Friday, August 30, 2013

Russell Simmons, Defamed Harriet Tubman

From the UK Guardian, "Russell Simmons, you defamed not just Harriet Tubman but all black women: Would the Def Jam co-founder, who released a 'sex video' about the great abolitionist, have made a comic spoof about lynching?" by Kimberly Foster, on 16 August 2013 -- Not all heroes are created equal. Some garner considerably more praise and attention. For a lucky few, we fight fiercely to preserve their work and reputation because collectively we agree that this is what they deserve.

But the women I most admire have stories that remain largely untold. They are not usually placed on pedestals, but these are the stories that need to be most diligently looked after. If not, the uninformed tellers of history will twist and obscure them beyond recognition.

The release and circulation (on YouTube) of the "Harriet Tubman Sex Tape" evidences how little is thought of the women of color who make history. The clip, made available on the All Def Digital YouTube channel owned by entertainment mogul Russell Simmons, depicts the noted conductor of the Underground Railroad seducing and deceiving her master. The video also shows Tubman (Shanna Malcolm) and her master (Jason Horton) in explicit sexual positions while donning antebellum drag.

The short video attracted widespread negative attention on social media, with black women leading the charge. All Def Digital removed the video from YouTube, but that action could not undo the damage already done by Simmons, writer/director Daryl Johnson, and the video's participants.

When presented with an opportunity to tell the stories of the under-recognized, the chronicler has a responsibility to tell the truth. Unfortunately, Simmons and Johnson contributed to the ongoing misinformation about black women, slavery, and sexual assault.

Tubman made her way and led hundreds of others to freedom during her many trips on the Underground Railroad. The depth of her courage and strength of her character cannot be understated, yet the "Sex Tape" falls back on tired stereotypes of black womanhood.

As black women continue the work to tell our stories, and those of our foremothers, with honesty and dignity, seeing one of our heroes reduced to a the role of "Lustful Jezebel" hurts. How disappointing that while Simmons advocates for the full humanity of black boys and men, he chose to support the degradation of an iconic black woman, while downplaying the rape and sexual abuse black women faced historically.

In a tweet sent before the furor began, Simmons called the video the "funniest thing" he had ever seen. Clearly, the traumas inflicted upon black female bodies mattered little in his eyes. The gendered nature of sexual violence allows Simmons and other men to find humor in the implied abuse, while striking out against the violence they feel affects them more directly.

Would Simmons produce a historical parody about lynching? Imagine a light-hearted spoof of the assassinations of Martin Luther King or Malcolm X. The absurdity of such undertakings reveals itself immediately.

That anyone would find the video appropriate underscores the necessity of accurate conversations about the realities of chattel slavery. Slave holders subjected enslaved women to nothing short of sexual terrorism. Whatever sexual relationships masters and the enslaved engaged in were overwhelmingly coercive, not consensual. In a culture that continues to marginalize the voices of sexual assault survivors, this inaccurate re-imagining is not only offensive, but irresponsible.

Simmons still appears to be unable to grasp the work's potential consequences. Hours after All Def Digital pulled the video, he offered an empty apology that displayed his disregard for the pain and frustration of black women and proves further that he should not be entrusted with creating or distributing images that portray black women.

We must take seriously the sacrifices of the women and men whose blood, sweat and tears made our existences possible. Harriet deserves nothing less than respect – the same respect shown to men and women of other races. Hypersexualizing Harriet Tubman only serves to diminish her power and historical importance.

Tubman is one of many black women revolutionaries whose legacies continue to inspire. In fully embracing her truth of survival and resistance, we can each stand tall in our own.  (source: The UK Guardian)

Wednesday, August 28, 2013

Prisoners: America's Medical Guinea Pigs

From the Kaiser Papers, "They Were Cheap and Available: Prisoners as Research Subjects in Twentieth Century America," Author: Allen M. Hornblum  --  Summary points:  From the early years of this century, the use of prison inmates as raw material for medical experiments became an increasingly valuable component of American scientific research

Testimony by American medical experts at Nuremberg allowed American physicians and researchers to believe that the Nuremberg Code was directed only at Nazi scientists Postwar American research grew rapidly as prisoners became the backbone of a lucrative system predicated on utilitarian interests

Uneducated and financially desperate prisoners volunteered" for medical experiments that ranged from tropical and sexually transmitted diseases to polio, cancer, and chemical warfare.

On 20 August 1947 Gerhard Rose, one of Germany's most respected physicians, stood in the prisoner's
dock at the Palace of Justice in Nuremberg, Germany, awaiting his sentence for "murders, tortures, and other atrocities committed in the name of medical science." Dr Rose, the department head for tropical medicine of the Robert Koch Institute, was on trial along with 22 of his medical colleagues, for perpetrating "ghastly" and "hideous" experiments on concentration camp prisoners during the war.1

At one point in the trial when the chief prosecution witness, Dr. Andrew C. Ivy of the medical school of the University of Illinois, underscored the basic principle "that human experimental subjects must be volunteers," Dr Rose and his defence counsel vigorously objected, arguing that the United States was guilty of similar medical practices and giving several examples to support this contention.1

Early experiments on prisoners in US

The Nazi doctor's first example of American complicity concerned the medical experiments of Dr Richard P. Strong, who performed a series of studies in 1906 with "cholera virus upon inmates of the Bilibid Prison in Manila." The Philippine Islands experiment on prisoners already sentenced to death resulted in 13 fatalities and was eventually attributed to a bottle of bubonic plague serum having been substituted mistakenly for a bottle of cholera serum.2,5

Strong, who later became professor of tropical medicine at Harvard University, was not deterred by the
error and continued experiments on Philippine prisoners. His beriberi experiments six years later also resulted in death, but survivors were compensated with cigars and cigarettes.

