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©2022 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

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The Walter C. Alvarez Award is named 

in honor of Walter C. Alvarez, MD, a pio-

neer in the field of medical communica-

tion. The award is presented to either a 

member or nonmember of the American 

Medical Writers Association (AMWA) to 

honor excellence in communicating health 

care developments and concepts to the 

public. The Alvarez Award is presented 

during AMWA’s Medical Writing and 

Communication Conference.

Hello. I want to begin by thanking the 

American Medical Writers Association 

(AMWA) for the Walter C. Alvarez Award. 

I’m deeply honored and very happy to 

join this august company of award win-

ners. I’d like to share with you a bit of my 

odyssey as a medical writer, including 

some of the very important influences  

on my work and on my perspective.

 My odyssey as a journalist and med-

ical writer has been one of expanding my perceptions of 

what that means. Like many people, I became interested in 

both science and then writing early on. Although I wasn’t 

quite sure how to integrate these 2, I perceived becoming a 

medical writer as a mission of translating science for every-

day people and helping them to make the best decisions for 

their health and welfare and for that of their family and of 

society. That certainly is an important part of our mission, 

but with science comes human values.

 I also have embarked on a discovery of things beyond 

pure science—human endeavors, human concerns, human 

biases and limitations, as well as human ethics and goals 

and motivations that also affect our role as medical com-

municators. Now it seems rather clear to me that science is 

not limited to data—a compendium of information and a 

bloodless analysis—but rather, it appropriates every human 

endeavor. Moreover, it’s not only the values of humanity that 

affect science but also its limitations. The same limitations 

that cause people to express bias, prejudice, a narrowing 

of one’s perceptions, a narrowing of one’s horizons…these 

things affect science, too.

 As Thomas Kuhn, author of The Structure of Scientific 

Revolutions tells us, aside from the strictly logical theories 

and hypotheses that enchant us all and that we rigorously 

adopt, there’s also the effect of politics and of racial con-

cerns and concerns around gender. Anything that affects 

human societies also weighs in and has some effect on the 

science that emanates from them. Winston Churchill prob-

ably said it most succinctly when he pointed out that “his-

tory is written by the victors.” We have a view of scientific 

endeavor and achievement and even science’s purpose, that 

is shaped by the values of people who are triumphant, who 

are dominant, who are telling their story through the history 

of science and through science as an endeavor.

Harriet A. Washington, MA / Writer and Medical Ethicist, Fellow of the New York Academy of Medicine, 
New York City, NY

2021 Walter C. Alvarez Award Address
The Journalistic Structure of Medical Revolutions 

CONFERENCE

Image 1. Carte Blanche, as well as other books written by Harriet A. Washington, and an article 
written by Washington on the removal of the statue of Dr James Marion Sims in New York 
City’s Central Park.

http://www.amwajournal.org


AMWAJournal.org     45The Journalistic Structure of Medical Revolutions 

 Dr Felix Okoye, a professor of African history, said basi-

cally same thing: “Don’t let the lion tell the giraffe’s story.” As 

we look at the history of science, a history whose first draft is 

written by medical journalists, we come to understand that 

much more than bloodless numbers affect science. I didn’t 

know this at the beginning. At the beginning, I was given a 

very different idea of my mission as a medical writer.

WHO CAN BE A SCIENTIST? WHO CAN INTERPRET 
SCIENCE?
My first job as reporter was at my college newspaper, like a 

lot of people. I was quickly confronted—in a polite but very 

powerful way—by the editors who gathered together to talk 

to me. The only thing they had to say was, “How can you be 

an objective journalist?” This was the 1960s, a time of racial 

tension on campus, and they pointed out that as an African 

American, I would almost certainly be promulgating the 

experiences and the aims of African Americans, and I could 

not be objective. And if I could not be objective, how could I 

be a good journalist?

