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Introduction
Intersections in Science was founded by the outreach team of UCLA’s science libraries. The group brings students and librarians together to publish research connecting science to the humanistic realities of our world. The team’s annual Science as Art competition encourages members of the campus community to share the beauty of science through artistic submissions.
The history of racism in the United States has influenced every aspect of society. The medical profession has a history of conducting experiments on vulnerable populations under the guise that they are for the greater good. In this post, we will discuss how experiments conducted on Black people played a role in advancing the field of gynecology and how race-based assumptions influence biases and health disparities in the medical system today.
Historical Background
James Marion Sims developed techniques used in modern gynecology today (James, 1997; West & Irvine, 2015). He developed the knee-chest position used to treat vesicovaginal fistula. A vesicovaginal fistula (VVF) is an opening that develops between the bladder and the wall of the vagina because of infection or stress during pregnancy (Stamatakos et al., 2012). The result is that urine leaks out of the vagina, causing discomfort. While the development of this technique was innovative, Sims’ experiments were conducted on enslaved Black women who were withheld anesthesia during their surgeries despite its emerging use in medical practice. Particularly well documented are the stories of Anarcha, Betsy and Lucy. These women were sent to Sims by their owners to treat their VVF and Sims housed these enslaved women in his hospital as he practiced on them (West & Irvine, 2013). Sims began performing surgery in 1845 before anesthesia in the form of sulphuric ether was successfully used in surgery in 1846 (Robinson & Toledo, 2012). The use of a stable gas to ensure a pain-free experience revolutionized surgery after 1846. Sims began using anesthesia in his New York clinic that catered to White women and in his asylum in North Carolina for poor women (West & Irvine, 2013). While it is unclear if Sims used anesthesia in his clinics where Black women were treated, he held the belief that Black women were able to withstand more pain than White women, a prevalent stereotype still held by certain practitioners (Washington, 2007; Spattel and White, 2011). His biographer, Seale Harris, commented that “Sims’s (sic) experiments brought them physical pain, it is true, but they bore it with amazing patience and fortitude — a grim stoicism which may have been part of their racial endowment” (Spattel and White, 2011).
Another example of the exploitation of Black bodies is Henrietta Lacks, a Black woman who was undergoing treatment for cervical cancer. Without her consent, a sample of her cells was sent to Dr. George Gey, a cancer researcher who studied the cells of cancer patients (Skloot, 2010). Through his observation, he realized that unlike other patient’s cells, Henrietta Lacks’ cells continue to double every 24 hours and could be a model system on which to experiment. Since then, her cells became the first immortal line of cells, have been commercialized, and have generated wealth for the researchers who patented her cells (Skloot, 2010). In the book, “The Immortal Life of Henrietta Lacks,” Skloot documents the abuse the Lacks family experienced at the hands of scientists and journalists who understood the value of her cells but didn’t understand Henrietta’s value as a person. These are some examples of Black people being treated as things to experiment with instead of humans who deserve excellent medical treatment.
Modern Practices
The belief that the medical system has failed Black people is widespread due to extensive limitations to access in healthcare for these communities (Frakt, 2020). One contributing factor is racial bias among medical professionals when treating Black people who experience pain (Sabin, 2020). A study conducted by Hoffman et al. investigated racial bias held by White medical professionals concerning pain assessment between Black and White patients. The authors investigated the link between race-based assumptions and disparities in treatment. Based on results, White medical professionals believed Black patients experience less pain than White patients making them less likely to receive pain medications than White patients (Hoffman et al., 2016).
Hospitals don’t always feel like a safe space for Black people to share their physical vulnerability. For example, in 2019, a nurse posted a video on Twitter mocking patients who were experiencing pain and said, “we know when y’all are faking” with laughing emojis. Many people retweeted the video, sharing experiences where they were not taken seriously by their doctors or nurses.
The American Public Health Association Public Health Nursing Section responded, “Nurses everywhere must listen to their patients, believe them, and act with the ethical duty they are charged with. Women not being heard and having their needs neglected is part of the #BlackMaternalMortality crisis in the US.”
During her pregnancy, famous Black American tennis champion Serena Williams suffered from a pulmonary embolism, which is when blood clots block one or more of the arteries in the lungs. She had an emergency C-section to deliver her daughter and experienced complications (Williams, 2018). Williams reports that she started to experience shortness of breath after her emergency C-section. Despite her history of developing blood clots, she struggled to convince doctors that she was experiencing complications. As a result, she had a hematoma in her abdomen and had coughing fits that tore her C-section wound (Williams, 2018). “[Williams] struggled to convince doctors, and when they finally checked her, it turned out she had several clots in her lungs” (Chuck, 2018).
The CDC released a report that indicates Black women experience four times more pregnancy-related deaths than White women (Petersen et al., 2019) and in particular, Black women are more likely to die from pulmonary embolism or hypertension disorders during pregnancy (Petersen et al., 2019).
Emerging Anti-Racist Practices
Arline Geronimus, a professor at the University of Michigan, coined the term “weathering,” which is when “Black women experience earlier deterioration of health because of the cumulative impact of exposure to psychosocial, economic and environmental stressors (Petersen et al., 2019). This culminates to implicit bias Black women experience in hospitals when they advocate for the same treatment and acknowledgment as White women. So what can medical professionals do to decrease mortality rates among Black women? Medical professionals can receive intentional training in implicit bias that provides better care and support to people of color.
