1. The Nature of Medical Racism

       The Origins and Consequences of Medical Racism

INTRODUCTION

      The idea that discredited (and even disgraceful) ideas about racial differences might play a role in medical diagnosis and treatment is a possibility that some doctors find profoundly disturbing. The racially biased treatment of patients would appear to be a grievous violation of medical ethics and a direct threat to the dignity of the profession. Yet, in the course of the last two decades, the medical literature has published hundreds of peer-reviewed studies that point to racially motivated decisions by physicians either to deny appropriate care to black patients or to inflict on them extreme procedures (such as amputations) that many white patients would be spared.¹ “How are we to explain, let alone justify, such broad evidence of racial disparity in a health care system committed in principle to providing care to all patients?” the socially active physician H. Jack Geiger asked in 1996. His reply to his own question offered two possible explanations. The first option was to attribute the observed disparity to “unspecified cultural differences” or decisions made by black patients who did not understand that they needed medical care. The second and more discomfiting explanation was, as Dr. Geiger phrased it, “racism—that is, racially discriminatory rationing by physicians and health care institutions.” Confronting the data that he had felt compelled to present to the medical community, Dr. Geiger could not bring himself to categorize the documented behavior of his medical colleagues as racist. Indeed, he added, “if racism is involved it is unlikely to be overt or even conscious.”² For this conscientious physician, medical racism that implied individual culpability was still somehow unreal, a specter to be exorcized rather than a threat to be acknowledged and confronted.

      Black and Blue is the first systematic description of how doctors think about racial differences and how this kind of thinking affects the treatment of their patients. While some fine studies of medical racism have appeared, they have not examined the thought processes and behaviors of physicians in any sort of detailed way. In effect, these studies have not seen fit to enter into the physician's private sphere where specific racial fantasies and misinformation distort diagnoses and treatments. Nor have they shown much interest in identifying the specific origins of racially motivated diagnoses and treatments of black patients that have ranged across the entire spectrum of medical sub-disciplines, from cardiology to obstetrics to psychiatry. It is true that American physicians have been “major perpetrators of racialist dogma,” as a monumental history of American medical racism states.³ Black and Blue moves beyond such general claims about racially motivated medical behaviors and describes how mainstream medicine devised racial interpretations that have been applied to every organ system of the human body.

      The studies to date have occasionally noted but failed to describe the oral traditions that convey medico-racial folklore and persist over generations of medical students and doctors. As we shall see, the physicianauthors who have taken the trouble to write about the racial dimension of medicine confirm that the medical profession has never embarked upon this kind of self-scrutiny in a serious manner. Interestingly, the medical profession's lack of interest in confronting the racial complexes of doctors has created little activism among even the most concerned medical observers beyond ritualized expressions of concern. While these white “medical liberals” profess to be “troubled” by this topic, their efforts at raising consciousness have been episodic and have never acquired the political traction that