American Journal of EPIDEMIOLOGY Volume 144 Copyright © 1996 by The Johns Hopkins University

Number 6 School of Hygiene and Public Hearth

September 15, 1996 Sponsored by the Society for Epidemiologic Research

REVIEWS AND COMMENTARY

The Bell Curve: On Race, , and Epidemiologic Research

Caries Muntaner,12 F. Javier Nieto,3 and Patricia d'Campo3'4

In a recently published book entitled The Bell regard to racial differences in and health Curve: Intelligence and Class Structure in American outcomes and to establish a parallel between the epis- Life (1, henceforth The Bell Curve), the late Harvard temologic stance of the book regarding race and main- professor of psychology Richard Herrnstein and Her- stream epidemiologic research. Herrnstein and Murray itage Foundation researcher Charles Murray claim that claim that several conclusions regarding racial differ- the position of US citizens in the country's class ences in tests of cognitive ability are "beyond signif- structure is, to a significant extent, the consequence of icant technical dispute" (1, p. 22). Chief among their inherited differences in "g," a general factor of intel- conclusions are that IQ tests are not biased against ligence that is measured by (IQ) ethnic or racial groups and that racial differences in tests. Furthermore, these differences in "g" are respon- cognitive ability are substantially heritable. The main sible for racial differences in class position (i.e., some but unstated assumption behind these conclusions is racial groups inherently have more or less "g"). Using that the variable "race," as operationalized in social a series of regression analyses of data from the Na- science and epidemiologic studies (i.e., "black," tional Longitudinal Survey of Youth, which include a "white"), has a fundamentally biologic interpretation. proxy for IQ as an independent variable, Herrnstein and Murray suggest that inherited differences in "g" are responsible for black/white differences in behav- CURRENT CONTEXT OF BIOLOGICAL iors such as crime and having children out of wedlock. DETERMINISM" The explanations put forward by Herrnstein and The debate regarding the inheritance of racial dif- Murray regarding the fact that disproportion- ferences in IQ is a long-standing academic battle that ately affects blacks in the United States (i.e., reflecting has sporadically surfaced in the broader public domain inherited differences in "g") has made race the center over the past several decades. In the late 1960s and of the controversies surrounding the book (2). early 1970s, similar arguments as those advanced by The aim of the present commentary is to briefly The Bell Curve were advanced by Jensen (3), Eysenck review the limitations of The Bell Curve claims with (4), and Herrnstein (5) himself. Efforts at debunking the claims of hereditarian explanations for racial dif- Received for publication March 20, 1995, and accepted for pub- ferences in IQ measures (6-10) were not successful lication January 5, 1996. enough to thwart this research program altogether. Abbreviation: IQ, intelligence quotient. 1 National Institute of Mental Health, National Institutes of Health, Thus, although The Bell Curve has been launched to Bethesda, MD. reach a nonacademic readership (2, 11), its assump- 2 Institute of Occupational and Environmental Health, West Vir- tions regarding the operationalization and interpreta- ginia School of Medicine, 3313 Robert C. Byrd Hearth Sciences Center, P.O. Box 9190, Morgarrtown, WV 26506-9190 (Reprint re- tion of the variable race are frequently found in the quests to Dr. Muntaner at this address.) academic world (12, 13), including public health (14). 3 Department of Epidemiology, The Johns Hopkins University The Bell Curve represents an effort to reach large School of Hygiene and Public Health, Baltimore, MD. 4 Department of Maternal and Child Health, The Johns Hopkins audiences, but its views are in many cases shared by University School of Hygiene and Public Health, Baltimore, MD. standard research publications working in the "biolog-

