All the Social Structures of Domination

Harriet A. Washington. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Anchor Books, 2006).

There has been considerable controversy over the ethics of using knowledge — even to save lives — that was obtained from Nazi medical experimentation on death camp inmates. Unfortunately far less attention has been paid to the role (far more significant as a source of medical knowledge and technique) of experimentation on black slaves in the United States.

Washington starts with the vignette of James Marion Sims, long revered a pioneer of gynecological research in the 19th century, who eventually became head of the AMA. Less known is that his research involved experimental surgery — without anesthesia — on unwilling female slaves who fought against their restraints and screamed in agony throughout the process.

Human medical experimentation in the United States has always relied disproportionately on the poor and powerless as subjects — at worst involuntary subjects like prisoners, military conscripts and forcibly committed psychiatric patients; at best, destitute people willing to “volunteer” for a few extra bucks. And who could be more powerless than a slave, or an African-American living in the legal, social and economic Apartheid that has prevailed since formal emancipation?

The public is dimly aware of some of the more notable examples — the Tuskeegee Syphilis Study, for example — but not of the continuous, ubiquitous history of such experimentation.

The slave appropriated by physicians for experimental surgeries, the impoverished clinic patient operated upon to devise or demonstrate a surgical technique, the sharecropper whose body is spirited from the morgue for dissection, the young girl whose fertility is stolen via an untested contraceptive technique or a “Mississippi appendectomy” (involuntary sterilization), the soldiers, prisoners, and children who find themselves without options when government physicians foist novel medications and techniques upon those with little legal protection — all these African Americans, and many more, have found themselves voiceless as medical lions have chosen to present this research in a bowdlerized manner.

As late as the 1960s, neurosurgeon Harry Bailey fondly recalled that it was “cheaper to use N****** than cats because they were everywhere and cheap experimental animals.” And in our own day, as a friend of the author put it, “Girl, black people don’t get organs, they give organs.”

Although there has been some deliberate suppression of this narrative, for the most part it has been suppressed by structural filtering mechanisms as effectively as though it had been done by design. The victims of experimentation under slavery were people barred by law from literacy; and the medical establishment’s version of history has crowded out that of black experimental subjects every step of the way since then by a society that privileges official literary histories over oral histories, and the testimony of professionals over that of the poor and uneducated.

Washington also argues convincingly that the African-American population have been casualties of this history of systematic violation of medical ethics in another way: Not only has unequal access to healthcare resulted in disproportionate amounts of chronic disease in the black population, but understandable distrust of the medical profession and institutionalized healthcare — based on experience — has created barriers to accepting effective care even when it is available.

The book adheres more or less to a chronological organization, although the sections covering the period from the mid-20th century to the present are broken up topically.

As already suggested, experimentation on slave women, as involuntary subjects, provided a heavily disproportionate amount of gynecological research in the 19th century. Not only would no free subject voluntarily submit to such life-threatening surgery without anesthesia, but experimentation on slaves enabled Victorian doctors to bypass social conventions that forbade them to view female patients unclothed. Note, by the way, that the absence of anesthesia didn’t mean it was unavailable; ether was in widespread use for surgery. Rather (to take one example) Sims judged vaginal surgeries were “not painful enough to justify” it — despite the rapid turnover of surgical assistants, who were traumatized by the experience of holding down the screaming women.

A Dr. Stillman in Charleston advertised to buy slaves by the dozen for experimentation (“for disposal,” in his words), whose masters considered them too sick to work profitably. Involuntary black surgical subjects were a staple in the operating theaters of teaching hospitals. Blacks also supplied a larger proportion of cadavers.

Even when slaves received medical treatment — of a kind often fatal for whites as well as blacks — for legitimately ameliorative purposes, it was forced on them without regard to their wishes in the same way a draft animal would receive veterinary treatment. Such treatment as they received was hampered, over and above the general state of medical knowledge, by quack “scientific racist” theories about African physiology. As for those who were the objects of medical attention for other purposes, the story of Dr. Sims is just one example. And of course black women suffered from sexual disease and unwanted pregnancies as the result of their utter defenselessness against rape.

After Emancipation the public health approach to free blacks was heavily distorted by scientific racism; diseases caused by inadequate diet and shelter, impure water and other environmental problems were dismissed as the result of inherent racial defects.

