Historical Reasons for African American Distrust of Doctors

Historical Reasons for African American Distrust of Doctors

Stephen Kenny, University of Liverpool

The history of human experimentation is as old as the practice of medicine and in the modern era has always targeted disadvantaged, marginalized, institutionalized, stigmatized and vulnerable populations: prisoners, the condemned, orphans, the mentally ill, students, the poor, women, the disabled, children, peoples of color, indigenous peoples and the enslaved.

Human subject research is evident wherever physicians, technicians, pharmaceutical companies (and others) are trialling new practices and implementing the latest diagnostic and therapeutic agents and procedures. And the American South in the days of slavery was no different – and for those looking for easy targets, black slave bodies were easy to come by.

Black bodies in the slave south

There is a rich and rapidly expanding scholarly literature examining the history of human subject research, including studies of the burgeoning bio-medical economy in the US in the 20th century. The Tuskegee experiment and other episodes of medical racism all feature prominently.

The history of the acquisition and exploitation of slave bodies for medical education and research in the US, first explored in depth by historians James Breeden and Todd Savitt, focused primarily on medical schools and the traffic in slave bodies in Virginia. Savitt’s work drew attention to professional medicine’s use of slaves in classroom and bedside demonstrations, in operating amphitheatres, and experimental facilities.

Slave Village
By Wesleyan Juvenile Offering – https://archive.org/details/wesleyanjuvenil07socigoog, Public Domain, https://commons.wikimedia.org/w/index.php?curid=44910848

Savitt argued that African Americans were easy targets for ambitious and entrepreneurial white physicians in the slave south. Slaves, as human commodities, were readily transformed into a medical resource, easily accessible as empirical test subjects, “voiceless” and rendered “medically incompetent” through the combined power and authority of the enslaver and their employee, the white physician. Savitt suggested that “outright experimentation upon living humans may have occurred more openly and perhaps more often owing to the nature of slave society,” and also that “the situation may have been (and probably was) worse in the Deep South.”

Power and opportunism

When an elite white enslaver-physician, Charlestonian Elias S. Bennett, published notes recalling the case of a truly extraordinary tumour afflicting a young female slave on the family’s James Island plantation, his narrative revealed much about the opportunities for human subject research under American slavery.

Bennett recalled an unnamed female patient-subject who had developed “a small tumour the size of a ten cent piece” behind her right ear when she was just four weeks old. In 1817, when Bennett was training to become a doctor and “anxious to perform an operation”, he, together with a fellow physician-apprentice, made a disastrously crude surgical attempt to explore and remove this growth.

In an era prior to anaesthesia and asepsis, this type of surgical intervention was extremely dangerous – especially when undertaken by two unsupervised medical apprentices – who took liberty of an opportunity presented by an extremely vulnerable enslaved child. As Bennett remembered, the child suffered a great deal of “inflammation” as a result, and only “by very close attention” did she recover “in six to eight weeks” – the plantation/labour camp’s seclusion providing perfect cover for what would prove to be a major medical blunder.

‘Unknown enslaved sufferer’. Waring Historical Library, Charleston

Bennett’s crude interference with the tumour, which may have been in a lymph node, was the cause of a severe inflammatory reaction and sudden excessive growth of the lesion. In 1821, when the child was six, Bennett described the tumour as being about the size of an ostrich egg, while in the years immediately prior to her death, his narrative reported that the tumour increased to an enormous, indeed “extraordinary” size. The case report concludes with an post-mortem analysis, or, as Bennett noted in a ghoulish tone, “an imperfect outline of the results furnished by the examination of the tumour, when I obtained the head, or at least so much of it as remained.”

The remains of the enslaved girl’s skull became a pathological specimen in the University of Maryland’s medical museum collection.

Dark medicine: cash for ‘negros’

All of the key training, networks and power bases of southern medicine —apprenticeships, private practice, colleges, hospitals, journals, and societies —operated through slavery’s ruthless traffic and exploitation of black bodies. White medical students, as a matter of course, expected education and training based on the observation, dissection and experimental treatment of black bodies.

White doctors, including those in remote rural locations, routinely sent reports of experiments on slave subjects to medical journals and trafficked black bodies to medical colleges. Medical museums openly solicited black body parts and medical societies relied on black bodies. Students too wrote graduating theses based on the medical manipulation of black “subjects” and “specimens”.

