In this book, the author has compiled and analyzed a vast amount of research to make the case that racist practices toward African-American people from slavery onward, in the name of science and medicine, have created an atmosphere of distrust among African-Americans toward the medical profession. As a result of this distrust, and often fear, this group of people may not be getting proper medical care when necessary.

I won't go into a major discussion here, but I thought the author did a fine job in terms of research and presentation. I'm not a scientist, nor am I conversant enough in the topic to judge her research, but this book really opened my eyes to some less than professional and less than ethical practices. I must say that I'm not surprised -- earlier I read the book "Bad Blood" about the syphillis experiments at Tuskeegee -- but that was probably the extent of my knowledge on the topic. Washington's book makes that study seem like only the tip of the proverbial iceberg. I have to say that sometimes she was a bit repetitive, but not enough to distract from the main points of her work.

I truly hope her work does some good. I'd recommend it to people who are interested in the topic, especially people like myself who have only a limited knowledge, or to people who want to add yet another dimension to their understanding of African-American history.

This is a sweeping account of the long, tragic history of the abuse of African Americans in medical research. The shocking nature of the abuses described in this book, along with the sheer quantity of them, is nearly overwhelming. But Washington does much more than merely shock the reader; she helps us to understand why the black community has been so distrustful of medicine and the health care system -- which tragically worsens the health disparities between blacks and whites -- and argues that restoring that trust must begin with an honest accounting of the wrongs that have been done.

The one major criticism I have of the book is, in describing some of the more recent episodes, its tendency to understate the role of socioeconomic class discrimination in order to continue pressing the issue of race. To be sure, class discrimination has meant that blacks have been overrepresented, there is a meaningful distinction to make between medical abuses motivated by racism and/or racist medical theory, and medical abuses that disproportionately affect blacks by taking advantage of the vulnerability of people in poverty. But this is a relatively small criticism of what is a powerful and important book that should be read by anyone concerned with social justice and ethical research. ( )

This is an overwhelming but highly worthwhile book. I would recommend it to anyone interested in the history of medicine, racism in America, or just good non-fiction. Harriet Washington attempts a very ambitious project and draws on a huge number of medical studies/records and personal narratives of those who participated in them, either as subjects or experimenters, and those who analyzed these studies. Her overall purpose is to explore and expose the role of racism in the history of American medicine and to restore the experiences and voices of black Americans - most of whom were unwilling or unwitting participants - to this history.

The title, which some may find hyperbolic, is an apt description of the history that Washington uncovers, as black and white Americans have truly existed in separate spheres where medical experimentation and medical care was concerned. Although she begins her story in antebellum America, describing medical experimentation on slaves and free blacks, her examination of studies conducted in the last 10 to 20 years demonstrates that, although the situation has certainly improved, the exploitation of disadvantaged blacks for the benefit of scientific "advancement" is far a thing of the past. Despite this history of abuse, Washington ends her book with a plea for more participation by blacks in clinical studies, arguing that - with strict control of such studies and improvements in study design and ethical constraints - these studies offer blacks an invaluable opportunity to improve their health, which has suffered throughout history due to precisely the kind of medical experimentation that she details in her book.

Washington's book is divided into a number of "themes" that emerged throughout the history of medical research on black Americans, most of which are manifested to a greater or lesser extent in different periods, so the chapters do tend to follow a rough historical progression from the plantation to the present. These themes include: (1) the display of black bodies, whether in surgical theaters or circus "freak shows" like the Worlds' Fair; (2) the misappropriation of black bodies by science, including grave robbing in order to procure bodies for medical school dissection instruction & use of individuals as experimental subjects without their consent - informed or otherwise, as in the practice of the "Mississippi appendectomy," the practice of sterilizing black women through hysterectomy or other means during the course of other surgical procedures; (3) the use of the least powerful among American blacks - slaves, sharecroppers, the poor or homeless, soldiers, children, prisoners, and the already-ill; and (4) the use of black experimental subjects to develop & perfect treatments that tended to benefit white and/or wealthy Americans.

