How Racism Creeps Into Medicine

Braun: The short answer would be racism. The more complex answer is that they were almost alone in arguing against racism in science. Then, as now, it’s hard to shift mainstream thinking. Lung capacity difference was a deeply entrenched idea by the late 19th century.

An alternative narrative that I point out was by the physician Jedidiah H. Baxter.

Shaban: Baxter did a separate study of black Union soldiers that showed no difference in lung function, right? His findings conflicted with Gould’s.

Braun: Yes. And what’s interesting there, it gets to the tension between knowledge produced by qualitative and quantitative research: Quantitative data is stripped of context. Gould’s was just numbers assembled into a table. He hardly comments at all. His work looks very, very objective, and very scientific.

Baxter produced quantitative data, but he also included rich narratives from army surgeons in the field. These narratives are racist but the army surgeons weren’t willing to write blacks off as having lower lung capacity or that they were incapable of fighting for freedom. The two studies produced different results, and although Baxter’s narratives were acknowledged, Gould’s study is cited in science journals even today.

The argument I make is that Gould’s study looked most legibly scientific—and it drowned out Baxter, and it drowned out Kelly Miller, and it drowned out Du Bois.

Shaban: Why have environmental or socioeconomic explanations for differing lung capacity never been taken seriously over some innate racial factor?

Braun: There have been scientific studies showing that people who live around high pollution areas have lower lung capacity. High pollution areas also map onto minority status. Why we have chosen both in the U.S. and internationally to focus on race to the exclusion of social class, I can only speculate. One piece of the story is that the accumulation of scientific research around a particular idea can make it hard to dislodge. With the spirometer, having the correction factor actually built into the machine makes racial assumptions invisible.

This is a problem not just with lung capacity measurements but with health inequality more generally. There’s vastly, vastly, vastly more research on genomics than on the social determinants of health. Part of the problem is the infrastructure of science. What kinds of questions are considered scientific?

Shaban: When you look at the race categories of the U.S. census and medical dictionaries throughout history, you find a baffling array of contradiction, bias, and hierarchy. Why has race as a biological concept, rather than a social or historical one, continued to attract scientific inquiry?

Braun: I wish I had an answer to that. Why race science is getting reinvigorated at this particular moment, I think is very interesting. Why is race-as-biology being reinvigorated at a time when we are claiming to be color-blind?

One possible piece of the puzzle is: There’s a long history of using science to solve social problems. And genomics is very exciting and it seems apolitical. The actual science of it is appealing. It’s been sold to the public as a solution to health. But addressing the social aspects of racism and class and gender discrimination is not something we have taken on, or wanted to take on, for centuries.

I am not making an argument never to use race in health research.  I think the use of race as a social category is entirely appropriate to study the health effects of a discriminatory social world—but always in combination with gender and measures of class.

It’s an entirely different matter to use race as a natural/scientific category to study genetic difference.

Shaban: In the scientific community there’s this insurgent belief that political correctness is getting in the way of discovery. This argument holds that the question “Is race real?” is a scientific problem whose truth should be pursued, whereas “Should we study it?” is a different, political question, one that scientists shouldn’t be too concerned about. What’s your take on this point?

Braun: The scientific and the social are inextricably linked. From the questions that you decide to ask, from the design of your study, from the way the science is interpreted, it’s always bound up with the social.

The claim of political correctness is a silencing mechanism. And it’s usually invoked to silence social and political questioning. I think a much more productive and interesting project is to examine how beliefs and values get into science—and medical instruments.

It is difficult to convey that race is real in terms of its social impact on people's lives and health, yet it is not rooted in nature. Humans are diverse, including genetically, but classifying that diversity is fundamentally a social process.

One strong piece of evidence, something we have known since 1972, against the biological/genetic concept of race is that there is more genetic variation among individuals within conventionally defined racial groups than between individuals of different racial groups.  This has been demonstrated by numerous researchers using different methodologies.  It is clear from this evidence that looking to genes according to racial group to explain health inequality is misguided.

Shaban: Is history clear that the science of racial difference has always been used to discriminate against non-whites, minorities, or one’s enemies?

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Hamza Shaban is a writer based in Washington, D.C.

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