6 minute read
To Do No Harm
Vol. 15 | Winter 2021
To Do No Harm
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written by Daniel John; illustrated by Sara Kian
In a room lined with shelves upon shelves of medical textbooks and anatomy models, I sat across from Dr. Tyrone Hardy. Doctors aspire to work the frontiers of their fields; Dr. Hardy is a peak example with 50 years of physicianship and as one of the first African American surgeons specialized in stereotactic neurosurgery. Medical students commit to such a path upon taking the Hippocratic Oath, committing to “do no harm” to patients, prevent illness whenever possible, and treat patients as humans rather than infectious beings.
However, if one were to follow the trajectory of Black individuals’ health care through the history of the United States, the opposite becomes apparent; medicine has often involved taking rather than giving. Many of the treatments we have today are a result of unethical experimentation on populations that were never compensated for their contributions. Unraveling and exposing this reality is important to understanding the foundations of Western medicine. Despite the barriers posed by racist institutions and the doctors that reinforced them, African Americans have time and again contributed to the advancement of medicine for all.
An understanding of contemporary medical practice would be remiss without considering its convoluted origins. Dr. Saiba Varma is a professor of Anthropology at UC San Diego. Varma teaches courses on global health, inequality, and medical and psychological anthropology. She asserts, “We have to think about the ways in which public health as a discipline emerged as a part of the project of colonialism; it was designed to control Black and Brown bodies and produce maximum labor out of these bodies.” Colonial medicine was informed by prejudiced beliefs rather than science. White doctors adjusted medical infrastructure according to their belief in their own superiority; they created separate hospitals and medical school curriculums, and their research studies treated Black bodies as fundamentally different from white bodies. According to the Washington Post, whiteslave-owning doctors put forth claims, for example that Black men had smaller brains and thinner blood vessels, despite a complete lack of evidence for their assertions. Specialized physicians relied on entirely different medical literature while treating Black slaves. Medical knowledge was generally inaccessible to the public, lending little means for accountability and allowing medicine to remain a tool for a small group of elites to justify racist beliefs.
With tensions over slavery flaring up across the United States in the 1800s, African American leaders concentrated their efforts to challenge racial norms. They recognized that racism would also have to be challenged on the scientific front to dispel notions of biological or intellectual inferiority. In 1837, Dr. James McCune Smith became the first African American to graduate with a medical degree. He had been rejected from medical schools in the United States, but he was welcomed by abolitionists at Scotland’s University of Glasgow. In a field that as a whole underestimated Black intelligence, Smith proved an undeniable contradiction. Despite the hatred and violence he faced, Smith opened a pharmacy—the first to be both African American-owned and operated. He believed in the importance of a robust education system within the African American community, which he argued was the only way the abolitionist movement could create a strong empirical foundation from which African Americans could dismantle racist hierarchies.
Smith became a beacon of hope and a model for Black academics; he opened the door for Dr. Daniel Hale Williams’s pioneering work in surgery. Hospitals were still entirely segregated, but Williams used this as an opportunity. He believed that the only way to improve Black access to health care was to build a medical infrastructure from within, saying, “A people who don’t make provision for their own sick and suffering are not worthy of civilization.” With this goal in mind, Williams opened Provident Hospital—the first Black-owned hospital in the country— where he trained Black interns and nurses.
Williams was also a crucial innovator in the operating room. With no invasive cardiac treatment available, the heart was considered untouchable for practicing doctors in the 1800s. This changed in the summer of 1893, when a man named James Cornish was rushed into Provident Hospital with a knife wound. After Williams repaired damage to the left mammary artery, he saw a small but fatal cut in the pericardium, the membrane enclosing the heart. In that moment, Williams sutured the tear while coordinating his movements with the rhythm of Cornish’s heart, jumpstarting the field of cardiovascular medicine. After 51 days of recovery, Cornish was successfully discharged with no complications. Williams thus performed the very first open-heart surgery and demystified the taboo surrounding the heart.
Even with these stories emerging into the limelight, recognition for African Americans’ contribution to medicine is lacking. As Varma says, “We are still a long way aways from medicine taking accountability for its role in producing racial harm. Medicine still sees itself as neutral.” Within medical school curriculum, inclusive material needs to be taught that celebrates African American innovators. In fields where race is a key aspect of treatment, the curriculum must be adapted to effectively train physicians in these nuances. For example, dermatology textbooks need pictures of medical conditions on all skin colors, as the same skin ailments often present differently depending on skin type and color.
Even after medical training, Black doctors face selective pressures outside the hospital. In my interview with Dr. Tyrone Hardy, he explained that one of the biggest challenges he and other Black doctors faced was gaining approval and coverage from health insurance companies, despite having evidence of comparable or superior quality of treatment. A vital part of Hardy’s story is the heroes around him that inspired him to challenge the social norms of what a doctor should be. At Howard Medical School in Washington DC, Hardy was able to study under Dr. Latunde Odeku, the first African American trained neurosurgeon, and Dr. LeSalle Leffall, the first Black president of both the American Cancer Society and the American College of Surgeons. In his experience, “there are always things holding back African Americans, but people like Dr. Daniel Hale Williams who broke the color barrier inspired me and other doctors to do the same.”
Hardy also helps patients break their own barriers—between their volition and the neurons that should fire in response. At the age of 60, my grandfather’s Parkinson’s had taken away many important aspects of his life, especially his independence in movement and talking. A few years into his diagnosis, he was able to take advantage of a deep brain stimulation, a new technology that gave him new bouts of energy and the opportunity to interact with me again in a way that wasn’t imaginable before. This would be impossible without the software Hardy invented, which regulates the function in my grandfather’s deep brain stimulation probes to alleviate the symptoms of his late-stage Parkinson’s.
Not all heroes wear capes. Mine was wearing a suit and tie as he sat across the table, explaining how he designed the technology responsible for giving me and my grandfather time we didn’t expect to have. Sometimes, they wear scrubs and have to overcome unfair challenges solely due to others’ perceptions of the color of their skin. With every Black doctor throughout the past hundreds of years, from Dr. Smith to Dr. Williams to Dr. Hardy, we get another step closer to healthcare that is genuinely equitable and medicine that truly does no harm.
