POLITICS JUNE 11, 2007
It seemed like just another harmless moment on daytime TV: Oprah Winfrey began an "Ask Dr. Oz" segment with the physician Mehmet Oz, and the two arrived at the subject of excessive sweating. Oz cited high blood pressure as a major cause and then asked Winfrey if she knew why black Americans experienced hypertension at disproportionate rates.
No problem so far. But then Winfrey answered Oz's question by reviving what scholars have called the "slavery hypothesis" of hypertension. Black Americans, that thesis holds, experience greater rates of hypertension today because those slaves most likely to survive the brutal journey to the New World had bodily constitutions that retained higher amounts of sodium; with more sodium, they were likelier to survive ailments related to salt- and water-deprivation that often resulted in death. But, while sodium-retention became an adaptive trait that helped many slaves survive, it also imperiled them and their descendants, since sodium is a major risk-factor for hypertension. Oz approved Winfrey's summary of her ancestors' "unique ability," in his words.
There was just one problem. The thesis is bunk. Since its heavy promotion in the 1980s by Thomas W. Wilson and Clarence Grim, the slavery hypothesis has steadily been demolished on theoretical and evidentiary grounds, most notably by the distinguished historian Philip D. Curtin in a 1992 American Journal of Public Health article. Curtin argued that Wilson and Grim had sloppily handled statistical data, made inexact citations to prior articles, and neither showed that salt was actually scarce on the voyages nor proved significant numbers of deaths had occurred due to salt depletion. Meanwhile, as Curtin also pointed out, other researchers found that blacks in other former slave societies, like much of the West Indies, did not have uniformly high hypertension. (For a thorough overview, see also epidemiologist Jay Kaufman's contribution to an excellent symposium on the new science of race.) In short, the case for salt-retention as a race-specific genetic trait is incredibly weak. But these rebuttals are not just esoteric academic arguments. Without more reflection on why they keep resurfacing, the assumptions behind the slavery hypothesis and other notions of genetic determinism will hinder racial equality, and they could even imperil people's lives.
HERE'S WHY. FIRST, by claiming an innate link between race and a chronic health condition, the hypothesis shifts the focus away from the external factors that public health researchers have identified as contributors to hypertension. A 1996 study by Nancy Krieger and Stephen Sidney, published in the American Journal of Public Health, explored links between victim responses to racial discrimination and high blood pressure. And a report this year by the city of New York found that the percentage of fast food restaurants in overwhelmingly minority (and low-income) East and Central Harlem is four times that of the white (and wealthy) Upper East Side. Two out of three grocers in Harlem are bodegas, compared with only one of three on the Upper East Side, which also has an extra supermarket per 10,000 people. Minority neighborhoods offer diets that cause not only hypertension, but also related problems like diabetes, obesity, and other conditions.
Second, the slavery hypothesis assumes a long discredited biological basis for "races." Such biologically-based racial essentialism has been rebutted by scientists like the late Stephen Jay Gould, Richard Lewontin, and Jonathan Marks. In 1998, the American Anthropological Association issued a statement that concluded: "[P]resent-day inequalities between so-called 'racial' groups are not consequences of their biological inheritance." Yet some folks clearly cling on to a link between a person's race and her health. In 2002, for instance, Sally Satel--a Brown University-trained psychiatrist--penned an eye-catching New York Times opinion piece titled "I Am a Racially Profiling Doctor." In it, she describes how she gives different initial dosages of medicine to black patients, because "blacks metabolize antidepressants more slowly." This goes beyond just the sloppy historical demography of Wilson and Grim. It's denial of equal treatment based on a shaky proxy--race--that has no true meaning beyond ideology. (And it's also wrong, as even Satel admits: "To be sure, not every African-American is a slow metabolizer of antidepressants; only 40 percent are.") It's not hard to see how dangerous this can be. Imagine being denied the treatment given to other patients because your physician believes that, occasionally, some members of your race respond differently.
Oz and Satel are not fringe oddities. The racial assumptions behind their claims seem to be coming back, and not just in medical quarters. In 2005, Roland Fryer, a black assistant professor of economics at Harvard University and the associate director of its W.E.B. Du Bois Institute for African and African-American Research, received a glowing profile in The New York Times. In it, he advanced a version of the slavery hypothesis and suggested that exploring innate connections between race and intelligence ought to be a viable research premise:
I want to have an honest discussion about race in a time and a place where I don't think we can. ... Blacks and whites are both to blame. As soon as you say something like, 'Well, could the black-white test-score gap be genetics?' everybody gets tensed up. But why shouldn't that be on the table?
