The Case for Medical Reparations

After forcing black people to suffer centuries of unethical medical experimentation, what does American medicine owe them?

WHEN Dr. Thomas Hamilton set out to find a remedy for heatstroke in the early 1800s, he conducted a simple experiment: he dug a hole in the ground and heated it with fire. Hamilton then seated a black slave named Fed on a stool atop a raised platform inside this pit. Fed’s head remained above ground to monitor his reactions. Wet blankets were fastened over the hole to retain heat. For two to three weeks Dr. Hamilton gave Fed different potential medications and watched to see which, if any, allowed him to withstand the heat. Each trial ended only after Fed fainted from exhaustion.

Even for its time, Hamilton’s methodology was flawed: a single test subject, an arbitrary selection of remedies, and a lack of reproducible results. But in other respects, his experiment was typical of early American medicine insofar as its development often relied on black suffering for its eventual successes. In the 19th century, a powerful synergy between the medical profession and slave economy allowed both industries to prosper. The labor of black bodies were converted, through gruesome experiments like Hamilton’s, into medical knowledge. American medicine owes its success to the black lives it consumed on the path to becoming a respected occupation.

The Tuskegee Syphilis Study, which took place for four decades starting in 1932, is a well-known favorite of anyone trying to speak to America’s dark history with human subjects abuse. And yet it’s pointed to so frequently, that many might accidentally understand it as a horrific exception, rather than the rule. Experiments like Tuskegee’s were routinely published in the medical journals of the 19th century; the experimental abuse of black bodies by the medical profession was not just commonplace but foundational to its development.

The metamorphosis of American doctors from frauds to innovators began during the last sixty years of slavery. Miracle cures, bloodletting, and other practices that had long categorized physicians as frauds and quacks faded into the background, replaced by a focus on rigorous testing. Slavery expedited the process of human subjects research by allowing aspiring innovators to purchase, use, and dispose of human property without concerns about consent. The same black bodies building America’s economy also served as expendable test bodies for new surgical procedures or vaccinations. Throughout the early to mid 1800s, physicians published chronicles of black people exposed to electro-therapies, risky tumor removals, and death.

While it has long been established that physicians take advantage of the disadvantaged and disenfranchised for medical studies, the reliance on slavery was more than just another means of obtaining bodies. The plantation itself--with its own scientific approach to managing its workers and output--was an important laboratory for the creation of medical knowledge, as historian Stephen Kenny has argued. White physicians performed risky procedures on the slaves of their patrons, often to salvage a slave that the slave owner thought was particularly valuable. Consider Dr. Hamilton’s true objective while searching for a remedy for heatstroke: finding a way to allow slave owners to work their slaves harder and for longer periods of time each day.

Despite increased scrutiny surrounding human subjects research in the 1970s, the use of black people in unethical experiments continued apace. Plantations gave way to prisons as sites for dubious medical trials, just as the end of slavery gave rise to the prison industrial system. Since the early 1900s, medical researchers in America have used a predominantly black prison population as guinea pigs for risky transplant procedures, drug, and vaccination tests. In experiments authorized by the prisons and at times government entities, incarcerated people have been exposed to everything from toxins to gonorrhea, malaria, and gas gangrene. Although the U.S. created new federal regulations in 1978 to ensure that prison research remained ethical, many of those restrictions have been ignored by physicians, drug companies, and prisons themselves. From 2006 to 2008, for example, a drug company called Hythian ran an experimental drug treatment program in five different states. Those unlucky enough to be incarcerated and enrolled in the program received three different drugs, none of which were FDA approved for addiction treatment.

Research on black bodies also served to “scientifically” confirm the racist beliefs American society already held--namely, that black people were unintelligent, hypersexual, and deserving of their lot in life. Part of the reason black people were continually used as test subjects is that the so-called results of medical inquiry reinforced myths that race was biological. In the 1800s, medical scientists trotted out dehumanizing racial stereotypes, protecting the legitimacy of slavery while also justifying the continued use of black bodies as test bodies. They theorized that black people had thicker skin that protected them from sunlight and were less susceptible to disease, making them better suited for work in harsh environments like mosquito-ridden swamps.

Even today, America continues to ignore the lived experience of African Americans, effectively claiming that the basic percepts of human biology do not apply to our bodies. When faced with Eric Garner’s famous last words, “I can’t breathe,” the EMTs who arrived on the scene ignored the state protocol of supplying oxygen to individuals having difficulty breathing. Sandra Bland might still be alive today if Waller County Jail did not fail to remove the plastic bag from her cell, a routine safeguard for anyone who has exhibited past suicidal behavior, as was evidenced by her intake forms. Freddie Gray pleaded for medical attention several times, but was refused it.

When researchers look into American medicine’s entanglement with slavery and racist institutions, they all point to the fact that African Americans have worse health outcomes when compared to whites in study after study. We are more likely to have diabetes, high blood pressure, and asthma; more likely to die from cancer, stroke, and heart disease. They note that America’s history of unethical experimentation on black bodies has resulted in the distrust that some African Americans have towards medicine today. And they go on to propose that physicians must correct, understand, and address this legitimate distrust in order to include more African Americans in future clinical trials. Never do they suggest that something is owed for using black bodies for profit--rather, the focus is on finding ways to continue using those bodies.

So what is to be done?

There is a history in calling for reforms and free health care to rectify disparities. The Black Panthers set up free medical clinics in the 1970s, simultaneously calling attention to illnesses like sickle cell anemia affecting black communities and arguing that African Americans deserve to have their basic health needs met. Black churches and religious organizations, likewise concerned about health care, created clinics or community-based initiatives in response.

Contemporary reparations, it seems, would compensate living descendants for contributions their ancestors were forced to make and to correct the health disparities black communities face today. For the medical profession, the class action lawsuit following the Tuskegee Syphilis Study serves as a starting place for discussing reparations: it awarded the men involved in the study monetary damages and a lifetime of free medical care not just to those harmed by the study, but to their wives, widows, and children. While monetary damages may only be appropriate when repaying individuals directly harmed by unethical experimentation, all African Americans are victims of American medicine’s violent legacy, burdened by their suspicions as well as systematic inequalities, and so deserve similar restitution.

To be considered a form of true compensation, a system of free health care for all African Americans must tackle issues of access and cost. America’s segregated medical system, where black neighborhoods lack quality health facilities, can be corrected by building sustainable medical infrastructures in black communities. That means investing in doctors’ offices, hospitals, and outpatient resources located in the community and it means training doctors to focus on health issues prevalent in the community. A free health care initiative would also tackle issues that have persisted after the Affordable Care Act, like inadequate premium assistance and out-of-pocket costs.

Of course, free medical care will not counteract the fear and stigma associated with doctors and medical research. Outreach, education, and cultural competency training are useful, but only half-measures when the issue is that for centuries doctors have justified their stereotyping of black bodies and behaviors by categorizing them as medical facts. Medical professionals need to listen to the lived black experience. It should not take another black person being ignored as they plead that they cannot breathe for the medical profession to realize this. Medical staff must learn to think outside of the noncompliant black patient paradigm.

Ultimately, equality is not enough to repair the racist dysfunction of the medical system. Just as America owes a debt for decades of unpaid slave labor, the medical system must pay reparations for its failure to treat black bodies with care.