Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

Content Warning: This section of the guide contains discussion of racism, sexual violence, mental illness, physical abuse, emotional abuse, illness, death, and graphic violence.

Gather initial thoughts and broad opinions about the book.

1. Washington opens Medical Apartheid with contrasting images of Dr. James Marion Sims—one a celebratory statue, the other a disturbing painting of him preparing to operate on an enslaved woman. How did this framing affect your reading experience, and what tone did it set for the rest of the book?

2. How has Medical Apartheid changed your understanding of the relationship between American medical institutions and Black Americans? Which revelations most transformed your perspective on medical history?

3. How does Washington’s exploration of medical ethics compare to the examination of similar topics in other works, such as Rebecca Skloot’s The Immortal Life of Henrietta Lacks and Chip Jones’s The Organ Thieves? What unique insights does each book offer about the intersection of race, consent, and scientific research?

Encourage readers to connect the book’s themes and characters with their personal experiences.

1. Washington introduces the concept of “iatrophobia”—fear of medicine—among African Americans. Have you observed or experienced medical mistrust in your own community, and how does the historical context Washington provides illuminate those experiences?

2. The book discusses how standards of informed consent have evolved over time. Reflect on your medical experiences: How thoroughly have procedures, risks, and alternatives been explained to you before treatments?

3. Throughout Medical Apartheid, Washington documents how the medical community often dismisses or minimizes Black patients’ reports of pain. It also describes how 19th-century teaching hospitals instructed doctors to have different levels of empathy for patients based on race and class. Have you ever witnessed disparities in how medical professionals responded to different patients’ reports of pain or in the quality of care that different patients received?

4. The eugenics movement sought to limit population growth in Black communities through birth control programs that claimed to offer reproductive freedom. How does this complex history affect your view of reproductive rights today?

5. Washington concludes her book by encouraging African Americans to participate in ethical medical research while remaining vigilant. How might you balance the benefits of advancing medical knowledge against potential risks when considering participation in a study?

Examine the book’s relevance to societal issues, historical events, or cultural themes.

1. Washington argues that health disparities between Black and white Americans today are partly rooted in historical abuses. What concrete steps might medical institutions take to address this legacy while building trust in communities that have valid reasons for suspicion?

2. Medical Apartheid explores how scientists manipulated data to support racist theories, such as the 1840 census that falsely suggested freedom was harmful to Black people’s health. How do you see similar misuses of data occurring in contemporary discussions of racial health disparities?

3. Washington discusses how contemporary genetic research and DNA databases raise new ethical questions about race and medicine. How might society ensure that technological advances in medicine benefit all communities equitably rather than perpetuating historical patterns of exploitation?

Dive into the book’s structure, characters, themes, and symbolism.

1. Washington structures her book in three parts, moving from historical abuses to experiments on vulnerable populations to contemporary issues. How does this organization strengthen her argument about the continuity of medical racism throughout US history?

2. Throughout Medical Apartheid, Washington moves between broad historical trends and intimate personal stories like those of Anarcha, Betsy, and Saartje Baartman. How does this narrative technique affect the impact of her argument?

3. Washington consistently emphasizes that the Tuskegee Syphilis Study was not an isolated incident but part of a pattern. How does this framing challenge common narratives about medical ethics in the US?

4. The title Medical Apartheid uses a metaphor that builds on the South African political system of racist segregation and inequality. How does Washington build her case for this metaphor throughout the book? Does it effectively capture the racial dynamics she describes? Why or why not?

5. Washington argues that research bias hampers moral neutrality in science. How does she illustrate this theme through examples like scientific racism, eugenics, and contemporary genetic research?

6. How does Washington’s approach in Medical Apartheid compare to her approach in her other works, like Infectious Madness and Deadly Monopolies? What themes or methodologies appear consistently across her body of work?

Encourage imaginative and creative connections to the book.

1. If you were designing a medical school curriculum based on the insights from Medical Apartheid, what specific elements would you include to ensure that future doctors understand this history and avoid perpetuating harmful practices?

2. Imagine that you are curating an exhibit about the history detailed in Medical Apartheid. What artifacts, images, or interactive elements would you include to educate visitors while honoring the dignity of those who were subjected to unethical experimentation?

3. Washington describes how numerous historical figures like Eunice Rivers and J. Marion Sims had complex roles in medical experimentation. Write a monologue from the perspective of one of these figures explaining their actions and the ethical dilemmas they faced.

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