 I was a bit shocked by that and quickly pointed out that 

one could say that of any ethnic group; I mean, why are you 

singling me out? I didn’t understand why they were singling 

me out at the time. Later, I came to understand that it had to 

do with who is perceived as someone who can be a scien-

tist, and for that matter, who can be a journalist. We’ve long 

had the attitude in society that only certain people can be 

scientists, that objectivity is out of reach for certain people. 

Notably, for a time, we thought women could not be objec-

tive for various reasons, and it was also felt that African 

Americans couldn’t be objective.

 But one’s definition of “objectivity” actually shrouds the 

uglier bias: That certain people are simply not equipped to 

craft an analysis that is devoid of unwanted emotional or 

social perspective that would “pollute” pure science. Donna 

Haraway articulated this point very powerfully when she 

pointed out that the word objectivity has come to stand for, 

in many cases, the requisite tone of the White male scien-

tist, who was assumed to be without these kinds of encum-

brances, to be objective by nature. That’s actually a flaw in 

our society—we assume certain people can be objective by 

nature. Of course, objectivity itself, as we know, is a bit of an 

elusive goal.

 This idea of who can be a scientist spills into who can be 

a medical journalist. For a while, I tried to hew to this ideal 

of someone who was demonstrating that yes, I can be objec-

tive. Yes, I can discuss things without invoking the messy 

business of race or of social frictions or, for that matter, of 

women’s concerns. Discussing the science, writing about 

science, analyzing science, without polluting it with these 

concerns, became something that I set as a goal for myself. 

It was a goal shared by many of the people that I wrote for 

and worked with.

 I remember, around the same time, in the 1970s, being 

told that medicine was an unrealistic career goal for me. 

I originally wanted to be a doctor, but I was told that no, 

there were no Black women doctors, and Black women were 

simply not suited for medicine, without more explanation 

than that. So having sterling grades and all the experiences 

that one would normally associate with being a good candi-

date didn’t seem to matter. I simply was constitutionally not 

an appropriate candidate. At 16 years old, I didn’t know any 

better. I’ve never since let someone tell me what I can and 

can’t do in that manner.

 Up to that point, I was used to being encouraged by my 

academic guides and leaders and teachers, so I believed 

them. I don’t believe them anymore. And as I matured and 

learned more about who can and cannot be a chronicler of 

science and what is and isn’t an appropriate addition to sci-

ence, I began to understand that my mission had changed. 

My mission was no longer to be a translator, simply trans-

lating science without any presumptions or bias, but to ana-

lyze and also criticize science when it was appropriate.

ACADEME AS CATALYST
Criticizing science was very difficult because doing so 

seemed to evoke hubris. And yet I saw racial bias in the 

hospital that I worked in during the 1980s. I also saw racial 

bias in reporting about medicine and science. This troubled 

me. How do you counter that and still adhere to promul-

gating scientific rigor? I felt it must be possible, but I didn’t 

see examples of this until I was fortunate enough to land a 

journalism fellowship at Harvard School of Public Health 

(HSPH) in 1992. They selected 3 medical journalists a year.

 The years at HSPH inspired me to venture beyond trans-

lation and focus on divining the medical truth by navi-

gating conflict of interest, financial bias, sexist, and later, 

racist assumptions. I was exposed to thought leaders, 

“The key role of writers in the evolution of medical 
thought and practice has been both exaggerated 
and, at key junctures, effaced. Writers are blamed 
for failings that they share with an inherit from 
scientists. Medical news has been a catalyst for 
change when it revealed momentous events such 
as ‘Mississippi appendectomies,’ the abuses at 
Willowbrook, and the USPHS study at Tuskegee.” 

– Harriet A. Washington

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AMWAJournal.org     46The Journalistic Structure of Medical Revolutions 

public health leaders, ethics leaders, very powerful, bril-

liant people who were advancing public health and medi-

cal ethics. The director, Bob Meyers at the time, was deeply 

invested in us and in our holistic education as medical writ-

ers. He put me in touch with people like Jonathan Mann, 

Larry Gostin, Allan Brandt. This opened an entire world for 

me. I began to see my mission as something that encom-

passed both my desire to address troubling facets of medical 

problems in this country and also being true to my desire to 

be a rigorous chronicler of science.

