Iatrophobia explained

Iatrophobia: an abnormal or irrational fear of doctors or going to the doctor.

Harriet Washington
17 September 2015
Imagining conspiracies


"History is written by the victors."- Winston Churchill.

“Don’t let the lion tell the giraffe’s story.” Nigerian proverb

When invited to participate in a January 2015 New York Times Room for Debate feature, I found there was no actual debate: I read the other respondents’  essays the same day other Times readers did, upon publication. When I did, I was immediately struck by an important omission. Only I had even attempted a definition of “conspiracy theory”. 

“From the Latin word "conspiratio," which means "breathe together," ‘ I wrote, “conspiracies emanate from those who work closely and in secret for a purpose that, as the philosopher Jeremy Bentham interpreted it, is evil, unlawful or both. But “conspiracy theorist," with its implications of irrational paranoia or the inability to accept the chaotic nature of catastrophe, is an even worse label that sabotages all credibility.”

Conspiracies require conspirators. This seems a tautology, but it is a fact that eludes many of those who dismiss complaints of orchestrated medical abuse and malfeasance.

The other essays shared an unsupported assumption that such theories were necessarily false and held only by the credulous or crazy, but this was hardly surprising in view of the bias revealed by the  piece’s title: “Are Conspiracy Theories All Bad?” as well as by the observation that “many conspiracy theories persist despite strong evidence to the contrary.”

The discussion was introduced without any acknowledgement that some such theories — the Watergate conspiracy, The “Tuskegee syphilis study”, and the CIA’s government-sanctioned vaccine malfeasance — are true, not imagined, events.

As my fellow essayists pondered not whether but which precise pathologies —“ suspicious and paranoid natures”, “mass cultural anxiety”  and/or  “negative social impact” most frequently characterized theorists . The stress was laid upon the limitations— moral, intellectual or psychological—held by various conspiracy theorists and denialists.

Such semantics have been deployed to rob marginalized people of credibility when they indict governments and other powerful institutions for medical malfeasance throughout a very long history. In Medical Apartheid: The Dark History of Experimentation from Colonial Times to the Present I documented among many other events, hundreds of years of salient medical abuse that was typically hidden or cloaked as benign and an equally long history of complaints being dismissed as “paranoia” “mythology” or “conspiracy theories”

Here I give a few examples of US medical events that, when decried or revealed by powerless African Americans or their advocates, have been dismissed, among with those demanding justice, as conspiracy theories.

US history of medicine has been curated to obscure the nature of questionable or exploitative  treatment of its marginalized populations, including African Americans. Semantics have been recruited in a manner that robs the complaints of the powerless of credibility. Nowhere has this exculpatory semantics been practiced so  dramatically as in the long practice of ascribing African American objections and fears not to iatrophobia but to  “paranoia” including “conspiracy theories”.

Smallpox epidemic of 1721

In 1721, an enslaved African named Onesimus owned by Cotton Mather, the Puritan preacher and amateur scientist, proposed a novel medical technique that saved the city of Boston from a dread smallpox epidemic and provided the first important medical advance in the New World. Onesimus, showed Mather how to perform  inoculation against smallpox, a successful preventive measure that was widely practiced throughout Africa.

When a smallpox epidemic revisited Boston in the summer of 1721, Cotton Mather called for a mass inoculation of the people of Boston. But the city’s physicians, led by William Douglass, resented being told by a gaggle of ministers that Africans had devised the panacea they had long sought.

The popular press served as the battleground while doctors condemned variolation because it was the laughable, “unchristian” product of occult African practices. In this case it was the physicians of Boston who subscribed to a conspiracy theory just as the Philadelphians feared that the city’s blacks were conspiring against their lives, all evidence to the contrary. 

The fact that inoculation worked seemed not to play into physicians’ assessments, and their bitter attacks were not confined to the intellectual sphere. A lighted grenade was thrown into Mather’s house, along with a note declaring, “Cotton Mather, You Dog, Dam You: I’ll Inoculate you with this, with a pox to you.” This prompted him to complain, “I do not know why it is more unlawful to learn of Africans, how to help against the Poison of the Small-Pox, than it is to learn of our Indians, how to help against the Poison of a Rattle-Snake.”

In the end, the obvious reduction of death rates—from 14 percent to less than 2 percent—convinced doctors that inoculation was the city’s savior, but Onesimus’ role was forgotten and the cure was largely ascribed to Cotton Mather.

