Books for Prep | |
 - Medical Apartheid, Trust, and Patient PreferencesI bought this book last year about this time because I was in the midst of writing a M.A. Thesis focused on racial differences in trust in the patient-physician relationship. I read the first and seventh chapters and put the book down because my stomach was deeply disturbed by the books' contents. I was disappointed that the terms, "trust," "distrust," or "mistrust" were not indexed in the back of the book. Nonetheless, I decided ind to put the book on the list for my qualifying exams--it was to my knowledge the most comprehensive assessment of race and medical experimentation written to date. I finished reading the book from start to finish last week. I was deeply impressed that Washington was able to cover the breadth of history without shortchanging the respect due to the grave matters dealt within between the covers of Medical Apartheid. Some critics of the book have stated that they are unsure whether she is accurately portraying the truth of the history of medical research. Others suggest that her emotions may have guided the presentation of the material. My review will be directed to such responses of the book. I myself had doubts initially. The things I began reading about last December were too grotesque for them to have actually happened and the dispassion characterizing the medical researchers who went about their work is at odds with the Hippocratic Oath that is supposedly the center of Western medicine. However, more recent work by Steven Epstein (2007) on the social movement that yielded the NIH Revitalization Act of 1994 and more dated work by Laurel Baldwin-Ragaven, Jeanelle de Gruchy, and Leslie London (1999) on the unethical behavior of South African doctors during this country's apartheid era confirm many of the facts and conclusions Washington herself puts forth in Medical Apartheid. Even with the research I had done on the roots of medical mistrust among blacks, this book came as a shock to me. First, it demonstrates in a measured manner a persistent pattern of unethical behavior by American scientists and doctors in a wide range of activities (it's not just about graverobbing). This is a rebuttal to the over-reliance of those who perceive that the Tuskegee Syphilis Study is "the" reason for blacks' aversion to doctors and hospitals. Instead, the devaluation of the bodies of socially marginalized racial groups can be seen in every aspect of medicine, even into the roots of how medical knowledge was first formed. Second, it demonstrates that blacks have been routinely (ab)used in medical research and are overrepresented in clinical studies that have no therapeutic value. This is in direct contradiction to the predominant public narratives of the 70s and 80s which led to the NIH Revitalization Act--narratives that claimed women and minorities had been excluded from medical research. Washington's analysis gives life to Otis Brawley's warnings that the mandatory inclusion of minorities in federally-sponsored research would lead to "an incentive to give minorities the 'hard sell' when offering enrollment in a clinical trial" (Brawley quoted in Epstein 2007: 95). Simply put, informed consent--an ethical standard that Washington shows has already been treated as a technicality by medical scientists with regards to blacks involved in non-therapeutic research--is truly in danger of becoming an endangered species. Third, and last, it demonstrates the many ways in which patient attitudes towards the medical institution (typically measured by distrust in medicine, refusal of robust treatments, unwillingness to seek a doctor for a problematic symptom, etc) can and have been shaped by unethical practices that prey on a lack of knowledge on the behalf of the patient and an imbalance of power within the therapeutic alliance. According to the 2003 IOM report on racial health care disparities, attitudes, or "patient preferences," are only a source of racial disparities in medical treatment IF these preferences are "not based on a full and accurate understanding of treatment options" (Smedley, Stith, and Nelson 2003: 4,32). While the contribution of patient preferences to racial disparities in medical treatment is minimized (and, I believe, under-theorized) in the seminal IOM report, Washington's analysis puts a whole new perspective on "patient preferences" as a legitimate source of racial disparities in health care and begs us to develop creative ways to measure it besides our trite attitudinal measures. In all, I still am disappointed that variants of "trust" were not indexed. However, to be honest, every chapter provides a different (and, at times, new) way to understand the role that trust plays in the clinical encounter. Thanks for this invaluable piece of work. Rating: - What I Didn't KnowThis is not a book for the faint of stomach or heart. I was astounded at what a physician who was to become head of the American Medical Association thought was appropriate medical research. It should be required reading for all medical students. Rating:  - Interesting book,This book was pretty eye-opening. I'm too young to remember Tuskegee and I grew up in the North so I've never felt very racially divided, so this book was very informative. When I was reading this book, I recommended it to everyone I could. It is a 'should read' not a must read, but if you are interested in medicine, research or just racial injustice, this will be a good read. As the book goes on it does seem like the author was kinda grasping for her theories to hold true in all of these situations. I am aware of inequalities in treatment towards people of different colors (and I'm really sorry that it's a reality), but I don't believe it is as prevalent as the author makes it out to be. Rating: - Painful TruthPresently reading this book and it's very informative while at the same time one finds it a shame that people were the way there were back in the 18th, 19th and even 20th century when it came to people of color. Rating: - Presumed Consent - De Corpe Gettin' de Shaft - Grave Robbing!"Harvard Medical School was move from Cambridge College to Boston in order to be in closed proximity to poor colored people. This gave them access to a huge supply of poor and powerless experimental subjects." So now I understand why all the teaching hospitals are generally in poor black neighborhoods. By locating these areas, medical staff have a unlimited supply of people to use as guinea pigs. I thought this book was fascinating, and I would absolutely recommend. However, she contradicts herself quite often. She is telling us about all the experimentation and abuse of black Americans and their African slave ancestors. She even said something to the effect that the experimentation and abuse doesn't occur anymore. Yet she discuss several relatively recent experiments and clinical trials. So it is like she giving me the a fantastic dinner and telling me it's poison, but then setting a plate before me to eat. I find Ms. Washington to be quite contradictory and annoying at times. The following made me say huh: "I am in no way suggesting that this predominance of black body parts was deliberately engineered, but the confluence of presumed consent statues and the appearance of black homicide victims on coroner's tables explains why their organs and tissue dominates body part scandals." She annoys me. Why is she stating a fact, then backing down. This is what she said in the previous paragraph to the statement above:: "Legal bias also exist in the form of presumed consent statutes, which were enacted in the 1980s to increased the number of organs donated for transplantation and research via various presumed consent statutes, which presumed that the descendent would want to donate his body parts." Oh hell naw, if I ain't signing nothin', I aint donating squat. I have told my family I am not donating nada. They know. So how can the government presume anything. This is fraud. This medical apartheid. Ms. Washington continues with "Many blacks do not wish to donate their bodies or body parts. Only 5 percent of Black Americans surveyed by DePaul law professor Michele Goodwin considered presumed consent a legitimate source of body parts. Eighty six percent of blacks she surveyed thought presumed consent should be illegal." It is blacks who organs and tissue are most likely to be appropriated via presumed consent by coroners after autopsy." "There is no such entity as a crack baby. - Washington "Birth control & abortion are turning out to be a matter of Eugenics steps. But if they had been advanced for eugenic reason, that would have retarded or stopped the acceptance." - Frederick Osborne, a Population Control Founder. I give this book a five star, even with Ms. Washington's back peddling. I absolutely recommend this fascinating book. I would encourage everyone to familiarize themselves with term "presumed consent." This means that doctors can confiscate your organs immediately after death without your consent before death or the consent of your family after death. This sophisticated grave robbing. Please visit my book blog for June with your review of the book and review thread "De Corpse Getting de Shaft. There was a lot of pain and ugliness in this book. Those poor slave women being tortured and brutalized could have been me, had I been born during that time. My family could have prayed that I would die in the summer. So my body would discompose quickly so that it would me it worthless for the grave robbers. I encourage all to read this book, but most especially, my people. In association with Amazon.com | |