COVID-19 and the rebiologisation of racial difference

The American Journal of Bioethics

The COVID-19 pandemic has taken a substantial human, social and economic toll globally, but its impact on Black/African Americans, Latinx, and American Indian/Alaska Native communities in the U.S. is unconscionable. As the U.S. continues to combat the current COVID-19 cycle and prepares for future pandemics, it will be critical to learn from and rectify past and contemporary wrongs. Drawing on experiences in genomic research and intersecting areas in medical ethics, health disparities, and human rights, this article considers three key COVID-19-related issues: research to identify remedies; testing, contact tracing and surveillance; and lingering health needs and disability. It provides a pathway for the future: community engagement to develop culturally-sensitive responses to the myriad genomic/ bioethical dilemmas that arise, and the establishment of a Truth and Reconciliation Commission to transition the country from its contemporary state of segregation in healthcare and health outcomes into an equitable and prosperous society for all.

American Journal of Law & Medicine

This symposium volume begins with a simple provocation: race and racism are central to the development of medicine and the health sciences. 2 If pursuits of health equity are to be taken seriously, this repositioning of race as central rather than peripheral to science and medicine suggests that improved health outcomes and reduced disparities cannot be attained until we acknowledge that these fields are sustained by racialized social, political, and economic forms of governance. Despite the seemingly progressive and socially benevolent role assigned to the health sciences, we must expand our inquiries to understand how they are constituted by forms of reasoning, belief, and practice that cannot be decoupled from power relationships that create racial inequality. The authors in this symposium issue provide a framework for identifying the latent racism within the health sciences and in turn propose new directions for conceptualizing human difference and group disparities. Within medicine and the health sciences, race is widely understood as a "natural" part of human diversity that scientists and physicians merely observe. These fields largely assume that the visual distinctions that align with social understandings of race reflect real and meaningful biological dispositions. Tied to this is the assumption that these racialized genetic and physiological dispositions explain why certain racial groups may be sicker-or healthier-than others. From this standpoint, racism is thought to be an external social or political variable that has little to do with the processes that shape health outcomes or that influence the measurement of human differences. This perspective is not only woefully inadequate, but also affirmatively harms human health by perpetuating theories of biological race in the clinic, the lab, and within our collective imaginations.

darkmatter: in the ruins of imperial culture

The New England Journal of Medicine, 2022

Misconceptions concerning the concordance of biological and social definitions of race are ongoing in American society. This problem extends beyond that of the lay public into the professional arena, especially that of biomedical research. This continues, in part, because of the lack of training of many biomedical practitioners in evolutionary thinking. This essay reviews the biological and social definitions of race, examining how understanding the evolutionary mechanisms of disease is crucial to addressing ongoing health disparities. Finally it concludes by laying bear the fallacies of “race-specific” medicine.

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

American Journal of Public Health, 2010

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.

Medium, 2020

Disparities in health exist, indeed. COVID-19 infection and mortality rates are higher among Black, Latin*, and Native American populations, but they should not be referenced alone without the historical and broader social context. Simply put, Black and Latin workers are more likely to work in “essential” positions and thus are still working outside of home during the pandemic, and thus are more exposed to the virus. Researchers have long been aware of the phenomenon that Black and Latin populations are more represented among what sociologist Arne Kalleberg (2011) calls “bad jobs.” The CDC also reports that racial and ethnic minorities are more commonly employed by industries that require workers to continue working despite the pandemic, including agriculture, healthcare, delivery, and public transportation services. Simultaneously, some of these industries have also suffered the most significant financial losses and laid off many employees.