In her book titled Medical Apartheid, Harriet Washington argues that African Americans have taken part in biomedical research right from its onset. The book belongs to the history genre and gives account of how African Americans have been exploited and abused by a medical establishment that is racist in nature. According to her, the history of exploiting and abusing African Americans extends past the notorious Tuskegee research commissioned by the United States Public Health Service (USPHS), (Washington, 2006) in which black Americans sharecroppers, were for four decades taken through various medical procedures and prohibited from receiving penicillin treatment. This went on regardless of the fact that the primary objective of the research, which was ascertaining the course of the disease, had already been met. She argues that researchers who exploit black Americans were a common thing for the American history at a time when African American patients were normally considered the most suitable subjects for nontherapeutic, nonconsensual studies (Washington, 2006). In her concluding remarks, she states that the reluctance that African Americans have to take part in medical studies and their skepticism towards medical establishment is an ill-fated result. Apart from detailing a shameful past, Washington intends to convince African Americans to take an active part in therapeutic medical studies, specifically in spheres that directly touch their community's health, but she warns them to be vigilant of possible abuses.
Washington has an ample background in the area of ethical research. She has been a senior expert at Tuskegee University in the National Center for Bioethics, she has worked at Harvard School of Public Health, and as an ethics lecturer at Harvard Medical School. Moreover, as an editor and journalist, she has been employed in many publications, including the USA Today. She was also a Knight Fellow at Stanford University. She has authored in academic forums like the New England Journal of Medicine and the Harvard Public Health Review. Washington has also received numerous accolades for her work and has been residing in New York City. Being a resident of a cosmopolitan city and having worked in various institutions in the ethics department, Washington is acquitted with the ills of the American society, which she cites as examples to make her work more convincing. All these adds to her ethos and increases the credibility of her research.
Washington starts her shocking account in the colonial period, a time when slave owners would sell or hire out slaves to medical establishments to be used as guinea pigs in clinical experiments. Moving into the 20th century, Washington shows the manner in which the pseudoscience of eugenics as well as social Darwinism was utilized to validate experimental exploitation and sloppy clinical treatment of African Americans, and the perception that they were oversexed, biologically inferior, and not suited for adult responsibilities. She provides shocking current details concerning the government-sponsored Tuskegee experiment in conjunction to the less famous medical atrocities carried out by the private institutions, prisons, armed forces, and government. A product of many years of research into experimental reports and medical journals long undisturbed, the book brings into light the concealed underbelly of medical research and makes it easier for one to comprehend the genesis of the black Americans health disparity. In the last chapter, it offers a complete potential context for understanding the fallout, which has made black Americans to have a negative attitude towards participating in clinical trials and distrust the entire medical establishment.
According to Washington, her main intention in writing Medical Apartheid was to bridge the health disparity that bothers black Americans. A gap that is evident, currently, research indicate that African Americans die at a younger age than their white counterparts do. Moreover, they get fewer medical services and have significantly greater infant mortality rates. She also seeks to encourage the black community to shun their negative attitude towards taking an active role in medical research and the entire medical industry and instead seek medical intervention. She presents her work in a clear, coherent, and accurate manner. For instance, she opens up the book by documenting the exploitation that occurred in the colonial times, then ventures into the 20th century, and concludes by offering a plausible solution to the problem. It is meticulously researched in archives that have been ignored for a long time owing to the numerous numbers of footnotes.
I found various claims to have been backed by strong evidence. For instance, she backs her claim that nontherapeutic, nonconsensual experimentation really happened by citing the 1963 case of the Jewish Chronic Disease Hospital where skillful researchers administered live cancer cells into the bloodstream of residents of a nursing home, a number of whom were Holocaust survivors. In this study, the researchers intended to assess whether the infection fighting mechanism of a sick person could recognize and conquer foreign cancer cells just like the immune systems of healthy individuals. Moreover, to prove that medical sadism has found its way to Africa, Washington provides substantive evidence to back her assertion that women subjects from underdeveloped nations taking part in thalidomide trials for AIDS and leprosy were never warned of the negative side effects of the drug, causing birth defects (Washington, 2006). She gives account of the trials conducted in Mali and Somalia.
