Black Americans and Medicine There's a sad legacy of medical experiments using black Americans as unwitting or unwilling subjects. Does that history influence the kind of health care black Americans get today? And what does a new study say about a difference in life expectancy between black and white Americans?
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Black Americans and Medicine

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Black Americans and Medicine

Black Americans and Medicine

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IRA FLATOW, host:

This is TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow.

You may have heard - I'm sure you've heard of the Tuskegee syphilis studies in which hundreds of African-American men were deliberately infected with syphilis so that researchers could study them and see what syphilis does to the body. The men were not told about what was happening to them. There was no informed consent. And even after a cure for syphilis was available in an antibiotic form, the men were not treated. The studies were made public only after a reporter unearthed them, and the hearings that were held afterward helped bring about a change in the way medical research using human subjects is done. Tuskegee might be the most famous, or infamous, but it is not the only case of abuse against black people by the medical establishment. From the era of slavery to the very recent past, black Americans have endured painful, often debilitating or sterilizing procedures, all done in the name of medical science.

My next guest says that this long history of abuse has caused many black Americans to deeply mistrust the medical establishment, and it's contributed to the disparities in health care we have today. Harriet Washington is the author of "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present." She's currently a visiting scholar at the DePaul University School of Law, and she joins me here in our New York bureau. Thanks for being with us to day, Ms. Washington.

Ms. HARRIET WASHINGTON (Author, "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present"): Thank you very much for having me, Ira.

FLATOW: Well, why did you write this book?

Ms. WASHINGTON: I wrote this book partly because of a personal experience, but largely because I knew that there was this shadowy culture among African-Americans where fear of medical research and fear of medical care was very predominant and yet had been insufficiently examined. And what had really been almost ignored by medical historians and ethicists was an important factor, an important cause of this iatrophobia, or fear of medicine, which I believe to be early and frequent and unfortunately persistent negative encounters with medical researchers.

FLATOW: Mm-hmm.

Ms. WASHINGTON: So I sought to examine historical records, look at old medical journals of physicians, in order to find out exactly what had happened. And no one was more astonished than I...

FLATOW: Really.

Ms. WASHINGTON: ...at the volume that I unearthed.

FLATOW: About what you uncovered, and some of them very frightening stories would have never expected. Give us what the most shocking one for you was.

Ms. WASHINGTON: Well, I...

FLATOW: It's hard to pick them out, you know.

Ms. WASHINGTON: And, you know, it's compounded by the fact that at this point I'm very difficult to shock.

(Soundbite of laughter)

FLATOW: Yeah.

Ms. WASHINGTON: But I must say one experience touched me personally to the point where I found myself crying on the train between New York City and Boston, where I was doing a fellowship. And that was when I read the 1956, 1957 medical journal articles written by a surgeon, a neurosurgeon named Orlando Andy, University of Mississippi. He had written about how he took young black boys and he cut out parts of their brains, a bladed part of their brains -these were living children - to try to cure their behavior disorders.

But these behavior disorders were not things that had been certified by psychiatrists or psychologists. These were institutionalized boys. Their parents had little or no say about what was done to them. And I read one account where he, over the course of five or six years, did six or seven surgeries, taking out various parts of the boy's brain and finally reporting that the boy was no longer a behavior problem. Well, I can well imagine that he wasn't because he didn't have enough personality left to be a behavior problem. And what chilled me I think was, first of all, it's a murder of a mind, and to do that to a child is just unspeakably cruel. And then you consider the very narrow range of acceptable behaviors for young black boys during that time. We're talking about the period during which Emmett Till...

FLATOW: Right.

Ms. WASHINGTON: ...was murdered on suspicion of whistling at a white woman.

FLATOW: Right.

Ms. WASHINGTON: So that I found just, you know, overwhelming. But the truth is there are so many negative episodes that many of them would eclipse that for other people.

FLATOW: 1-800-989-8255 is our number. We're talking with Harriet Washington, author of "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present."

