*CONTENT WARNING: this essay details elements of the violent and racist history of American Biomedicine. We also discuss contemporary injustice in medicine. Take care of yourself.
Fifty years ago in March, 1965, Martin Luther King Jr. led the march from Selma to Montgomery to demand voting rights for African Americans in the South. Upon reaching Montgomery, Dr. King delivered an impassioned speech. While elucidating different forms of discrimination faced by African Americans and poor people of all races, Dr. King proclaimed, “of all the forms of inequality, injustice in healthcare is the most shocking and the most inhumane.” Fifty years later, while the civil rights movement has accomplished much, there is still great inequality in the health care system. As healers with conscience, it is vital that we acknowledge this injustice and avoid reinforcing this paradigm.
African American Injustice in Healthcare: History of the US Healthcare System
One way we can address the continuing injustice of the American healthcare system is to know our history. We will present a brief overview of some of this history here; however, we encourage you to use the extensive, but by no means exhaustive, bibliography as a starting point for your own research. While this content is disturbing, it is important that we look at the foundation of conventional American medicine, its continuing biases and the ways holistic practitioners can inadvertently mimic this injustice.
Medical Experimentation on Slaves
While poor people of all races suffer from the inequalities of our wealth-based health care system, African Americans have been singularly affected by this system. American Biomedicine is, in fact, founded on race based experimentation and dissection. To acknowledge this terrible history allows us at least to honor those who suffered and continue to suffer in the name of medical science. For example, take a simple and useful instrument, the vaginal speculum. This tool facilitates examination of the cervix as well as diagnostic tests and surgical repairs. Countless lives have been improved and even saved due to this invention. A man named James Marion Sims invented the speculum. Celebrated as the father of modern gynecology and surgery, Sims developed breakthrough techniques for the preparation of vaginal injuries resulting from difficult births. Many women, both white and black, suffered from vesico-vaginal fistulae in the 1800s. (Ironically, if not surprisingly, this number increased with the growing use of forceps by obstetricians such as Sims.) The ability to repair this damage was life changing and heralded a new era of medical possibility. Unfortunately, the development of this procedure, and the tool that facilitated it, epitomize the horror of medical research in an era of race-based slavery.
Sims lived and practiced in Alabama, where people of European descent in the ruling class had license to do whatever they wished with those individuals of African descent who were their property. To develop gynecological surgical procedures, Sims procured eleven slaves suffering from vesico-vaginal fistulae. Over the course of several years, Sims practiced surgical techniques on these women without consent or anesthesia. One of them suffered 30 separate surgical attempts. When the doctors assisting Sims with these procedures could no longer bear to witness the ordeals, the slaves were forced to hold each other down in turn for the duration of the operation. The story of Sims and the eleven women who bore the pain of his research is not an isolated case. Selling old or sick slaves to doctors, surgeons and medical schools was common practice. The innovations of American surgeons in the 1800s that revolutionized medicine around the globe were often developed on slaves.
African Americans in the Medical Field in the 19th Century
While overtly non-consensual research and surgery was no longer legal after the abolition of slavery, American medical schools continued exploitation of African Americans in the name of science. Medical philosophy and education of the 19th century emphasized dissection as the best means of learning anatomy and physiology. As has been the case across time and culture, Americans of that time saw funeral rites as important rituals, with burial an important symbol of peace. However, the medical schools needed cadavers and a robust business of grave robbing, overwhelmingly from black cemeteries, arose to meet this demand. As there was less access to such cemeteries above the Mason-Dixon line, Northern medical schools shipped bodies up from the South by rail. Grave robbing is no longer the primary source of cadavers for medical schools, yet there continues to be a disparity in the race of bodies that are used for dissection. Aside from individuals who donate their own bodies to science, the majority of cadavers were once homeless people, those whose families cannot afford burial, and those tragically referred to as the friendless poor. Because we continue to live in a country with entrenched institutional racism, these groups contain a higher percentage of African Americans than society as a whole. Take a moment to consider the irony that the individuals who contribute their bodies to train future doctors and nurses likely received little to no medical care within their lives.
Eugenics and African Americans
No examination of the troubling history of American Biomedicine would be complete without a discussion of the Eugenics movement. In the early 1900’s, in the name of creating a more evolved race of humans, the United States developed a program of forced sterilization for those deemed unfit to reproduce. Eugenics theorists referred to the 3 D’s: dependency, delinquency and mental deficiency as factors determining who should be sterilized. In 1907, Indiana passed the first state sanctioned sterilization law and many other states followed. Sixteen years later, Hitler and the National Socialist Party implemented a sterilization program inspired by the American model.
