Black & Blue is the first systematic description of how American doctors think about racial differences and how this kind of thinking affects the treatment of their black patients. The standard studies of medical racism examine past medical abuses of black people and do not address the racially motivated thinking and behaviors of physicians practicing medicine today. Black & Blue penetrates the physician’s private sphere where racial fantasies and misinformation distort diagnoses and treatments. Doctors have always absorbed the racial stereotypes and folkloric beliefs about racial differences that permeate the general population. Within the world of medicine this racial folklore has infiltrated all of the medical sub-disciplines, from cardiology to gynecology to psychiatry. Doctors have thus imposed white or black racial identities upon every organ system of the human body, along with racial interpretations of black children, the black elderly, the black athlete, black musicality, black pain thresholds, and other aspects of black minds and bodies. The American medical establishment does not readily absorb either historical or current information about medical racism. For this reason, racial enlightenment will not reach medical schools until the current race-aversive curricula include new historical and sociological perspectives. “This eye-opening work will enable health professionals to face racism in their practices and bring about racial awareness and enlightenment in medical education. It is a pioneering, systematic study of racial issues in medicine/health care. . . . Highly recommended.” ― CHOICE “ Black and Blue goes where previous studies have not. It is an unapologetic and systematic analysis of how American doctors perceive racial differences and how their opinions determine diagnoses and treatment of their black patients.” ― Tampa Bay Times "[Those] who have an interest in the intersection of race and health should be introduced to Hoberman’s comprehensive work on this thorny and important subject." ― American Journal of Psychiatry John Hoberman is a social and medical historian at the University of Texas at Austin, and the author of Darwin's Athletes: How Sport Has Damaged Black America , The Olympic Crisis: Sport, Politics, and the Moral Order , and Sport and Political Ideology . Black and Blue The Origins and Consequences of Medical Racism By John Hoberman UNIVERSITY OF CALIFORNIA PRESS Copyright © 2012 The Regents of the University of California All rights reserved. ISBN: 978-0-520-27401-3 Contents Acknowledgments, ix, 1. THE NATURE OF MEDICAL RACISM: THE ORIGINS AND CONSEQUENCES OF MEDICAL RACISM, 1, 2. BLACK PATIENTS AND WHITE DOCTORS, 18, 3. MEDICAL CONSEQUENCES OF RACIALIZING THE HUMAN ORGANISM, 71, 4. MEDICAL APARTHEID, INTERNAL COLONIALISM, AND THE TASK OF AMERICAN PSYCHIATRY, 146, 5. A MEDICAL SCHOOL SYLLABUS ON RACE, 198, Notes, 235, Index, 279, CHAPTER 1 The Nature of Medical Racism The Origins and Consequences of Medical Racism INTRODUCTION The idea that discredited (and even disgraceful) ideas about racial differences might play a role in medical diagnosis and treatment is a possibility that some doctors find profoundly disturbing. The racially biased treatment of patients would appear to be a grievous violation of medical ethics and a direct threat to the dignity of the profession. Yet, in the course of the last two decades, the medical literature has published hundreds of peer-reviewed studies that point to racially motivated decisions by physicians either to deny appropriate care to black patients or to inflict on them extreme procedures (such as amputations) that many white patients would be spared. "How are we to explain, let alone justify, such broad evidence of racial disparity in a health care system committed in principle to providing care to all patients?" the socially active physician H. Jack Geiger asked in 1996. His reply to his own question offered two possible explanations. The first option was to attribute the observed disparity to "unspecified cultural differences" or decisions made by black patients who did not understand that they needed medical care. The second and more discomfiting explanation was, as Dr. Geiger phrased it, "racism—that is, racially discriminatory rationing by physicians and health care institutions." Confronting the data that he had felt compelled to present to the medical community, Dr. Geiger could not bring himself to categorize the documented behavior of his medical colleagues as racist. Indeed, he added, "if racism is involved it is unlikely to be overt or even conscious." For this conscientious physician, medical racism that implied individual culpability was still somehow unreal, a specter to be exorcized rather than a threat to be acknowledged and confronted. Black and Blue is the first systematic description of how doctors think about racial differences and how this kind of think