by Dorothy Roberts, guest contributor
Biological scientists established decades ago that the human species can’t be divided into genetically discrete races. Social scientists have shown that the racial classifications we use today are invented social groupings. And historians of medicine have traced doctors’ current practice of treating patients by race to justifications for slavery. Doctors I’ve talked to readily concede that race is a “crude” proxy for patients’ individual characteristics and clinical indicators. Countless patients have been misdiagnosed and treated unjustly because of their race.
So why do doctors cling so fiercely to race-based medicine?
One reason is force of habit. For generations, beginning in the slavery era, medical students have been taught to take the patient’s race into account. Race is built into the foundations of medical education, which assumes that people of different races are biologically distinct from each other and suffer from diseases in peculiar ways. What’s more, medical students aren’t given much latitude to question the lessons they are taught about race. Without a radical disruption, these students go on to train the next generation of doctors with the same flawed racial dogmas.
Another reason is that doctors aren’t immune from commonly-held racial stereotypes and misunderstandings. Most Americans believe some version of a biological concept of race, and doctors are no exception. In fact, the entire field of biology has been plagued by controversy and confusion over the meaning of race. It is not surprising that the medical profession would be influenced by racial thinking that has been perpetuated in U.S. education, culture, and politics for centuries.
In addition, there are institutional and commercial incentives to continue practicing medicine by race. Starting in the 1980s, the federal government required the scientific use of racial categories to ensure greater participation of minorities in clinical research and to address health disparities. Unfortunately, this effort to diversify clinical studies focused on biological rather than social inequalities and has reinforced genetic definitions of race. In 2005, the federal Food and Drug Administration approved the first race-specific drug, a therapy for African-American patients with heart failure, that was repackaged as a race-based pill to enable the cardiologist who developed it to obtain a patent. Labeling drugs by race may be financially advantageous to pharmaceutical companies by providing a marketing niche and an avenue for FDA approval. The biomedical research and pharmaceutical industries have tremendous influence over how medicine is practiced.
Doctors are quick to bristle at any suggestion that treating patients by race results from their own racial prejudice. They disavow any connection to blatantly racist medicine of the past—the horrific treatment of enslaved Africans; unethical medical experimentation on African Americans, such as the Tuskegee Syphilis Study and use of Henrietta Lacks’ cancer cells; Jim Crow segregation of medical services; and mass sterilization of black, Mexican-origin, Puerto Rican, and Native American women in the 1960s and 1970s.
Doctors argue that they are using race for benevolent reasons or, at most, as a benign way to classify their patients. But race is not a benign category. Race was invented to support racism and it is inextricably tied to racial oppression and the struggle against it. There is no biological reason to divide human beings into white, black, yellow, and red. Race seems natural only because we have been taught to see each other this way. Sometimes, when I speak to doctors about this topic, I can see their physical discomfort with giving up their reliance on race. It feels like asking deeply religious people to give up their belief in their deity. Race is more than an ordinary medical feature—it is part of people’s deeply-held identities, their sense of their place in society, and their view of how the world is ordered. This is why ending race-based medicine will require a great leap of imagination, a new vision of humanity tied to a movement for racial justice.