Way Back When (Episode 4)
TRANSCRIPT
Why are non-Hispanic black women more likely to be diagnosed with cervical cancer than non-Hispanic white women?
That’s a great question. And I think the best way to answer that is to remind people of a couple of things. First of all, that race is a social construct. So, there really isn't a genetic difference that is causing black women to unfortunately die at higher rates of cervical cancer. It really has to do more with historical background with things like racism, and now systemic racism, these disparities that started way back when and that have infiltrated the healthcare system and have affected these women's access to resources and therefore, some of the health care that they need. And this trickles down into poor outcomes, essentially. (Cardenas-Trowers, 2022 )
[00:56]
You just heard an excerpt from Mayo Clinic’s Q&A podcast. The particular episode this clip is from is titled The Link Between Racial Disparities and Cervical Cancer.
When Dr. Cardenas-Trowers said “ these disparities that started way back when”, she said sooo much by saying so little. So what we gon’ do right here is go back, way back, back into time. The Blackstreet version in case you were wondering.
Last week we looked at botany to unearth the coloniality in western science. This week we’ll delve into modern medicine to do the same thing to unearth that coloniality.
[2:05]
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Hey listeners!
I'm LaToya Strong and I'm a doctoral candidate at The Graduate School and University Center of the City University of New York.
You are listening to my dissertation!
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[2:46]
The objectification of Indigenous Africans and their descendants on the plantation and in general shaped how the medical profession developed in the United States. Physicians used enslaved Black people to bolster their careers, by experimenting with different procedures and techniques. And because of this, enslaved Black folk were instrumental in building modern medical practice in the United States.
Okay so prior to hospitals, medical research was conducted in slave hospitals or slave quarters (Washington, 2006). Modernizing medical schools in the 19th century meant having actual bodies for medical students to practice on, dissect, and handle to prepare for their eventual careers in medicine. And lo and behold enslaved African peoples were the source for such education, and “Blacks were considered more available and more accessible in this white-dominated society: they were rendered physically visible by their skin color but were legally invisible because of their slave status” (Savitt, 1982, p. 332).
Okay listen, I do not study literature, but I will read all the books. Non-fiction books. That are sci-fi, fantasy, horror, or spec fic. So technically not all the books. Anyway this is why a lot of vampire literature or tv/film are either set during this time period or have some portion of the plot that is in this time period because they can have the vampires feed on Black people and they don’t have to explain it. And personally, I just think it’s lazy writing when there’s nothing else to it except what is already happening in society. But I know somebody out there is writing or talking about this so I need to find their work. There’s no point to this digression except maybe we can think of Europeans during colonization as vampires.
Anyway, advances in medicine such as new techniques and treatments, were first performed on slaves or freedmen (and poor Whites in the North though this was smaller in number) before being enacted on the White population (Washington, 2006).
[3:56]
Medical schools competed for students and having access to enslaved Black folk, both alive and dead, gave some medical schools the edge over others (Savitt, 1982). The need for cadavers opened up a market for robbing graves. African-American burial grounds were often the target for these body snatchers (Humphrey, 1973). Many northern states had to pass anatomy acts that established legal ways of obtaining cadavers, but this did not stop body snatching because this created a short supply. Medical schools circumvented this by receiving shipments of Black bodies from body snatchers in the south (Humphrey, 1973). Many of these schools would post ads in newspapers.
In 1831, South Carolina Medical College posted the following in the Charleston Mercury:
Some advantages of a peculiar character are connected with this institution, which it may be proper to point out. No place in the United States offers as great opportunities for the acquisition of anatomical knowledge. Subjects being obtained from the coloured population in sufficient numbers for every purpose, and proper dissection carried out without offending any individuals in the community (Weld, 1968)!
[5:20]
To incentivize slave owners, hospitals covered the cost of food, housing and treatment so that slave owners would send old, sick or unproductive slaves to the hospital costing the slave owner nothing, but with the chances of a sick slave becoming healthy enough to work again (Savitt, 1982).
The following newspaper clip speaks to this and is from a clinic in Charleston for the treatment of African Americans.
