Racism, Sexism, Individualism and Public Health: Two PBS Documentaries Explore Their Deadly Clashes

by Mark Gabrish Conlan • Copyright © 2024 by Mark Gabrish Conlan for Zenger’s Newsmagazine • All rights reserved

On Tuesday, March 26, PBS showed two quite compelling documentaries on public health campaigns that provided an interesting then-and-now comparison and also showed how racism, sexism and America’s cult of the individual interfered with our nation’s ability to survive and respond effectively to major health crises. The first was an episode of PBS’s long-running series American Experience called “The Cancer Detectives,” about Dr. George N. Papanicolaou’s invention of the PAP Smear for detecting cervical cancer in the 1920’s and his 35-year struggle to get his test approved and routinely used.

The second, shown immediately afterwards, was the first episode of a four-part mini-series called The Invisible Shield, about public health in the U.S. and how it’s been hamstrung by an early decision to leave the responsibility for protecting the public health to individual states rather than at the federal level. Though there is such an organization as the U.S. Public Health Service (PHS), it arose largely from the system of U.S. military hospitals created by Congress in 1798 – the same year it passed the law giving states, not the federal government, overall responsibility for protecting the public health – and its Wikipedia page describes it thusly:

“PHS had its origins in the system of marine hospitals that originated in 1798. In 1871 these were consolidated into the Marine Hospital Service, and shortly afterwards the position of Surgeon General and the PHS Commissioned Corps [PHSCC] were established. As the system's scope grew to include quarantine authority and research, it was renamed the Public Health Service in 1912. A series of reorganizations in 1966–1973 began a shift where PHS’s divisions were promoted into departmental operating agencies. PHS was established as a thin layer of hierarchy above them rather than an operating agency in its own right.”

Both “The Cancer Detectives” and “The Old Playbook,” first episode in the four-part mini-series The Invisible Shield, show how Americans’ ability to protect their collective health has been affected by various outside factors, including racist and sexist prejudices as well as America’s deep suspicion of collective actions of all kinds. “The Cancer Detectives” is an unlikely tale of a dedicated, determined Greek-born medical researcher; his wife, also of Greek extraction, who emigrated with him and became his first research subject; a Japanese immigrant artist; and a Black woman doctor in Philadelphia whose father had escaped from slavery and who had overcome racism and sexism to make it through medical school and set up a practice among largely poor inner-city patients.

The Greek-born medical researcher was George Papanicolaou, who settled in the U.S. in 1913 with his wife, Mary Mavroyeni. He arrived bilingual in Greek and German but knowing almost no English, though he was able to get hired by Cornell University in 1914. The person who hired him was Dr. Charles Stockard, an anatomist and zoologist who was also a prominent activist in the eugenics movement. Eugenics was a racist pseudo-science that not only believed in the innate superiority of whites over people of color, but argued that people should select their mates according to who should pair with whom to produce the most talented, intelligent and otherwise desirable offspring.

Eugenics lost most of its credibility when the Nazis adopted it and cited it as one of their justifications for the Holocaust, but before then it was quite popular and influential. Eugenic principles were used not only to encourage the supposedly “superior” people to have more children but to forcibly sterilize the supposedly “inferior” to keep them from reproducing at all. In 1927 the U.S. Supreme Court, by a vote of 8 to 1, authorized the forced sterilization of women like the plaintiff in the case, Carrie Buck. In an opinion written by the usually progressive Justice Oliver Wendell Holmes, the Court held, “It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. … Three generations of imbeciles are enough.”

George Papanicolaou began examining the vaginal fluid first of research animals, including guinea pigs, and then his wife, using a tool called the speculum. It had been invented in the 1840’s by a researcher with his own contacts with racism: James Marion Sims. He had done his research on enslaved African-American women, who of course had no legal right not to consent to being his test subjects. For Dr. Papanicolaou, the speculum gave him the ability to examine the cells of women without having to do a biopsy – a highly invasive surgical procedure – to obtain them. Ultimately he observed that certain cells showed signs of becoming cancerous, and he realized that his test offered the chance of detecting cervical cancer well before it advanced to the stage of being untreatable.

