 Well, good morning. My name is Doug Thompson, and I serve as vice president for equity and inclusion here at Gustavus Adolphus College. I want to take this time to welcome you to our annual Dr. Martin Luther King, Martin Luther King, Jr. celebration. On behalf of our president, Rebecca Bergman, our board of trustees, faculty, staff, alumni, and most important, our current students, welcome. It is indeed a tremendous honor and privilege for us to be here together as a community and participate in this momentous occasion. Dr. King often talked about the beloved community. He said, our goal is to create a beloved community, and this will require a qualitative change in our souls as well as a quantitative change in our lives. Dr. King's work and words continue to serve as examples of solidarity, strength, compassion, along with his commitment to equality, justice, peace, and inclusion. The critical work of diversity, equity, and inclusion is a perpetual work in progress that will take all of us as a community, a beloved community. Today, as we celebrate the legacy of Dr. King, who devoted himself to service, we encourage you to listen, to learn, and to participate with a renewed sense of purpose. Now, we are so excited to have with us today Dr. Caroline Roberts. Dr. Roberts is an assistant professor at Yale University. She holds joint appointments in the departments of history, history of science and medicine, and African-American studies. She is an award-winning educator who teaches courses in the history of race, science, and medicine from the 16th to the 21st centuries. Dr. Roberts will be presenting a talk entitled Historical Roots of Racism and Colonialism in Science and Medicine. There will not be time for questions at the end of this talk. However, this afternoon, there will be time for students and another time for faculty and staff to meet with Dr. Roberts. Welcome, Dr. Roberts. We are so, so, so glad to have you here. Thank you so much. It is wonderful to be here with you. And on Martin Luther King, Jr. Day, which is such an important day for us to remember, I'm really excited to think with you about science and medicine and colonialism and racism. These are difficult kinds of topics, but I hope that you'll see that they are well worth our time, our effort, and our energy. So this is our outline for today. We will begin by thinking about the mutual influencing between science and society as a kind of overarching framework for our talk. Then we will turn to colonialism and science, then racism and medicine, which is going to take us all the way into the present. And then we will turn to what you can do now that you have this information, the mutual influencing between science and society. We are living in a unique moment. Never before have so many people been calling for efforts to decolonize science, to embrace greater diversity in STEM, and to adopt anti-racism interventions. And as all of you know quite well, when the George Floyd murder occurred, efforts were made to perform more inward-looking work at many of our institutions, and to think intentionally about the difficult histories of which all of us are a part. And so much writing and thinking has occurred over the past few years. For example, this is from the conversation from June 1920. The director of science at Q. It's time to decolonize botanical collections. We too have a legacy that is deeply rooted in colonialism. In my own field of research, you can see an imperialist view prevail. This is from the journal Physics in Perspective, Decolonizing Physics, Learning from the Periphery. The authors write the role of physical knowledge, material technologies, and engineering in the practical work of imperialism in the 19th and 20th centuries, especially in energy, transport, communication, and weapon systems, means that physics was central to colonialism. And this is from the journal Signs. The title is making black women scientists under white empiricism, the racialization of epistemology in physics. And the author asks, who is allowed to be an observer in physics? And who is fundamentally denied the possibility? I propose that race and ethnicity impact epistemic outcomes in physics, despite the universality of laws that undergird physics. And this article was importantly written by Chanda Prescott Weinstein, who in 2010 became the 69th black woman in the US to earn a PhD in physics. So as you can see, the past is indeed present. The legacies of our difficult histories remain with us. History ought to be a fundamental disciplinary partner in our efforts to move forward intelligently. You see, history has salient vitality. It is never dead, not even sleeping, at worst napping. We can never entirely let go of the ongoing past, for it never lets go of us. To say dismissively that history or history is nothing to do with me is a profound error. We are fully historical creatures. Our consciousness and memory bound up with pasts, both near and remote, and rational present action demands insight into other people's pasts as well as our own. But as we think about the needs of our present moment, STEM poses a special set of challenges. We often think of scientific inquiry existing in the abstract. Science has typically been understood to function in a pristine space devoted to neutrality and objectivity, unsullied by the messy social, political, and cultural worlds in which we live. However, this vision of science is unfortunately incomplete. The idea of science being unsullied by the messy social, political, and cultural worlds in which we live, in fact obscures some of the fundamental realities of the history of modern science that we will be discussing today. We need to reckon with the mutual influencing between science and society. Sheila Jasanoff, Professor of Science and Technology Studies at Harvard University, explains the mutual influencing between science and society this way. Scientific knowledge in particular is not a transcendent mirror of reality. It both embeds and is embedded in social practices, identities, norms, conventions, discourses, instruments, and institutions. In short, in all the building blocks of what we term the social. So today's talk looks at the mutual influencing between science and society by thinking about the historical roots of racism and colonialism in science and medicine. This history matters. It matters because we need to know the traditions, ideologies, beliefs, and practices that have shaped our fields. They are still shaping us, whether we realize it or not. So let's turn now to colonial science. What comes to mind when you think of the origins of modern Western science? If you go back in the recesses of your mind, you might recall something called the scientific revolution. This