Chapter 10: Medicine in a Pluralistic Society
Social Context: Women, Men, and Biomedical Research makes use of the following sources:
“FDA Drug Safety Communication: FDA Approves New Label Changes and Dosing for Zolpidem Products
and a Recommendation to Avoid Driving the Day after Using Ambien CR,” U.S. Food and Drug
Administration, May 24, 2013;
“GUMC Expert Leads Charge for Gender Equity in Preclinical Research,” Georgetown University Medical
Center, June 20, 2014; Annaliese K. Beery and Irving Zucker, “Sex Bias in Neuroscience and Biomedical
Research,” Neurosci. Biobehav. Rev. 35, no. 3 (2011): 565–572; Lesley Stahl, “Sex Matters: Drugs Can
Affect Sexes Differently,” 60 Minutes, February 9, 2014; V. Simon, “Wanted: Women in Clinical Trials,”
Science 308, no. 5728 (2005): 1517; Roni Caryn Rabin, “Labs Are Told to Start Including a Neglected
Women’s Health Watch, “Experts Recommend Low–Dose Aspirin to Prevent Stroke in Women,” Harvard
Health Publications, May 1, 2009; Tayla Holman, “Women and Heart Disease Statistics and Facts,”
Healthline, April 10, 2012; “Drug Safety: Most Drugs Withdrawn in Recent Years Had Greater Health Risks
for Women,” U.S. Government Accountability Office, February 9, 2001; Tara Parker-Pope, “Women’s Heart
Symptoms Often Blamed on Stress,” The New York Times, October 13, 2008; Cardiovascular Research
Foundation, “Study Reveals That Signs of Heart Disease Are Attributed to Stress More Frequently in
Women Than Men,” EurekAlert!, October 12, 2008; Richard M. Steingart et al., “Sex Differences in the
Management of Coronary Artery Disease,” The New England Journal of Medicine 325 (1991): 226–230,
doi:10.1056/NEJM199107253250402; John Z. Ayanian and Arnold M. Epstein, “Differences in the Use of
Procedures between Women and Men Hospitalized for Cornoary Heart Disease,” The New England
Journal of Medicine 325 (1991): 221–225, doi:10.1056/NEJM199107253250401; “ ‘Medical Sexism’:
Women’s Heart Disease Symptoms Often Dismissed,” KABC-TV, November 2, 2011;
Bias in U.S. Clinical Trials, Finds Men—Not Women—Underrepresented in Most Research,” Johns Hopkins
Bloomberg School of Public Health, April 30, 2001; Melinda Wenner Moyer, “Drug Problem: Women Aren’t
Properly Represented in Scientific Studies,” Slate, July 28, 2010; Nicholas Wade, “Researchers See New
Importance in Y Chromosome,” The New York Times, April 23, 2014; Carl Zimmer, “Seeing X
Chromosomes in a New Light,” The New York Times, January 20, 2014; Alice Dreger, “Where’s the
Rulebook for Sex Verification?” The New York Times, August 21, 2009; Xia Yang et al., “Tissue-Specific
Expression and Regulation of Sexually Dimorphic Genes in Mice,” Genome Research 16 (2006): 995–
1004, doi:10.1101/gr.5217506; and Roni Caryn Rabin, “The Drug–Dose Gender Gap,” The New York
Times, January 28, 2013.
Case Presentation: Policing Pregnancy relies on Lisa Belkin, “Is Refusing Bed Rest a Crime?”
The New York Times, January 12, 2010; Susan Donaldson James, “Pregnant Woman Fights Court–
Ordered Bed Rest,” ABC News, January 14, 2010; Letitia Stein and Curtis Krueger, “Pregnant Woman’s
Involuntary Hospitalization Raises Legal, Ethical, Medical Questions,” Tampa By Times, January 26, 2010;
Julie D. Cantor, “Court-Ordered Care—A Complication of Pregnancy to Avoid,” The New England Journal
of Medicine 366, no. 24 (2012): 2237–2240; Paul Christopher Estaris Torio, “Nature Versus Suture: Why
VBAC Should Still Be in Vogue,” National Advocates for Pregnant Women; Patricia Salber, “Pregnancy and
Autonomy—Just Whose Body Is It Anyway?” The Doctor Weighs In, June 17, 2012; Howard Minkoff and
Anne Drapkin, “In re A.C.,” Hastings Center Report 40, no. 6 (February 2012); Martha Neil, “Pregnant Pro
CD003576; Judith A. Maloni, “Lack of Evidence for Prescription of Antepartum Bed Rest,” Expert Rev.