Another German physician on trial for his life at Nuremberg, Dr. Georg August Weltz, the chief of the Institute for Aviation Medicine in Munich, offered the name of another American doctor who used prisoners on behalf of medical science. Dr Joseph Goldberger, a public health official, sought to unravel the mystery of pellagra, a deadly and at times disfiguring disease that was particularly virulent in the southern United States.

Goldberger parted company with medical colleagues who blamed the disease on everything from poor sanitation and personal habits to spoiled corn and flawed hereditary traits for the disease. He believed pellagra was due to the provincial and poor diet in the south, which supplied calories but not protein. Milk, vegetables, and fresh meat, he theorized, were the missing staples.

To prove his theory, Goldberger convinced Gover nor Earl Brewer of Mississippi to allow him to perform an experiment on a dozen inmates of Rankin Farm prison. His plan was simple: to "induce pellagra in white adult males, the one group in the population that statistics had shown was the least likely to contract the disease."6 The inmate volunteers after a promise of a pardon where gradually weened away from their normal diet and given a steady supply of cornbread, sweet potatoes, grits, and rice. Complaints grew as the men suffered from lethargy, dizziness, and pains in their backs, sides, and legs. Soon skin lesions began to appear and the "red flame" of pellagra was identified on each of the test subjects. The governor kept his  promise and pardoned the men. One test subject said he had been through "a thousand hells," whereas another swore he would choose a "lifetime of hard labor" rather than go through such a "hellish experiment" again.6

Dr Joseph Goldberger

As part of their defense strategy, the Nazi doctors on trial at Nuremberg named other examples of dubious human experimentation in American prisons, but those few cases paled in comparison to what transpired after Nuremberg.Though American doctors, lawyers, and justices at the Doctors' Trial excoriated Nazi physicians and denounced the German medical establishment for horrific and pseudoscientific experiments on prisoners, the American medical community disassociated itself from the implications of the trial and from the subsequent code of ethical research principles-the Nuremberg Code-that all doctors were supposed to observe. By the end of the war, America's rapidly emerging scientific dominance was not to be hamstrung by a code of medical conduct that was perceived by the American Medical Association to be directed specifically towards "the brutalities of Nazi physicians."7 Moreover, even though American jurists enumerated 10 human rights principles to safeguard the lives of research subjects-and imposed the death penalty on seven members of the Nazi medical hierarchy for violating such principles-self interest, utilitarianism, and the aura of science militated against the adoption of the Nuremberg Code in the United States. Research subjects, particularly prisoners, were considered too valuable.

The realization that incarcerated criminals had new utility as human guinea pigs did not emerge until the
second world war. Earlier efforts at using prisoners were not embraced by the orthodox medical community, which thought such practices were the preserve of unsophisticated medical eccentrics investigating offbeat scientific theories. For example, between 1918 and 1922 a doctor in the state prison system in California was "transplanting testicles from recently executed convicts to senile and devitalized men."8 By 1920, the procedure had been altered so that "animal glands were substituted for the human and were grafted to the recipient's testes." Dr L L Stanley, the resident physician at San Quentin Prison (California), where the operations were performed, recommended that the material to be used was "best taken from a ram, goat or boar" aged between a year and 18 months. Hundreds of San Quentin inmates received injections of animal testicular substance; some received a piece of ram's testicle the size of a silver dollar, which was implanted into the scrotum or abdominal wall. The innovative researcher on prisoners was convinced that the procedures had a "decided effect" on everything from "general athenia" to renewed "sexual stimulation." He also believed he was "fortunate" the operations-which he called "practically painless and harmless"-could be carried out in a prison because of the regimented lifestyle of prisoners.8 San Quentin inmates received testicular implants One prewar experiment that was less dramatic than testicular transplants, but captured the  public's attention due to extensive newspaper coverage, was the series of tuberculosis experiments at Denver's National Jewish Hospital in 1934. After years of trials on animals, Dr H J Corper claimed a tuberculosis vaccine he had been developing was "now ready for trial on human beings."9

Two convicts from the Colorado Penitentiary were selected as the guinea pigs from the 800 who had volunteered for the risky experiment after Governor Edwin C Johnson offered executive clemency to the survivors. Carl Erickson, one of the lucky inmates chosen, said: "I don't want to die, I volunteered to help so I could get out of here."10 Mike Schmidt, his partner in the experiment, was equally suspicious of his good fortune: "I don't exactly relish the idea of making an experiment out of myself."11 Though Schmidt became very ill during the course of the experiment, newspapers eventually proclaimed "Tuberculosis test a success" and the men were granted their freedom.12 Interestingly, not all reviews of the Denver experiment were favourable. One critic, apparently more concerned about crime than disease, commented: "We fail to see any excuse for releasing upon the community two life term fellows because they didn't get tuberculosis when inoculated with a preparation of microscopic bugs."13

For the most part, however, experiments on prisoners during the early decades of the century were uncommon medical oddities of dubious worth. Surprisingly, the practice received a big boost with the outbreak of the second world war. With American soldiers fighting and dying in Europe and the South Pacific, a whole new industry utilizing "human material" was about to emerge that would shape researchers' behavior for decades to come.