is often named as the beginnings of modern Western science. And we often date the scientific revolution from 1543 to 1687. We begin with Copernicus and Heliocentrism in 1543 and we end with Newton in 1687. In traditional accounts of the scientific revolution, some of the things you would learn about would be Newton's laws of motion and universal gravitation, Galileo's telescope, his discovery of craters on the moon, William Harvey's discovery of the circulation of the blood, Descartes' developments in analytical geometry, as well as his dualistic mind-body formulation, I think, therefore I am. Cacitil ergo sum, astronomy, physics, mathematics, chemistry, medicine, and more left ahead. These are the great men and their great discoveries. This traditional telling helps us imagine the origins of modern Western science as a pristine search for universal knowledge. It is, in this telling, unsullied by the messy social, political, and cultural worlds in which we live. It's the scientist and their discrete discoveries that matter. And so as I frequently say to my students, figure out what is missing. What is absent? What am I not seeing? There are always absences and some of those absences will change the fabric of the whole. We are, in fact, missing an important part of the story. One of the most significant and world-altering sciences of this age is absent from the traditional account, and that is navigational science. By 1543, navigational science in the hands of Portuguese and Spanish cosmographers had quite literally redrawn the map of the Earth. European circumnavigation had become possible. This spurred advances in geography, chemistry, botany, astronomy, and cosmography. But this new science became indispensable to colonial conquest, slavery, and slave trading. So if we were to include navigational science in the origins of modern Western science, we would see quite clearly the mutual influencing between science and society, which occurred from the very start. And it also brought devastating consequences that we ought to pause and remember. By the time we get to 1543, the colonization of parts of India had begun. When Goa was taken over by the Portuguese in 1510 from its Muslim rulers, over 6,000 Muslim children, women, and men were killed and their mosques were set on fire. By 1567 mass baptisms to Catholicism had occurred. 300 Hindu temples were destroyed. Hindus were prohibited from practicing most of their rituals. The Inquisition had begun arresting, imprisoning, and torturing Hindus, Muslims, and Jews. The Goa Inquisition lasted from 1560 to 1812 and Goans are still asking the Vatican to apologize. When we turn to the Americas, by 1543 colonial conquest was well underway. The genocide of indigenous peoples was unimaginable in its scope and horror. It was in full force as violence, disease, and dislocation decimated bodies, cultures, and worlds. This is a protest that occurred in June, 2020 in Albuquerque, New Mexico, protesting the statue of the conquistador who colonized New Mexico in 1598. According to the latest research from 2019, there were approximately 60.5 million indigenous peoples in the Americas in 1492. In 1600, approximately 6 million were alive. Historical trauma and grief, a soul wound endures, that impacts health outcomes in indigenous communities today. By the time we get to 1543, European slave trading in Africa had already been going on for over 100 years. The transatlantic slave trade began in 1441 with the Portuguese. It lasted for 426 years. The Atlantic slave trade was the largest forced oceanic migration in human history. Over 12 million African children, women, and men were captured, chained, and put on board slave ships where they were beaten, raped, and medically abused. By the end of the scientific revolution in 1687, most of Western Europe was involved in this human trafficking operation. Switzerland, Sweden, Norway, Britain, France, the Netherlands, Germany, Denmark, Spain would all be involved in this global trade in human flesh. It is important to pause and never lose sight of the human costs of science, of colonial conquest and slavery, which continue to have such strong legacies today. As colonial conquest began to spread across various parts of the world, colonial spaces began to function as their own scientific laboratories. For Francis Bacon, who was the father of the scientific method, the discovery of the Americas by Europeans proclaimed the beginnings of a new world of science where knowledge would not be gained by books but by discovering the secrets of nature. It was not only about the colonization of peoples, but also the colonization of nature. What we'll see is that colonization propelled advances in astronomy, botany, chemistry and medicine. When I conducted over two years of archival research in the UK for the book that I'm writing, the first place I visited was the Royal Society. Founded in 1660, the Royal Society is the oldest professional scientific society in the Western world. Also founded in 1660 was Britain's government funded slave trading corporation, the Royal Adventurers into Africa. Not only were the two organizations founded in the same year, but they had overlapping memberships. Fellows of the Royal Society helped run the slave trading corporation and directors of the slave trading corporation were members of the Royal Society. In 1667, Thomas Spratt wrote the first official history of the Royal Society and called the two organizations Twin Sisters. Slave traders and scientists had similar priorities. The gathering of scientific knowledge and slave trading were closely aligned projects. This was because scientific inquiry, economic profit and the building of empire went hand in hand. And this would be the case into the 20th century. And so the Royal Society established a global network of correspondence and these included slave traders, ministers, physicians, botanists and others. They were tasked with scientific labor. They were meant to collect plants, animals and minerals, describe climate, topography and air quality, test waters for chemical constituents and test medicinal plants for their healing properties. These colonial spaces were laboratories and slave ships were often the vehicle of choice for transporting their scientific collections. So let's look at one example from Cape Coast Castle in present day Ghana. This is Cape Coast Castle, which was the British slave trading headquarters in West Africa. A man named John Smith was the minister there in the 1690s. This is the dungeon at Cape Coast Castle. It was referred to as the Black Hole. Minister John Smith held prayer services in the chapel and the chapel was located right above the Black Hole. In these incarceration units, African people were