Introduction: Critical Race Theory and the Health Sciences

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

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.

Journal of Laboratory and Clinical Medicine, 2005

Philosophy of the Social Sciences, 2001

The biomedical sciences employ race as a descriptive and analytic category. They use race to describe differences in rates of morbidity and mortality and to explain variations in drug sensitivity and metabolism. But there are problems with the use of race in medicine. This article identifies a number of the problems and assesses some solutions. The first three sections consider how race is defined and whether the racial data used in biomedical research are reliable and valid. The next three sections explain why racial variation in disease, including genetic disease, is not evidence that race is biological. The final section explains how a proper understanding of the role of race in medicine bears on public policy.

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.”

Du Bois Review: …, 2011

Although racial disparities in health have been documented both historically and in more contemporary contexts, the frameworks used to explain these patterns have varied, ranging from earlier theories regarding innate racial differences in biological vulnerability, to more recent theories focusing on the impact of social inequalities. However, despite increasing evidence for the lack of a genetic definition of race, biological explanations for the association between race and health continue in public health and medical discourse. Indeed, there is considerable debate between those adopting a "social determinants" perspective of race and health and those focusing on more individual-level psychological, behavioral, and biologic risk factors. While there are a number of scientifically plausible and evolving reasons for the association between race and health, ranging from broader social forces to factors at the cellular level, in this essay we argue for the need for more transdisciplinary approaches that specify determinants at multiple ecological levels of analysis. We posit that contrasting ways of examining race and health are not necessarily incompatible, and that more productive discussions should explicitly differentiate between determinants of individual health from those of population health; and between inquiries addressing racial patterns in health from those seeking to explain racial disparities in health. Specifically, we advance a socio-psychobiological framework, which is both historically grounded and evidence-based. This model asserts that psychological and biological factors, while playing a central role in determining individual risk for poor health, are relatively less consequential for understanding racial disparities in health at the population level. Such a framework emphasizes the etiologic role of social inequities in generating and perpetuating racial disparities in health and highlights their impact on psychological, behavioral, and biological disease processes.

The Yale Journal of Biology and Medicine, 2021

This perspective describes three new policies passed at the November 2020 Special Meeting of the American Medical Association House of Delegates. These policies (1) denounce racism as a public health threat; (2) call for the elimination of race as a proxy for ancestry, genetics, and biology in medical education, research, and clinical practice; and (3) decry racial essentialism in medicine. We also explore the social and institutional context leading to the passage of these policies, which speak directly to the harmful legacy of racism in America, and its insidious impact on the healthcare system.

Philosophy of Social Science, 2001

The biomedical sciences employ race as a descriptive and analytic category. They use race to describe differences in rates of morbidity and mortality and to explain variations in drug sensitivity and metabolism. But there are problems with the use of race in medicine. This article identifies a number of the problems and assesses some solutions. The first three sections consider how race is defined and whether the racial data used in biomedical research are reliable and valid. The next three sections explain why racial variation in disease, including genetic disease, is not evidence that race is biological. The final section explains how a proper understanding of the role of race in medicine bears on public policy.

Palgrave Encyclopedia of the Health Humanities, 2021

This encyclopedia entry examines the historical and political contexts of race, racism, medicine, and medical racism in the United States from the colonial era to present. This entry consists of an area of health humanities study that applies critical race theory and social justice theory to examine race as a social construct with consequences for both theoretical medicine and the lived experience of medical care and medical practice based on racialized identity.

New England Journal of Medicine, 2021

Welcome to the Race and Medicine Roundtable hosted by the New England Journal of Medicine. My name is Michele Evans. I am the deputy scientific director at the National Institute on Aging. I will serve as the moderator today. In addition, I'm a member of the NEJM editorial board.