Under the Shadow of Tuskegee: African Americans and Health Care

Vanessa Northington Gamble, MD, PhD

Introduction foundation for today's pervasive sense of black distrust ofpublic health authorities."6 On May 16, 1997, in a White House The syphilis study has also been used to ceremony, President Bill Clinton apolo- explain why many African Americans gized for the Tuskegee Syphilis Study, the oppose needle exchange programs. Needle 40-year government study (1932 to 1972) exchange programs provoke the image of in which 399 Black men from Macon the syphilis study and Black fears about County, Alabama, were deliberately genocide. These programs are not viewed denied effective treatment for syphilis in as mechanisms to stop the spread of order to document the natural history of HIV/AIDS but rather as fodder for the drug the disease.' "The legacy of the study at epidemic that has devastated so many Tuskegee," the president remarked, "has Black neighborhoods.7 Fears that they will reached far and deep, in ways that hurt our be used as guinea pigs like the men in the progress and divide our nation. We cannot syphilis study have also led some African be one America when a whole segment of Americans with AIDS to refuse treatment our nation has no trust in America."2 The with protease inhibitors.8 president's comments underscore that in The Tuskegee Syphilis Study is fre- the 25 years since its public disclosure, the quently described as the singular reason study has moved from being a singular behind African-American distrust of the historical event to a powerful metaphor. institutions of medicine and public health. It has come to symbolize racism in medi- Such an interpretation neglects a critical cine, misconduct in human research, the historical point: the mistrust predated pub- arrogance of physicians, and government lic revelations about the Tuskegee study. abuse ofBlack people. Furthermore, the narrowness of such a rep- The continuing shadow cast by the resentation places emphasis on a single his- Tuskegee Syphilis Study on efforts to torical event to explain deeply entrenched improve the health status of Black Ameri- and complex attitudes within the Black cans provided an impetus for the campaign community. An examination of the syphilis for a presidential apology.3 Numerous study within a broader historical and social articles, in both the professional and pop- context makes plain that several factors ular press, have pointed out that the study have influenced, and continue to influence, predisposed many African Americans to African Americans' attitudes toward the distrust medical and public health authori- biomedical community. ties and has led to critically low Black Black Americans' fears about exploi- participation in clinical trials and organ tation by the medical profession date back donation.4 The specter of Tuskegee has also been raised with respect to HIV/AIDS preven- The author is with the History of Medicine and tion and treatment programs. Health educa- Family Medicine Departments and the Center for B. Thomas and the Study of Race and Ethnicity in Medicine, tion researchers Dr Stephen University of Wisconsin School of Medicine, Dr Sandra Crouse Quinn have written Madison. extensively on the impact of the Tuskegee Requests for reprints should be sent to Syphilis Study on these programs.5 They Vanessa Nortiington Gamble, MD, PhD, University argue that "the legacy of this experiment, of Wisconsin School of Medicine, 1300 University with its failure to educate the study partici- Ave, Madison, WI 53706. pants and treat them adequately, laid the This paper was accepted July 24, 1997.

