A Covert Script: The AMA's fight against racial inclusion in US healthcare

Abstract

In 2008 the American Medical Association (AMA) formally apologized to African American Physicians for 150 years of racial discrimination. The report sparked attempts to remedy injustice by establishing an equity committee and by denouncing AMA leaders and AMA events that led to discriminatory practices. By 2008 the AMA lacked control over the medical establishment that it had largely created, and its admission of wrongdoing barely mentioned the very core of the AMA’s Zeitgeist constructed through the scientific debasement of African American bodies, an edifice that exists even today.In this paper I will argue that American healthcare grew and prospered by relying on a medical-racial script that relegated African American bodies to the realm of dangerous alterity while degrading African American medical providers. This script germinated during the colonial and liberal epochs of American history and blossomed after the AMA seized regulatory control over the cogs of American medicine in the early 1900’s. The marginalization and exclusion of African American medical providers from mainstream orthodox medicine constituted not a series of racist acts by people within defined moments, but rather a foundational building block of modern healthcare. During its Progressive rise, and especially after the publication of the Flexner Report in 1911, the AMA silently used racial exclusion as a means of elevating the status of its white members and its own organizational hegemony. To understand the fabric of racial caste in healthcare provision requires us to transcend demonizing certain individuals and isolating certain moments in time during which the AMA engaged in racist acts. The AMA did not create the nation’s medical-racial script, but nor did it dispute it, relying on it throughout its existence to establish its own scientific status and to bring white orthodox doctors under a singular dogmatic roof. It is not possible to understand the rise of corporate, scientific, and academic medicine in this country without placing our gaze on its racial roots. This paper will explore America’s medical-racial script from its origins in the colonial period, its growth during the liberal period, and its ascension during the Progressive period. The AMA became the singular architect of our current corporate healthcare system, and for over 50 years after it crafted the Flexner Report in conjunction with corporate entities, its overseer. During its entire existence it promoted the medical-racial script, but aside from a singular moment in 1870, it never uttered racial depredations, nor did it ever interact with a growing African American professional medical class, relying instead on silences and neglect to construct its medical juggernaut. The science of racial degradation had become so normalized by the time even of the AMA’s birth in 1847 to render it as scientific fact, freeing the AMA from discussing it even as its leaders utilized it to build its base of power. This is not a tale of a few bad players or deplorable events, as the AMA apology suggests, but rather one of persistent racial alterity that catalyzed orthodox medicine’s triumph in the twentieth century and beyond.