The Second World War

By the summer of 1942, American prisoners in state penal systems had embarked on a series of dangerous medical experiments, including injections of blood from beef cattle as a new source of plasma, atropine studies, and experiments with sleeping sickness, sandfly fever, and dengue fever.14,15 Federal prisoners were recruited to participate in medical experiments that ran the gamut from exposure to gonorrhea and malaria to induction of gas gangrene.16

One of the more widely publicized prison experiments during the war years, and one that was mentioned prominently at the Nuremberg Doctors' Trial, was the series of malaria studies at Stateville Penitentiary in Illinois. Over 400 prisoners were involved in this two year study investigating treatment and purported cure of malaria. One popular account of the experiment was Nathan Leopold's book, Life Plus 99 Years. An  enthusiastic participant in the dangerous study, Leopold was one of the famous killers in the 1924 Leopold and Loeb case. He proudly proclaimed that even though the inmates had to contend with periodic mosquito bites, raging fevers, nausea, vomiting, blackouts, endless untested medicinal potions, and occasional relapses, "no one squawked. They all took it like men."17 The highly publicized Stateville Prison malaria experiments received much public praise. An editorial in one newspaper proudly wrote that "these one-time enemies to society appreciate to the fullest extent just how completely this is everybody's war."18

The war years had become the transforming moment for human experimentation Inmates received a dollar or two a day for participating in this skin study in the 1950's. in America and particularly for penal institutions as a site of such scientific endeavors. What had once been a small, underfunded, unsophisticated cottage industry had blossomed into a well financed, broad clinical research programme investigating avant garde procedures, cures, and treatments. Human experimentation had been legitimised and prisoners had become the guinea pigs of choice for scores of inspired researchers. Public opposition to such medical initiatives was scant The overriding goal was to win the war in Europe and Asia; everything else was secondary, including research ethics and the issue of consent Millions of American fighters were risking life and limb daily; at the very least, lawbreakers could contribute to the war effort with similar commitment And they did. One close observer described it as "another shining light in the galaxy of wartime achievement" by imprisoned Americans.19

Curiously, once the war was over, there was no decline of medical experimentation in prisons. Battlefield victories were replaced by medical triumphs as the focus of governmental concern, and prisoners were once again the subjects of choice for research.

The eradication of disease had become the enemy, and postwar budgetary priorities supported this societal mission. For example, in the last year of the war, the National Institute of Health received about $700 000, which had climbed to $36 million by 1955, and over 10 times that just 10 years later. In 1970, $1.5 billion was awarded to some 11 000 grant applicants, nearly a third of them performing experimentation.20 Called "the gilded age of research" by Professor David Rothman, this new era of laissez-faire attitudes in the laboratory ushered in a frenzy for research on prisoners that lasted for over a quarter century.20 Rothman argues that a "utilitarian ethic" was able to dominate the field of human experimentation because "the benefits seemed so much greater than the costs" and because "there were no groups or individuals prominently opposing such an ethic.21

Postwar experimentation

One individual who contributed greatly to the postwar acceptance of prisoners as appropriate subjects for research was Andrew C. Ivy, an eminent researcher and vice president of the University of Illinois Medical School. Asked by the American Medical Association to be its representative at the Nuremberg Doctors' Trial and the prosecution's key witness on American medical ethics, Ivy testified to the high ethical standards of American researchers during the war, including those working in penal institutions. No American prisoner, Ivy reiterated, had ever been experimented on against his will. Defense counsel strongly objected to Ivy's sanitized portrayal of American prison research and peppered him with questions about numerous penal experiments both before and during the war.22 Dr Ivy remained intransigent; he did not believe that official coercion was necessarily inherent in a prison environment and restated his belief that prisoners in the United States had a choice as to whether they should participate in clinical experiments. Ivy articulated three "principles" for establishing ethical prison research: if "the consent of the subject was obtained"; if the experiment was based on "animal experimentation"; and if it was directed by "scientifically qualified persons" the medical procedure was acceptable.22 For American researchers anxious to utilize the thousands of potential subjects behind bars, Ivy's emphasis on acquiring voluntary consent from experimental subjects represented a seal of approval. In fact, the seal of approval came less than a year after the Doctors' Trial, when the journal of the American Medical Association published a "special article" that endorsed the "ideal" medical practice used in the Stateville malaria experiments, where Ivy claimed his principles had been implemented.23

Although the Doctors' Trial culminated in the establishment of the Nuremberg Code-whose first principle emphasized that the human subject "should have legal capacity to give consent ... exercise free power of choice, without the element of force ... constraint or coercion"-the American medical Community either claimed ignorance of the document or ignored it.24 The first principle of the code seemed to preclude the use of prisoners, but Ivy, America's star witness on medical ethics, extolled the virtues of just such scientific practices. The muddy ethical waters that resulted from the dual codes allowed American medical researchers to follow their own moral guidelines or utilitarian interests.

The result was tremendous expansion in prison experimentation in postwar America. Federal prisoners, for example, were enlisted in a broad range of clinical studies that included athlete's foot, histoplasmosis, infectious hepatitis, syphilis, and amoebic dysentery, and in additional malaria experiments.25 State prisoners were considered to be equally valuable and were soon utilized for studies of syphilis, malaria, influenza, viral hepatitis, and flash burns "which might result from atomic bomb attacks.26,30 Some of these postwar medical initiatives were scientifically unsound and placed prisoners at great risk. Louis Boy, for example, a prisoner in Sing Sing (New York), volunteered to become a human blood cleaning agent for a young "girl dying of cancer."31 For 24 hours the prisoner
and the 8 year old girl were laid side by side, "their circulatory systems linked together with rubber tubing," in the hope that her cancerous "poisoned blood" would be cleansed as it proceeded through his body. Unfortunately, the risky experiment proved unsuccessful and the girl died. However, public interest in the human drama resulted in the prisoner, a lifer, receiving a Christmas gift from the governor-his freedom.32

In the 1950s, American prisons hosted an increasing variety of non-therapeutic medical experiments, some of which captured national headlines because of the perceived dangers of the tests. The Ohio state prison system, for example, allowed researchers from the Sloan-Kettering Institute for Cancer Research to inject over 100 inmates with live cancer cells. The study was designed to examine "the natural killing off process of the human body"; inmates were informed they faced "no grave danger. Any cancer that took would spread slowly ... and could be removed surgically."33 One physician intimate with the study four decades ago recently said that prisoners were a "stable group of people" that contributed to the "assurance of continuity." Researchers, he argued, clearly found it " more difficult to work with unrestrained, unrestricted" test subjects (C. Southam, personal communication).