American Joumal of Public Health 1773 Gamble to the antebellum period and the use of operation was not successful, and Sims last drop of blood from the victim, the slaves and free Black people as subjects for later attempted to repair the defect by body is dumped into some secret place dissection and medical experimentation.9 placing a sponge in the bladder. This where it is impossible for any person to Although physicians also used poor Whites experiment, too, ended in failure. He noted: find it. The colored women are so worked up over this phantom that they will not as subjects, they used Black people far The whole urethra and the neck of the trip to the venture out at night, or in the daytime in more often. During an 1835 bladder were in a high state of inflam- any sequestered place.'5 United States, French visitor Harriet Mar- mation, which came from the foreign tineau found that Black people lacked the substance. It had to come away, and there Fry did not find any documented evi- power even to protect the graves of their was nothing to do but to pull it away by dence of the existence of night riders. dead. "In Baltimore the bodies of coloured main force. Lucy's agony was extreme. However, she demonstrated through exten- people exclusively are taken for dissec- She was much prostrated, and I thought sive interviews that many African Ameri- tion," she remarked, "because the Whites that she was going to die; but by irrigating cans expressed genuine fears that they can- the parts of the bladder she recovered with would be kidnapped by night doctors and do not like it, and the coloured people great rapidity. not resist."'l Four years later, abolitionist used for medical experimentation. Fry Theodore Dwight Weld echoed Mar- Sims finally did perfect his technique concludes that two factors explain this tineau's sentiment. "Public opinion," he and ultimately repaired the fistulas. Only paradox. She argues that Whites, especially wrote, "would tolerate surgical experi- after his experimentation with the slave those in the rural South, deliberately ments, operations, processes, performed women proved successful did the physi- spread rumors about night doctors in order upon them [slaves], which it would exe- cian attempt the procedure, with anesthe- to maintain psychological control over crate if performed upon their master or sia, on White women volunteers. Blacks and to discourage their migration other whites."1' Slaves found themselves as to the North so as to maintain a source of subjects of medical experiments because cheap labor. In addition, Fry asserts that physicians needed bodies and because the Exploitation After the Civil War the experiences of many African Ameri- state considered them property and denied cans as victims of medical experiments them the legal right to refuse to participate. It is not known to what extent African during slavery fostered their belief in the Two antebellum experiments, one car- Americans continued to be used as unwill- existence of night doctors.'6 It should also ried out in Georgia and the other in Alaba- ing subjects for experimentation and dis- be added that, given the nation's racial and ma, illustrate the abuse that some slaves section in the years after emancipation. political climate, Black people recognized encountered at the hands of physicians. In However, an examination of African- their inability to refuse to participate in the first, Georgia physician Thomas American foLklore at the turn ofthe century medical experiments. Hamilton conducted a series of brutal makes it clear that Black people believed Reports about the medical exploita- experiments on a slave to test remedies for that such practices persisted. Folktales are tion of Black people in the name of medi- heatstroke. The subject of these investiga- replete with references to night doctors, cine after the end of the Civil War were tions, Fed, had been loaned to Hamilton as also called student doctors and Ku Klux not restricted to the realm of folklore. repayment for a debt owed by his owner. doctors. In her book, Night Riders in Black Until it was exposed in 1882, a grave rob- Hamilton forced Fed to sit naked on a Folk History, anthropologist Gladys-Marie bing ring operated in Philadelphia and pro- stool placed on a platform in a pit that had Fry writes, "The term 'night doctor' vided bodies for the city's medical schools been heated to a high temperature. Only (derived from the fact that victims were by plundering the graves at a Black ceme- the man's head was above ground. Over a sought only at night) applies both to stu- tery. According to historian David C. period of 2 to 3 weeks, Hamilton placed dents of medicine, who supposedly stole Humphrey, southern grave robbers regu- Fed in the pit five or six times and gave cadavers from which to learn about body larly sent bodies of southern Blacks to him various medications to determine processes, and [to] professional thieves, northern medical schools for use as which enabled him best to withstand the who sold stolen bodies-living and anatomy cadavers.'7 heat. Each ordeal ended