Lucinda. Waring Historical Library, Charleston

Under slavery, there was also an extensive network of specialist “negro hospitals”. The grimmest of slavery’s institutions, these hospitals were often sites of risky medical research and were closely linked to “negro traders” anxious to patch up their “stock” for sale. Large numbers of individual doctors routinely advertised in southern newspapers that they would pay cash for black people suffering from chronic disease. The fate of these trafficked medical subjects, of course, assumed the very worst possibilities.

Slaves were generally unable to prevent treatments chosen by their owners and physicians could take enormous risks with the lives of these patients. Those risks were all the greater when doctors were also the owners of the enslaved patients. The opportunities presented by the system of chattel slavery meant that white doctors had at hand an easily accessible population upon which they could execute experimental research programs and develop new tools, techniques and medicines.

White racist attitudes, the enormous traffic in human chattel, and the slave regime rationalised and normalised the use and abuse of black bodies. Human subject research under American slavery was ultimately nothing unusual. In the context of a society defined by dehumanisation, impoverishment, violent punishment, incarceration, a vigorous trade in human property, racialisation and sexual interference, it should come as no surprise that human experimentation and the exploitation of enslaved bodies was a frequent, widespread and indeed commonplace feature of medical encounters between physicians and slaves. That was the culture of American slavery and every day slave patients faced appalling dangers.

Click here to read more articles in The Conversation’s series On Human Experiments.

Stephen Kenny, Lecturer in 19th and 20th-century North American History, University of Liverpool

This article was originally published on The Conversation. Read the original article.

Flu Shot

Why it’s your job to get a flu shot – and call in sick if you do get the flu

Patricia Schnabel Ruppert, Columbia University Medical Center

Seasonal influenza is a major global health concern. Worldwide, annual influenza epidemics result in three to five million cases of severe illness, and about 250,000 to 500,000 deaths. In industrialized countries, most deaths associated with influenza occur among people age 65 or older, who are also 10-30 times more likely to be hospitalized due to influenza-related complications.

In the United States, the overall burden of influenza disease during 2014-2015 across all ages was 40 million flu illnesses, 19 million flu-associated medical visits and 970,000 flu-associated hospitalizations resulting in more than 36,000 deaths due to influenza-related complications.

You play an important role in stopping the spread of flu, not just to yourself but to others. As a doctor and public health professional who has treated many people with influenza, I’ll explain why.

And no, getting the vaccine will not give you the flu.

Protecting yourself also helps others

Almost everyone should get a flu shot, preferably before the end of October, though flu vaccine should still be administered until the season is over, usually by late spring. The influenza vaccine has been shown to be one of the most important preventive measures against the flu. Almost everyone can receive the flu vaccine. Exceptions include babies younger than six months and people who have serious reactions to the flu vaccine, like anaphylaxis, a serious and life-threatening reaction.

Some people gets hives from eggs, but this is not considered a serious reaction. If you are one of these people, it is still OK for you to get a flu shot from standard providers. Even those who have a serious egg allergy can get the flu vaccine in a medical setting.

Flu vaccine via Shutterstock. From www.shutterstock.com

For the 2014–15 influenza season, the CDC estimates that influenza vaccination prevented about 67,000 influenza-associated hospitalizations, an estimated 1.9 million illnesses and 966,000 medical visits associated with influenza.

Getting the vaccine is not just good for you but also for the larger community. About 70 percent of the population needs to receive the flu vaccine to ensure what we call “herd immunity.” That happens when a critical portion of a community is immunized against a contagious disease.

When that occurs, most members of the community, including those who are not vaccinated, are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines get some protection because the spread of contagious disease is contained. This can effectively stop the spread of disease in the community.

Matching the flu vaccine with the strains

The seasonal flu vaccine protects against the influenza viruses that research indicates will be the most common that season. In
16 of the past 20 influenza seasons, the viruses in the influenza vaccine were well matched to the predominant circulating viruses. Due to the large numbers of flu-associated illnesses and deaths in the United States, combined with the evidence from many studies showing that flu vaccination is not only safe, but provides protection, the current recommendations for flu vaccination are supported.

The World Health Organization works with labs that collect specimens from hundreds of countries to determine which viruses might be most common each year. Since flu strains move fairly predictably around the world, the decision of which strains of flu should be included in the annual vaccine is made months in advance.

