How has default example of white men affected medicine?

Just before Christmas, a series of images of student and medical illustrator Chidiebere Ibe went viral on social media. Ibe is a talented artist, but what attracted the most attention in his illustrations was that everyone depicted was black. Most medical textbooks, on the other hand, treat white males by default.

A recent study of medical illustrations showed that only 4.5 percent represented non-white skin. Ibe’s most striking image was of a black fetus, because even when textbooks include female bodies, these are invariably white.

How did people who look like me become the norm for medical research when we only make up a percentage of the world’s population? And how does this affect the practice of medicine?

The earliest medical diagrams that have come down to us are papyrus sheets from the 4th century BC. AD, found in Alexandria. Human dissection was rarely performed for the next 1,000 years (anatomy was taught largely from the bodies of apes and dogs), but by 1300 it had resumed at the University of Bologna, where Modino de Luzzi produced the first anatomy textbook in 1315.

Medical practice in the 19th century often reflected racist assumptions, such as black people being naturally resistant to pain.

During the Renaissance, the development of printing and graphic perspective made it possible to easily reproduce illustrations and represent the dimensions of the human body more faithfully. The most famous anatomist of the time was Andreas Vesalius, who popularized human dissection across Europe and published an illustrated textbook.

Soon after, Europeans began to construct the concept of race. In the Age of Enlightenment, scientific practice gave priority to the categorization of the natural world. One of the results was the creation of racial categories based on observable differences such as skin color. In the context of colonialism and the Atlantic slave trade, the term “white” was used to differentiate Europeans from indigenous and enslaved peoples. Racialized assumptions permeated colonial societies; even depictions of Jesus became noticeably whiter and blond during this period.

Because racial categories were meant to be scientific, they were seen as respectable. Medical practice in the 19th century often reflected racist assumptions, such as black people being naturally resistant to pain. In the 1820s, Thomas Hamilton repeatedly inflicted scars and blisters on a slave, John Brown, in a futile attempt to demonstrate that black skin was thicker.

James Marion Sims, “the father of gynecology,” tested his surgical techniques on bonded, non-anesthetized black women in the prewar south, while providing anesthesia to his white patients. Unethical research on blacks continued into the 20th century. Between 1932 and 1972, 399 black men in Alabama were misled by authorities and studied for the effects of untreated syphilis. Although the syphilis is treatable, they did not receive any medical intervention and more than 100 died.

Blacks were treated as objects of research, but the medical textbooks hypothesis was that the subjects of treatment would be largely white. Despite the considerable damage inflicted on blacks in the name of research, the illustrations were invariably white. In the 1860s, a newly developed device, the spirometer, was used by plantation physicians such as Samuel Cartwright to demonstrate that enslaved blacks had lower lung capacity than whites.

Two former black players sued the NFL, claiming they were unfairly denied payment because they had to show more cognitive decline than a white player

While this generally reflected the horrific environmental conditions that slaves were forced to endure, it was used to claim that slavery was beneficial, as hard labor would help strengthen the lungs. Even today, the spirometer readings are calibrated so that values ​​for whites are the norm, and those for other ethnic groups are “race-corrected.”

In 2013, the NFL struck a billion dollar deal with former American footballers for concussion-related brain damage. But the system used to judge cognitive decline is corrected for race and assumes that blacks have lower cognitive function. Last year, two former black players sued the NFL, arguing that they had been unfairly denied payment because they had to demonstrate greater cognitive decline than a white player.

Black skin may not be thicker than white skin, but it contains more melatonin. This difference in pigmentation results in different skin conditions in white and black patients.

Yet because textbooks assume patients will be white, dermatologists are less trained to spot these differences. Outcomes of diseases typically diagnosed by observing the skin, such as meningitis, melanoma, and Kawasaki disease, are considerably worse for black patients. Thanks to the efforts of illustrators like Ibe, this may not be the case for long.

Dr Stuart Mathieson is a postdoctoral fellow working at the School of History and Geography at Dublin City University.

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