when Fed fainted dead-to physicians for medical During the early 20th century, and had to be revived. But note that Fed research."'4According to folk belief, these African-American medical leaders pro- was not the only victim in this experiment; sinister characters would kidnap Black tested the abuse of Black people by the its whole purpose was to make it possible people, usually at night and in urban areas, White-dominated medical profession and for masters to force slaves to work still and take them to hospitals to be killed and used their concerns about experimentation longer hours on the hottest ofdays.'2 used in experiments. An 1889 Boston Her- to press for the establishment of Black- In the second experiment, Dr J. Mari- ald article vividly captured the fears that controlled hospitals.'8 Dr Daniel Hale on Sims, the so-called father of modem African Americans in South Carolina had Williams, the founder of Chicago's Provi- gynecology, used three Alabama slave ofnight doctors. The report read, in part: dent Hospital (1891), the nation's first women to develop an operation to repair Black-controlled hospital, contended that vesicovaginal fistulas. Between 1845 and The negroes of Clarendon, Williamsburg, White physicians, especially in the South, women on whom and Sumter counties have for several frequently used Black patients as guinea 1849, the three slave and to 30 weeks past been in a state of fear pigs.'9 Dr Nathan Francis Mossell, the Sims operated each underwent up there is a white The himself trembling. They claim that founder of Philadelphia's Frederick Doug- painful operations. physician man, a doctor, who at will can make described described the agony associated with some lass Memorial Hospital (1895), himself invisible, and who then approaches "fears and of Black people, of the experiments'3: "The first patient I and the prejudices" some unsuspecting darkey, having especially those from the South, as operated on was Lucy. . . That was rendered him or her insensible with such the to a bucket "almost proverbial."20 He attributed before the days of anaesthetics, and chloroform, proceeds fill up in bore the with the victim's blood, for the purpose of attitudes to southern medical practices poor girl, on her knees, operation forced to with great heroism and bravery." This making medicine. After having drained the which Black people,"when

November 1997, Vol. 87, No. 11 1774 American Journal ofPublic Health African Americans and Health Care accept hospital attention, got only the the Negro has been written about, ex- 1056 Black church members who respond- poorest care, being placed in inferior ploited and experimented upon sometimes ed believed that AIDS was a form of geno- wards set apart for them, suffering the not to his physical betterment or to the cide.30 A New York Times/WCBS TV News brunt of all that is experimental in treat- advancement of science, but the advance- poll conducted the same year found that ment, and all this is the sequence of their ment of the Nordic investigator." More- 10% of Black Americans thought that the race variety and abject helplessness."2' over, he charged that "in the past, men of AIDS virus had been created in a laboratory The founders of Black hospitals claimed other races have for the large part inter- in order to infect Black people. Another that only Black physicians possessed the preted our diseases, often tinctured with 20% believed that it could be true.3' skills required to treat Black patients opti- inborn prejudices."25 African Americans frequently point to mally and that Black hospitals provided the Tuskegee Syphilis Study as evidence to these patients with the best possible care.22 support their views about genocide, per- Fears about the exploitation of Fears ofGenocide haps, in part, because many believe that the African Americans by White physicians men in the study were actually injected played a role in the establishment of a These historical examples clearly with syphilis. Harlon Dalton, a Yale Law Black veterans hospital in Tuskegee, Ala. demonstrate that African Americans' dis- School professor and a former member of In 1923, 9 years before the initiation of the trust of the medical profession has a longer the National Commission on AIDS, wrote, Tuskegee Syphilis Study, racial tensions history than the public revelations of the in a 1989 article titled, "AIDS in Black had erupted in the town over control of the Tuskegee Syphilis Study. There is a collec- Face," that "the government [had] purpose- hospital. The federal government had tive memory among African Americans fully exposed Black men to syphilis."32 Six pledged that the facility, an institution about their exploitation by the medical years later, Dr Eleanor Walker, a Detroit designed exclusively for Black patients, establishment. The Tuskegee Syphilis radiation oncologist, offered an explanation would be run by a Black professional staff. Study has emerged as the most prominent as to why few African Americans become But many Whites in the area, including example of medical racism because it con- bone marrow