Harriet Washington: Confronting medical apartheid and its industrial complex (ep342)
“African Americans who earn $50k - $60k a year are much more likely to be exposed to environmental toxins than white Americans who earn over $10k per annum—profoundly poor white Americans have less exposure to environmental toxins than do African Americans.”
In this episode, we revisit our past conversation with Harriet Washington, an award-winning medical writer and editor and the author of the best-selling book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. She's also the author of A Terrible Thing to Waste: Environmental Racism and its Assault on the American Mind.
In her work, Harriet focuses mainly on bioethics, the history of medicine, African-American health issues, and the intersection of medicine, ethics, and culture.
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Transcript:
Note: *Our episodes are minimally edited. Please view them as open invitations to dive deeper into each resource and topic explored. This transcript has been edited for clarity.
Harriet Washington: I was interested in bioethics before I even understood that it was a discipline, possibly before it was a discipline because I worked in hospitals for a very long time, both as an undergraduate student and after I graduated. Working in a teaching hospital in upstate New York, I had occasion to see a great deal of health care disparities, a great deal of disparate treatment, not only of patients but also of staff, I knew things were profoundly wrong, but no one was talking about health care disparities in the 1970s and 1980s.
So these were things that I perceived that were transpiring. But there wasn't any interest in people pursuing them or quantifying them or even admitting that they existed. I felt that was profoundly wrong. I also knew I was unequipped to do anything about it. I wasn't a writer yet. I was a pretty medical student, actually, and it just seemed more prudent to keep my head down and make observations, but I was not really sure what I would do with them.
As time went by, I became less interested in the practice of clinical medicine and more interested in the ethics component. But again, I frankly did not have the training to investigate it as I should. So I had a practice of collecting information without knowing what I was doing with it. Eventually, when I stopped working as a medical social worker and as I ran the poison control center at the hospital for a while, I worked in a lot of laboratories as a lowly technician and I moved over into journalism.
That's when I began to see an outlet for this. So I began addressing it to some extent, but not very profoundly until I was a page-one editor at USA Today. They had a Loan-Ed program where editors would come in through other papers around the country. They would come to Washington D.C. to work at USA Today for a while.
While I was there, I learned that Harvard actually had a competition for journalism fellows. They had a program where they would bring three people into the medical center to be the medical-writer-in-residence for a year or so. In my case, I won the fellowship and I spent two years at the Harvard School of Public Health, and that's where I began gathering the information that would allow me to put my concerns and observations in context.
I followed that up with a fellowship at the medical school in medical ethics, and now I felt that I had the requisite philosophical basis, historical sense, and vocabulary to analyze what I had learned. I used all that to write Medical Apartheid. Since then, I've been focused pretty heavily on medical ethics in medicine, although there are other things I'm interested in as well, and I've had a chance to pursue them.
I did a book on infectious causes of mental illness, something I think had been neglected for a very long time but is now gaining some traction as people recognize that not just psychological pressures and stresses, but also infection are some causes of mental illness. They often help trigger mental illness or even come predisposing factors.
So anyway, I've been really fortunate, I think, to take my passion for seeing justice in medicine to a level where I can communicate with other experts and with laypersons about the issues that threaten us most profoundly when it comes to making sure that medicine lives up to its stated ideals. So I feel really fortunate.
Kamea Chayne: One of your most notable books is Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. This was, as you mentioned, the first and only comprehensive history of medical experimentation on African Americans. I'm assuming you wrote this because you couldn't find such a compilation of information focused on this angle out there.
So is this history something you feel that the average person or even the medical community has a lack of awareness of? And to our listeners who may never really have thought about this, what do you think is most significant for them to know and keep in mind?
Harriet Washington: Well, there are several questions here. Let me take your first observation about there being a vacuum of information about this. There is indeed a vacuum, but it's more than not having it addressed. I was rather surprised to find out that this has been, if not a conscious decision, a systematic decision.
In 2001, I went to Munich, Germany, for what was billed as an international conference on the history of medical experimentation. I got there and discovered that there were a lot of Europeans. There were some Americans. There was one Russian that I recall and one person of Asian descent. I believe she was Japanese. That's it. It was not global, as I would define global. It was not international. There was no one there from Africa. There was no one there from the developing world of the Global South.