Prison experiments during the 1960s

By the 1960s, new drug testing regulations mandated by the Food and Drug Administration permitted increased human experimentation as large pharmaceutical companies sought stronger relationships with
penal institutions. Phase I drug testing now required larger pools of healthy subjects for non-therapeutic
experiments, and using hospital patients was thought to be inadequate. Prisoners, on the other hand, were in abundance and, as one pharmaceutical company researcher commented, "guaranteed to show up" (G. Wachs, personal communication).

The rush to acquire prison testing sites, combined with a relaxed ethical atmosphere and little governmental oversight, provided a financial opportunity for some opportunistic physicians, while at the same time jeopardising the health of the unsophisticated test subjects. One of the best examples of this unfortunate but all too common scenario was the controversial career of Dr. Austin Stough. Claimed to have grossed close to $1 million a year, Stough-and the pharmaceutical companies he worked for profited handsomely, while the inmates he used were made ill and some even died in an extended series of drug tests and blood plasma projects in Oklahoma, Arkansas, and Alabama.34

Stough's high volume plasmapheresis programme attracted great commercial interest, but his poorly trained staff and shoddy operations resulted in inmate volunteers receiving the wrong blood type and as many as 30 inmates a month contracting viral hepatitis. "They're dropping like flies out here," wrote one alarmed inmate to the outside world.34 Throughout the 1960s the use of prisoners as research subjects remained popular as prisons tested everything from tropical diseases and respiratory infections to infectious hepatitis and "pain tolerance studies.35,39

In rare cases, some prisons became super-markets of investigatory opportunity for zealous physicians representing aggressive private and public sector institutions. In Holmesburg Prison, for instance, a county facility in Philadelphia, an array of studies explored everything from simple detergents and diet drinks to dioxin and chemical warfare agents. The long list of sponsors included major pharmaceutical houses and diverse entities such as RJ Reynolds, Dow Chemical, and the United States Army.40

The end of prison experimentation

By the early 1970s, social and political indifference to human experimentation had begun to shift. Events as disparate as drug scares (thalidomide), hospital embarrassments (the use of 22 senile patients for live cancer cell studies at the Jewish Chronic Disease Hospital in New York City), alarming articles in professional journals (Dr Henry Beecher's analysis of unethical medical studies41), and popular books (Jessica Mitford's Kind and Usual Punishment39) contributed to a growing repugnance towards scientific experiments on unwitting and institutionalized populations. By 1973, with the controversial revelations surrounding the Tuskegee syphilis experiments, lawmakers and the general public had been chastened by the cavalier use of vulnerable populations for non-therapeutic medical studies.

Legislation was beginning to be introduced "to limit the use of prison inmates in medical research"42; prison administrators were voicing "serious doubts about the ability of prisoners to volunteer for any form of medical research"43; and prison research programmes were being terminated, especially the more controversial ones such as the decade-long studies in Oregon and Washington that irradiated the testicles of prison inmates.44

The pendulum that represented the public's acceptance of human experimentation had not only swung, but had swung decisively. Even physicians who had been long time advocates of the practice were forced to concede that scientific investigators and drug companies could continue their work without the use of prisoners.45 Some doctors- Dr. Albert Sabin, for example-resisted the new ethical current and continued to argue that prisoners were "a stable, long time permanent study group" perfect for medical research.46 By 1975, only 12 state prison systems were hosting medical experiments, and their numbers were declining rapidly.47 Less than a year later, the federal government announced the end of medical research on federal prisoners.48

After a quarter century of unrestrained use of prison inmates as cheap and available raw material for medical experimentation, the once widely accepted practice had come to an end. Victims of scientific and social forces, prisoners were still shunned, but they were no longer seen as the human equivalent of laboratory guinea pigs. Though some researchers initially resisted this new medical ethic, it gradually encompassed the entire medical community and terminated any thought of "the wealth of test material that there is in penitentiaries."49 [source: Kaiser PapersDigitization of the British Medical Journal and its forerunners (1840-1996) was completed by the U.S. National Library of Medicine (NLM) in partnership with The Wellcome Trust and the Joint Information SystemsCommittee (JISC) in the UK. This content is also freely available on PubMed Central. Department of Urban Studies, Temple University, Philadelphia, PA 19122-2585, USA; Allen M Hornblum, instructor Correspondence to: 7100 Bustleton Ave, Philadelphia, PA 19149, USA; BMJ 1997;315:1437-41]

Racism and Health Outcomes

Dr. David R. Williams, (Florence Sprague Norman and Laura Smart Norman Professor of Public Health (Harvard School of Public Health and Professor of African and African American Studies at Harvard University), presented "Racism and Health: Findings, Questions and Directions" at UMass Amherst on Mar.5, 2013. Dr. Williams' lecture draws from years of research. He provides an overview of his findings and strategies going forward. The lecture should be viewed in its entirety. Unfortunately, the slides were not filmed during his presentation.

This lecture is co-sponsored by the UMass Center for Research on Families' Tay Gavin Erickson Lecture Series, the 2012-13 Clinical Psychology Diversity Speaker Series (awarded a 2012 APA CEMRRAT Implementation Grants Fund (IGF) for Ethnic Minority Recruitment, Retention and Training in Psychology), the College of Social and Behavioral Sciences, the Psychology Department Research Mentoring Group Speaker Series which is supported by the UMass Amherst Center for Teaching & Faculty Development's Mutual Mentoring Initiative, funded by The Andrew W. Mellon Foundation, the Department of Public Health in the School of Public Health and Health Sciences and the Western MA Public Health Training Center.

Tuesday, August 27, 2013

Jewish Unsung Heroes: Joseph Goldberger and His Gift to the Southland

From Jewish Magazine, "Jewish Unsung Heroes: Joseph Goldberger and His Gift to the Southland, by Ted Roberts, from the August 2001 edition --  I wasn’t surprised the other day to see a list of the hundred greatest Synagogue Garbage Committee Chairmen of the millennium. (I was 59th.)