Most states used the first Intelligence Quotient tests, originally developed by Eugenics advocates, to determine who was an appropriate candidate for sterilization. This data, along with a history of criminal activity, use of social services, and perceived promiscuity could mark a person as unfit for reproduction. North Carolina ran a particularly aggressive eugenics program. Policy makers there expanded the qualification for forced sterilization to include not only IQ, but also level of poverty. To prevent the reproduction of people on public assistance was to prevent the further burdening of the state. Social workers recommended candidates for sterilization to the state Eugenics Board and were rarely denied. Between 1929 and 1974, over 7500 people were sterilized in North Carolina. As in all the other state sanctioned sterilization programs in the United States, all of those who underwent the procedure were poor and uneducated. While many poor white people were sterilized, poor people of other races were sterilized at higher rates. States with significant Native populations sterilized more indigenous people. Likewise, states with large African American populations sterilized exponentially more poor blacks than poor whites. Thus the quest for a more evolved race thinly disguised a quest for racial purity.
In looking at the history of eugenics, we must acknowledge that this was not an aberrant policy written and enforced by a few bigots. This was very much a mainstream mindset for white Americans. Reproductive rights pioneer Margaret Sanger and African American activist and writer W. E. B. DuBois advocated eugenics policy. In every state and county that performed forced sterilizations, there were doctors, nurses and social workers who sincerely believed they were helping humanity by sterilizing the poor, especially poor people of color.
Medicine as an Institution of Social Control
As we see with the complicity of the medical establishment in implementing eugenics policy, conventional medicine can be used as a means of social control. This is especially apparent in the field of mental health where the values that maintain the power structure are not only reflected but enforced. Suppose a psychiatrist interviews a new patient. The patient is distressed and complains of feeling watched. He claims the police threaten him when he is doing nothing wrong. The world seems stacked against him. It feels like a conspiracy, he can’t get ahead. Often, this intake would lead to a diagnosis of schizophrenia with paranoid delusions. But what if we consider the racial context of the patient. This is a young black man living in the United States. After a lifetime of police harassment, he was stopped while walking home from work and accused of committing a crime. He became agitated and aggressive. The police arrest him. While in custody, he becomes more agitated. He is then committed to a “72 hour hold” psychiatric facility. In this context, is he paranoid? Delusional, dangerous? Or is he fed up? When we examine his context, we may see that yes, in a sense he is being watched, the world is stacked against him. However, many mental health practitioners do not see their clients in the context of a racist, sexist, classist society. These professionals wield power: they can keep people in institutions, perform mind-altering procedures and sedate their wards with tranquilizers. They also hold the life-determining power of diagnosis, a mark that cannot be removed from one’s record however specious it may be.
In the year 2014, the brewing tensions between police and African American communities reached a boiling point. In the 60’s and 70’s there were similar, more frequent and widespread periods of unrest. During those decades, record numbers of black men were institutionalized with little chance of rehabilitation and release. Acclaimed neurosurgeon Orlando J. Andy, MD performed partial lobotomies on scores of children he deemed aggressive or hyperactive. Some were as young as six, all of them were black. Dr. Andy publicly stated that participants in the Watts riots would be appropriate candidates for this type of surgery. The explosion of anger and violence in cities then and now is often deemed a symptom of pathology by health practitioners of all kinds. As is often the case in our culture, the symptoms of an ailing society are ascribed to the individual.
Medical research reflects and reinforces the inequalities of society. In the infamous Tuskegee Syphilis Study (1932-1972,) six hundred poor black men with syphilis were offered free treatment for participating in an experiment. In fact, researchers withheld treatment as they sought to study the progression of the untreated disease. The researchers continued to deny care even after life-saving treatment options became available decades into the study. This experiment is a blight on the already spotty history of American medical research. The medical establishment seeks to place this episode firmly in the past as an embarrassing incident only possible in the racist South. Unfortunately, despite improvements in research oversight and the requirement of informed consent for research participants, there continue to be troubling facets of contemporary medical research that stem from and contribute to our unjust society.
