Race-based medicine is the process pharmaceutical companies use to assign specific drugs to racial groups. The idea of race-based medicine asserts that racial groups are biologically different. Therefore, drugs, tailor-made for racial groups are the best means for efficacious treatment within minority populations. For example, let’s use a headache as an ailment. If an African American, Hispanic, and white individual followed the practice of race-based medicine, they would need an African American, Hispanic, and white aspirin to alleviate discomfort. However, such racially coded aspirin is not beneficial because a headache is not innately different due to anyone’s racial classification. Illnesses and diseases do not discriminate. When all individuals take the same aspirin, the time it will take to alleviate the pain may vary due to each individual’s internal response to pain and medicine, but the reaction to the aspirin is not dependent on external traits.
Consequently, the use of race-based medicine fragments racial groups. Its use attributes behavioral traits, labels, stereotypes and diseases which can stigmatize minority groups. Also, it can lead to prejudice and discrimination in the clinical practice. Race-based medicine misconstrues the distinctions of race, ancestry and genetics by assuming that race alone is the marker of disease, which inaccurately influences scientific studies and research. Race-based medicine is not the way to solve prevalent diseases in racial groups. Health disparities can be alleviated by the awareness and acknowledgement of predispositions and socioeconomic inequities existing in minority groups. This book examines the ways in which race is an inaccurate proxy for basing therapeutic intervention and how race-based medicine undermine minority communities’ health.
This chapter uses the methods of the history of medicine, law, politics, genetics, and sociology to explore the origins of race-based medicine through eugenics. Eugenics was influenced by French biologist Jean Baptiste de Lamarck and Charles Darwin. Francis Galton, Charles Darwin’s cousin, created the word ‘eugenics.’ There were two schools of eugenics: positive eugenics and negative eugenics. Positive eugenics asserted human breeding should be controlled to produce genetically superior human beings. Negative eugenics asserted the improvement of humanity can only happen by eliminating or excluding genetically inferior human beings.
Charles B. Davenport, the Father of American eugenics, established and directed The Eugenics Record Office. Davenport redefined eugenics as “the science of the improvement of the human race by better breeding” 1 to accomplish eugenics “we apply science to the problems of a class-ridden and socially heterogeneous society.” 2 Eugenic influencers were exclusively self-identified as “White,” “Anglo Saxon,” “Nordic,” or “Caucasian,” stressing the idea of their racial superiority. Davenport categorized Africans, African Americans, Indians, and indigenous tribes as “genetically unfit” or inferior because they were less intelligent and primal. Davenport’s racial classification was the first official American categorization of races. Davenport’s 1908 Inheritance in Canaries study influenced the idea of disease and intelligence being associated to certain racial groups, 3 which created the notion of race-based medicine. As a result, eugenics’ ideology embraced sociomedical racialism, meaning diseases were classified and attributed to certain races. 4 Eugenic influence created social and racial classifications through pathology- specifically, African Americans with Sickle Cell Anemia (SCA) and Jews with Tay Sachs Disease (TSD).
To be clear, eugenics did not solely dehumanize African Americans and Jews. Slavs, Italians, Poles, Irish, Asians, Turks, and Greeks were included in socially unfit classifications. However, there was a particular paranoia of an American epidemic with individuals with SCA and TSD. SCA affects groups from Indian, Asian, Saudi Arabian and Mediterranean backgrounds, but SCA was deemed a “black disease” due to the medical science, medical literature, and anthropological eugenic influences. SCA was perceived as a plague brought by black people, but factually it provided immunity from malaria.
The fear of SCA lead to the notion of Jim Crow (separate but equal) medicine, which led to segregated blood banks by the American Red Cross in WWII. 5 Neurologist Dr. Isador H. Coriat alleged TSD nerve cells contained poison that was transmitted through Jewish mother’s milk. 6 Due to the social fear of contagion from SCA and TSD, African Americans and Jews faced abuse through sterilization and other forms of population control, including birth control, marriage control, and immigration policies.
Chapter 2 uses the methods of medical anthropology, clinical ethics, studies of the physician-patient relationship, biology and sociology to explore the misappropriations of the black body, race-based medical experiments, consequences of misappropriating the black body and the black community’s response to false associations and harmful treatment. The eugenic perceptions of the “black body” produced misappropriations and falsified theories of the anatomy and biology of black individuals. The ideologies of African Americans being “lesser than” or “inferior” transferred into the fields of anthropology, anatomy, and biology, creating myths of innate human differences. The understanding that black bodies were innately different produced the terms “black hardiness” and “black durability,” which affirms blacks have the innate capacity to endure or tolerate extreme conditions or illnesses. It was thought the experience of slavery made African Americans evolve to be a people of great endurance and stamina.