Let's talk about some of the abuses you document. There was this radiation experiment that was just amazing, conducted on unwilling or unwitting participants. You start a chapter of your book talking about a truck driver - this was amazing...

Ms. WASHINGTON: Yes.

FLATOW: ...who was a kind - let me just read the first few words.

On a dewy spring morning in 1945, Robert S. Stone(ph), M.D., usually a quiet, deliberate professor of radiology, burst into a neighboring office at the government's Oakridge, Tennessee, nuclear facility shouting, Carl - I don't want to say what he called the truck driver...

Ms. WASHINGTON: The N-word.

FLATOW: ...the N-word - that had his accident some time ago. And pick up the story. What happened to this truck driver?

Ms. WASHINGTON: Well, it's shocking. The truck driver's name was Ed Cabe(ph), and he actually worked for the government indirectly, driving trucks. However, he was in an accident. He was taken to the nearby hospital where the doctors assessed his condition as grave. He was a 55-year-old man in very, very good health.

FLATOW: Mm-hmm.

Ms. WASHINGTON: But they made the assessment that they didn't expect him to survive till morning. And as the physician whose quote you just read said -Carl Morgan said, you know, this is our chance. Robert Stone said we're going to inject him with plutonium. What happened was the hospital that he'd been brought to happened to be populated by doctors who were under contract to the Atomic Energy Commission. And they had been charged with taking moribund hospital patients - Dr. Stone indicated that you take patients who are very sick - and surreptitiously inject them with plutonium...

FLATOW: Not just a little plutonium.

Ms. WASHINGTON: Oh no, a whopping dose, a dose that was known to be...

FLATOW: Forty-one times the normal lifetime exposure.

Ms. WASHINGTON: Exactly. And when one considers that the half-life of plutonium is something on the order of 24,000 years, he was never going to get rid of this load of plutonium.

FLATOW: Now what gave them the rights to do these things?

Ms. WASHINGTON: What's interesting is that nothing gave them the right to do this, but during this time we didn't have all the protections that we have today. Today we have a matrix of laws that protect subjects. That existed only in a very rudimentary form then. We didn't really see a very comprehensive one until the Nuremburg Code, after the war.

What happened was these doctors were sanctioned by the government in a program that I categorize as secret, and people will contest that. They'll say how can you say it's secret? There are documents laying it out. But it certainly was not transparent as far as the American people were concerned. People who were in hospitals expecting to be cared for by their doctors became subjects of these radiation experiments.

FLATOW: What kind of medical attention did slaves get back in those days?

Ms. WASHINGTON: Very good question, a very pregnant question, because slaves - attention was paid to their fitness for work, not to their health. Very important distinction. And when you're watching interaction between a physician and a slave it may look very much like the interaction between a physician and a person who's not enslaved. But the truth is a physician cares for a person who is free, who is white, who has money, they're trying to bolster your health. With slaves, they wanted to increase their ability to do work, the ability to extract work from them, the ability for them to bear children - that would be profitable for the master - and so very different rules governed it. For one thing, the care of the slave was dictated by the master's wishes. You had to do what the master wanted you to do. He had to be satisfied. He paid the physician. The physician satisfied him. So in every important sense of the word, it was the owner rather than the slave who was a patient. The slave was left outside, unconsulted and with no recourse...

FLATOW: Right.

Ms. WASHINGTON: ...if he were harmed or killed or unsatisfied.

FLATOW: Having started the research in the book and finishing the research on the book, and now thinking of everybody who will read the book, are people going to be - black people going to be more fearful now of medicine than before? And do you find yourself more distrusting?

Ms. WASHINGTON: I will say for myself, I'm surprised at my reaction. I have to say that I have noticed that I'm a little slower than I used to be to discount things as conspiracy theories.

FLATOW: Mm-hmm.

Ms. WASHINGTON: I'm a little bit more tolerant and a little bit more open to considering - because I've learned so many things that seemed completely outlandish and impossible actually happened. But I haven't - I've never had any fear that I was going to make black people afraid of medical research or medical care. The truth is I can't. That's already been done by the people whose abuses I chronicle.