Dr. Papanicolaou first began his researches on human women in 1925 at the Women’s Hospital of the City of New York. By 1928 he felt he’d obtained enough data to present his findings, Unfortunately, he chose to do this at a eugenics conference, the so-called “Race Betterment Conference,” in Battle Creek, Michigan in 1928. Though his presentation didn’t have anything to do with scientific racism, he presented anyway but got nowhere. Partly that had to do with the poor quality of the slides he presented, but also, according to historian Leah Hazard, the doctors there regarded biopsies as the gold standard of cervical cancer diagnosis and didn’t “understand why it would be appealing to switch from the biopsy, a painful, invasive diagnostic, to one that was arguably uncomfortable, but not painful. There probably wasn’t really a recognition that the woman's comfort and the patient’s preference would be in any way a deciding factor.”

Undaunted, Dr. Papanicolaou continued with his research, and ultimately he hooked up with a Japanese-American artist named Hashime Muriyama. Born in Japan and trained at the art school in Kyoto, Muriyama had emigrated to the U.S. and got a job at Cornell doing artists’ renderings for medical researchers. Muriyama’s skills enabled Dr. Papanicolaou to collect images that could educate doctors in just what abnormalities to look for in women’s uterine cells to indicate whether or not they’d get cancer. Unfortunately, just as the two were nearly finished with the book the doctor was writing and Muriyama was illustrating, the Japanese bombed Pearl Harbor in December 1941. Muriyama escaped internment for a bit over a year, but in March 1943 he was arrested and taken to one of the camps, ironically enough on Ellis Island, which had been the entry point for European immigrants in the late 19th century.

Fortunately, Hashime Muriyama had powerful friends most of the Japanese-American internees didn’t. Dr. Papanicolaou wrote extensive letters to everyone he could think of in the U.S. government to request Muriyama’s release. So did a lot of other prominent people. Eventually in August 1943 U.S. Attorney General Francis Biddle, just about the only person in the federal government willing to express misgivings about the internment policy in general (the U.S. military had insisted on it as a necessity and President Franklin Roosevelt didn’t think he should second-guess the military on how to fight the war; later documents were released that revealed racism, not military considerations, had been the motive behind the policy), ordered Muriyama to be freed, and he went back to work with Dr. Papanicolaou on the text that was finally published in 1946 explaining how the PAP Smear worked and what diagnosticians should be looking for to diagnose cervical cancer.

A Black Light in the White Darkness

One of the physicians who read the Papanicolaou/Muriyama book was an African-American woman doctor named Helen Dickens. She had graduated from medical school at the University of Illinois in 1934 and had settled in Philadelphia. She’d endured the racist taunts of her fellow medical students and adopted an unusual strategy to deal with them: she’d always sit in the front row of the classroom, where she couldn’t see the white men taunting her and if they wanted a clear view of the blackboard, they’d have to sit next to her. Resistance to racial oppression ran in her family; her father had escaped slavery in Kentucky, taught himself to read and write, and had abandoned his slave name and called himself Charles Dickens, after his favorite author.

“The Cancer Detectives” included an archived audio interview with Dr. Helen Dickens herself as well as reminiscences from her daughter, Dr. Jayne Henderson Brown. Dr. Dickens had got a job at the Aspiranto birthing home for Black mothers, where she was mentored by another Black woman doctor, Virginia Alexander, “The patients came to us,” Dr. Dickens recalled. “She had two rooms in her house for patients and one little room where you delivered patients. Oh, it was different. The O.B. patients stayed in nine days. Most of them were poor. People weren't able to pay, they weren't expected to pay a lot.” Dr. Dickens also did direct outreach to women in the Black community of North Philadelphia. “Going in the middle of the night, and you were going into all kinds of communities,” she said. “You were going into the homes, you were seeing all these people. You were taking responsibility for taking care of people.”