There are three main types of influenza virus that cause disease in humans; A, B and C. Influenzas A and B are associated with more severe illness and are included by the WHO in the flu vaccine each year.

Sometimes, there are three strains in the flu vaccine, two A’s and one B. There is also a vaccine with four strains, with two each of A and B.

For influenza A, there are two major antigens, or proteins, on the influenza virus. The body reacts to an antigen with an immune response by producing antibodies.

Influenza antibodies develop in the body about two weeks after vaccination and provide protection against infection with the strains that are in the vaccine. They may also be of benefit for closely related strains.

The major antigens on the influenza A virus are H (hemagglutinin) and N (neuraminidase). They both have multiple subtypes and can combine as different strains of influenza, such as H1N1 and H3N2. Influenza B is named for the location and year first identified and the lineage, for example, B/Brisbane/60/2008-like virus (Victoria lineage).

Typically, hens’ eggs are used to make influenza vaccine. Vaccine manufacturers inject influenza viruses into fertilized hens’ eggs, which are then incubated for several days to allow replication. The virus-containing fluid is harvested from the eggs and formulated into the vaccine.

In injectable vaccine, the influenza viruses are inactivated, or killed. The intranasal vaccine is live, but is made from weakened flu virus. The CDC is not recommending the intranasal vaccine this year due to concerns of effectiveness.

Neither influenza vaccine causes the flu, but you may still get the flu even if you are vaccinated. That can happen if you are exposed to a strain that is not in the vaccine, or if you were exposed within two weeks of being vaccinated. Also remember that although no vaccine provides 100 percent protection, the vaccine can make what would have been a bad case of the flu a much milder one.

The CDC conducts studies to measure the benefits of seasonal flu vaccination each year. These vaccine effectiveness studies confirm the value of flu vaccination as a public health intervention. While vaccine effectiveness can vary, studies show vaccine reduces the risk of flu illness by about 50 to 60 percent among the overall population during seasons when most circulating flu viruses are like the vaccine viruses.

This effectiveness is a major benefit because the flu affects five to 10 percent of adults and 20 to 30 percent of children each year. For the 2015-2016 flu season, the adjusted overall effectiveness of the flu vaccine was 47 percent.

And remember, even if it’s not a perfect match, it can protect you and your loved ones from getting a potentially life-threatening, yet preventable, disease.

Other things to do, too

While the vaccine has been shown to be one of the most important preventive measures against the flu, you can do other things, too. Wash your hands. If you cough or sneeze, cover your mouth or nose with your sleeve, not your hands. Avoid those who are ill.

Cough into your elbow, not your hands. Via Shutterstock. From www.shutterstock.com

Antiviral medication can help you feel better if you contract the flu, but it must be started early in your illness, so call your health provider when symptoms begin.

Good advice: Stay home if you have the flu.
Better advice: Get a flu shot!

The ConversationPatricia Schnabel Ruppert, Commissioner of Health, Fellows Ambassador New York Academy of Medicine, Distinguished Lecturer in Epidemiology and Community Medicine, New York Medical College, Assistant Professor of Medicine, Columbia University Medical Center

This article was originally published on The Conversation. Read the original article.

Grassroots politics led to the 14th Amendment and black citizenship

How black grassroots politics led to the 14th Amendment and black citizenship

Frederick Knight, Morehouse College

In 2008, the United States elected its first African-American president. But in the last year of Obama’s final term, the paradox and tragedy of race is as apparent now as any time in recent American history. A poll released earlier this month indicates a growing pessimism about race relations in the U.S., an attitude triggered by the deaths of black people at the hands of law enforcement officers and subsequent attacks on police in Baton Rouge and Dallas.

As the nation seeks to understand the recent violence, and as the Black Lives Matter Movement claims the mantle of black leadership, now is an important time to remember an earlier period of race-based violence and civil rights struggles.

150 years of black ‘citizenship’

A critical period in the history of civil rights in the United States began 150 years ago and led to the ratification of the 14th Amendment to the Constitution in 1868. For nearly a century after, the federal government failed to enforce the 14th Amendment’s provisions. Yet, the 14th Amendment is arguably the Constitution’s most important because it defined the meaning of citizenship and established the rights of citizens to “due process of law” and “equal protection of the laws.”

The 14th Amendment was the result of local struggles and national debates on the political status of African-Americans in the wake of slavery and the Civil War. The 600,000 people sacrificed during the Civil War, and the 13th Amendment that abolished slavery, were not enough to guarantee equal treatment and protection of African-Americans by local governments.

