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46. The Evolution of Medical Apartheid in America

Author: Taylor Glenn, Junior

Although the unequal treatment of African Americans has become less prevalent, its consequences still have major implications on current society. The behaviors that our history of apartheid has instilled in both black and white Americans, although sometimes driven by subconscious attitudes, still affect the way in which people interact. For example, trust, a vital aspect of healthy relationships, is often weak between individuals of different races. One institution that has been greatly impacted by this lack of trust is that of medicine. The medical field is obviously one of great importance as it sometimes involves considerations of life versus death. Specifically, the Tuskegee syphilis study represents the point at which black Americans’ distrust in medicine became widespread, leading to a movement in the medical community that considered the ethics of using human subjects in biomedical research. As a culmination of generations of medical apartheid, this study permanently scarred many black Americans’ trust in medicine and finally made the issue a subject of social questioning, both effects still apparent today.

Most definitions of apartheid include the policy of segregation and political and economical racial discrimination. These factors of apartheid were apparent, made obvious by the societal rules set clear by Jim Crow laws of segregation. Meanwhile, the intense racial discrimination that occurred in the medical world stayed hidden on a national scale for a long period of history. It was not until Tuskegee’s exposure in 1972 that the idea of informed consent and just treatment in bioethics became a key to all medical research. A suspicion of trust is central in contemporary autonomy-based bioethics, and generally caused by fears of the cost of trusting the untrustworthy. Philosophers of the 21st century argue that although trust is never without risks, we cannot do without it (Manson and O’Neill 158-162). The study of syphilis proved to be the interlocking factor between concerns over medicine and morality, a consideration never previously made on a large enough scale to elicit significant change (Reverby, The Infamous Syphilis Study 23).

The lack of consideration between medicine and its ethical implications that characterizes much of our medical history must be put into societal context in order to completely understand why the Tuskegee study specifically led to such a culture shock. Putting blacks’ historical aversion to medical care into context, it must be considered that American progress in modernizing changes to public-health measures such as widespread vaccination, scientific medical education, and the growth of hospitals that spread throughout Europe during this time lagged behind significantly, especially in the South (Washington 27). Medicine in the United States reflected a limited understanding of disease and a cursory training of medical practitioners, both of which blacks bore the most negative consequences. Being that at the time the majority of blacks lived in the South, these conditions had immense effects on their lives.
Especially in the antebellum South, black slaves bore the worst abuses of uninformed American medical practices. Because for a long time American surgeons were unaware of bacteria being the cause of infection, slaves were often operated on with dirty hands in filthy shacks known as “slave hospitals.” This often caused life-threatening infections from things as simple as minor incisions (Washington 29). Whites on the other hand never received this kind of treatment, not necessarily to avoid infection but simply because of the respect whites held for each other. This environment created an acceptance of differential treatment that would gain more severe implications as it continued to be employed. Although some records show that black slaves appreciated the sympathy of white physicians, the physicians’ incompetence caused many health-issues that blacks began to notice, creating friction in the relationship (Washington 31). Further, as American medicine advanced into the realm of medical experimentation, the aversion of black patients towards white physicians began to heighten dramatically.

As medical experimentation grew and began to involve live subjects, the mistreatment of blacks took on greater implications. In its growth, the use of black slaves as subjects of harsh, ineffective, and experimental studies became common practice, especially in the South. Southern scientists believed that because they lived in proximity to blacks and understood their characteristics they alone could study blacks with authority (Washington 32). The basis of this belief came from state-accepted consideration of slaves as property. Blacks were denied the legal right to their own bodies; they could not deny to participate in studies, no matter how abusive, and even lacked the power to protect the bodies of their deceased, which were often dug up and dissected (Gamble 1774). Supported by these dehumanizing beliefs, black slaves became increasingly subject to cruel experimentation with no regards to the individual’s well being.

Two experiments specifically, both conducted in the antebellum South on black slaves, exemplify the ridiculous mistreatment of the subjects who undergo unfathomable pain for the purpose of furthering benefits for their white superiors, all without their consent. A white physician named Thomas Hamilton carried out the first of these two studies in Georgia on a black slave named John Brown, but known as “Fed,” who had been loaned to Hamilton as repayment of a debt. Fed was forced to sit naked on heated stool in a deep pit, only his head reaching above the surface. Each time, Hamilton administered to Fed a different medication to see which allowed him to better sustain the heat. Every trial ended with Fed fainting and having to be revived; all this pain for the purpose of finding out how hard slave owners can push their slaves in the hottest parts of the day before they would die. To make matters worse, Fed later described how Hamilton “set to work to ascertain how deep my black skin went” by “applying blisters to my hands, legs and feet, which bear the scars to this day” (Washington 54). There were many people like Fed, including women such as those Dr. J Marion Sims experimented on in Alabama between 1845 and 1849.