donors. "The biggest fear, members of the Ku Klux Klan, did not firms, if not authenticates, long-held and she claimed, is that they will become vic- want a Black-operated federal facility in deeply entrenched beliefs within the Black tims of some misfeasance, like the the heart of Dixie, even though it would community. To be sure, the Tuskegee Tuskegee incident where Black men were serve only Black people.23 Syphilis Study does cast a long shadow. infected with syphilis and left untreated to Black Americans sought control of After the study had been exposed, charges die from the disease."33 The January 25, the veterans hospital, in part because they surfaced that the experiment was part of a 1996, episode of New York Undercover, a believed that the ex-soldiers would receive governmental plot to exterminate Black Fox Network police drama that is one of the best possible care from Black physi- people.26 Many Black people agreed with the top shows in Black households, also cians and nurses, who would be more car- the charge that the study represented "noth- reinforced the rumor that the US Public ing and sympathetic to the veterans' needs. ing less than an official, premeditated policy Health Service physicians injected the men Some Black newspapers even warned that of genocide."27 Furthermore, this was not with syphilis.34 The myth about deliberate White southerners wanted command ofthe the first or last time that allegations of infection is not limited to the Black com- hospital as part of a racist plot to kill and genocide have been launched against the munity. On April 8, 1997, news anchor sterilize African-American men and to government and the medical profession. Tom Brokaw, on "NBC Nightly News," establish an "experiment station" for The sickle cell anemia screening programs announced that the men had been infected mediocre White physicians.24 Black physi- of the 1970s and birth control programs by the government.35 cians did eventually gain the right to oper- have also provoked such allegations.28 Folklorist Patricia A. Turner, in her ate the hospital, yet this did not stop the In recent years, links have been made book I Heard It through the Grapevine: hospital from becoming an experiment sta- between Tuskegee, AIDS, and genocide. In Rumor and Resistance in African-Ameri- tion for Black men. The veterans hospital September 1990, the article "AIDS: Is It can Culture, underscores why it is impor- was one of the facilities used by the Genocide?" appeared in Essence, a Black tant not to ridicule but to pay attention to United States Public Health Service in the woman's magazine. The author noted: "As these strongly held theories about geno- syphilis study. an increasing number ofAfrican-Americans cide.36 She argues that these rumors reveal During the 1920s and 1930s, Black continue to sicken and die and as no cure much about what African Americans physicians pushed for additional measures for AIDS has been found some of us are believe to be the state of their lives in this that would battle medical racism and beginning to think the unthinkable: Could country. She contends that such views advance their professional needs. Dr AIDS be a virus that was manufactured to reflect Black beliefs that White Americans Charles Garvin, a prominent Cleveland erase large numbers of us? Are they trying have historically been, and continue to be, physician and a member of the editorial to kill us with this disease?" 29 In other ambivalent and perhaps hostile to the exis- board of the Black medical publication words, some members of the Black com- tence of Black people. Consequently, The Journal ofthe National Medical Asso- munity see AIDS as part of a conspiracy to African-American attitudes toward bio- ciation, urged his colleagues to engage in extenminate African Americans. medical research are not influenced solely research in order to protect Black patients. Beliefs about the connection between by the Tuskegee Syphilis Study. African He called for more research on diseases AIDS and the purposeful destruction of Americans' opinions about the value White such as tuberculosis and pellagra that African Americans should not be cavalierly society has attached to their lives should allegedly affected African Americans dis- dismissed as bizarre and paranoid. They not be discounted. As Reverend Floyd proportionately or idiosyncratically. are held by a significant number of Black Tompkins of Stanford University Memorial Garvin insisted that Black physicians people. For example, a 1990 survey con- Church has said, "There is a sense in our investigate these racial diseases because ducted by the Southern Christian Leader- community, and I think it shall be proved "heretofore in literature, as in medicine, ship Conference found that 35% of the out, that if you are poor or you're a person

