Is Race-Based Medicine Good for Us?: African American Approaches to Race, Biomedicine, and Equality (original) (raw)
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From race-based to race-conscious medicine: how anti-racist uprisings call us to act
The Lancet, 2020
and countless others-coupled with horrifying statistics about the dispro portionate burden of COVID-19 on Black and Brown communities-have forced the USA and the world to reckon with how structural racism conditions survival. Although clinicians often imagine themselves as benef cent caregivers, it is increasingly clear that medicine is not a stand-alone institution immune to racial inequities, but rather is an institution of structural racism. A pervasive example of this participation is race-based medicine, the system by which research charac terising race as an essential, biological variable, translates into clinical practice, leading to inequitable care. In this Viewpoint, we discuss examples of race-based medicine, how it is learned, and how it perpetuates health-care disparities. We introduce raceconscious medicine as an alternative approach that emphasises racism, rather than race, as a key determinant of illness and health, encouraging providers to focus only on the most relevant data to mitigate health inequities. Research in clinical medicine and epidemiology requires explicit hypotheses; however, hypotheses involving race are frequently implicit and circular, relying on conventional wisdom that Black and Brown people are genetically distinct from White people. 1 This common knowledge descends from European colonialisation, at which time race was developed as a tool to divide and control populations worldwide. Race is thus a social and power construct, with meanings that have shifted over time to suit political goals, including to assert biological inferiority of dark-skinned populations. 2 In fact, race is a poor proxy for human variation. Physical characteristics used to identify racial groups vary with geography and do not correspond to underlying biological traits. Genetic research shows that humans cannot be divided into biologically distinct subcategories. 3,4 Furthermore, ongoing overlap and mixture between populations erodes any meaningful genetic difference. 5 Despite the absence of meaningful correspondence between race and genetics, race is repeatedly used as a shortcut in clinical medicine. For instance, Black patients are presumed to have greater muscle mass than patients of other races and estimates of their renal function are accordingly adjusted. 6 On the basis of the understanding that Asian patients have higher visceral body fat than do people of other races, they are considered to be at risk for diabetes at lower bodymass indices. 7 Angiotensin-converting enzyme (ACE) inhibitors are considered less effec tive in Black patients than in White patients, and they might not be prescribed to Black patients with hypertension (table). 1,6-28 We argue
What’s Wrong with Race-Based Medicine?
2011
This article is based on the 2010 Dienard Memorial Lecture on Law and Medicine at University of Minnesota and part of a larger book project, Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century (The New Press, 2011). In June 2005, the Food and Drug Administration approved the first pharmaceutical indicated for a specific race. Its racial label elicited three types of criticism – scientific, commercial, and political. I discuss the first two controversies en route to what I consider the main problem with race-based medicine – its political implications. By claiming that race, a political grouping, is important to the marketing of drugs and that race-based drugs can reduce health disparities, which are caused primarily by social inequality, those who promote racialized medicine have made this a political issue. Yet, having made these political claims, these very advocates answer criticism by saying we must put aside social justice concern...
Race to Health: Racialized Discourses in a Transhuman World
DePaul journal of health care law, 2015
DEPAUL JOURNAL OF HEALTH CARE LAW things should give us pause. Historically, biological race has only been used to justify subordination and segregation. It has served no benign purpose. In addition, the emerging explanatory power of biological race follows closely in time the resurrection of eugenics as a medical and social practice. 6 Against this background, a debate about the desirability of transhumanismthe use of biotechnology to enhance human mental and physical capacitieshas formed. Proponents of transhumanism point to the hope that science could substantially prolong human life, make us smarter, and free of genetic defects. Others worry that new technologies will also be used to for social control, for eugenic purposes, or that in the process of enhancing ourselves, humans will lose the experiential or other basis that makes us "human." Proponents and opponents have alternately framed transhumanism as the next frontier and a no-human's land. The debate, in part, reflects hopes and fears about the role of science in society, differences in ways of defming progress and the boundaries of humanness, and varying degrees of faith in our governing institutions. Not surprisingly, the debate is framed in nearly exclusively modernist terms. Perhaps just as unsurprising is that while participants in the debate address the possibility that enhancement technology use could create inequalities between the enhanced and the not-enhanced, the debate barely addresses the possibility that a transhumanist world may be a racist world. Nor does the debate consider the role that biological race may play in this world. If there is anything we have learned about the power of racialization is that it is far-reaching. As ahistorical as transhumanism may seem, novel uses of biotechnology and their potential to reformulate our understandings of humanity and human will not necessarily and finally disrupt the power of racialization. Nor will the apparent race-neutrality of the transhumanist debate make the future so. Enhancement technology use is already intertwined with racial ideology, including the notion of biological race. The formation of biomedical knowledge takes place in a sociopolitical context that shapes it content. In other words, science is an interpretive process and therefore, a product of cultural, social and political forces. 7 Biology, and genetics in particular, are often, and in 6 TROY DUSTER, BACKDOOR TO EUGENICS 4-5 (2d ed. 2003).
