What Message Does this Medical School Yearbook Photo Send to African-American Patients?
When I first saw the above-image of two future doctors, one dressed in blackface, the other in a KKK hood and sheet, I just felt really sad.
I was reminded of so many African-American clients I represented who felt that their treatment was somehow “less” because of their race - The man who was ignored over and over with complaints that turned out to be a progressively worsening spinal cord injury, leaving him barely able to walk –The child with Erb’s Palsy whose family wasn’t offered a primary nerve graft repair until it would have been year’s too late for it to help - The woman who’s urine was the colour of Coke before anyone recognised her end-stage kidney disease - The young woman who bled to death in the emergency room reception area, waiting for hours to be seen for a ruptured ectopic pregnancy.
So when I saw this photo, I thought about how all of the African-American patients in the US who felt they got “different” treatment from their doctors must have felt when they learned that photo was feature in a Medical School Yearbook.
I then thought about the infamous and unethical study undertaken by the US Public Health Service over the course of 40 years. “The Tuskegee Study of Untreated Syphilis in the Negro Male” was purposed at observing the natural history of untreated syphilis, something that I thought we already knew plenty about , (I mean, didn’t Shakespeare write about it in the 1500s?). The subjects who were recruited, 600 impoverished African-American sharecroppers from Macon County, Alabama, were told that, for their participation, they would receive free health care from the US government, hot meals and free burial insurance. They were also told the study would only last six months.
399 of the men in the study had syphilis. 201 did not have the disease. Despite the loss of funding for the treatment of syphilis in the study, the study was not cancelled. Instead the study continued without the men being informed that they had a disease or that they would never receive treatment in the study. Instead they were simply told that they were being treated for "bad blood.”
About 15 years into the study, penicillin was the standard treatment for syphilis. But this group of African-American men were not told of their diagnosis, and were not told of the treatment. Instead, the medical researchers continued the study for another 25 years, and many of the men were lied to and given placebo treatments so that researchers could observe the full, long-term progression of the fatal disease. The study then required all participants to undergo an autopsy after death in order to receive the promised funeral benefits.
In 1972, a whistleblower came forward to tell what was occurring. The story ran on the front page of the New York Times. The article suggested that the African-American men's status did not warrant ethical debate, to the researchers. “They were subjects, not patients; clinical material, not sick people.”
By the time the story broke, only 74 of the men in the study were still alive. 128 had died of syphilis or related complications. 40 of their wives had contracted the disease. 19 of their children born with congenital syphilis. All of the victims were African-Americans.
At its end, the study was controlled by the Center for Disease Control (CDC), and was supported by local chapters of the National Medical Association (NMA) and the American Medical Association (AMA).
In a twist of irony, the US Government paid $10 million, plus provision of free medical treatment to surviving participants and family members who were infected as a consequence of the study.
On May 16, 1997, 25 years after the story broke, President Clinton formally apologized on behalf of the United States:
What was done cannot be undone. But we can end the silence. We can stop turning our heads away. We can look at you in the eye and finally say on behalf of the American people, what the United States government did was shameful, and I am sorry ... To our African American citizens, I am sorry that your federal government orchestrated a study so clearly racist.
The mistreatment under the Tuskegee Syphilis Study is reported to have significantly damaged the trust of the African-American community toward public health efforts in the United States, and to have contributed to the reluctance of many poor African-Americans to seek routine preventive care. I query whether seeing future doctors dressed in blackface and as clansmen will have a similar impact.