 None were so transformative as Marcia Angell and 

Patricia Thomas. We were lucky enough to meet Marcia 

Angell while she was editor of The New England Journal 

of Medicine. By challenging the conventional wisdom that 

medical practice and research were purely motivated by 

scientific rigor, she pointed out the immense corporate 

influence on any number of conflicts of interest, which had 

nothing to do with scientific accuracy and everything to do 

with promulgating power and money in the hands of people 

who held it. In meeting her and hearing her talk about her 

work so fearlessly, I felt I’d been given permission to look 

into things that troubled me, to see whether they were as 

accurate and rigorous as I’d been told or, perhaps, whether 

they were also being affected by conflicts of interest. And 

that was revelatory.

 Patricia Thomas, who was then editor of Harvard Health 

Letter, commissioned me to write some pieces, but I learned 

more from her than simply as a medical editor. She was 

also challenging conventional wisdom, in part by looking 

at the reporting around women’s issues. And one of the 

very basic tenets was that very often journalists were writ-

ing reports that did not include the perspective of women’s 

health experiences. Thomas, who took me to my first AMWA 

meeting in 1993, helped me to see beyond the role of trans-

lation and generating accurate useful messages from med-

ical journals, to then seeing the unsupported assumptions, 

subtle and missing data, unasked questions.

 An example was the “inappropriateness” of including 

women in research because of their hormonal fluctuations, 

pregnancies, and monthly cycles—messy things that would 

disturb the pristine data, conclusions, and health portrait 

that could be gleaned only by investigating that 150–pound 

White male. And just like Marcia Angell, Thomas was fear-

less and pointed out that this is wrong—you’re excluding 

more than half the population and emerging with a very 

inaccurate picture.

 These fearless women, these fearless scientists, made 

me see that my mission was something deeper. I wanted 

to certainly promulgate medical truth, but I also wanted to 

look at deeper truths. How were women being mischarac-

terized and affected by medical missteps? How were people 

of color being affected?

 That became my mission which I have devoted myself 

to for 20 years. I could not have done it without the exam-

ples set by these other scientists early on. I followed this up 

with a few years at Harvard Medical School where I was a 

medical ethics research fellow and emerged with my first 

important work, which was Medical Apartheid, essentially a 

correction of the history of medicine, which has systemati-

cally excluded the experience of people of color.

 I went on to teach ethics at Columbia University. I teach 

a course on journalism and bioethics in which I talk about 

parallels between medicine and journalism. Very often we 

find scientists and physicians accusing journalists of sensa-

tionalism. Quite frankly, I can’t say that we were innocent, 

but they also share these limitations. I remember, very fre-

quently, having articles disparaged by scientists who’ll say, 

“ah, that’s not accurate,” and more to the point, “it’s written 

to sell more papers and attract more attention.”

 And yet, at the School of Public Health, I remember 

during the very first year being mystified by how many pro-

fessors who, after having the students introduce ourselves, 

would flock to me. They didn’t flock to the people who were 

brilliant, had done research, worked in the developing 

world, done all kinds of fascinating science. They flocked to 

me because they wanted media attention. A lot of these sci-

entists had biotech companies, and they understood that 

media attention could help them to attract investors, and 

they wanted to know if I could help them do that.

 There’s nothing wrong with seeking attention if it doesn’t 

interfere with the accuracy and ethics of your work. But to 

accuse journalists of that when the field itself engaged in it 

is really not fair. When I worked at USA Today, I interviewed 

a doctor who astonished me by asking, “Can you get me on 

Oprah?” He also was seeking attention for his work.

 I had been told that when I worked at USA Today, any 

scientist I called would call me back immediately. That had 

not been my experience, but they would call back because 

it was USA Today, which at that time had a large circulation. 

