Roshae Roberts • 2021 Science Communication Series Cohort
Image accessed here. Omikron/Science Source
Jennifer arrived at the hospital seeking relief from excruciating pain. She had woken up that morning with such unbearable abdominal pain that she felt as if she could no longer walk or talk -- she knew something was horribly wrong. When she relayed this to the medics in the emergency room, they ignored her cries for help, attributing her need for medicine as another druggie looking for a fix. When she finally saw a doctor, her request for medication was denied as the doctor did not believe that she was truly in pain. Even though she was sent home that day, Jennifer persisted until, weeks later, doctors finally examined her and discovered fluids leaking from a ruptured ovarian cyst.
This experience has been shared by millions of people in the Black community for years and exemplifies prevalent misconceptions that all Black people do not feel pain and are drug abusers. These misconceptions are rooted in the American enslavement of African people during the 18th and 19th centuries and the subsequent perpetuation of racially discriminatory practices since then. The field of science did not escape these racist ideologies—they show up in the way science and medicine systemically neglect to include members of the Black community both as participants in research studies and as members of the science and medical workforce.
White as the Standard in Research
Some may be hesitant to believe that science is racist because, by definition, science should be objective. However, we need to take into consideration that people aren’t inherently objective. We all understand the world differently and generate biases influencing the way we conduct research as scientists. Furthermore, new scientific work and medicinal treatments today build off the foundational studies conducted by biased people which were not conducted to include diverse populations. Having biases is natural, but the field of science continues to uphold structural racism which unfortunately has deleterious effects for members of the Black community.
In America, the constitution is the foundation for every law and practice. For scientists, the constitution is seemingly peer-reviewed journal articles. These published scientific articles are the foundations of so many medical practices today, and just like the U.S. constitution, the scientific constitution was built on inequalities and injustices—especially as it relates to Black people.
Since foundational scientific studies often did not include a diverse range of participants, many of the findings today are based on white males. The impact of this is that data from white males is set as the “norm,” with any diversion from this being considered as ‘other’ and, therefore, wrong. For example, a cancer study on Ethnic Neutropenia found that people of African descent naturally have white blood cell counts lower than the “standard”—that of white males. The effect of this is that when doctors observe the white blood count of a black person, it appears to be “normal,” when in reality, it is significantly high for someone of African descent. Black women especially experience treatment delays as a result of this, as doctors aren’t able to detect their blood-related cancers until a much later stage [1]. The result is the exacerbation of the harmful effects of cancer as treatment efficiency dwindles.
With Ethnic Neutropenia, the effect is mainly experienced by Black people, but using white as the standard can be harmful to people of other ethnicities, as well. Take Sickle Cell Anemia (also known as sickle cell disease), for example. A common public misconception is that Sickle Cell is a black issue when in reality it is also prevalent in people of Mediterranean and Middle Eastern Ancestry [2]. While the disease is harmful, it is advantageous to carry the sickle cell trait as it provides immunity for malaria, a prevalent disease in these regions. Associations such as this can be harmful because they lead to human error. Oftentimes, when a non-black person demonstrates signs and symptoms of Sickle Cell Disease, doctors instead offer up a misdiagnosis of a similar but different condition: thalassemia [2]. Once again this leads to late or no detection, creating harmful outcomes for these people, simply because “Sickle Cell is a black disease.”
Influence in Medicine
On the other hand, when Black people were included in these studies, it was often to perpetuate racist beliefs. One clear example of this is the Eugenics movement, in which science played a significant role in crafting opinions about people of color. Out of this movement came one notably disastrous study known as the “Tuskegee syphilis study.” During this study, scientists were on a mission to investigate the natural progression of this disease within the Black community by studying Black men with syphilis. After the treatment, penicillin was developed, the participants of the study were left untreated to die [3]. Not only did this malpractice leave the black community ravaged with this disease and numerous losses, but it also perpetuates negative stereotypes about Black people being promiscuous and innately disease-ridden creatures [2]. Since scientific research studies influence medicine, it is no surprise that findings of harmful scientific research studies have a trickle-down effect that impacts the progression of healthcare.
