lax ethical standards to conduct experiments that they would otherwise be unable to perform in a domestic context.