[5:54]
Surgery at the Medical College of South Carolina ... The faculty inform their professional brethren, and the public that they have established a surgery, at the old college, Queen Street, for the treatment of Negro’s, which will continue in operation during the session of the college, say from first November, to the 15th of March ensuing.
The object in opening the surgery is to collect as many interesting cases, as possible, for the benefit of instruction of their pupils—at the same time they indulge the hope, that it may not only prove an accommodation, but also a matter of economy to the public. They would respectfully recall the attention of planters living in the vicinity of the city to the subject; particularly such as may have servants laboring under surgical diseases. Such persons of color may not be able to pay for medical advice, will be attended to gratis, at stated hours, as often as may be necessary.
The faculty will take this opportunity of soliciting the co-operation of such to their professional brethren as are favorable to their objects (Weld, 1968 as cited in Halperin, 2007, p. 491-492).
[7:24]
When it comes to experimentation, J. Marion Sims and his gynecological experimentation on enslaved Black women and girls is usually the prime example. I’m not going to focus on J. Marion Sims. Not because I do not think it’s important, but because J. Marion Sims was one of many.
Our first example is Elias S. Bennet. Now Elias was out there performing exploratory surgeries on slaves that he owned. He once tried to remove a tumor from a two year old unsuccessfully, and in fact made the condition worse (Kenny, 2015). Unfortunately, we do not know the name of this toddler. Her condition, unfortunately, worsened over time and she died at age 17. After her death Bennett did an autopsy and then gave her skull to Eli Geddings, the editor of the Baltimore Medical and Surgical Journal for his pathological collection (Kenny, 2015).
Edward Jenner is a familiar story. He observed the relationship between cowpox and smallpox in dairy maids and subsequently inoculated an 8 year boy with a dairymaids cowpox pus earning him the title “father of immunology. I want to point out that Edward Jenner was not the first to make this observation, nor the first to try this inoculation (Riedel, 2005). I also want to point out that the concept of inoculation was introduced to England by Turkey, and that inoculation was practiced in parts of Africa, in China, and in India well before it was introduced to Europe (Riedel, 2005). So I’m just saying that that whole “father of immunology” title is looking a bit sus.
[9:02]
About 30 years before Edward Jenner emphasis inoculation, John Quier was in Jamaica doing thee absolute most and experimenting with smallpox inoculations on the 850 enslaved people under his care (Schiebinger, 2017). When there was a smallpox outbreak, Quier would inoculate infants, elderly, and pregnant enslaved people from the pus of a pox from somebody already infected (Mitchell, 2020). And these experiments were done in the name of scientific curiosity and building medical research and knowledge. These experiments were also about building “white professional capital” as there was a lot of publishing in medical journals and lots of career growth because of it (Kenny, 2015).
Okay I’m splicing this in. This phrase “scientific curiosity” been gnawing at my spirit. Because, in my experience of how people be using the word curiosity it always has a neutral but positive tone to it. Except for when they be saying curiosity killed the cat. Anyway, it’s a phrase that’s used a lot to describe what was happening during this time period. I mean, I been using it throughout tehse episodes.. Underneath that phrase is some real evil stuff. I googled the actual definition of curiosity because I was like ain’t no way we using this word right, like this can’t be a good use of the word curiosity. But yall, it is!
[10:47]
So, Merriam-Webster gives 3 definitions with some sub-definitions.
1.Desire to know
1a. inquisitive interest in others' concerns : NOSINESS
1b. interest leading to inquiry
The second definition is archaic so we gon’ go head and skip it.
3a. one that arouses interest especially for uncommon or exotic characteristics
3b. an unusual knickknack : CURIO
3c. a curious trait or aspect
[11:31]
But then I thought in the context of what we’re even here examining, this type of treatment of land and people across the globe being described as “scientific curiosity” makes sense because of the descriptive statement of man. Which again is Europe’s overrepresentation of itself as Human. But the way this word curious has been changed for me oh my goodness. So I’mma resume where we left off and do that awkward transition back to what was actually supposed to come next.