Although forcible experimentation and sterilization continued in cases where blacks fell into the clutches of the state (prisoners, mental patients, orphans and recipients of relief) in other cases deception was required to experiment on them without their knowledge. A notorious example is the Tuskegee Experiments, to which Washington devotes a separate chapter.

Scientific racism persisted in its effects on the treatment of African-Americans in the Progressive Era, and on into the 20th century. The so-called “Progressives,” much like the British Fabians, were heavily into social control of the economic underclass and the broad category of people regarded as in some way “undesirable” — especially people of color — and this attitude was manifested particularly in the form of eugenics.

Margaret Sanger, known to most people who have heard of her as a feminist saint and apostle of contraception, was at least as dedicated to eugenics as she was to family planning. She went out of her way to conceal the fact that her clinics in black communities were intended to suppress fertility rates for eugenic purposes (the “Negro Project”). Much as today’s Republican operatives enlist preachers to suppress black voter turnout, Sanger relied on a religious approach to propaganda. “We do not want the word to get out that we want to exterminate the Negro population, and the minister is the man who can straighten out that idea if it occurs to any of their more rebellious members.”

And of course sterilization, whether by force or by deception, was part of the eugenic toolkit. By 1935 twenty-seven states had laws mandating the sterilization not only of the “feeble-minded” and those with genetic defects, but those on welfare. The number of forced sterilizations by 1941 approached 100,000. Even so, sterilizations by deception under cover of medical treatment exceeded those administered by force. The so-called “Mississippi appendectomy” referred to the common practice of sterilizing black women without their knowledge during other surgery.

There is considerable public awareness of the military deliberately exposing unknowing subjects to radiation, whether by injection of radioactive material into hospital patients or the exposure of soldiers to radiation from nuclear blasts. What’s less well-known is that many or most of the subjects were black. A number of black patients who were expected to die were injected with radioactive isotopes without their knowledge, just to see what would happen. Several of them defied expectation and lived for years afterwards.

One of the most shocking facts Washington presents is the use of hundreds of “rehabilitated” Nazi doctors, given new identities and settled in the United States, to perform medical experiments with radiation on unknowing patients. Because of the secrecy it’s unknown what the ethnic breakdown of the subjects was, but based on contemporary experiments whose makeup was known it’s a likely guess they were disproportionately black.

Experimentation on prisoners continued through the ’70s, and has experienced a partial revival since the late ’80s. Although nominally voluntary, securing “volunteers” for drug testing relies on leverage over sentencing and the offer of modest amounts of money where the alternative is a few dollars a day for prison labor. Prisons are ideal for Phase I trials of new drugs, which test them for safety and non-toxicity; prisons are the only places where large enough sample sizes for toxicity studies can be obtained. The majority of new drugs never go into use, because they’re weeded out as too toxic in Phase I studies. For example dermatological experiments at Philadelphia’s Holmesburg prison from the 1950s through the 1970s involved three quarters of the inmate population, many of whom suffered horrible scarring and other injuries.

Even small children have not escaped. For example in the 1990s a five-year study by the New York State Psychiatric Institute and Columbia University’s Lowenstein Center for the Study and Prevention of Childhood Disruptive Behavior enlisted 126 boys mostly aged 6-10, deliberately selected by race. As it turns out, they were also selected because (supposedly confidential) probation records showed their older brothers had been processed through the criminal justice system. The experiments were designed to test whether there was a biological basis for violent behavior. They were given high doses of fenfluramine to see if it would cause abnormally high spikes in serotonin, on the hypothesis that abnormal serotonin regulation might be associated with aggression. Even worse were experiments like those of neurosurgeon Orlando Andy performed on young black children in the 1960s, who actually severed, destroyed or removed parts of the brain to see what effect it would have on “aggression” and “hyperactivity.”

The psychological experimentation extended to surgery in the heyday of lobotomies as an alternative to medication, in the ’60s and ’70s. The procedure was used on children as young as six who were deemed “aggressive” or “hyperactive.”

The last part of the book extends to the present day. One chapter is devoted to the forcible collection of DNA samples. Police forces are compiling databases of DNA not only from convicted felons, but from anyone arrested or stopped by the police (still presumed innocent). Anyone familiar with the behavior of the NYPD or any other big city police force can guess which demographic groups will be stopped the most (hint: it’s black people).