Yellow fever epidemic of 1793

Fear of contagion and of medical abuse was dramatically abetted by epidemics  which often threw racial medical tensions into sharp relief.

Philadelphia's yellow fever epidemic of 1793 was the largest in the history of the United States, claiming the lives of nearly 4000 people. In late summer, as the number of deaths began to climb, 20,000 citizens fled to the countryside, including George Washington, Thomas Jefferson, and other members of the federal government (at that time headquartered in Philadelphia).

A mythology that had been deliberately inculcated and popularized by physicians Josiah Nott and Samuel Cartwright held that African Americans were immune to yellow fever and did not die from the disease as whites did. Even this supposed biological advantage was cast as a racial flaw. One physician denounced the “inferior susceptibility” of black slaves to yellow fever.

Philadelphia’s physicians had fled with the others, so its free black community led by Absalom Jones, Richard Allen, and William Gray … put aside their racial resentment and dedicated themselves to working with the sick and dying in all capacities, including as nurses, cart drivers, and grave diggers. Despite the belief that blacks could not contract the disease, 240 of them died of the fever.
As the weather cooled, the disease subsided, and the deaths stopped.

Instead of gratitude, accusations flew against the black citizens led by Mathew Carey, whose pamphlet attacked many in the black community for profiteering, and some even accused the black citizens of starting the epidemic to kill the city’s whites.  

Richard Allen and Absalom Jones responded by publishing A Narrative of the Proceedings of the Black People, During the Late Awful Calamity in Philadelphia in the Year 1793 and a Refutation of Some Censures, Thrown upon them in some late Publications. In addition to the baptisms and burials that took place at Christ Church and St. Peter's - 214 of the latter due to yellow fever - the broadside noted the number of burials among other congregations and denominations, including evidence that would, "convince any reasonable man ... that as many coloured people died in proportion as others." Their "bill of mortality" was published at the end of the year by the clerks and sexton of Christ Church and St. Peter's Church.

yellow fever epidemic.jpg

Yellow fever epidemic

Clinical abuse and display

Mid nineteenth century African American fears and outrage over their treatment in clinics, which were sometimes shared by sympathetic whites, tended to be dismissed as “paranoia” .

For example, an outraged owner solicited the opinion of an editor of the Richmond, Virginia, medical journals, who agreed that therapeutically unjustified surgical procedures were being performed “wantonly” upon moribund slave patients in hospitals—and even upon relatively well ones—merely to allow doctors opportunities to practice or teach techniques.

One such incident involved a slave whose master sent him to the medical school clinic for treatment of a stubborn leg ulcer. The surgeon decided to amputate the leg, surrounded by students, although no clinical indications existed for this extreme procedure. The slave complained that “his leg was cut off just to let the students see the operation and to bring the doctor as well as the medical college . . . into notice.” The journal editor investigated and then agreed, censuring the surgeon as a “heartless monster.” However, neither the name of the surgeon nor of the medical school was revealed in the journal. The outraged editor even failed to sign his name.

When Georgia physician W. H. Robert similarly decided to amputate the leg of a fifteen-year-old slave girl without making any other attempts to treat the relatively minor injury, the surgeon told his students flatly that the decision to amputate should be weighed differently according to the person’s race and class. “[Amputation] should be very differently estimated in the different classes of society.” He explained that although such an extreme remedy is a “horrid deformity” that should be the last resort for a rich man, amputating the limb of a slave was “a matter of comparatively little importance.” Students should “hesitate much less to remove a limb . . . , if he be slave, than if he be a free man, and especially a white man.” Robert supplemented his hierarchy of amputation with the familiar observation that the surgical pain felt by a slave was negligible, minor in comparison to what a white man facing the procedure would feel.

Yet in 1854, the Richmond Daily Dispatch wondered, “Among them [blacks] there prevails a superstition that when they enter the [medical college] Infirmary they never come out alive, although no where are they better treated. . . .”

Sims’ colossus

James Marion Sims (1813–1883) used enslaved black and mulatto women exclusively to perfect his invasive painful vesicovaginal surgeries, without their consent and without anesthesia. He confined them to a shack on his property, yet he referred to this as a “hospital” and to the women as “brave volunteers”.

