Medicine sometimes snatches away health, sometimes gives it. — Ovid

African-American patients suffer greater numbers of deaths from the COVID-19 virus than white patients. Why is that?

Racists and those who follow the teachings of people like William Shockley, the Nobel prize-winning physicist who developed the transistor, would see a damaged-from-birth individual.

He spent the second half of his career, from the 1960s on, espousing a racist eugenics agenda, taking occasional breaks to help promote a high-IQ sperm bank. He ended up a disgraced bigot — ostracized and (as his biographer speculates) perhaps mentally ill. Shockley believed African-Americans were inferior and he would have, undoubtedly, attributed their high death rate to this inferiority.

The famed physicist wasn’t alone in his distorted beliefs about persons who trace their origin to Africa. He was one of many who clung to this belief in white exceptionalism. Often, they put their beliefs into action.

An unfortunate urban myth surrounds the eminent Black physician’s death, Dr. Charles R. Drew, who developed blood banks. While driving a car, he was involved in a serious auto accident. Despite the efforts of hospital staff, Drew died. He had been taken to a “white” hospital, and the erroneous belief that he had been denied blood transfusions was born.

Drew’s injuries were so severe and his loss of blood so great that he could not be saved. His family later wrote letters to the attending physicians thanking them for their efforts. But the belief of denial of blood survived.

Marks on the History of Medicine

The infamous Tuskegee “research” is probably the best-known study involving Black men. It was to be a study of untreated syphilis. Begun in 1932 with 600 black men, 399 with syphilis, 201 who did not have the disease, it was conducted without informed consent. The men were told it was to assess several ailments, including syphilis, anemia, and fatigue.

As is usual in some studies, participants received free medical exams, free meals, and burial insurance. The initial objective was to conduct the study for six months, but it lasted for 40 years and many men died of the horrific, debilitating disease.

Once the unethical aspects were discovered, and that the researchers failed to provide treatment for men with syphilis, the research was halted and branded as highly unethical.

A review of the study found that the subjects were never given a choice to quit even when new, highly effective treatments were available. The most likely available medication would have been penicillin, which was an accepted treatment in 1945.

A class-action lawsuit against the researchers was won in an out-of-court settlement in 1974. Participants and their families were awarded $10 million. Men and women weren’t the only Blacks involved in questionable research studies.

Children as young as three months old were, according to one researcher, used as guinea pigs in UK medical experiments to test out drugs such as those for HIV. The children in the clinical trials were either Hispanic or Black and resided at an orphanage.

Tests were performed to check for drug safety and tolerance, and the president of the Alliance for Human Research Protection said the children had been treated like “laboratory animals.”

Pain has also received new research attention as it pertains to Black patients. A belief in differences not only in the color of their skin, but the thickness of Black skin vs. white and pain tolerance persists.

…a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. It also provides the first evidence that racial bias in pain perception is associated with racial bias in pain treatment recommendations.

The result is that many Black patients are undermedicated for pain and do not receive the relief that a white patient would under the same circumstances.

Good Reasons for Hesitancy

What are the barriers to greater participation of Black people in Covid-19 trials? Although they are multiple, a critical factor is the deep and justified lack of trust that many Black Americans have for the health care system in general and clinical research in particular.

This distrust is often traced to the legacy of the infamous syphilis study at Tuskegee, in which investigators withheld treatment from hundreds of Black men in order to study the natural history of the disease. But the distrust is far more deeply rooted, in centuries of well-documented examples of racist exploitation by American physicians and researchers.

The unethical medical practices perpetrated against Black patients were not limited to the Tuskegee syphilis experiment. During the 19th century, the physician James Marion Sims performed gynecological surgery on enslaved Black women without anesthesia.

Defenders of his actions indicate that this was groundbreaking surgical research for which the women may have asked. But, according to articles written since that time, there was no way to know that they either gave consent or that their owners agreed to the procedures.

The owners, however, had a financial interest in their slave’s recovery and most probably would have agreed with the procedure going forward.

Considering the requirements for medical school today, Sims’ period of study was rather slim. He worked with a physician for a short period of time and took a three-month course at a medical school before starting his medical practice.

Sims, in his autobiography, indicated that once he established himself in a small hospital on a slave plantation, he operated daily and had many patients. Considered the “father of modern gynecology,” Sims worked in an area of medicine considered undesirable, if not somehow unsavory.

When any of Sims’s patients died, the blame, according to him, lay squarely with “the sloth and ignorance of their mothers and the Black midwives who attended them.”

Medical researchers have not always been forthcoming in their work. One reason they would indicate is that to do so would skew the results. But there is sufficient evidence of medical deceit and continuing bias to cause vaccine hesitation — especially in the Black communities.

An additional consideration might be found in how the studies of the vaccines have been carried out. What was the number of Black persons involved in the samples, and were genetic differences noted? When I worked in a research study of an Alzheimer’s drug, few Black patients were enrolled.