As we presented our papers and had our discussions, I thought, what a great chance to talk to all these international experts in the history of medicine and talk to them about what I should be sure to include in this book that deals with how American medicine has treated African-Americans. Every person I approached told me there's really nothing there. There's the Tuskegee experiment, but nothing else happened. I said, well, I'm finding quite a bit. They said, “Oh, those are all conspiracy theories.”
Well, I knew they were not because I garner almost all my information from sources that are respected by medical scholarship in the pages of medical journals, in doctors memoirs themselves, and government records. So all these things happened, but none of these experts were willing to admit that they had happened. Certainly none of them had written about them.
I realized that for whatever reason, the decision to exclude this part of history of medicine is something that was essentially agreed upon and I found that totally unacceptable.
I did not have much difficulty in finding information. In fact, my big challenge was to turn in a book that, as my editor said, would not have 700 pages and cost $100. So the problem was just culling from all the information I had. So this was unfortunately an example of censorship for whatever reason, and that really disturbed me. But it also fired my determination to make sure the book was completed and published.
Kamea Chayne: So something you've really shown is a fallacy is researchers using the I.Q. test to determine intelligence. This assumption that I.Q. equals intelligence is so pervasive that I think it's important for us to unpack here. What exactly does the I.Q. test actually measure and what environmental factors might affect it, which shows that it's not a test of hereditary intelligence?
Harriet Washington: Exactly. What I.Q. tests measure is achievement, educational achievement, and I.Q. tests will tell you how literate you are. It's telling that the S.A.T. test, although it makes no claim of measuring intelligence, is used as a proxy for I.Q. in many situations, including college admissions. But the S.A.T. test, like the key to I.Q. test, does a good job of telling us how many words you have mastered, how many words you can use correctly, and what's your literacy level.
Also, I.Q. tests do a good job of measuring your ability to manipulate numbers in prescribed ways. So, can you do the kind of mathematical functions we expect someone to master at a certain age? Now, what's interesting about this is we're talking about learning. We're not talking about innate capacity. Which is what I.Q. tests are often described as measuring, but they don't measure, and there are quite a few pieces of evidence for that.
One is that something called the Flynn Effect. James Flynn wrote a book in which he documented how in our country and in much of the West, I.Q. points have been rising steadily, three points per decade. Over a long time span now, there have been rising I.Q. test scores. Does that mean that we're getting smarter, or does that mean that education has become more commonplace in a society like ours, where education is compulsory?
Does it mean that more people are learning to read and to a certain level and that more people are learning to do basic mathematical functions and analytic reasoning? That's much more likely than supposing that for some reason, human beings in one country have suddenly begun to get smarter and smarter. Also, people often point to I.Q. tests as a proxy for intelligence.
But if you look at the most commonly used book that purports to rank countries by I.Q., what you find is that you have rankings where the U.S. covers just about one hundred, the “normal” I.Q. But you look at the countries in the Global South, in depressed areas, in areas with a great deal of sickness, and you find very low I.Q. in fact, in Africa. The first edition in the book found that there were only two countries in Africa where the average IQ was over 70. Seventy, by most measures, is a cut off from mental retardation.
So what the authors were actually saying is that all of Africa is mentally retarded. Now, that's unlikely, but it's even more unlikely when you look at the populations that they looked at to do these tests and their incredibly sloppy, incredibly poor methodology, often relying on very old tests and often relying on constructs that we wouldn't even recognize. The tests were a little bit too diffuse.
For example, in Ethiopia, which they ascribed an I.Q. of around the high 60s, initially, it might even have been in the 50s, they determined that by looking at around 130 children in one orphanage in Ethiopia. The orphanage was filled with children who had survived war, genocide, the death of their parents, and starvation.
This is not a representative sample for many reasons. First, the kids have been orphaned, they've been starved, they've been traumatized, and not all the children were tested in the language in which they were proficient. These I.Q. tests. ignore the fact that in a lot of societies, being “literate” is not a constituent of intelligence. In our country, we can't imagine calling someone intelligent who can't read and write. But the reality is, in many countries and societies, being able to read and write has almost no bearing on your ability to make a living, care for your family, do all the things that we think intelligence helps us to do in many countries.
In agrarian societies, what makes more sense is looking at how well a person can read the landscape, how well they can determine which plants are helpful and harmful, which helps them survive.
They have very, very different criteria for intelligence. We completely ignore that and we test them on the procrustean bed of our own I.Q. The things that make sense to us that constitute high intelligence for us are the things that we test them on without acknowledging the fact that they may have nothing to do with their life. One researcher said an I.Q. test can tell if you'll be a good office worker. It can't tell you'll be a good farmer.
