The past, present and future of race and colonialism in medicine.

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Author: Ellen J. Amster
Date: May 24, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 20)
Publisher: CMA Impact Inc.
Document Type: Article
Length: 2,050 words
Lexile Measure: 1720L

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Western medicine has begun a reckoning with its inconvenient pasts, from dethroning medical heroes to an increasing awareness of how doctors have treated colonized and enslaved populations. A statue of the "father of modern gynecology," J. Marion Sims, was removed from New York City's Central Park in 2018 after protestors in "blood-spattered" hospital gowns objected to glorifying a doctor who experimented on enslaved Black women (Figure 1). (1) In 2020, the release of video recorded by Joyce Echaquan, an Indigenous woman who died in a Quebec hospital as nurses repeated racial slurs, sparked street protests. Medical students at the University of Pittsburgh are rewriting their Hippocratic oath to include a commitment to social justice. Medical journals, professional medical associations and public health authorities in several North American cities have declared structural racism a public health crisis.

These are not isolated fragments but elements of a single story--the past, present and future of race and colonialism in medicine. Complex histories like Sims' have been edited to create a hero's narrative, an attempt to "keep the good and leave the bad," but unmooring medicine from its problematic past does not conquer racism. Instead, racism goes underground, to continue invisibly in medical structures and cause misdiagnosis, poor patient care, dysfunction, abuse and public backlash.

What can be done? Histories reveal the why and how, the mechanics of racism in health policy, medical research, diagnosis, training, clinical spaces, patient experiences, professionalism and institutions. Sims matters precisely because he was considered a successful doctor, one celebrated by his colleagues and lionized by the medical establishment. The actual and unexpurgated historical Sims shows how "good" doctors can do bad things, and it unearths the specific ways that individual doctors, culture, institutions, knowledge, society and power intersect to perpetuate racism. Medicine can use history to help achieve structural competency, an interdisciplinary medical education approach that applies an understanding of structural inequities and social determinants to clinical care. (2)

How colonialism shapes medical knowledge

European empires were global capitalist systems for the extraction of resources, created and maintained through violence. Empires generate racism because empires need racism to exist. Race theory validated colonial conquest and naturalized white imperial rule. (3) Consider Rudyard Kipling's 1899 poem, "The White Man's Burden," which exhorts the "white races" to govern the non-Western world, "your new-caught sullen peoples, half devil and half child." Empire shaped medicine--Sims could "borrow" 3 enslaved women for experimentation because empire made some human beings into property. Gynecology was useful to slaveholders who wanted to breed human slaves and thus increase their capital and wealth. (4)

Science served colonialism primarily by codifying race, by "discovering" it in physical and social reality--in biometrics, pathology, physiology, architecture, philology, history, ethnography and sociology. (5) Enshrined in edifices of data and perpetuated by institutions, racism has continued in medicine long after formal empire and slavery have ended.

Consider, for example, "exotic syphilis," a theory begun in French colonial Algeria by Dr. Emile-Louis Bertherand (d. 1890). Bertherand argued that Muslim Algerians were constitutionally different...

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Gale Document Number: GALE|A704355521