Therefore, accusations of sensationalism or sloppy reporting 

can frankly go in both directions, as can less than rigorous 

standards. It’s important to remember that and perhaps not 

become defensive about it.

AN APOLOGY AND A BANISHMENT
During the 20 years that I have done the work I felt greatly 

blessed and enabled to do by meeting these fearless sci-

entists, there have been a few things that stand out as 

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AMWAJournal.org     47The Journalistic Structure of Medical Revolutions 

especially significant. One was a 2008 apology from the 

American Medical Association (AMA) to the nation’s Black 

doctors based on a paper that my coauthors and I wrote 

and published in the Journal of the American Medical 

Association (JAMA) in July 2008.1 I then popularized the 

report findings in a piece I wrote for The New York Times.

 The apology was a good sign, but what’s really import-

ant about apologies is what happens afterward. In this case, 

what happened afterward was very promising. There were a 

few projects that AMA and the National Medical Association 

worked on together, a committee to end health care dispar-

ities and such things, that were the lasting significant events 

emanating from that apology.

 The other event that I’m especially satisfied with was in 

2018, the banishment of the statue of Dr James Marion Sims 

from Central Park. This was after I had detailed the unethi-

cal nature of his research with enslaved Black women who, 

of course, could not give consent. The statue sat right across 

from the Academy of Medicine in New York. Women living 

in the area—mostly Black and Hispanic women—cease-

lessly besieged City Hall and the Parks Department to have 

the statue removed. They did so with assistance from mostly 

White medical students who also lived in the area. This hap-

pened 10 years after I had given a talk at the Academy of 

Medicine in which a medical student jumped up and said 

we ought to tear his statue down.

 These are 2 really important things I have had a role in 

bringing attention to.

AN EROSION OF INFORMED 
CONSENT, A CALL TO 
ACTION
I’m still working on the third 

thing, and it is something that I 

hope other medical writers will 

find worthy of looking into. In 

fact, we might need a ground-

swell of attention. It’s my con-

tention that informed consent is 

waning in US research. Two laws 

have passed that formally allow 

research to be legally conducted 

without people’s permission or 

without, even, their knowledge. 

And many, many enterprises are 

burgeoning.

EROSION OF CONSENT2,3

•  Department of Defense obtained a waiver to force  

8.9 million ground troops headed to the Persian Gulf 

to be inoculated with experimental anthrax vaccines. 

(1990-2005)

•  Poor Black women in North Carolina were forced into 

racialized nonconsensual drug studies. (1994)

•  New York City law enforcement officials helped 

researchers to coerce Black parents to enroll their boys 

in a study that south to establish a genetic propensity 

for violence without their consent. (1994-1995)

•  Modifications to the Code of Federal Regulations  

(21 CFR 50.24) permits investigators to conduct 

research with trauma victims without their knowledge 

or consent. (1996)

•  Northfield Laboratories ran a national trial in which 

ambulance crews randomly administered blood  

substitute PolyHeme to unconscious victims of car 

accidents, shootings, and cardiac arrests. (2003)

•  Resuscitation Outcomes Consortium is recruiting 

21,000 subjects in the United States and Canada to 

test experimental drugs and devices for severe injury 

and cardiac arrest without consent.

Image 2. Screenshots of articles Washington has written on lack of consent in medical research.

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AMWAJournal.org     48The Journalistic Structure of Medical Revolutions 

 My concern is that there is little attention to this—people 

simply don’t know. Unless we take a stance and examine 

this ethically and determine whether it’s the way we want 

to conduct medicine and science in this country, I’m afraid 

people won’t realize it until it’s too late, until we’ve lost 

informed consent. I don’t know if you’ll agree with me, but 

I hope that people will at least think about this and whether 

they think it’s worth their time.

