Health and Race: A History of Unequal Treatment in Medicine

A century-old study is still affecting doctor-patient trust today.

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The health disparities in the United States stem from a number of factors. Systemic obstacles to health care can make good care less accessible to vulnerable populations, lack of insurance coverage can make it unaffordable, and a mistrust in the healthcare system can make Black Americans hesitant to visit their doctors at all.

The mistrust in the healthcare system—and even in individual physicians—has a complex history. White physicians may carry implicit cultural biases that make Black patients feel misunderstood, unheard, or neglected. To make it worse, only 5 percent of active physicians in the U.S. are Black or African American, according to the Association of American Medical Colleges.

But it’s not simply present-day treatment of Black Americans that shapes the doctor-patient relationship. “There’s one very big blemish in our nation’s history when it comes to our research on Black patients,” says Sanjai Sinha, MD, internist at Weill Cornell Medicine. “Between 1930 and 1970, there was a famous study called the Tuskegee Syphilis Study.”

The Tuskegee Syphilis Study

Today’s medical studies demand following specific standards to keep human subjects safe. For example, if you are testing a new medication, your human subjects must give informed consent (meaning you have told them the purpose and extent of the study), and the study must be ethical. Before testing can begin, the study must get approval by Institutional Review Boards (IRB).

But this process didn't go into effect until the 1970s. It was a direct response to a study called the “Tuskegee Study of Untreated Syphilis in the Negro Male.”

The study began on the wrong foot right away when researchers told the Black men (who were low-income sharecroppers in Alabama) that they were being "treated" for “bad blood." In reality, the researchers were not providing any treatment at all. The researchers also told the men that the study would last just six months, but it stretched for 40 years.

When news broke of the study in 1972, it obviously appalled the public. Further investigation revealed that the men had consented to the study, but the researchers had severely misled them about the purpose of the study. In other words, the participants did not provide informed consent.

Thanks to the investigation, study stopped immediately, a class-action lawsuit was filed, and a benefit program began to provide reparations for any living participants, as well as their wives and offspring.

The Lasting Effects of the Study

While you certainly can't blame all of today's health disparities on this one study, it became a symbol of a system that was neglecting and objectifying Black lives.

“Because of this very unethical research on Black men, it’s not very much of a stretch to understand why the Black community … has a grave mistrust of the healthcare system. That kind of history doesn’t die quickly,” says Dr. Sinha.

Today, physicians like Dr. Sinha are working to understand how to improve doctor-patient relationships for Black patients, cultural competency among physicians, and accessibility to healthcare facilities.

The goal? Reduce the factors, biases, and obstacles that lead to higher rates of certain diseases among Black Americans. Learn more about what healthcare facilities are doing today to connect vulnerable populations.