Obstat. Gynecol. 6, no. 4 (2011): 385–393; Sarah Bilston, “Don’t Take This Lying Down,” The New York
Times, March 24, 2006; Emily Oster, “Against Bed Rest,” Slate, August 19, 2013; J. A. Maloni, “Antepartum
Bed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth,” Biol. Res. Nurs.
12, no. 2 (2010): 106–124; Julie Deardorff, “Value of Bed Rest for Pregnant Women Questioned,” Chicago
Tribune, January 29, 2011; “Legal Interventions During Pregnancy: Court-Ordered Medical Treatments and
Legal Penalties for Potentially Harmful Behavior by Pregnant Women,” JAMA 264, no. 20 (1990): 2663–
2670; Sarah Kliff, “Court Cases Tackle Fetal Rights,” Newsweek, January 18, 2010; Bill Kaczor, “Fla.
Woman Fights Ruling That Kept Her in Hospital,” Seattle Times, January 26, 2010; Jennifer Portman,
“Court Hears Pregnant Woman’s Appeal,” Tallahassee.com, January 17, 2010; Bonnie Steinbock, Life
Before Birth: The Moral and Legal Status of Embryos and Fetuses (New York: Oxford, 1992); Terry E.
Case Presentation: The Tuskegee Syphilis Study—Bad Blood, Bad Faith is based on the
classic study by James H. Jones, Bad Blood: The Tuskegee Syphilis Experiment, New and Expanded
Edition (New York: Free Press, 1993) and Alison Mitchell, “Survivors of Tuskegee Study Get Apology From
Clinton,” The New York Times, May 17,1997. For an analysis of the roots of long-standing distrust of
medicine in the African American community, see V.N. Gamble, “Under the Shadow of Tuskegee,”
American Journal of Public Health 87, no. 11 (1997):1773–1779.
Social Context: Race, Poverity, and Disparity—A Crisis in Public Health draws on the
following sources: William H. Frey, “New Projections Point to a Majority Minority Nation in 2044,” Brookings
Institution, December 12, 2014; Bill Chappell, “For U.S. Children, Minorities Will Be The Majority By 2020,
Census Says,” NPR News, March 04, 2015; Kenneth D. Kochane.; Elizabeth Arias, and Robert N.
Anderson, “How Did Cause of Death Contribute to Racial Differences in
Salamon, “Poorer Blacks May Face Higher Odds of Heart Disease,” U.S. News and World Report, May 27,
2015; Laura Shin, “The Racial Wealth Gap: Why A Typical White Household Has 16 Times The Wealth Of A
Black One,” Forbes, March 26, 2015; “Poverty Rate by Race/Ethnicity,” The Henry J. Kaiser Family
Foundation, October 22, 2015; Nicholas Kristof, “When Whites Just Don’t Get It,” The New York Times,
August 30, 2014; Nicholas Kristof, “Tearing Down the Confederate Flag Is Just a Start,” The New York Times,
June 24, 2015; Philethea Duckett and Samantha Artiga, “Health Coverage for the Black Population Today
and Under the Affordable Care Act,” The Henry J. Kaiser Foundation, Jul 24, 2013; Rakesh Kochhar and
Richard Fry, “Wealth inequality has widened along racial, ethnic lines since end of Great Recession,” The
Pew Research Center, December 12, 2014; Christopher Ingraham, “White people are more likely to deal
What can one prosecutor do about the mass incarceration of African-Americans?” The New Yorker, May
11, 2015; “Criminal Justice Fact Sheet,” NAACP, October 22, 2015; Bruce Drake, “Incarceration gap
widens between whites and blacks,” Pew Research Center, September 6, 2013; Joshua H. Tamayo-
Sarver, Susan W. Hinze, et al., “Racial and Ethnic Disparities in Emergency Department Analgesic
Prescription,” Am J Public Health 93, no. 12 (December 2003): 2067–2073; John Hoberman, Black and
Blue: The Origins and Consequences of Medical Racism (Berkeley: University of California Press, 2012)
34–5); Rebecca Dube, “World of hurt: Minorities get less treatment for their pain,” NBC News, November
For further background, see M. G. Marmot, G. D. Smith et al., “Health Inequalities among British
Civil Servants: the Whitehall II Study,” Lancet 337 (June 8, 1991):1387–93. Marmot’s findings are the basis
for his book The Status Syndrome: How Social Standing Affects Our Health and Longevity, (Holt
Paperbacks: 2005). See also Patricia Cohen, “Forget Lonely. Life Is Healthy At the Top,” The New York
Times, May 15, 2004; and Katie Hafner, “Think the Answer’s Clear? Look Again,” The New York Times,
August 30, 2010. Also see the following and related data on race and health from the Henry J. Kaiser
health disparities, see Thomas A. LaViest, ed., Race, Ethnicity, and Health: A Public Health Reader (San
Francisco: Jossey-Bass, 2002).