When information about the PAP Smear became available, Dr. Dickens was determined to reach out to Black women and get them to take the tests. She ran into a lot of opposition, suspicion and outright hatred from her would-be patients for the medical community in general. Part of that was a legacy of the eugenics movement; under the laws allowing forcible sterilization which the U.S. Supreme Court had O.K.’d in 1927, Black women had frequently been sterilized without their consent or foreknowledge. The procedures acquired the dark nickname, “Mississippi appendectomies.” Dickens opened a clinic to do PAP Smears at Mercy Hospital in Philadelphia, where she’d been appointed to run the cancer center in 1953 despite the stereotype that Black people didn’t need to worry about cancer because they would die from something else before they had a chance to get cancer.

Meanwhile, the first mass test of the PAP Smear as a diagnostic tool for cervical cancer was going on in Memphis, Tennessee from 1952 to 1957. It was called the Memphis Cancer Survey Project and it operated not only from established clinics but from old buses converted into mobile testing labs. “You took a van and went out to the churches in various places, and invited women in to have a PAP Smear done,” Dr. Dickens recalled of the early years when she expanded the testing program to Philadelphia. With the aid of the American Cancer Society, originally the American Society for the Control of Cancer until philanthropist Mary Lasker took it over in the 1950’s and rebranded it, raised more money for it and expanded its outreach, PAP Smears became a standard practice in women’s health. In 1958 Dr. Papanicolaou and his wife Mary were invited to the White House for a dinner with President Dwight Eisenhower. “The PAP Smear changed the landscape for cancer, for its detection, its diagnosis, management, and treatment,” Leah Hazard said at the end of “The Cancer Detectives.” “Suddenly we could envision a time when we could screen healthy people, and we could all be thriving in a new and quite exciting way.”

Public Health: Where the Victories Are Invisible

“The Old Playbook,” first out of four episodes of a mini-series on American public health called The Invisible Shield which PBS showed right after “The Cancer Detectives,” was largely centered around the fact that the triumphs of public health campaigns are invisible. They’re measured in intangibles: how many people don’t get sick, what giant outbreaks of disease don’t happen. Though “The Old Playbook” touches on the entire history of U.S. government responses to disease and real or threatened epidemics, it focused largely on the response to COVID-19 from 2020 to date and the bizarre political and social divisions that arose in response to the threat and the various ways individuals in government, medicine and science responded to it.

It brought to mind my own reactions to COVID-19, especially after the mass government-ordered lockdowns began in March 2020. In a post to the Zenger’s Newsmagazine blog on March 23, 2020, “SARS-CoV-2 and the Rush to Judgment” (https://zengersmag.blogspot.com/2020/03/sars-cov-2-and-rush-to-judgment.html), I wrote, “The advent of the SARS-CoV-2 virus and the COVID-19 pandemic it is causing has hit the human race like a whirlwind. Less than two months after the World Health Organization (WHO) identified it as a global health threat (though they hung back from calling it a ‘pandemic’ — a worldwide epidemic — for another month after that), nations, states and cities are taking drastic actions to stop it that countries usually don’t take unless they’ve been directly attacked in a war. I started writing this article about a week ago — March 16, 2020 — and already the state of California has taken actions I would have considered unthinkable then. On Thursday, March 19 California Governor Gavin Newsom essentially declared public life illegal in this state.”

Two months later, in a post called “Life During Wartime” (https://zengersmag.blogspot.com/2020/05/life-during-wartime.html), I had calmed down just a little. I began the post with a quote from Johann Wolfgang von Goethe’s poem “Song of the Flea,” a satire about how a lowly flea gets elevated by the Russian Czar and the other nobles are afraid to scratch themselves for fear of killing the Czar’s new favorite, to indicate how “[t]his submicroscopic package of RNA, proteins and a lipid coat has done what the armed forces of Germany and Japan were unable to do to the U.S. in two world wars: end professional sports and live concerts, shut down the Broadway theatres and make millions of Americans essentially prisoners in their own homes. It has caused almost all the world’s advanced industrial countries to bring their economies to a skidding halt and zoomed the U.S.’s unemployment rate from 3.4 to 14.7 percent in just one month (from February to March 2020). It threatens to start a long-lasting worldwide depression rivaling the one from the 1930’s.”