In these experiments, conducted by Dr. J Marion Sims, each of three slave women underwent up to thirty brutally gruesome operations without anesthesia so that Sims could develop an operation to repair vesicovaginal fistulas. Sims himself noted that “Lucy’s agony was extreme,” and did not attempt the procedure on white women, using anesthesia, until the procedure had been perfected (Gamble 1774). Interestingly, Sins, the former president of the American Medical Association, received worldwide recognition for his medical advances. At this point in history, experiments involving unwilling slaves as subjects, though known to be extremely painful and possibly fatal, were not questioned. Slaves were simply items of possession with which their owners could do as they pleased. Importance lied solely in the possibility of benefits for the white race.

Physicians and slave owners shared similar interests in slaves, both regarding the subjugation of the blacks by the use of their bodies in order to benefit whites. In order to provide biological and ethical rationale for their actions, both physicians and slave owners took a blame-the-victim approach to the poor health and living conditions of blacks (Washington 32). Along these lines, popular society began to explain differences in intelligence and disease by race, leading to the creation and broad usage of a term created for a purpose, “bad blood.” In its vernacular, “bad blood” described syphilis and other prominent illnesses of the black community, but in support of the blame-the-victim approach, reflected a “blood taint—a propensity toward moral and medical degeneracy” that in the eyes of whites, caused blacks’ increased propensity towards things such as sexual promiscuity and disease (Lombardo and Dorr 295). These views allowed both physicians and slave owners to push aside ethics when dealing with powerless black slaves and eventually had a large part in the foundational ideals of the Tuskegee syphilis study.

Ideologies about race shaped understandings of syphilis from the moment it became a central concern. During surveys taken of American soldiers during World War I, black soldiers were reported to have higher rates of syphilis, although black men known to have syphilis were allowed in the armed forces while white men were kept out (Reverby, The Infamous Syphilis Study 24).  As soon as Americans formed the belief that the effects of syphilis vary widely among different races, all new knowledge discovered about syphilis was viewed through that standard. For example, one of the first major studies of syphilis, led by Caeser Boeck at the University Hospital in Oslo Norway, yielded data that suggested that of those untreated for syphilis in its early stages, regardless of race, a majority would live a life unharmed. However, this study, which became known as the Oslo Study, posed a problem for American syphilologists such as the Public Health Service’s (PHS) Vonderlehr, who in 1938 stated his concern regarding the “definite biological differences in the disease in Negroes and whites” that he believed the study failed to recognize (Reverby, The Infamous Syphilis Study 26). Americans had an obsessive concern with both the danger of Negroes’ “bad blood” and the spread of syphilis. Once public health leaders began to mix these two concerns, syphilis became a threat to racial relations, a terrifying prospect in the South at the time. 
In order to control syphilis, the PHS believed more about its “natural history” had to be understood. With only the Oslo study, which focused only on whites, as a source of such information, researchers aimed to determine “the relative benefits accrued from adequate and inadequate treatment” of syphilis in black men (Reverby, The Infamous Syphilis Study 38). A perfect opportunity was presented to the leader of this effort, the PHS’s Taliaferro Clark, when a series of blood tests performed on black men in Macon County, Alabama revealed that 39.8 percent of those who participated tested positive results for syphilis (Reverby, The Infamous Syphilis Study 35). This high prevalence of syphilis did not for Clark suggest need for treatment but instead opportunity for experimentation (Washington 161). Even though these men were no longer slaves and no longer property by law, the sentiments that shaped those laws remained; it would be a shame to not use this pool of what physicians called “clinical material” for medical experimentation considering ethics would not be an issue (Reverby, The Infamous Syphilis Study 38). After all, the hope was that the discovered model of care, once perfected, could be used as a model for all. Once again, blacks would become subjects of completely experimental medicine without their consent.