The observations that physicians made about the physiognomy and anatomy of Black people were used by slavery apologists to justify slavery (Hogarth, 2017). FYI, physiognomy is judging someone’s personality, character and/or intelligence based on their outward appearance. These early theorizations developed ideas around the suitability of Africans for slave conditions such as thicker skin to tolerate working conditions under the harsh sun (Gamble, 1993), as well as notions of promiscuity and the ‘jezebel’ label for Black women who were forced to or were rewarded for reproducing (Roberts, 2014). Medical theories at the time argued that different types of work could lead to insensible skin. White people believed that Black people had naturally tough and leathery skin which provided protection against the sun and blistering thereby making them suitable for slavery, ownership, and possession (Smith, 2008).
[13:16]
The experimentation and observation that physicians made also provided the anatomical and physiological proof for the racial differences between Black and white people they already perceived to be true (Hogarth, 2017). This perceived racial difference impacted how physicians perceived illness and disease in Black people. And we’re gonna look at yellow fever as an example of this.
So although yellow fever is not a concern in the United States today, starting in the late 17th century and for the next 200 years, yellow fever was endemic to the USA stretching from the Gulf Coast region, think New Orleans and the Mississippi Valley, up the east coast to Boston (Bosch, & Chin, 2006). Let’s look at the havoc that yellow fever was wreaking.
In 1793, from August to November, a yellow fever outbreak killed 5,000 people in Philadelphia which was 10% of the city’s population. In the summer of 1800, 1200 people died in Baltimore from a yellow fever outbreak. In the summer of 1853, 8000 people died in New Orleans from a yellow fever outbreak. And with this New Orleans outbreak, 7.4% of white residents died, but only 0.2% of Black residents died showing a racial disparity in yellow fever mortality (Bosch, & Chin, 2006).
At this time, the low mortality of Black people during a yellow fever outbreak was believed to be because of an innate immunity that Black people had to the disease (Hogarth, 2017). So if and when Black people contracted yellow fever, the assumption never wavered as it was assumed that something had interfered with the person’s Blackness, making them susceptible to the disease (Hogarth). This knowledge circulated among the medical community and because physicians believed this to be true, Black people with yellow fever suffered.
[15:04]
And you know, unfortunately these stereotypes did not die with the plantation, but still persists today with medical professionals who are charged with taking care of Black communities.For example, when it comes to pain, Black people are inadequately treated when compared to white people (Goyal, Kupperman, Clearly, Teach, and Chamberlain, 2015). This discrepancy in medical treatment is a direct result of the racial bias held by White medical students in regards to biological differences between Black and White patients.
There was a study done in 2016 where researchers asked 418 White medical students and residents whether 15 biological differences between Blacks and Whites was true or false. (Hoffman, Trawalter, Axt & Oliver, 2016). Blacks and Whites is not my language, that is from the study. Two particular questions serve as examples of how the way back then has infiltrated the now. The coloniality if you will.
[16:00]
In response to the prompt Blacks’ skin is thicker than Whites’ skin what percentage of 1st year medical students do you, yes you the listener, think believed this statement was true? Take a guess. And what about 2nd year medical students? 3 year medical students? Residents? I really do wanna know what yall guessed.
42% of 1st year medical students, 41% of 2nd year, 22% of third year medical students, and 25% of residents believed that Blacks’ have thicker skin. Second question in this unfortunate absurdity.
In response to Blacks’ have denser, stronger bones than Whites’ what percentage of 1st year medical students do you think believed this statement was true? 2nd year medical students? 3 year medical students? residents? Yall, 25% of 1st year medical students, 78% of 2nd year medical students, 41% of 3rd year medical students and 29% of residents thought Blacks’ have denser, stronger bones than Whites’.
[17:45]
In this same study participants rated the pain of Black patients lower than that of Whites and based treatment on these perceptions, resulting in what would have been inadequate treatment for the Black patients. This unfortunately, is not just a hypothetical situation as research has documented that Black youth in the ER for appendicitis are less likely “to receive any pain medication for moderate pain and less likely to receive opioids for severe pain, suggesting a different threshold for treatment” (Goyal et al., 2015, p.996). It’s just so clear how the way back when is very much impacting the today.
