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Toward the Abolition of Biological Race in Medicine 1 Lives, Are Inherently Political—A “Theory in the Flesh.”2 Text and Harm of Their Practices

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Toward the Abolition of Biological Race in Medicine 1 Lives, Are Inherently Political—A “Theory in the Flesh.”2 Text and Harm of Their Practices Biological Race inMedicine Race Biological Transforming Clinical Education, Research, and Practice Research, Education, Clinical Transforming Toward the Abolition of the Abolition of Toward Noor Chadha, Bernadette Lim, Madeleine Kane, and Brenly Rowland and Brenly Kane, Madeleine Lim, Noor Bernadette Chadha, MAY 2020 BELONGING.BERKELEY.EDU | INSTITUTEFORHEALINGANDJUSTICE.ORG POLICY BRIEF This report is published by the Institute for Healing and Justice in Medicine, and the Othering & Belonging Institute. The Institute for Healing and Justice in Medicine is an interdisciplinary hub - a community, a research epicenter, and a dialogue space related to healing, social justice, and community activism in Western medicine and public health. The Othering & Belonging Institute brings together researchers, community stakeholders, and policy-makers to identify and challenge the barriers to an inclusive, just, and sustainable society in order to create transformative change. The use of biological race in med- world where the social construct Nicole Carvajal icine is an unchallenged, outdated of race is not conflated with biol- Willow Frye norm throughout clinical educa- ogy and the health consequences Nazineen Kandahari tion, research, and practice. of racism are acknowledged, Inderpreet "Preet" Kaur addressed, and cared for in all Aminta Kouyate Medicine largely frames racial their forms. Sharada Narayan health disparities in terms of Luke Silverman-Lloyd biological difference and individ- Scott Swartz ual behavior, despite evidence Coauthored By Nathan Swetlitz that social and structural factors Noor Chadha Shreya Thatai generate and perpetuate most Bernadette Lim Kay Walker health issues. Madeleine Kane Brenly Rowland As a result, medicine fails to Copy Editor address racism and its health Stacey Atkinson Interdisciplinary Faculty Editors consequences. This is bad and and Advisors irresponsible science. Layout & Design Tina Sacks, PhD Christopher Abueg Racism—a structure and ideology Osagie Obasogie, JD, PhD that oppresses and limits resourc- Amy Garlin, MD Published May 2020. es to minority groups—is rarely Monica Hahn, MD, MS, MPH discussed in clinical health and the Seth Holmes, MD, PhD Contact health sciences as a meaningful Othering & Belonging Institute at determinant of health outcomes. Interdisciplinary Cosponsors UC Berkeley Thus,racial health disparities are University of California, Berkeley 460 Stephens Hall Berkeley often wrongly attributed to biology —Othering & Belonging Institute CA 94720-2330 and physiology of racial groups University of California, Berkeley Tel 510-642-3326 rather than the stratified —Center for Race & belonging.berkeley.edu socioeconomic opportunities that Gender Studies are available. Institute for Healing and Justice As medical students and gradu- Peer Editors and Peer in Medicine ate student researchers, we wit- Contributors for Our instituteforhealingandjustice.org ness these harms every day in our Initial Drafts textbooks, classrooms, clinics, Rachel Bigley and communities. We envision a James Cevallos Content Why We Wrote This 1 Who Is This Work For? 2 Introduction 4 SECTION 1 Racism, Not Race, Causes 5 Health Disparities What Are Racial Health Disparities and Why Do 5 They Exist? A Note about Language 7 Race 8 White Supremacy 8 Racism 9 Interpersonal Racism 10 Internalized Racism 11 Cultural Racism 12 Institutional Racism 13 Structural Racism 13 SECTION 2 Cranial Capacities to Eugenics: 16 How Medicine and Health Sciences Biologize Race SECTION 3 Race-Based Medicine in Diagnosis 19 and Treatment Heart Disease 20 Hypertension—Salt Sensitivity Hypothesis 21 BiDil 22 Kidney Disease and Glomerular Filtration Rates 24 Lung Function, Spirometry, and Current 28 Recommendations by the American Thoracic Society Genetics Research, Precision Medicine, Race, 31 and Ancestry Looking Ahead 36 Epigenetics: One Intersection of Biology with 36 Sociopolitical Determinants of Health Our Conclusions 38 Vision Forward 39 Next Steps 39 Trainees 39 Clinicians and Providers 39 Educators 40 Researchers 40 Community-based Organizations 40 Community Members 40 Bibliography 41 Appendix: For Further Reading 51 Racism, Not Race, Causes Health Disparities 51 White Supremacy Dismantling 51 Fundamental Texts and Resources in 52 Race-Based Medicine Endnotes 53 Why We Wrote This We are students of medicine and public health at the errors in traditional clinical textbooks, research, Joint Medical Program of the University of California, and practice that contribute to root causes of racial San Francisco’s School of Medicine and University health