FLATOW: Mm-hmm.

Ms. WASHINGTON: You know, this hundreds of years of abuse and maltreatment in research settings has already made black people have fear. My hope is that I'm going to initiate a dialogue. By bringing these cases into the light of day I'm hoping that I am going to enrich the discussion. First of all, enrich our appreciation of medical history to encompass these things, and also to foster a discussion whereby, when these abuses can no longer be denied, now we can discuss them and discuss ways of making sure they never happen again.

FLATOW: And there are still current issues coming up all the time. Let me just bring one up. The North Carolina legislature is proposing a plan to offer prisoners time off their sentences if they donate a kidney.

Ms. WASHINGTON: Yes.

FLATOW: What do you think of that?

Ms. WASHINGTON: I think it's...

FLATOW: Considering the prison population is proportionately black...

Ms. WASHINGTON: I'm not sure I can...

FLATOW: ...you're going to have more black people influenced.

Ms. WASHINGTON: Right, that's true. But whether they were black, white, Asian, or anything else, the fact is that this is unconscionable.

FLATOW: Mm-hmm.

Ms. WASHINGTON: Essentially, if you tell a prisoner that if you give up an organ, you get time off, that's the same thing as offering him payment. And payment schemes are becoming very popular in this country. And prison is a very troubling situation because prison research was all but ended in the 1970s in this country because of horrible abuses, unspeakable abuses. And recently, just this past fall, a federal panel recommended that prisons be opened again to research. This is only a harbinger of what's to come. I hope I am wrong, I hope I will be proven wrong, but I feel certain that we're about to see a renaissance of the same horrible abuses that we put an end to 25 or 30 years ago.

FLATOW: Because?

Ms. WASHINGTON: Because prison is an essentially coercive environment, you know. I don't think you can have voluntary informed consent in a prison. Prisoners have lost the most important civil rights. They're in a very hostile, you know, environment in which violence is present, they desperately need money, and the whole nature is coercive. So these are people who don't actually have free will, and that makes informed consent impossible, and that makes research with them just unconscionable. The excuse is often given that we have to do research to give them medical care. Prisoners desperately need medical care, so give them medical care but don't make them research subjects.

FLATOW: And they have no choice, basically.

Ms. WASHINGTON: In my opinion, it's not really voluntary. You know, they don't really have a choice. Because the kind of - the Hobson choice offered a prisoner are not things that you and I are ever presented with.

FLATOW: And...

Ms. WASHINGTON: You know, lose an organ or have bail money that may enable you to get out of jail. That's not a choice.

FLATOW: And as Woody Allen said, and such small portions. I mean they're offering six months for a kidney.

(Soundbite of laughter)

Ms. WASHINGTON: That's very - it's almost insulting. But it really isn't.

FLATOW: Yeah.

Ms. WASHINGTON: It's just unacceptable.

FLATOW: All right, we're going to come back and talk lots more with Harriet Washington about her book, "Medical Apartheid." Very interesting stories in the book, very frightening stories. Maybe you'll have some you want to share with us of your own experiences. Our number: 1-800-989-8255, 1-800-989-TALK. Stay with us, we'll be right back after this short break.

(Soundbite of music)

FLATOW: I'm Ira Flatow. This is TALK OF THE NATION: SCIENCE FRIDAY from NPR News.

(Soundbite of music)

FLATOW: You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow.

We're talking this hour about the history of medical experimentation on black Americans. My guest is Harriet Washington, author of "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present." And during the break she reminded me that I misspoke about the Tuskegee experiments. They gentlemen were not injected with syphilis. They already had it, right? Thank you for pointing that out.

The syphilis studies didn't hurt just men, though, who were infected. The wives and children of the men and the people in the surrounding community suffered too. And my next guest has tried to help address some of that suffering in a rather unique way. The Bioethics Quilt Project brought together some of the women in the surrounding community to talk about their experiences and at the same time to sew quilts. Pictures of some of the quilts are on our Web site at sciencefriday.com, right there on the home page. You click on it, you go to collection of all the quilts there.

