Black & Blue: The Origins & Consequences of Medical Racism by John Hoberman (review)

In Black and Blue: The Origins and Consequences of Medical Racism, the author argues that the persistence of folkloric beliefs about racial differences both inside and outside of the medical profession affects the medical treatment received by African Americans. Hoberman provides a thorough discussion of the historical legacy of this practice beginning with plantation medicine and continuing through the 21st century. Much of the book is devoted to demonstrating how deeply this practice is embedded in physicians’ thinking about the minds and bodies of their African American patients. He goes on to state that another significant issue is the lack of demand for African American physicians’ insights on race-related behaviors in the medical world.

The author contends that the current orientation of the medical profession regarding racial issues continues to preserve some dysfunctional habits. Suggestions for transforming these habits are offered with the goal of improving medical treatment for African Americans. He states that transformation of these habits is the responsibility of medical educators who supervise the training of medical students. Practical guidelines are provided to initiate changes. For example, he argues for more humanities in the curriculum of medical student’s educational experience, with the rationale that such additions to the medical curriculum would strengthen future physicians’ encounters with such frequently encountered phenomena as therapeutic fatalism. Extra instruction would introduce future practitioners to the legacy of mistrust among some of the nation’s underserved and allow them to establish better working relationships with Black patients.

Hoberman critiques cultural competency programs as a series of do’s and don’ts that define how to treat a patient of a given ethnic background (pg. 225). He states that the problem with such an approach to difference is that it oversimplifies the cultural and ethnic medical experience, a simplification that can hinder accurate medical diagnosis. He argues that the idea that physicians’ attitudes toward patients must become more empathetic and humanized is not new and has circulated in medical circles for centuries. Finally, he asserts that the medical establishment has not elected to treat the African American health crisis as an emergency and that it has not accepted racial health disparities as a fact of life.

Though the book provides a reasonably thorough review of the historical literature to back the author’s claims, it seems to see the African American experience as monolithic. This is particularly noticeable in repeated references to a shared socioeconomic status among African Americans. Such over-generalization serves to reinforce stereotypes and does not address the multiple dimensions of class within the African American population. His remarks regarding the medical establishment’s disregard for African American viewpoints neglects African American practitioners whose opinions on medical practices do make it to the media (e.g., Ben Carson, David Satcher). Despite these omissions, the book is well written and would appeal to graduate students in medical anthropology, medical sociology, African American Studies, and medicine.