Officially titled the “Tuskegee Study of Untreated Syphilis in the Negro Male”, the study, which began in 1932, not only disregarded fair treatment by denying the informed consent of its participants, but also by manipulating them into participating through purposeful deception ("The Tuskegee Timeline").  Flyers were placed all throughout the poverty-ridden county that enticed blacks to come to the Tuskegee Institute to be “treated” for their “bad blood,” actively hiding the completely experimental nature of the study under the guise of treatment. This “treatment” included blood tests, extremely painful spinal taps, the dispersal of ineffective vitamins, as well as worse-than-useless arsenic pills and mercury salve (Washington 162). With the guarantee of what they believed was free medical examination and treatment, as well as transportation to and from the Tuskegee Institute, free meals upon examination, and free burial after death, the PHS, through cruel victimization, got 600 African American men involved in their study: 399 with syphilis and 201 without, the ones without acting as a control group ("U.S. Public Health Service Syphilis Study at Tuskegee"). Whatever distrust blacks at this time had in medical research was not strong enough to counter to lure of treatment for their “bad blood.”

The participants failed to understand and the researchers failed to question the real plan: to find out what happens to individuals with late latent, or dormant, syphilis that were left untreated. Initially intended to last six months to a year, the study would focus on observing the three stages of syphilis: first the development of sores, second the development of rashes and additional sores, and third, representing the latent stage, damage of internal organs leading to death (“Syphilis – CDC Fact Sheet”). The sores of the active first and second stages were most easily recognized on the genitals, the main reason leaders including Taliaferro Clark decided to eliminate women from the study, since the sores could exist inside the vagina and therefore be more difficult to identify (Reverby, The Infamous Syphilis Study 40). Clark and his colleagues never considered these exams, based in deception and subjugation, could be a violation of privacy as well as basic human rights. In their eyes, the black men undergoing their tests were less than human, “clinical material,” and what they lost in the study would be insignificant compared to what the researched would gain.

Again, even the first step of this study, the identification of penile sores, serves as evidence of the dehumanizing way researchers viewed the black men they studied. Clearly displaying this perspective, Johns Hopkins’s Joseph Earle Moore, even argued that penile sores could not be determinate because “the average negro has had as many penile sores as rabbits have offspring,” referring to the contemporary belief in negro’s inability to refrain from crazy sexual drives and representing the constant objectification of all black men (Reverby, Tuskegee’s Truths 78). The cycle of objectification and deception did not end but instead acted as the driving force for the entirety of the Tuskegee study. For example, influenced by the offered advice of Joseph Earl Moore, after determining a man to have syphilis painful and medically risky spinal taps were performed in order to distinguish between those recently infected and those with the desired later stages of the disease. Again, because these men were simply subjects of a medical experiment, deception was employed at this step as well without any questioning of its ethics. In order to ensure its subjects would return for spinal taps, the PHS sent out notices with this now-famous closing: “REMEMBER THIS IS YOUR LAST CHANCE FOR SPECIAL FREE TREATMENT. BE SURE TO MEET THE NURSE” (Washington 163). The PHS and main physicians involved in the Tuskegee syphilis study were prepared to use many demeaning tactics to promote the success of their study.

The researchers at Tuskegee relied on covering up endless breaches of trust in order to maintain the participation of the study enrollees. Another tactic taken in support of the disguise of the experiment involved a member of the participant’s own race, as Nurse Eunice Rivers was hired to act as a liaison between the starkly different groups. Nurse Rivers’ job involved preventing the men from getting treatment elsewhere as well as doing regular house-visits to check in on the men and make sure they were planning on coming to their next appointment (Washington 165). Nurse Rivers also did the dirty work after a participant died, for it was also her job to ask the family’s permission for the doctors to perform an autopsy on their loved-one’s body, a cut from scrotum sack to skull in return for a measly offer of fifty dollars and the promise of “free burial” (Reverby, The Infamous Syphilis Study 47). Many could find Nurse Rivers’ equally as guilty in deceit as her employers unless they realize that she too was victimized by race relations of the time. Essex Hemphill put it well in his poem “Civil Servant,” written in Nurse Rivers’ honor, as in her point-of-view he explained that she had to obey orders “or be dismissed, / which would end my nursing career,” because the Tuskegee Institute and its leaders “trained me to obey the instructions of white men” (Reverby, Tuskegee’s Truths 554). To the PHS, Nurse Rivers simply served as yet another avenue by which they could manipulate the participants of their study.
Nurse Rivers’ main job of keeping the men away from treatment, either by other facilities or by the army after enlistment to fight in World War II, became difficult as more and more knowledge about the treatment of syphilis was acquired, most significantly the discovery of penicillin. In 1943, the PHS began administering penicillin as treatment to people with syphilis in a number of different treatment centers, but refused to administer the drug to the men in the study (Reverby Tuskegee’s Truths 35). Through these efforts, the study continued, but the added attention to syphilis turned questioning eyes towards Tuskegee. The PHS would not surrender but set out to once again explain all the benefits of the work they were doing. In 1946, three years after treatment by penicillin became widespread, the PHS’s John R. Heller published the second report of the study, tellingly titled “Untreated Syphilis in the Male Negro: Mortality during Twelve Years of Observation” (Reverby, Tuskegee’s Truths 35). The article proudly stated its results including the learned knowledge that those syphilitic men left untreated had their life expectancies “reduced by about 20%,” while continuing to hide the fact that these same men thought they were being treated (Reverby, The Infamous Syphilis Study 62-63). By the end of this decade, numerous reasons to question to study existed, including but not limited to the discovery of penicillin and the obvious poor health effects of untreated syphilis.