[18:30]
Racial disparities in the u.s. are big and there are they've persisted and stuff obviously something we've seen in the current Covid crisis in the most recent reports the US Department of Health and Human Services finds that Blacks and Hispanics in this country received worse care than Whites for about 40 percent of quality measures.
Quality measures include the receipt of specific services to treat or prevent medical conditions as well as the outcomes of those treatments outcomes that include mortality so this is really consequential these healthcare disparities I think are really striking in the pain management space we know from research and this is an excellent review that Black patients are less likely to receive pain meds when they're in pain and if they do receive pain meds they receive less of them. So just to give you a sense of what that scope looks like
Here's one study looking at long bone fractures in this study we find that whites receive pain meds 74% of the time and that's significantly more than black patients who received payments 57 or so at the time another study looking at bone fractures again finds here that whites on average get significantly more a meds than blacks and Hispanic patients and this is not specific to bone fractures in fact we see it in cancer pain as well and cancer here is a really important and notable context because the World Health Organization has established clear guidelines about how to treat cancer pain and so here Dylan and colleagues argue that it's not just that White's get treated more that they receive more pain meds are more likely to receive them is that black patients minor and patients more generally are undertreated for pain.
[20:07]
That was Sophie Trawalter, who is also one of the researchers on the article that I mentioned.
The perceived and “observed” difference between Black people and White people even impacts some of the medical tools used to diagnose disease.
A spirometer is a device used by medical professionals to examine the respiratory function of a patient and diagnose respiratory diseases.
[four deep breaths]
It measures the volume of air that one can exhale after a deep breath. The history of the spirometer that is used currently can be traced back to the plantation. The spirometer uses race correction, which means thresholds are adjusted based on one’s race or ethnicity. Lundy Braun details this in her book Breathing Race into the Machine. The story of this begins with Thomas Jefferson, who in his Notes on the State of Virginia asserts the difference of Black people’s respiratory function. Yall, this is what this man said:
[21:09]
They secrete less by the kidnies, and more by the glands of the skin, which gives them a very strong and disagreeable odour. This greater degree of transpiration renders them more tolerant of heat, and less so of cold, than the whites. Perhaps too a difference of structure in the pulmonary apparatus, which a late ingenious* experimentalist has discovered to be the principal regulator of animal heat, may have disabled them from extricating, in the act of inspiration, so much of that fluid from the outer air, or obliged them in expiration, to part with more of it.
The spirometer has a history in Europe before making its way to North America, but we’re going to fast forward to Cartwright who was a physician and also owned a plantation and slaves (Lujan and DiCarlo, 2018). This man designed his own spirometer and did experiments on Black folk and claimed that Black people’s lungs had less expansibility than White people’s lungs, specifically by 20 percent, and in order to correct this they have to labor (Villarosa, 2019). White folk were really out there like “these less-expansible-lungs having ass Black people could not “vitalize the blood” unless doing manual labor and so they must be slaves. Wild. But also, just so we’re clear on what typa time Cartwright was on, he also claimed that Black people had drapetomania, a mental disease that caused them to flee their enslavers (Villarosa, 2019).
[22:23]
Okay, so we’re going to fast forward again. This race correction is still used.
What this means today, is that instead of calculating these race corrections by hand as they were once done, they are now built into spirometers. So you can input someone’s race, say Black or Asian, and the spirometer will automatically do the correction. The adjustment now is about 10-15% for Black folk and 4-6% for Asian folk. The numbers were updated in 1999 by the National Health and Nutrition Examination Survey using a population of Caucasians, African-Americans, and Mexican Americans Anderson, Malhtroa, & Non, 2021). Their language, not mines.
[23:07]
Research that focuses on racial differences in physiology is still being done. For example, a 2022 article (Witonsky, Elhawary, and Eng et al.) in Chest magazine had the following research question: Racial/ethnic-based spirometry reference equations: are they accurate for genetically admixed children? Their research was, What is the influence of genetic ancestry on the fit of race- and ethnicity-based spirometry reference equations in populations of genetically admixed children?
