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Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
Harriet A. Washington;

Doubleday, 2006
Author Harriet A. Washington's Medical Apartheid: the Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present is a resurrection of medical horror stories heard in the dialogue of black barbershops and church health ministries. The brutal essence of the author's message to the world is what many African Americans have long suspected:that institutionalized racism is endemic in American medicine. Washington provides credible evidence to pull this assertion out of rumor, myth and folklore. The 500 pages of Medical Apartheid are meticulously chronicled with numerous references from books, essays, journal articles, popular press accounts and personal interviews. These sources, and the author's exceptional writing skills, build a substantial case for institutionalized racism in American medicine. Washington sets the tone in the book's introduction, where she gives credentials and reveals the "kill-themessenger" obstacles she faced. She is an accomplished journalist and, just as importantly, highly qualified in the nomenclature and functions of biomedicine. Washington's ability to explain in layman's terms how medicine is supposed to work is

just as important as explaining racism in the American society. Some readers can relate to having experienced similar resistance whenever the probability of medical racism is
raised. Journalism and medical ethics are Washington's forte. She is not a historian and makes no such claims. Therefore, Medical Apartheid might

be somewhat lacking in the kind of academic style found in basic historical treatises. Unlike other books of the same genre, Medical Apartheid does not center on a particular time or particular event but across centuries of American racial history. Comparatively, James Jones' Bad Blood dealt with the Tuskegee Syphilis experiment in Macon County, AL; Judith Walzer Leavitt's Typhoid Mary addressed the demonizing of Mary Mallon in New York; and Anne Fadiman's The Spirit Catches You and You Fall Down detailed the clash of cultures in a small California town. These excellent works were strengthened by their focus on a single time and place and event. MedicalApartheid is much more expansive and with a relentless spotlight on a power elite. Such an approach cannot help but evoke almost knee-jerk criticisms, recalling the barrage being unleashed against former President Jimmy Carter's Palestine: Peace Not Apartheid. Aside from the expected defensiveness to be generated from the title alone, Washington seems to have invited further negative reactions from editorial carelessness. In one particular passage, for example, she reports on the missing body of Addie Mae Collins, one of the four little girls murdered in the 1963 civil rights era church bombing. The context of Collins' missing corpse is deemed to be indicative of the illegal resurrections of black bodies done by some medical schools for unauthorized anatomical dissection, yet there is no source citation for this particular incident (as there are for others). Knowing the obvious fire this would draw, the author and her editors should have been more careful. MedicalApartheid is an excellent compilation of historical facts detailing in sequential order what many health scholars already know. For instance, the Eurocentric mentality of "biological determinism" and the

social construction of "race" are issues Joseph L. Graves has covered thoroughly in The Emperors New Clothes. Graves, in my view, reads a bit more scholarly. But Washington provides a harder-hitting takeno-prisoners discourse that charges through the social milieu that bred such mind-bending racism and is therefore more likely to reach a larger audience. Good. In the literary fashion of prize-winning author Zadie Smith but without Smith's reprieve of humor, Washington draws a painful, gut-wrenching, anger-inducing portrait of a race-conscious medical Frankenstein who has been allowed to live within American medicine. Medical Apartheid lays bare a disturbing historical landscape that is infested with medical thugs and corporate gangsters-all in the business of "health" research. The brutality of some morally corrupt doctors who experimented on slaves is maddening. Washington then carries this medical immorality from the antebellum period through Emancipation, Reconstruction, Jim Crow, the hypocrisy of the "separate-butequal" era, and through the U.S. involvement in foreign wars and into the modem civil rights and black power movements. Even our post9/11 era and the age of bioterrorism have been characterized by research opportunities where African Americans have been unequal subjects. It is very important to point out that the author is not against African Americans participating in medical experimentation. Washington provides-what seem to me to be-reasonable recommendations to check the potential for medical exploitation. She points out that institutional review boards, of which I am a member, continue to fall short in protecting all human subjects. Medical Apartheid ends with a timely and chilling warning that in this era of global health the continent of Africa has (re)emerged as ripe for medical research. Ravaged
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by the pandemics of HIV/AIDS, malaria, tuberculosis, malnutrition and a host of assaults upon an impoverished and vulnerable people, there exists the possibility of the past repeating itself.

Reviewed by Clarence Spigner, MPH, DrPH Associate Professor Department ofHealth Services Box 357660 University of Washington Seattle, WA 98195 phone: (206) 616-2948 fax: (206) 543-3964 cspigner@u. washington. edu

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