The trial of Nazi doctors in Nuremberg, Germany created another powerful change in research in the postwar period that held the strong possibility of questioning the reasons for the Tuskegee syphilis study’s continuation. These trials became an examination of research ethics that concluded in 1947 with the creation of the Nuremburg Code, a set of principles for human experimentation protecting the rights of its subjects. The code however, had little impact on the study at Tuskegee as its leaders had themselves convinced that what happened in Nazi Germany had no relation to their “good science.” Again, John Heller spoke out in defense. To questions regarding whether or not the Nuremburg Code had caused a pause in the study, Heller responded, “But they were Nazis” (Reverby The Infamous Syphilis Study 66). The two cases were set up as complete opposites. The first official objection by a medical professional was not made until after the publishing of ten more reports and nearly twenty years of the study’s continuation.

The issue of informed consent was so well deflected by the PHS that the Tuskegee syphilis study ran for a grand total of forty years, with nearly all the syphilitic men receiving no treatment, before inevitably being stopped (Washington 165). In the end, changing climate in the medical society invoked the defining ethical debates, not a change in conscious of any leaders of the study. By the mid-1960’s, in the context of the growing civil rights movement, discussion of research ethics and societal distrust of the government’s actions became extremely prevalent (Reverby, The Infamous Syphilis Study 74). With this shift, people outside the PHS began questioning the study, exposing its concerns outside just the medical realm. However, as it had in response to many prior obstacles, the PHS ignored the issues and focused on finding a way to sustain its study. For example, the PHS had reached further difficulties sustaining the number of participants in study, so in 1958 it attempted to retain the participants’ remaining trust by distributing certificates of appreciation and cash payments of twenty-five dollars, one dollar for each year of participation, to each subject (Reverby, Tuskegee’s Truths 36). Although the first official complaints were pushed aside by the PHS, it was only a matter of time before the study’s atrocities could no longer be concealed. The breaking of this silence had consequences still strongly felt to this day.

When questions arose about ethics the PHS did its best to defend its study, however as soon as the national press became involved, it was game over. In 1965, in the midst of growing civil rights movements and increased discussion regarding human subjects of medical experimentation, Irwin J. Schatz, a young cardiologist from Detroit became the first member of the medical profession to formally object to the syphilis study at Tuskegee through a written letter to the PHS (Reverby, Tuskegee’s Truths 37). In this letter, Schatz made clear that he was “utterly astounded by the fact that physicians allow patients with potentially fatal disease to remain untreated when effective therapy is now available.” The PHS official who received the letter never replied to Schatz and explained why: this was “the first letter of this type we have received.” This was not true, but she would not have known because any previous letters were not shared with the study team but instead concealed in silence (Reverby The Infamous Syphilis Study 75-76). The end game was reached when in 1972 the concerns exploded on a national stage.

This explosion led to the creation of an entirely new world for medical research that remains today. The eventually fatal blow to the Tuskegee syphilis study came from a relentless Peter Buxton, a young Polish immigrant who worked as a sexually transmitted disease interviewer for the PHS. Starting in 1966, Buxton repeatedly risked his job by expressing his concerns to his supervisor, and eventually left the agency in order to further pursue his cause (Washington 168). Finally, the explosion was set in motion in July 1972 when Buxton told an Associated Press reporter, Jean Heller, about the study. On July 26th, 1972, the story became front-page news in The New York Times under the heading “Syphilis Victims in U.S. Study Went Untreated for 40 Years” (Reverby The Infamous Syphilis Study 85). Once the story of the Tuskegee study (a shortened name of the study that arose through this article) left the confines of the PHS’s medical journals and private meetings, all ability of concealing its atrocities was lost. With all of the lies now written out for blacks to see, the remaining survivors, their families, and generally the African-American race as a whole would never again find complete trust in medical research and its true intentions.