Case Presentation: BiDil and Beyond—The Controversy Over Race-Based Medicine draws
on the following New York Times articles: Andrew Pollack, “Big DNA Files to Help Blacks Fight Diseases,”
May 27, 2003; Nicholas Wade, “Articles Highlight Different Views on Genetic Basis of Race,” October 27,
2004; and “Race-Based Medicine, Continued,” November 14, 2004; Stephanie Saul, “U.S. to Review Drug
Intended for One Race,” June 13, 2005; Stephanie Saul, “FDA Approves a Health Drug for African-
Americans,” June 24, 2005; editorial on BiDil, “The First Race-Based Medicine,” June 19, 2005; Nicholas
Case Presentation: The Bouvia Precedent—Patient Autonomy or Disability Discrimination?
makes use of the following New York Times articles: Judith Cummings, “Husband Opposes Wife’s Wish to
Starve to Death,” December 9, 1983; “Judge Prepares to Rule on Death Plea,” December 13,1983; and
“Plea by Patient for Starvation Barred by Court,” December 17, 1983. From UPI, “Court Allows Patient to
Refuse Solid food,” November 3, 1983; “Patient’s Bid to Refuse Food Termed Suicide,” December 6, 1983;
“Hospital to Discharge Woman Seeking Death,” December 25, 1983; “Quadriplegic Will Appeal Order on
Force-Feeding,” December 27, 1983; “Court Rejects Decision in a Force–Feeding Case,” March 16, 1986;
and “Quadriplegic Loses Plea to Retain Morphine,” April 23, 1986; Associated Press, “Coast Hospital Ends
Effort to Oust Quadriplegic Who Asks to Starve,” January 18, 1984; and “Forced-Feeding Figure in New
Court Fight,” April 22,1986; Wayne Biddle and Margot Slade, “Withdrawal’ or Suicide?,” December 11,
1983; “Doctors Delay Discharge of Paralyzed Woman,” December 29, 1983; Walter Goodman,
Case Presentation: Lee Larson and Cochlear Implants uses information from: Alicia Ouellette,
“Hearing the Deaf: Cochlear Implants, the Deaf Community, and Bioethical Analysis,” Valparaiso University
Case Presentation: Intersex Care—Beyond Shame and Surgery draws on the following
sources: Bryce Wolfe, “Interview with Pidgeon,” Intersects, December 13, 2009; Susan Donaldson James,
“Intersex Babies: Boy or Girl and Who Decides?” ABC News, March 17, 2011; Kat Kinsman, “Intersex
dating: Finding love across the intersection,” CNN, April 15, 2014; Sarah Terez-Rosenblum, “Crush of the
Month: Pidgeon Pagonis,” Chicago Sun-Times, September 29, 2013; “OAS IACHR Intersex Human Rights
Hearing,” YouTube, Apr 7, 2013; Benedict Carey, “John William Money, 84, Sexual Identity Researcher,
Dies,” The New York Times, July 11, 2006; Jesse Walker, “The Death of David Reimer,” Reason, May 24,
2004; Emily Greenhouse, “A New Era for Intersex Rights,” The New Yorker, December 30, 2013; Ariel
Levy, “Either/Or: Sports, sex, and the case of Caster Semenya,” The New Yorker, November 30, 2009;
Information for Social Context: The DSM and Sexual Minorities came from David Healy, “The
Latest Mania: Selling Bipolar Disorder,” PLoS Med. 3, no. 4 (2006): e185; E. J. Brown, “The DSM-V: Where
Is Mental Health Treatment Heading?” Advance 28, no. 10 (2012): 10; Marcia Angell, “The Illusions of
Psychiatry,” The New York Review of Books, July 14, 2011; Gregory M. Herek, “Facts About
Homosexuality and Mental Health”; “Sigmund Freud: Letter to a Mother of a Homosexual,” Fordham
University; “The History of Psychiatry & Homosexuality,” LGBT Mental Health Syllabus; Liam Hoare, “The
Barely Remembered Gay Victims of the Nazi Concentration Camps,” Slate, January 27, 2015; Katharine S.
Milar, “The Myth Buster,” Monitor on Psychology 42, no. 2 (2011): 24; Jamie Scot, “Shock the Gay Away:
Secrets of Early Gay Aversion Therapy Revealed,” Huffington Post, August 28, 2013; Ira Glass, “81
Words,” This American Life, January 18, 2002; “APA Applauds Supreme Court Decision Supporting Same–
Sex Marriage,” American Psyciatric Association website, June 26, 2015; Stephen Vider and David S.
