How Race Became a Category in the Medical World

Imagine a typical routine checkup at the doctor’s office. You get your weight and height checked. You give blood and urine samples to the doctor for routine laboratory tests that provide insight into the inner biochemical workings of your body. In your preliminary questionnaire, you check off a box that is ubiquitous on all official U.S. forms; your race. Much like your height and weight, your race is also part of your doctor’s checkup. Perhaps a blood test value increased just because you self-identify as one race over another. Medical test values are imperative to the diagnosis and treatment of critical diseases but are subject to change due to arbitrary racial classifications. A 2005 episode of the medical television show House M.D. showed a Black patient refusing to take BiDil, a heart failure drug approved by the Food and Drug Administration only for “self-identified” African Americans, to which the patient claimed “Look. My heart's red, your heart's red. And it don't make no sense to give us different drugs,” [2]. The patient takes the stance that racial classifications are unscientific and do not belong in medicine. This scene asks the question: how did racial classifications become incorporated into medical science?

In the United States, racial classifications are determined by skin color and deviations from “whiteness,” [4]. Since 2001, any NIH-funded researcher has been required to report U.S. Census racial categories of participants. These categories include American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, or White, and Hispanic/Latino or not Hispanic/Latino [2]. These are the racial categories you would likely see in any official document—including forms at medical appointments. However, the roots of race in medicine stretch back thousands of years before 2001.

A historical analysis of race indicates that it is a social construct meant to classify people based on an arbitrary set of criteria [1]. Ancient medical scholars began to look at physical characteristics to classify people and predict biological outcomes since the dawn of medicine. The ancient Roman physician Galen put forth the idea of biological and psychological inferiority based on slave status and skin color [3]. A general definition of race is that it is a category constructed by social structures rooted in white supremacy to impose power and stratification over those seen as “inferior” [1]. These ideas of race permeated Western medicine for the next 1,500 years. The 18th century Age of Reason and Enlightenment brought forth new ideas of using logic and reason to justify discrimination and hierarchy in Western medicine. Religion, nascent scientific principles, prejudice, and ethnocentric biases were used to organize and rationalize medical discoveries—which led to harmful and dangerous ideas [5]. A shocking example of this is the lexicon called “Negro Diseases” created by white physicians during chattel slavery to claim that Black people were genetically predisposed to certain medical conditions [3]. In reality, however, it was the grueling and dehumanizing environment that led to poor health in slaves [3]. These ancient ideas permeate medicine today, but we have the ability to modernize and improve our ways of treating a diverse population.

Race has no genetic or biological backing to support it [4]. According to Chadha, there are high levels of genetic variation within racial groups and less genetic variation between groups. The concept of race is an “inadequate proxy” for the genetic variations in populations because the categorization of people into racial groups is so arbitrary. Remnants of these inconsistent and ambiguous racial classifications still exist today, particularly in the American healthcare system. Compared to other high-income countries, the American healthcare system is responsible for treating a larger, more ethnically and economically diverse population. In the United States, race has been treated as a way to legally classify people in a country more diverse than many others. But, for this reason, many problematic ideas on how to treat different people have risen. For example, biomedical guidelines suggest treating hypertension differently in the non-black population versus the Black population. BiDil is an antihypertensive drug introduced in 2005 for only self-identified African Americans, which opened up the question of using race as a criterion in medicine is scientifically correct. The concept of “racial medicine” involves using the Black racial identity to crudely substitute for an actual analysis of the discriminatory factors that play into the embodiment of these conditions to Black peoples’ bodies [4].

The question of race in medicine is still being debated today. Although race is a social construct, the effects of racism have had real and lasting effects on the health of the groups of people affected by it. However, one aspect of this debate is certain: the practice of an individual’s race being used as a criterion in the modern U.S. healthcare system is a remnant of the shocking history regarding race in Western medicine.

References:

1. Bowker, G. C., & Star, S. L. (1999). Sorting things out classification and its consequences. MIT Press.

2. Braun, L., Fausto-Sterling, A., Fullwiley, D., Hammonds, E. M., Nelson, A., Quivers, W., Reverby, S. M., & Shields, A. E. (n.d.). Racial categories in medical practice: How useful are they? PLOS Medicine. Retrieved November 13, 2021, from https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.0040271.

3. Byrd, W. M., & Clayton, L. A. (2001, March). Race, medicine, and health care in the United States: A historical survey. Journal of the National Medical Association. Retrieved November 13, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593958/.

4. Chadha, N., Lim, B., Kane, M., & Rowland, B. (2020, July 28). Toward the abolition of biological race in medicine. eScholarship, University of California. Retrieved November 13, 2021, from https://escholarship.org/uc/item/4gt3n0dd#article_main.

5. Kaufman, J. S., Merckx, J., & Cooper, R. S. (2021). Use of racial and ethnic categories in medical testing and diagnosis: Primum Non-Nocere. Clinical Chemistry, 67(11), 1456–1465. https://doi.org/10.1093/clinchem/hvab164