A study conducted by Williams and Cooper discusses an intervention that taught medical professionals “multiple new prejudice-reducing strategies including stereotype replacement, counter-stereotype imaging, individuation, perspective taking and increasing interracial contact” (Williams & Cooper, 2019). This training reduced implicit bias in medical professionals after a three-month follow-up, but no long-term follow up was done. Another way implicit biases can be reduced is by abrogating textbooks used to teach “cultural differences in response to pain.”
An image from a nursing textbook published by Pearson in 2014 went viral on Twitter(opens in a new tab) because of misconceptions regarding how different cultures respond to pain. Oversimplified culture- or race-based categorization of pain response is a demonstration of the implicit biases in the medical education system that impacts the treatment patients receive. Medical students learn biased concepts early in their medical career that plays a role in how they provide diagnosis and treatment to their patients who do not identify as White.
In congruence to the training medical professionals receive, automated medical systems implemented to streamline healthcare systems have perpetuated biases that disproportionately affect Black people. In a study conducted by Obermeyer et al., they investigated an algorithm that was implemented in some hospitals to help triage whether or not individuals should receive certain types of care. The authors found that the algorithm caused Black people to be deprioritized from the care White patients received. The assessment system used patient costs as a means of predicting health needs; however, the study pointed out that due to barriers in access to care, Black people spend less money on healthcare. As a result, the algorithm assumed Black people were healthier than they were. To address this, the authors created a health risk score based on the number of active chronic conditions, rather than health spending. When comparing their risk score with the original algorithm-predicted risk, they found that Black patients were sicker than White patients at the same predicted cost. Based on these results, the authors found that correcting the algorithm could increase the percentage of Black patients receiving additional help from 17.7% to 46.5%. The authors explored several options to correct this algorithmic disparity and create more accurate predictors of health which are ongoing.
Conclusion
Racial prejudice does not stop at the prison industrial system or police brutality. It continues to permeate the walls of medical practices and is reflected through research conducted on pain management and the increasing mortality rates of pregnant Black women in America. In this post, we highlighted the history of bias in the medical system, evidence of bias in medical training, patient treatment, and patient treatment algorithms. Throughout this post, research has indicated that White patients receive better treatment than Black patients because of race-based biases in treatment and training, in addition to systemic and economic barriers to medical care. The research conducted on this subject shows the urgent need to change the medical system and educate practitioners on implicit biases that permeate nearly every level of the medical profession.
Additional Resources
- Find articles in PubMed(opens in a new tab)
- Visit Kanopy(opens in a new tab) to watch an episode of Unnatural Causes, titled “When the Bough Breaks.” Kanopy is available to UCLA students, staff and faculty.
References
Frakt, A. (2020) Bad Medicine: The Harm That Comes From Racism. New York Times.
Hoffman, Kelly M., Trawalter, Sophie, Axt, Jordan R., Oliver, M. Norman. (2016) Racial bias in pain assessment. Proceedings of the National Academy of Sciences, 113 (16) 4296-4301; DOI:10.1073/pnas.1516047113
Kenny, Stephen C. (2007). ‘I can do the child no good’: Dr. Sims and the Enslaved Infants of Montgomery, Alabama, Social History of Medicine, Volume 20, Issue 2, Pages 223–241, https://doi.org/10.1093/shm/hkm036(opens in a new tab)
Obemeyer, Z., Powers, B., Vogeli, C., Mullainathan, S. (2019) Dissecting racial bias in an algorithm used to manage the health of populations, Science, Vol 366, Issue 6464, DOI: https://doi.org/10.1126/science.aax2342(opens in a new tab)
Petersen E. E., Davis N. L., Goodman D., et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep 2019; 68:762–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6835a3(opens in a new tab)
Robinson, D. H., & Toledo, A. H. (2012). Historical development of modern anesthesia. Journal of investigative surgery: the official journal of the Academy of Surgical Research, 25(3), 141–149. https://doi.org/10.3109/08941939.2012.690328(opens in a new tab)
Sabin, Janice A. (2020). How we fail black patients in pain. AAMC, https://www.aamc.org/news-insights/how-we-fail-black-patients-pain(opens in a new tab)
Skloots, Rebecca (2010). “‘Henrietta Lacks’: A Donor’s Immortal Legacy” NPR. https://www.npr.org/2010/02/02/123232331/henrietta-lacks-a-donors-immortal-legacy(opens in a new tab)
Spattel, Sara, White, Mark D (2011). “The Portrayal of J. Marion Sims’ Controversial Surgical Legacy”, Journal of Urology, Vol. 185: pp. 2424-2427. DOI: 10.1016/j.juro.2011.01.077(opens in a new tab)
Wall L. L. (2006). The medical ethics of Dr. J Marion Sims: a fresh look at the historical record. Journal of medical ethics, 32(6), 346–350. https://doi.org/10.1136/jme.2005.012559(opens in a new tab)
West, M., & Irvine, L. (2015). The eponymous Dr. James Marion Sims MD, LLD (1813–1883). Journal of Medical Biography, 23(1), 35–45. https://doi.org/10.1177/0967772013480604(opens in a new tab)
Williams, D. R., & Cooper, L. A. (2019). Reducing Racial Inequities in Health: Using What We Already Know to Take Action. International journal of environmental research and public health, 16(4), 606. https://doi.org/10.3390/ijerph16040606(opens in a new tab)
William, Serena (2018). Serena Williams: What my life-threatening experience taught me about giving birth. CNN. https://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html(opens in a new tab)