Unequal Representation in Leadership
Systemic racism in science and medicine also shows up as a lack of diversity within the community. For a long time, Black people were kept out of higher education institutions because of segregation and Jim Crow laws. Despite the fact that Black people are legally permitted to earn degrees to become doctors and scientists, there are still many roadblocks to getting to the finish line. One headline this year read “Percentage of doctors who are black barely changed in 120 years,” with an increase of only 4 percent within that time. Black people represent one of the lowest ethnic groups represented in the biomedical research workforce [4,5]. This does not reflect a lack of trying but is rather a reflection of much of the gatekeeping still happening in these fields. A major barrier for Black people is the cost. Once again, slavery’s impact is to blame for the lack of generational wealth present within this community. Entering fields in science and medicine requires numerous applications, tests, internships, and volunteering. There are usually financial costs, but when you consider socioeconomic factors, black people are less likely to be participating because they cannot financially afford to spend a lot of money on application fees or volunteer their time in a lab when they have to work to help support their families. The lifestyle required from academia is not conducive to the lives of many black families, which results in a disproportionate exclusion within these fields. To prevent negative outcomes in the black community, academia and medicine must do a better job of promoting diversity at all levels.
Moving Forward
Members within the field need to be more knowledgeable of how certain practices affect Black communities. This includes but isn’t limited to: correcting the way race-based data is determined, understanding the social factors and context to the differences observed among racial groups, and also diversifying the decision-makers and people who influence, and carry out healthcare. It has been demonstrated that there is greater genetic variability within races rather than between them, but our society is so racialized that scientists and medical workers need to be reminded of the way race plays a role in human health. Race may not be the cause of illnesses and sickness, but an individual’s experience in the world will depend on their race and will influence their susceptibility to these illnesses and sicknesses. Take COVID-19, for instance: the virus can’t see color but Black people are twice as likely to die from it than their white counterparts [6]. The reason for this is not that Black people are genetically weaker, but due to socioeconomic factors. Black people are more likely to be found in denser urban areas, with air and water pollution, with less access to healthcare, not to mention less financial stability to have the privilege of social distancing. Having diversified fields will increase the likelihood that these considerations are being made at administrative levels. Additionally, diversity increases relatability, and if patients have a good relationship with their medical providers then patient compliance is strengthened and so is the likelihood of successful care. Imagine the progress that could be made if there are more diverse voices and diverse participants within these fields.
Although commonly referred to as such, science isn’t an arbitrary thing. We all contribute and are all capable of actively changing the environment. Scientists must understand the world around them, how it affects their data, and what that means in terms of translating their findings and the implementation of treatments. The only way we can eliminate these effects is to individually embody anti-racism while assessing the scientific constitution to generate more equitable and accurate healthcare and medical practices. The fields of science and medicine do themselves a disservice by continuing to promote practices rooted in systemic racism. It will take a radical change to accomplish this goal of leaving behind regressive and racist ideologies. Lives are literally at stake, and so is the progression of science and medicine.
References:
Hershman, D., Weinberg, M., Rosner, Z., Alexis, K., Tiersten, A., Grann, V. R., … Neugut, A. I. (2003, October 15). Ethnic Neutropenia and Treatment Delay in African American Women Undergoing Chemotherapy for Early-Stage Breast Cancer. OUP Academic. https://academic.oup.com/jnci/article/95/20/1545/2520494?login=true.
Washington, Harriet A. Medical Apartheid The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Knopf Doubleday Group., 2010. Print.
Brandt, A. M. (1978, January 1). Racism and Research: The Case of the Tuskegee Syphilis Study. The Hastings Center Report. http://nrs.harvard.edu/urn-3:HUL.InstRepos:3372911.
Tilghman, S., Alberts, B., Colón-Ramos, D., Dzirasa, K., Kimble, J., & Varmus, H. (2021, April 9). Concrete steps to diversify the scientific workforce. Science. https://science.sciencemag.org/content/372/6538/133.full.
Service, C. N. (2021, April 20). Proportion of Black Doctors in U.S. Has Changed Little in 120 Years, UCLA Study Finds. NBC Los Angeles. https://www.nbclosangeles.com/news/local/proportion-of-black-doctors-in-u-s-has-changed-little-in-120-years-ucla-study-finds/2577020/.
Fair, Malika A., and Sherese B. Johnson. "Addressing Racial Inequities in Medicine." Science. American Association for the Advancement of Science, 23 Apr. 2021. Web. 11 May 2021.