kept naked. They were kept in darkness on the dank floor. They were fed out of troughs with vermin nipping at their angles. They suffocated under the stench of urine and feces. In the midst of that scene of horrors, Smith conducted scientific inquiry on behalf of the Royal Society and produced the first scientific account of West African medicinal plants published in English. Smith became an active student of West African plant-based medical knowledge. He learned cures for stomach aches, headaches, wound care, smallpox, worms, venereal disease, tooth aches, dysentery, scurvy and hemorrhaging. These were among the lengthy list of cures Smith discovered from African people. He sent plant specimens back to London with detailed instructions on how the plants were used in healing. Learning new medicinal knowledge was crucial for European health in the tropics, but drugs could also be incredibly profitable. And this was very much the case in the Spanish Americas. Bark from the Sincona tree was the world's first antimalarial. The bark contained quinine. The tree is located deep in the Andes and the Spanish Jesuits claimed to have discovered it. In fact, the Jesuits learned about the healing properties of Sincona from indigenous people in modern-day Peru. Spain claimed a monopoly on the plant and it was widely used across the globe between the 17th and 19th centuries. Chemistry also developed in the context of slavery. Jamaica was Britain's most profitable slave colony during the 18th century and Thomas Dance was a Scottish physician who worked with the enslavers. He carried out a series of chemical analyses on various mineral springs across the island. And through these chemical inquiries, he was able to test and catalog the curative properties in the water. Mineral springs became widely used medicinal not only in the Caribbean, but in Europe as well. Jean Richet, a French astronomer, conducted famous astronomical observations from French Guiana, a slave colony in the Caribbean. Richet investigated atmospheric refraction near the equator. He measured the parallax of Mars, which led to the first reasonably accurate calculation of the dimensions of the solar system. And he provided data that allowed Newton to prove that the earth was not a sphere. The roots of GlaxoSmithKline are also embedded in slavery. On the GlaxoSmithKline website, they make reference to Ploughport Pharmacy. From Ploughport's records, we know that they made the bulk of their money by supplying drugs to slave plantations in the Caribbean. The drug manufacturing operation they developed gained an impressive reputation for producing high quality pharmaceuticals during the 18th century. But we must ask the question, what else are we missing from the story? We are missing the African and indigenous practitioners whose medical and botanical knowledge was extracted by Europeans for the benefit of modern Western science. And I will share now some examples from my own research. In my research, the gardens at Cape Coast Castle during the era of the slave trade contained a plant called velvet tamarind. It was growing there as an important medicinal. The inhabitants soaked the pulp of the fruit in water and the resulting beverage was then consumed by fever patients with positive results. Researchers today have confirmed the analgesic, antimicrobial and antibacterial and antimalarial qualities of velvet tamarind which includes its ability to inhibit the growth of the Plasmodium falsiparum parasite which causes malaria. African basil was another fever remedy in use on the Gold Coast during this period. Africans boiled the leaves to create a decoction that was not only drunk but was used in a steam bath four times a day. In chemical screenings, we know that the essential oils in the leaves contain significant antimalarial properties. Researchers today also confirm that a steam bath is particularly effective for obtaining the antimalarial benefits. There is so much documentary evidence in the archives about the excellence of African and African-descended medical and botanical knowledge. And this is just one example from a Dutchman named Willem Bosum who was stationed on the Gold Coast. He wrote in 1705, the green herbs, the principal remedy in use amongst the Negroes are of such wonderful efficacy that is much to be deplored that no European physicians has yet applied himself to the discovery of their nature and virtue. For I don't only imagine but firmly believe that they would prove more successful in the practice of physics or medicine than the European preparations. But we don't tend to think about enslaved Africans as botanists, scientists and doctors. Cultural geographer Judith Carney writes, one legacy of the Atlantic slave trade is the lingering failure to consider its victims as deliberate botanical agents. Plantation reliance upon forced migration of enslaved Africans delivered a steady infusion of African plant knowledge in the region. For example, some of our plant species today are named after enslaved people. Majo Bitters is named after Majo, an enslaved healer in Jamaica. She used the plant to cure yaws and venereal disease. Bitter root or cassia amara is named after posse, an enslaved man in Suriname who effectively used it as a fever remedy, stomach tonic and restorative. The plant became one of Suriname's major drug exports. But this knowledge was not considered science. As Kathleen Murphy writes, the expertise possessed by indigenous and black people represented nearly the raw materials out of which they, Europeans, fashioned new natural knowledge. Black and indigenous people were erased as scientific knowers. They were precluded from being capable of science. The widespread exclusion and erasure of black and indigenous scientific knowledge has legacies today. We see it in regard to who is and who is not considered capable of being a scientist. But this dynamic of erasure on one hand and exploitation on the other only becomes fully legible when we contend with racism, racism and medicine. What do you see me as? What do you see me as? This young man's question is crucial. And to begin answering it, we will go back to the 15th century, meaning to the 1400s. In other words, we will travel back in time 600 years when anti-blackness took a special kind of place in the European mind. Now, the language and ideas that I'm about to share will be upsetting and disturbing to some of you, but it's important that we get clear about how anti-blackness began to circulate in Europe and the Americas during this period. And please also remember that these statements that I'm about to read are not true. They are based on European biases and ethnocentrism. This is a quote from one of the earliest Portuguese chroniclers of