But “if he is not guilty,” our fedora-wearing devil’s advocate might ask, “what is the problem for a man in the database? He has nothing to worry about.”

But he does. Multiple levels of bias feed the all-black and all-Hispanic databases, and… DNA evidence is no more immune to fraudulent or incompetent manipulation than is other evidence. Then, too, there is the issue of collective stigmatization: If only men of color are in the database, only men of color become suspects and only they can be convicted.

Then, too, there is the question of how many DNA fragments (single nucleotide polymerases, or SNPs) it takes to reliably match two samples, and whether particular testing techniques are sufficiently reliable. And when a database is composed of people from a single racial group, the random variation between individuals is reduced and the problem of false positives increases.

Employers, as well as police, use genetic testing for nefarious purposes — often without the knowledge of the subjects. Tests for genetically based disease focus disproportionately on sickle cell anemia, which obviously affects mainly the African-American population. The result, when workplace health rules exclude those with that condition despite its irrelevance to any actual safety concern, is to create a genetic underclass.

On the other hand the Human Genome Project’s database of sixty families included none of African descent, although the project is touted for its potential to find cures for many illnesses. That means the project is far more likely to benefit suffers of, say, cystic fibrosis — an overwhelmingly white disease — than of sickle cell anemia. And mitochondrial DNA shows that the ancestry of everyone outside Africa went through one of two very narrow genetic bottlenecks, whereas the African population has the full original genetic variety of our species. That means that HGP gives a very misleading view of human genetic variation.

Forced hospitalization for those with infectious diseases like tuberculosis also falls disproportionately on the black population. And as diseases like AIDS shift to the black population, public health approaches predictably become more punitive and authoritarian. The approach to finding an AIDS cure is also quite asymmetrical; in 2003 AIDSVAX was abandoned as worthless despite the fact that some evidence (“some” meaning a correlation with only a 2% possibility it could have been chance) showed it quite effective for black and Asian populations.

The last chapter, and perhaps the most appalling, is on the US military’s R&D programs for chemical and biological weapons, which were tested on unknowing black populations. For example, the residents of Carver Village, an integrated state-built housing complex opened in Miami in 1951. The joint CIA-Army MK-NAOMI offensive biological warfare program, located at the Army Chemical Corps base at Fort Detrick, MD, released swarms of millions of mosquitoes near the all-black community at Carver Village, to determine if they could be used as an attack vector for spreading disease. The result was a sharp uptick in whooping cough, along with a rash of other illnesses through 1960. According to the records of MK-ULRA, of which MK-NAOMI was a part, the CIA released biological agents including mosquitoes and bacteria in hundreds of similar dispersals — including a mosquito release at another community called Carver Village in Georgia. Local residents recalled the Army placing mosquito traps in backyards and conducting surveys to record the incidence of mosquito bites, even as people began sickening and dying.

After news of the Tuskegee experiments broke, resulting in widespread outrage over Cold War use of the public as guinea pigs, MK-ULTRA director Dr. Sidney Gottlieb attempted to destroy all case files. Eventually citizen activists reconstructed the lost material by piecing together evidence from train tickets, receipts for lab animals, crop dusters and biological testing supplies, and the like. For example, signed receipts (stamped MK-NAOMI) for cultures of a whooping cough pathogen in the same year cases of that disease tripled in Florida.

From a libertarian standpoint, the evils Washington recounts are a powerful example of the need for thick libertarian analysis (for an explanation of what that means, see Charles Johnson’s excellent article “Libertarianism Through Thick and Thin,” The Freeman, July 1, 2008). Certainly the state was central in creating the slave codes, organizing slave patrols, enforcing titles and contracts in court, and all the other aspects of enforcing the status of human beings as property. And even after legal Emancipation, the state remained a major actor in inflicting direct harm on African-Americans. But even during slavery, the state was simply the most active and coercive in a larger complex of mutually reinforcing economic, social and ideological institutions; and the other institutions in that complex have continued to interact and to reinforce each other as an interlocking system of power even as the state has partially receded into the background.

For that reason, our work as libertarians cannot be limited to fighting against the coercive activity of the state, narrowly conceived. We must fight against all the social structures of domination, of which the state is a part.

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The Anatomy of Escape
Organization Theory