Racism in Medicine

RETHINKING THE WAY WE TRAIN FUTURE DOCTORS By Celia Cacho & Ngozi Okoli

The Black Lives Matter movement and events surrounding it have brought to light how ingrained racism, specifically anti-Blackness, is within American society. Although systemic racism manifests itself in many forms, it is particularly rooted in the damage of Black bodies and the deaths of Black people. The term “medical racism” is the embodiment of this destruction and encompasses the ways in which Black people have been exploited, overlooked in terms of their scholarship and contributions to the medical field, and altogether disregarded. This historical abuse, coupled with recent protests, prompted several pre-health students to write an open letter and create a resource document to guide future health professionals in addressing the problematic origins of medicine that continue to a ect Black, Indigenous, and people of color (BIPOC) patients today.

e use of Black people for experimentation has existed since the early days of slavery. John Brown, an enslaved man, endured several experiments at the hands of a white doctor (Washington, 2008). He was exposed to extreme temperatures—sometimes using re—as the doctor attempted to nd remedies for sunstroke (Mithcell, 1997). Anarcha, Betsey, and Lucy, three of twelve enslaved women, underwent various painful operations carried out by James Marion Sims (Washington, 2008). His procedures became the foundation for modern gynecology. ough slavery ended before the turn of the 20th century, the experiments and exploitation did not. From 1932 to 1972, six hundred black sharecroppers from Macon County, Alabama were enrolled in the US Public Health Service’s Tuskegee syphilis study (“Tuskegee Study”, 2020). e men endured unnecessary procedures, and those with syphilis were never formally diagnosed nor treated, resulting in blindness, dementia, and death (“Tuskegee Study”, 2020). Undoubtedly, the need for medical “innovation” has consistently been used as an excuse for white doctors and researchers to justify harm done to Black people.

Beyond the experimentation and exploitation endured by Black people, the contributions of Black physicians and researchers within the eld of medicine continue to be underappreciated. Dr. Charles R. Drew developed techniques for blood preservation, saving the lives of millions of patients in need of blood transfusions today (“Charles R. Drew, MD”, n.d.; “Celebrating 10”, 2019). Dr. Marilyn H. Gaston’s 1968 study on oral penicillin in children with sickle cell anemia led to the development of a national sickle cell anemia screening program, which has become a staple of newborn

screenings in the US (“Celebrating 10”, 2019). Dr. Patricia E. Bath founded the discipline of community ophthalmology, a community health-based approach to vision care, to address the inequities she observed during her residency (“Celebrating 10”, 2019). Although the groundbreaking work of these Black doctors has positively contributed to the health outcomes of patients across the country, few people can associate these scholars with their work.

Today, medical racism manifests itself in the disproportionately high rates of mortality and morbidity experienced by Black patients in America. Black people are less likely to receive pain medication when compared to their white counterparts (Goyal et al., 2015; Meghani et al., 2012). Among Black women, roughly forty per one hundred thousand live births result in pregnancy-related deaths, over three times the rate among white women (Petersen, 2019; Hoyert & Miniño, 2020). What is worse is that many of the deaths are preventable, mainly attributable to systemic issues including lack of access to quality treatment and physician bias (Petersen, 2019; Hoyert & Miniño, 2020). e recent pandemic has failed to break the cycle. As of June 2020, Black people have made up twenty-three percent of COVID-19 deaths despite making up less than thirteen percent of the US population (“COVID-19 Provisional”, 2020). us, healthcare facilities are more o en than not a line between life and death for the Black community.

Medical racism also involves the perpetuation of harm done to Black bodies within medical education. Most o en cited is a 2016 study that surveyed rst- and secondyear medical students. Forty percent of these students believed that “Black people’s skin is thicker than white people’s,”(Ho man et al., 2016) and with this belief comes the assumption that Black patients feel less pain and are biologically di erent from their white counterparts. Students like those in the study eventually become doctors, allowing their biases and false beliefs to permeate the healthcare system—causing even more harm to Black patients. Unfortunately, this issue is not isolated to the Black community but extends to the BIPOC community at large. In 2018, 56.2 percent of active physicians were white, 17.1 percent were Asian, and only 11.1 percent were under-represented minorities (URMs) (“Figure 18”, 2019). is lack of diversity among physicians compounds the damage done by inadequate medical school curricula, leading to increased distrust between BIPOC patients and their physicians. As stated in the open letter, “[H] istory always manifests itself in the present,” and as the medical system stands now, this pattern of bias and misinformation paired with distrust is guaranteed to continue.

So how do we x this? How can we make things better for patients of color?

Part of the solution is to increase the number of URMs in medicine. Although increased minority representation in the medical eld should not be viewed as the cure-all-end-all solution to this problem, URMs o en share lived experiences that are very useful in combating physician biases. However, with this goal realistically being achieved far in the future, it is important to set and achieve smaller goals that more immediately improve the quality of care for minority patients. One option is to educate all pre-medical and pre-health students on topics ranging from the history of racism in medicine to inequities in access and quality of healthcare to BIPOC patients. Such education would compel doctors to face their implicit biases, including those they may not even realize exist. Because doctors are entrusted with the lives of others, they must have a profound understanding of how the history of medicine and race impacts their patients’ access to and ability to receive care.

Medical school prerequisites are excellent at ensuring that medical students are competent in the sciences but do very little to ensure that doctors, with all of their scienti c knowledge, can properly care for their patients. ough many schools recommend that students take a social science course (typically introductory psychology or sociology), choosing which courses satisfy this requirement are largely le up to the applicant. Additionally, these introductory courses rarely, if ever, adequately cover a topic like medical racism. Consequently, many medical school students matriculate without ever having learned about the disparities of medicine and why they exist. ese doctors will continue to put the lives of BIPOC at risk by belittling their pain and not comprehending how such patients’ experiences outside of the doctor’s o ce directly impact their state of health. Hence, without knowledge of these disparities and this history, doctors are doomed to perpetuate them.

Medical racism exists two-fold, within the prejudices that doctors hold and within the structural biases that make healthcare disparities an institutional problem that will ultimately require institutional support to x. As aspiring doctors, we have learned about these disparities. And as black women in America, we have experienced the results of continued racism within healthcare. We know that as wellintentioned as we are, certain systems—as they stand today—will continue to deter us and others from nally bridging the gaps in the quality of medical care between white patients and BIPOC patients. Checking biases is, at the very least, a very productive place to start doing the necessary work.

e open letter is intended to raise awareness about medical racism and provide resources for education against it, but it is just a small start to the anti-racist work that needs to be done at medical institutions. Medical schools should follow suit and require pre-med students to take courses on racism in medicine and health disparities among BIPOC patients. is revised premed curriculum would re ect the value of understanding both patients and science within the practice of medicine. Both are inextricably important to cultivating properly trained doctors. ■

Link to the open letter: https://bit.ly/33FtXxV

CELIA CACHO om Bronx, New York, USA, and NGOZI OKOLI om Glenview, Illinois, USA, are both undergraduate students currently studying at Yale University.