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Racism In Medicine Casts A Pall Over COVID-19 Vaccinations

SCOTT DETROW, HOST:

A lot of Black Americans are skeptical about taking any of the coronavirus vaccines. It's a sentiment that's been captured by several polls and reflected in interviews for the NPR podcast Code Switch.

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UNIDENTIFIED PERSON #1: I'm hesitant to take the COVID-19 vaccine because of the way the medical industry has treated Black people since the start of this country.

UNIDENTIFIED PERSON #2: My wife has described me as vaccine hesitant. I can't really argue with that, although I tend to think of it as more of an acute lack of enthusiasm.

UNIDENTIFIED PERSON #3: I will absolutely not get the COVID vaccine.

DETROW: One factor often cited for that mistrust - the Tuskegee syphilis experiment, one of the most infamous medical studies in U.S. history. Our colleagues at Code Switch examined the long shadow of Tuskegee and also pushed back on this idea that this is the main cause of this reluctance by many Black people to get the COVID-19 vaccine.

Gene Demby is one of the co-hosts of Code Switch. Gene, thanks for joining us.

GENE DEMBY, BYLINE: Thanks for having me, Scott.

DETROW: So let's start by reminding people what exactly the study was.

DEMBY: Yeah, so the Tuskegee syphilis study - the full name was the Tuskegee Study of Untreated Syphilis in the African American Male. It began in 1932, and it was carried out by the federal agency that would be a precursor to the Centers for Disease Control and Prevention that we have today. And one rationale for the study was that they wanted to see how the disease progressed over time in Black people differently.

We spoke to Reverend Roosevelt Baums, who was raised by his grandfather near Tuskegee. His grandfather was actually one of the men who was unknowingly part of this experiment. And he would have these occasional checkups with doctors working with the government.

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ROOSEVELT BAUMS: He was thinking that he was getting health care. In other words, they told him that if anything happened - oh, he told them that they had bad blood.

DEMBY: So these doctors would give the men that they were poking and prodding, you know, placebos and occasionally some, you know, mild medications like aspirin. But they avoided any treatment that would slow the disease. And remember - you know, this is the rural South in the Jim Crow period, so this was often the only medical care that these men were getting.

DETROW: I mean, there's a lot of enraging details about this study.

DEMBY: Yes, absolutely.

DETROW: But one of them - I mean, syphilis had been around a long time. Its symptoms..

DEMBY: A very long time.

DETROW: Yeah, not much was there to be learned about this. And we knew at that point that it was serious. If untreated, it can cause blindness, deafness, dementia and eventually even death.

DEMBY: Yeah. I mean, about a decade into the study, penicillin had pretty much emerged as the most common therapy for this disease. So there was treatment out there for them. So many of these men, they were going to pass it on to their wives or their partners. And because syphilis can be congenital, they would pass it on to their children, too. So when the study was finally exposed in 1972, it became a national scandal. Reverend Baums told us that when it all blew up, that was when he found out about the study for the first time. And his family only found out that his grandfather was one of the people involved as a subject a little bit later, when the government gave his grandfather a settlement.

DETROW: I couldn't imagine learning about that as an adult for one of my family members.

DEMBY: Yeah. Yeah, this is a horrible, horrible story all the way around.

DETROW: So you're talking to Reverend Baums in the context of mistrust over the COVID vaccine. I was listening to this episode, and I'm waiting for him to say, and there's no way I'm taking this vaccine.

DEMBY: (Laughter) Right, right, right. But that's, you know, not what he told us at all. He said he was absolutely getting the shot.

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BAUMS: I'd rather have the shot than wait and see whether I'm going to fall dead.

DETROW: Yeah, and then you kept exploring this and did some reporting that maybe Tuskegee is an overblown reason for this hesitancy among Black people.

DEMBY: Yeah, this was a little surprising to us. But I guess it makes sense. We spoke to Harriet Washington. She studies the history of medical ethics, and she wrote the book "Medical Apartheid." So one of the first things we asked her was, should we talk more about this long shadow of Tuskegee as - you know, as a driver for some of this elevated hesitancy among Black people?

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HARRIET WASHINGTON: No, because it's the wrong question.

DEMBY: You know, the history of medical experimentation on Black people stretches back farther and much wider than Tuskegee. There were all kinds of horrible experiments, you know, where enslaved people were used as subjects. But more importantly, she said that the opinion research out there shows us pretty clearly that Tuskegee is not the driver. She pointed to one study that found...

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WASHINGTON: People who have never heard of Tuskegee are more likely than others to distrust medical research.

DEMBY: Which, you know, kind of makes sense when you think about it.

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WASHINGTON: You know, people may not have known the encyclopedic history noted in my book, but they do know that their own families and the families of their friends and many people they know have, over generations, been abused in the medical research arena.

DETROW: I mean, a year into this pandemic, we have been having this conversation so many times of just how many different ways there are inequalities in how Black people get treated for medical conditions in this country.

DEMBY: And that's one of the things that Harriet Washington sort of underlined, is that we need to look at these inequities and how they affect the way Black people feel about the medical establishment. You know, just as one example, our colleagues, Renee Montagne and the Science Desk, they looked into the ways that Black women, you know, up and down the income scale, are much more likely to die during or after childbirth than are white women. You know, there are still all these huge differences in medical treatment that we get, depending on our race.

And, you know, when you zoom out, we have all these social realities that play a big role in the kind of medical treatment we get because of things like housing segregation and discrimination. Black people are more likely to live, you know, in old housing stock with lead paint, more likely to live near landfills or factories, you know, less likely to live in neighborhoods with trees and clean air. Here's Harriet Washington again.

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WASHINGTON: Look at the data. They tell us that African Americans who make $50- or $60,000 a year, who are, you know, solidly middle class by most standards, they are far more likely to be exposed than are whites who earn only $10,000 a year, which is profoundly poor. Profoundly poor whites are less likely to be exposed to environmental toxins than are African Americans who are middle class. So you can't rely on socioeconomic data to find disease risk.

DETROW: I mean, as you tick through all of these damning stats, it's pretty clear there are a whole lot of reasons why a person of color might be hesitant to go to the doctor, to get engaged in the health care system, to go sign up for a vaccine.

DEMBY: And so, you know, on top of just having less access to health care to begin with, you know, Black people are showing up to the doctor sicker, and when they do show up to the doctor, they're getting worse treatment. Harriet Washington says, you know, we're talking about Black people's distrust as the problem and not the lack of trustworthiness of the health care system.

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WASHINGTON: It's not only lazier, but it's a lot easier to simply invoke Tuskegee. But it's simply not true, and it's not scientifically rigorous.

DEMBY: Harriet says, frankly, we know better at this point, and we should do better.

DETROW: That's NPR's Gene Demby on the long-lasting effects of the Tuskegee syphilis study and broader ongoing inequities in health care. Gene, thank you.

DEMBY: Thank you so much, Scott.

DETROW: And if you want to hear that full report, you can find the Code Switch podcast wherever you get your podcasts.

(SOUNDBITE OF BLANDI MERCI'S "STEPS") Transcript provided by NPR, Copyright NPR.

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