The idea that discredited, repugnant ideas about racial differences might play a role in medical diagnoses and treatment today is one that doctors ought to find profoundly disturbing. The racially biased treatment of patients is a grievous violation of medical ethics and a direct threat to the dignity of the profession.

But over the past two decades, American medical literature has published hundreds of peer-reviewed studies that point to racially-motivated decisions by physicians that may do serious medical harm. The principal result of these studies has simply been more studies of the same kind.

An official report on racial health disparities in the United States from 2003 raised awareness of this issue, but has had no discernible effect on the education of medical students or continuing education for doctors. Medical ethicists long ago banished medical racism from their sphere of interest, so they can’t be expected to sound the alarm.

Hidden history

Most physicians in the United States know little or nothing about the disastrous history of American medical racism. They learn nothing about it in medical school, and professional literature does little to enlighten them after they’ve completed training. And medical journal editors with little interest in the racial dimension of medicine function as gatekeepers perpetuating the ahistorical and ill-informed status quo.

African American physicians, who constitute about 3% of American doctors, occupy a marginalised position within the profession. The black-edited Journal of the National Medical Association is ignored by the medical profession and the media, and has the impact rating equivalent to that of the Croatian Medical Journal.

All of this means that American doctors are not prepared to understand their own vulnerability to racist habits of thought and behaviour. Many in the current generation of medical students, and other young people in health-related fields, find it easy to deny that medical racism exists at all. But today’s undergraduate students, from whose ranks medical students are recruited, tell me that racial stereotyping is rampant on American college and university campuses, the Obama presidency notwithstanding.

While homophobia has visibly decreased in recent years, the racial stigmatising of black people has proven to be stubbornly resilient. Among American institutions, it’s the military that has done most to eliminate racial bias.

Professional reticence

The medical establishment finally accepted racial integration in 1968 but has never occupied a leadership role in this struggle. Apart from an occasional study, American medicine has refused to conduct systematic studies of racially-motivated diagnoses or of the medico-racial folklore that has infiltrated medical specialities from cardiology to obstetrics and psychiatry.

African American discomfort with and estrangement from the medical profession has been a fundamental part of the black experience for generations. For many African Americans, doctor avoidance has became chronic, dysfunctional behaviour. This estrangement results from the racist views and behaviours of white doctors, which has left a poisonous legacy among an abused and under-educated black population.

Shocking numbers of African Americans today either believe or are willing to consider conspiracy theories about the creation and dissemination of HIV/AIDS by US government agents for the purpose of wiping out the black population. The racist views and behaviours of white physicians have created this legacy of mistrust that persists to this day.

Over and over again, I’ve been surprised to hear well-educated African Americans talk about how difficult it is to have a comfortable relationship with a physician. And the search for a black physician, especially in certain medical specialities, proves fruitless in many cases.

Anyone who finds these claims unfair or improbable ought to read the lawsuit filed in April 2012 by an African-American physician against the David Geffen School of Medicine at the University of California at Los Angeles (UCLA). The lawsuit filed by Dr. Christian Head, a tenured head-and-neck surgeon, alleges multiple forms of racial harassment carried out over several years.

UCLA will surely contest these claims. But what it doesn’t contest is the allegation that, in 2006, Dr. Head was depicted as a sodomised gorilla during a slide show at a medical faculty event attended by 200 people. Only one doctor who witnessed this protested. To date, the university has not issued an apology.

It’s hard to imagine a more dramatic demonstration of American medicine’s lack of regard for the black people.

Black and Blue: The Origins and Consequences of Medical Racism by John Hoberman is published by University of California Press