Introduction: Critical Race Theory and the Health Sciences
American Journal of Law & Medicine
This symposium volume begins with a simple provocation: race and racism are central to the development of medicine and the health sciences. 2 If pursuits of health equity are to be taken seriously, this repositioning of race as central rather than peripheral to science and medicine suggests that improved health outcomes and reduced disparities cannot be attained until we acknowledge that these fields are sustained by racialized social, political, and economic forms of governance. Despite the seemingly progressive and socially benevolent role assigned to the health sciences, we must expand our inquiries to understand how they are constituted by forms of reasoning, belief, and practice that cannot be decoupled from power relationships that create racial inequality. The authors in this symposium issue provide a framework for identifying the latent racism within the health sciences and in turn propose new directions for conceptualizing human difference and group disparities. Within medicine and the health sciences, race is widely understood as a "natural" part of human diversity that scientists and physicians merely observe. These fields largely assume that the visual distinctions that align with social understandings of race reflect real and meaningful biological dispositions. Tied to this is the assumption that these racialized genetic and physiological dispositions explain why certain racial groups may be sicker-or healthier-than others. From this standpoint, racism is thought to be an external social or political variable that has little to do with the processes that shape health outcomes or that influence the measurement of human differences. This perspective is not only woefully inadequate, but also affirmatively harms human health by perpetuating theories of biological race in the clinic, the lab, and within our collective imaginations.
The Indispensability of Race in Medicine
Theoretical Medicine and Bioethics, 2023
A movement asking to take race out of medicine is growing in the US. While we agree with the necessity to get rid of flawed assumptions about biological race that pervade automatic race correction in medical algorithms, we urge caution about insisting on a blank eliminativism about race in medicine. If we look at racism as a fundamental cause, in the sense that this notion has been introduced in epidemiological studies by Bruce Link and Jo Phelan, we must conclude that race is indispensable to consider, investigate, and denounce the health effects of multilevel racism, and cannot be eliminated by addressing more specific risk factors in socially responsible epidemiology and clinical medicine. This does not mean that realism about human races is vindicated. While maintaining that there are no human races, we show how it is that a non-referring concept can nonetheless turn out indispensable for explaining real phenomena.
Racial Prescriptions: Pharmaceuticals, Difference, and the Politics of Life
2014
In the contemporary United States, matters of life and health have become key political concerns. Important to this politics of life is the desire to overcome racial inequalities in health; from heart disease to diabetes, the populations most afflicted by a range of illnesses are racialized minorities. The solutions generally proposed to the problem of racial health disparities have been social and environmental in nature, but in the wake of the mapping of the human genome, genetic thinking has come to have considerable influence on how such inequalities are problematized. Racial Prescriptions explores the politics of dealing with health inequities through targeting pharmaceuticals at specific racial groups based on the idea that they are genetically different. Drawing on the introduction of BiDil to treat heart failure among African Americans, this book contends that while racialized pharmaceuticals are ostensibly about fostering life, they also raise thorny questions concerning the biologization of race, the reproduction of inequality, and the economic exploitation of the racial body. Engaging the concept of biopower in an examination of race, genetics and pharmaceuticals, Racial Prescriptions will appeal to sociologists, anthropologists and scholars of science and technology studies with interests in medicine, health, bioscience, inequality and racial politics.
The American Journal of Bioethics , 2017
Perez-Rodriguez and de la Fuente (2017) assume that although human races do not exist in a biological sense (“geneticists and evolutionary biologists generally agree that the division of humans into races/subspecies has no defensible scientific basis,” 36), they exist only as “sociocultural constructions” and because of that maintain an illusory reality, for example, through “racialized” practices in medicine. The authors convincingly postulate the removal of the ongoing practices “required by the NIH [National Institutes of Health] of utilizing racial identification as a demographic characteristic with assumed biological implications” (36), because they may unintentionally contribute “to perpetuating the fallacy of natural differences between persons of different skin color, which has been used in the past to advance the cause of racial discrimination” (36). Agreeing with the main postulates formulated in the article, we believe that the authors treat this problem in a superficial manner and have failed to capture the current state of the field of knowledge in science and the humanities. In our commentary, we want to highlight two main omissions, and to notice three important implications for “a postracial medicine.”