There are all these reasons why I.Q. tests are frankly nonsensical, the bias is not sufficient a word to describe it. They simply lack context and they lack any kind of linkage to what's really intelligence. We have to acknowledge the fact intelligence varies from area to area. What's intelligence in the U.S. may have nothing to do with what intelligence in Malaysia or what constitutes intelligence in a different part of the world.
This kind of ignorance is really driving a lot of bias against people of different societies. In fact, none of the researchers with whom I spoke was able to give a really cogent definition of intelligence. We can't even define it, and yet we feel perfectly comfortable, some of us, in deciding that some people, as a result of I.Q. tests, show that they are less intelligent than we are than others.
It's really no accident that Europeans from industrialized countries and Asians—from certain countries, not all— Asians tend to top these measures, and that people of color are at the bottom. It's a clear indication that we've got this profound lens through which we are seeing intelligence and we're trying to force everybody onto it.
Kamea Chayne: Right. So it seems like there are a lot of these standardized tests. They're really narrow-minded in what they measure, and perhaps they've been used as a tool to justify and perpetuate this institutionalized racism.
Harriet Washington: That's exactly what they've been used for. I detail in the book and Stephen Jay Gould also details in his book, The Mismeasure of Men, and also a wonderful book by Robert Guthrie, Even The Rat Was White. He was a psychologist who looked at psychology in the U.S. and with deadly accuracy…
He denuded a lot of the rampant racial bias in testing and assessment. Yes, all this was indeed a tool of oppression.
Because from the Victorian era in the 1800s, when you had this new piece of scientists called the American School Technology. One of their tenets was that Africans and African-Americans, they didn't really distinguish the two, were lower in intelligence, profoundly lower in intelligence than whites. Quickly, after a time, scientists began to prove and use it in quotation marks, despite collecting data about African-Americans.
But as Gould masterfully outlines in this book, even though these tests were very detailed, collected enormous amounts of data, they were often nonsensical. For example, George Morton, had a collection of hundreds, if not thousands of skulls of different races. He painstakingly measured the volume of the skulls and decided that the lowest volume skulls were of the least intelligent people. Of course, it was completely unscientific, not only do volume and brain volume have nothing to do with intelligence, [but] he didn't account for the fact that some of the skulls came from smaller people, so their brain volume might have been relatively larger than the others, but he didn't acknowledge that fact. So it's completely absurd.
Yet what I find very interesting is that from the beginning, the scientists who have espoused this hereditary view that intelligence is racial and passed on genetically, they have taken care to use a great deal of data, spidery columns of numbers. I don't know about you, but I think like most people, I see enormous amounts of numbers and manipulation, and I'm immediately intimidated. I think most people have that reaction and that's something that they capitalize on. Think about The Bell Curve. I mean, there is so much data in The Bell Curve, so many graphs, so many illustrations. I'm not sure that most readers of The Bell Curve even understand the graphs or understood their context, but they impress people.
So it's something that we have to be very careful about. One of the things about environmental intelligence is that because of this, we've inherited this body of work from hereditarians. We have all these scientists that are presently hereditarians, not only scientists like Charles Murray, The Bell Curve, but even James Watson, who's revered among geneticists for having been awarded the Nobel Prize for discovering the structure of DNA. These scientists believe in inherited intelligence. They believe that African-Americans are less intelligent than whites, and they always use a belief in a genetic propensity to intelligence. But there's no gene that has been found for that.
I've heard this prediction ever since the 1960s. Every decade, a prominent scientist like Watson will say, ”We're going to find a gene in 10 years,” and it's never been found. It doesn't exist. But what does exist? Profound evidence that environmental exposures profoundly affect what we think of as intelligence. The example I used in the book is assault, the fact that in 1924, there was a “15-point gap” that some pointed to between African-Americans and white Americans and they say, “There you have it, proof-positive that African-Americans are inherently less intelligent than white Americans.”
But in 1924, we had this gap and scientists were worried about it, not because of intelligence. They were worried about it because of goiters. They knew that having an iron deficiency would lead to a goiter, which is an unsightly lump in the throat that usually is not life-threatening, but sometimes requires surgery. It looks terrible. They wanted to eliminate goiters, so they began adding potassium iodide to salt. It was cheap, only cost two dollars to infuse a ton of salt with some iodide. Soon it was common, just like it is today. You find it everywhere.
