United States: Health care, racism and death

COVID-19 has exposed the devastating realities of long-standing structural racism in the United States.

Dr Susan Moore died of COVID-19 in December, after making a video and declaring: “I put forth and I maintain: If I was white, I wouldn’t have to go through that.”

Four female African American medical professionals put it bluntly in a Washington Post Op-Ed on December 26: “Susan Moore’s death underscores the racism embedded in the United States health care system.”

Aletha Maybank is chief health equity officer at the American Medical Association. Camara Phyllis Jones is a family physician, epidemiologist and past president of the American Public Health Association. Uché Blackstock is founder and CEO of Advancing Health Equity. Joia Crear Perry is president of the National Birth Equity Collaborative.

They wrote that Moore, “a family physician, University of Michigan Medical School graduate, Black woman” had described in the video “how the white doctor treating her ‘made me feel like I was a drug addict’, refusing to prescribe her additional narcotics when she complained of pain — even though he knew she was a fellow physician.”

In the video, Moore “related how he rejected her plea for additional doses of remdesivir; how ‘he did not even listen to my lungs; he didn’t touch me in any way’; how he suggested she should just go home.

‘This is how Black people get killed, when you send them home and they don’t know how to fight for themselves,’ Moore said.”

Racism in Medicine

The deeply racist way Blacks are still treated by the medical system is rooted in the structural discrimination based on 401 years of national oppression. Black professionals, including medical doctors and nurses, continue to face treatments that are inferior to white men and women.

COVID-19 has exposed the devastating realities of long-standing structural inequities experienced by Black and brown people. They are more likely than whites to be infected, and more likely to die.

As the Op-ed authors wrote: “If anyone knew how to fight for herself, it would have been Moore. Still, she was sent home. Less than three weeks later, she was dead, at 52.”

“Her experience,” they continue, “offers stark confirmation that there remains a system of structuring opportunity and assigning value based on skin colour in this country. That system has a name: racism.

“No matter how well-intentioned our health-care system is, it has not rooted out the false idea of a hierarchy of human valuation based on skin color and the false idea that, if there were such a hierarchy, ‘White’ people would be at the top.

“This white supremacist ideology has long shaped our values and practices, even in the health-care sector. Moore’s educational background makes her experience slightly more nuanced: Her being a physician brings the privilege of credibility and attracts the attention of many who do not believe that such mistreatment is pervasive.”

Serena Williams’ case

Being famous and wealthy doesn’t protect you if you are Black and a woman. Take the example of tennis super star Serena Williams, who almost died after giving birth to her daughter, Olympia.

Williams’ story illuminates what less well known and working-class Black women face in medicine and treatment by the racist system.

Initially, Williams said, the doctor did not listen to her concerns about a possible blood clot. She pressed her case and finally action was taken.

She told The Guardian in 2018, the pregnancy had gone smoothly before she encountered problems: “First my [caesarian]-section wound popped open due to the intense coughing I endured as a result of the embolism.

“I returned to surgery, where the doctors found a large haematoma, a swelling of clotted blood, in my abdomen. And then I returned to the operating room for a procedure that prevents clots from traveling to my lungs.”

Williams said she was lucky to have received excellent medical care, but others are not so lucky: “According to the Centers for Disease Control and Prevention (CDC), Black women in the US are over three times more likely to die from pregnancy or childbirth-related causes.

“But this is not just a challenge in the US. Around the world, thousands of women struggle to give birth in the poorest countries. When they have complications like mine, there are often no drugs, health facilities or doctors to save them.

“If they don’t want to give birth at home, they have to travel great distances at the height of pregnancy.”

A 2016 study  showed that many white medical students and residents believed false race-based metrics and narratives, such as that Black people experience less pain than whites.

This is the same false belief held by J Marion Sims, considered the father of modern gynecology, who performed vaginal surgical procedures on enslaved women without anesthesia.