African Americans Access to Healthcare
In a society in which only some people have access to health care, those who do not have access are more likely to take risks to receive any kind of treatment, even if it is experimental. For example, in 2003, the Division of AIDS, a primary branch of the National Institute of Health, sponsored a study of the “treatment limiting toxicities” of two HIV drug regimens. Physicians in urban areas found subjects by offering to test pregnant mothers for HIV even if they presented no symptoms. They did not inform the mothers-to-be that pregnancy is a leading cause of false positives in HIV testing. Imagine that you are a young mother who is told she is HIV+ and that she will pass on the virus to her child unless she takes these experimental drugs. Most of the women facing this dilemma agreed to be in the study. Many got sick and at least one woman died from liver failure. The protocol proved too toxic for public release, knowledge gained at the expense of over 400 women and their children.
This example typifies the injustice of our medical system. Teaching hospitals are often located in poor neighborhoods. Researchers rely on underserved populations to obtain willing, even desperate subjects. Children in foster care, prisoners, mental health and emergency room patients all provide subject pools with limited if any ability to say no to study participation. When ethical parameters are too binding in this country, researchers go abroad finding hordes of potential subjects in Africa or India. There, people are desperate for medicine and if something goes wrong, there will be little backlash here in the United States. When a pharmaceutical or risky procedure does make it through the experimental phase, the final irony of our medical system rears its head: those whose bodies provided the data can no longer afford the treatment.
The subsequent high cost of care creates a wide disparity in contemporary healthcare. As Americans rely increasingly upon high-technology medical interventions to support our rising expectations of health & longevity, those on the other side of the healthcare gap suffer from preventable diseases and disease complications. As the envelope is pushed further and further to develop the means of maintaining health against all odds for the wealthy or well-insured, high-technology care is withheld even from those with life-threatening conditions if they cannot afford it. Life expectancy is longer and overall health outcomes continue to be better for white Americans. Those below the federal poverty level have a higher prevalence of most chronic illnesses, infant mortality rates that are more than double, and receive higher rates of HIV diagnoses. These health profiles more closely resemble that of Third World countries than a country that boasts at having the best healthcare treatments available worldwide. These are only a few examples but they are representative of the larger health inequality that exists in this country.
Medical Distrust in African Americans
The disparity in health care is further widened by a fear of conventional medicine that stems from historical atrocities perpetrated upon these already underserved populations. As new information continues to come out exposing unethical experiments, it is hard to have faith that anything has actually changed. It is understandable that marginalized populations have gained a healthy distrust of the current system of healthcare & medicine; regrettably, this contributes to the large rift in the quality of care provided.
This distrust, the cost of contemporary healthcare, & strong cultural traditions create the conditions for a continuing reliance on plants for medicine. Many underserved populations in both urban & rural settings have a deeper & more recent connection to herbalism than those who have had consistent access to conventional health care. Marginalized populations in urban areas have a strong tradition of plant medicine that is heavily influenced by both the merging of various immigrant cultures & the lack of accessible care due to cost. For undocumented immigrants, in rural and urban areas, this lack of access is compounded by the fear of deportation. In rural locations, many people cannot afford health care and live far from hospitals and other health care facilities. Isolation and poverty, as well as proximity to a host of herbal remedies, traditionally led rural populations to rely on plant medicine. In both types of environments, this reliance upon plant medicine upholds a long-standing relationship with herbal medicine.
Medical Herbalism: The Science and Practice of Herbal Medicine: What Are Some Issues or Concerns of Herbal Medicine?
This connection to herbal medicine is at risk. As herbal medicine transitions into a more mainstream modality, it falls prey to the demands of the market. While many are excited about the possibilities of herbalism traversing from a currently sidelined “complementary” medicine to celebrity status, this transformation threatens to remove the people’s medicine from the toolkit of the marginalized. Herbalist's upgrade to a luxury medicine isolates it from those who can’t afford the market determined price. As plant medicine moves in this direction, it becomes less accessible to the very people who have continued its tradition & relied upon it until now.
As plant medicine moves away from its traditional origins, it also begins to more closely resemble allopathic medicine. Herbs are increasingly packaged for easy consumption, similar to conventional over-the-counter medicines. This commercial rendition of plant medicine allows the market to drive up the price of herbs and to determine how they are sold. The resulting discontinuity in the way people relate to plant medicines can have a deleterious effect on both the plants and the communities that have maintained a connection to them through the ages. When people are separated from the source of their medicine, they no longer notice the effects of the market on the plants. Furthermore, as the plants are removed from the context of their natural habitat, they are no longer sustained by the traditions that have tethered them to humans for generations. The commodification of plant medicine, both the product and the service, effectively removes this medicine from the very hands of the people who once relied on it.