Joining me now to talk more about it is the director of the Bioethics Quilt Project. Muhjah Shakir is assistant professor of occupational therapy at Tuskegee University. She's also bioethics senior scholar at the National Center for Bioethics in Research and Health Care there. She joins us from Tuskegee, Alabama. Thanks for being with us today.

Professor MUHJAH SHAKIR (Director, Bioethics Quilt Project): It's my pleasure.

FLATOW: You know, it sounds a little bit like the AIDS Quilt.

Prof. SHAKIR: It does.

FLATOW: Tell us about this idea.

Prof. SHAKIR: Well, I was interested in learning more about the stories of women in particular because, as you probably know, the study itself involved men. And, you know, given the nature of how syphilis is transmitted, the story of women and the women in the lives of these men and also their children, you know, has not been told. It's a discussion that just has not really been had. And I wondered about the impact of the syphilis study on their lives and also on the life of the community. And so I thought of bringing a group of women together also because quilting is a culturally significant activity that people still do. In this particular part of the country they still engage in that quite a bit. And as an occupational therapist I thought, well, what a fine way to bring a group of women together and to have them engage in this projected medium to begin a dialogue, but also to end up with something really tangible, like a quilt, that could be hung and shown and stimulate public conversations about the study.

FLATOW: Each of these people tell their own story in one panel on the quilt?

Prof. SHAKIR: No, the quilt is made up of squares. It's not a full panel. It's maybe a 16 by 16-inch square, and each square does sort of tell a story. But when you put it all together, it tells a bit of a story.

FLATOW: And who are these people?

Prof. SHAKIR: I had one group in '04 who was a group of - all of the women are retired senior citizens. The oldest woman in the group was 97. The youngest woman in the group is 51. And they are just women in the community. Some of them are professional women, but most of them are working-class, nonprofessional women. Some of them had relatives that were in the study, but the majority of this particular group were just folks from the community.

FLATOW: When they get around and do their quilting, do they tell stories about what was happening in those days?

Prof. SHAKIR: Yes. You know, I explained to them what the purpose of the project was all about, and so I actively elicited the stories. One of the things that we learned is that there's still a lot of silence about the syphilis study.

FLATOW: Mm-hmm.

Prof. SHAKIR: I mean big, big secrets, you know, in the community. And I thought and believed that the quilting made it easier for people to tell and to talk about something that was pretty painful.

FLATOW: Harriet, if you want to jump in anytime, just feel free to say something.

(Soundbite of laughter)

FLATOW: Do they talk about Nurse Rivers who was - I understand she was an African-American and she knew what was happening to the men, but she didn't try to stop it.

Prof. SHAKIR: Yes, it comes up quite a bit, and there's always a mixed kind of response, a mixed review. Some of the women were angry and felt that she had betrayed the men in the race, and others had a very compassionate understanding of the complexities of the dynamics of what was happening in that particular time period and knew of her commitment to the community as a public health nurse, and actually, like I said, felt very compassionate towards her and did not believe that she should be held totally responsible.

Ms. WASHINGTON: I'm glad that we're talking about Eunice Rivers, because I think black complicity is a very important part of what I've discussed in my book in part of this history. And she has been made, in my opinion, to bear a disproportionate part of the burden of the study. If we look at the Tuskegee syphilis study, which actually was a Public Health Service study with Tuskegee only marginally involved, the architects of the study were PHS physicians, very powerful men, government physicians: Taliaferro Clark, O.C. Wenger, Raymond Vonderlehr, and Surgeon General Thomas Parran. These men put together the study and propagated it. Eunice Rivers was a public health nurse in rural Alabama, a black nurse, arguably at the very bottom of the medical totem pole.

Prof. SHAKIR: Yes.

Ms. WASHINGTON: You know, the (unintelligible) her agency is very, very limited. And although personally I wish she had asked more questions about the study, I think it's unrealistic to expect her to have had much agency in terms of ending its course.