Ironically, my husband Charles and I were not among the millions who were made “essentially prisoners in their own homes.” He was (and still is) a grocery clerk and I, until a health crisis entirely unrelated to COVID-19 forced me to retire in December 2021, two years earlier than I’d hoped to, was an in-home caregiver. Both were considered “essential occupations” under the terms of the lockdown orders, so we went on working throughout the worst of the pandemic, albeit under some level of anxiety and a few dirty looks as we used the buses to go to work (I’ve never learned to drive and Charles has a driver’s license but not a car) and wore face masks as instructed. In fact, both of us still wear masks on the buses even though they’re no longer required. And fortunately the U.S. and the rest of the world have largely, if not totally, recovered from the economic effects of the COVID-19 lockdowns and the fears of “a long-lasting worldwide depression rivaling the one from the 1930’s” haven’t materialized.

In my “Life During Wartime” post, I unwittingly pointed out the same problem public-health authorities have in general, a dilemma made in The Invisible Shield: no one remembers the epidemics that don’t happen. “For the last 50 years epidemiologists and virologists have been screaming their little heads off about one virus or another that was supposed to cause a pandemic and kill millions of people worldwide,” I wrote. “Remember Legionnaire’s Disease? Swine flu? Swine fever? SARS? MERS? Ebola? Zika? None of these materialized as pandemics. Even AIDS, as devastating as it was to the Gay male community and the other so-called ‘risk groups,’ never became a general threat in the developed world, either because the virus was so weakly transmissible (according to the HIV/AIDS mainstream, your likelihood of getting infected from a single unprotected sexual contact is one in 500) or, as I’ve believed all along, because it was never a viral disease at all.”

There’s no way we can run a controlled experiment on whether the interventions we made to stop the spread of SARS-CoV-2, the virus that causes COVID-19, actually worked. Nor would we want to. What’s certain is that the interventions themselves – particularly the lockdowns – created a massive backlash that led in some cases to physical threats against individuals in elective office and appointed positions. One of the worst effects of Donald Trump’s Presidency and his continuing campaign to regain the office is the extent to which they’ve legitimized political violence in general, and violence against people perceived by Right-wing extremists as being in the way of their so-called “freedom” in particular.

According to director Jason Kliot and the other people behind The Invisible Shield, the collapse of America’s confidence in its public health system began with Ronald Reagan and his election as President in 1980. Reagan explicitly challenged the notion that individuals had any responsibility to come together for collective action to solve the nation’s dilemmas. The show included the famous clip from early in Reagan’s Presidency when he said, “Government is not the solution to our problems. Government is the problem.” It was an ethos that trashed the whole idea of collective responses to anything, including public health. It was what was behind Reagan’s fabled unwillingness even to mention AIDS from the White House (or anywhere else) until 1987, just one year before his second term expired.

One of the arguments made in The Invisible Shield is that America has done a decent job of responding to public health emergencies once they occur but a thoroughly lousy effort to maintain the capacities to deal with them before they happen. It seems that the U.S. mobilizes to deal with each new epidemic and then forgets the lessons we learned and lets those capabilities go. Ironically, it’s what we used to do with our military as well: we’d build it up to fight each new war and then let it go to pieces, shrinking the war budget and letting go both the people and the industrial capacities we’d built up to fight and win the last war. We stopped doing that with the military after World War II, when the rise of the Soviet Union, the Communist takeover of China and other factors kicked off the Cold War and led to the creation of a permanent military-industrial complex that has made the U.S. the country that spends more on its military than the next 25 nations in the world combined.