Africa. The author wrote, they lived like beasts without any custom of reasonable beings. They had no understanding of good, but only knew how to live in a bestial sloth. Such ideas would continue. According to Richard Ligon in 1673, African women resembled animals. He wrote, their breasts hang down below their navels so that when they stoop at their common work of weaving, they hang almost to the ground. That at a distance, you would think that they had six legs. African women not only look like animals, but they also gave birth like animals without pain. One of the doctors that I study in the slave trade wrote a widely circulated text that included this description of African people. Their natural temper is barbersly, cruel, selfish, and deceitful. As for their customs, they exactly resemble their fellow creatures and natives, the monkeys. Jamaican slave holder, Edward Long wrote, orangutans have the same intellectual faculties to many of the Negro race. The amorous intercourse between them may be frequent. And as you know, science had a major role to play in this as well. When Linnaeus began describing humans based on newly invented racial categories, this is how he described black people. Black, phlegmatic, hair black, grizzled, nose flat, lips tumid, women without shame. They lactate profusely, crafty, indolent, negligent, governed by caprice. And this is how he categorized white people. White, sanguine, muscular, eyes blue, gentle, inventive, governed by laws. What is particularly helpful for us to notice is that you can see how scientific understandings of human difference were laced with European notions of culture, behavior, political structures, and ideals of beauty. This is the mutual influencing between science and society. It is nowhere more vivid than when it comes to biological fictions concerning racial difference. Given that anti-blackness had been operative for hundreds of years in the European mind, long before the founding of the US as an independent republic, it should not be terribly surprising that these ideas appear in the language of our founding fathers. In 1785, Thomas Jefferson famously wrote, their griefs are transient. In other words, black people feel less emotional pain than white people, but they also feel less physical pain. Dr. Benjamin Rush, another founding father who was the first professor of chemistry in the US, and he also published the first psychiatric textbook in the US, wrote the following in 1799. He believed black skin was a form of leprosy, and he wrote that it caused more mid insensibility in the nerves, meaning that black people were less sensitive to physical pain than white people. One of the individuals that Dr. Rush quotes in his writings on leprosy is Dr. Benjamin Mosley. Dr. Mosley writes, they are void of sensibility to a surprising degree. They sleep sound in every disease, nor does any mental disturbance ever keep them awake. They bear surgical operations much better than white people and what would be a cause of insupportable pain to a white man, a Negro would almost disregard. So as you can see, the idea that black people don't feel the same level of physical or emotional pain as white people has a long history. Race was becoming a biological fact. Longstanding centuries old anti-black attitudes were given a scientific hue and were infused with medical meanings. During the era of slavery, many of the incorrect ideas that people still hold today about medical and biological differences between blacks and whites developed during the era of slavery. There was the idea that blacks have poor pulmonary function, smaller skulls, weaker brains, less prone to depression are bigger and stronger, making them better slaves then and better athletes today. All are biological fictions. However, while scientists were arguing for black biological inferiority, at the same time, American medicine in the 19th century began to use enslaved people's bodies to advance medical science. Newspapers contained advertisements like this to entice slaveholders to sell their six slaves for medical research. This is from the Charleston Mercury. Wanted 50 Negroes, any person having sick Negroes considered incurable by their respective physicians and wishing to dispose of them, Dr. Stillman will pay cash for Negroes. The highest cash price will be paid as above. So the enslaved body was forced into medical service. During the 19th century, scientific medicine was beginning to take root in the United States and doctors needed bodies both alive and dead to understand more about how organs and tissues were impacted by disease. There was an enormous demand for sick patients and cadavers for study. Yet among the white population, hospitals were undesirable because medical care largely continued in home and dissection was considered an affront. But slavery created a population of people who were forced to comply. This is a slave narrative written by an enslaved man who was subjected to painful medical experiments. Yet John Brown was not alone. A slave named Sam was pinned down into a chair by five physicians so that his lower jawbone could be removed without anesthesia. Dr. Walter Jones in Virginia poured boiling water on naked enslaved pneumonia patients at four hour intervals to test their pain threshold. Dr. John Hardin stripped blood vessels from the limbs of an enslaved man and from three hogs to measure the arteries for comparison. Dr. James Dugas performed experimental eye surgeries on black subjects. During slavery there were many instances of medical experimentation. Yet J. Marion Sims experiments on enslaved women are particularly well known today. Picture here are three enslaved women. Adarka, who was pictured at front and center. Lucy and Betsy. These are the women we now call the mothers of gynecology. J. Marion Sims, who was pictured at the far right was trying to find a surgical cure for vesicovaginal fistula where an abnormal opening forms between the bladder and the walls of the vagina. It causes urine to leak out of the vagina. It's incredibly painful condition and often leads to incontinence. The enslaved women were his research subjects. Sims operated on Anarka, for example, 30 times over a period of five years without anesthesia, although ether was available. He believed black women didn't feel as much pain as white women. Over and over again, he scarified, sutured and resutured the vagina. When the surgery was finally perfected with silver sutures rather than red, Sims treated the white women of Montgomery and made sure to give them anesthesia. Sims remains a part of our lives today. His vaginal speculum is still used during gynecological exams. By utilizing the bodies of black women, doctors advance their understanding of how to remove