As they began to use it commonly 20 years later, when they did testing for the army of soldier recruits, they found out that soldiers from the low I.Q. area now had the same average I.Q. as everybody else. That 15-point gap had been closed. They were shocked to see this and only now do we realize that iodine deficiency can cause mental retardation. In fact, it's the largest cause of mental retardation in the world. The people who had had a 15-point lower I.Q. had it because of iodine deficiency and when they began taking the iodine, it was closed. So we closed that 15-point gap in 20 years very cheaply by adding iodine to salt.
That's a powerful piece of evidence. It shows how powerful the environment is when it comes to determining your I.Q. and of course, by extension in many people's minds, to determining your intelligence. I don't think that I.Q. actually denotes intelligence, but it does denote one's educational achievement [and] how well one has learned, which can be an indirect indication of a problem with your intelligence. An I.Q. gap does a good job of showing that something has happened to impede your learning. But it does not actually designate how you are in comparison to other people. It was never designed to do that.
Kamea Chayne: Right. So I guess it shows more of the circumstantial factors and environmental factors and privilege as well compared to who you actually are as a person. You focus a lot on environmental racism that you just touched on, which you said initially you didn't want to talk about environmental issues through the lens of race, but you realized that was absolutely necessary. Can you illuminate for us why indeed this is a racial issue and not simply a socioeconomic or class issue, as many people presume it to be?
Harriet Washington: It's often been assumed to be a socioeconomic issue. We can talk about why later, but that has been the presumption and that has been the context in which not only news reports but some scientific reports have placed it. They have started with the assumption that it’s socioeconomic and then look for socioeconomic cues to it.
But what we have come to learn is that it's not socioeconomic. With better data collection and better analysis, we have learned that if you look at the points where I.Q. and exposures to environmental toxins coalesce, these are racially mandated.
It means, for example, African-Americans who earn $50 to $60 thousand dollars a year—making them suddenly middle class in most parts of the country—they are much more likely to be exposed to environmental toxins than are white Americans who earn over $10 thousand dollars per annum. Profoundly poor, profoundly poor white Americans have less exposure to environmental toxins into African-Americans.
Our country's history of forcing African-Americans into living in certain areas has really been the cause of this. In fact, segregation has not ended. It just ended legally. The law struck down segregation in the 1960s, but that was the jury. Segregation, de facto segregation has not only continued, it has escalated, is actually gotten worse. I spoke with David R. Williams at the Harvard School of Public Health, and he pointed out to me that if we wanted to achieve parity so that Black people and white people lived in the same areas, 66 percent of African-Americans would have to move. So African-Americans have always been trapped in areas where they're exposed to environmental toxins far more dramatically than were white Americans.
The only group for which the situation is even worse is Native Americans, who often are deprived of the very services that run through their lands. I mean, you have many Native Americans living in areas where electrical cables go through or water pumps are active and they don't have access to clean water or electricity.
Basically forcing people to live in these environmental sacrifice zones is something that has happened throughout our country's history and has got to be addressed if we're going to achieve parity and remove the disparate assault.
It's interesting to point out, though, that until Dr. Mona Hatta-Attisha, she's a pediatrician who wrote a paper in 2016. Up until that point, all the newspapers and all the medical reports discussed the poisoning of Flint, Michigan, and areas of Detroit as if they were socioeconomically based and all they all did. She was the first one who confronted it and said, no, look at the data. Exposure is stratified by race.
I think part of the confusion stems from the fact that I'm not saying that socioeconomics is not a risk factor, it certainly is. Poverty is a risk factor for greater environmental exposure, but it's a weak one in comparison to race. Race is such a stronger one that eclipses poverty. So I think people are much in general are more comfortable with acknowledging socioeconomics than they are with acknowledging race.
What does it say about your society if one has to admit that they live in a country where people of color are forced into environmental sacrifice zones?
That's an ugly thing to have to admit about your country. It's much more comfortable to say that, oh, it's because they're poor. You can't be blamed for poverty in the same way that you can be blamed for racism. Poverty can be portrayed as a tragedy, but racism definitely has guilty actors, if not consistently, at least initially. That's why I think people are very uncomfortable with facing this fact.