 Here’s a copy of the article that we wrote for JAMA 

detailing the treatment of African American doctors by 

White doctors and The New York Times article accompa-

nying that. And here are some pieces I wrote about how 

informed consent is being slowly and insidiously taken 

off the table in American medical research. And here’s the 

book I published just this year, Carte Blanche, in which I 

talk about the erosion of informed consent, how the law is 

allowing informed consent to be dispensed with, and how 

the pandemic is, not surprisingly, escalating this tendency.

 I want to share an 

image with you. Dr Sims’ 

statue was carted away 

from Central Park and 

banished to Brooklyn, out 

of sight, and I was there.

RESEARCH IN THE 
DEVELOPING WORLD
The final thing I wanted 

to touch on is something 

that medical journalists 

should be writing about 

more frequently and, 

perhaps, should take a 

departure from much of 

the ethical literature. We 

are using the developing world more and more frequently 

to conduct research on which our medications are predi-

cated. And yet, informed consent in the developing world, 

is—if anything—less frequently observed than it is in the 

United States. That’s been a concern for a very long time. 

Some researchers, for a very long time, have cast a rather 

jaundiced eye toward informed consent in the developing 

world, offering various reasons why it’s not appropriate, or 

efficient, or convenient. But the question is, is it right? Is it 

ethical to dispense with it? I say no.

 I think that sometimes we have failed to understand the 

ethical breaches because they’re cloaked in language that 

hides them. If you look at the 2014 West African Ebola epi-

demic, the outbreak was deeply concerning, not because 

of the loss of life, the many illnesses, but because there was 

a potential remedy, Zmapp, that was being promulgated. 

Only a few doses were available and discussions about who 

would get the medication troubled me greatly. There was 

a consensus that it should be given to White and Western 

caregivers and not be given to West Africans.

 The excuses covered the gamut. Some people said the 

caregivers have to survive in order to treat people, so they 

should get it first. I can see prioritizing them, certainly. But 

withholding it from Africans was excused by saying that, 

well, Africans don’t really trust Western medicine, it would 

be a waste, they wouldn’t take it anyway, they wouldn’t take 

it properly. And some people, including Dr Kent Brantly, 

who treated West Africans and contracted Ebola, said they 

can’t really understand the informed consent as I can.

 At the end, Brantly received it, but Sierra Leone’s chief 

virologist, Dr Sheik Umar Khan, was never told it was avail-

able. He died without ever receiving Zmapp. The discussion 

around that was rather uninformed sometimes. One CNN 

doctor–journalist said, you can’t give it to Africans because 

the medication has been only tested in monkeys, and now if 

you give it to Africans, people will say that that sounds racist. 

And I thought, surely, he must know that by law, every medi-

cation must be tested in animals first. I don’t know if he did or 

not. But his opinion seemed to carry the day.

I had a discussion with CNN about it.4

Interviewer: You know, you bring up a point that I have cer-

tainly heard among some friends of mine just asking this 

question, you know, who is it to decide, at the end of the 

day, who lives, who dies. Who gets this drug if, in fact it, you 

know, manages to help these Americans or not?

Washington: Right. Well, that is the obvious question. 

And certainly, no one intends to withhold the drug from 

Africans. But for economic and historical reasons, that is 

precisely what tends to happen. It’s not an accident that 

they, so far, have not had access to it, which I hope will 

change as more becomes available. There are economic rea-

sons, a network, to which Westerners tend to have access 

but not people from developing countries that influences 

who gets scarce drugs.

Interviewer: Let me flip the script because we could be 

having, Harriet, a very different discussion if the headline 

instead were “experimental drug only used in monkeys and 

now being tested on West Africans.” I mean, I think that 

there would be outrage that people would be saying they’re 

being used as guinea pigs.

Image 3. Sims statue being removed 
from Central Park.