burst ovaries, deliver stillborn children, stop intrauterine bleeding, fix fused labians, repair obstetrical fistula, remove ovarian tumors. The first full uterine removal was done by Dr. Paul E. Caesarean sections 30 of 37 experimental Caesarean sections were performed on black women in 1830. And there's more. But while medical experimentation was done on the living, enslaved people's dead bodies were also used for dissection. Here's another advertisement from the Charleston Mercury. No place in the United States offers as great opportunities for the acquisition of anatomical knowledge, subjects being obtained from among the colored population in sufficient numbers for every purpose and proper dissections carried on without offending any individuals in the community. You can imagine the community that he's referring to are not the African-American community. When Harriet Marchineau visited Baltimore in 1835, she noticed that the bodies of colored people exclusively are taken for dissection because the whites do not like it and the colored people cannot resist. Enslaved people's bodies became part of a lucrative national cadaver trade that shuttle black people's bodies from Texas to New Hampshire. Few enslaved people rested in peace. Death did not end their commodification. And I want to show now some of the images of these dissections. And I want to warn you that these are gruesome and explicit. But I believe we need to face this history head on and we need to honor their sacrifice. But please avert your eyes as necessary. After slavery in the 100 years between 1865 and 1965, the relationship between black people and American healthcare remained as fraught as ever. Black people went from being considered valuable human commodities to being a problem that needed to be controlled and brutalized to be kept in their place. Through the 1960s, segregation infected all aspects of the U.S. healthcare system, whether by law or by custom throughout the country. Deaths occurred because black people couldn't get to a hospital or doctor willing to treat them. When they were allowed into white hospitals, African Americans were put into waiting rooms that were little more than broom closets with a few chairs. Hospital wards for African Americans were often in dingy basements and back rooms. My late father-in-law who served in World War II practiced medicine in Cleveland and he saw all of his patients at their homes. He was an African American doctor. And these patients, they wouldn't go to the hospital because they were treated terribly. You only went to the hospital if you wanted to die. Because of poverty and segregation, the majority of black people had to live in deplorable conditions and it compromised their health. In the early 20th century in Atlanta, African Americans crowded into one room dwellings with their homes sometimes facing directly into outhouses. Their homes were located in alleyways. They received no city services, new pavement, new sewage. Whenever it rained, the alleyways were filled with mud and garbage. Sewage from the white sections of the town flowed into the city's poorest black neighborhoods. The waste collected in pools and streams in their backyards and streets. The city's clean water supply was largely inaccessible to black people. They drank well water that was often contaminated with feces as they succumbed to diseases like tuberculosis. Doctors attributed their high mortality rate to the fact that they were black and biologically inferior, not that they were living in deadly conditions, not that they didn't have access to health care. Their race was the culprit, not the social conditions under which they were forced to live. One doctor wrote, they had smaller brains, so they succumbed to all diseases unlike whites who are endowed with a better developed brain structure. So rather than showing black people sympathy or compassion, they were treated with disgust, considered carriers of contagion, people that many hoped would simply die off. Black people knew they could only rely on each other. Groups of black women mobilized public health campaigns in black communities across the country. Groups like the National Association of Colored Women, which was the first national black organization in the US, had a Department of Health and Hygiene. Their local chapters, such as this one from Newport, Rhode Island, integrated health education and health care into their activities. The first half of the 20th century also brought us an increasing number of black health care professions. They founded black hospitals and black medical schools. However, they were barred from joining the American Medical Association, so they founded organizations like the National Medical Association, which is still thriving today. Despite these extraordinary achievements, the numbers of black health care professions was not sufficient to serve the millions of black people who had no access to medical care. As a vulnerable population, largely kept out of the health care system, many who did get access to white medical spaces were abused and exploited in them. For most of the 20th century, states sanctioned forced sterilizations were performed disproportionately on black women, often without their knowledge or consent. Fannie Lou Hamer, the famous civil rights activist, went to a hospital in Sunflower County, Mississippi. She was going to have flyboats removed, but she was given a hysterectomy without her knowledge or consent. Forced sterilization was such a common experience for black women in the South that Hamer called it the Mississippi appendectomy. And the famous Tuskegee Syphilis experiment. This occurred between 1932 and 1972. It was the longest involuntary and non-therapeutic medical experiment conducted on human beings in the history of American medicine and public health. The US government performed this experiment on black men in Macon County, Alabama. The men thought they were getting free medical care to treat syphilis. This was the lie they were told. The study was actually designed to observe untreated syphilis in black men. The people running the experiment, the US government, they pretended to give the men medicine. It was little more than sugar pills and vitamin water. They withheld lifesaving medicines so they could observe how the disease killed black people. Purposefully withholding lifesaving medicine for men as they slowly died from syphilis or from its complications is absolutely shocking. And the next slide contains disturbing images. So please avert your eyes as necessary. Syphilis kills you slowly and often with excruciating pain. We know that some of the men went blind, some went insane, some became paralyzed, some suffered complications from cardiovascular