Kamea Chayne: So a lot of things that Black and brown people and Native people disproportionately face, from air pollution to food deserts, food swamps, chemical toxicity, all of these things really interact with one another synergistically in ways that you say are not yet quantifiable by research. So I guess the question that I have is, isn't so much of this intuitive? Do we really need to wait for decades of real-life experiments causing harm to people in order to know for sure that the component effects are serious and then have enough data and proof of harm to show the government that this is not acceptable?
Harriet Washington: You're absolutely right. Of course we don't. But guess who thinks that we do? Industry. It's the interesting thing about these continued, escalating demands for more and more proof of something that is clearly a hazard. For one thing, that's something that happens in our country and doesn't certainly happen everywhere.
The precautionary principle is that principle that says if you have strong suspicion of harm, if you've got a correlation that points to harm, it makes more sense to address it than to wait for all the data to roll. That kind of data collection takes decades and can be very expensive, and during the time that we have had to amass data to satisfy industry, their toxic exposures really are harming people.
How many I.Q. points have we lost? How much illness and death has ensued? So you're absolutely right. But one of the things that happened to me in the course of writing this book was my definition of an industry scientist has changed.
I used to think of it [an industry scientist] as a scientist who was paid by industry, who made his living working for an industry, whose title reflected the fact that he was an industrial scientist. But now I've come to view an industry scientist as someone working for anyone, a university, on his own, but as long as she is working and being paid by industry, she is working for industry because industry will not continue to pay a scientist for results that put it in a bad light, for results that fail to support its stance and the stance of casting doubt on the seemingly clear hazards posed by these chemicals.
It's not only a scientific stance, it's also a profitable economic stance. To deny the harms as long as they can and as effectively as they can with lots of data is their key to evading responsibility. Scientists who they pay to do research again will only be paid as long as their results are in line with the industrial stance so that they are actually are working for industry and they are using their science to perpetrate industries denial of culpability.
In my classes, I taught about one scientist who talked about the fact that when he was doing research on atrazine and found that it sterilized frogs in extremely low concentrations and found that in turn, farmworkers and people who were exposed to it were also having reproductive problems. Then he says, the first reaction from the people who had hired him was, here are some statistical tools you can use to basically make these effects disappear. He wouldn't do that, and as a result, he now has a very contentious relationship with this industry, but it's the kind of manipulation and the embracing of doubt that is really problematic.
Part of the problem, I think, is that we tend to have a lot of testing of industrial chemicals that people will have proximity to, a lot of testing that either is flawed, doesn't work well, or we simply aren't testing enough. After someone is harmed and their claims of harm, then we'll do better tests, more tests, which are not always better tests. We have to revise the way we do tests. We have to be more like the European Union and demand more tests before people are exposed and also be a lot more discriminating and demanding about the quality of the tests that we perform.
Because sometimes, in fact often, tests are done at thresholds with the assumption that no one is below a certain threshold. That was conceptually made with lead for a very long time.
Now we acknowledge that no exposure is safe.
But I remember in the 80s when I worked with the poison control center, we were only recommending people be seen or treated if they had what looked like enormously high levels now. So we really need to revise the way we do testing, and we need to be much more, much more discriminating when it comes to rejecting the downspouts industry.
Kamea Chayne: Right. I think a lot of the general public may feel like we should get our information as much as possible from research. But at this point, we also have to question how that research was done, how it was set up, and who was funding it as well. So not all research can be 100 percent trusted.
So often when we're talking about things like obesity, diabetes, or even poor performance in school for children, we have a culture that tends to see these as their personal problems. So, “they need better education, they need to study harder, they need better impulse control,” and on and on and on. You call these “blame the victim” messages. Can you expand on this further to show how much of our health is really based on individual choice and accountability versus on the contextualized environmental injustice that maybe shows the often illusion of choice?
Harriet Washington: Personal responsibility and health is really important and we should be espousing that.
The problem is when one focused on personal responsibility in situations where an individual has no responsibility, has no power to change things that are happening: environmental exposure is one of those.
If we talk about someone who lives across the street and has been for decades from a diesel-fuel-spewing bus depot in Harlem and then tell that person that, “oh, well, you're sick, you've got diabetes, you have kidney disease, you need to lose weight.”
This is not an uncommon scenario. Perhaps the person does need to lose weight. That has nothing to do with the fact that fumes have been triggering their kidney disease, have been triggering their asthma, have been exacerbating their hypertension, and that things over which they have no control are ruining their health.