November 1997, Vol. 87, No. I I American Journal of Public Health 1775 Gamble of color, you were the guinea pig, and you pital in my area," she recalled. "The first Medical factors did not fully explain the continue to be the guinea pigs, and there is thing that they began to ask me was how differences. This study suggests that an the fundamental belief that Black life is not many sexual partners I'd had. I was mar- already-existing national health insurance valued like White life or like any other life ried and owned my own house. But imme- program does not solve the access prob- in America."37 diately, in looking at me, they said, 'Oh, lems of African Americans.44Additional she just has pelvic inflammatory studies have confirmed the persistence of disease.`'4' Perhaps because of her nursing such inequities.45 Not Just Paranoia background, Georges recognized the Why the racial disparities? Possible implications of the questioning. She had explanations include health problems that Lorene Cary, in a cogent essay in come face to face with the stereotype of precluded the use of procedures, patient Newsweek, expands on Reverend Tompkins' Black women as sexually promiscuous. unwillingness to accept medical advice or point. In an essay titled "Why It's Not Just Similarly, the following story from the Los to undergo surgery, and differences in Paranoia," she writes: Angeles Times shows how racism can severity of illness. However, the role of We Americans continue to value the lives affect the practice ofmedicine: racial bias cannot be discounted, as the and humanity of some groups more than the When Althea Alexander broke her ann, the American Medical Association's Council lives and humanity of others. That is not attending resident at Los Angeles on Ethical and Judicial Affairs has recog- paranoia. It is our historical legacy and a County-USC Medical Center told her to nized. In a 1990 report on Black-White present fact; it influences domestic and "hold your arm like you usually hold your disparities in health care, the council foreign policy and the daily interaction of can of beer on Saturday night." Alexander asserted: millions of Americans. It influences the who is Black, exploded. "What are you way we spend our public money and talking about? Do you think I'm a welfare Because racial disparities may be occurring explains how we can read the staggering mother?" The White resident shrugged: despite the lack of any intent or purposeful was an treat patients differently on the statistics on Black Americans' infant "Well aren't you?" Turned out she efforts to basis of race, physicians should examine mortality in administrator at USC medical school. mortality, youth mortality, their own practices to ensure that middle and old age, and not be moved to This example graphically illustrates inappropriate considerations do not affect action.38 that health care providers are not immune to their clinical judgment. In addition, the African Americans' beliefs that their the beliefs and misconceptions of the wider profession should help increase the lives are devalued by White society also community. They carry with them stereo- awareness of its members of racial influence their relationships with the med- types about various groups ofpeople.42 disparities in medical treatment decisions ical profession. They perceive, at times by engaging in open and broad discussions correctly, that they are treated differently about the issue. Such discussions should because of take place as part of the medical school in the health care system solely Beyond Tuskegee curriculum, in medical journals, at their race, and such perceptions fuel mis- professional conferences, and as part of trust of the medical profession. For exam- There is also a growing body of med- professional peer review activities.46 ple, a national telephone survey conducted ical research that vividly illustrates why in 1986 revealed that African Americans discussions of the relationship of African The council's recommendation is a strong were more likely than Whites to report that Americans and the medical profession acknowledgment that racism can influence their physicians did not inquire sufficiently must go beyond the Tuskegee Syphilis the practice ofmedicine. about their pain, did not tell them how Study. These studies demonstrate racial After the public disclosures of the long it would take for prescribed rnedicine inequities in access to particular technolo- Tuskegee Syphilis Study, Congress passed to work, did not explain the seriousness of gies and raise critical questions about the the National Research Act of 1974. This their illness or injury, and did not discuss role of racism in medical decision making. act, established to protect subjects in test and examination findings.39 A 1994 For example, in 1989 The Journal of the human experimentation, mandates institu- study published in the American Journal American Medical Association published a tional review board approval of all federally of Public Health found that physicians report that demonstrated racial inequities funded research with human subjects. were less likely to give pregnant Black in the treatment of heart disease. In this However, recent revelations about a women information about the hazards of study, White and Black patients had simi- measles vaccine study financed by the smoking and drinking