disease, some became horribly disfigured. This is Raymond von Delaire, the on-site director of the Tuskegee Syphilis study. He later became director of the CDC. He said, it is my desire to keep the main purpose of the work from the Negroes in the county and to continue their interest in treatment. This was a government program led by the future director of the CDC. As Gretchen Craig Turner writes, racism in the United States has roots that extend deep into the history of medical research. But the 1960s would come. The medical committee on human rights was the medical arm of the civil rights movement. Hospitals would eventually desegregate during the late 1960s. This means, however, that black people have only had more equal access to healthcare over the past 50 years, at least in theory. Change has been slow. Inequities never went away. The majority of black patients who are in their 70s today are currently experiencing the health effects of our earlier segregated healthcare system. This is a study from 2016 that's entitled Jim Crow and premature mortality among the US black and white population. And what the study finds is that in 1960, 63% of African Americans lived under legal Jim Crow. Black people born between 1921 and 1945 living under Jim Crow are 20% more likely to die prematurely. Black people born between 1921 and 1945 in any jurisdiction are twice as likely to die prematurely compared to whites. So if you are a black person in your 70s and you existed under segregated healthcare, this is in your living memory. And by extension, it is also in the living memory of all those who participated in this exclusionary segregated healthcare system, whether by law or by custom. So given this history, it should not be entirely surprising that there is provider bias and black medical distrust. In the 50 years that black people have been able to access a less segregated healthcare system, the results are truly troubling. As you can see the relationship between black people and American healthcare has always been broken. Desegregation efforts did not tackle anti-blackness. They merely opened the doors so that black people could more easily walk into white spaces. But now we have over two decades of evidence showing that black people received lower quality and disparate care in healthcare settings. Provider bias really gained national attention in a national study that was conducted in 2002 called unequal treatment by the Institute of Medicine. They found that healthcare providers diagnostic and treatment decisions, as well as their feelings about their patients are influenced by patients race or ethnicity. The key to understanding the evidence related to provider bias in healthcare are what we call differential treatment studies. These are studies that have been conducted where they standardized each patient in all aspects except race, controlling for confounding variables like insurance status, socioeconomic status, education and medical condition. These are some of the results. For cardiac catheterization, women and blacks less likely to be referred with black women being offered the lowest rates of cardiovascular procedures. For rectal cancer, blacks are more likely to receive a permanent colostomy after surgery. For coronary artery surgery, blacks are less likely to be recommended. In intensive care unit, blacks have less time with physicians. For lung cancer, blacks are 12.7% less likely to receive early stage curative surgery. For prostate cancer, blacks are twice as likely to undergo removal of testicles. For pneumonia, blacks are less likely to have blood cultures taken during the first two days of hospitalization. For appendicitis, black children are less likely to receive adequate pain medication. For long bone fractures, blacks are less likely to receive adequate pain medication. For diabetes, blacks are more likely to have a limb amputated. For heart transplants, blacks are less likely to be referred for a transplant and more likely to be prescribed ventricular assist devices. Some of this research began to make national news. Racial disparities seen in how doctors treat pain even among children. Some medical students still think black patients feel less pain than whites. And then the news cycle started to report more frequently about the crisis of black maternal mortality. Black women are three to four times more likely to die during or after delivery than white women. Black women's pain is not listened to. We know that healthcare providers believe black women exaggerate our symptoms. We are written off or not taken seriously and death has occurred as a result. And it doesn't matter if you are rich or poor living in an under-resourced neighborhood or in a mansion. There are many women who have experienced this. For example, this happened to Serena Williams. This also happened to LaShonda Hazard. In January of 2019, LaShonda, a healthy 27-year-old pregnant black woman went to a hospital in Providence, Rhode Island. She was having a great deal of pain but she wasn't listened to, so she was sent home. When she returned home, she tweeted this, I've been having excruciating stomach pain, cramps, and they're not doing anything about it. My whole left stomach, hard, and in pain. I'm literally dying. And LaShonda did die. She was dead 24 hours later. Her system is racist and we're all participants in the system. I had a black woman come in with back pain who every time she coughed, she would get chest pain and she was just there with back pain. She coughed, she was like, oh, my chest, my chest. And she had a very histrionic personality. And so all the providers were inclined to just be like, oh, okay, let's just give her some coffas and give her some coffas. So one day I was like, let me put an EKG on you because I know I think the New England Journal of Studies came out that black women have the worst health outcomes with heart attacks because they're not listened to. So I'm like, okay, let me just try this. So I put an EKG on her and every time she coughed, she had ST elevation. She was having a heart attack. I said, oh my, oh my God. So I called the cardiologist and I said, can you please cap this lady? Because I think she has a bridge artery going through her, you know, myocardium. So when your thoracic pressure is increased, it's collapsing the artery and she's having cardiac issues. And he said, well, send her to my outpatient clinic. He said, this woman will never show up to your outpatient clinic. I know this woman, I've known her for five years. She'll never show up. She's here in the hospital. She's gonna be here for a couple of days with back pain. Let's just do a cap. And he refused to do the cap. And so finally I said, you know, I don't want this woman to become a