[23:36]
The truncated version of their findings is that because spirometer reference equations rely on people’s self identification, the wrong reference equation might be used. For example, they found that for people who are not monoracial, their self identification did not necessarily match their genetic ancestry distribution and so the wrong reference could potentially be used. So a genetically admixed person (their language, not mines) that has more than 80% African ancestry would be best fit by equations derived from African American populations. Puerto Rican children with African ancestry of less than 20% are best fit by equations derived from White populations.
There are severe consequences to this type of research. Removal of the race-based adjustment would increase the number of Black folk who are diagnosed with respiratory illnesses and therefore get them the medical attention they need. One study showed a 20.8 percent increase from 59.5% to 81. 7%, which includes illnesses such as obstructive lung disease, restrictive breathing, and restrictive lung disease (Moffett et al., 2021).
This is still ongoing and so much work has been done that the removal of the race based adjustments would increase the number of Black folk who are diagnosed with respiratory illness and therefore increase the people who need medical attention.
[25:07]
I could go on and talk about eGFR, which stands for estimated glomerular filtration rate, a measure of how well your kidneys are working. The race correction for this was just removed on September 23, 2021. I am unsure what implantation looks like. Or I could talk about cervical cancer. There are no shortages of examples.
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There are other consequences of the practices on the plantation that we see today. Publishing books and articles are a huge part of academia. We saw this with the doctors who were doing experiments on enslaved people to bolster their reputation and careers.
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This is a standard practice in academia. Building off the legacy of publishing to build one’s academic brand and mixing in some parachute science, we have a research practice that Elle Lette refers to as “health equity tourism” (Lette et al., 2022).
Health equity tourism is “the practice of investigators—without prior experience or commitment to health equity research—parachuting into the field in response to timely and often temporary increases in public interest and resources” (Lette et al., 2022). Researchers do this to build their career. It’s where the money and publications are at the time so it is where they are. These touring researchers, usually white, do research about equity in an extractive way where they build lucrative careers and reputations while never actually contributing to the wellness of the community they research and also erasing the work of folks that have been in the field.
[26:45]
Modern medicine and also human subject research, which I did not tease out and name, but it is absolutely threaded throughout, were made possible because of racial chattel slavery and other colonial systems.
In these past two episodes I attempted to connect the culture of Western science with its colonial past using modern botany and modern medicine as examples. Although I treated them as separate examples, they are interconnected. For example, plants, like sugar cane, from one region of the world was sent to other parts of the world to be worked by slaves on plantations. The botanical networks were at the center of all of this. Europe’s overrepresentation of itself as human at the expense of multiple genres of humanness created a one dimensional way of being.
[27:47]
Colonial epistemology “sacrifices pluriversity for university and imposes a one best way of attaining singular and universal truths” (Nyamnjoh, 2012, p.3). It does not mean they are 100% successful, it does mean that they try really hard to be. Our understanding of all of this was aided by the weaving of 3 theories: Black geographies, settler colonialism and decolonial thought.
[28:13]
We’ve reached the end of connecting Western science to its historical past and its culture.
This coloniality that we’ve unearthed also shows up in science teaching and learning in regards to what is taught, how it is taught, who teaches, who does the researching, who gets researched on, who makes the policy. Without understanding how this coloniality takes shape, we reinforce it and risk further marginalizing students or further contributing to the consequences of racial capitalism.
[28:50]
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Next week, we’ll look at how the coloniality described in this episode has been codified in science education. Spoiler alert, it involves the military, among other things.
Thank you to my moms, my sister Eboni, and my brother Man Man for reading quotes.
And thank you for tuning in to this episode.
For coherency and flow of narrative, I did not always name who I was citing or drawing from so please visit the transcript to see all citations and references.
Click here for works cited/references
Welcome back to the Coloniality, Western Science, and Critical Ethnic Studies in STEM Education dissertation!
In this episode, I continue to examine the coloniality of Western Science using modern medicine as the example.