Medical Apartheid:
The Dark History of Medical Experimentation on Black Americans

J. Marion Sims is called the “father of modern gynecology.” He is memorialized in statues across the American South, a bust in Central Park (removed in 2018), and medical school lecture halls. He developed the surgical repair of vesico-vaginal fistula — a devastating childbirth complication — between 1845 and 1849. He developed it by operating on enslaved Black women in a makeshift hospital in his Montgomery, Alabama backyard. He operated on the same women, some as many as thirty times, without anesthesia. His justification, standard for the era, was the prevailing medical belief that Black people had a higher pain tolerance than white people — that they did not experience pain in the same way, or to the same degree.

This belief was not an incidental prejudice. It was a formal medical position, published in medical literature, taught in medical schools, and cited in surgical textbooks. It justified not administering anesthesia to Black patients as both cost-effective and medically appropriate. It also justified using Black bodies as experimental subjects: if they did not suffer as white people did, then the ethical cost of experimentation was lower.

In 1851, Louisiana physician Samuel Cartwright published a paper in the New Orleans Medical and Surgical Journal describing two mental illnesses unique to Black people: Drapetomania — a disease causing enslaved people to flee captivity — and Dysaesthesia Aethiopica, which he described as a “hebetude of mind” causing enslaved people to be disobedient, destroy property, and refuse to work. The prescribed treatment for Drapetomania was whipping. The medical establishment had invented psychiatric diagnoses to pathologize the desire for freedom.

Medical schools in the antebellum South relied heavily on the bodies of enslaved people for anatomical instruction. Grave-robbing from Black cemeteries was widespread and largely unprosecuted. Bodies of enslaved people who died were used for dissection without any consent process — a practice that continued at some institutions through the early 20th century. The foundational knowledge base of American medicine was built, in part, on people who had no say in what was done to their bodies in life or after death.

The pain-tolerance myth did not die with slavery. A 2016 study published in the Proceedings of the National Academy of Sciences surveyed medical students and residents and found that a significant percentage still endorsed false beliefs about biological racial differences — including that Black people have thicker skin, less sensitive nerve endings, and a higher pain tolerance than white people. These beliefs directly correlated with undertreating Black patients for pain. The study was conducted 151 years after the end of slavery. The medical mythology invented to justify operating on enslaved women without anesthesia was still shaping clinical decisions in the 21st century.

In 1932, the U.S. Public Health Service launched a study in Macon County, Alabama, to observe the natural progression of untreated syphilis in Black men. 399 Black men with syphilis and 201 without were enrolled. They were told they were being treated for “bad blood” — a local term for various ailments. They were not told they had syphilis. They were not told the study was observational, not therapeutic. They received free meals, free burial insurance, and free medical examinations that were deliberately non-therapeutic.

In 1947, penicillin was established as the standard treatment for syphilis. It was widely available. The Public Health Service actively prevented study participants from receiving it — working with local draft boards during World War II to ensure that participants who were called up for military service (where they would have received penicillin) were excluded from the draft. The study continued for 25 years after an effective cure existed, specifically to maintain the integrity of an observational study of disease progression.

By the time the study was exposed in 1972 — by PHS whistleblower Peter Buxtun, who had been raising concerns internally since 1966 — 28 men had died directly of syphilis, 100 had died from related complications, 40 wives had been infected, and 19 children had been born with congenital syphilis. The study ran for 40 years across 8 presidential administrations. No one was ever prosecuted.

President Clinton formally apologized for Tuskegee in 1997 — 25 years after it ended. The study’s legacy is measurable and ongoing. Economists Marcella Alsan and Marianne Wanamaker published research in 2018 showing that the 1972 Tuskegee disclosure was directly associated with a reduction in Black men’s interactions with the medical system in nearby counties, and that this withdrawal from care is associated with a 1.4-year reduction in Black male life expectancy in the affected areas — an effect still detectable decades later. Tuskegee did not just kill the men in the study. It killed, through medical avoidance, a countable number of people who were never in it.

On February 8, 1951, Henrietta Lacks — a 31-year-old Black woman from Baltimore — was treated for cervical cancer at Johns Hopkins Hospital. During a biopsy, her physician, Dr. Howard Jones, removed a sample of her tumor cells without her knowledge and without consent. The cells were sent to researcher George Gey’s lab. Every other human cell sample Gey had worked with had died within days. Henrietta Lacks’s cells did not die. They divided. They kept dividing. They are still dividing today.

The cells — named HeLa, for Henrietta Lacks — became the first immortal human cell line in history. They were used to develop the polio vaccine. They have been used in cancer research, HIV research, COVID-19 vaccine development, radiation studies, gene mapping, and in vitro fertilization technology. Henrietta Lacks’s cells have been bought and sold by biomedical companies for decades. The global market in HeLa cells and HeLa-derived research products is worth billions of dollars. Henrietta Lacks died of her cancer on October 4, 1951. Her family received nothing.