So public health began in this country focusing on confronting industry, confronting government when necessary, about eliminating hazards of public health, and we've moved from that to focusing on personal responsibility. The problem is, one needs both and one needs to pursue them appropriately. It's not appropriate to invoke personal responsibility for people who are trapped in environmental sacrifice zones, that's not appropriate.
We should be confronting industry, and our weakened EPA is not doing that, far from it. The Environmental Protection Agency today seems much more interested in supporting businesses that are crippling and killing people than it is in trying to impose better regulations or making them live up to the regulations that already exist. EPA is actually failing Americans at this point and not doing its job to protect them.
So invoking personal behavior is a slap in the face. There's also a very long history of them doing this successfully, lead being the prime example. The EPA-lead industry association successfully turned the tables and invoked the “bad-housekeeping, dirtiness, ignorance of African—I think they call them “Black and Puerto Rican parents”—back then, saying it was” because they were such bad housekeepers that lead dust was everywhere and their kids were being poisoned.”
Of course, it's ridiculous. That dust was everywhere because industry imported it. They militated for lead to be put into cars. Even though ethanol would have been a nontoxic and equally-effective additive, they wanted to use lead. They militated for lead paint being used on children's toys. They militated for the government to use lead to line pipes that carry water, even though we think the ancient Romans even glimpsed toward the end that this was a toxic material they were having in their water.
So we've known that for a long time, and yet the government did not stop them. Industry was able to triumph and they're still now today industries are successfully demonizing African-Americans who complain about being poisoned. So we really need to dramatically revise the way that we handle this.
Kamea Chayne: So on the podcast, we've previously talked about the military-industrial complex, which profits off of perpetuating violence and wars overseas. We've also talked about the prison industrial complex, which profits off of dehumanization and mass incarceration and often criminalizes poverty and people's reactions to desperation and struggle for both of these systems.
While not justified at all, violence, exploitation, and punishment seem to be embedded into their reasons of existence. But when we're talking about our healthcare industry, something that should exist to support people's health and be of service to our public wellbeing, a lot of people don't know that we also have a medical-industrial complex.
As you outline in your book, Deadly Monopolies, “the profit motive has encroached in colonizing human life and compromising medical ethics.” What exactly does this medical-industrial complex consist of, and in what ways do you think they've been overstepping and finding ways to capitalistically extract value and profit?
Harriet Washington: How long do you have? Many, many ways. I'll just say that in Deadly Monopolies, I talked about the fact that in the 1980s, a series of laws catalyzed a very cozy relationship between American corporations and universities, as well as between universities and the military.
Essentially, for the first time in a long time, it became legal for universities to take a patent, to take a discovery, a drug, a molecule, or medically important drug that had been invented or refined by an academic and then assign it to a corporation for profit, to sell the patent to a corporation to license a drug or a molecule to the corporation, so they became very cozy.
Now, universities began making a lot of money selling the discoveries to corporations and corporations began making a lot more money by selling them to the American public. It's very interesting because when corporations began doing this, it was promulgated as a way to encourage industry to make better use of the patents and then make more drugs available. The problem is that now the corporations own these licenses and own these patents. They began charging and the ability to make money from patents began eclipsing the motivation of universities to find drugs that people really needed.
So now, instead of looking for drugs that are desperately needed, like new and better antibiotics, new and better antidepressants, new and better drugs against malaria…
Now corporations are focused on making the most money with the least effort: copycat drugs, drugs for very common, trivial conditions.
Like gastric distress and erectile dysfunction. Why do we have 20 erectile dysfunction drugs and nothing new and efficient for malaria? It's because which one makes more money? The people who suffer from malaria don't have the money that Americans have to pay. In the case of cancer drugs, almost a million dollars a year for treatment of cancer, I mean, some Americans can do that. Nobody in Africa can do that, with few exceptions. Nobody in Brazil or Thailand can do that. So, unfortunately, we've ceded that role of the university as a public health supporter to corporations who are mostly interested in making money. That's why drugs cost so much. That's why people in the developing world can't get the drugs.
But more to the point, that's why drugs for needed conditions are either not being developed at all or only being developed in situations where they can charge a lot of money. So this is a very ugly situation that we’ve found ourselves in now. What makes it worse is the patents we give to drugmakers are different from patents in the European Union and elsewhere.
Many countries have patents that are tailored to the use of the drug. The patent might be given five years of exclusivity or the patent might be given for a short period of time as a test to see if it helps distribute the drug. But in our country, we give 14 years minimum, which most companies can expand to at least 20 years by various manipulations. So a company will have a drug that they will patent, they will profit from exclusively for 20 years.