531 532 Muntaner et al. ical determinist" paradigm. For example, The Bell RELEVANCE TO EPIDEMIOLOGIC RESEARCH Curve defends research in developmental psychology Significance of causal assumptions underlying that includes the extension of inherited racial differ- the use of the variable race ences in cognitive ability to brain size, rate of sexual Race is widely used in biomedical research, often maturation, length of the menstrual cycle, penis size, without any explicit indication of the theoretical con- infant mortality, and mental health (15). struct that its use implies (20). Even basic pathophys- The research program on biological determinism is iologic mechanisms shared by different animal species also represented in the recent history of epidemiology are systematically studied in humans separately by and public health. An extreme and rare instance is the race without a clear rationale. The underlying and enduring opposition to considering smoking as a major often unstated assumption, however, is that racial dif- risk factor for lung cancer and cardiovascular disease, ferences are mainly genetically determined, which in coupled with the attempt to explain away the risk turn can lead to conclusions that could have profound attributed to cigarette smoking in terms of inherited public health implications, as in the following exam- personality traits differentially distributed among ra- ples. cial groups (16). A more prevalent case of biological determinism are studies on the inheritance of cognitive abilities as an explanation for the different location of Race-specific standards for hematologic minorities in the social structure as well as their un- parameters dermining of welfare policies aimed at improving the Without any evidence from genetic studies, the ob- health of African-Americans (17). servation that blacks tend to have lower leukocyte Given the increasing skepticism among biologists count than whites, for example, led scientists to the and anthropologists surrounding the use of race as a conclusion that "neutropenia is probably a normal biologic category (18, 19), its use in epidemiology and genetically determined characteristic" in people of public health as an implicit biologic category should African descent (31, p. 1023). Similarly, African- be reexamined (20, 21). In biology and , Americans have been reported to have lower hemo- the resiliency of the biological determinist research globin values than whites even after "controlling for program has been explained by the influence of the socioeconomic differences" (32). However, this study, broader social environment in defining what consti- as well as many other epidemiologic studies, do not in tutes worthwhile research (7, 19, 22). In contrast, in fact adequately control for socioeconomic confound- epidemiology and public health, the "falsifiability cri- ers. If racial differences persist after stratification or terion" toward scientific knowledge prevails (23, 24). adjustment by surrogates of socioeconomic position Consequently, in epidemiology, cautious calls for ad- and other risk factors, no matter how imperfect or ditional studies allow the perpetuation of hypotheses partial these surrogates are, investigators often con- of race as a biologic category predisposing to illness in clude that a genetic factor must be playing a role. A major biomedical forums, even when more realistic basic methodological principle, i.e., that adjusting for alternative mechanisms have been suggested (18-21) an imperfect surrogate of a suspected confounder leads and even tested (25, 26). to imperfect adjustment (residual confounding), is un- fortunately rarely invoked. Our attempt is not to censor the authors' version of biological determinism. One of the ethical principles Clearly, despite criticism of the genetic hypothesis of scientific conduct is tolerance for the test of hy- to explain racial differences in hematologic parameters potheses and the use of methods that one dislikes (27). (33), the majority of scientists take at face value the Nevertheless, as the sociology and history of science "normality" of lower hemoglobin and neutrophil val- have shown, decisions about basic assumptions guid- ues in blacks. Moreover, some researchers recommend ing research are social phenomena not understandable separate hematologic reference values for blacks (34) by simply monitoring the empirical progress of a given without concern for the biologic plausibility of the field (22). The scientific community determines in part mechanisms linking skin color to hematologic param- the acceptability of hypotheses for inquiry, publica- eters (i.e., the philosophy of pragmatism). tion, and continued funding through a social process in which certain assumptions are uncritically accepted Race-specific birth weight distributions even in the face of empirical refutation (28). In the A second example of implicit genetic determinism biomedical fields including epidemiology, one such involves arguments regarding the potential genetic assumption is that racial labels such as "black" and origins of low birth weight in infants from different "white" classify human beings into groups with ge- racial/ethnic groups. Since the 1940s, recommenda- netic homogeneity for health outcomes (20, 29, 30). tions for race-specific standards of black and white

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infants to define low birth weight have been published review by Cooper and Rotimi (47), the weakness and (35-37), and more recently differences in birth weight inconsistencies of this prevalent dogma are high- distributions between white and Asian infants have lighted. Critical psychosocial aspects of the lifelong been studied (38). The proposals for race-specific experience of racial discrimination are not taken into standards have been fueled by the consistent finding account. For example, black women who responded that low birth weight blacks as defined with the passively to the experience of racial discrimination are <2,500-g cutoff have lower perinatal mortality than more likely to have high blood pressure than those white counterparts (39). The subject has been recently who respond actively when faced with discrimination revived after the application of statistical models that (25). Studies have also suggested that denial of the separately fit the population distribution of birth experience of racial discrimination and acceptance of weight (40) and birth weight-specific mortality for its associated belief system, in addition to the direct blacks and whites (41). The result is a standardized experience of discrimination in the workplace, pro- and different birth weight distribution for blacks and duce adverse effects on blood pressure (20). whites. These models eliminate the "apparent para- Although the role of racial discrimination as a pos- dox" of better survival in small black babies since with sible determinant of hypertension has been empha- these standardized distributions, blacks generally have sized by a few epidemiologists (29), most investiga- greater perinatal mortality (39, 42). These results have tors continue searching for biologic mechanisms that been interpreted as suggesting that the differences in would explain an increased genetic susceptibility in population distributions of birth weight are genetically blacks. Increased susceptibility to sodium or sodium determined (39). However, the authors did not take retention is a popular one, although the results are far full advantage of the information that was available on from consistent (49). Even if some populations had a social class, such as maternal (39). The main higher sensitivity to sodium, this most likely would argument here is not derived from biologic theory but represent a phenotypic difference (47). Speculative is statistical (i.e., their model fits the apparent paradox historical hypotheses (e.g., Middle Passage) of this of better survival in small black babies as compared suspected racial susceptibility to salt intake have been with white babies). However, the predominant factors discredited (47). For example, one may challenge such causing low birth weight and prematurity may differ hypotheses by noting the impropriety of solely using because of unmeasured social exposures determined US samples to make inferences about white and black by class position and racial discrimination, with dif- races (26). ferent severity in terms of mortality. The mechanical As the hypertension research illustrates, the disre- use of the variable race precludes an understanding of gard for racial discrimination as an explanation for why black immigrants show much lower low birth racial inequalities in health is matched by the lack of weight rates than United States-born blacks, why evidence supporting genetic explanations. The consid- black-white differences in low birth weight rates are eration that a specific phenotypic trait such as skin not evident in other nations, or why paternal race does color is a marker for an increased susceptibility to a not affect the birth weight distribution of those born to wide variety of diseases and pathophysiologic traits white mothers and black fathers (e.g., 43-45). Al- must be justified. Skin color is mostly a reflection of a though adjustment of birth weight to population- common history of exposure to ultraviolet radiation, specific weight standards underscores racial differ- and its use for characterizing a discrete "package" of ences in preterm delivery (46), the assumption or genetic material has been by now widely discredited in suggestion that such a relevant risk factor might be anthropologic research (19, 29, 47, 50). Since the genetically linked to skin color (e.g., 38, 39) promotes 1950s, it has been known that human biologic charac- a biologic notion of race, providing justification for teristics affected by migration selection or drift are more research on the biology of race and making distributed in geographic gradations or clines such as direct examination of race-associated social depriva- those for facial features, hair texture, epidermal mel- tion secondary. anin, ABO alleles, which do not correlate (19). For example, the gene codes for type B blood increase in Racial differences in blood pressure frequency from west to east across Europe and Asia, A third example of implicit biological determinism reflecting migrations out of Asia, whereas epidermal is hypertension, in which an elevated prevalence is melanin is distributed in a decreasing pattern from the still observed in blacks after adjustment for education equator to northern latitudes in response to selection or income levels (47, 48). The genetic origin of the for protection against ultraviolet B radiation. Thus, elevated risk of hypertension in blacks is taken for discordant patterns of heterogeneity falsify descrip- granted in epidemiology and medicine. In a recent tions of populations as if they were genotypical or

