A Black man receives a vaccine from a doctor

The roots of medical mistrust

In his ethics course, dentistry professor Carlos Smith teaches the dark history of medical exploitation of Blacks in America — and how to address its persistent effects

Soon after Carlos Smith, D.D.S., arrived at VCU in 2015 to teach dentistry, he came across the 2011 documentary, “Until the Well Runs Dry: Medicine and the Exploitation of Black Bodies,” directed by VCU psychology professor Shawn Utsey, Ph.D.

Watching it “floored” him.

“I thought: I have to teach this,” says Smith, who has practiced general dentistry for more than a decade and now serves as director of diversity, equity and inclusion and director of the ethics curriculum for VCU’s School of Dentistry. “In Richmond, this history is literally across the street.”

Utsey’s 51-minute film details how in the 19th and early 20th centuries, hired men called resurrectionists disinterred Black bodies for medical dissection and experimentation at the Medical College of Virginia. Body snatching to study human anatomy was common (and even tolerated) for hundreds of years, going back to the Renaissance and peaking in the 18th and 19th centuries because of a medical school boom. The cadavers were often executed criminals.

In Richmond, though, the practice was more insidious. The city’s position as a longtime hub for the domestic trade of enslaved Africans all but ensured that. 

Smith teaches some of this history in his second-year course on ethics and ethical decision-making. He added Utsey’s film to the curriculum as a way to discuss the use of Black bodies in scientific experimentation — the Tuskegee syphilis study, conducted in Alabama by U.S. government agencies from 1932-72, is a notorious example — and its connection to the present-day mistrust many Blacks have of doctors and the medical field at-large.

This addition to the class has been particularly relevant in recent years as both the COVID-19 pandemic — vaccination rates among Blacks still trail those of whites — and the murder of George Floyd and subsequent protests helped expose racial disparities in American society, health care among them. With his class, Smith tries to prepare students to understand the economic, social and environmental factors that influence health for Black people and other groups the U.S. has, historically, targeted for discrimination.

Here, Smith untangles those connections and talks about the importance of understanding these painful histories.

Carlos Smith, D.D.S.

“I have to teach this,” Carlos Smith thought after watching “Until the Well Runs Dry.” Seven years later, his dentistry course on ethics and ethical decision-making is a window into the dark history of medical exploitation. (Jud Froelich)

You said after watching the documentary that you thought, “I have to teach this.” Why?

There are a lot of unfortunate lapses in the ethical delivery of health care in the United States, particularly around race and ethnicity. For many years, there was a myth that African American people had a different pain tolerance [because of a false belief that Black people have thicker skin and less sensitive nerve endings]. That has shown up in a myriad of ways. Less anesthesia is administered because of this and prescriptions aren’t offered. Some of that is grounded in these thoughts of these differences in the body and how there was this medical exploitation of the body.

I often talk about the history of Puerto Rican women in the U.S. and how they were experimented on in terms of hysterectomy and forced sterilization. Not long ago, I was giving that example [at a seminar], and one of the attendees said that’s why she got into health care. Her grandmother was unknowingly sterilized after the birth of her mother. She just woke up and they had performed a hysterectomy.

Some of our patients are of the age that they remember stories about not crossing the viaducts [connecting Black neighborhoods to the MCV Campus] or the doctors would catch them at night. These stories seem like folklore and were maybe passed down as folklore, but we’ve discovered that they have a foundation in the truth. This is their lived experience.

That’s how I approach Richmond’s history in the class. We have medical mistrust in our vulnerable communities. What do we do about that as health care providers, particularly as dentists, when people come in with fear or anxiety?

What was the response when you started including this material in your ethics class?

I was expecting a little bit of pushback, because it’s not specifically dentistry-related. But I didn’t really get any. I think that’s because I made room to show the documentary in my course and then we had a dialogue about how patient care is affected. Some students did tell me they weren’t braced for the gore [of disinterring cadavers]. That part had never dawned on me because we work on cadavers. But now I do a preface to let them know they’re going to see some things.

It wasn’t much of a leap to go from talking about the history of how Black bodies were used for science to today’s COVID vaccination rates and how the virus affects certain communities. When you think about vaccine hesitancy, that distrust wasn’t created in a vacuum. A lot of it stems from these practices.

After the murder of George Floyd, I was surprised that in the dental school’s town hall, our students brought forth that my course had been the only course where they learned about experimentation on Black bodies. They felt there was more room in our curriculum to discuss these incidents and connect to overall health disparities and social determinants of health.

Is that changing?

We’ve done some work with our curriculum in the dental school. We started a required dental public health course in January 2022 that covers health disparities and social determinants of health. Our students also have to take a mandatory course on interprofessional communications that’s taught by our colleagues from the College of Health Professions who specialize in behavioral health. Part of that course is understanding bias in health care. And we’re developing a certificate program around public oral health and oral health equity that will also connect resident burnout and implicit bias.

When we talk about faculty and staff recruitment, I think about this course. I can almost guarantee that these issues were never discussed in a quintessential ethics of dental care course. But because of how I’m wired, because of my lived experience, because of the lens through which I view things, this information is not only taught to communities of color. It’s beneficial information to all health care providers. I hope that it allows them to have greater compassion and awareness for everyone they interact with, and that it’s a difference-maker for why we have to have a diversity of faculty and staff.

How could this knowledge shape the way students practice dentistry in the future?

Often in dentistry, we intercept the patient because they’re in dental pain, but they’re not seeing their regular physician. I had a patient when I was in private practice in Durham, North Carolina. She was a young girl, early 20s, and it came up in conversation that she was pregnant. I knew she was a smoker and I asked if she had thought about stopping smoking. Then I found she was not under the care of a physician and she was not taking prenatal vitamins. That’s not my area of practice, but I was able to have this conversation and refer her to an OB/GYN.

Maybe she would have made her way to an OB/GYN without me, but it’s important that our students understand how these things can intersect. We have to remember that it’s not just a tooth that we’re treating. That tooth is connected to an entire person. We have to have that historic understanding and know how it informs the disparities we’re dealing with today.