The Chapter 10 Briefing Session utilized the following sources: Alice Dreger, “Is Anatomy
Destiny?” TED Talks, June 2011; Howard Brody, The Future of Bioethics (Oxford: Oxford University Press,
2009); A. Lincoln and G. Vidal, Lincoln: Selected Speeches and Writings (New York: First Vintage Books,
1992), 120–121; Martin Luther King, Jr., “I Have a Dream,” August 28, 1963, transcript, American Rhetoric;
Arthur Caplan, James McCartney, and Dominic Sisti, Health, Disease, and Illness: Concepts in Medicine
(Washington, D.C.: Georgetown University Press, 2004); Samuel A. Cartwright, “Diseases and Peculiarities
of the Negro Race,” DeBow’s Review XI (1851); Kevin White, An Introduction to the Sociology of Health
and Illness (Thousand Oaks, CA: Sage, 2002), 41, 42; Alexander Thomas and Samuell Sillen, Racism and
Psychiatry (New York: Carol Publishing Group, 1972); Emily Largent, “The Civil Rights Movement and the
of Hypertension in African-Americans,” Scientific American, February 1999, 56–63; K. Wolf-Maier et al.,
“Hypertension Prevalence and Blood Pressure Levels in 6 European Countries, Canada, and the United
States,” JAMA 289, no. 18 (2003): 2363–2369; Richard S. Cooper et al., “An International Comparative
Study of Blood Pressure in Populations of European vs. African Descent,” BMC Medicine 3 (2005): 2,
doi:10.1186/1741-7015-3-2; Jay S. Kaufman et al., “The Contribution of Genomic Research to Explaining
Racial Disparities in Cardiovascular Disease: A Systematic Review,” American Journal of Epidemiology
181, no. 7 (2015): 464–472; “Risk of Fatal Heart Disease Higher among Black Men, Women,” UAB News,
November 5, 2012; Lindsey Cook, “Why Black Americans Die Younger,” U.S. News & World Report,
January 5, 2015; “Breast Cancer Rates by Race and Ethnicity,” Centers for Disease Control and
Prevention, August 20, 2015; “Age-Adjusted Rate per 100 of Civilian, Noninstitutionalized Population with
Federal Data Suggests,” The New York Times, June 3, 2013; “Criminal Justice Fact Sheet,” National
Association for the Advancement of Colored People; Cheryl Katz, “People in Poor Neighborhoods Breathe
More Hazardous Particles,” Scientific American, November 1, 2012; Jane Kay and Cheryl Katz, “Pollution,
Poverty, People of Color: The Factory on the Hill,” Environmental Health News, June 4, 2012; Christopher
Ingraham, “White People Are More Likely to Deal Drugs, but Black People Are More Likely to Get Arrested
for It,” The Washington Post, September 30, 2014; David Pace, “Minorities Suffer Most from Industrial
Pollution,” NBC News, December 14, 2005; Margaret Lock and Vinh-Kim Nguyen, An Anthropology of
Biomedicine (Oxford: Wiley-Blackwell, 2010); Carl Zimmer, “White? Black? A Murky Distinction Grows Still
Murkier,” The New York Times, December 24, 2014; Bill Plante, “Surprising Link Found in Obamma’s
Family Tree,” CBS This Morning, July 30, 2012; Choe Sang-Hun and Norimitsu Onishi, “South Koreans
React to Shooting in Virginia,” The New York Times, April 18, 2007; Editorial Board, “The Quest for
(New Haven, CT: The American Eugenics Society, 1926); “Sterilization,” Eugenics: America’s Darkest
Days; Bill Sizemore, “Va. 2nd State to Pay Victims of Forced Sterilization,” Detroit Free Press, March 22,
2015; Paul Lombardo, “Eugenic Sterilization Laws,” Image Archive on the American Eugenics Movement;
Edwin Black, “The Horrifying American Roots of Nazi Eugenics,” History News Network, September 2003;
Lutz Kaelber, “Eugenics: Compulsory Sterilization in 50 American States”; Harry Hamilton Laughlin,
For further background, also see New York Times articles by: P.T. Kilborn, “Black Americans
Trailing Whites in Health, Studies Say,” January 26,1998; S.G. Stolberg, “Cultural Issues Pose Obstacles in
Cancer Fight,” March 14, 1998; Richard Rothstein, “Linking Infant Mortality to Schooling and Stress,”
January 6, 2002; Editorial Board, “Subtle Racism in Medicine,” March 22, 2002; James Sterngold, “Los
Angeles Inner City Beset by Chronic Health Problems,” May 2, 2002; S.G. Stolberg, “Racial Disparity Is
Found in AIDS Clinical Studies,” May 1, 2002; Nicholas Wade, “Race Is Seen as Real Guide to Track
