Gamble, a medical historian, traces the various factors which account for a general distrust and fear of exploitation in the attitude of the U.S. African-American community toward physicians and medical institutions. Today's literature might falsely paint the picture that the memory of the Tuskegee syphilis study was the single factor responsible for this fear and distrust. Gamble shows how in actuality the syphilis study is simply a metaphor and a reminder of a set of issues which are much more deep-seated and which predated the study by many decades. She begins with examples of exploitation of African-Americans as research subjects and as subjects for medical teaching dating before the Civil War and traces the examples of exploitation to the present period. Current evidence regarding the unequal treatment of black and white patients at the hands of the US medical system show that this view among African-Americans cannot be dismissed as paranoia: "The powerful legacy of the Tuskegee Syphilis Study endures, in part, because the racism and disrespect for Black lives that it entailed mirror Black people's contemporary experiences with the medical profession." However powerful the message and the metaphor of the Tuskegee syphilis study, Gamble urges us to go beyond that one historical incident in understanding the relationship between the American medical profession and its African-American patients.