Prejudice and the medical profession: A five-year update

Journal of Law, Medicine and Ethics

Volumn 37, Issue 1, 2009, Pages 118-133

  Clark, Peter A ^a,b  

^a Institute of Catholic Bioethics   (United States)

^b SAINT JOSEPH S UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AFRICAN AMERICAN; ARTICLE; CULTURAL COMPETENCE; ETHICS; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH DISPARITY; HISTORY; HUMAN; MEDICAL ETHICS; MINORITY GROUP; SOCIAL PSYCHOLOGY; TRUST; UNITED STATES;

AFRICAN AMERICANS; CULTURAL COMPETENCY; ETHICS, MEDICAL; HEALTH CARE REFORM; HEALTH SERVICES ACCESSIBILITY; HEALTH STATUS DISPARITIES; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HUMANS; MINORITY GROUPS; PREJUDICE; TRUST; UNITED STATES;

EID: 61349187828     PISSN: 10731105     EISSN: 1748720X     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2009.00356.x     Document Type: Article

References (96)

1. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Institute of Medicine, Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Health Care (Washington, D.C. : National Academy Press, 2002).
2. A. Gifford, W. Cunningham, and K. Heslin et al. Participation in Research and Access to Experimental Treatments by HIV-Infected Patients New England Journal of Medicine 346, no. 18 (May 2 2002 1373 1382.
3. G. Corbie-Smith, S. Thomas, and D. St. George Distrust, Race, and Research Archives of Internal Medicine 162, no. 21 (November 25, 2002 2458 2463.
4. The term "medical profession" is a social construct and in this paper is being used in a broad sense. The medical profession is comprised of millions of individuals in which, many may be racist and insensitive, but there are many of whom are not racist. For lack of a better term, the term "medical profession" will be used to designate medical professionals in the United States knowing full well not all are being deemed racist.
5. See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 4.
6. United States Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ), 2007 National Healthcare Disparities Report, Washington, D.C., February 2008.
7. The Tuskegee Syphilis Study will be discussed in more depth later in this article. For a more detailed analysis of the Tuskegee Syphilis Study see, J. H. Jones, Bad Blood: The Tuskegee Syphilis Experiment - A Tragedy of Race and Medicine (New York : The Free Press, 1981).
8. G. W. Allport and L. Postman, The Psychology of Rumor (New York : Henry Holt, 1947 ix.
9. P. Turner, I Heard It Through the Grapevine: Rumor in African American Culture (Berkeley : University of California Press, 1993 at 4.
10. Id., at 5.
11. Allport and Postman make a case that legends are often little more than solidified rumors. See Allport and Postman, supra note 8, at 167.
12. Id., at xv and 108.
13. See Turner, supra note 9, at 138.
14. V. Gamble A Legacy of Distrust: African Americans and Medical Research American Journal of Preventative Medicine 9, no. 6, Supplement (1993 35 38.
15. Id., at 35. See also, T. D. Weld, American Slavery As It Is: Testimony of a Thousand Witnesses (New York : 1939 F. N. Boone, Dr. Thomas Hamilton: Two Views of a Gentleman of the Old South (New York : Phylon, 1967 and. J. M. Sims, The Story of My Life (New York : Appleton, 1998).
16. Id., at 35-36.
17. For a more detailed analysis of the influence of the Paris school on American medicine, see E. Ackerknecht, Medicine at the Paris Hospital, 1794-1848 (Baltimore : Johns Hopkins Press, 1967 R. Shryock, The Development of Modern Medicine: An Interpretation of the Social and Scientific Factors Involved (New York : Elsevier 1947 M. Foucault, The Birth of the Clinic: An Archeology of Medical Perception (New York : Routledge Classics, 1973 and. G. Gerald, Edward Garvis and the Medical World of Nineteenth Century America (Knoxville : Turner, 1978).
18. T. Savitt The Use of Blacks for Medical Experimentation and Demonstration in the Old South Journal of Southern History 48, no. 3 (1972 332 333.
19. Id., at 333.
20. G.-M. Fry, Night Riders in Black Folk History (Athens, GA : University of Georgia Press, 1991 at 174-176.
21. Id., at 174-178.
22. Id., at 176. See also Guttmacher Bootlegging Bodies Society of Medical History of Chicago 4, no. 2 (January 1935 353 402.
