dpc-arcive

Dermatopathology: Practical & Conceptual

July – September 2010 | Volume 16, No. 3

Racism in medicine for profit

Ackerman, A. Bernard; Goldblum, Elyse; Yun, Jasmine

dpc1603a03 - Dedication

Contents

Preface

Foreword

Part I: Perspective historical

Parlance pertinent to “colored people” and variations on that designation derisive

Evolution of the notion of “skin of color”

Part II: Authenticity medical of “skin of color”

Definition and exegesis of terms

Justifications offered for creation of a discipline dedicated to “skin of color”

-To generate research about “racial” differences in skin and hair

-To resolve controversies about “racial” differences in (a) skin and (b) skin diseases

-To provide better treatments for “skin of color”

-To produce a literature about “skin of color”

-To give expression to altruism as a “person of color”

Fallacies inherent in the notion of “skin of color” from a vantage medical

Part III: Legitimacy ethical of “skin of color”

Ramifications of institutionalized racism in medicine

Profit from racism in medicine

Fallacies inherent in the notion of “skin of color” from a vantage ethical

Afterword

Acknowledgments

Preface

Seemingly out of nowhere in 1998, came the phrase “skin of color” and since then it has taken hold firmly in the mind of American dermatologists and in the parlance of them. The number of courses didactic devoted to that topic at the annual meeting of the American Academy of Dermatology (AAD) has risen from none in 2000 to seven accredited for Continuing Medical Education (CME) in 2007. Among the offerings listed in the “AAD Scientific Program, 65th Annual Meeting” are ones titled, “Aesthetics and Cosmetic Surgical Procedures in Darker Racial Ethnic Groups,” “Practical Approaches to Skin of Color Patients,” “Skin Cancer in Skin of Color,” “Ethnic Hair,” “Cosmetic Treatments in Ethnic Skin,” “Issues and Approaches in Skin of Color,” and “Treatment Considerations for Ethnic Hair and Scalp Disorders.” The subject of “skin of color,” much en vogue and gaining popularity ever-increasing, appears with predictability in journals various of dermatology, in courses and symposia given for CME, such as the one at the San Diego Marriott Hotel and Marina on July 26, 2006, captioned, “Natural Considerations for Skin of Color,” to say nothing of derivatives numerous of the first “Skin of Color Center” established in an “academic institution,” that being in 1998 at the St. Luke’s/Roosevelt Medical Center in New York City. The year 2004 saw the birth of the “Skin of Color Society.” An entire supplement to the Journal of the American Academy of Dermatology in 2002 was devoted to issues germane to “Skin of Color,” it being titled, “Colloquium on race/ethnicity/skin color.” So popular in 2007 is the theme of “skin of color” that the journal, Cutis, in nearly every monthly issue of it, invites submission of manuscripts for publication given specifically to “Highlighting Skin of Color.”

Some sense for the raison d’être and dynamic of the field of “skin of color” can be gleaned from these lines in 2003 of Susan C. Taylor, M.D. (Taylor SC. Brown skin: Dr. Susan Taylor’s prescription for flawless skin, hair, and nails. New York City: Amistad, 2003, page 5), perhaps the proponent foremost and most prolific of “skin of color”:

“To better serve my patients and deepen the scientific understanding of color, in 1998 I became director of the Skin of Color Center at St. Luke’s Hospital Center in New York City. When I helped establish the Skin of Color Center, it was the first such center of its kind. As the number of people of color in the United States has steadily grown to 24 percent of the population (Blacks constitute 12 percent, Hispanics 10 percent), the need for medical information and expertise specific to pigmented skin has grown. At the center – where about 90 percent of people are of color – a cadre of highly regarded dermatologists is clarifying the differences between skin of color and white skin. This groundbreaking work will soon lead to better treatments for skin of color and greater choices for you and all women of color.”

Parenthetically, it is to “women of color” that the cosmetic industry appeals as it creates more and more products designed specifically for needs it creates for them. We undertake in this work to explore comprehensively the phenomenon of efflorescence of activities in the service of “skin of color,” to attempt to explain the reasons for it, and to subject to scrutiny the matter of differences morphologic and biologic in skin, other than the fact of color and the implications for function of the integument as a consequence of that difference, as well as to assess critically the issues of “race” in general and of the place, if any, for “race” in medicine, those considerations being a preliminary requisite to coming to a judgment reasoned about the validity medically and the legitimacy ethically of “skin of color.” Because of limitations serious of the very concept of “race,” as will become apparent on perusal of the first few pages in Part II of this work, that word when employed throughout the text will be framed always by quotation marks.