Then they'll tweak an electron or modify it slightly into a totally different drug that they will also patent. So this has not been good for innovation, it discourages innovation. We're at the point now where we're actually having fewer new drugs instead of more new drugs than we were before the laws were passed. So it's an ugly situation. It was then to say industry's desire for money, but it's effectively taken control of the development of new drugs from the university. And by the way, as a grace note, we're paying for these very expensive drugs twice. We pay for them when we pay our taxes that go to support university innovation, and then we pay for them again when they come onto the market in a very overpriced form.
Kamea Chayne: So the military-industrial complex, the prison-industrial complex, the medical-industrial complex, there's also the media-industrial complex, which we've yet to dive into on the show, but we'll do that in a future episode. I'm wondering if you think there's a way in which these industrial complexes are connected at certain levels and feed into upholding one another today.
Harriet Washington: They're all connected.
They're connected by greed.
I actually teach a course in journalism bioethics at Columbia. One of the really disappointing things we have seen with the news media is that around the time of the first Gulf War, I was really disappointed. I was working in the newsroom then. I was disappointed to see how quickly news organizations, including my own, went from being highly critical and skeptical, making analysis of government behavior and policies to falling into line, becoming “embedded reporters.”
What does that mean? That means you see what the military wants you to see. You go where the military wants you to go. So I would think to myself more than once this into a newspaper, or are we basically a mouthpiece for the military? So that's a problem. Same problem with industry. What's interesting is when it comes to the media, I think that very often, it's less economic and financial bias that allows an industry to basically distort its role in the pages of newspapers and magazines and digital media. I think it often has more to do with the curation of information.
Journalists, not all, of course, they vary widely from publication to publication, but we have to remember, most newspapers are not The New York Times or The Wall Street Journal, Washington Post, most papers in a mid to small-city, sometimes do not have people on staff who are equipped to do their own independent analyzes and often will fall into accepting what they've been told simply because they can't analyze it differently.
So the scientific analysis that they're given, they will accept and not always stop or be able to question whether they're hearing from a disinterested scientist. Are they hearing from an industrial employee or someone in the pay of industry? So. It's very insidious, like a creature with many tentacles, but the effect is always the same, we end up with a view of reality that's been carefully curated through attention to profits and attention to presenting a certain image of industry and science that may not always be accurate.
Kamea Chayne: Well, as you've said before, threats to people of color and their cognition actually harm everybody in society. So for racial justice, for environmental justice, for the betterment of our world, what do you see as our pathways going forward in addressing these disparities? And what are some of your calls to action for our listeners?
Harriet Washington: I think it's really important to realize that what you just said is very true. But it's the way that it's true, I think people always understand it's more than a noble sentiment, it's also a reality of how we are all in this together because many health effects from pathogens to environmental exposures have a way of affecting us all. African-Americans, Native Americans, Hispanic Americans are canaries in the coal mine.
What's happening to us today? What's happened to us yesterday will happen to you tomorrow.
There's something called the Robin Hood Index. Ichiro Kawachi and Deborah Prothrow-Stith at the Harvard School of Public Health used this index to look at health. What they found was that countries that had wide disparities dramatically harmed people of color. Of course, they also harmed the middle class.
So these rich people are able to buy their way out of a lot of difficulties. The middle class cannot. So what happens is that we have these profound harms that today are ravaging the bodies and minds of African-Americans and Native Americans, but tomorrow [might] ravage the minds of a large group of Americans. So it is not only an ethical, noble sentiment, but it's also a physical reality that this horrible devastation is going to affect almost all of us eventually.
I think that's really important to realize. But I also think that in terms of what people can do, one of the things I found really powerful is if you go way back to around the 1980s and after in North Carolina, there's this mostly African-American, middle-class city, that had found itself the recipient of a crime. The government and the EPA decided to dump PCB poison oil into that community and they thought they did it because we're Black. We're the only largely-Black community in the area.
They began protesting PCBs and the sheriffs came out and got on their bullhorns being talked about law and order and began arresting them. But guess who else came out? Whites from the surrounding areas, many of them. As a result, in my opinion, it's because of the whites who came out that the news coverage went on for six weeks. For six weeks, you saw daily newscasts of these people being brutalized by the police. I'm convinced that the help of our white allies needs to continue being public and sustained. I think that really helped us get through the civil rights movement successfully, and it's going to help us now.