Tuskegee Syphilis experiments: 1931-72

The most notorious mistreatment of African Americans was the Tuskegee Syphilis experiments.

According to the CDC, in 1932, the Public Health Service, working with the Tuskegee Institute, began a study to record the natural history of syphilis in hopes of justifying treatment programs for Blacks. It was called the “Tuskegee Study of Untreated Syphilis in the Negro Male.”

The study initially involved 600 Black men – 399 with syphilis and 201 without the disease. The study was conducted without the benefit of patients’ informed consent.

Researchers told the men they were being treated for “bad blood”, a local term used to describe several ailments, including syphilis, anaemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness.

In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last six months, the study actually went on for 40 years.

In July 1972, an Associated Press story about the Tuskegee Study caused a public outcry that led the Assistant Secretary for Health and Scientific Affairs to appoint an Ad Hoc Advisory Panel to review the study.

The panel found that the men had agreed to be examined and treated; however, there was no evidence that researchers had informed them of the study or its real purpose.

In fact, the men had been misled and had not been given all the facts required to provide informed consent: “The men were never given adequate treatment for their disease. Even when penicillin became the drug of choice for syphilis in 1947, researchers did not offer it to the subjects.”

The advisory panel found nothing to show that subjects were ever given the choice of quitting the study, even when this new, highly effective treatment became widely used.

The panel concluded that the Tuskegee Study was “ethically unjustified” – the knowledge gained was sparse when compared with the risks the study posed for its subjects.

In October 1972, the panel advised stopping the study at once. A month later, the Assistant Secretary for Health and Scientific Affairs announced the end of the Tuskegee Study.

In the summer of 1973, a class-action lawsuit was filed on behalf of the study participants and their families.

In 1974, a $10 million out-of-court settlement was reached under which the government promised lifetime medical benefits and burial services to all living participants.

Is it any wonder why African Americans don’t trust white doctors or the medical care industry?

COVID-19 vaccines distrust

Are the COVID-19 vaccines really safe for African Americans? Many tens of thousands of Blacks aren’t sure. Moore’s case reinforces that concern.

Ask any African American about basic treatment by most white medical providers, and there is suspicion. Pain care, is especially suspicious — as I know from my long experience. Patients are forced to do their own research so the right questions are asked and hopefully the best treatment given.

I will never forget my experience with extreme pain in my 20s in my right foot. I went to several doctors who said it was in my head. One doctor yanked my foot. I lived on 24 aspirins a day for years.

There were few Black doctors at the time. Moore’s treatment proves it doesn’t matter, if the provider is operating under a racist mindset.

There remains a “colour line” in vaccine distributions. Indigenous peoples, African Americans, Latinos and the undocumented are generally last in line. Some of the disparity is due to lack of health care providers and insurance. Another cause is simply skin colour.

Must act to dismantle racism

To fight systemic racism in these communities requires learning the history of racism in medicine and forcing the authorities to take steps to provide free vaccines and health care to these essential working-class communities. It begins with truth in education and ends with mass political action.

“If a physician can’t be heard by her own peers to save her life, then who will listen?” wrote Maybank, Jones, Blackstock and Perry in their Op-Ed.

“Who will be held accountable? What actions are necessary to ensure that no one feels that their only way to survive and be heard is by posting a cellphone video on Facebook?

“Over the past several months, since the public killing of [George] Floyd, many health-care institutions and associations have made important commitments to acknowledge that racism is a public health threat and to pledge efforts to dismantle racism in the health care system.

“This is an important step forward. But these commitments are meaningless if not matched by urgent and sustained action. As a nation, we need to understand four key messages about racism: Racism exists. Racism is a system. Racism saps the strength of the whole society. We must act to dismantle racism.

“Say Susan Moore’s name. Heed her message. Do not let her death be in vain.”

[Abridged. Malik Miah is an Advisory Editor of Against the Current, where this article first appeared.]

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