Chapter 11: African Americans
and Medicine
Introduction
• Chapter 10 defined “sexism” as the unjustified
discrimination against a person because of the person’s
gender.
• It examined, in a medical context, how sexist attitudes
can affect everything from level of individual medical
care and the availability of medical resources to the
kinds and extent of gender-focused research.
• This chapter examines similar forms of discrimination
based on race (racism), specifically racism towards
African Americans.
Introduction
• But it also touches on a perhaps broader category that might be
called “classism” discrimination based on some inappropriate social
category. (This possibility is raised in the section “The Oscar
Advantage”)
• As with sexism, the key ethical questions are: when, if ever, should
the race of an individual make a difference to medical treatment,
research or medical policy?
• On the one hand, are those who say that race should not be used in
medicine because of the abuse it can lead to such as in the
infamous Tuskegee syphilis Study (which is summarized in this
chapter).
• Patricia King in “The Dangers of Difference: The Legacy of the
Tuskegee Syphilis Study” develops this perspective in Section 1 of
the readings.
Introduction
• The idea of “race” has been rightly stigmatized because it has often
been used as a method of classifying people with the aim of then
showing that one race is morally inferior or superior to the other
without any ethical justification. The idea has been a deep part of
America’s history, exemplified by slavery.
• Because of this stigma, it may seem that race should never be used
as an acceptable category in discussing bioethical issues. But, as the
readings in this chapter suggest, this represents an over-simple
perspective.
• First, the discredited notion of race based on ethical superiority or
inferiority has given way to an ethically neutral, evolutionarygeographic definition of race that can potentially benefit people of
whatever “race” they belong to. This idea is developed in the
reading by Armand Leroi “A Family Tree in Every Gene”.
Introduction
• Second, ignoring race can lead to forms of exclusion. As Annette Dula
argues in “The Need for a Dialogue with African Americans”, people of
different races and ethnicities can bring unique perspectives to medicine
that would be missed if race is not considered.
• Additionally, as H. Jack Geiger observes in “The Demise of Affirmative
Action and the Future of Health Care”, by 2050 minority groups will make
up the majority of the US population. Geiger argues that addressing the
medical needs of these diverse groups will require “a diverse culturally
competent physician workforce”. This goal cannot be achieved without
acknowledging racial and ethnic differences.
• Third, it can happen that by not taking one’s race (however vaguely
defined) into account, individuals of a particular race may receive inferior
medical care or lose out on a medical discovery. This possibility is
illustrated by the BiDil heart drug study discussed in this chapter.
Some facts about African American
health
• Although African Americans no longer constitute the
largest minority in the United States, they have the
highest death rate of any group.
• African-Americans enjoy eight fewer years of relatively
good health than do white people or Hispanic
Americans.
• The death rate for African Americans from stroke,
cancer, respiratory disease, influenza, pneumonia, and
HIV/AIDS is higher than that for whites.
Some facts about African American
health
• African-Americans are 2.2 times more likely than whites to
develop diabetes, are 30% more likely to have a foot or leg
amputated because of the disease, and 2.2 times more
likely to die from the disease.
• Black men are 20% more likely than white men to suffer
from heart disease and 1.5 times more likely to be
diagnosed with lung or prostate cancer. Their five-year
survival rate is lower than that of whites for lung, prostate,
and pancreatic cancer.
• Black women are almost twice as likely to be obese than
white women, and this makes them more likely to develop
diabetes and heart disease.
Some facts about African American
health
• Lupus, the chronic and potentially fatal
autoimmune disease, is three times more
common in black women than in white women.
• Black women, beginning in their 20s and
extending into their 50s, develop breast cancer
earlier than white women.
• Although African-Americans make up only 13% of
the population, they account for more than 52%
of new HIV/AIDS cases.
Some facts about African American
health
• Black women account for 72% of all new cases of HIV/AIDS among
women, and black women are 11 times more likely than white
women to become HIV positive.
