Mixed Race Studies

Medicating Race: Heart Disease and Durable Preoccupations with Difference

Massachusetts Institute of Technology
2007
250 pages

Anne Pollock, Assistant Professor of Science, Technology and Culture
Georgia Institute of Technology, Atlanta, Georgia

Submitted to the Program in Science, Technology and Society In Partial Fulfillment of the Requirements of the Degree of Doctor of Philosophy in the History and Social Study of Science and Technology At the Massachusetts Institute of Technology

This dissertation is an examination of intersections of race, pharmaceuticals, and heart disease over the course of the 20th century and today. Each of these parts has had a dynamic history, and when they are invoked together they provide a terrain for arguments about interventions in health and in justice in the present.

An enduring aspect of discourses of heart disease over the past century has been articulating connections between characterizations of the modem American way of life and of heart disease. In that process, heart disease research and practice has participated in differentiating Americans, especially by race. This dissertation uses heart disease categories and the drugs prescribed for them as windows into racialized medicine.

The chapters are organized in a way that is roughly chronological, beginning with the emergence of cardiology as a specialty just before World War II and the landmark longitudinal Framingham Heart Study that began shortly thereafter. A central chapter tracks the emergence and mobilization of African American hypertension as a disease category since the 1960s. Two final chapters attend to current racial invocations of two pharmaceuticals: thiazide and BiDil. Using methods from critical historiography of race, anthropology, and science studies, this thesis provides an account of race in medicine with interdisciplinary relevance.

By attending to continuities and discontinuities over the period, this thesis illustrates that race in heart disease research and practice has been a durable preoccupation. Racialized medicine has used epistemologically eclectic notions of race, drawing variously on heterogeneous aspects that are both material and semiotic. This underlying ambiguity is central to the productivity of the recorded category of race. American practices of medicating race have also been mediating it, arbitrating and intervening on new and renewed articulations of inclusion and difference in democratic and racialized American ways of life.

Table of Contents

• Abstract
• Acknowledgements
• Chapter 1: Introduction
• Chapter 2: Preoccupations with Racialized Modernity in Early Cardiology
• Chapter 3: Constructing and Supplementing Framingham’s Normal White Americans: The Framingham and Jackson Heart Studies
• Chapter 4: The Durability of African American Hypertension as a Disease Category
• Chapter 5: Thiazide and Racialization of a Generic Drug
• Chapter 6: BiDil: Medi©ating the Intersection of Race and Heart Failure
• Epilogue: Tracking Plural Noninnocent Discourses
• Works Cited

…Early Framingham investigators did their research in an all-white population, but they participated in larger conversations about black/white differences, too. The Framingham investigators themselves participated in the simultaneous constructions of hypertension and African American hypertension in the 1960s, an era that saw the ascendance both of hypertension as a risk factor and of the Civil Rights Movement. Their own study’s lack of inclusion of African Americans did not preclude their participation in arguments about racial differences in hypertension. Addressing “Environmental Factors in Hypertension” in a 1967 publication, the investigators wrote:

The principal population groups among whom blood pressures have been reported to be lower than among Americans and Europeans are various primitive peoples. The sample size has usually been small, especially in the older ages, and conclusions about age trends are complicated both by this fact, and by the fact that it is often not possible to accurately determine the age of the subjects. Among those population groups studied adequately, the following may be said:

Blood pressure distributions are similar among such diverse groups as: Caucasians living in Europe, the United States, and the West Indies; among Chinese living in Taiwan, and among Japanese in Japan.

Negro populations have higher blood pressures than whites living in the same areas and studied by the same investigators, particularly among females and in the older age groups. Distributions of blood pressures among Negro populations living in the United States and in the West Indies, whether rural or urban, high or low salt eaters, are similar. Their blood pressures are higher than those of Negroes in Liberia, a principal source of Negro migration to the Western Hemisphere. Admixture of the Negro races in the Western Hemisphere makes the interpretation of this data difficult. It is in this general background of unencouraging experience that the study of particular environmental factors, which could conceivably affect the blood pressure level, must be approached.

I will return to the question of African American Hypertension as a disease category in Chapter 4, but for now attend to other aspects of this quote. Here, we can see the distance between direct evidence or argument and the invocation of a common sense of racialization of cardiovascular disease. Although their phrasing evokes neutral grammars of data, there are no citations or evidence for these assertions about “Negro populations,” suggesting that the authors conceive of these statements less as arguments than as reflecting the consensus of the field. Unable to grapple with the embodied admixture that is not merely biological but also historical and cultural, much history is paved over in word choices such as “migration” to describe the slave trade and “admixture” to describe oppressive sexual relations under slavery.

