Race, Ethnicity, and Residency

Post #2: Learning – Race isn’t Scientific

See the prior post introducing this topic.  This discussion is not meant to be comprehensive, nor are the listed resources, but I hope it can shed some light on race, science, and racial medicine.  Please contact me with any comments or additional sources.

“White man, hear me!  History, as nearly no one seems to know, is not merely something to be read.  And it does not refer merely, or even principally, to the past.  On the contrary, the great force of history comes from the fact that we carry it within us, are unconsciously controlled by it in many ways, and history is literally present in all that we do.  It could scarcely be otherwise, since it is to history that we owe our frames of reference, our identities and our aspirations.  And it is with great pains and terror that one begins to realize this.” James Baldwin, “White Man’s Guilt” in The Price of the Ticket

Photo: Ted Thai/Getty Images

Race is not inherent.  It is neither scientific nor biologic.  It was created.  Consider those statements for a moment.  They are radical – they fly in the face of what is taught and understood from grade through medical school.  For an excellent review on the history of race, read The History of White People by Nell Irvin Painter or Stamped from the Beginning: The Definitive History of Racist Ideas in America by Ibram X Kendi.  If you’d rather listen, the second season of the podcast Scene on Radio entitled Seeing White covers this well.

There are aspects of racial science that seem appalling by today’s standards. A great book that covers the bullets below and much more is Superior:  The Return of Race Science by Angela Saini:

  • Carl Linnaeus, the father of taxonomy, in his tenth edition of Systema Naturae in 1758 created a human hierarchy within the animal kingdom in the following order:  H. sapiens europacus, H. sapiens americanus, H. sapiens asiaticus, and H. sapiens afer.  Their corresponding colors of white, red, yellow, and black remain with us today.
  • Dr. Samuel Morton, the founder of anthropology in the United States, published Crania Americana in 1839 evaluating his collection of human skulls – the largest in the world – and determined from a detailed analysis of nearly 100 skulls that the Caucasian race has the largest mean internal capacity and therefore the highest intellectual endowment of all races.
  • The biologist Francis Galton, cousin of Charles Darwin, coined the term “eugenics” in 1883 from the Greek prefix eu for “well” or good”.  His intent was to use social control to improve the health and intelligence of future generations.
    • In 1907, the first involuntary sterilization law was passed in the state of Indiana (and not repealed until 1974), with eugenicists endorsing the heredity of criminality, mental health issues, and poverty.  An excellent podcast episode on this dark period of US history was produced by “Radiolab”.
    • Eugenics reached its logical culmination with the holocaust.  Karl Pearson, who is known for his contribution to statistics (he’s the “p” in p-value), was also the successor to in the eugenics movement.  He brought the below box to London, representing 30 locks of artificial hair, with the most “desirable” colors and textures in the middle.  This device was initially trialed by the Nazis during the first genocide of World War II in Namibia, where ¾ of those deemed to be “non-white” were systematically killed.
Credit: David Harrison
  • A similar Nazi scientific device utilized eye color to measure race, especially amongst the Jewish people and for similar purposes.

Comparable atrocities are well known to medicine specifically, with these serving as two examples:

  • Dr. J Marion Sims, president of the American Medical Association and founder of the American Society of Gynecology in the late 1800s, performed up to 30 procedures each on 11 enslaved, healthy women over 4 years to develop his procedure to treat vesicovaginal fistulas.  These women were provided no anesthesia even though it was available, yet used it when performing the procedure on white women a few years later.  He claimed – as was widely believed – that Blacks did not feel pain the same way as whites.
  • In 1932, the US Public Health Service began its “Study of Syphilis in the Untreated Negro Male” in six hundred syphilis-infected sharecroppers in Tuskegee, Alabama.  The investigators secretly withheld treatment and awaited death of the participants to confirm the hypothesis that syphilis more likely influenced the cardiovascular rather than neurologic system of Blacks compared to whites, in part due to the findings of Morton above that buttressed the belief that Blacks had relatively primitive and underdeveloped brains. The study was initially projected to last 6 months, but was not halted until 1972 – forty years later – when it was exposed by the media.
The Public Health Service took photographs during the Tuskegee syphilis study, but no captions remain. This is one of them.

These episodes stand out as historical reminders.  We can collectively shudder, yet feel comforted that we have moved on and are more enlightened. 

Turns out we’re not.  The protests in the streets of our nation today suggest otherwise.  Recent scientific literature also suggests otherwise.  Both are just harder to see.  Harriet A. Washington argues in her book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present these are not isolated events and relying solely on the stories fails “to discern the stubborn and illuminating patterns characterizing the medical abuse of African Americans.”

While the human genome project finished 20 years ago in June 2000 and demonstrated that “human beings, regardless of race, are more than 99.9 percent the same” and there “are greater genetic differences between individuals of the same racial group than between individuals of different groups”, our literature is filled with studies analyzing genetic differences based on race, ancestry, descent, or other analogous terms.  These are being published today.  And this is despite the fact that the US Census Bureau and National Institutes of Health (NIH) amongst many other governing bodies claim that race is “a social category recognized by the United States and does not attempt to define race biologically, anthropologically, or genetically.”

Race is not scientific.  While we may take that statement for granted, the converse remains entrenched in our profession at an institutional and individual level.  For example, in 2016 (to repeat, 2016) a study of 121 white resident physicians at the University of Virginia found that over half believed:  Blacks’ nerve endings are less sensitive than whites’ (see Marion Sims above), whites’ have larger brains than Blacks’ (see Morton above), and Blacks’ skin is thicker than whites’.

Hoffman KM, Trawalter S, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS 2016;113(16):4296-4301.

Race is not scientific.  But, race absolutely is real.  It carries social, economic, and medical significance, and to be “color blind” is perilous as a healthcare provider.  The next post covers this in greater detail.  What I want to emphasize in conclusion, though, is how important it is to not just learn about these matters, but better understand the implicit biases we carry into the exam room as a result not just of our socialization, but the historical roots of racial science that remain pervasive in ourselves and profession today.

Wearing red stained garments to symbolize the blood shed by his research subjects, protestors called for the removal of the Dr. James Marion Sims statue at Manhattan’s Central Park. Called the father of modern gynecology, his critics cite Sims’ experiments on black female slaves, without their consent.
(Howard Simmons/New York Daily News)

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