*** CLOSING ***
Kamea Chayne: What's an impactful publication you follow or a book that's been really profound for you?
Harriet Washington: Philippe Grandjean, who I should have mentioned before, is a scientist and expert in toxicology. He wrote a book called Only One Chance. He talks in great detail about the environmental assault of industrial chemicals on the cognition of Americans. He's not talking only about Americans of color. He's talking about Americans in general. It's not only packed with information, but it's a profoundly poetic book. I strongly recommend them, and I follow the accounts of Mustafa Ali and Kim Tomber, I always learn something deeply illuminating in terms of not only environmental problems, people of color, but of other challenges as well, so follow them.
Kamea Chayne: And we've had the honor of having Dr. Ali in a past episode. So I highly recommend our listener go back to check that out. What do you tell yourself to stay motivated and inspired?
Harriet Washington: Well, sometimes the world looks quite bleak, like it does today, right? You ask yourself what isn't, from a pandemic to racial violence in the street, almost open warfare, environmental devastation. But I always remember that God works through serendipity. He works through other people. The cliche that your mom told you—it's a cliche because it's true—it often is darkest before dawn.
I think what really always gives me hope is the fact that when there are these horrible challenges, how we face them is what's key. You know, we always ask God to help us, as we should, but I believe God helps those who help themselves. So when we face them the way we are now, I'm very happy with the way a lot of people are facing these challenges today.
Yes, a lot of people are doing foolish things, but we have a lot of people also who are in solidarity, people who are deeply concerned about the lives of people, African-Americans being challenged on every front and are translating their concern into being, publicly protesting and making their voices heard, putting their bodies on the line. I think it's those things that predicate success. Things can look really, really bad. But if you see people reacting in solidarity in the right way, that gives me hope and that's what I'm seeing today.
Kamea Chayne: What are you working on right now to improve your health?
Harriet Washington: To stop sitting at a computer. It's become a real challenge for me. It's hard to remember that I was once a person who used to run regularly and do other things. But I really love my work. I really love writing. But like a lot of people, I am definitely like a lot of Americans, I fall into this really bad, sedentary lifestyle. It's a constant is a challenge for me.
Kamea Chayne: What are you working on right now to elevate your positive impact for our planet?
Harriet Washington: Right now, I'm writing a book about consent in medicine. It's something that I know not enough attention is being turned toward. I have a fear that consent to medical research, to medical practices is something that's slowly being taken away from us. I have this fear that we're going to wake up one day and find that we don't have it any longer and that people are not aware of. It's being taken from us with no transparency laws and rules that are being changed quietly without notifying the public. I finally decided to stop worrying about it. I'm writing a book about it in hopes that people will see this danger and do something about it.
Kamea Chayne: Well, we're really looking forward to that. And finally, what makes you most hopeful for our world at the moment, if anything?
Harriet Washington: Other people, it's easy to focus on what's going on. We can't avoid it, but I'm very heartened by and frankly also surprised I'm very heartened by, the fact that now when we have a Black man murdered in broad daylight, completely horrible situation, but the response is not the response I've grown inured to over the decades, which is, “Oh, he must be doing something wrong. Oh, isn't that terrible? Turn the page. “
You know, the response is people who are just refusing to accept any longer. I find that really hard. That's going to make change. The fact that people are motivated to erase injustice and cruelty that doesn't affect them directly. I find that a very incredibly refreshing view into the human spirit and incredibly heartening view when it comes to seeing justice done.
Kamea Chayne: Harriet, it's been an incredible honor to have you here on the podcast. Thank you so much for sharing your story and expertise with us. And we look forward to continuing to follow your work and learning from you. What final words of wisdom do you have for us as green dreamers?
Harriet Washington: The wisdom, I don't know. But wisdom, doubt assuming there was anything there to begin with. But yes, I would just say it's important not to give up. I think in times like this when things look really bleak, we can't hear that enough. It's really important. If you're convinced that what you're doing is right, it is important not to be dissuaded from it, not to be deflected from it, and most importantly, not to be lulled into settling for something that's insufficient to deal with the problem.
I think, as I age, probably the thing that I'm most grateful for is that I feel like I have not sort of tempered or slowed down in that way, which some people would say is the opposite of wisdom. But I think that there's no point in being alive or trying if you're not sometimes radical and it's important to be radical.