The Tuskegee syphilis study is the longest and most infamous but hardly the harshest case of experimental abuse of blacks. However, dropped into a political landscape newly concerned with issues such as sterilization abuse and the use of birth control as black genocide, the very name “Tuskegee” immediately became a condensed symbol of all medical exploitation of African Americans (Reverby The Infamous Syphilis Study 86). Despite uproar, the PHS and CDC, or Centers of Disease Control and Prevention, which had become partners with the PHS at Tuskegee, still failed to acknowledge the deceptions of the study. For example, Dr. John Heller spoke in reaction to the New York Times article by sharing his opinion that “the men’s status did not warrant ethical debate” because they were “subjects, not patients; clinical material, not sick people” (Lombardo and Dorr 305). However, the political atmosphere at the time these revelations were exposed about the Tuskegee syphilis study invoked drastically different reactions in the majority of people, especially within the black community. Heller and his colleagues’ refusals to acknowledge even the most basic of racial assumptions that shaped their study only made the concerns more powerful.

The Tuskegee syphilis study became the most prominent example of medical racism because it confirmed and authenticated long-held beliefs within the black community about their exploitation by the medical profession. As the story grew, the focus of many shifted to the source of the men’s infection, leading to charges that the study represented “nothing less than an official, premeditated policy of genocide” (Gamble 1775). Many stories jumped to the conclusion that the PHS had deliberately infected the men with syphilis, a claim that was not just paranoia but was more than plausible considering the status of race relations (Reverby, The Infamous Syphilis Study 89-90). It was clear that the PHS researchers lacked scientific as well as ethical integrity, yet some claimed that the Tuskegee syphilis study was not racist because it simply followed the procedure of the Norwegian Oslo Study, an absurd claim considering that the Oslo Study was retrospective as well as performed in an environment of much more racially homogeneous social-welfare (Washington 183). People with these defensive beliefs became uncommon after the testimonies of survivors became public; instead, sympathetic sentiment grew and calls for stricter regulation of medical research became harder to ignore.

After the publication of Jean Heller’s article in The New York Times, participants of the study began to piece things together. Many of these men were unaware that they even had syphilis until the story broke out. Once realizations were made, the story landed in a Senate hearing held in 1973 by Senator Ted Kennedy; the testimonies of four survivors were given, examples of innocent victims that called for reparation of the PHS’s sins. One of the victims, Mr. Charles Pollard, illustrated this innocence by unveiling the disguise of treatment by which the PHS presented their study to its victims through stating his belief that “they said I had bad blood and they was working on it” (Reverby, Tuskegee’s Truths 138). Each man made it clear that they had been mislead by the government and needed to be monetarily compensated for what happened to them, the first steps to what would become an official lawsuit.

The conclusion of the Senate hearings marked the beginning of profound change in the use of human subjects in biomedical research. Prompted by the outcry regarding the Tuskegee study, the National Research Act was passed in 1974, created protection for human subjects in research by articulating the importance of informed consent and patient autonomy (Reverby, The Infamous Syphilis Study 103). This movement led to the formation of many commissions that would be responsible of monitoring biomedical research. Initially, in 1974, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was set up as the first force. However, the trend never stopped. The early 1980’s gave us the President’s Commission for the Study of Ethical Problems in … Research, followed by the creation of the National Bioethics Advisory Commission in 1995 and the President’s Council on Bioethics in 2001, just to name a few. Further, the NAACP filed a class-action lawsuit that won ten million dollars to be divided among the participants of the study (“The Tuskegee Timeline”). Although not the first offense of medical exploitation of blacks, the Tuskegee syphilis study because of its length, social prominence, and timing, initiated the largest movement in the medical community regarding biomedical research by finally making the issue a subject of political discussion.

Although these political outcomes provided positive changes for both participants of the study and the medical society as a whole, the Tuskegee study had severely negative consequences, most importantly by solidifying many black American’s fear of medical care, having an effect still felt today. Many leaders have attempted to lessen this fear, called iatrophobia, but its long history and ignored early signs make it difficult to quell (Washington 33). The most memorable attempt was made in 1997 at a ceremony in the White House held by President Clinton in honor of the study participants. His main message was that although we cannot undo the past and pain, we can end the silence; Clinton also called for African American participation in medical studies (Reverby, Tuskegee’s Truths 576-577).

