While the nation’s media is currently embroiled in the turmoil of abortion rights and rampant gun violence, it is critical not to overlook that this year also marks the 50-year anniversary of a different crisis: the national media exposure that revealed and ultimately terminated a different politically and medically sanctioned injustice, the U.S. Public Health Services (USPHS) sponsored Tuskegee Study of Untreated Syphilis in the Negro Male.
More than during the times of Tuskegee, medicine is aware today of the many ways that societal inequity kills Black Americans - as evidenced by its willingness to cite racism as a public health crisis and publish thousands of papers each year about health disparities. Yet, instead of boldly naming these deaths as racist injustices like we clearly descrbe the deaths caused by Tuskegee, now we simply call them “racial disparities” to be more appeasing and less triggering to the sensitivities of predominantly white healthcare providers.
Medicine will not achieve equity through internal accountability because the roots of structural and institutional racism are stronger today than ever before. Rather, just as the media fiasco precipitated a national outcry for external accountability that forced the Tuskegee Study to end, so must the American public and media outlets force external pressure to eradicate medical racism,
The Tuskegee Study is remembered in notoriety because White male researchers were so invested in a belief in biological racial differences supporting White superiority that they spent decades passively documenting the needless suffering of at least 400 African American men. Worse, the U.S. government knowingly withheld the intervention, penicillin, that could have cured them and spared their families from disease transmission.
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The researchers’ anticipated and desired goal was for untreated illness to eventually kill these men so that they could perform autopsy dissection, write publications, and gain promotions that showcased how sickness ravaged every part of their bodies. Physicians openly accepted fifteen of the study’s publications into academic medical literature at that time, reflecting medicine’s unspoken core value that Black human beings are vulnerable and disposable.
One might hope that modern medicine has developed a zero-tolerance policy for racist harms to Black Americans since Tuskegee. Instead, medicine today normalizes lasting injustices to Black Americans with euphemisms gently describing our deaths as “racial disparities,” which blames race for the inequity, as opposed to language that more explicitly denounces medical racism as driving inequity, like “racialized health inequity” or “racist disparities.”
Existing performance improvement efforts are far insufficient in scale to achieve true change and often discard the ideal focus on equity in favor of cookie cutter solutions, as evidenced by the persistence and worsening of these same disparate outcomes across decades. Rather than effectively dismantling healthcare’s structural inequity in ways that far surpass the complicit acceptance of Tuskegee, we write follow-up papers and create task forces without the power, expertise, or representation to push the widespread reform that will never truly come from within.
To be clear, we are not critiquing individual researchers and wholeheartedly believe that disparities research has been necessary to uncover mechanisms of medical racism and clearly depict a starting point of racialized inequity. Rather, we are criticizing the lacking accountability amongst healthcare systems and institutions in what comes after an inequity is identified. Too often, medical professionals are socialized into a culture of “rhetorical exculpation” where good intentions and external pressures offer endless exemptions to accountability for racist outcomes, and medicine just chugs along as if early and painful Black death is normative and unavoidable.
For example, in our field of psychiatry, academic researchers have known for decades that Black patients are overdiagnosed and misdiagnosed as being psychotic when in fact they have severe depression or trauma. We also know that much of this disparity is driven by clinicians’ own racial bias and rating scales that inappropriately pathologize Black patients’ experiences of racism.
In the five decades since Tuskegee, medicine has yet to develop a system of internal accountability necessary to end racist health inequity. But as in 1972, the public holds immense untapped power to pressure external responsibility for medicine’s racist wrongdoing. Consider the calls for reform in law enforcement culture, policies and practices as an extraordinary example of the public leveraging its position and voice to rid a taxpayer funded service of its racism.
Medicine, too, is largely funded by taxpayer dollars, making doctors a form of public servants. And yet, “racial disparities” kill countless unarmed Black Americans each year. Worse, more Black lives have been senselessly lost to medical racism over centuries – beyond the tens of thousands lost to healthcare discrimination during the COVID-19 pandemic alone – than the Black lives lost to police brutality. After all, had George Floyd survived until the hospital, “racial disparities” would still have awaited to hinder his fight to breathe.
To honor the historic anniversary of Tuskegee’s public reveal and ultimate termination, we urge Americans to confront medicine and medical professionals with demands for health equity to Black patients, just as we do for police.
The call to end racist medical treatment must be louder than the call for medical professionals to be unconditionally revered in their benevolence, more than any other public servant. We are calling on the nation to hold all of us accountable to a better medicine today, as we did for Tuskegee 50 years ago.
Carmen Black, MD, is an assistant professor and Director of Social Justice and Health Equity Curriculum at Yale Department of Psychiatry. Jessica Isom, MD, MPH, is a clinical instructor at Yale Department of Psychiatry and owner of Vision for Equity, LLC.