FARAI CHIDEYA, host:
I'm Farai Chideya and this is News & Notes. First, do no harm. That's one of the tenets of medicine. But what happens when doctors prevent their own colleagues from serving the greater good? According to a new report, that's exactly what happened, when for decades white American doctors shut their black colleagues out of the profession. Last week, the American Medical Association issued a formal apology for its, quote, "past history of racial inequality towards African-American physicians."
Harriet Washington is a medical ethicist and co-authored the AMA report. She joins us now. Harriet, welcome back to the show.
Ms. HARRIET WASHINGTON (Medical Ethicist; Co-Author of AMA Report): Hello, Farai. Thank you so much for having me.
CHIDEYA: So the AMA was founded in the 1840s and this legacy of discrimination that you helped document has its roots back in 1870, when a group of black doctors tried to become members. Tell us that story.
Ms. WASHINGTON: Precisely. In 1870, three physicians, black physicians, tried to be seated as delegates at the AMA convention. Being seated as a delegate was the usual prerequisite to membership. But they were rejected. They were not allowed to take their seats, not allowed to participate. The AMA later explained that it wasn't because of their race, but because they belonged to organizations that admitted - gasp - women, and also admitted what the AMA called non-traditional practitioners. Practitioners of natural medicine, Thompsonsim (ph), hydrotherapy and homeopathy.
However, they AMA had also seated other delegates, other physicians, who also belonged to groups that accepted these people, so that could not have been the reason. The AMA claimed that they didn't practice racial discrimination. In fact, after this event, when the National Medical Association and other organizations decried their failure to seat the blacks, they passed a resolution part of their own guidelines, saying that they would not discriminate racially. But they did, and they continued to do so well into, and I would say almost completely through the civil rights era.
CHIDEYA: Well, what effect did this have on black doctors?
Ms. WASHINGTON: The effect has been devastating. And one can see the legacy of this discrimination even today. Look at the numbers of black physicians. The estimates range from - no one's quite sure how many there are, which is interesting. But the estimates range from two to three percent to six percent. Even if one takes the higher six percent number, we're talking about a number of black physicians that's roughly half what it should be, blacks being 12.2 percent of the population.
So we have fewer black physicians. But the damage doesn't stop there. We have fewer black physicians, we have a ruptured trust between black physicians and black patients, and the American Medical Association. Part of the legacy of this very tragic history is that many physicians and patients simply don't believe the American Medical Association is looking out for its interests and advocates on behalf of them as well as white physicians.
We also have a lack - besides a lack of racial diversity in medicine, we also have this haunting problem of healthcare disparities, this huge gap in the health between whites and blacks. And I also lay this in part to the American Medical Association policies. Because by excluding black physicians, they excluded physicians that had a bank of trust with patients and who had specialized knowledge of the challenges facing black patients. By excluding these people and by telegraphing their lack of concern for black patience by countenancing segregation, the AMA has unfortunately contributed to this problem. So, I'm sorry.
CHIDEYA: Let me jump in, because how did this whole apology come about? I mean, you've written a book called "Medical Apartheid," but how did they put together a team to look into this, and why did they decide to apologize?
Ms. WASHINGTON: Well, the - I would trace it - I think that there are a lot of places you could point to and say it's a possible beginning. But I personally trace it to 2005, when John C. Nelson, who was then president of the American Medical Association, addressed the black physicians' group, the National Medical Association. Dr. Nelson made a personal apology for the policies and practices of the American Medical Association. Of course, it had to be a personal apology because it had not been promulgated by the group itself, but the fact that he was the AMA president certainly was not lost upon people who heard him. And that's where I date my hope that, you know, there would be an eventual apology.
It's not coincidentally, that same year, we were commissioned to do an independent history, the AMA promised not to be involved. And it wasn't involved. The group of experts, including myself, we decided what the parameters would be, how we would address it, what the paper would look like and what avenues we were going to research. And we hoped that after this paper was published and that the history was revealed, we hoped that eventually the American Association would be moved to apologize. But probably no one was more surprised that myself when the AMA opted to apologize immediately. I found that very heartening.
CHIDEYA: Practically, in terms of how it could affect people, what does this apology do? Because it's targeted at physicians, not directly at patients. But do you think it will have a ripple effect at all on American medicine?
Ms. WASHINGTON: I think the effect will be two fold, the effect of the apology itself I think will effect Americans, specifically black patients, as well as black physicians. Because, black patients - it's true it's directed at physicians but black patients have watched and are well aware of this troubling history between the AMA and the National Medical Association.
Black patients - there are black patients who are alive today who are doing the civil rights movement saw, that the American Medical Association opposed Medicare, opposed Medicaid, did not support the efforts of black physicians to be admitted to practice into hospitals - into specialty practice. They saw this and they quite logically came to me at the American Association - Medical Association as not working in their best interest. And I think that the apology will be cathartic, it's not enough, but it's a necessary first step and an important first step. I think the real import of the apology can only been seen in concert with the AMA's behavior.
And when I look at the AMA's behavior over the past years, I'm very heartened, it elected its first black president in the mid-1990's, and has already been working with the National Medical Association, as well as the Hispanic Doctors Association on a project called, The Commission to End Health Care Disparities in which the black and white physicians and Hispanic physicians are all working together trying to close this racialized health gap. So, I think that the apology itself will have some input, but I think it's going to have its best input in conjunction with a new found association of equals, with black physicians.
CHIDEYA: Well, Harriet thanks again.
Ms. WASHINGTON: Thank you, Farai.
CHIDEYA: Harriet Washington, is a medical ethicist, she co-authored a recent report in the journal of the American Medical Association, it's called, "African and American Physicians and Organized Medicine 1846 to 1968, Origins of a Racial Divide," she's also author of the book, "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present." She joined us from our studios in New York City.
Copyright © 2008 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.