My policy as editor for The American Journal of Medicine (AJM) has been to avoid reviewing books despite the fact that we receive a number of courtesy copies of excellent volumes every month. Because we also receive many outstanding manuscripts, this policy preserves space for our clinical and scientific contributions. However, on a rare occasion, I have reviewed a remarkable book that has the potential to greatly influence public policy or clinical practice in the United States or beyond. So, I wish to call attention to a book that should have a major impact in the US, especially at a time when so many are working to sustain the recent progress made toward health equity in our country.
Prior to praising this scholarly text and its remarkable and courageous authors, it is necessary that I disclose that the editor and principal author, Richard deShazo, MD, MACP is a member of the AJM editorial board and a highly valued associate. deShazo recently concluded many years of successful chairmanship of the Department of Medicine at the University of Mississippi Medical Center in Jackson, Mississippi. There he had the opportunity to become friends with the surviving members of a little-known group of around 20 black physicians who took incredible personal and professional risks to be actively involved in the civil rights movement at a time when they and other African Americans were disenfranchised from organized medicine, medical education, and health care. Their objective was to improve the health of African Americans by desegregation of Mississippi hospitals and clinics, including those at the University of Mississippi Medical Center, that provided no or suboptimal heath care to blacks. In addition, they sought to obtain membership in the American Medical Association, which was denied to them but necessary for hospital privileges and continuing medical education opportunities.
In this volume, deShazo et al explore the historical context of African American physicians and their patients from prior to and after the Civil War and Reconstruction and during the Jim Crow period of legalized segregation in the South. The source material for his research included a wide variety of primary and secondary sources, some of them newly available, as well as face-to-face interviews with many physicians and other health care workers who were eyewitnesses to what occurred in Mississippi.
The initial result of this work, involving years of careful observation and discovery, was 3 review articles published in 2013 and 2014 in The American Journal of Medicine.1, 2, 3 These articles were widely discussed and praised. They were eventually awarded the AJM Excellence in Publishing Award given each year by the journal editorial board for the most important article or series of articles published during that year. deShazo’s current book, The Racial Divide in American Medicine. Black Physicians and the Struggle for Justice in Health Care,4 builds on the 3 articles published in the AJM with new material, including concise biographies and interviews with black physicians who provided health services to black and white civil rights workers and participated in the struggle for civil rights throughout the South. Most of those workers who came to Mississippi were threatened with violence and many were beaten, jailed, and in some cases, murdered.
The book also tells the story of how those same black physicians addressed attempts at intimidation by their local (white) Citizen’s Councils, Ku Klux Klan members, and bankers who called in their loans as retribution for their civil rights leadership. deShazo and colleagues also meticulously document the care these fearless African American physicians continued to deliver to their predominantly black patient population in Mississippi despite ongoing threats. Their services to impoverished patients and demonstrators and their participation in federal efforts for desegregation like the US Civil Rights Commission, were all performed pro bono.
In my opinion, every physician on the planet should take pride in the work of these amazing physicians. They lived up to the principles of the Hippocratic Oath that they took upon completion of their medical education. Reading about them made me feel proud to be a physician working in the company of so many courageous, dedicated, and selfless individuals.
deShazo prefaces and concludes the book with reference to another book, this one by South African Bishop Desmond Tutu entitled No Future Without Forgiveness.5 Tutu suggests that the pathway to racial reconciliation after periods of social injustice like those in South Africa during apartheid and the United States during the Jim Crow era should not be to forget these events, but to forgive and remember them through documentation and open discussion by all sides. I could not agree more with this sentiment. We still have a long journey ahead and implicit bias to address before we resolve the major disparities in our health care system.6
I hope that the publication of The Racial Divide4 will increase awareness and empathy concerning one of the greatest problems we have here at home. And, perhaps, it will help to bring about changes in our society that will benefit us all.
I welcome comments to this editorial and to Dr. deShazo’s remarkable book at jalpert@shc.arizona.edu or on our blog at amjmed.org.
To read this article in its entirety please visit our website.
-Joseph S. Alpert, MD
This article originally appeared in the January issue of The American Journal of Medicine.