But we’ve never similarly prioritized public health. When Ronald Reagan took office, his officials looked for things they could cut in the domestic budget to fund his desired expansion of the military and tax cuts for the rich, and one of the things he zeroed in on was the “War on Cancer” Richard Nixon and Congress had declared in 1969. As a result, the nation’s cancer virologists zeroed in on AIDS and attributed it to a virus they’d previously been studying as a potential cause of cancer so they could keep their labs funded. In the later years of Barack Obama’s Presidency, he’d set up a task force in the White House to develop ways to fight a new, emerging virus that might cause an epidemic, or even a pandemic. When Donald Trump succeeded him, he immediately disbanded that task force, so America was left essentially defenseless when SARS-CoV-2 hit and the COVID-19 pandemic began.

The reason the first episode of The Invisible Shield was called “The Old Playbook” was because, suddenly confronted with the threat of COVID-19, public health officials and state and local governments reached for measures that had been in place to fight previous viral epidemics. One of the most fascinating reports during the height of the COVID crisis was one on 60 Minutes showing what medieval governments had done to fight plague – including requiring people to wear face masks outdoors (the masks back then were quite a bit fancier than the ones now, including giant nose covers that looked like beaks) and stay at least six feet apart from each other. People were encouraged to carry long sticks so they could push away anyone else who came too close to them. It struck me that even in an era where no one had any idea that germs even existed, much less that they could cause disease, humans still intuited that diseases were transmitted between people based on proximity, and one way to minimize your risk is to keep others at a distance.

At the height of the COVID pandemic, Turner Classic Movies showed a 1950 film called The Killer That Stalked New York (reviewed by me at https://moviemagg.blogspot.com/2021/02/the-killer-that-stalked-new-york.html). At least loosely based on a true story, it dealt with the threat of a smallpox epidemic unwittingly sparked in New York City by a lounge singer whose husband was a crook. I posted about this movie to my moviemagg blog on February 7, 2021, and one of the things that most impressed me was it showed the mayor of New York publicly getting inoculated with the smallpox vaccine as an example to the rest of the city’s residents to do so as well.

“One of the most powerful scenes in the movie is the one in which the mayor summons the CEO’s of the leading pharmaceutical companies and essentially demands that they drop everything else during the present emergency and just produce smallpox vaccine – and his shame campaign works.” I wrote. “There’s also a brief acknowledgment of an anti-vaccine campaign similar to the ones we’ve seen around COVID – though unlike today’s anti-vaxxers, the ones in the movie stop at legal demonstrations and don’t actually try to disrupt the vaccinations. Though the New York vaccine campaign – both as depicted in this film and the real one that occurred in 1947 – had several advantages over the one today (they were only trying to vaccinate a city, not an entire country; and the smallpox vaccine was an established product that companies knew how to produce, and it required only one vaccine dose instead of the two needed for COVID), the biggest difference between then and now was an aggressive government response that grabbed the emergency by the proverbial tail and did not allow the disease to become a political football.

“If today’s health crisis is virtually an object lesson in how not to respond to a public-health emergency – especially in the contemptible response of ex-President Trump and his consistent belittling of the threat and anyone who wanted to take it seriously – the depiction of one in The Killer That Stalked New York is an example of how to deal with one,” I added. Unfortunately, the political polarization we saw emerge over COVID-19 has only increased even as the immediate threat has receded. Donald Trump found that out to his cost when one of his usually ultra-faithful rally audiences actually booed him when he urged them to take the COVID-19 vaccine. Ironically, rushing the vaccine through development under what he called “Operation Warp Speed” was one of the few things about COVID Trump actually got right (though it took Joe Biden’s administration to distribute it effectively), but so many B.S. conspiracy theories got floated around the vaccine and so many of Trump’s supporters believed them that vaccination against COVID became yet another victim of America’s intense political polarization.