FLATOW: Professor Shakir, are the quilts visible or, you know, open to the public to see anyplace?

Prof. SHAKIR: Not at this particular time. However, I am available to give talks and to bring the quilts around. Probably at some point in time in the near future they will be on display for people to see.

FLATOW: Well, I want to thank you for taking time to talk with us, and good luck to you.

Prof. SHAKIR: And thank you for having me.

FLATOW: You're welcome. Muhjah Shakir is assistant professor of occupational therapy at Tuskegee University. She's also bioethics senior scholar at the National Center for Bioethics in Research and Health Care there. And she joined us from Tuskegee, Alabama.

Our number, 1-800-989-8255 is our number. Still with us is Harriet Washington, author of "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present."

Harriet, do you still think there's unethical things going on?

Ms. WASHINGTON: There are unethical things still transpiring, but I hasten to add that they pale in comparison to what happened in the past. The horrible abuses of the past almost never happen anymore. We no longer see black people herded into segregated hospitals, where they are experimented on to devise new procedures or just to train physicians. That doesn't happen anymore. But there are problems, there are abuses, and a lot of them are racially disproportionate. In large part they fall under what I call the erosion of consent. Since 1990, there have been a variety of laws passed, part of the Code of Federal Regulations, that have been watering down the concept of informed consent, which has been sacrosanct in medical research here, and black people are suffering disproportionately from that.

I think, for example, of the artificial blood studies that have been conducted in Detroit until fairly recently, where as you were brought into an emergency department in Detroit - and six other centers across the country - unconscious and you need blood, you may be given blood or you might get artificial blood, which in this case is old, expired human blood. And the person deciding it is not a physician who looks at your clinical picture. It's a computer. And this study only ended about six and a half weeks ago not because there was a ethical complaint or a public outcry, but because the company, Northfield Laboratories, had all the data that it wanted and ended the study. We're going to see more of these.

FLATOW: So you're saying it's unethical to withdraw the artificial blood from these people.

Ms. WASHINGTON: I'm saying it's unethical to give someone an experimental therapeutic, including artificial blood, without getting their permission.

FLATOW: Right.

Ms. WASHINGTON: These people are unconscious so nobody's even asked them, are you willing to be part of research? If they were giving some kind of...

FLATOW: No matter what race you are.

Ms. WASHINGTON: Oh, no matter what race you are.

FLATOW: Yeah, yeah.

Ms. WASHINGTON: That's why I said, you know, it affects blacks and whites. However, if you look at the demographics, you find that black people are more likely to use emergency department as their private physician than whites. And also many emergency departments, like the one in Detroit, are located in heavily inner city areas, so you do see proportionately more black people than white.

FLATOW: 1-800-989-8255. Kimberly in St. Louis. Hi, Kimberly.

KIMBERLY (Caller): Hi, good afternoon.

FLATOW: Hi there.

KIMBERLY: My question is two-fold. Firstly, I'm originally from Maryland, and there is certainly a pervasive belief in Baltimore city, especially amongst the older people, that back in the day that you were not to go seek treatment at Johns Hopkins. Because apparently people would go get treatment and come back worse off than where they were, or they would just not be seen ever again. And I was wondering if Ms. Washington had ever found any evidence of that.

And secondly, I've known several black men in my family, family friends, who just seem to die, be it from cancer, a variety of other types of illnesses. But they die, like, in their early fifties. And I know someone - and my father passed away at 53, and I knew several other black men in that age range to die around that age. And is that an across-the-board thing? Or - I mean, do these black men just not live to see 70, 80 years old? And I'll take my answer off the air. Thank you very much.

FLATOW: Thank you.

Ms. WASHINGTON: Hi. Yes, I have heard very often people voice the fears about John Hopkins University. What I have found is that not pertaining to John Hopkins in particular but at hospitals in general there - again there is a grain of truth to people's fears. Because the truth is, earlier in our nation's history, black people were treated in separate clinics and separate wings of the hospital, and they were expected to undergo research as payment for having been treated in the charity wards.

