Essential(ist) Medicine Promoting Social Explanations for Racial Variation in Biomedical Research

Article Summary by Iliya Gutin

When all you have is a hammer, every problem looks like a nail—and when all you have is a definition of race rooted in biology and genetics, every racial disparity in health outcomes is attributed to these intrinsic differences. Fortunately, this narrative applies far less to contemporary biomedicine than the racial (if not, explicitly racist) science used to justify white supremacy and racial hierarchies throughout much of social and scientific history. Biomedical researchers are often at the forefront of initiatives and interventions designed to resolve racial disparities in health, across a broad spectrum of outcomes. Many scientists explicitly frame their work as a form of social justice, hopeful that the therapies and treatments they develop help narrow Black-White gaps in morbidity and mortality.

But the way biomedicine “talks” and “thinks” about what race means—and what it represents in their research models and results—has not quite kept pace with the tremendous rate of advances and breakthroughs in the discipline over past decades. Racial differences in the efficacy of some pharmaceutical or treatment are chalked up to unobserved biogenetic factors, rather than equally unobserved socioenvironmental influences that disproportionately shape the health of some racial groups and not others. And these seemingly minor, technical decisions are immensely consequential. Contemporary biomedicine represents a socially-significant interaction between race, genetics and medicine; assumptions about racial differences in genetics inform ‘personalized’ medical treatments and, critically, validate scientific and public beliefs about race as a biological truth rather than a social fabrication. Most perversely, when researchers fall into the same, historical traps of “essentializing” race as a biological construct, they subvert their own progressive goals for using biomedical research to achieve racial health equity and equality.

How, then, do researchers steer clear of these traps and avoid promoting a form of “essentialist medicine” that prioritizes biogenetic explanations for racial variation in health? Perhaps philosopher Ian Hacking’s “looping effects” framework can serve as a guiding light. Hacking’s work focuses on the top-down process by which broader societal themes and prejudices trickle down through institutions and individuals to inform scientific knowledge and evidence—which then loops back to substantiate the underlying social beliefs and biases. However, we can tweak the framework by repositioning scientists at the fulcrum point of this knowledge-creation process, emphasizing how the choices they make in explaining racial variation in their research can help other scientists and the lay public understand the social construction of race. This paper presents a bottom-up “louping” process, by which scientists’ prioritization of social explanations over biological ones is magnified upwards and outwards to inform the schemas used to discuss race in society writ large. However, this louping is contingent on greater structural competency in the biomedical field, whereby biomedical researchers are empowered, encouraged, and educated to present socioenvironmental factors as mechanisms underlying racial variation in individuals’ presentation of disease or response to medicine.

Researchers don’t need to—and cannot—abandon the use of race in biomedical research; but they can think more critically about its meaning, and how this meaning plays a key role in shaping both the scientific and social impact of their work. And instead of relying on a binary view of the world as hammers and nails, racial disparities in health can be addressed by using all of the tools at our disposal.

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