statistic that black women get worse medical care around heart attacks than everybody else because the medical institution doesn't listen to them. And he said, are you calling me a racist? And I said, well, I think our system is racist and we're all participants in the system and I'm trying to check myself. And I had to check myself and actually go, she's pain, chest pain, get an EKG. Like that's what you're trained to do. Why wasn't I doing it, right? And so I think a part of it is just starting to unlearn our own implicit biases from that we've been raised with in this society and challenge yourself with each patient encounter. Now I just challenge myself when I'm looking at black indigenous Latino person, I challenge myself, okay, what am I not seeing? What am I not asking? Because I'm a part of the system. And through that own self inquiry and examination, I also now start, you know, talking with my colleagues. Look what I missed. Over 100 years ago, Dr. Oliver Wendell Holmes Sr. put it like this. The truth is that medicine, professively founded on observations is as sensitive to outside influences, political, religious, philosophical, imaginative as the barometer to the change in atmospheric density. There is a huge personal social psychological cost to this reality. And I want to give the last word of this section of the talk to a woman named Dr. Susan Moore who died from COVID. Dr. Susan Moore, a black medical doctor was the victim of disparate care and the medical center admitted as much after she died. Dr. Moore left us her direct experience in a viral video two weeks before she died. And we will listen to part of the video. This is Democracy Now, democracynow.org, The Quarantine Report, I'm Amy Goodman. As the United States reports, world record deaths and hospitalizations from COVID-19 in the final days of 2020. We look at how the pandemic, that's ravaged the country this year, has shown stark new light on racism and medical care. We begin with a now viral video recorded by black physician, Dr. Susan Moore, and posted to her Facebook earlier this month in which she describes racist treatment by medical staff at a hospital in Indianapolis who did not respond to her pleas for care despite being in intense pain and being a doctor herself. Dr. Moore says she had to beg to receive the antiviral drug remdesivir and pain medication and accuses a doctor at Indiana University Health North Hospital of ignoring her pleas because she was black. This is Dr. Susan Moore. As she summoned the energy to speak from her hospital bed days before she would die, she had an ox oxygen tube in her nose. At that time, I don't even see two treatments of the remdesivir. He says, ah, you don't need it. You're not even short of breath. I said, yes I am. Then he went on to say, you don't qualify. I'm lost because I've gotten two treatments. Then he further stated, you should just go home right now. I feel comfortable giving you any more narcotics. I wasn't so much pain from my neck. My neck hurts so bad. I was crushed. I feel like I was a drug addict. And he knew I was a physician. I don't take narcotics. I was hurt. So I spoke to a patient advocate who left me wanting. There's not much I can do. So I started asking, send me to another hospital where they can treat me. They're not gonna treat me here properly. Send me to another hospital. I'm getting a stat, CT of my neck with and without contrast. The CT went down a little bit into my lungs and you could see new pulmonary infiltrates, new lymphadenopathy all throughout my neck. And all of a sudden, yes, we'll treat your pain. You have to show proof that you have something wrong with you in order for you to get the medicine. I put forward and I maintain. If that was white, I wouldn't have to go through that. The other thing that that white Dr. Bannick said was that if I stayed, that he would send me home Saturday at 10 p.m. in the dark. Who does that on a weekend? Who does that? This is how black people get killed when you send them home and they don't know how to fight for themselves. I had to talk to somebody, maybe the media, somebody to let people know how I'm being treated up in this place. So what can you do now that you have this knowledge? Now that you've been on a journey that's taken you through 500 years, exploring a rather dark and disturbing history. I teach one of the most popular classes at Yale where we spend all semester digging deeply into this kind of material. It draws hundreds of students and it's broken records at the university. The students are undergrads in STEM, public health students, medical students, doctors and even retired physicians have taken the course. In pre COVID days, I gave a lot of hugs in that class. A lot of students in tears, upset, angry, class after class, but they were happy and enthusiastic and wanted so badly to be there at the same time. Perhaps you can see just a bit of what they saw, which is that this history, despite its devastation, brings light. It helps us stand in truth on solid ground, understanding more clearly how we got into the mess we're in. It offers a diagnostic and it invites us into a rehabilitative space that beckons with new possibilities because we have more of the knowledge we need to move forward intelligently. My first invitation to you is to break the silence, share this knowledge and this history. Bring it up gently in conversation. Encourage others to think about these issues. Continue to educate yourself about it. Listen to audio books while you cook dinner like I do. Listen to podcasts when you're exercising. You might ask yourself, what are you doing for Black History Month in your church, public library, community center or family? These can be spaces where you gently encourage more conversations about this history. This invitation and recommendation to break the silence might sound small and insignificant, but it's actually big. Our country is still afraid to talk about its difficult histories. Heated battles are erupting all over the country. The anger that you see is in part fear. And yet I hope that you can see this history is devastating, but it is not something to fear. And it is not something that needs to create additional divisions among us. It is part of our collective human story. This history breeds grief. I had to give a talk at West Point. I was thinking a lot about patriotism before giving that talk. And I reflected in thought love of country does not mean papering over our imperfections and sweeping them under the rug, pretending they're not there. We can look ugliness in the face and use it to inspire deeper levels of action, of justice, of care and commitment to our nation. This is actual love. Love that is resilient in the face of the imperfect, not