The use of American blacks to develop treatments for whites is particularly interesting given the fact that most of the history of experimentation on black Americans has tended to promote and reinforce the belief in an inherent racial difference between blacks and whites; additionally, blacks were not simply different, they were inferior to whites - more prone to disease, less intelligent, hyper-sexual, less evolutionarily advanced. Even traits found primarily among blacks that indicated superior immunity to certain diseases were rephrased as "inferior susceptibility" to those diseases. Despite the belief that blacks and whites were completely different "species," black bodies provided the testing ground for many medical treatments and devices that were later used on whites.

A further theme that runs throughout Washington's book, but is only made explicit in the later chapters focusing on contemporary American studies of urban blacks, is the assumption that all pathologies found in American blacks, whether physical, psychological, or social in nature, were the result of genetics. Social explanations - poverty, lack of opportunity, violent environments, etc - that might contribute to criminal behavior amongst urban black youth were dismissed in favor of claims that they were inherently condemned by faulty brain chemistry, leading to attempts to predict criminal behavior among younger siblings of boys already in the juvenile justice system by measuring the younger boys' levels of neurotransmitters thought to be linked to aggression. Lobotomies were practiced and promoted in the 1960s as a cure-all for urban riots, in total dismissal of the reality that discontent among urban blacks in the 1960s might reflect genuinely oppressive social conditions, rather than mental illness or some other deviancy that needed to be stamped out.

Despite this history of abuses, many of which occurred as recently as the 1990s, Washington does feel that - with strict controls & improved ethics - it is vitally important for American blacks to participate in clinical trials and to not fear the American medical system, because this fear causes communities to avoid truly beneficial therapies. She feels that, by clearing the air and addressing the issue of exploitation of black Americans by the scientific and medical communities throughout history, she paves the way for this participation. I don't know if I agree with that, however, because after reading this book, even I - an educated, upper-middle class white woman - felt highly paranoid about the safety of a lot of drugs and supposedly "safe" medical interventions. Still, a great book - very highly recommended, even though it is quite emotionally draining. ( )

If your faith in humanity is already at an all-time low, don’t expect this book to be in any way uplifting or to provide any hope for the future. It is, however, very worth reading, bringing to light the many, many medical transgressions suffered by African Americans in the US, from the medical torture of slaves who could not object, all the way up to pharmaceutical company experiments in the 20th century whose objectives, procedures and side-effects were not disclosed to (and, in fact, were purposely kept from) their subjects.

While the subject matter was interesting and, at times, even fascinating, the author seemed to go in circles within the earlier chapters. By midway through the book she finds her stride. ( )

Wow great book! It's been some time since I've read a book that had such an effect on me. I didn't sleep well for a week after reading it.

There are some minor defects; It is weak on some of the science, and in some instances she doesn't make enough distinction between things that were done because of race and things that were more general problems with government-run human experimentation - some (clearly not all) of the discussions could just as easily apply to poor whites in appalachia for instance. However, I realize that is not the purpose of this book. I think that if she had talked more about generalities of human experimentation, the book would have lost focus and become just another bioethics history book. I should also mention that from hearing interviews with her, the author clearly has developed a political agenda which weakens some of her arguments about present day experimentation. (but after reading this book I'll keep a more open mind as to whether she might be correct in her views) Some of the negative comments in an interview about the role of genetics in racial predisposition to disease appeared to be simply uninformed. Also as a libertarian, I don't think she paid enough attention to the fact that for the most part, these were government actions (maybe that's a book for someone else to write)

BUT minor problems aside, this book is so well researched and documented, that I can overlook the minor problems. This is the takehome message - It is one damned important book that everyone who works with human subjects should read. In fact, due to the vast number of subjects to which this book applies - race, ethics, biology, history, etc - I plan to nominate this for the freshman summer reading list. ( )