23. Id. (Fry), at 171.
24. For a more detailed analysis of the black migration to industrial centers, see D. Henderson The Negro Migration of 1916-1918 Journal of Negro History 6, no. 2 (January 1921 383 498.
25. See Fry, supra note 20, at 171.
26. Id., at 172.
27. D. C. Humphrey Dissection and Discrimination: The Social Origins of Cadavers in America, 1760-1915 Bulletin of the New York Academy of Medicine 44, no. 9 (1970 819 827, at 822. Humphrey also cites T. S. Sozinsky Grave-Robbing and Dissection Penn Monthly 19 (1879 216.
28. Id. (Humphrey), at 824.
29. Id., at 824 825.
30. See Gamble, supra note 14, at 36.
31. Id., at 36. See also, T. W. Murrell Syphilis and the American Negro Journal of the American Medical Association 54, no. 11 (1910 846 849 at 847 and H. H. Hazen Syphilis in the American Negro Journal of the American Medical Association 63, no. 6 (1914 463 468 at 463.
32. J. G. Caldwell and E. V. Price, et al. Aortic Regurgitation in the Tuskegee Study of Untreated Syphilis Journal of Chronic Diseases 26, no. 3 (1973 187 94 S. Hiltner The Tuskegee Syphilis Study under Review Christ Century 90, no. 43 (1973 1174 1176 R. H. Kampmeier The Tuskegee Study of Untreated Syphilis South Medical Journal 65, no. 10 (1972 1247 1251 R. H. Kampmeier Final Report on the 'Tuskegee Syphilis Study South Medical Journal 67, no. 11 (1974 1349 1353 S. Olansky and L. Simpson et al. Environmental Factors in the Tuskegee Study of Untreated Syphilis Public Health Report 69, no. 7 (1954 691 698 D. H. Rockwell and A. R. Yobs et al. The Tuskegee Study of Untreated Syphilis: The 30th Year of Observation Archives of Internal Medicine 114 (1964 792 798 S. H. Schuman and S. Olansky et al. Untreated Syphilis in the Male Negro: Background and Current Status of Patients in the Tuskegee Study Journal of Chronic Diseases 2, no. 5 (1955 543 58.
33. In August, 1972, HEW appointed an investigatory panel which issued a report the following year. The panel found the study to have been "ethically unjustified" and argued that penicillin should have been provided. See A. Brandt Racism and Research: The Case of the Tuskegee Syphilis Study Hastings Center Report 8, no. 6 (December 1978 21 29 at 21 and Ad Hoc Advisory Panel, Department of Health, Education and Welfare, Final Report of the Tuskegee Syphilis Study (Washington, D.C. : Government Printing Office, 1973). For a more detailed analysis of the Tuskegee Syphilis Study see. A. Caplan When Evil Intrudes Hastings Center Report 22, no. 6 (November-December 1992 29 32 H. Edgar Outside the Community Hastings Center Report 22, no. 6 (November-December 1992 32 35 P. A. King The Dangers of Difference Hastings Center Report 22, no. 6 (November-December 1992 35 38 and. J. H. Jones The Tuskegee Legacy: AIDS and the Black Community Hastings Center Report 22, no. 6 (November-December 1992 38 40.
34. For a more detailed analysis of the impact of birth control on the African American community, see R. G. Weisbord Birth Control and the Black American: A Matter of Genocide Demography 10, no. 3 (1973 571 590.
35. Norplant is the trade name for a birth control product consisting of six thin capsules that, upon being implanted in the woman's arm, releases an ovulation-inhibiting hormone. See Turner, supra note 9, at 221.
36. Id., at 222. See also, Editor One Well-Read Editorial Newsweek 31, December 1990, at 65-66 and. D. Kimelman Poverty and Norplant Philadelphia Inquirer 12, December 1990, at A-18.
37. T. Abate Brave New World of Genetics Explored at Academy of Science Meeting San Francisco Chronicle, February 25, 2002, E-1.
38. Id., at E-1.
39. For a more detailed analysis of the effects of race on medical care see, J. H. Geiger Race and Health Care: An American Dilemma New England Journal of Medicine 335, no. 12 (1996 815 816 M. E. Gornick, P. W. Eggers, and T. W. Reilly et al. Effects of Race and Income on Mortality and Use of Services among Medicare Beneficiaries New England Journal of Medicine 335, no. 11 (1996 791 799.
40. D. Y. Wilkenson For Whose Benefit?: Politics and Sickle Cell Anemia The Black Scholar 5, no. 8 (1974 26 31. See also King, supra note 33, at 37.
41. Id.
42. Id. (Wilkenson), at 30.
