‘Race Correction’ in Medicine: A History of Lung Function Measurements
The Life of Breath project was delighted to host Professor Lundy Braun in Bristol recently to speak at our bi-annual team meeting “Breathing Space” along with a special public lecture. Life of Breath researcher Coreen McGuire reflects on Lundy’s visit…
She wondered how to un-know certain things, certain specific things that she knew but did not wish to know. How to un-know, for example, that when people died of stone-dust, their lungs refused to be cremated. Even after the rest of their bodies had turned to ash, two lung-shaped slabs of stone remained behind, unburned.
~Arundhati Roy, The Ministry of Utmost Happiness
How are our lungs affected by the way we live, how we work, or where we sit on the side of the road even? The character in Arundhati Roy’s recent novel, quoted above, ruminates on the death of three manual labourers who have been sleeping next to a main road to take advantage of the mosquito-repellent qualities of the passing traffic’s exhaust fumes. Roy’s novel vividly highlights the intersections and interrelations between class, race, poverty, and health inequalities – the local conditions making the inhalation of exhaust fumes attractive to individuals. What of more global concerns?
Such considerations are at the heart of Professor Lundy Braun’s research on racial differences in lung function. Between Wednesday 9th and Thursday 10th of May the University of Bristol – with The Centre for Black Humanities and The Centre for Health, Humanities, and Science – had the pleasure of hosting Lundy, who is Professor of Africana Studies, Pathology and Laboratory Medicine at Brown University. This was due to the generous sponsorship of the Wellcome Trust-funded Life of Breath project. The highlight of her visit was a public lecture on the topic of her most recent book: Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics.
This issue of ‘race correction’ in medicine is at the heart of Braun’s research, and was the main subject of her public lecture. She opened her discussion by explaining why it is so important that the idea of race and racial difference is historically situated by showing images of the remarkable resurgence of nineteenth century scientific racism repurposed and plastered on posters in college campuses in modern-day US. Analysis of the way in which racialised conceptions of health have been historically reinforced can work against biological reductionism and essentialist ideas about race. These are exactly the kinds of ideologies that have been illuminated by Braun, who has identified that the practice of correcting for race in spirometry has promoted scientific acceptance of difference between racial groups, without due concern to the racial categories employed to organise this data in the first place, or to the way that social conditions and living conditions affect lung function. Indeed, the root causes of some respiratory ill-health may be more closely related to occupational hazards and air pollution affecting lung function, an issue that has been recently highlighted in Bristol by the group Bristol Friends of the Earth.
Many audience members expressed disbelief about the extent to which racist thinking has been invisibly embedded in medical technology. Braun emphasised that race correction is literally programmed into the spirometer. It will not work unless you select race by pushing a button, or picking a race from a selection on a pull-down menu. However, many medics are unaware of how this process affects lung capacity measurements. Yet this could mean that if you are claiming compensation for occupational disease and you are black, a lower norm means that you could be deemed ineligible even with the same degree of lung damage as your white coworker. This works either through a scaling factor (of up to 15%) or through race-specific population standards, all of which vary between different manufacturers and regions.
However, as a tool for evaluating respiratory health the spirometer is very useful – it is necessary for diagnosis of COPD, for example – and it gives good information about the progression of an individual’s illness over time. Moreover, normal reference population values are used for many reasons in medicine, not least because they offer easy and fast ways to assess health. Yet Braun concludes that we must move towards a more intersectional understanding of health inequality, with more consideration for how socioeconomic status affects lung function. She explains that by “considering race, class, and gender as deeply intertwined and the lungs as sensitive indicators of lived experience, we can ask how global inequality affects respiratory health” (from p.205 of her book Breathing Race into the Machine). Reference classes work against such considerations and use race as a proxy for both socioeconomic status and genetics. Indeed, Braun ended the lecture with a fascinating critique of the way that genetic research looks purely at genomic explanations for racial differences in a way that obfuscates the social and structural dimensions of health. Finally, she calls for greater depth and engagement between science, medicine, and medical humanities. As she made clear at the outset of her lecture, engagement and consideration of how politics and inequality have shaped medical research can’t come quickly enough.
Lundy Braun is Professor of Africana Studies, Pathology and Laboratory Medicine at Brown University, and is affiliated with the Science and Technology Studies programme there.