Such benign fictions were often immortalized in  art, as in the painting by Robert Thom, which casts Sims as a medical benefactor and the women as complicit and unafraid.  And when Sims emigrated from Alabama to New York City, he took care to illustrate the journal article detailing the surgeries with pictures of white women, not black. Yet later, when black surgeon Daniel Hale Williams criticized Sims’ exploitation of the women, he found little sympathy among his medical brethren who accused him of paranoia and misunderstanding Sims’ altruistic healing.

Medicalized racial display c. 1904

 Ota Benga, a Mbuti man, known as one of many “ subhuman peoples” was exhibited at the Louisiana Purchase Exposition in St. Louis, Missouri in 1904, and in 1906 he was singly exhibited at the Bronx Zoo in a cage with an orangutan. The zoo, the news media, and scientists, accepted the contradictory self-serving tales of the impresario  who profited from Benga’s kidnapping and display. Years after the New York Times spent weeks documenting the display and the resistance to it in articles, it published a denial that he had ever been displayed in the Zoo and labeled such a belief a “myth”.

The plutonium experiments: a photograph  c. 1947

Mrs. Fredna Allen is being comforted by her daughter, Elmerine Whitfield Bell at their home in Italy, Texas. Mrs. Allen in turn holds a photograph of her deceased husband, Elmer Allen, one of at least eighteen Americans surreptitiously injected with plutonium by government scientists. When Elmer Allen sought care for a cancerous leg on July 18, 1947, doctors at the University of California at San Francisco who were secretly under an Atomic Energy Commission contract to conduct nontherapeutic experiments on unwitting patients injected him with a dose of plutonium before they amputated his leg.

Allen suspected that he has been experimentally used by these scientists, yet they denied it. Decades later, when Allen’s doctor enquired whether he had been subjected to research at the institution, the government scientists who had taken an oath of secrecy, lied to him as well, again denying that Allen has been used in research. Allen’s doctor then told his family that his suspicions had no basis in fact and diagnosed him as a paranoid schizophrenic.

Contemporary vaccine distrust in the global South: a context

In March 2000, Werner Bezwoda, a cancer researcher at South Africa’s Witwatersrand University, was fired after conducting medical experiments involving giving very high doses of chemotherapy to black breast-cancer patients without obtaining informed consent. Dr. Michael Swango was ultimately convicted of murder after pleading guilty to killing three American patients with lethal injections of potassium, but he is also suspected of the deaths of sixty others, mostly in Zimbabwe and Zambia during the 1980s and ’90s. In 1995, Richard McGown, a Scottish anesthesiologist practicing in Zimbabwe, was accused of five murders and convicted in the deaths of two infant patients whom he had injected with lethal doses of morphine. Wouter Basson, the former head of Project Coast, South Africa’s chemical and biological weapons unit under apartheid, was charged with killing hundreds of black citizens of South Africa and Namibia from 1979 to 1987, many via injected poisons. He was tried but not convicted by an apartheid-holdover judge in a South African court, even though his lieutenants testified in detail and with consistency about the medical crimes they conducted against blacks. Malicious research agendas, such as the Project Coast division that vowed to create agents to selectively harm or sterilize black Africans in the guise of vaccines, are well documented. In 2015, the South African medical association censured Basson for the killings that took place under his direction during apartheid.

Yet resistance to vaccination campaigns in Africa is typically ascribed to ignorance, superstitious fears or unsubstantiated “distrust”.

Vaccination as a CIA covert operation

Moreover, the widely publicized CIA perversion of vaccination programs as fronts for covert operations such as the search for Osama bin Laden and other political schemes has done much to feed Third World distrust of westerners proffering injections. At least one CIA sham vaccination program encouraged the spread of infection by providing only one injection of a three-dose protocol, an inadequate treatment that made people believe they were protected against disease when they in fact were not.

The practical result of all these reckless mistreatments is unambiguous: suspicious patients avoid care, and this iatrophobia, or fear of physicians, means that “conquered” diseases such as polio are seeing a resurgence on the African continent.

Even when vaccinations are delivered by the most dedicated health-care workers, poverty makes treatment in the developing world fraught with risk. Infection control to prevent the spread of disease is difficult or impossible when there is limited access to clean water and no access to the antiseptics and cleaning agents that we take for granted in the west.

smallpox epidemic_0.jpg

Smallpox epidemic

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