Why? Because it has been roundly debunked from multiple disciplinary angles, most recently after the 1994 publication of The Bell Curve, the infamous neo-eugenic tome of Charles Murray and Richard Herrnstein that proposed an innate link between race and intelligence. The Bell Curve (an adaptation of which ran alongside more than a dozen responses in The New Republic in 1994) resulted in not just one but at least two major anthologies in which scholars from a variety of fields and political orientations almost unanimously disputed its premises and conclusions. And, yet, sloppy connections between biological conceptions of race, health, education, and other social phenomena aren't going away.
WE REALLY OUGHT to ask why, even after the Bell Curve debate, racial determinism anchored in biology has come back as a respectable idea. One possible reason is that there are huge institutional and financial interests in such explanations. The science of finding genetic solutions to medical and social problems is booming. So-called genomics is a big business with billions in venture capital and university research centers at stake. And the FDA's 2005 approval of NitroMed's BiDil--a heart drug that claims to have racially particular benefits for black heart patients (controversially, the core clinical trial that earned BiDil FDA approval was performed only on black patients)--suggests we'll see more and more attempts to extend the grandiose (but as yet largely untested) promises of genomics to race.
But it's not just self-interest fueling the boom in genomics. There's an element of techno-utopia as well, especially with all the undeniable strides in DNA testing and the Human Genome Project of the past decade. As the political scientist Adolph Reed puts it in a recent Journal of Race and Policy article, these new "innovations in medical genetics have given race a new central place in medical research and debate." He continues,
Genomic research holds out promises to enable design of more finely tailored diagnostic and treatment regimes than ever before. As in earlier moments, these new research technologies have encouraged exuberance for biological determinist perspectives, which appeal to an enduring fantasy of millennial discoveries that will provide clear technical solutions to vexing social problems.
What's ironic, too, is that, when it comes to mixing race and genomics together, the strongest proponents are hardly the overt racists of the early twentieth century. And they definitely aren't the ones behind the Pioneer Fund, the notorious eugenic foundation that funded much of the research in The Bell Curve (the Pioneer Fund declares on its website that its origins are in the "Darwinian-Galtonian evolutionary tradition," a reference to Francis Galton, the intellectual father of nineteenth-century eugenics). Fryer comes off in his Times profile as someone sincerely interested in studying and dismantling racial inequality. And BiDil won the endorsement of the Association of Black Cardiologists. There's no reason to doubt the good intentions.
But that doesn't mean there's no road to hell. It's worth also recalling the essayist C.P. Snow's worries, in 1956, about the growing separation of the sciences and the humanities into "two cultures" oblivious to the insights each could offer the other. Many of those who take race as a fixed biological category would do well to review the work of scholars in the humanities who have shown how the numbers, names, and members of respective races are always in flux. Go somewhere else on the planet or step back a century, and you'll likely encounter a different racial schema all together.
Just look, for example, at the Dillingham Commission of the United States Congress, which, a century ago, began studying immigration from Europe. In one of its many publications, the bizarre Dictionary of Races or Peoples, the Commission summarized the state of thinking on race as follows: "Some writers have reduced the number of such basic races to 3, while others have proposed, 15, 29, or even 63." The Commission went with five.
Indeed, race will always be a byproduct of context--especially in an age when scientific advances claim to pinpoint racial differences (and the health conditions tied to them). In this way, we've changed little since 1916, when Madison Grant's bestselling eugenic tome, The Passing of the Great Race, contained a chapter called the "The Physical Basis of Race" that detailed the exact skull, nose, eyes, body posture, and hair characteristics that fit its racial types. (In 1917, Franz Boas trashed the book in these pages in one of the few major negative reviews.) However technologically precise current attempts at biological determinism may appear, they inevitably rest on the same fallacy as their antecedents--the fact that race is too intellectually murky and fluid to anchor a theory in the first place.
It's time we stop and really consider C.P. Snow's brilliant insight and think about the underlying tenets behind the new racial science, often presented as value-free. It'd be especially sad if those who act out of serious concern for black Americans' health end up embracing ideas of racial particularity not too distant from those underlying the Dillingham Commission, Madison Grant, The Bell Curve, and other sorry chapters in the history of American thought.