“A bright mulatto...is stripped to a nude condition...and a careful examination is made of all parts of the body by the Dr. and [she] is pronounced by him to be sound. The money is then paid and she is transferred to her new owner.” With this mid-19th-century description of the sale of a human being in the nation’s capital, Harriet A. Washington begins her important new work, Medical Apartheid. Ms. Washington wrote her book while a research fellow at Harvard Medical School. The project involved years of research, including not only a close study of antebellum physicians’ memoirs and periodicals, but also a close examination of 20th-century government documents. The latter make clear the unethical practices of U.S. officials who condoned and even encouraged the kinds of medical experimentation on African-Americans—and poor people in general—that not only exploited them, but in many instances led to their disablement and even death. It is a long and sordid history. The author’s earlier employment as an inner-city social worker and then a medical journalist prepared her well for this undertaking.
Especially in the 19th century, medical experimentation on powerless women and men allowed physicians to advance their careers and even to become honored citizens esteemed as pioneers in their field. One such physician was the Southerner J. M. Simms, M.D., credited with being “the father of American gynecology.” His statue stands in New York City’s Central Park, facing Fifth Avenue and, ironically, directly across the street from the prestigious New York Academy of Medicine. He did indeed develop a surgical procedure for correcting a condition known as vesicovaginal fistula, but he did so by experimenting on slaves whom he did not consider it worth his while to provide with anesthesia–even though it was always provided when operating on white women once the procedure was perfected.
In the 20th century, the federal government itself became involved in exploitative medical experimentation. The most notorious of such government-sponsored experiments was the U.S. Public Health Service’s “Study of Syphilis in the Untreated Male Negro.” Begun in 1932 in Macon County, Ga., with uneducated sharecroppers as human guinea pigs, the study continued until 1972. It might have gone on longer had not a white Columbia University graduate student caught wind of it by accident and brought it to the attention of the media. Public Health Service personnel lied to the men under observation, telling them that they were receiving treatment when in fact they were not. After they died, they were autopsied in order to trace the ways the disease had destroyed their bodies, and often their minds as well. Without being told, unsuspecting wives and children were frequently infected too. So great was the ensuing scandal that then-president Bill Clinton issued a formal apology at a White House ceremony in 1997. Nevertheless, as Ms. Washington points out, the very length of the study (four decades) still “holds us in thrall” by the sheer horror at what was allowed to be inflicted upon unsuspecting people.
Prisons, too, have provided fertile ground for medical professionals in need of subjects for often dangerous experimentation. Generally poor and uneducated, inmates often welcomed the chance to earn small sums. Although the author points out that white prisoners also took part, the majority were black—again, sometimes with the blessing of a federal agency, the Food and Drug Administra-tion. Some of the experimentation with various drugs took place at the Holmes-burg prison complex in Pennsylvania. But even the F.D.A. became alarmed at the reckless procedures of one dermatologist there, Albert Kligman, who tested hundreds of experimental drugs during the 1950’s and 1960’s. Some prisoners were injected with herpes and wart viruses to test the efficacy of new drugs. The F.D.A. finally removed Dr. Kligman’s name from its list of approved researchers.
During the cold war, another government agency, the Atomic Energy Commission, began experiments that included injecting plutonium into subjects who were not always informed beforehand of the risk. The goal was to determine at what dosage radioactive substances could cause illnesses like leukemia, with a view toward testing the effects on soldiers exposed to radiation. The A.E.C. (later absorbed by the Department of Energy) continued experiments of this kind for five decades, from 1954 to 1994. One notorious case cited in Medical Apartheid concerns a Pullman porter who, after a work-related accident, developed cancer in one leg. During his stay in a California hospital, he was given an injection of plutonium with no therapeutic intent, only as an experiment. Many years later, to the federal government’s credit, Hazel O’Leary—the first African-American to hold the position of secretary of the U.S. Department of Energy—acknowledged the agency’s guilt and ordered that records dealing with human radiation experiments be opened.
The Central Intelligence Agency also comes in for sharp criticism for its experiments in bioterrorism. One involved the Army Chemical Corps’s releasing swarms of yellow-fever-carrying mosquitoes in two primarily African-American Florida communities. Its residents, and those of a neighboring white area, were used as test subjects for the C.I.A.’s plan to study the usefulness infected mosquitoes might have as a biological weapon for possible use against Soviet forces. Despite an increase in illnesses and death rates where the experiments took place, the C.I.A. denied for years that biological agents had been used against U.S. citizens.
Has the situation changed for the better? Near the end of her book, Ms. Washington notes that because of media exposure that led to public condemnation, the worst kinds of abuses no longer occur—a development that has led to positive changes in research ethics. She warns, though, that the possibility of medical abuse remains, with medical experimentation having simply been exported to developing countries. Sub-Saharan African nations, in particular, have become what she calls “the laboratory of the West.” There, medications considered too dangerous to test on human beings in the United States are used in clinical trials. Poverty-stricken men and women with no recourse to medical care of any kind in their own countries become in effect, like the prisoners at the Holmesburg prison complex, willing participants in risky experiments. Poor and vulnerable people of any country are always at risk of exploitation of one kind or another, but that flagrant injustices in the area of medical experimentation have taken place in the United States, right into the present time, makes the revelations of Medical Apartheid all the more disturbing.