Abandoning the Term “Voodoo” in Medicine

Spend enough time around medical practitioners here in the United States and you will definitely hear the word “voodoo.” In medicine, the term is used to denote an absence of evidence or a superstitious practice, either as an apology for one’s own medical choices in the face of limited or contentious evidence or often as a disdainful dismissal of the medical choices of others. When my medical career began in the mid-to-late 90s, the term was already in use. I suspect it had been in use for some time, but it took on particular relevance in the evidence-based medicine (EBM) era. In the EBM context, it often signifies practices that lack sufficient evidence by EBM standards.¹  I suggest we abandon this use of the term “voodoo” to refer to medical practices of unsure or poor quality of evidence.

The problem with the use of the term “voodoo” in this dismissive or derogatory way is that Voodoo, also written Vodou, Vodun, or Vodu, is a religion. This religion grew out of the inheritances, beliefs, and experiences of mostly West African people who were enslaved and brought to the island of Quisqueya, present-day Haiti and the Dominican Republic, as well as from the dynamic experiences of their descendants as they navigated a changing world of colonial power, slavery, revolution, occupation, and dictatorship. Voodoo has direct connections to several West African and Central African religious systems and practices, including the Vodun practices of the Fon people of Benin, Togo, and Nigeria, from which it gets its name, and also shares some similarities with other rich and creative African-diasporic religious practices found throughout the Americas, such as Santería, or Lucumí, and Candomblé. Voodoo has a rich history in Haiti, the Dominican Republic, and parts of the United States, and in its variant forms continues to have a thriving community of practitioners to this day, within both the Americas and Africa. In its Haitian form, it is a religion that is organized around the veneration and service of spirits (lwa), the dead, and ancestors, all of whom mediate our experiences in the world created by Bondye, the supreme creator god. Like many Black religious systems, Voodoo involves and often centers on ritual healing practices; indeed, it may serve as much as a local alternative health care system for its adherents as it does a religious home.² 

Voodoo has a long history of generating fear and disdain in the United States that can be traced back as far as the Haitian revolution, when slaves and free Black people in Haiti revolted, eventually establishing the first free Black republic in the Americas in 1804. By some accounts, it was a Voodoo religious ceremony under the leadership of Dutty Boukman that was the catalyst for the 1791 slave revolt that started the revolution. Amid the success of this revolution, fear of similar slave revolts spread throughout much of the Americas, including the United States, in particular its southern slaveholding states. In American culture, because of racism and fear of Black power, Voodoo became associated with black magic, headhunters, Voodoo dolls, and devil worship, among other superstitious practices. As far back as the 1930s, Hollywood began depicting Voodoo as frightening witchcraft and its practitioners as evil villains, reinforcing many of these pernicious stereotypes and exporting them throughout the world. Indeed, its current use in medicine, as well as in other fields such as economics, is likely borrowed from its stereotype in popular culture. It should surprise no one that a religion mostly associated with Blackness, revolution, and poverty would become a stand-in for backward practices, superstition, or practices of poor evidence in medicine here in the United States given the long history of racism and anti-Blackness in our country.

Another good reason not to use “voodoo” as a substitute for practices of poor evidence, apart from its problematic use in our history, is that there are people in our country, who are our patients, their families and our colleagues, who practice Voodoo as their religion, particularly in areas of the country with large Haitian or Dominican immigrant populations.³  Therefore, it is important for us to be knowledgeable and considerate of the context of our use of specific language to limit negative impacts on these patients and communities. It is through such efforts that previous racist or bigoted expressions, such as the term “Indian-giver,” which, ironically, conferred bad faith dealing to those who were its greatest victims, have largely been abandoned in our popular lexicon. The cultural misappropriation of the term “voodoo” is rooted in racism, the latent racism in our society by which it is assumed that things pertaining to or stemming from Blackness are more suspect, inferior, or even dangerous, and it deserves a similar fate.

Although this problem is not specific to pediatrics, there are reasons it has particular salience in our chosen field. Most importantly, there is strong evidence that children are particularly vulnerable to both short- and long-term effects of racist rhetoric, even when it is unintentional.⁴  Children who report perceiving discrimination experience higher rates of depression and lower self-esteem.^4,5  We, as a community of child specialists, should do our best to prevent such harm and instead seek to foster the use of language that uplifts our children and our collective, diverse communities. It is now recognized that we cannot effectively care for children without centering their families as well; the extension of this is that we cannot effectively care for children or their families without appropriate and respectful consideration of their communities. Our current use of the term “voodoo” fails to show such respect and consideration. Second, although there have been recent attempts to rectify or improve the situation, historically, pediatrics has suffered from an evidence gap when compared to adult medicine.^6,7  There are fewer drugs, devices, and therapies tested in pediatric populations than adult populations and fewer large randomized or controlled studies to guide our care. If “voodoo” is used as a substitute for poor or absent evidence by EBM standards, standards which currently hold sway across our disciplines, and pediatric practice frequently relies on evidence less than the highest grade of those same standards, there may be both more opportunity and temptation to use this expression to characterize or dismiss our own medical practices or the practices of our pediatric colleagues.

At a time when people around our nation are rising up to decry racism and injustice in our police and criminal justice systems, we cannot lose sight of the important equity and justice work that remains to be done in medicine, including the many issues brought to stark public attention with the ongoing coronavirus disease crisis. It is a priority that we in the medical field engage in serious efforts to improve our health and economic systems to reduce the health burdens on the most vulnerable among us, including communities of color, while in tandem raising our own consciousness and reducing harm through better understanding and awareness of our expressions. Let us abandon the use of “voodoo” as a term in medicine, other than to refer to the religion itself or the medical and botanical practices found within the religion.

EBM

evidence-based medicine