The book has two major weaknesses. To start with, it does not place the experience of black Americans in an ethical, scientific, social, and historical context, paralleling it to that of research subjects. Secondly, the book has several exaggerations, contradictions, distortions, confusions, and errors that reduces its credibility. The American history of medical research has been rife with triumphs and tragedies. Although there have been several issues of exploitation, measures have been put in place to curb future occurrence. Since Tuskegee and past scandals, more safeguards have been put in place such as the creation of independent review boards that are charged with the responsibility of ensuring that a research is conducted in an ethical manner. Further, the claim by Washington that the racial homogeneity seen in American medical researchers is based on skin color is erroneous (Washington, 2006). Although it is evident that most American researchers, both in the past and current times, may be racist, this explanation is simple-minded. Risky research has normally depended upon various susceptible populations such as the mentally disabled, prisoners, orphans, and soldiers from all occupations. It is understandable that African Americans have experienced exploitation; however, they have not been singled out predominantly or exclusively. David Rothman, a medical historian asserts that medical research, particularly in the years following the Second World War, was unabashedly utilitarian (Rothman, 2006). Both the government and the pharmaceutical industry pumped in millions of dollars to develop antibiotics, vaccines, and other drugs, as well as to determine radiation and various toxicities. Therefore, it was not improper to enroll vulnerable populations in research as it offered an avenue to know the ills that faced them, this offer them a solution.
As part of the solution, Washington claims that the laws that seem to water informed consent down such as the law enacted in 1996 allowing emergency room patients to be used in research without seeking their consent should never erode the issue of informed consent. Further, she advocates the need to establish a patients education program since majority of people participate in medical research without the knowledge of how to safeguard themselves while others do not know what their rights are. Lastly, she demands African Americans to take charge of the situation. According to her, the answer is does not lie in asking African American to distance themselves from participating in medical research since it is an integral part of treatment. However, she cautions that there is a need for them to be informed on the how they can protect themselves. African Americans needs to educate themselves as well as militate for better treatment.
Washington intended her message to reach the African American community who for many years have been exploited by racist researchers, eventually withdrawing from seeking medical intervention, or participating in scientific research. Washington assumed that by detailing the scientific racism (Washington, 2006) that has been directed towards the black community since the colonial eras, she would be able to show them why they are afflicted by health disparity and would in turn motivate them to take an active role in medical research. She does this with the help of persuasive language, in which she employs ethos, pathos, and logos to reach to the minds of the audience. She brings about the image of a powerful and horrible medicine, sex, race, and abuse of power. The book offers a rich resource for medical students to learn on the best ways to conduct an ethical research.
When I first read the book, I was shocked of the various injustices that have been happening to the African American community. The issue of medical sadism kept resonating in my mind. All while reading the book, I could not help pity the black Americans that for a long time have been subjected to heinous act at the hands of medical researchers. Before going through the book, my understanding of the health gap that is faced by blacks was limited. I always thought that it rose from lack of inclusive healthcare policies on the part of government and other inequalities like lack of proper medical infrastructures in the areas that are populated by the black community. Nonetheless, the book has helped me gain new insight into the health disparity that exist between the black Americans and whites. It is now clear to me that the health gap that is prevalent in African Americans is largely because of the lack of trust for the medical establishment that has seen many blacks keep off care. The book has transformed me into a healthcare advocate where I will continue the fight started by Washington. Going forward, I will not only advocate for fair treatment for all susceptible groups but also create awareness on the need for them to seek medical intervention whenever they feel sick. I intend to send the message that the medical exploitation was a thing of the past and no one needs to fear participating in medical research or visiting a physician for a medical advice or intervention. In my opinion, the best way to protest and remembrance to address the diversity issue(s) presented in this book is to pile pressure on the government to enact legislations that will make it mandatory for anyone seeking to conduct a research on human subjects to first train them on how to protect themselves. Other than informing the African American community concerning their rights, I also believe that racism starts in the minds of those who practice it. Therefore, carrying out campaigns to show that all races are equal would go a long way in eliminating the notion that a certain race is inferior to the other. Eventually, there would arise dignity for human life. I would certainly recommend this book to any medical student.
Apart from detailing a shameful past, Medical Apartheid intends to convince African Americans to take an active part in therapeutic medical studies, specifically in sphe...
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