Episode 141: Antiracism in Medicine Series Episode 2 – Dismantling Race-Based Medicine Part 1: Historical and Ethical Perspectives with Edwin Lindo

1. History matters​. Medicine has never been an apolitical field, and understanding the specific ways the medical field contributed to socio-political definitions of race through practices rooted in medical racism can help us avoid repeating the same harms of the past (e.g. racial essentialism). This education needs to span the whole MedEd continuum.

2. Definitions matter​. In research, clinical practice, and MedEd, we need to be explicit in our understanding and discussion of race vs. ethnicity vs. ancestry, and how each of these categorizations does or does not impact biological or genetic traits.

3. Bias is everywhere​. Objectivity is a top priority in medicine and research; however, history shows us how initial assumptions have tainted both study design and interpretation of results.

Conversation Starters and Reflection Questions for Trainees​ & ​Faculty

What teachings lie at the root of your belief that race has a biological basis?
– Dismantling race-based medicine starts at home by asking yourself, colleagues, and

classmates this question. Much of the data promoting biological difference amongst races comes from poorly-designed studies where race as a variable is ill-defined or confounding variables are inadequately controlled. This reflexive acceptance that race is rooted in biology comes from stereotypes created by Carl Linnaeus and other racial taxonomists.

How is racism causing the outcomes that I am seeing in my patient?
– Recognizing that racism, not race, is the root cause of racial health disparities is the first step to improving health outcomes for Black, Indigenouls People of Color (BIPOC) patients. Acknowledging this truth highlights the necessity of mitigating the harms of racism as part of any comprehensive treatment plan. This is done on an individual level, by offering existing support and resources, as well as on a systemic level through advocacy.

Pearls

Defining Race

Race is a socio-politically constructed taxonomy that was invented based on factors such as perceived skin color and culture, not science or biology. The concept of race emerged for the purpose of allocating and/or extracting resources. In the United States, the concept of race was key to extracting resources from Black and Indigenous peoples during the formation and expansion of the country.

The Role of Science and Medicine in Defining Race and Racism

In 1839, Dr. Samuel Morton asserted that White people were the most intelligent of all races and Black people were the least so based on head circumference and cranial capacity. In an 1850 report commissioned by the Louisiana legislature, Dr. Samuel Cartwright argued that Black people were lazier, less intelligent, and more susceptible to infectious diseases than White people because they had less lung capacity. Cartwright’s study influenced the equations that medical professionals still use to calculate the impact of various diseases on lung function. This baseless race correction impacts treatment decisions, which contributes to racial health inequities. In the early 1900s, eugenicists and social anthropologists claimed that Black people were predisposed to violent crime, which justified institutionalization and sterilization of Black people. Despite their claims being based on unproven assumptions, their research was praised for scientific rigor and used to justify subjugation based on race.

“The scientific method is only as strong as the variables you input into it and if you are not critical of the questions you are asking, who you are researching, how you are doing that research then the biases, the history, the legacy, they seep in.” – Edwin Lindo, JD

Why is color-blindness not a solution to dismantling race-based medicine?

Ignoring race and racism does not negate the profound impact that race and racism have on our BIPOC patients’ health. Colorblindness inflicts harm through erasure. Instead, researchers and clinicians must be aware of the impact of racism in order to explore ways of mitigating its damage. For more on this concept, stay tuned for the next episode!

Is race a good proxy for ancestry? For genetics?

Since race is a socio-political construct, its definition has changed over time and space. For example, racial categories in the US Census have changed numerous times, with new categories being created and others disappearing or returning depending on the political atmosphere at the time. In another example, a person who is considered Latinx in the US could be considered Mulatto in Brazil or Coloured in South Africa. Given that there is no standard definition of race, its imprecision does not meet the standards of clinical medicine. As Prof. Lindo states, “our eyes see race” when we study disease disparities, but the true risk factor may actually be racism, geographic ancestry, or a specific genetic variant. However, assuming a genetic difference based on a perceived association with race is poor science.

Links

References discussed throughout episode

1. “The Praxis” Podcast: ​https://clime.washington.edu/praxis

2. Boyd RW, Lindo EG, Weeks LD, McLemore MR. On Racism: A New Standard For

   Publishing On Racial Health Inequities. ​Health Aff Blog​. Published online July 2, 2020.

   https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/

3. Marya R, Lindo E. Healing the Nation’s “Broken and Scattered” Hoop. ​Common Dreams. Published online June 19, 2020.https://www.commondreams.org/views/2020/06/19/healing-nations-broken-and-scattered -hoop

4. Tsai J, Cerdeña JP, Khazanchi R, Lindo E, et al. There is no “African American physiology”: The fallacy of racial essentialism. ​J Intern Med.​ 2020;288(3):368-370. doi:10.1111/joim.13153

5. Chadha N, Lim B, Kane M, Rowland B. “Toward the Abolition of Biological Race in Medicine.” ​Institute for Healing & Justice in Medicine​; 2020. https://www.instituteforhealingandjustice.org/download-the-report-here

6. Wilkerson, I. (2020). Caste: The Origins of Our Discontents. Random House.

Additional references and papers as mentioned in episode

1. Roberts, D. (2012). Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century (50852nd ed.). The New Press.

2. Braun, L. (2014). Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics (1st ed.). Univ Of Minnesota Press.

3. Harris, C. (1993). Whiteness as Property. Harvard Law Review, 106(8), 1707-1791. doi:10.2307/1341787

4. Williams DR. Miles to go before we sleep: racial inequities in health. J Health Soc Behav. 2012 Sep;53(3):279-95. doi: 10.1177/0022146512455804.

Disclosures

Mr. Khazanchi is a member of the American Medical Association’s Council on Medical Education, but the views presented herein represent his own and not necessarily those of the AMA or the Council. The hosts and guests report no other relevant financial disclosures.

Citation

Lindo E, Nolen L, Paul D, Ogunwole M, Fields N, Onuoha C, Williams J, Essien UR, Khazanchi R. “Episode 140: Dismantling Race-Based Medicine, Part 1: Historical & Ethical Perspectives.” ​The Clinical Problem Solvers Podcast.​ ​https://clinicalproblemsolving.com/episodes​ November 17, 2020.

Show Transcript

1. Music

2. Introduction

3. Introduction to the Antiracism in Medicine team

4. Introduction of this episode and the Dismantling Race-Based Medicine series

5. Introduction of Prof. Edwin Lindo

6. What is race? How is race a social construct? Why was it constructed in the first place?

7. Why color-blindness is not a solution to dismantling race-based medicine

8. How has medicine played a key role in defining race throughout history?

9. Race vs. ancestry vs genetics–implications for research and clinical practice

10. What can we start doing tomorrow?

11. Conclusion and outro