• Almost twice the number of blacks die of AIDS compared with
whites, a gap that has been increasing since 1998.
• A 2006 study found that African Americans with treatable lung
cancers are less likely to get the best diagnostic tests and less likely
to get the optimum treatment than whites.
• African-Americans who have a heart attack are less likely than
whites to undergo diagnostic cardiac catheterization, regardless of
the race of their physicians.
• .
Section 1: Race, Research, and
Medicine
Reading: A Family Tree in Every Gene
Armand Marie Leroi
• Armand Leroi rejects the idea that race is an
exclusively social construct. If we look at
correlations of genetic variants instead of single
variants, he argues, populations sort into groups
deriving from the five inhabited continents.
• When larger numbers of variants are considered,
further subdivisions show up. Race is thus a
shorthand way of talking about differences that
are genetic rather than political or cultural.
Reading: A Family Tree in Every Gene
Armand Marie Leroi
• The notion of an “ethnic group,” by contrast,
conflates genetic, cultural, and political
differences. Leroi believes that, until individual
genome sequencing becomes possible, the best
way to improve medical care is by employing the
concept of race.
• It offers a more accurate way to assess a patient’s
risk for certain diseases and serves as a guide to
select the best therapy.
Reading: The Dangers of Difference: The Legacy
of the Tuskegee Syphilis Study
Patricia A. King
• Patricia King claims that recognizing racial differences in
medicine poses a dilemma. Even when the intention is to
help a stigmatized group or person, the result may be to
cause harm.
• King proposes that research always begin with the
presumption that, with respect to disease, blacks and
whites are biologically identical.
• While the presumption may be shown to be wrong in the
course of the study, it acknowledges that, historically
speaking, more harm has come from imputing racial
differences than from ignoring them.
Section 2: Taking Race into
Account
..
Reading: Bioethics: The Need for a Dialogue with
African Americans
Annette Dula
• Annette Dula argues for the importance of expanding
bioethics to include the perspectives of various racial
and ethnic groups.
• While she focuses on African Americans, she sees the
points she makes as also applying to Hispanics, Native
Americans, Asians, and other groups that have had
health care experiences out of the mainstream.
• The African American perspective, according to Dula,
has been shaped by the experience of receiving poorquality care (a situation mostly ignored as a problem by
bioethics) and by the emphasis on action and social
justice found in the work of black philosophers.
Reading: Bioethics: The Need for a Dialogue with
African Americans
Annette Dula
• By reviewing the history of the birth control
movement and the Tuskegee experiment, Dula
illustrates the need for an African American
perspective on health care.
• She then use the entrance of blacks into
professional psychology and the “white women’s
movement” to illustrate how the introduction of
a new perspective can change social perceptions
of a group, weaken stereotypes, and promote
justice.
Reading: Bioethics: The Need for a Dialogue with
African Americans
Annette Dula
• Dula asks that bioethics recognize access to
health care as a serious bioethical problem
requiring debate and action.
• She ends by calling for the formation of a
community of scholars who will “conduct
research and articulate the perspectives of
African Americans and other poor and
underserved peoples.”
The Demise of Affirmative Action and the Future of
Health Care
H. Jack Geiger
• Jack Geiger argues that the drop in medical school
admissions of African Americans and other minorities,
due to factors like the rollback of affirmative action and
the underfunding of public schools, is the beginning of
a “potential public health disaster.”
• By 2050, minority groups will make up the majority of
the population, but who will be their physicians?
• A diverse population, Geiger says, “requires a diverse,
culturally competent physician workforce” able to
meet people’s needs.
The Demise of Affirmative Action and the Future of
Health Care
H. Jack Geiger
• Developing such a workforce requires recognizing
that medical education is a social good and not
merely a prize awarded to favored individuals.
• Yet our policies appear to be taking our society in
the opposite direction. In 1998, two years after
California voters outlawed the use of race in
educational policies, minority enrollment in state
medical schools had declined by 32 percent.