love of a myth or a shadow, but flesh and blood reality. We need you to break the silence because the stakes are actually life and death. What we believe about one another leads to grave harm. We must find ways of speaking honestly and intelligently about our past. We need more people opening up conversations, removing the taboo and changing the culture of silence by breaking the silence. My second invitation and recommendation is to know thyself. We bring ourselves to any action that we take, including much of what I'll be discussing in the afternoon sessions. Our own personal internal work must be an ongoing part of our strategy. For example, developing self-awareness, particularly through mindfulness practices, has been shown to minimize bias. Studies show that mindfulness appears to target prejudice indirectly by lessening our cognitive biases. Mindfulness is a practice that invites non-judgmental, compassionate presence toward the self and others. It fosters the ability to recognize our thought patterns, our emotional hooks, and improve our emotional regulation. For all of us who are invested in creating a more inclusive culture and a sense of belonging, means that we will at times have to deal with difficult, sensitive, charged topics that are fraught with vulnerability. We need the internal resources to keep us steady, compassionate, open, and generous. And as a mindfulness practitioner myself, I can attest to the rich values that can accrue to such practice. This is also what Rhonda McGee refers to as the inner work of racial justice. McGee writes, mindfulness is about having a regular daily commitment to a kind of practice that is about awakening and awareness in a very deep way. That is ongoing for one's life. Combating bias requires that we create spaciousness in ourselves to understand how we hold various forms of bias in our own brain, body, and experience. Mindfulness allows us to look within and see how we've been trained and conditioned. To know thyself is also one of the five competencies advocated by biologist Brian Dewsbury in his deep teaching model for the STEM classroom. It's part of his evidence-based teaching guide. For Dewsbury, self-awareness is essential to the inclusive STEM classroom because without knowledge of self, we are unaware of how we internalize various social norms that may no longer serve. Self-awareness helps us gain clarity about how our identities might impact our relationship with students and shape classroom and institutional culture. Dewsbury, who is a black immigrant from the Caribbean, takes the implicit association test every semester. He sees it as a never-ending journey. My third invitation and recommendation is to always question how the category of race is being used. This is particularly relevant for those involved in or who hope to be involved in clinical medicine and research. Is race being used to describe social inequities or biological difference? After all, race has no biological foundation. However, doctors have been trained over these hundreds of years to see race. And as this July, 2021 article explains, race continues to be misused as a proxy for genetic ancestry and ethnicity when it comes to medical diagnosis, treatment and outcomes, often with harmful consequences. It's also clear from the genetic data that there are no clear boundaries in terms of genetic ancestry that correlate with what we call races in the US. For example, if you are of African descent and you had a C-section previously and you are now pregnant, the vaginal birth after cesarean calculator gives you a much lower chance of success with a vaginal birth. And this is because of its race-based algorithm. The doctor is more likely to recommend that you have a C-section. You are subjected to an unnecessary surgery, which puts you at risk for blood loss, infection and a longer recovery period. Just last year, race was removed from the algorithm. And this calculator is one of several clinical algorithms being scrutinized in this way. Race has been assumed to be a causal mechanism in a range of health outcomes rather than the social determinants of health. For example, blacks are assumed to have lower pulmonary function because of their race, an idea that developed during slavery. It actually began with Thomas Jefferson. However, most studies conducted on pulmonary function since 1922 have failed to show why such a difference seems to exist. It's our habit to turn to race as an explanatory factor because we've always done so. What we do know is that if we considered social class, if we studied neighborhoods, people's zip codes and social determinants, such as disproportionate exposure to toxic environments, we can arrive at a meaningful explanation of differences in pulmonary function. An explanation that gets at the conditions under which black people have suffered, lived and died. And so as you question and scrutinize how the category of race is being used, I would encourage you to consider, instead, approaching human health holistically. Nancy Krieger at Harvard School of Public Health writes, bodies tell stories about and cannot be studied divorced from the conditions of our existence. We, like any living organisms, literally incorporate biologically the world in which we live, including our societal and ecological circumstances. What is the story that my body is telling? The story will in fact include race, not as biology, but as a social reality as a force that curtail, constrain and shows the lives of so many. So those are the three invitations that I leave you with. Break the silence, know thyself, always question the category of race. Thank you all so much for being part of this journey today. Thank you for your attention and your interest. And I look forward to seeing you in the afternoon sessions. Thank you. Thank you so much, Dr. Roberts, for that powerful presentation. Next, virtual facilitated discussions from 1130 to 1230. We encourage you to grab lunch and join a virtual session to reflect on this powerful presentation that Dr. Roberts just delivered. These facilitated yet informative discussions is really for our campus community and Dr. Roberts will not be a part of these sessions. One session is for students and the other is for faculty and staff. This afternoon, two information Q&A sessions with Dr. Roberts will be held. One for students, a student breakout session is from 230 until 320. And she will be discussing healthcare ethics for future providers, researchers and administrators. The faculty breakout session with Dr. Roberts begins at 330 and it runs to 5 p.m. And she'll be talking about how design of STEM curriculum can advance inclusion. Thank you so much. And we look forward to seeing you at our facilitated discussions.