But yet, if you were black, you couldn't go into a regular paying ward. And so it's true that sometimes people would go into the hospital and have procedures such as amputations done simply as part of medical training, not because there was medically indicated. And that was a horrific thing.

It doesn't happen now. But the memory, of course, of these things persists. And also our fears of burking(ph), which is being killed for anatomical dissection. And I did find one documented case of that.

It took - but only - it happened to a white woman, not a black person, a white woman who lived in a black area. It doesn't mean it didn't happen to other people. But thankfully it's among the abuses that I think we can place firmly in the past.

In terms of the death of black men, I think that was actually a quite question on your part because I think we're going to be talking more about that later on.

FLATOW: Yeah. Let's bring him on now.

Ms. WASHINGTON: Yeah. Okay. Great.

FLATOW: Let's talk about the - we've heard many times before how white people are living longer than black people on the average. And the numbers are a little different for men and women but the outcomes are the same. You live longer on the average if you're white. And now there's a new study in the journal of the American Medical Association that says that the gap in life expectancy between blacks and whites has narrowed a bit.

And even though that sounds like good news, the authors are quick to point out that the gap remains substantial. Joining me now to talk more about the gap and some of the reasons is Sam Harper. He's a research fellow in the Department of Epidemiology at McGill in Montreal. And he joins us by phone.

Thanks for being with us today, Dr. Harper.

Dr. SAM HARPER (Research Fellow, McGill University): Glad to be with you.

FLATOW: Let's start with some definitions. Tell us what we mean by a life expectancy gap.

Dr. HARPER: Sure. Well life expectancy is basically a way of summarizing mortality. So one way to think of it is sort of as the average life span that would be expected for an individual living under sort of the current mortality conditions.

So, for example, life expectancy in the United States is currently about 78 years, meaning that on average an individual born today can expect to live to about 78.

Now that's the average for the United States as a whole. The average life expectancy for whites is about 78.1 currently but for blacks is about 72.7. So there's about a five and a half year gap at present between blacks and whites.

FLATOW: Mm-hmm.

Dr. HARPER: So that's what we mean by the gap.

FLATOW: I got you. And how has the gap changed over the years and how has it shrunk?

Dr. HARPER: Well as you pointed out, for most - actually, since we've been recording mortality statistics, life expectancy has been higher for whites than for blacks.

But for most of the 20th century the size of that gap has been declining. However, we did see during the 1980s a rapid increase in the gap. And subsequently over the past decade or so we've actually seen a rather rapid decline in the gap.

FLATOW: We're talking about life expectancy this hour with black versus white on TALK OF THE NATION: SCIENCE FRIDAY from NPR News, talking with Sam Harper.

So why does the gap persist, Dr. Harper?

Dr. HARPER: Well one of the things we looked at was trying to look at different causes of death and how they might contribute to this gap. So in terms of the existing gap that we see, we found that among men about 30 percent of that gap is due to black/white differences in cardiovascular disease.

And similarly among women we see cardiovascular disease accounts for about 40 percent of the existing gap. So clearly that's a major component to the gap.

FLATOW: Is this because of medical care being different?

Dr. HARPER: That's certainly an element of why we might observe this contribution to the gap. Clearly we know that for some risk factors for cardiovascular disease - in particular, things like hypertension and diabetes - we know that blacks seem to have higher levels of these risk factors than whites do.

So clearly those things are potentially targets that could be addressed through the medical care system.

FLATOW: People ask also, perhaps there's a genetics difference.

Dr. HARPER: Well I think we don't have much evidence at this point that that makes much of a contribution to this difference in life span. And it seems very unlikely that it makes any really contribution to this decline in the gap that we saw over this recent decade.

FLATOW: So you really don't understand what the decline in the gap?

Dr. HARPER: Well, we do n terms of understanding sort of the major causes of death that contributed to the decline. Really, we found that actually it was really down to only a few causes.

