Note: italicized quotations come from the Original Medical Articles
“Black people have just as many rights as white people nowadays”
“It was just a joke, don’t be so dramatic”
“Racism doesn’t exist anymore”
White people seem to have no shortage of opinions on just how common racism is in today’s world, but what is the reality of the situation? Sociologists and historians have long observed a phenomenon whereby populations become too comfortable in their marginal social progress to the point that attempts to push the issue further are effectively silenced. Black people gained immense legal and social rights in the civil rights movement of the mid twentieth century. It was such an improvement on previous conditions that many white people were convinced of the end of racism. In spite of this fact, racist ideas, media, and stereotypes persist in the wake of these events. More recently, Americans elected the first Black president this country has ever seen. It is surprising to some, but painfully predictable to those familiar with this pattern, that the following two presidents fell short of the groundbreaking new diversity many expected and hoped for after Obama’s presidency. Each step of social progress seems to bring with it a dangerous type of complacency that continues to allow glaring racist structures to survive in a supposedly racially equal environment. One institution which continues to harbor structural effects of a historically racist society is that of the American healthcare system.
When examining racism in the American healthcare system, no field exhibits more glaring and consistent evidence than psychiatry. For as long as this discipline has existed, doctors and researchers have found ways to leverage their power to oppress non-white individuals. In Paul Garon’s 1998 article Psychiatry’s White Problem: Racism as Therapy, many examples of this phenomenon are covered in detail. For example, in the 1840s, census data was skewed to show increased levels of insanity in free Black Americans versus enslaved Black Americans. The existence of the supposed mental illness, “drapetomania” was popularized as an explanation for why slaves desired their freedom and attempted to escape. This was one of many attempts to justify discrimination with a “scientific” basis. Since that time, research data has continuously been skewed to frame white people as the superior race. Other studies illustrate this. When white participants scored lower than Black participants in a study of sensory perception speed, these results were interpreted to suggest another facet of white superiority due to a heightened capacity for reflection and deliberation in white people. Perhaps the most glaring evidence of racialized psychiatric care is found in the differential diagnoses given to black and white patients presenting with the same symptoms:
Certain diagnoses seem never to be given to Blacks: Multiple Personality Disorder MPD, now called Dissociative Identity Disorder) is one. Significantly, this diagnosis seems to be awarded only to upper class patients, perhaps because the only treatment recommended by those who countenance this disease is long, drawn-out, and expensive… Even more blatant in the diagnosis of so-called kleptomania, reserved exclusively for rich white women whose families can buy them out of jail… A Black kleptomaniac is diagnosed as a thief.
The harmful racial bias which shapes the history of psychiatry also lies deep among the roots of most other medical specialties. Although this discrimination is often more obscure, it is no doubt still prominent in many ways. One more subtle example of this ever-present bias can be seen in the calculation of a patient’s estimated glomerular filtration rate (eGFR), an indicator of kidney function. A person’s eGFR is calculated using an algorithm which takes into account age, gender, and creatinine level. As recently as 2021, race was also included in this measurement. Utilizing race in this calculation was a result of the inaccurate assumption that Black people tend to have higher muscle mass than white people, artificially inflating their kidney function. Nephrologist Nwamaka Eneanya, MD, MPH advocated for the removal of race from the eGFR formula, explaining why the calculation was inaccurate and dangerous:
Human genome studies have shown there are no inherent biological differences between races. Those studies reporting that Black people had greater muscle mass were flawed, but no one questioned them. Patients’ eGFR scores inform many clinical decisions; guidelines recommend a chronic kidney disease diagnosis at less than 60, a specialist referral at less than 30, and placement on a transplant list at less than 20. If we “correct” Black patients’ scores, we refer them for care too late. (Source)
As Dr. Eneanya pointed out, the consequences of racial bias in the medical field are tangible and deadly. A Black patient and white patient of the exact same age, gender, and with identical lab values would receive different treatment based solely on their race. Although most physicians today hold no conscious “racial prejudice”, disparities in healthcare persist due to biases, such as that seen through the eGFR, which are deeply ingrained in the fabric of our medical system. In order to eliminate such discrepancies, systemic issues must be addressed.
Considering the dangerous racial prejudice at play in our existing healthcare system, we must be vigilant as new technologies develop to ensure that this harmful pattern is not perpetuated. One such advancement which carries the potential to cause racial and class divisions has been the emergence of gene editing techniques. While the main focus of this technology at this point in time is in preventing genetic disease, many have proposed the possible ethical dilemmas involved in making this type of procedure available to the public. The heart of this issue is explains in detail in Miserabilism and the New Eugenics by Eric Bragg:
Consider the people who would be denied employment because they have been classified as ‘predisposed’ to genetic disease – a new version of the old problem of employers who would rather not pay for the ‘maintenance’ of ‘their’ employees. Consider also the scenario in which an unborn child is predicted to develop a genetic disease at a young age. Should the parents decide to abort the child or carry it to term? Better yet, perhaps there is a new gene therapy which could improve the conditions of the child. But can the parents afford this gene therapy?… The question is: Who will have access to these new augmentative treatments? How will these services be regulated, and by whom?
At the time this article was written in 1998, these discussions were primarily theoretical, but today they are quickly becoming a reality in the medical field. Concerningly, implicit in many of these difficult questions is the idea that society may soon have the ability to determine which human traits are preferable to others, a mindset that could too easily be applied to racial superiority. Furthermore, because non-white individuals are disproportionately impacted by economic disadvantage, these individuals may find themselves without a voice in the very system which has the potential to cause them harm. In order to ensure that race does not become a factor in an already ethically charged biomedical debate, we must take steps to correct the social systems which have for too long been allowed to influence medical care in the United States. As Garon finished his article over 20 years ago: It is the structure of society that must be changed, and locating the problem within the province of each individual’s symptoms will never illuminate the social source of the symptoms as the true cause of our current despair.