Paucity of data is not actually the problem. The investigators make an odd claim about the cause of the difficulty of research into environmental causes of racial disease disparities: that “admixture” gets in the way of interpretation. Logically, assimilation would be the kind of mixing that would pose a problem for separating out environmental causes of disease by race, but the investigators lacked a language for cultural, in addition to biological admixture. The peculiarity of the investigators’ framing should alert us both to the fact of racialized hypertension’s existence at the nexus of the biological and the environmental, and that Framingham is telling both a white story and a universal one…

Read the entire dissertation here.

A Racialized Medical Genomics: Shiny, Bright and Wrong

RACE-The Power of an Illusion
July 2005

Robert Wallace, Postdoctoral Fellow
Public Health Phylogeography
Department of Ecology and Evolutionary Biology
University of California, Irvine

Armand Marie Leroi announces in his Times op-ed that race is biologically real (New York Times, March 14, 2005). The crusty trope that race is a social artifact crumbles in the face of the bright new genomics, he asserts. Genetic variation may be greater within groups than between groups, as Richard Lewontin pointed out back in the dark ages of the 1970s, but only for single genes. Taken together, across genetic loci allelic distributions correlate into clusters long recognized as the five races: European, East Asian, African, Amerindian, and Australasian. So suck it up, constructionists, race is biologically intrinsic.

Moreover, get out of the way. The recognition that race is inherently biological, Leroi writes, can improve medical care, “as different races are prone to different diseases.” African Americans, for example, suffer greater prevalences of heart disease and prostate cancer. Even if such differences arise from socioeconomic causes, Leroi argues, we should—ignoring the man behind the curtain—embrace geneticists’ very important mission, “searching for racial differences in the frequencies of genetic variants that cause diseases.”

And yet much of Leroi’s article unravels his own argument. Leroi takes population geneticists to task for caving into political correctness by investigating “ethnic groups,” a euphemism that conflates human differences across scale. Never mind that population geneticists prefer the term less out of deference to present sensibilities than to the data themselves. Work by Luigi Cavalli-Sforza’s group (Cavalli-Sforza 2001, Underhill 2003), among others, show human history—back to our species’ origins—to be marked by layers of migration sweeping back and forth across the continents, gurgling here and there into local pools of idiosyncratic admixture. While the resulting genetic frequencies do not embody a homogenous mush, neither does a stark black and white favored by the new racialists result. Instead, genetic maps are marked by fine-scaled and functionally important population gradients…

…For one, according to Leroi, the pharmaceutical companies. As race can affect medical treatment, “many new drugs are now labeled with warnings that they may not work in some ethnic or racial groups.” That such effects need not be predominantly biological in origin apparently matters little. Leroi admits differences among races arise from population averages alone. But as we are unlikely to have individuals’ genomes sequenced any time soon, and presumably won’t be able to individualize medical treatment that way, we’ll just have to accept a racialized medical genetics. Nothing like an argument of expediency to convince a crowd. The pharmaceutical companies are doing it, so get with it, baby!

Here, Leroi, an evolutionary developmental biologist, bumbles back into the typology the Darwinian revolution revoked. As Ernst Mayr (1976, 2004) explained, until the early 19th century biologists classified species in essentialist terms. A specific type or specimen defined a species and any variation from the type was considered deviant or unreal. In statistical terms, a centroid measure such as the mean phenotype defined the species, while the variance was thought noise. Typological definitions accounted for the differences among species and, without variation, explained the impossibility of evolution.

Darwin and his colleagues turned biology on its head. The population thinking they introduced emphasized the variation in populations. As natural history studies accumulated, it became apparent individual organisms varied in just about any and all characteristics, both across and within species. Individuals even changed over the course of their lifespans. Here, averages became thought of as constructs and the variances the reality. Variation’s reality proved fundamental to Darwin’s natural selection. The greater the variation in the population, the faster natural selection works and adaptations arise…

Read the entire article here.