There are millennium lists of everything. The Rochester Jewish Ledger, in early January, ran a list of one hundred acclaimed Jews picked by the readers of the Jerusalem Report. Among significant notables like Einstein, Salk, and the Baal Shem Tov, there were Danny Kaye, Sid Caesar, Abbie Hoffman, and Marilyn Monroe (remember, she converted when she married Arthur Miller?). Small potatoes among the giants of Judaism, I say. Nowhere on the list was Dr. Joseph Goldberger.

Goldberger seated at a table in a hospital

Who was Joseph Goldberger, do I hear you ask?

Oh, only the medical researcher who cured Pellagra in the South. But his fame was a victim of his victory. Like a wound that heals without a scar - who remembers Pellagra? It is yesterday’s banished assassin - thanks to the good doctor.

So, don’t feel bad that you recognize Sid Caesar, but not Joseph Goldberger. Nobody else, outside of medical historians, has any idea of his gift to undernourished, poor people everywhere - but especially the rural South. He did most of his work in the 20’s - not a great economic decade for maintaining a balanced diet if you were a maid or sharecropper in Mississippi or layed around your room all day and thumbed through want ads because you were unemployed.

Paul DeKruif, the famous historian and popularizer of medical science, tells of Goldberger in his 1926 book - “The Hunger Fighters”. Goldberger was born in Austria, Hungary and came to New York with his family in 1881. After his medical education at Bellevue Hospital Medical College, he joined the Public Health Service - basically a band of "microbe hunters" as they were called. It was an exhilarating era in public health history. Syphilis, Typhoid Fever, and Tuberculosis were under siege. "Identify the bug and kill it" was their modus operandi.

In 1912, the Surgeon General took note of soldier Goldberger who was battling infectious diseases around the U.S. and the Caribbean. He assigned him to Pellagra, the “Scourge of the South”, which flourished like the Boll Weevil in Dixie’s cotton fields.

It was a killer of the poor. Gout was for rich folks, Pellagra fed on poor folks. And it fed well in those years. In 1915 thousands died in Mississippi alone. The good doctor took a long look around the South before he unpacked his laboratory test tubes. Pellagra stalked the land hand-in-hand with poverty.

It’s host was poor folks whose diet had three major elements; cornbread, cornmeal, and corn on the cob. Maybe sweetened up with molasses for Sunday dinner - or an entree of white lard. So, contrary to his "microbe hunter" philosophy, the Jewish researcher decided that there was no bug - no infectious side to this malady. You didn’t catch it by sharing a bologna sandwich with Betty Lou McElhaney. It was a failure of nutrition. He noted that eating cornbread, molasses, and pork fat practically invited the disease into your ill-nourished frame. And, with a keen Talmudic eye he registered that institutionalized orphans fell victim, but the staff who had a separate dining room, was as healthy as a show hog at the County Fair.

In 1915, with the permission of the governor of Mississippi, he conducted a landmark experiment at Rankin Prison Farm down in Mississippi. The control group were fed the typical diet of the Southern poor, while the experimental group lapped up meat, fresh vegetables, and milk. As he suspected, the malnourished inmates came down with Pellagra.

Goldberger announced his discovery; the medical community, obsessed with infectious diseases, snickered. He didn't spend much time debating the issue. Instead, he injected himself, his wife, and assistants with Pellagra-tainted blood. In all, he played Russian roulette seven times with self-induced Pellagra. But it never took. He and his staff thrived on a balanced diet.

Finally, Goldberger discovered that a daily yeast tablet - cheap enough for the poorest of the poor - would defeat Pellagra. After his death in 1929, it was found that the missing nutritional element was Niacin; both a prevention and cure. A nice gift to the Southland from a Jewish doctor.

If I made up a Jewish millennium list, after placing my wife around 20th I’d put Dr. Joseph Goldberger somewhere after Einstein, but stratispherically above Abbie Hoffman, Marilyn Monroe, and that crowd. (source: Jewish Magazine)

Goldberger and the "Pellagra Germ"

Joseph Goldberger's theory on pellagra contradicted commonly-held medical opinions. The work of Italian investigators as well as Goldberger's own observations in mental hospitals, orphanages, and cotton mill towns, convinced him that germs did not cause the disease. In such institutions, inmates contracted the disease, but staff never did. Goldberger knew from his years of experience working on infectious diseases that germs did not distinguish between inmates and employees. Lombroso had speculated that spoiled maize caused pellagra. 

Goldberger found no evidence for that hypothesis, but diet certainly seemed the crucial factor. Shipments of food which Goldberger had requested from Washington were provided to children in two Mississippi orphanages and to inmates at the Georgia State Asylum. Results were dramatic; those fed a diet of fresh meat, milk and vegetables instead of a com-based diet recovered from pellagra. Those without the disease who ate the new diet did not contract pellagra. []

Experimenting on Mississippi Prisoners

Critics, many unable to part from the germ theory of pellagra, raised doubts. Goldberger hoped to squelch those reservations by demonstrating the existence of a particular substance that when removed from the diet of healthy individuals resulted in pellagra. With the cooperation of Mississippi's progressive governor, Earl Brewer, Goldberger experimented on eleven healthy volunteer prisoners at the Rankin State Prison Farm in 1915. Offered pardons in return for their participation, the volunteers ate a corn-based diet. Six of the eleven showed pellagra rashes after five months. 

