October 9, 2019
Page 9
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Many Stories about Bias in Medicine True
Why some
people don’t
trust doctors
by a rMen
h enderson
On a recent night on
duty at my hospital, I
was called to the room
of a 60-year-old patient
from Puerto Rico. He
had a treatable cancer
that had now turned
end-stage and meta-
static. But he refused medical in-
terventions such as intubation or
resuscitation.
Upon questioning him, I
learned he was not fond of hospi-
tals or medical treatment. In fact,
he said he’d never accept chemo-
therapy from any doctor — even
if it could have cured his disease.
He told me that a white phy-
sician once came to Puerto Rico
and killed unsuspecting people
using the same chemicals used
to treat cancer. One of the vic-
tims was his relative, and the sto-
ry was passed down through the
generations, along with a warn-
ing: Never trust doctors.
I’m a black, Florida-based
physician who grew up in third
world Philadelphia. When I hear
a story like this one, I investigate
further.
My Puerto Rican patient
proved to be no conspir-
acy theorist.
The man he referred to
was Cornelius Rhoads,
who traveled to Puerto
Rico in 1931 to study
anemia.
Soon after, Rhoads
wrote a racist screed to
a colleague: “What the island
needs is not public health work
but a tidal wave or something to
totally exterminate the popula-
tion. I have done my best to fur-
ther the process of extermination
by killing off 8.”
Hospital staff in Puerto Rico
discovered the letter, spurring
a scandal. A government inves-
tigation cleared Rhoads of his
own claims, and he went on to
start what we now know as mod-
ern-day chemotherapy. Yet a Uni-
versity of Puerto Rico researcher
later found evidence to support
the original allegations.
Throughout our history, black
and brown people have repeat-
edly been used as test subjects
without their consent, from the
Tuskegee experiment that short-
ened the lives of black men with
syphilis, to forced sterilization of
unsuspecting poor black women
in Mississippi.
While I don’t know any doc-
tors who emulate Rhoads, more
subtle biases abound. A 2015 sur-
vey found that 50 percent of med-
ical students at the University of
Virginia think black people nat-
urally feel less pain. Nationally,
other studies show, black people
are under-treated for pain.
Doctors are also 71 percent less
likely to suggest routine clinical
screening such as colonoscopy to
black patients with a family histo-
ry of colon cancer — and 31 per-
cent less likely to Latino patients
— compared to white patients,
even though these patients are
more likely to die from the cancer.
These biases and others have
horrifying effects. For instance,
black women experience over
3 times more pregnancy-related
deaths than white mothers.
Such cases remain in the minds
of many people of color when we
go to the doctor — and in my
mind, too, as a black doctor.
Here’s a prescription for Amer-
ican physicians: Stop violating
the Hippocratic oath. Physicians
must confront their biases by first
recognizing what they are. The
same way these are learned, they
can be unlearned.
Take implicit bias tests to probe
some of your own hidden preju-
dices. Read books like Medical
Apartheid by Harriet Washington,
which medical schools should
make required reading. Join or
start a local chapter of Campaign
Against Racism to identify institu-
tional bias and find solutions.
Finally, if patients say they
don’t trust doctors, understand
that they’re probably right on
some level.
My Puerto Rican patient died
before I could apologize for the
evil that had been done to his
family by people who swore to do
no harm. How many more people
have to die feeling that way?
Armen Henderson is a Flori-
da-based physician and founder
of the Dade County Street Re-
sponse. Distributed by other-
words.org.
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