during pregnancy.40 lar rates of hospitalization for chest pain, Centers for Disease Control and Prevention The powerful legacy of the Tuskegee but the White patients were one third more (CDC) demonstrate the inadequacies of Syphilis Study endures, in part, because likely to undergo coronary angiography these safeguards and illustrate why African the racism and disrespect for Black lives and more than twice as likely to be treated Americans' historically based fears of that it entailed mirror Black people's con- with bypass surgery or angioplasty. The medical research persist. In 1989, in the temporary experiences with the medical racial disparities persisted even after midst of a measles epidemic in Los Ange- profession. The anger and frustration that adjustments were made for differences in les, the CDC, in collaboration with Kaiser many African Americans feel when they income.43 Three years later, another study Permanente and the Los Angeles County encounter the health care system can be appearing in that journal reinforced these Health Department, began a study to test heard in the words of Alicia Georges, a findings. It revealed that older Black whether the experimental Edmonston- professor of nursing at Lehman College patients on Medicare received coronary Zagreb vaccine could be used to immunize and a former president of the National artery bypass grafts only about a fourth as children too young for the standard Moraten Black Nurses Association, as she recalled often as comparable White patients. Dis- vaccine. By 1991, approximately 900 an emergency room experience. "Back a parities were greatest in the rural South, infants, mostly Black and Latino, had few years ago, I was having excruciating where White patients had the surgery received the vaccine without difficulties. abdominal pain, and I wound up at a hos- seven times as often as Black patients. (Apparently, 1 infant died for reasons not

November 1997, Vol. 87, No. 11 1776 American Journal ofPublic Health African Americans and Health Care related to the inoculations.) But the infants' Toward a Participant-Friendly System," Jour- 19. Eugene P. Link, "The Civil Rights Activities parents had not been informed that the vac- nal of the National Cancer Institute 87 of Three Great Negro Physicians (1840- cine was not licensed in the United States (1995): 1747-1759; Dewayne Wickham, 1940)," Journal of Negro History 52 (July associated with an "Why Blacks Are Wary of White MDs," The 1969): 177. or that it had been May 1997, 13A. increase in death rates in Africa. The 1996 Tennessean, 21 20. Mossell graduated, with honors, from Penn in 5. For example, see Stephen B. Thomas and San- 1882 and founded the hospital in 1895. disclosure of the study prompted charges dra Crouse Quinn, "The Tuskegee Syphilis 21. "Seventh Annual Report of the Frederick of medical racism and of the continued Study, 1932 to 1972: Implications for HIV Douglass Memorial Hospital and Training exploitation of minority communities by Education and AIDS Risk Education Programs School" (Philadelphia, Pa.: 1902), 17. medical professionals.47 in the Black Community," American Journal 22. H. M. Green, A More or Less Critical Review The Tuskegee Syphilis Study continues of Public Health 81 (1991): 1498-1505; of the Hospital Situation among Negroes in to cast its shadow over the lives of African Stephen B. Thomas and Sandra Crouse Quinn, the United States (n.d., circa 1930), 4-5. Americans. For many Black people, it has "Understanding the Attitudes of Black Ameri- 23. For more in-depth discussions of the history of come to represent the racism that pervades cans," in Dimensions of HIV Prevention. the Tuskegee Veterans Hospital, see Gamble, American institutions and the disdain Needle Exchange, ed. Jeff Stryker and Mark D. Making a Place for Ourselves, 70-104; Pete Smith (Menlo Park, Calif.: Henry J. Kaiser Daniel, "Black Power in the 1920's: The Case in which Black lives are often held. But Family Foundation, 1993), 99-128; and its significance, it cannot be the of Tuskegee Veterans Hospital," Journal of despite Stephen B. Thomas and Sandra Crouse Quinn, Southern History 36 (1970): 368-388; and only prism we use to examine the relation- "The AIDS Epidemic and the African-Ameri- Raymond Wolters, The New Negro on Cam- ship ofAfrican Americans with the medical can Community: Toward an Ethical Frame- pus: Black College Rebellions of the 1920s and public health communities. The prob- work for Service Delivery," in "It Just Ain't (Princeton, NJ: Princeton University Press, lem we must face is not just the shadow of Fair": The Ethics ofHealth Care for African 1975), 137-191. Tuskegee but the shadow of racism that so Americans, ed. Annette Dula and Sara Goering 24. "Klan Halts March on Tuskegee," Chicago profoundly affects the lives and beliefs of (Westport, Conn.: Praeger, 1994), 75-88. Defender, 4 August 1923. all people in this country. [] 6. Thomas and Quinn, "The AIDS Epidemic and 25. Charles H. Garvin, "The 'New Negro' Physi- the African-American Community," 83. cian," unpublished manuscript, n.d., box 1, 7. Thomas and Quinn, "Understanding the Atti- Charles H. Garvin Papers, Western Reserve tudes of Black Americans," 108-109; David Historical Society Library, Cleveland, Ohio. L. Kirp and Ronald Bayer, "Needles and 26. Ronald A. Taylor, "Conspiracy Theories Endnotes Races," Atlantic, July 1993, 38-42. Widely Accepted in U.S. Black Circles," 1. The most comprehensive history of the study 8. Lynda Richardson, "An Old Experiment's Washington Times, 10 December 1991, Al; is James H. Jones, Bad Blood, new and Legacy: Distrust of AIDS Treatment," New Frances Cress Welsing, The Isis Papers: The expanded edition (New York: Free Press, York Times, 21 April 1997, Al, A7. Keys to the Colors (Chicago: Third World 1993). 