Is "race" real?
I consider it real in the sense that other people believe in it. But I don't.
Today's Guest Post author looks at population differences. She writes that the notion of race is too imprecise to be useful in medical science.
College classmate Constance Hilliard is an evolutionary historian who has devoted the past fifteen years to investigating the intersection of evolutionary history and human health. Her latest book, Ancestral Genomics: African-American Health in the Age of Precision Medicine has been published by Harvard University Press with a release date of April 16, 2024. She maintains a website: Evolutionary History & African-American Health.
Guest Post by Constance Hilliard
In late August of 2008, the last item on my check-off list as I wound up a year-long visiting professorship in Japan was a medical wellness exam. Their national health insurance program made the task virtually free. At the age of 59, I had taken considerable pride in the few lifestyle changes that I had adopted over the course of that year. Strolling through a lush garden on the way to campus each morning and making culinary choices that favored the artistic presentation of broiled salmon bento boxes over the sheer poundage of steak and fries had lightened a load that I had not known I carried. But that was before the clinic called me back for an urgent consultation and informed me that I was suffering from kidney failure.
Returning home to Texas two weeks after that devastating diagnosis, my longstanding primary care physician informed me that I had been misdiagnosed. Handing me the lab report, he insisted that my kidneys were perfectly fine. It was then that I noticed a check-off box for “race” at the top of the form. When I asked him what that was about, he merely shrugged and said that it was some kind of algorithmic adjustment that laboratories used. Suddenly, I remembered a remark the Japanese doctor had made at the time of the diagnosis. “Given your lab results,” he said, shaking his head in puzzlement, “quite frankly I have never seen such a healthy-looking patient at such a late stage of renal disease.” Relief entangled with utter confusion launched me on the most iconoclastic journey of my academic career. After all, hadn’t I insistently taught my students over the years that “race” was not biological. It was merely a social construct?
This investigation led me as an evolutionary historian to vital clues that might broaden the way the medical community approaches population differences in health. For instance, the median Japanese daily intake of sodium is 10,000 mg. Americans consume between 3400 and 5000 mg/sodium/day. On the other hand, as an African-American of slave descent, my ancestors emanated from one of the most sodium-deficient regions of the world, that is, the deep interior of West Africa. They farmed in the sweltering heat of the tropics, consuming less than 200 mg/sodium/day. These communities had never tasted table salt, and seasoned their food with the burnt ashes of millet and other plant leaves, a compound high in potassium chloride.
Modern medical researchers had for years puzzled over the fact that 75% of African-Americans over the age of 55 suffer from salt-sensitive hypertension, in some cases leading to kidney failure. But we can now see that an ancestral population carrying highly-sodium-retentive gene variants (APOL 1 g1 and g2) will fare poorly in a U.S. food culture, where the median consumption is 3400+/mg/sodium/day. It should also become apparent that an African-American professor who takes a blood test calibrated to a healthy Asian population genetically adapted to a sodium consumption pattern of 10,000 mg/day will appear to a local doctor to be on the verge of a serious medical crisis.
Race is a meaningful social tool in America’s civil vocabulary. It helps us celebrate our cultural diversity and calibrate how far we’ve come in addition to how much farther we need to go in order to realize our aspirations as a truly democratic society. It can also at times serve as an approximation of population differences as was the case in correcting my kidney failure misdiagnosis. Nevertheless, it is far too crude and imprecise a measurement of genetic populations and needs to be removed from medical science. This is especially the case now that we have the greater precision of DNA ancestry testing. The model that I have developed in my own health disparities research classifies populations according to the unique ecological niches to which their ancestors were genetically adapted. This methodology offers vital clues to chronic diseases and certain cancers whose etiologies have previously been misinterpreted.
As a nursing student in 1975, I questioned my instructor about why race was a factor in lab tests. He proudly informed me that I would have a hard time in medicine if “I just couldn’t accept the facts” & proceeded to not answer the question. Another instructor informed us that African Americans had an extra muscle in their legs that made them faster runners, which made me laugh out loud as I left the room as it seemed a hallmark of racism to me. I’ve thought of those two people & how racist the medical system has been to POC all of these years, continuing to now.