“Racially-Tailored” Medicine Unraveled

American University Law Review
Volume 55, Number 2 (December 2005)
pages 395-452

Sharona Hoffman, Professor of Law, Professor of Bioethics, and Associate Director of the Law-Medicine Center
Case Western Reserve University School of Law

Table of Contents

• Introduction
• I. “Race-Based” Research and Therapeutic Practices
  • A. The Story of BiDil
  • B. “Race-Based” Research
  • C. A Growing Interest in “Race-Based” Medicine: Why Now?
• II. Does “Race” Mean Anything?
  • A. “Race” in the Medical and Social Sciences
  • B. “Race” and the Law
  • C. Shifting the Focus Away from “Race”
• III. The Dangers of “Racial Profiling” in Medicine
  • A. Medical Mistakes
  • B. Stigmatization and Discrimination
  • C. Exacerbation of Health Disparities
• IV. Violation of Anti-Discrimination Provisions
  • A. Constitution and Federal Civil Rights Laws
  • B. State Laws Prohibiting Discrimination in the Medical Arena
    • 1. Civil rights statutes
    • 2. Hospital and medical facility licensing requirements
    • 3. Patients’ bill of rights laws
    • 4. Public services regulation
    • 5. Insurance codes
  • C. Violation of Research Regulations and Guidelines
    • 1. NIH policy and guidelines
    • 2. Federal research regulations
  • D. Discrimination Theory
• V. Recommendations
  • A. Review of Research Studies by Scientific Review Boards and IRBs
    • 1. Scientific reviews
    • 2. Institutional review boards
  • B. Investigators and Health Care Providers
  • C. Public Discourse Concerning Attribute-Based Medicine:The Responsibilities of Investigators, Institutions, and the Media
• Conclusion

Introduction

F.D.A. Approves a Heart Drug for African-Americans. This June 2005 headline announced the arrival of BiDil, a heart failure edication that is approved for African-Americans only. BiDil is the first drug in pharmaceutical history that will constitute standard therapy for only one particular “race.”Health care professionals are becoming increasingly interested in “racebased” medicine in the research and therapeutic contexts. Many researchers are attempting to discern “racial” differences in disease manifestation, biological functioning, and therapeutic response rates. As this approach develops, physicians may prescribe different dosages of medication for people of separate “races” or may provide them with entirely different drugs. In light of the success of BiDil, investigators are also likely to pursue the development of additional “racially-tailored” medications. In fact, several academic and professional conferences have already devoted significant time to the discussion of “race-based” medicine. On April 18, 2005, the University of Minnesota hosted aconference entitled Proposals for the Responsible Use of Racial & Ethnic Categories in Biomedical Research: Where Do We Go From Here? Likewise, the Eighth World Congress on Clinical Pharmacology and Therapeutics, held in 2004 in Brisbane, Australia, devoted an afternoon to ethnopharmacology.While “racial profiling” in medicine has generated significant discussion in medical and bioethics circles, it has thus far gained relatively little attention in legal literature. This Article aims to develop the discourse concerning this important topic. It argues that “race-based” medicine is an inappropriate and perilous approach. The argument is rooted partly in the fact that the concept of “race” is elusive and has no reliable definition in medical science, the social sciences, and the law.  Does “race” mean color, national origin, continent of origin, culture, or something else? What about the millions of Americans who are of mixed ancestral origins—to what “race” do they belong? To the extent that “race” means “color” in colloquial parlance, should physicians decide what testing to conduct or treatment to provide based simply on their visual judgment of the patient’s skin tone? “Race,” consequently, does not constitute a valid and sensible foundation for research or therapeutic decision-making.

Further, this Article contends that “racial profiling” in medicine can be dangerous to public health and welfare. A focus on “race,” whatever its meaning in the physician’s eye, can lead to medical mistakes if the doctor misjudges the patient’s ancestral identity or fails to recall that a particular condition affects several vulnerable groups and not just one “race.” The phenomenon can also lead to stigmatization and discrimination in the workplace and elsewhere if the public perceives certain “races” as more diseased or more difficult to treat than others. In addition, “racial profiling” could exacerbate health disparities by creating opportunities for health professionals to specialize in treating only one “race” or to provide different and inferior treatment to certain minorities. It could also intensify African-Americans’ distrust of the medical profession. Finally, “race-based” medicine might violate numerous anti-discrimination provisions contained in federal law, state law, and federal research regulations and guidelines…

…The Article will proceed as follows. Part I of the Article will describe “race-based” research and therapeutic practices and will examine the growing interest in “race-based” medicine and the reasons for it. Part II will argue that “race” is a concept that has no coherent meaning and that is potentially pernicious. Part III will focus on the dangers of “raciallytailored” medicine, and Part IV will analyze a variety of anti-discrimination mandates that could potentially be violated by the practice. Finally, Part V will detail recommendations for the development of attribute-based medicine in a manner that will promote the health and welfare of all population groups…

…This Article argues against substantial use of the concept of “race” in medical settings. A primary reason for this restriction is that “race” has no coherent meaning, and therefore, reliance upon it for research or treatment purposes can be confusing at best and can lead to significant adverse consequences at worst. This section will build the argument that based on medical science, the social sciences, and the law, “race” has no reliable definition or real meaning. Moreover, it is a pernicious concept that has been used to suggest that human beings can be divided into subspecies, some of which are morally, intellectually, and physically inferior to others. Thus, medical professionals should focus on more precise and meaningful aspects of human identity rather than on the amorphous concept of “race.”…

Read the entire article here.

