In the 2007 nonfiction book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, medical researcher Harriet A. Washington describes the long history of American medical experiments on Black Americans. Although some of these abuses are well-known, such as the Tuskegee Syphilis Study, the book presents a comprehensive history that describes the long-standing pattern of exploitative practices. By uncovering how American medicine has been built upon the abuse of Black people, Washington hopes to repair relations between doctors and Black Americans, thereby bridging the gap between the health profiles of white and Black people in the US.

Harriet A. Washington is a writer and important figure in the field of medical ethics. Medical Apartheid, her first book, won the National Book Critics Circle Award, the PEN Oakland Award, and the American Library Association Black Caucus Nonfiction Award. Her other books include Infectious Madness and Deadly Monopolies.

This guide references the paperback edition of Medical Apartheid, published by Knopf Doubleday Publishing Group in 2008.

Content Warning: The source material and this guide include discussions of racism, eugenics, and medical experimentation.

Summary

Part 1 of Medical Apartheid focuses on the historic treatment of African Americans by scientists and doctors. Washington argues that Black people have been unfairly treated by American doctors since the birth of the US. In Chapter 1, she describes the general culture of health care in the Antebellum South, exploring how medical treatment of enslaved people rested solely in the hands of enslavers. In order to justify the institution of slavery, scientists claimed that Black people naturally lacked physical and mental prowess and required the supervision of white enslavers to survive—a set of beliefs known as “scientific racism” (32). Chapter 2 explores how Southern surgeons developed medical advances through abusive experiments on enslaved people. For example, James Marion Sims helped pioneer modern gynecology by repeatedly operating on a group of enslaved women without consent or anesthetics. In Chapter 3, Washington focuses on sideshow exhibitions of Black people, arguing that such displays helped popularize the theories of scientific racism.

In Chapters 4 through 6, Washington explores how the bourgeoning 19th-century movement of teaching hospitals relied on Black bodies to train physicians. Many doctors learned how to operate by practicing needless surgeries on African Americans, and cadavers were robbed from Black cemeteries to provide material for dissections and autopsies. Part 1 closes with Chapter 7’s exploration of the infamous Tuskegee Syphilis Study. In the study, the US Public Health Service allowed a group of poor Black men with syphilis to go untreated so that scientists could observe the long-term effects of the disease. Rather than treat the study as an isolated instance of medical abuse, Washington argues that it was part of a continuous pattern of the medical establishment’s neglect of Black people.

In Part 2, Washington focuses on a variety of 20th-century instances of medical abuse. The chapters are grouped thematically around “vulnerable subjects” who are particularly susceptible to abuse (19), such as children and prisoners. Chapter 8 focuses on the history of birth control programs targeting African Americans. Washington argues that such programs have to be understood in relation to the early 20th-century eugenics movement, which sought to reduce or eliminate reproduction in African American communities due to racist beliefs that Black people were genetically unfit. In Chapter 9, Washington describes radiation experiments performed upon Black people, often without the patients' knowledge. Chapter 10’s discussion of prison experiments similarly focuses on a lack of informed consent. Scientists such as Dr. Albert M. Kligman performed dangerous experiments on Black prisoners, using manipulation and coercion to get the prisoners to agree to be research subjects. Chapter 11 focuses on experiments on Black children, many of which treated them as naturally aggressive “born criminals” (277).

Washington uses Part 3 to describe how cutting-edge developments in medicine may impact African Americans. While advances in DNA testing have freed many falsely imprisoned Black people, Washington notes that the growth of governmental genetic databases may grant the police new ways to unfairly target Black people. Washington describes a number of experimental medical devices, such as an artificial heart and artificial blood, that were disproportionately tested and refined on Black subjects. Although African Americans may play a central role in developing these devices, they are often unable to afford the very same devices when they are approved for the marketplace. Finally, Washington explores the history of bioterrorism targeting Black populations, from the CIA’s MK-NAOIMI program to apartheid South Africa’s attempts to develop a biological chemical weapon that only affected Black Africans.

In Medical Apartheid’s Epilogue, Washington explores the contemporary climate of medical research. In Washington’s view, most present-day medical experiments are ethically sound. Washington encourages African Americans to participate in medical research to improve the health profile of Black people, although she warns that one has to still be thorough in investigating any potential experiments. Washington concludes her Epilogue with suggestions for ensuring medical experiments remain free of abuse. These include “ban[ning] exceptions to informed consent” and requiring medical researchers to follow the same standard of ethical conduct whether they are conducting research in the US or Africa (403).