In late 1865, a U.S. military official filed a report that made it into the hands of congressional leadership. The report highlighted how the state of Mississippi had enacted laws limiting the rights of freedmen and women. In the report, submitted on Nov. 28, Lieutenant Eldridge wrote that a Mississippi law barred African-Americans from leasing land, “testifying in cases of whites,” “doing any independent business” and appealing court cases past the county level.

The Mississippi law did give African-Americans the right to marry, to sue and to own property. But the ultimate goal of the state’s “Black Codes” and those passed in other states like Alabama and South Carolina was to limit the movement and gain control over the labor of freedmen and women. In the state of Mississippi and in other southern states, black and white people were to live under different laws.

Senator Lyman Trumbull from Illinois.
Wikimedia Commons

With the failure of white Southerners to recognize African-Americans as citizens, Senator Lyman Trumbull of Illinois led a congressional response and wrote the Civil Rights Bill. It passed Congress but was vetoed by President Andrew Johnson. Congress mustered the votes to override the veto and passed the bill into law in April of 1866. Its principal objective was to make explicit the citizenship rights of African-Americans, and in effect prevent racial discrimination. More specifically, the law guaranteed black people protection by the government.

In a message delivered on April 4, 1866, Trumbull responded to President Johnson’s veto message. Drawing on the ideas of political theorists and the opinion of military officials, Trumbull argued that the federal government was responsible for providing protection to all citizens regardless of race. The law, Trumbull argued, would make binding policies that had already been undertaken by the military in the post-Civil War South.

The United States military had filled the vacuum created by the collapse of the Confederacy. One of their roles was to administer justice and adjudicate disputes. Within this context, Major General Sickles, based in South Carolina, ordered in late 1865 to early 1866 that the government’s role was to “secure the same equal justice and personal liberty to the freedmen as to other inhabitants.”

Black grassroots politics and the contest for equal rights

Leading up to the civil rights debate at the federal level, African-Americans in the North and South organized grassroots movements to secure their rights as citizens.

Pennsylvania Equal Rights League leader Octavius Catto.
Library of Congress

For example, the Pennsylvania Equal Rights League emerged in the wake of the Civil War. Led by William Forten, Octavio Catto and other prominent black Philadelphians, they pressed the state legislature for black male voting rights and an end to segregation on Philadelphia’s streetcar lines.

African-Americans in the South held political conventions to define their new roles in the U.S. as citizens. Freedmen held a convention in Augusta, Georgia, in January of 1866 to define what they meant by citizenship rights. They resolved they had the right to protection, to land, to serve on juries, to individual and collective property ownership, to pensions for military service and to universal male suffrage. This meeting also launched the Georgia Equal Rights Association to realize this vision.

Yet, the Civil War had not fully come to an end. Violence broke out in the streets of New Orleans and Memphis. As African-Americans flocked to Memphis looking for a refuge from rural poverty and exercising their new rights to move about freely, the white press of Memphis reacted by painting blacks as “lawless.”

The “Massacre in Memphis” erupted on May 1, 1866, leaving nearly 50 black people dead and another 70 to 80 wounded. White rioters went after black women in particular, perpetrating rape as a form of terror. On July 30, mob violence led by Confederate veterans and the police in New Orleans left over 40 African-Americans dead. The 1866 massacres and Johnson’s earlier veto of the Civil Rights Bill pushed Congress to pass the 14th Amendment and send it to the states for ratification.

White Americans attacked black men and women in the Memphis Riot of 1866.
WikimediaCommons/Alfred Rudolph Waud

The process was not without its imperfections. Men and women, blacks and whites had joined common cause before the Civil War to promote women’s rights and an end to slavery. But throughout the push for civil rights in 1866, rhetoric used by politicians, military officials and equal rights organizations called for the rights of “men.” This would ultimately translate into a focus on black male suffrage, which was embedded in the 14th Amendment. The specific rights of women were put on hold.

As a result of this compromise, fissures grew in the interracial coalition of men and women who had fought for equal rights before the war. The unraveling of this coalition was emblematic of a larger process.

Soon after, in the face of corruption scandals and an economic crisis, the federal government lost its will to defend African-Americans and failed to protect their civil rights. Through a long, complicated and contested process, white vigilante groups, local and state governments, and even the Supreme Court rolled back the political gains of the 1860s.

