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

In “Nuclear Winter,” Washington focuses on America’s history of radiation experiments. For much of the 20th century, the US Atomic Energy Commission (AEC) subjected a variety of Americans to doses of radiation to study the effects radiation has on the body. Although standards of informed consent began to circulate in the years after World War II, many scientists knowingly violated these standards to pursue their experiments.

Such radiation experiments trace their beginnings to Wilhelm Conrad Roentgen’s discovery of X-rays in 1895. The use of radiation quickly became a medical fad, and doctors began using it on their patients in high doses. Some clinics opened that encouraged the use of radiation for beautification, specifically targeting African Americans through advertised treatments that claimed to lighten skin.

Although the use of atomic bombs in World War II proved radiation to be harmful and deadly, many scientists desired precise studies to track the exact ways in which radioactive substances change and harm the human body. Many of the doctors administering these experiments were former Nazi scientists, who were legally brought to the US to continue their studies through “Operation Paperclip” (229). In many cases, patients involved in these studies were intentionally tricked into participating. Ebb Cade, a truck driver who was involved in an accident, was secretly injected with radioactive plutonium while unconscious. Cade was kept in a hospital for months while the doctors took bone and teeth samples for analysis before he finally escaped. Another subject, Elmer Allen, was told by doctors that he was being given an injection to treat cancer in his leg. The doctors failed to inform Allen that the injection was actually plutonium and that they “expect[ed] no therapeutic effect” (221-22).

As Washington notes, these studies had a more complicated relationship with race than the studies described in the book’s earlier chapters. Many of the studies did use white subjects, and not all of them specifically targeted Black people. However, Washington argues that the radiation studies almost always used proportions of Black research subjects far larger than the proportions of subjects in the overall population. Some studies purposefully used Black subjects, such as one study that wished to test whether Black people had a higher tolerance for radiation than white people. The study proved that Black skin was actually more sensitive to radiation. However, the myth that Black people had a higher radiation resistance persisted for years, and lab technicians administering X-rays would frequently use higher levels of radiation than they would for white patients.

“Caged Subjects” focuses on the history of medical experiments performed on prisoners. Washington argues that prisoners make for an especially attractive testing group for Phase I trials of experimental drugs. Phase I trials, which study “How safe is this drug?” (246), require a group of research subjects that can be closely followed to observe all possible side effects. As the prison population in the US is disproportionately composed of African Americans, the result is that these studies exploit Black people to test highly experimental drugs for use by the larger population. In reporting their findings, doctors often focus on the stories of their white subjects to downplay the unbalanced racial makeup of their prison studies.

While Washington describes a number of abusive experiments in prisons, she focuses on those performed by Dr. Albert M. Kligman, a dermatologist based at the University of Pennsylvania. Kligman was one day called to the Holmesburg Prison in Philadelphia to prescribe medication for athlete’s foot. Upon visiting the institution, Kligman was quickly struck by the possibility of conducting lucrative experiments on the prison population. Kligman was soon testing a variety of skin medicines and products on the inmates, and he made a fortune for himself from the development of dermatological medications. However, Black inmates often suffered intense and permanent physical damage from the myriad experimental drugs Kligman tested. Former inmate Jesse Williams describes his experience:

Williams told the audience of being burned by radiation and sulfuric acid, of immersing his arms in chemicals that had tanned his skin like leather, and of how physicians and technicians had rubbed acid into his scrotum until the skin fell away—all for three dollars a session (244).

Williams was never informed of the risks of these treatments and suffered effects from them for decades after. Kligman’s experiments extended beyond dermatological medicine and included testing the effects of LSD on inmates as part of the CIA’s MK-ULTRA program.

Many American doctors claim that prison testing meets the highest ethical standards set by the Nuremberg Code and that the participation of prisoners is always voluntary. Washington, however, details a variety of ways in which prisoners were forced to partake in experimental trials. In some extreme cases, prisoners were forced by the institution to participate, even after saying no. The forms of coercion, though, were often more subtle. Many of the prisoners came from poverty and were pressured by social workers into participating in experiments to earn money. In other cases, prisoners participated in hopes that it would help their chances of making parole. While the number of medical experiments on prisoners decreased in the 1970s due to the passing of higher ethical standards, medical institutions continue to use prison populations for drug experiments into the present day.

Washington uses “The Children’s Crusade” to explore the various medical experiments that were conducted on African American children throughout the 20th century—often with little regard for the child’s health or respect for the parent’s right to informed consent. Often, these studies were meant to test whether Black people have a genetic predisposition to violent and aggressive behaviors.

According to Washington, such an understanding assumes that Black people are “born criminals” (277), and behavior that might be understood as normal teenage acting out is instead characterized by doctors as pathologically violent. Often, Black juveniles in the prison system are diagnosed with a variety of mental health conditions, including “conduct disorder, oppositional defiant disorder, and attention-deficit hyperactivity disorder” (274), forever marking them as psychologically unfit. By focusing on the supposedly innate violence of Black people, the medical establishment fails to fund studies that might focus on the ways in which violence and aggression are a response to the systemic poverty that ensnares African Americans.

One such study in the 1990s, conducted by Columbia University, specifically targeted the younger siblings of Black teenagers in a juvenile penitentiary. The study sought to observe “younger brothers of male offenders in an effort to identify early predictors of antisocial behavior” (273). To test aggression, the researchers administered a drug called fenfluramine to Black children under the age of 10 and charted the resulting changes in serotonin levels. The scientists believed that excessive increases in serotonin would indicate the child had a predisposition toward acting aggressively—a claim that Washington characterizes as “based upon questionable science” (275). In seeking subjects for the study, researchers offered families payments of $100, as well as a $25 gift certificate to Toys “R” Us to the child. The researchers did not explain the full purpose of the study, nor the nature of the drug they were administering, solely saying that they were testing the children for possible medical issues. Charisse Johnson’s son Isaac, who participated in the study, began having headaches and other mental problems soon after the study began. In the years following the study, fenfluramine was shown to cause brain damage, and Johnson unsuccessfully filed a lawsuit against Columbia.

Washington also describes the history of lobotomies performed on Black children in which physicians inserted surgical tools into the brain and “blindly” cut away brain tissue—an act that Washington calls “a murder of the mind” (284). While white children might have been prescribed psychiatric treatment to deal with misbehavior, Black children were almost immediately assumed to be pathologically unfit and in need of lobotomies. One neurosurgeon, Dr. Orlando J. Andy, performed a variety of intensive lobotomies to cure a young Black boy, J. M., of his supposedly “aggressive” behaviors. While Andy reports that J. M. ultimately developed a calm demeanor through the surgery, Washington notes that Andy essentially removed all parts of J. M.’s brain that allow one to feel emotions.