9. Todd L. Savitt, "The Use of Blacks for Med- Press, 1991), 298-299. Although she is not President in Apology for 2. "Remarks by the ical Experimentation and Demonstration in very well known outside of the African- Done in Tuskegee," Press Release, the Study the Old South," Journal of Southern History American community, Welsing, a physician, White House, Office of the Press Secretary, 48 (1982): 331-348; David C. Humphrey, within it. The Isis Papers 16 May 1997. is a popular figure "Dissection and Discrimination: The Social headed for several weeks the best-seller list 3. "Final Report of the Tuskegee Syphilis Study Origins of Cadavers in America, 1760-1915," Legacy Committee," Vanessa Northington maintained by Black bookstores. Bulletin of the New York Academy of Medi- 27. Jones, Bad Blood, 12. Gamble, chair, and John C. Fletcher, co-chair, cine 49 (1973): 819-827. 20 May 1996. 28. For discussions of allegations of genocide in 10. Harriet Martineau, Retrospect of Western the implementation of these programs, see 4. Vanessa Northington Gamble, "A Legacy of Travel, vol. 1 (London: Saunders & Ottley; Distrust: African Americans and Medical Robert G. Weisbord, "Birth Control and the New York: Harpers and Brothers; 1838), 140, A Matter of Genocide?" Research," American Journal of Preventive "Dissection and Dis- Black American: quoted in Humphrey, 571--590; Alex S. Medicine 9 (1993): 35-38; Shari Roan, "A crimination," 819. Demography 10 (1973): Medical Imbalance," Los Anqeles Times, 1 11. Theodore Dwight Weld, American Slavery As Jones, "Editorial Linking Blacks, Contracep- November 1994; Carol Stevens, "Research: It Is: Testimony of a Thousand Witnesses tives Stirs Debate at Philadelphia Paper," Distrust Runs Deep; Medical Community (New York: American Anti-Slavery Society, Arizona Daily Star, 23 December 1990, F4; Seeks Solution," The Detroit News, 10 1839), 170, quoted in Savitt, "The Use of Doris Y. Wilkinson, "For Whose Benefit? Poli- December 1995; Lini S. Kadaba, "Minorities Blacks," 341. tics and Sickle Cell," The Black Scholar 5 in Research," Chicago Tribune, 13 September 12. F. N. Boney, "Doctor Thomas Hamilton: Two (1974): 26-31. 1993; Robert Steinbrook, "AIDS Trials Short- Views of a Gentleman of the Old South, 29. Karen Grisby Bates, "Is It Genocide?" change Minorities and Drug Users," Los Phylon 28 (1967): 288-292. Essence, September 1990, 76. Angeles Times, 25 September 1989; Mark D. 13. J. Marion Sims, The Story of My Life (New 30. Thomas and Quinn, "The Tuskegee Syphilis Smith, "Zidovudine: Does It Work for Every- York: Appleton, 1889), 236-237. Study," 1499. one?" Journal ofthe American Medical Asso- 14. Gladys-Marie Fry, Night Riders in Black Folk 31. "The AIDS 'Plot' against Blacks," New York ciation 266 (1991): 2750-2751; Charlise History (Knoxville: University of Tennessee Times, 12 May 1992, A22. Lyles, "Blacks Hesitant to Donate; Cultural Press, 1984), 171. 32. Harlon L. Dalton, "AIDS in Blackface," Beliefs, Misinformation, Mistrust Make It a 15. "Concerning Negro Sorcery in the United Daedalus 118 (Summer 1989): 220-221. Difficult Decision," The Virginian-Pilot, 15 States," Journal of American Folk-Lore 3 33. Rhonda Bates-Rudd, "State Campaign August 1994; Jeanni Wong, "Mistrust Leaves (1890): 285. Encourages African Americans to Offer Some Blacks Reluctant to Donate Organs," 16. Ibid., 210. Others Gift of Bone Marrow," Detroit News, Sacramento Bee, 17 February 1993; "Night- 17. Humphrey, "Dissection and Discrimination," 7 December 1995. ABC 6 1994; Patrice line," News, April 822-823. 34. From September 1995 to December 1995, with the Truth in a for A of the to Gaines, "Armed Fight 18. detailed examination campaign was the 10 Fran establish Black hospitals can be found in New York Undercover top-ranked Lives," Washington Post, April 1994; 122nd in Organ Donation from Vanessa Northington Gamble, Making a show in Black households. It ranked Henry, "Encouraging "Poll: Blacks," Cleveland Plain Dealer, 23 April Place for Ourselves: The Black Hospital White households. David Zurawik, 1994; G. Marie Swanson and Amy J. Ward, Movement, 1920-1945 (New York: Oxford TV's Race Gap Growing," Capital Times "Recruiting Minorities into Clinical Trials: University Press, 1995). (Madison, Wis), 14 May 1996, SD.

1777 November 1997, Vol. 87, No. II American Journal of Public Health Gamble

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