About 70 percent of the decline among men was due to only three causes of death. So that was improvements in homicide, HIV/AIDS, and unintentional injuries. And those same factors also improved the gap among women, although among women we also did see improvements in heart disease mortality make an important contribution to reducing the gap over this period. So that's at least some sign of progress.

FLATOW: 1-800-989-8255 is our number. Harriet Washington, do you think it's worth investigating the genetic differences?

Ms. WASHINGTON: No, because of something called Occam's razor, the scientific principle saying that it's not necessary to invoke genetics. We know of the many very dramatic causes.

And frankly if you look at the causes of death of black people, we're talking about genetics contributing to .5 percent; that's less than one death in 200. So that we know that many of the things Dr. Harper's investigated - heart disease, HIV disease, diabetes, infant mortality - we know these to be gross contributors. So it's not necessary, I think, to invoke any sort of genetic approach when we know exactly what diseases are carrying us off in greater numbers.

FLATOW: Sam Harper, do you agree?

Dr. HARPER: Yeah. I think that's a great point. And also it's worth mentioning that we actually - yeah, we already know quite a bit about how to change sort of the environmental, that is to say non-genetic determinants of these diseases.

So we know how to sort of treat things like hypertension and high cholesterol. And we also know, you know, how to try to work to get people to improve their lifestyles, such as improving, you know, their diets and maintaining healthy weights. And again, we don't need to - as she said, we don't need to invoke genetics to explain what we observed in our study.

FLATOW: So you saw the gap change. We're going to - we have to take a break, so stay with us.

Dr. HARPER: Sure.

FLATOW: We're going to have to come back right after this short break. We'll be right back.

(Soundbite of music)

FLATOW: You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow. A brief program note: On Monday, Neal Conan will be here with a look at the hierarchy of accents. You know, Americans love a good accent. You've got the Governator, Tony Blair, even Rosie Perez. Which accents rank highest? Call it accent discrimination. That's coming up on Monday on TALK OF THE NATION from NPR News.

This hour for the rest of the hour, or for a little bit more we're going to talk about medical ethics and experimentations on African-Americans over the years. And with me is Harriet Washington. She's author of "Medical Apartheid." Also talking with Sam Harper at McGill University.

And I've got about one - time for one more question, Harriet. I want to ask you, Martin Luther King spoke of the inequality of the American health care system.

In your book you talk about it in a speech he gave in Montgomery in 1965, he said of all the forms of inequality injustice in health is the most shocking and the most inhumane.

Ms. WASHINGTON: Yes.

FLATOW: Hard to amplify on that, isn't it?

Ms. WASHINGTON: I think that says it all.

FLATOW: Do you think enough attention is paid now to inequality in healthcare?

Ms. WASHINGTON: I think we're making great progress. You know, work like Dr. Harper's, initiatives such as Dr. Satcher setting - in progress when he was surgeon general, where it was very ambitious but it was important that it was done. It gave an impetus so that we now have attention turned to the importance of resolving health care disparities. Because, in the end, you know, we're medically interdependent. And I think it's real folly to say that we - any of us is going to enjoy good health when we have pockets of people who are sick and disaffected.

FLATOW: Sam Harper, do you agree?

Dr. HARPER: I do agree. And I think it's actually quite interesting that Professor Washington mentions Dr. Satcher, because that's also a good example of areas where we can think about making success if you really sort of redouble our efforts toward addressing this problem.

I think one of the things he really tried to look at was reducing race ethnic disparities in childhood immunizations. And as a result of really focusing on this problem in particular, we've actually come quite a long way toward, you know, reducing that gap.

So I think that's, you know, it's a positive. We can affect this problem, but we do need to work harder.

FLATOW: Sam Harper, I want to thank you for taking time to be with us today.

Dr. HARPER: Thanks very much for having me.

FLATOW: Sam Harper is a research fellow in the Department of Epidemiology at McGill University in Montreal. Harriet Washington, thank you.

Ms. WASHINGTON: Thank you.

FLATOW: She's author of "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present." It is an eye-opening book. And thank you for writing it.

She's currently visiting scholar at the DePaul University School of Law.

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