43. See C. Curtis, Vaccines Are Dangerous: A Warning to the Black Community (Brooklyn : A&B Books, 1991).
44. B. O'Connor Foundations of African-American Mistrust of the Medical Establishment unpublished manuscript, Hahnemann University Medical School, Philadelphia, Pennsylvania, at 10-11.
45. A national survey, conducted by the Roper Starch Worldwide polling company, found that out of 500 blacks, 18% said they believed AIDS was a man-made virus; 9% in the general population agreed. When asked more specifically whether HIV and AIDS were part of a plot to kill blacks, 9% of the all-black group said it was definitely true; compared to 17% in the general group. See L. Richardson An Old Experiment's Legacy: Distrust of AIDS Treatment New York Times, April 21, 1997, at A-9.
46. See Gamble, supra note 14, at 37. See also, S. B. Thomas and S. C. Quinn The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community New York Times, April 21, 1997, at A-9.
47. See Turner, supra note 9, at 158. See also E. A. Kloniff and H. Landrine Do Blacks Believe That HIV/AIDS Is a Government Conspiracy against Them Preventative Medicine 28, no. 4 (1998 451 457 G. Corbie-Smith, S. B. Thomas, M. V. Williams, and S. Moody-Ayers Attitudes and Beliefs of African Americans toward Participation in Medical Research Journal of General Internal Medicine 14, no. 9 (1999 537 546.
48. Cneters for Disease Control HIV/AIDS in the United States-Fact Sheet March 2008, at 1-5, available at http://www.cdc.gov/hiv/resources/factsheets/ print/us.htm last visited January 9, 2009).
49. It should be noted that "age, sex, diet, underlying disease, and the concomitant use of other medications, race and genetic factors may play pivotal parts in the variability of subjects' responses to a medication." See T. King Racial Disparities in Clinical Trials New England Journal of Medicine 346, no. 18 (May 2, 2002 1400 1402.
50. See Gifford et al., supra 2, at 1373 1382.
51. Id., at 1376-1379. The NIH and the FDA both established guidelines encouraging inclusion of more women and minority groups in clinical trials. See, National Institutes of Health Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Trials Federal Register 59 (1994 14508 14513 and. Food and Drug Administration, Modernization Act of 1997 (FDAMA or the Act), Public Law No. 105-115 (November 21, 1997). It should be noted that experts at the NIH challenged the findings of Gifford et al., saying that because the study was based on patient interviews in 1996-1998, it was therefore out of date.
52. See Gifford et al., supra note 2, at 1379.
53. See Corbie-Smith et al., supra note 3, at 2458 2463.
54. See King, supra note 49, at 1402.
55. Id., at 1402. See also L. Fogarty, D. Roter, and S. Larson et al. Patient Adherence to HIV Medication Regimens: A Review of Published and Abstract Reports Patient Education Council 46, no. 2 (2002 93 108.
56. See King, supra note 49, at 1401.
57. J. Merz Report Claims Clinical Trials Miss Many Populations Washington Post, April 3, 2008, available at http://www.irbforum.org/forum/read/2/167/ 167Vt?PHPSESSID=656c640dfe552e73efb2e3877c277473 last visited December 11, 2008).
58. See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 2.
59. Id., at 3 4.
60. United States Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ), supra note 6, at 5 6.
61. Id., at 6.
62. Id., at 7.
63. D. Williams, H. Gonzalez, and H. Neighbors et al. Prevalence and Distribution of Major Depressive Disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites Archives of General Psychiatry 64, no. 3 (March 2007 305 315.
64. M. Halpern, E. Ward, and A. Pavluck et al Association of Insurance Status and Ethnicity with Cancer Stage at Diagnosis for 12 Cancer Sites: A Retrospective Analysis Lancet Oncology 9, no. 3 (March 2008 222 231.
65. N. Powe et al. Black Americans Still Wary of Clinical Trials Medicine Online (January 14, 2008 available at http://www.medicineonline.com/news/12/ 10849/Black-Americans-Still-Wary-0f-clinical last visited December 11, 2008).
66. Editor Did Tuskegee Damage Trust On Clinical Trials CNN.com, March 19, 2008, available at http://www.cnn.com/2008/HEALTH/03/17/clinical.trials.ap/ index.html last visited December 11, 2008).
