Several weeks ago, I read Ta-Nehisi Coates’s new book, Between the World and Me, a bold, compelling, and beautifully written letter to his son about the struggles and fears of being black in America — or more specifically, of being a black man in America. Over the past year, we have seen black lives being threatened and taken away by police, an acute reminder that the destruction of black bodies is, as Coates puts it, “heritage” in this country and will not end until the Dreamers, “those who believe that they are white” wake up from their Dream and realize the violence on which it is built.
Of the many themes in this book (Dreamers, fear, struggle, Mecca, etc.), the one that piqued my interest the most was that of the destruction of black bodies. Perhaps it is because I am in medical school, where all we think about is the body, but this question kept nagging at me: What does this theme or idea mean for medicine — an institution that has upheld, and in many ways continues to perpetuate, racism? The first thought that came to mind was that the institution of medicine itself was built on the destruction of black bodies and of maintaining the belief (or rather, myth) of the Dreamers — that they are white.
What I mean by the latter, and what Coates explains in his book, is that medicine (and science in general) has been used to justify slavery by describing distinct “biological races,” with the white race being the most superior, and the black, the least. This “scientific” knowledge was, of course, used to defend and justify slavery. And unfortunately, the idea of biological races remains hard to shake in medical practice, research, and education. Pulmonary function tests, for example, are still adjusted for race based on the age-old assumption that black people have different lung capacities than white people; black people are less likely to be given appropriate pain medication because of the implicit bias that they experience pain differently; and using racial categories in an uncritical manner in research studies can lead to false conclusions by failing to interrogate the ways that race and socioeconomic status are conflated. And in medical schools, race as a social, rather than a biological, concept is often glossed over, if mentioned at all.
But the literal destruction of black life is, in many ways, the heritage of medicine specifically, in the same way that it is the heritage of American society more generally. As Harriet Washington writes in Medical Apartheid, white doctors and surgeons experimented on black slaves, often denying them analgesia. Medical care for slaves was limited to the bare minimum needed to get them back to work rather than the standard of care provided to white folks. This history is hardly mentioned in medical curriculum (or at least, it has not been my experience, nor have my friends at other medical schools told me about discussing this topic in class).
What we will talk about, though, is the Tuskegee syphilis study, in which white doctors allowed syphilis to run its natural course in poor, black men, even after penicillin was discovered to be an effective treatment. Most, if not all, American medical students have heard about this study at some point in their educational journey, even before starting medical school. The Tuskegee study, which ran from 1932 to 1972, is taught in social medicine courses, bioethics courses, and even in microbiology courses as an example of racism in medicine as well as an example of how not to conduct medical research.
While it’s great that we acknowledge that the Tuskegee study happened and that we need to prioritize ethical research methods, it is a bit troubling that it is often framed as That One Time the Institution of Medicine Was Hella Racist. As I described earlier, the history of racism in medicine extends to well before that time.
But perhaps more troubling, especially for me as a black woman, is that in teaching that Tuskegee as That One Time Medicine Was Racist, we have also sent the message that racism in medicine only affects black men. This is a lie. Black women, too, have been subject to unethical experimentation and have been subject to things such as sterilization without knowledge or consent. That we are comfortable teaching racism in medicine as it affects black men but fail to acknowledge racism as it affects black women is misogynoir (i.e. misogyny specifically against black women). That we teach the Tuskegee syphilis study but not the history of gynecology, for example, is misogynoir. Few medical students are aware that Marion Sims developed the surgical technique to repair vesicovaginal fistulas by experimenting on black slave women, including three named Lucy, Anarcha, and Betsey (#SayHerName), who were unable to properly consent due to the power differential between physician and slave. Moreover, Sims failed to provide analgesia to these women while perfecting his technique, but then provided analgesia to white women he later operated on; this, too, is misogynoir. And that we know his name — but only those of three of the many black women through whom his discoveries were made, that we honor him as the Father of Modern Gynecology, and that we memorialize him in public spaces is misogynoir.
Misogynoir is also seen in the medical advances that have been made through research done on HeLa cells. These cells, cultured from a cervical biopsy taken from a black woman, Henrietta Lacks, and used for research without her consent, have led to medical breakthroughs that have allowed medical institutions to profit. This, too, is the destruction of black women’s bodies and misogynoir.
These are the handful of examples that I know of black women’s bodies being destroyed for the sake of medicine. And I will admit that I only know a few because these stories are ignored more often than not (and the little I know, I learned from books* I read in the past, not from my medical school courses). Just as society has a broader problem of misgynoir (which has required us to #SayHerName as a response to the fact that #BlackLivesMatter is largely understood as #BlackMensLivesMatter), so does the institution of medicine. We — myself definitely included — are unaware of the ways that black women have been exploited in the name of scientific advancement and medical knowledge; this erasure is a form of misogynoir.
For those of us in medicine, racism — and specifically, misogynoir — is, as Coates would say, our heritage. We have profited off of the destruction of black bodies, both male and female, and until we can stare that ugly history in the face, we cannot truly address the ways we continue to destroy black bodies today.
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington
The Immortal Life of Henrietta Lacks by Rebecca Skloot