Expert dermatologists made the actual diagnosis of pellagra to avoid the appearance of a conflict of interest on Goldberger's part. Although many scientific colleagues sang Goldberger's praises, even mentioning a Nobel nomination, others still doubted. In the pages of the Journal of the American Medical Association, critic W.J. MacNeal challenged the results. One Birmingham physician referred to the experiment as "half-baked." Still others thought the whole experiment a fraud. []

Goldberger's Filth Parties

Angry and frustrated, Goldberger would not give up trying to persuade his critics that pellagra was a dietary disorder, not an infectious disease. He hoped that one final dramatic experiment would convince his critics. On April 26, 1916 he injected five cubic centimeters of a pellagrin's blood into the arm of his assistant, Dr. George Wheeler. Wheeler shot six centimeters of such blood into Goldberger. Then they swabbed out the secretions of a pellagrin's nose and throat and rubbed them into their own noses and throats. They swallowed capsules containing scabs of pellagrins' rashes. Others joined what Goldberger called his "filth parties," including Mary Goldberger. None of the volunteers got pellagra. Despite Goldberger's heroic efforts, a few physicians remained staunch opponents of the dietary theory of pellagra.  []

Mississippi Prisoners and Pellagra

From the Journal of the Royal Society of Medicine, "Pellagra and the blues song ‘Cornbread, meat and black molasses,'" by John Middleton, on 1 November 2008  --  In his book Blues fell this morning,1 Paul Oliver, the celebrated historian and biographer of the blues, describes a conversation with Sonny Terry, the blind virtuoso blues harmonica player. Cornbread, meat and black molasses was a ‘field holler’ – a song sung by prison farm inmates on hard labour field detail.

‘Boy, I'm gonna tell ya about this song – now this is a chain gang song. And now the boys on the chain gang, don't eat, they don't feed on nothin' but cornbread, meat and molasses.’

Prisoners, black and white, across the Deep South of the USA were aware of Joseph Goldberger's experiments,2,3 which were designed to find the cause of pellagra4 by assessing and modifying the diets of prisoners at Rankin Prison Farm, Mississippi. The archives of the State of Mississippi hold evidence of the extensive public controversy, involving outraged victims of the crimes of these inmates, the general public and Governor Brewer, who had sanctioned Goldberger's experiment and the offer of pardon to the volunteers.

In the early 1900s, pellagra affected an estimated 50,000 people in the southern USA and killed 7000 poor blacks and whites. Goldberger believed that pellagra was caused by a dietary deficiency, not by an infection, as was widely believed. He was so strong in this belief that he had tested the hypothesis on himself, his wife and other members of the American public health service. To test the assumed infectiousness of pellagra, they had variously inoculated themselves with skin squames and nasal secretions and eaten faeces from pellagrins.

Goldberger's experiments feeding volunteer prisoners cornbread, fat meat and black molasses induced pellagra, which was alleviated by variations including peas, beans, cabbage greens and wheat bread. By 1926, Goldberger proposed yeast extract supplements to combat the disease and arranged distribution through the Red Cross Stores that were supplying food handouts, canned grapefruit juice (vitamin C – in Champion Jack Dupree's Warehouseman Blues), clothes and blankets.

This dietary support did reduce the frequency of pellagra. However, poor blacks felt stigmatized by handouts and the Red Cross Stores themselves carried a bitter reputation. Oliver describes how, after the great floods of 1927, ‘Negroes who entered the Red Cross food stations were seized and put into forced labour… Negro refugees under armed guards did the entire work on the Vicksburg levees and the treatment of the suffering homeless people was less than human.’ Many did not return from this latter-day slavery. Many collapsed exhausted, to be buried in the earth mounds of the great river – hence, in Red Cross Store Blues, Alabama Sam sings:
‘She talked last night talked for an hour, Go get a sack of that Red Cross flour. / I told her nooh, I don't wanna go. I said, I cannot go down to the Red Cross Store / But you know the government takin' a change, say they gonna treat everybody right. They gonna give them two cans of beans and one little can of tripe / I told her no…’

Leadbelly and Mississippi Fred McDowell have also sung the song; the words vary, with some versions alluding to another blight on the Red Cross Stores: their association with military recruitment stations for the World Wars.

Goldberger's courageous research was eventually rewarded when mass supplementation of cornbread flour with yeast extract eradicated pellagra. The pellagra preventing agent was niacin. Although the niacin molecule had been isolated by Weidel in 1873, its role in preventing pellagra was not identified until 1937, by Conrad Elvehjem.  (source: Journal of the Royal Society of Medicine, 2008 November 1; 101(11): 569–570. doi: 10.1258/jrsm.2008.08k007 PMCID: PMC2586849)

DRAPETOMANIA: "Diseases and Peculiarities of the Negro Race"

Slave-owner shooting a fugitive slave

It is unknown to our medical authorities, although its diagnostic symptom, the absconding from service, is well known to our planters and overseers...

In noticing a disease not heretofore classed among the long list of maladies that man is subject to, it was necessary to have a new term to express it. The cause in the most of cases, that induces the negro to run away from service, is as much a disease of the mind as any other species of mental alienation, and much more curable, as a general rule. With the advantages of proper medical advice, strictly followed, this troublesome practice that many negroes have of running away, can be almost entirely prevented, although the slaves be located on the borders of a free state, within a stone's throw of the abolitionists.

If the white man attempts to oppose the Deity's will, by trying to make the negro anything else than "the submissive knee-bender," (which the Almighty declared he should be,) by trying to raise him to a level with himself, or by putting himself on an equality with the negro; or if he abuses the power which God has given him over his fellow-man, by being cruel to him, or punishing him in anger, or by neglecting to protect him from the wanton abuses of his fellow-servants and all others, or by denying him the usual comforts and necessaries of life, the negro will run away; but if he keeps him in the position that we learn from the Scriptures he was intended to occupy, that is, the position of submission; and if his master or overseer be kind and gracious in his hearing towards him, without condescension, and at the sane time ministers to his physical wants, and protects him from abuses, the negro is spell-bound, and cannot run away.