Despite President Clinton’s sincere attempts to heal the relationship between African Americans and medical society, including the admittance of the racist nature of the Tuskegee study and his emotional apology, distrust remained, as it still does to this day. Albert Jukes, whose father and uncles were victims of the Tuskegee study, put it best when he told a reporter “there never will be a closure” to slavery but that instead “this offers a salve on a festering sore.” The damaged trust of African Americans would perhaps be much more difficult to heal than originally expected (Reverby, The Infamous Syphilis Study 226). Although the Tuskegee syphilis study and its exposure represents the point at which African Americans’ distrust in medicine became widely recognized and authenticated, it can not be the only event used in examination of the relationship between blacks and the medical community.

Frequently, the Tuskegee study is described and the single factor in African American distrust in the institutions of medicine and public health, a misinformed interpretation of history (Gamble 1773). In actuality, the iatrophobia seen today existed even before the Civil War and is a result of the culmination of decades of mistreatment. During pre-Civil War times, black slaves would conceal their illnesses in order to avoid distrusted white physicians by working through illnesses, discarding medications, and even hiding the sicknesses of their children, all of which enraged masters and physicians (Washington 31). Instead of a singular event, African Americans’ distrust is fueled by the at times correct perception that they are treated differently in the health care system solely because of racial differences (Gamble 1776). In fact, many blacks that refuse to partake in American health care programs do not even know the history of what happened in Tuskegee (Reverby, The Infamous Syphilis Study 191). The Tuskegee study has simply become a central metaphor for medical racism and government abuse of black people.

Tuskegee study was not the first or the last time that accusations of medical genocide have been launched against the government: programs such as sterilization, birth control, and most recently AIDS, have also been seen as part of a conspiracy to exterminate African Americans. A sentiment that remains today, a significant percent of the black community sees AIDS as part of a conspiracy created by the government to exterminate African Americans (Gamble 1775). In a study conducted by Rand Corp and Oregon State University on 500 African Americans from 2002-2003, 48.2 percent of blacks agreed that HIV is a man-made virus and 53.4 percent believed that there is a cure being withheld from the poor. Additionally, representing the most extreme fears, 12 percent agreed that HIV was created and spread by the CIA and 15.2 percent that AIDs is a form of genocide (Bogart and Thorburn 213-215) Clearly, black people’s distrust in medicine did not end in 1972 with the closing of the Tuskegee syphilis study and still presents significant problems to the current medical society.

Modern medical research continues to lack support from the black community, holding medical society back from progress in many different subjects of investigation. As only an acute example of this lasting distrust, a survey conducted at the Children’s Hospital of Pittsburgh in 2009 illustrated the difference between white and black parents’ trust in medical research. The survey, which asked questions of both black and white parents with children being seen at the Primary Care Center, found that black parents are twice as likely to distrust research as white parents. Specifically, more black parents said that they believe medical research is a way of experimenting on unknowing patients and that it therefore involves too much risk to the patient. Pittsburgh doctors, who share the feelings of physicians throughout the nation, believe that these perceptions of medical research today result in a lack of participation in clinical trials by black people (“Children’s Hospital study finds black distrust research”). African American absence from research reflects not only the reactions to the Tuskegee syphilis study but more broadly the effects racism that have shaped the lives and beliefs of people to this day.

Today, the worst cases of the exploitation of blacks by medical experimentation are a story of the past. Although issues persist, none compare to the atrocities survived by black slaves and those involved in later studies such as the Tuskegee syphilis study. However, put into great words by medical ethicist Harriet A. Washington, “medical abuse is more than historical fact” (Washington 386). Therefore, in order to regain trust and progress into the future of medical research, more must be done than just acknowledging the past. Evidence that further efforts must be made are illustrated by a 2002 estimation of an American Journal of Law and Medicine journal that to that year at least twenty million Americans have enrolled in formal biomedical research studies, but fewer than one percent are African American (Washington 387). Focus should not be put on why blacks refuse to participate but instead what makes American medical research so untrustworthy. While refusing to deny the ever-existing possibility of dangers in both current and future medical research, we must work to maximize protection of research subjects, minimizing fear and hopefully beginning to regain the trust of African Americans, a difficult yet extremely important challenge.

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