Medical school is rigorous. The sheer scope of material medical students must learn is immense. How much history, rather than science, should medical students be required to learn? Beginning in 1932 there was a horrendous experiment which purposely followed African American men with syphilis but did not treat them. Instead, public health officials merely monitored the disease progression even though penicillin was available for much of the study. Two-thirds of the Tuskegee Syphilis Study participants had latent syphilis that went untreated. More than 100 died. The men were recruited to participate with offers of free medical care and funeral expenses. (Note to self: do not participate in a clinical study that offers free funeral expenses.) The Bone Museum in New York City has some interesting videos of what syphilis does to you in the later stages.
The infamous Tuskegee experiment is not the only example of unethical medical studies. Writing in STAT, George Washington University medical student, Uzma Rentia, describes other medical experiments and clinical trials that were breaches of medical ethics. A common denominator is participants who were desperately poor, uneducated, and lacked the sophistication to make informed decisions. These anecdotes are worth reading about, but it is debatable whether medical schools should take time away from medical science to teach more about them. The following is from Rentia:
My medical school prides itself on its focus on health equity, yet — like many institutions and media outlets — it has fallen into the habit of invoking Tuskegee as shorthand for the entirety of medical abuses. But this history does not begin and end with Tuskegee. The belief that certain bodies are somehow more expendable — more durable, more suitable for risk — has quietly sustained American biomedical advancement for decades, with consequences that continue to reverberate.
… I believe this point must be emphasized beyond a cut-and-paste PowerPoint slide on the Tuskegee experiment. Tuskegee is important, to be absolutely clear. Yet for it to be the only wrongdoing medical students are taught obscures a central lesson of Tuskegee: that medical racism is more pervasive, closer to home, and more contemporary than we often acknowledge.
Medical schools and institutions must be at the forefront of teaching about the inequities that persist to this day — and equally at the forefront of rebuking studies like the hepatitis B vaccine trial. Some may argue that medical curricula are already overstuffed and straining at the seams.
Rentia’s last sentence should be the definitive answer. Tuskegee is an interesting case study on unethical medical experiments, but it is not medicine. It is not clinical training. The Tuskegee experiment is history. While I understand Rentia’s logic, medical school should not turn into a series of case studies on ethical failures of past generations. Such case studies could benefit PhD candidates, training to design and conduct research studies as part of their training, However, MD’s and DO’s schedules are full.
At what point is history valuable for medical students training to treat diseases? Let me give some examples of how race can affect medicine that is beneficial to physicians. Racial and ethnic minorities experience death at a younger age and illness more frequently across a broad range of chronic conditions. These include high blood pressure, heart disease, diabetes, obesity, asthma, just to name a few. The so-called social determinants of health are a vast area of research nowadays. For example, to what degree does being born into poverty affect your health in later years? What effect does racism have on your mental health? Does your race affect the way your doctor treats you? These are all worthy questions that epidemiology studies. We are a nation of immigrants, whose ancestors came from diverse parts of the World. Those differences could mean a lot in terms of genetic makeup, which in turn could affect Americans’ health in numerous ways. The following is an example.
Throughout history the African interior had little salt. There was a thriving trade where those in the middle of the continent traded gold for salt. Over eons of time people in the heart of Africa evolved to survive on diets mostly devoid of salt. The high sodium levels in Western diets wreak havoc on their blood pressure today due to evolutionary biology that makes many African Americans extremely sensitive to salt.
Learning about unethical medical studies serves little purpose in medical school curriculum unless it improves clinical care. The later examples are anecdotes about how race can affect different patients. Let’s stick to training science and leave teaching uncomfortable history to the historians.
Read more at STAT: Medical education on inequity shouldn’t stop with Tuskegee
Also see the Goodman Institute Health Blog: Could Racial Health Disparities All Be in Our Genes?