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AMWAJournal.org     49The Journalistic Structure of Medical Revolutions 

Washington: Well, those people would be wrong because 

it happens all the time. We have to remember that the way 

our system of testing drugs is designed, some people are 

always the first to get a drug. And increasingly, those people 

are people in the developing world where now 2 out of every 

5 clinical trials are being held… So, it’s frequently the case 

that these people are the first to get a drug that’s been tested 

in animals. And that’s perfectly acceptable—we’ve decided 

those are acceptable risks. What is important and what is 

not acceptable, sometimes, is the way in which the trials are 

administered and conducted.

Interviewer: What about the drug maker itself and the 

fact that, you know, this had only been tested, according 

to Sanjay Gupta, you know, in monkeys and now this is the 

first time it’s being used in humans. Your point just being 

that this happens—we just don’t talk about it as often?

Washington: No, my point is that this is actually more akin 

to the normal course of things than it looks. Our clinical 

trials are set up so that every drug that is tested in humans 

has to first be tested in animals. But if you think about it, 

some group of humans is always the first group to get the 

drug tested in them before any other humans. So, there’s 

always a case that there are…are people who are initially 

tested. The questions arise when who these people are 

seems to be a product of some kind of bias, whether it’s 

intentional or economic or some other kind of bias.

 And when the testing violates ethical principles that are 

very well entrenched like informed consent, what we are 

frequently hearing about, in the Third World, are trials in 

which there’s not informed consent. As we would expect to 

have in Connecticut, someone explain to us, according to 

our laws, what the drug is, what the known side effects are, 

what the possible results of taking a drug are, all the possi-

ble options of taking a drug, these are very carefully spelled 

out in our law in the Code of Federal Regulations. But once 

researchers begin testing drugs abroad, all too often, these 

rules fall by the wayside, and there’s not as much oversight, 

so it’s easy to cut corners abroad. That is actually the prob-

lem—not the fact that some people become the first group 

to get the medication.

Interviewer: I’ve got it.

 Today we remain in the throes of difficult ethical deci-

sions about the people in the developing world who are 

testing medications, making them possible for us to use, 

and then ending up without access to those medications 

themselves. What we’re going to do will be the result of how 

well we’re able to analyze what’s happening and what the 

various people’s rights and needs are. Medical journalists 

will play a key role in that. If we thoroughly look at all the 

issues and promulgate them, whether or not these are the 

issues being discussed by doctors and ethicists, then we will 

have fulfilled our mission to help us make the best deci-

sions. If we fail to do that, then we will not.

 I want to express, in closing, my deep, deep gratitude at 

not only having had the chance to pursue things that I think 

are really important but also to widen my horizons to be 

able to address what I think is important. Whether or not I 

look objective enough to suit other people, the example of 

the seminal scholars that I’ve learned from and the semi-

nal writers who have fearlessly explored what they thought 

was key—without regard to what others thought about their 

objectivity—has meant everything to me.

 Again, I thank you very much. And thank you for listen-

ing to me.

Acknowledgment

I thank Nadine Odo, CCRC, ELS, FACRP, Medical Writer and 

Author’s Editor, Augusta University, for her help in bringing 

the transcript to the page.

Author declaration and disclosures: The author notes no com-
mercial associations that may pose a conflict of interest in rela-
tion to this article.

Author contact: haw95@aol.com

References
1.  Baker RB, Washington HA, Olakanmi O, et al. African American 

physicians and organized medicine, 1846-1968: origins of a racial 
divide. JAMA. 2008;300(3):306-313.

2.  Washington HA. Non-consenting adults. Slate website. Published 
January 22, 2012. Accessed October 2021. https://slate.com/
technology/2012/01/the-nuremberg-code-set-up-to-protect-the-
human-subjects-of-research-is-being-routinely-ignored.html

3.  Washington HA. Carte Blanche: The Erosion of Medical Consent. 
Columbia Global Reports, 2021.

4.  Washington HA. Make more Ebola drug and give it to Africans. 
CNN website. Published August 6, 2014. Accessed October 2021. 
https://www.cnn.com/2014/08/06/opinion/washington-ebola-
zmapp-drug-africa/index.html

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