disparities: of California, Berkeley. We each bring a background y In our textbooks, we are taught that race can serve in racial and social justice work and research to our as a risk factor for disease. Yet we know that race current studies. Our unique dual-degree program is a social construct, not a biological risk factor. affords us the opportunity to build upon these backgrounds, providing instruction and opportuni- y In clinical research, we are told that disparities ty to question many of the accepted norms of our in disease among Black and brown communi- clinical education. ties are due to culturally determined individual behaviors. Yet we know that structural barriers Dorothy Roberts, a foremost critical race theory to food and stress-free lives, as well as targeted scholar (and hero), says in her seminal 2015 TEDMED discrimination, prevent many people of color talk, “Race is not a biological category that naturally from achieving health and well-being. produces these health disparities because of genetic difference. Race is a social category that has staggering y In clinical practice, we are mentored by clinicians biological consequences, but because of the impact of who blindly follow guidelines that instruct them social inequality on people’s health.”1 to prescribe based on race rather than overall effectiveness. Yet we know that these guidelines In other words, racism, not race, causes health dis- are built on a deep history of biological racism parities. This truth guides our work. We are united and othering within medicine and health care. by a common goal: to place justice and challenging anti-Black racism at the center of our practice of We have found these scenarios to be commonplace medicine to ensure the care and well-being of all and largely unchallenged throughout our medical communities, especially those that have been histori- education and training. Racist, outdated notions are cally marginalized and disenfranchised. taught in clinical education, solidified in research and perpetuated in practice. As learners of both medicine and critical race theory, we regularly engage in discussions about critical race We are astounded, outraged, and driven to make a theory as we study racial disparities in health. We are call to action. able to see both at once, in ways that many fellow This action is personal, political, and technical. We learners can’t yet see. We also care for underserved follow the tradition of women of color scholar-ac- patients of color at community clinics and safety net tivists, like Dorothy Roberts, Cherríe Moraga, Gloria hospitals throughout the Bay Area. These opportuni- Anzaldúa, and countless others, who embrace that ties have allowed us to put theory into practice, and the way we move through the world, our “personal” the results are shocking. There are critical, deadly Toward the Abolition of Biological Race in Medicine 1 lives, are inherently political—a “theory in the flesh.”2 text and harm of their practices. Some are simply As physicians-in-training, our world is furthermore ignorant of the impact of their actions. We hope this inherently technical as we learn the algorithms of di- paper may provide them with the education and agnoses, and those diagnoses are sometimes visibly language to pause, reflect on their complicity, and and sometimes invisibly political. It is all connected. begin to question and to shift their practice. Oth- Therefore, this work presented here is unapologeti- ers do not care. We hope this paper begins critical cally personal, political, and technical. These are the dialogue and change that one day will change their lives we live and the lens we bring to building a just, practice as well because we know how deeply his- antiracist field of medicine. torical scars run in medicine. Our politics, purpose, and intentions to further ad- This is our action. As members of the health-care vance an antiracist, people-centered medicine are workforce, we find the current state of racism in inspired by abolitionist frameworks of those who medicine untenable. We refuse to be part of a system seek the end-of-the-prison industrial complex.3 that perpetuates harmful, deadly practices against Central to the abolitionist framework is the under- Black people and people of color. We aim to use our standing that all cages that restrict autonomy and unique positionality and experiences as medical and expose people to harm—physical, mental, emo- graduate students to offer a way forward for our cur- tional, psychological, and structural—are connect- rent and future instructors, colleagues, and mentees. ed. So, too, in medicine are all the forms of racism We are inspired by the growing body of research and connected, and much like abolitionism, in order to commentary by clinicians and learners challenging fight them, we must see them in their entirety and both the normalized uses of biological race and the then work to eradicate them
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