Runnymede film nominated for Limelight Award

Runnymede Trust
2012-05-10

Clench, a Runnymede short film written and directed by Riffat Ahmed, has been nominated in the Best Drama category at this year’s Limelight Film Awards, to be held on 14 June 2012.
 
Made as part of the Generation 3.0 project, the film tells the story of Ash, a mixed-race girl from Old Trafford, Manchester, who signs up to a one-week boxing course after a her social worker presents her with a final chance to turn her life around.
 
The film looks Ash’s own experience of racism and the preconceptions she holds about other people and places.

Read the entire article here.

The Vanishing American Negro

The American Mercury
Volume LXIV, Number 278 (February 1947)
pages 133-139

Ralph Linton (1893-1953), Professor of Anthropolgy
Yale University

In the question period following any talk on minority problems, someone invariably brings up the query, “What do anthropologists consider to be the long range solution of the Negro problem?” Though I usually avoid this point when I can, I sometimes have to reply that most anthropologists agree there will be no Negro problem in another two hundred years; by then there will not be enough recognizable Negroes left in this country to constitute a problem.

When a New York newspaper headlined this statement in reporting a lecture, the main body of which did not deal with this subject, I found myself quoted with indignation in both the white and Negro press. But I was not disturbed by these repercussions until I was misquoted, and with approval, by Senator Bilbo, who said in a campaign speech:

Dr. Linton . . . stated a few weeks ago that if the present rate of intermingling, intermarriage and interbreeding of whites and blacks in this country goes on . . . within nine generations we will have no whites and no blacks . . . only yellow. … I had rather see my race destroyed by the noted atomic bomb than to see it gradually destroyed by mongrelization of the white and black races.

This convinced me that some amplification and clarification of my statement was necessary.

The prophecy of the ultimate disappearance of the American Negro in the United States is based on three facts. First, while the number of Negroes has been steadily increasing since 1790, when the first Negro census was taken, the white population has increased so much more rapidly that the over-all proportion of Negroes to whites is steadily declining. Second, the Negro is no longer concentrated in the South but is redistributing himself more evenly over the entire country. Third, and most important, the American Negro is steadily becoming lighter…

…But the main reason for believing that the Negro will disappear as a distinct American minority is that the Negro population is becoming lighter with each successive generation. This is not a matter of paling out in a northern climate — it takes thousands ofyears to evolve a new biological type—but of steady infiltration of white blood into the Negro group…

…Miscegenation has been going on since the Negroes first arrived in America. While most of the slaves imported were black Forest Negroes from West Africa, there were also a considerable number from the West Indies, where some race mixture had already taken place. At the beginning of the slave-trade era there were still many Indians in the Southeast, and considerable interbreeding took place between Indians and slaves. Runaway slaves frequently took refuge in the Indian camps, where they were protected and frequently adopted into the tribe. Indian genes began to take the kink out of Negro hair and to thin Negro lips…

Read the entire article here.

The blonde, blue-eyed black man who one goal—racial justice

The News-Times
Danbury, Connecticut
2010-02-24

Antoinette Bosco

Barack Obama has already made history in our nation, becoming the first black candidate ever to be elected to the U.S. presidency.

But, in truth, he is following a path that has long been set by black people before him, who believed in justice and equal rights for all, and worked to get these.

This is Black History Month, a special time to remember this.
 
One of these courageous people, too long forgotten, was Walter White, born 117 years ago, called “the man most responsible for the triumph of racial justice” by Maryknoll Father Albert J. Nevins back in the early 1950s.

This priest had put together a book he called “an anthology of Christian literature,” which he hoped would “give you a little more understanding of our complex world, that it will inspire you to a greater appreciation of the principles for which Christ lived and died.”
 
I found this book, fortunately, at one of the great book fairs put on each year by the Danbury Library.
 
In it Father Nevins had included a piece written by Walter White titled “Why I Remain a Negro.” With a title like that, my curiosity took over immediately.
 
His story began, “I am a Negro. My skin is white, my eyes are blue, my hair is blonde. The traits of my race are nowhere visible upon me.”…

Read the entire article here.