The political struggles of 1866, the ratification of the 14th Amendment and the aftermath demonstrate the intertwined nature of grassroots and national politics. It also shows how fragile political coalitions can be. Ultimately, it reveals that political progress is neither linear nor inevitable – that forces of reaction, regression and retrenchment meet every forward movement.

The Conversation

Frederick Knight, Associate Professor of History, Morehouse College

This article was originally published on The Conversation. Read the original article.

Why storytelling skills matter for African-American kids

Why storytelling skills matter for African-American kids

Nicole Gardner-Neblett, University of North Carolina – Chapel Hill

Children begin telling stories as young as age two or three. And they continue to develop storytelling skills in their interaction with parents and others who provide guidance and feedback.

The ability to tell a coherent and well-developed narrative may be important for children’s literacy development. However, most of the studies on children’s storytelling and reading skills have been conducted with samples of middle-class white children.

To address this gap in the research, my colleague, Iheoma Iruka, and I studied data of children from different socioeconomic and racial/ethnic groups from across the United States.

What we found surprised us.

Storytelling among African-American children

For our research, we used national data from the Early Childhood Longitudinal Study, a study of about 14,000 children born in the US in 2001, that examined their development, school readiness and early school experiences. We focused on 6,150 children who were identified as African American, Asian American, Latino and European American.

To understand the role that storytelling skills play in the link between language and early literacy, we used data from when children were two years old until they were five years old.

When the children were two years old, parents were asked to describe their children’s language abilities. Later, when children were four years old, their storytelling skills were measured by asking them to retell stories they had just heard a researcher tell them. At five years old, children were given an assessment of their early literacy.

For most racial/ethnic and socioeconomic groups of children, we found that children who had better language skills as toddlers did better on the literacy assessment when they were five years old.

But when we looked at how storytelling plays a role between early language and early literacy, we found that when it came to African-American children, it made a big difference. For these children, the higher their storytelling scores, the better they did on the early literacy assessment. Interestingly, it didn’t make a difference for the other groups.

What this study tells us

Storytelling skills may be less important for the early literacy skills of most children. But for African-American children, these skills seem to be important for early literacy in a way that may not be true of other children.

African-American culture inculcates orality.
Rod Library, CC BY

We also know from other research that from early on, African-American children tell stories that are vivid, elaborate and rich in imagery. The quality of stories produced by African-American children has been found to be on par with or exceed that of stories told by their white peers. Other studies find that African-American children have a wide repertoire of storytelling styles, which they use flexibly depending on the context.

The strong storytelling skills of African-American children may stem from the cultural and historic influences that have fostered a preference for orality among African Americans.

All this should lead us to believe that African-American kids, with their strong storytelling skills, should do better with their reading skills. However, we know that African-American children are failing to learn basic reading skills. A nationwide test of reading achievement showed that four out of five African-American fourth graders failed to achieve competency in reading in 2013.

So, why are African-American children not performing better in reading? More research is needed, but possible explanations suggest that the low-quality schools many of these kids go to end up having a negative impact on their reading skills. In addition, many of these kids may have language skills that differ from those expected at school.

Why does storytelling matter?

For most other kids, studies suggest that storytelling skills may show their influence when children are older.

And that could be because storytelling uses “decontextualized” language. Decontextualized language differs from conversational or contextualized language in that decontextualized language functions independently from the immediate context or shared knowledge between listeners and the storyteller.

As children tell stories, they gain practice in using the same type of language that is used in written text, which can help them as they learn to read.

While teachers and parents have been told to read books to children to support their language and literacy development, encouraging children to tell stories as a way to support language and literacy has received less attention.

So, what can teachers and parents do?

Many schools have a “show-and-tell” time that can allow children a chance to practice storytelling skills as they share information about a valued object. As teachers and peers ask questions, they can facilitate children’s storytelling skills.

Parents and teachers can also model storytelling for children by sharing their own experiences, in the form of a story that has a clear beginning, middle and end, and addresses the questions of who, what, where, when and why. Using props like wordless books, puppets, dolls and photographs may also help children in developing stories.

While learning to tell stories can be useful for all children, this skill may be most needed for those at risk of achieving reading competency.

The Conversation

Nicole Gardner-Neblett, Investigator, University of North Carolina – Chapel Hill

This article was originally published on The Conversation. Read the original article.