Am J Epidemiol Vol. 144, No. 6, 1996 534 Muntaner et al. even phenotypically homogeneous (i.e., biologic rac- minority students with the same academic achieve- es; 19). Furthermore, 85 percent of human genetic ments as their white peers are less likely to be included variation is found within human populations rather in accelerated tracks in the public school system (54); than between the major populations socially labeled as and minority defendants with identical socioeconomic "races" (51). Therefore, according to the "received position as white defendants are subjected to a harsher view" in physical anthropology and evolutionary bi- administration of justice (55). These are examples of ology (19, 30), biologic races appear to be the outcome differential life experiences that are not accounted for of social perception. by the standard surrogates of social class. Another form of implicit biological determinism in epidemiology takes place when researchers use indi- SUGGESTIONS FOR EPIDEMIOLOGIC vidual level categories (e.g., occupation, race, gender) RESEARCH without an explicit statement of the theory that might Now is the time for social explanations to constitute explain differences in health outcomes associated with the first hypotheses when looking at racial inequalities these categories. Thus, some researchers may adopt a in health. Different racial/ethnic groups might have pragmatic approach to social epidemiology (56) and different social experiences that affect health. Exam- conclude that "education" is the preferred social strat- ples of this are presented in table 1, which is a sum- ification predictor of health. This practice leaves the mary of discrimination mechanisms that might operate explanation of what determines education to the read- as cumulative exposures over the lifetime. It has been er's implicit theory of causality (57). Because people empirically demonstrated, for example, that African- in general have a tendency toward attributing people's Americans are less likely to receive a mortgage loan behavior to intrinsic properties of the person (57), than whites of similar education and income level (52) biological determinism becomes a likely explanation and are systematically denied access to middle and among biomedically trained scholars in particular (7). upper income housing developments (53). In addition, This mechanism might be even more compelling when

TABLE 1. Mechanisms of discrimination experienced differently by race/ethnic groups with potential health significance over the life span by mode of social Interaction according to published sources

Discrimination

Economic Political Cultural Access to goods and services Political rights (e.g., civil rights, Belief systems (e.g., stereotypes, (e.g., loans, health desegregation, democratic attitudes, beliefs and depiction insurance, health care, representation, empowerment) of groups by media, firms, and justice, schooling) Fraser (2) government) Myers (63) Jacoby and Glauberman (11) Williams et al. (20) Darity et al. (65) Mann (55) Kriegeretal. (21) Barbarin(67) Lott and Maluse (62) Greenwald and Banaji (68) Residential segregation (e.g., Swim et al. (69) housing, environmental Rugglero and Taylor (70) exposures) Lerner (75) Massey et al. (64) James (72) Brown (66) Judd et al. (73) Access to labor markets (e.g., schooling, training, employment, promotions, primary labor markets) (I.e., "good Jobs" with benefits); and salaries; workplace hazards; and psychosocial environment Turner et al. (52) Oakes(54) Darity et al. (65) Barbarin (67) Reich (71)

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