According to my experience, the "genu flexit"--the awe and reverence, must be exacted from them, or they will despise their masters, become rude and ungovernable, and run away. On Mason and Dixon's line, two classes of persons were apt to lose their negroes: those who made themselves too familiar with them, treating them as equals, and making little or no distinction in regard to color; and, on the other hand, those who treated them cruelly, denied them the common necessaries of life, neglected to protect them against the abuses of others, or frightened them by a blustering manner of approach, when about to punish them for misdemeanors. Before the negroes run away, unless they are frightened or panic-struck, they become sulky and dissatisfied. The cause of this sulkiness and dissatisfaction should be inquired into and removed, or they are apt to run away or fall into the negro consumption. When sulky and dissatisfied without cause, the experience of those on the line and elsewhere, was decidedly in favor of whipping them out of it, as a preventive measure against absconding, or other bad conduct. It was called whipping the devil out of them.

If treated kindly, well fed and clothed, with fuel enough to keep a small fire burning all night--separated into families, each family having its own house--not permitted to run about at night to visit their neighbors, to receive visits or use intoxicating liquors, and not overworked or exposed too much to the weather, they are very easily governed--more so than any other people in the world. When all this is done, if any one of more of them, at any time, are inclined to raise their heads to a level with their master or overseer, humanity and their own good require that they should be punished until they fall into that submissive state which it was intended for them to occupy in all after-time, when their progenitor received the name of Canaan or "submissive knee-bender." They have only to be kept in that state and treated like children, with care, kindness, attention and humanity, to prevent and cure them from running away.  [from: "Diseases and Peculiarities of the Negro Race," by Dr. Cartwright (in DeBow's Review)]

Monday, August 26, 2013

American Medical Association Discrimination

From Pro Publica, "Exploring the AMA’s History of Discrimination," by Jonathan Sidhu, on 16 July 2008  --  Last Thursday, the American Medical Association apologized for its history of discrimination against African-American physicians. The apology comes on the heels of a JAMA paper published ($) by a panel of independent experts, which among other things detailed how the AMA worked to close down African-American medical schools. We spoke with one of the paper’s authors, Harriet A. Washington, who last year also won the National Book Critics Circle Award for “Medical Apartheid,” a history of medical experimentation on black Americans.

What did the AMA apologize for?

The AMA apologized to black physicians specifically for a history of systematic exclusion of black physicians from the AMA and its constituent societies. In order to join the AMA for most of its history, you had to belong to a local medical society. Many of those local medical societies were closed to black physicians, particularly in the South. And this condition persisted right up to the civil rights era. The AMA countenanced this—it refused to interfere or penalize those societies.

The AMA has also apologized for other decisions it made that marginalized black patients and physicians.

Why was the JAMA paper pursued now? And could you tell me about the process of putting together this historical inquiry?

In 2005, John Nelson, then-president of the AMA, visited the National Medical Association [which represents African-American physicians]. He gave a speech, and during that speech, he apologized personally. Now, because the AMA is a democracy, he could not presumed to be speaking for all of the AMA, but of course he was also AMA president.

However, the AMA could not issue an apology without going through certain procedures. And being scientists and physicians who are wedded to the concept of evidence-based medicine, they also would need documentation.

John Nelson wanted this history looked into, and yet he also understood it should not be the AMA that did the historical discovery—that it should be independent experts. And I can say that since 2005, when we began writing the paper, we were given utterly free hand.

What was the actual mandate the AMA gave you in pursuing this paper?

That’s probably most indicative of their hands-off stance: they didn’t give us a mandate. They asked us to look into the history of black physicians and the American Medical Association. And it was we who decided how to form the paper, and it was we who decided that we wanted to submit it for publication.

Could you summarize the key findings of the paper?

Overall, the really important finding is that we took several signal events that not only dramatically illustrated the sort of bias and the sort of discrimination practice, but some of them had pretty clearly traceable long-term effects.

  • The AMA was founded in 1847. Shortly after the Civil War, black physicians tried to join it. They attended the annual meeting and tried to get seated as delegates and were rebuffed. And the reason given by the AMA, after the fact was, “We did not seat you because you come from groups and schools that admit women and that admit irregular practitioners.”

But there were also representatives from other groups that included these kinds of irregular practitioners in their fold. They only castigated the black physicians.
And after refusing them admission, they went on to pass an addendum to their code of ethics indicating that they don’t practice racial discrimination, and that their only basis for excluding people was scientific accuracy and practice codes.
So, not only did they discriminate against the black physicians, but then they exonerated themselves for having done so.
  • Then you look a bit farther in the future, and you find that in 1910, the American Medical Association commissioned a report of all medical schools. They were very interested in lowering the number of physicians. They wanted to raise the professional stature of physicians, and they wanted to do that by exclusion. They commissioned Abraham Flexner to go to every medical school in the U.S. and Canada and make an assessment—basically which medical schools should and should not be encouraged to continue. When Flexner did this, he deemed every black medical school substandard and recommended they all be closed, except for two, Howard and Meharry.

And he also went beyond that to stipulate that black physicians should only treat black patients, that black physicians should have their roles curtailed. And he warned that an essentially untrained Negro bearing an MD label is dangerous. So he looked on all black physicians with a jaundiced eye.
His recommendations were prophetic. All the black schools except for Howard and Meharry closed—they could not attract funding any longer because of the damning indictment of them. And black physicians were indeed kept from specialties like surgery. They were kept from research.
This report was singlehandedly responsible for not only drastically lowering the number of black MDs but also for deranging the image of black MDs in the eyes of not only the white population in the U.S. but also the black population of the U.S.
  • Finally, during the civil rights era, things came to a head. We were seeing open warfare between black and white physicians. Black physicians picketed AMA meetings. Black physicians pushed legislation that AMA doctors were visiting Congress trying to get annulled. Black physicians wanted Medicare and Medicaid passed. But white physicians and the AMA, in particular, were damning it as “socialized medicine.”