67. T. Sequist, G. M. Fitzmaurice, and R. Marshall et al. Physician Performance and Racial Disparities in Diabetes Mellitus Care Archives of Internal Medicine 168, no. 11 (June 9, 2008 1145 1151 and. L. Minnema Race May Limit Care Washington Post, June 17, 2008, available at http://www. washingtonpost.com/wp-dyn/content/article/2008/06/13/AR2008061303263 last visited December 22, 2008).
68. Id. (Sequist et al.), at 1145. See also K. A. Schulman, J. A. Berlin, and W. Halrell et al. The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization New England Journal of Medicine 340, no. 8 (1999 618 626 J. M. Abreu Conscious and Nonconscious African American Stereotypes: Impact on First Impression and Diagnostic Ratings by Therapists Journal of Consulting and Clinical Psychology 67, no. 3 (1999 387 393 and. M. Van Ryn and J. Burke The Effect of Patient Race and Socio-Economic Status on Physician's Perceptions of Patients Social Science and Medicine 50, no. 6 (2000 813 828.
69. D. Satcher Our Commitment to Eliminate Racial and Ethnic Health Disparities Yale Journal of Health Policy, Law, and Ethics 1, no. 1 (2001 1 14.
70. Id., at 1.
71. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research (Washington, D.C. : U. S. Government Printing Office, 1979 at B-1.
72. E. D. Pellegrino and D. C. Thomasma, A Philosophical Basis of Medical Practice (New York : Oxford University Press, 1981 at 213.
73. See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 2.
74. See Corbie-Smith et al., supra note 3, at 2460.
75. See Powe et al., supra note 65, at 2.
76. See Gifford et al., supra 2, at 1373 1375.
77. Id., at 1373.
78. See King, supra note 28, at 1402. See also, C. K. Svensson Representation of American Blacks in Clinical Trials of New Drugs Journal of the American Medical Association 261, no. 2 (1989 263 265.
79. Centers for Disease Control and Prevention United States HIV/AIDS Statistics HIV/AIDS Surveillance Report 13, no. 2 (June 2001 1 4.
80. See Powe et al., supra note 65. A. Gardner Black Americans Still Wary of Clinical Trials U.S. News and World Report (January 20, 2008 available at http://health.usnews.com/usnews/health/healthday/080114/black-americanstill- wary-of-clinical-trials last visited December 22, 2008).
81. G. Barrett Deadly Delay Newsweek Web Exclusive (February 17, 2008 available at http://www.newsweek.com/id/112952/output/print last visited December 11, 2008).
82. See United States Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ), supra note 6, at Chapter 4 Priority Populations at 1-10.
83. M. Gilliam Health Care Inequality Is Key in Abortion Rates Philadelphia Inquirer, August 10, 2008, available at http://www.philly.com/inquirer/currents/ 20080811-health-care-inequality-is-key-in-abortion-rates.html?adString=ing. currents/currents;!category=currents;&randomOrd=081308104817 last visited December 22, 2008).
84. Id., at 2.
85. U.S. Department of Health and Human Services Key Themes and Highlights from the National Healthcare Disparities Report 2007, at 1-11, available at http://www.ahrq.gov/qual/nhdr07/Key.htm last visited December 11, 2008).
86. See Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, supra note 1, at 5 6.
87. Council on Ethical and Judicial Affairs, Code of Medical Ethics: Current Opinions with Annotations, American Medical Association, Chicago, 1998, at 9.121.
88. See Corbie-Smith et al., supra note 3, at 2462.
89. Id., at 2462.
90. See U.S. Department of Health and Human Services, supra note 74, at 10.
91. M. Angell The Forgotten Domestic Crisis New York Times, October 13, 2002, at Wk-13.
92. S. G. Stolberg Race Gap Seen in Health Care of Equally Insured Patients New York Times, March 21, 2002, at A-1, A-34.
93. See Gardner, supra note 80, at 3.
94. E. Cohen Tuskegee's Ghosts: Fear Hinders Black Marrow Donation CNN.Com, February 7, 2007, at 1-2, available at http://www.cnn.com/2007/HEALTH/02/07/ bone.marrow/index.html last visited January 9, 2009).
95. See Barrett, supra note 81, at 2 3.
96. A. Mozes Report Claims Clinical Trials Miss Many Populations U.S. News & World Report, April 1, 2008, available at http://health.usnews.com/usnews/ health/healthday/080401/report-claims-clinical-trials-miss-many-populations. html last visited April 3, 2008).