Her family did not know her cells had been taken or that they existed outside her body until 1973, when a researcher contacted them — not to ask permission or offer compensation, but to request blood samples from her children to help distinguish HeLa cells that had contaminated other cell lines. Her children learned what a cell was from a scientist who wanted more of their blood. In 2013, the NIH published Henrietta Lacks’s full genome without the family’s consent — a second, genomic violation of the same person.

The legal framework governing tissue taken from patients during medical procedures was clarified in the 1990 California Supreme Court case Moore v. Regents of the University of California: patients have no property rights in their own excised tissue. A doctor can take your cells, patent a cell line derived from them, and profit from it indefinitely without owing you anything. The legal rule that enabled the exploitation of Henrietta Lacks was set after her case but applies retroactively to everything already taken. The framework that made what happened to her legal was designed, in practice, to keep it legal going forward.

Rebecca Skloot’s 2010 book The Immortal Life of Henrietta Lacks brought her story to wide public attention. In 2021, a federal lawsuit brought by the Lacks family against Thermo Fisher Scientific — a biomedical company that commercially produces HeLa cells — alleged unjust enrichment. The case was dismissed in 2023. Henrietta Lacks’s cells are in labs in 183 countries. Her family cannot afford health insurance.

In 1927, the Supreme Court ruled in Buck v. Bell that states could forcibly sterilize people deemed “unfit” for reproduction. Justice Oliver Wendell Holmes, writing for an 8–1 majority, said: “Three generations of imbeciles are enough.” Buck v. Bell has never been overturned. It remains valid precedent. Between 1907 and 1963, more than 64,000 Americans were forcibly sterilized under state eugenics programs. The programs disproportionately targeted Black women, poor women, women with disabilities, and immigrant women.

In the rural South, the practice had a colloquial name: the “Mississippi appendectomy.” Black women who came to public hospitals for other procedures — appendectomies, cesarean sections, postpartum care — were sterilized without their knowledge or consent, often by medical students practicing surgical technique. Fannie Lou Hamer, the civil rights activist who became one of the most important voices at the 1964 Democratic National Convention, went to a Sunflower County, Mississippi hospital in 1961 for the removal of a small uterine tumor. She was given a hysterectomy without her consent. She learned what had been done to her from a family member who worked at the hospital. She called it “the Mississippi appendectomy” in speeches for the rest of her life.

North Carolina’s eugenics program ran until 1977 and sterilized approximately 7,600 people, of whom nearly two-thirds were Black women. The program was administered through the North Carolina Eugenics Board and explicitly targeted welfare recipients. The state formally apologized in 2011 and in 2013 established a $10 million fund — $20,000 per living survivor — for reparations. Most survivors had already died.

In September 2020, a whistleblower complaint filed by a nurse at the Irwin County Detention Center in Georgia reported that a gynecologist contracted by ICE was performing hysterectomies on immigrant women detained at the facility at an unusually high rate, without adequate explanation or informed consent. Multiple women reported not understanding why the procedure had been performed on them. The continuity between Fannie Lou Hamer in 1961 and an ICE detention center in 2020 is not coincidence. It is a documented pattern of the state exercising control over Black and brown women’s reproductive capacity across a century.

Black Americans die younger, suffer more preventable illness, and receive worse medical care than white Americans across almost every measured health outcome. Black women are three to four times more likely to die from pregnancy-related causes than white women — a disparity that is not explained by income, education, or access to care, but persists even among high-income, highly educated Black women. Black patients are systematically undertreated for pain. Black patients are less likely to receive appropriate cardiac care. Black patients are less likely to be referred to specialists.

When researchers and public health officials encounter Black Americans who are reluctant to participate in medical studies, delay seeking care, or express skepticism about medical institutions, the response is often to characterize this as a cultural problem — a health literacy deficit, a community attitude that needs to be corrected through outreach. This framing inverts the causal chain. The distrust is not the problem. The distrust is the accurate diagnosis of a real and documented danger. The history that produced it is the problem.

The COVID-19 pandemic made this visible at scale. Black Americans were initially vaccinated at lower rates than white Americans. Public health officials expressed frustration. What they were encountering was not ignorance of vaccine efficacy. It was the rational calculation of a population that had been lied to by the Public Health Service for forty years within living memory, that had watched Henrietta Lacks’s story break into mainstream culture a decade earlier, and that had no structural reason to assume that this intervention was different from the previous ones.

Harriet Washington’s Medical Apartheid, published in 2006, is the definitive accounting of this history. Washington — a medical ethicist and journalist — spent years in medical archives documenting the full arc from colonial-era experimentation through 20th-century federal programs to contemporary health disparities. Her argument is precise: the health gap between Black and white Americans is not a natural phenomenon. It is the accumulated output of a medical system that treated Black people as research material rather than patients, for centuries, and that has never fully reckoned with what that history produced.

The reckoning that has not happened would require the medical establishment to acknowledge that the distrust Black patients bring into clinical encounters is not an obstacle to good care — it is information about what good care has historically meant for them. It would require medical schools to teach this history not as a past aberration but as the foundation of the present. It would require addressing the documented disparities in pain treatment, maternal mortality, and specialist referral as outcomes of a system that was never fully reformed — not as cultural behaviors that need correction in the patient population. The body keeps the score. So does the record.