Black doctors who attended an AMA meeting in Atlanta were arrested by the police because the AMA luncheon was being held in a segregated cafeteria. When the AMA was asked for comment, they did not defend them. The AMA simply stressed the importance of adhering to the laws of the land. And of course segregation was the law of the land.

What sorts of responsibilities does the AMA have to correct the injustices it has committed?

The first important thing the organization has had to do it’s already done: and that is an apology. The apology is very important partly for cathartic reasons. It’s really important if you’re going to gain the trust of black physicians and black patients, to openly admit that you are divorcing yourself from the policies of the past. And that’s been done.

A few other things have also been done. There’s a commission to end health care disparities. It’s a multi-pronged attempt. They are pursuing research, legislation and changes in political practice, trying to end racial health disparities that are haunting the country.

For the future, what’s going to be very important, in my opinion, is for there to be efforts to recruit and retain black physicians not only in medical school but also in specialty practice.

Do you see the AMA serving as a model for other institutions and organizations in grappling with similar histories?

Well, I can certainly hope it will. It seems to me that there has been a trend of organizations making apologies for terrible behavior of the past. Of course, the key is for these apologies to be the prelude to real action. Words are very important sometimes—in this case I think the words are very important—but we will need to see more activity as well.  (source: ProPublica)

Black Surgeon Dr. Christian Head of UCLA's Medical School Wins a $4.5 Million Racial Bias Lawsuit

As reported in the LA Times, "Black surgeon to get $4.5 million in racial bias suit: Dr. Christian Head of UCLA's medical school alleged that the university failed to prevent discrimination and said he was routinely humiliated," by Stephen Ceasar, on 18 July 2013 --  Dr. Christian Head, a surgeon at UCLA's medical school, will receive $4.5 million to settle a racial discrimination lawsuit against the UC Board of Regents, the university system announced Thursday.

The agreement settles the lawsuit, filed in April, that accused the university of failing to prevent discrimination, harassment and retaliation against Head. The head and neck surgeon alleged that he was retaliated against for filing complaints through normal channels and was denied teaching opportunities.

Head, 51, also alleged that he was routinely publicly humiliated and once was depicted as a gorilla being sodomized in a slide show presentation during a resident graduation event.

"The case presented difficult issues of alleged discrimination and retaliation that were strongly contested," the university said in a statement. "…The matter was settled to the mutual satisfaction of the parties."

The regents approved the settlement in a closed-session meeting in San Francisco on Thursday.

During a 2006 event for faculty, staff and graduating medical school residents, a slide show created by the residents — and typically reviewed by staff — included a photo in which Head's face was superimposed on a gorilla that was being sodomized by a department chairman, according to the complaint.

Without admitting fault or liability, the university acknowledged that "an inappropriate slide was shown" and regrets the incident, the statement said.

Dr. Gerald Berke, chairman of the David Geffen School of Medicine's Department of Head and Neck Surgery, and Dr. Marilene Wang were named in the lawsuit and were accused of making "inappropriate racial comments and insinuations about blacks" and Head for years, the court document stated. Both are UCLA physicians and professors.

Neither Berke nor Wang could be reached for comment.

The settlement will be paid through a state general liability fund.

Head, who resigned from his position, could not be reached for comment. His attorneys deferred to the statement released by the university.

Head received his medical degree from Ohio State University in 1993. He joined UCLA's medical school as part of a fellowship in 1994, then worked as an intern in 1996 and began his residency there in 1997. (source: LA Times)

Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination

An Interview with Alondra Nelson by Gina Mitchell | Boston Review

Prevailing narratives of the Black Panther Party have focused almost exclusively on its militant advocacy. In Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination, Alondra Nelson documents a less familiar aspect of the Party’s history: its health care activism. Editorial assistant Gina Mitchell asks Nelson how concern over health care emerged from the Party’s ideals of self-defense, its campaign to combat sickle cell anemia, and the significance of health care for contemporary black politics.

Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination

Gina Mitchell: What sparked your interest in the health activism of the Black Panther Party?

Alondra Nelson: The book began as something of a research detour! I was interested in the hurdles African American communities faced in organizing around the HIV/AIDS epidemic. This prompted me to explore how blacks had collectively responded to health crises and medical issues in the past, specifically in the 1970s—the decade immediately preceding the emergence of HIV/AIDS. And this led me to rudimentary details—passing mention, really—of the Black Panther Party and its health activism. More importantly, this initial research impressed upon me how little work had been done on this aspect of the organization’s activities.

GM: Why hasn’t this topic been examined until now?

AN: The Black Panthers’ health activism has gone mostly unnoticed due to a failure of our collective memory. We tend to remember the Black Panther Party through iconography—the symbol of the black panther borrowed from civil rights activists in Alabama and other idiosyncratic political art; the graphic identity the organization established with its newspaper, The Black Panther; and the many photographs that captured the Panther posture. Compared to this, the Party’s politics of health and race is a more ephemeral legacy. Across the political spectrum, a one-dimensional characterization of the Black Panther Party has persisted: both the demonization and criminalization of the Party by forces on the Right and the valorization of the Party’s “radical chic” and militancy by well-meaning supporters on the Left.

We’ve also had a failure of imagination regarding responses to medical discrimination. The basic narrative emphasizing the mistreatment of minority communities by the medical sector—eugenics programs in North Carolina and elsewhere, the Tuskegee syphilis study, etc.—and these groups’ resultant distrust of medicine is easy to grasp. The counter-narrative that highlights how blacks, the poor, and others actively resisted medical discrimination complicates this story–perhaps it has been easier just to disregard or forget about it. The Party was concerned not only to catalog horrendous and enduring medical discrimination, but also to challenge it. Adding accounts of agency and empowerment through health activism to our conversations about race and health in the U.S. can help in a small way to transform apprehension into engagement.  (source: Boston Review)

Watch Alondra Nelson discuss her new book “Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination”


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