Herbal Medicine Education
What are we to do? How can we avoid the traps of the market? How can we avoid reinforcing the injustice of a wealth-based health care system? How can herbalists address race and class-based inequalities in our practices? The first step is self-education. When we work with individuals from populations different from our own, we should take the time to consider what specific stressors they might face. Be careful not to reduce a person to one characteristic. Race, ethnicity, class, gender, sexual orientation, religion, culture, region of origin, age and size multiply and enrich a person’s medical narrative.
As we self-educate, it is vitally important that we look at our own cultural beliefs and assumptions. How do we define healthy? Is that definition applicable to all kinds of people? What are our assumptions about race and class? What kinds of privilege inform our perspectives? Do we assume our concepts of health and disease are best? Are our concepts of healthy living prohibitive to people in urban areas or on fixed incomes? Does the dominant economic system determine how we value our time? How do we price our consultations or our medicine? Remember that the atrocities we discussed earlier were/are perpetrated by people who think they are behaving ethically. As herbalists with conscience we must ask ourselves difficult questions and answer honestly even if we do not like what we hear.
Educating our clients and communities is an essential component of working for change. When working with clients, do not simply prescribe herbs or supplements. Explain what the herbs do, teach nutrition and physiology when appropriate. If you recommend dietary changes, sleep hygiene, exercise, or time outdoors, fully explain your reasoning. When possible, empower your clients by teaching them to make their own medicine. If you live in a rural setting or a less toxic urban one, teach them to grow and harvest their own herbs. Teach ethical wildcrafting. Reconnection with plants is an important part of the healing process.
Offer affordable classes to increase the amount of herbal knowledge in our communities. This knowledge spreads. Each student we encounter will share some of what they learn with their friends and families. The more of us who know how to identify and use plant medicines, the better. As you teach, acknowledge the sources of herbal medicines. North American herbalism draws heavily from Native traditions; if you are not native, be sure to cite this source without fetishizing or appropriating their culture.
When working with individuals who come from families or communities who used herbs, try to bridge your therapies and their culture. It may be possible to use plants, remedies or methods of delivering medicine that they are already familiar with. Allow yourself to learn from their culture to expand your clinical horizons. If you are lucky enough to work with someone from an unbroken tradition of herbal medicine, use this opportunity to learn from their tradition.
With clients and in the classroom, emphasize kitchen medicine. Culinary spices and common herbal teas are familiar and comforting. Teach medicinal foods such as lemon, garlic and ginger. If your students or clients are on public assistance, they can purchase this medicine with food stamps. Focusing on common spices and teas also cultivates holistic practices. Medicine for everyday, not just when you’re sick. Medicine as nourishment.
As for consultations, there are a growing number of strategies for increasing access to holistic care. For decades, herbalists have used herb shops to offer quick consultations. The community acupuncture model allows clients regular affordable treatment. In New Orleans, Maypop Community Herb Shop offers NADA weekly. NADA (National Acupuncture Detoxification Association) is a protocol utilizing ear acupuncture for behavioral health, including mental health, addictions, and disaster and emotional trauma. It is always offered for free and is easily adapted in numerous settings since it does not involve any diagnosis and everyone receives the same treatment.
Work with non-profits when possible. In Asheville, the Sassafras Community Health Collective ran a free clinic in a day shelter for the homeless, hosted self-care workshops at the domestic violence shelter and at Nuestro Centro, a Latin American community center. Look in your area for groups open to working with herbalists. Pop-up and mobile clinics such as HerbBus in Atlanta offer valuable services with low overhead. Free clinics operate around the country, often benefiting from donations of medicine from large herb companies. In the rural South, folk herbalists may charge for medicine only, not for the consultation. Many of these communities also maintain an active practice of barter, or more appropriately, exchange of gifts. If you live in a rural community, this is often an option. There are many ways we can get medicine and information to the people, we need only imagine them and make them happen.
We are in an exciting era of herbalism. Knowledge of the use of plant medicines is becoming more widespread, even prescribed by some conventional doctors. Interest in herbal medicine is growing exponentially each year. But with this growth, comes temptation. We are at a crossroads. Will we cash in on the excitement, find our niche in the luxury health care market, or will we choose a humbler path? We can either reinforce the systems of oppression that deny access to marginalized groups or we can stay true to the roots of herbalism. We have a chance to create a system of healing that is accessible to everyone. For thousands of years, healers have learned from the plants and brought this healing wisdom to their communities. Let us honor that tradition and work to create the world we want to live in.
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