This endeavor of ours is presented in such a way as to enable a reader to come to his/her own conclusions about each of the issues just mentioned, that desideratum being facilitated by presenting, as fully as possible and in their own words, the positions various of advocates and enthusiasts of the concept of “skin of color,” that being followed, in every instance, by our own vantage of those same matters. In that way, we have sought earnestly to set forth in fashion “fair and balanced” perspectives conflicting. You decide!

For more than three centuries, the United States of America was unable to be true to its own ideals because of the matter of “race,” the color of skin of many people who lived on its shores preventing those persons from being treated as human beings. Even after slavery was abolished by Abraham Lincoln, Woodrow Wilson, who came originally from Virginia, instituted during the course of his presidency segregated toilet facilities in the nation’s capital, Washington, D.C. Until the Civil Rights Movement of the 1960s, galvanized in large measure by Reverend Martin Luther King, Jr., “blacks” in the south of the country endured segregation – continuous and merciless – in every aspect of life. In regard to medicine, they were cared for mostly by black physicians who had done their training at the black medical schools of Howard and of Meharry; when seen uncommonly by a white physician, they were secluded in a waiting room for “colored” only and when hospitalized were admitted either to a strictly “colored hospital” or to a segregated ward in a city or county hospital. The lynching in 1955 of Emmett Till, a young “Negro” boy said to have whistled at a “white” woman in Mississippi, so revolted many Americans of all strata of society that not long thereafter, “Jim Crow laws,” universal in southern states, no longer would be tolerated, they being overturned by law. In short, it was not so long ago in the United States that the color of a man’s skin prevented him from being treated as a man, let alone a citizen.

Americans were slow to come to the realization of how destructive to everyone concerned was this fixation on color. Lincoln in the 19th century and King, Jr. in the 20th alerted their fellow Americans to how erosive that obsession was to human dignity of those who were “white,” as much as to those who were “black.” Leaders of the Civil Rights Movement championed the cause of a society color blind, one in which merit, not the color of skin, was the sole and ultimate arbiter.

Now, in the 21st century, some among us, paradoxically and ironically, mostly those who in that shameful past were referred to as “colored people” and who, moreover, are physicians, have reintroduced race to the culture of medicine in the form of a discipline they named “Skin of Color.” We in this Arbeit deny the proposition that there is a place in medicine for distinctions based on the color of skin. At the same time we affirm that, for purposes practical, skin is skin, whether normal or diseased, and to segregate on the basis of its color is inherently racist. Those principles animate the pages of this endeavor, one that is consummately “politically incorrect,” and it is they that galvanized us to undertake it. We are pleased and proud to have done what we believe to be socially conscionable correct.

A. Bernard Ackerman, M.D.

Jasmine Yun, M.D.

September 2008

New York City

Foreword

“Distinctions of race, nationality, color, and creed are unknown within the portals of the temple of Aesculapius.” W. Osler [1]

All human beings possess the very same organs, skin being one of them. Disciplines like internal medicine and general pathology are dedicated largely to diagnosis of disease in those organs diverse, and it is evident to practitioners of those specialties that the color of the skin of a patient whose other organs also are being assessed in no way is germane to their purpose. Of course, as is the case near always for statements declarative in medicine, there are exceptions, one notable being management of hypertension in persons whose skin has a particular color, to wit, that of Africans and African-Americans. Despite that reality, cardiologists have yet to create a niche, nor will they ever, dedicated specifically to “heart of color.” In analogy to cardiology, dermatology is the study of skin; it is not the study of “skin of color,” nor does the color of skin change in any way the actuality of the patient as person or of the disease as object for diagnosis. Nowhere is that more apparent than in dermatopathology, i.e., pathology of the skin, where diagnoses with exactness turn not a whit on the color of skin, only on the findings histopathologic themselves. What is true for microscopy conventional applies equally to other methods utilized for diagnosis of skin diseases, e.g., electron microscopy, immunofluorescence, immunohistochemistry, and molecular biology; efficacy of them is not influenced in any way by the color of skin. Once again a caveat obvious is in order: diseases inflammatory present themselves differently in “white” skin vis-à-vis “black” skin by virtue of erythema, i.e., redness, being visualized much more readily on a background white than on one black.

If the assertions just made are true, what justification can there possibly be for the field spawned recently of “skin of color”? In this monograph, we will set forth the facts as directly and dispassionately as possible, each reader being encouraged to decide on the basis of the “facts” the legitimacy of the notion of “skin of color.” In coming to a determination about that, it might be worthwhile now to contemplate a hypothetical as follows: If, say, psoriasis, fungal disease, and melanoma were much more common in whites, would that justify the creation of a special province given to “skin of non-color”?

dpc1603a03 - Part I: Perspective historical

Part II: Authenticity medical

Definition and exegesis of terms