Such ideologies asserted black skulls were so thick that the skull would bruise or break the slave-owner’s hand if he punched a slave, 7 or that longer limbs and shorter trunks were the reason why blacks could run faster than any group. Black hardiness led to an infatuation with the black body that created unconscionable harm in the clinical practice. As a result, J. Marion Sims, the father of gynecology, performed painful procedures on slave women without anesthesia. 8 The US government conducted mustard gas experiments on blacks and Hispanics which caused immediate and severe eye injuries, burns, oozing sores and blistering on the face, hands, underarms, buttocks, and genitals, resulting in “lung damage, psychological disorders, cancer, asthma, eye problems, and blindness.” 9 Sloan-Kettering Institute’s Dr. Chester M. Southam injected over 180 black Ohio State Prison inmates with live human cancer cells to see how a healthy human body would react to cancer cells. 10 Such experiences remain in the psyche of the black community through a key means of communication called oral tradition. As a response to race-based experimentation and race-based medicine, slaves created black homeopathy, a medical system that offers herbal, botanical, traditional, psychological, and spiritual approaches to medicine. 11
Chapter 3 uses the methods of history of medicine, genetics, clinical ethics, research ethics, pharmacology, studies of the physician-patient relationship and sociology to assess significant heart studies before BiDil, “the black heart failure drug.” There are numerous problems with BiDil. The data out of BiDil’s clinical trials were based on unclear data because there was no control group to prove the drug was efficacious. BiDil was a rushed drug, only taking five years to reach the market with insufficient research funding. BiDil costs three times more than any other drug in its class, which does not benefit African Americans who are socioeconomically disadvantaged.
The idea of BiDil medicalizes race, a nonmedical issue, and interprets, defines and treats race as medical a problem. This recreates stigmas, stereotypes, and projected behavioral traits that are rooted in eugenic ideas. Finally, self-identification of one’s race has no contextual validity. That is, it is a poor proxy based on other people’s perception, excludes people who cannot self-identify (i.e. multi-racial or bi-racial individuals), has no use related to research questions on ancestry, and does not reflect the descent and ethnic origin of individuals. 12 BiDil an overly priced “quick fix” is not an adequate solution to health inequities in minority communities.
Race is a myth. Therefore, race should not be a proxy for disease. We are all genetically similar. For example, human genomes, 3 billion base pairs spread across 23 chromosomes, are 99.9% similar to one another with 0.1% difference (3 million pairs) with a smaller selection of the 0.1% that provide the raw material for locating the source of difference. 13 A more practical means for alleviating health inequity is improving physician’s cultural competency, empathy and awareness with a keen focus on diet and nutrition.
Chapter 4 uses the methods of theology, textual criticism, exegesis, eisegesis, black church history and a combination of biblical and medical narrative to examine race in biblical literature as a tool for minority patient empowerment. This chapter also considers examples of the black church and personal clergy role in health advocacy. Black theology analyzes the oppression of black people, affirms the personhood of black people, and advocates their social and political liberation. 14 Black theology as survival theology is a response to the labels of race and illness by liberating minority communities to participate and speak out against the stigma of racial disease. Black theology is a tool that demonstrates multiple black perspectives and experiences. In contrast, race-based medicine encourages a truncated look at black experiences. Race-based medicine does not look at the totality of the African American pathological experience. Rather, it irrationally uses drugs as an inadequate solution for health inequity.
Black theology advocates empowerment and justice for African Americans in race-based environments that are rooted in and thrive on oppression. Blacks replaced dehumanizing identifications of race-based medicine and biblical literature with the belief that they were created by the same God with equal value. Black theology condemns race-based medicine because it separates racial groups as different beings through the construction of race. Furthermore, black theology asserts it does not matter what skin color you are, for we are all human beings and come from the same God.
As a response to race-based medicine, I suggest scripture, specifically the illness narratives in the gospels, can be used as an effective aid. For example, I connect the biblical and medical narrative of the leper in Galilee (cf. Mark 1:40–45) being denied healing ...