Fear of the White Coat: The History Behind Black American Distrust of Medicine

With the disproportionate rates of chronic and infectious diseases affecting Black Americans, one would think that this subpopulation would regularly and willingly seek medical care. Research says otherwise. According to a study analyzing the racial and ethnic differences in physician distrust, Black Americans are more likely to report distrust for physicians in comparison to White Americans.[1] The history of racism and discrimination in the medical field sheds light on why many Black people experience iatrophobia or fear of the healer. Doctors have harmed Black patients historically and continue to do so in the modern day. Here are five reasons why Black people fear the doctor.

1. Henrietta Lacks and HeLa cells

The story of Henrietta Lacks is one of the grossest examples of medical paternalism and bioethical injustice to this day. Lacks was a poor Black tobacco farmer whose cancer cells were taken by doctors at Johns Hopkins in Baltimore while she was undergoing a biopsy for cervical cancer in 1951. Her cells became the first immortal human cell line because they reproduced infinitely in the lab. Her cells were then shared freely with scientists across the world, without her consent, to develop the polio vaccine, cloning, gene mapping, in vitro fertilization, and more. While her cells have been used to create a million-dollar industry in health research, her children still live in poverty, without health insurance, and without access to many of the medical advances afforded to the world by their mother’s cells.

2. Tuskegee Syphilis Experiments

The “Tuskegee Study of Untreated Syphilis in the Negro Male” began in 1932 as a cross-collaboration between the Public Health Service and the Tuskegee Institute. The initial purpose of the study was to record the natural history of syphilis to justify treatment programs for Black Americans. The study involved 600 Black men — 399 with syphilis and 201 without the disease — and was conducted without their informed consent. Although the Tuskegee Syphilis Experiments were projected to originally last for 6 months, it went on to last for 40 years. An Ad Hoc Advisory Panel reviewed the study in 1972 to discover that the researchers never informed the men about the study or its purpose. Furthermore, the men were never given adequate treatment for their syphilis despite penicillin becoming the standard treatment in 1947. The advisory panel revealed that the men were also never given the choice to leave the study. The study only stopped after Peter Buxtun, a US Public Health Service (PHS) employee who had filed two ethics complaints to the PHS, alerted news outlets of the study in 1972.

3. The Negro Project

Margaret Sanger, a staunch believer in Malthusian eugenics, created the controversial “Negro Project” in 1939 under the name “Birth Control Federation of America.” The Birth Control Federation of America is known today as Planned Parenthood. The aim of the program was to restrict the size of the Black population, with larger implications for complete extermination. Sanger disguised her plan under the pretense of better health and family planning. In reality, she selectively targeted low-income Black women with birth control so that they could no longer reproduce.

4. Medical Experimentation on Enslaved African Women

James Marion Sims is constantly credited as the “father of modern gynecology” for developing tools and techniques related to women’s reproductive health. Sims invented the vaginal speculum, a tool used for dilation and examination. He also pioneered a surgical technique to repair vesicovaginal fistula, a common 19th-century complication of childbirth consisting of a tear between the uterus and the bladder. Sims, a southern-born slaveholder, made his discoveries through painful experimentations done on enslaved African women. He tortured enslaved African women by conducting research on their bodies without the use of anesthesia, actions of medical barbarism. Anarcha, Lucy, and Betsey are three of the women who were objectified by Sims’ experiments, where he operated on the notion that Black bodies do not experience pain. Sims is not the only doctor to have experimented on slaves, but he is a notable example.

5. Medical Stigma in Pain Management Treatment

Medical stigma in treating pain among Black patients is still very much alive today. Kelly Hoffman, a Ph.D. student at UVA, conducted a study linking racial disparities in pain management to racial bias among White doctors. Hoffman and other researchers found that a substantial number of White medical students and residents hold false beliefs about biological differences between Black and White people, which are responsible for Black patients being undertreated for pain according to World Health Organization (WHO) guidelines. Common falsely held beliefs included the idea that Black people’s skin is thicker and Black people’s blood coagulates more quickly. These are ideas that seem to worsen as students advance in medical school and residency.[2] Furthermore, some textbooks in the healthcare field were written with racial bias. Just last year, Pearson Education had to recall nursing textbooks because of the racial stigmas included within the texts. The textbook reported that “Blacks often report higher pain intensity than other cultures” when advising nursing students on how to evaluate patients from different racial and ethnic backgrounds.

It is important to note that these are just a few cases of the iatrogenic harm experienced by Black Americans throughout the history of the United States. These incidents have looming effects that are felt to this day. Black people’s bodies have been used to create and advance the medical industry, yet many Black people have been denied access to those advancements. When Black people do access health care, they are more likely to be faced with poor health communication or be subjected to medical stigma, making it more difficult to achieve favorable health outcomes. Given this history and contemporary disparities in medicine, it is understandable why Black communities distrust the medical field. We now must think of ways the medical community can address and correct for these harms.

References

1. Armstrong, K., Ravenell, K. L., Mcmurphy, S., & Putt, M. (2007). Racial/Ethnic Differences in Physician Distrust in the United States. American Journal of Public Health, 97(7), 1283-1289. doi:10.2105/ajph.2005.080762
2. Trawalter, S., Hoffman, K. M., & Waytz, A. (2012). Racial Bias in Perceptions of Others’ Pain. PLoS ONE, 7(11). doi:10.1371/journal.pone.0048546