The Re-Emergence of Race as a Biological Category: The Societal Implications- Reaffirmation of Race

• Author: Alex M. Johnson, Jr.
• Position: Perre Bowen Professor of Law, Thomas F. Bergin Research Professor, University of Virginia School of Law.
• Pages: 03

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I Introduction

As the Dean of the University of Minnesota Law School in 2005, I was privileged to host and attend a conference at the Law School entitled, "Proposals for the Responsible Use of Racial and Ethnic Categories in Biomedical Research: Where Do We Go from Here?"¹ To say the least, it was a fascinating conference replete with interesting speakers engaged with topical and controversial issues. The papers presented and discussed were proof of the success of the conference and the relevance of issues addressed. ² Professor Susan Wolf prepared a concise summary of those articles for Nature Genetics, and the reader is encouraged to review that summary before continuing with this Article. ³

Although the conference quite appropriately focused on the topic at hand-the use of racial categories in biomedical research-my thoughts kept drifting to a related, and perhaps more important, issue: the re-emergence of race as a biological category rather than as a social construct. I also pondered the implications of that development in a society in which race continues to be the most prominent social issue,⁴ even though an African-American⁵ was recently sworn in as President of the United States.⁶ I kept returning to this thought because of the topics addressed during the conference, topics which were not new to me.

As a scholar who has written several articles about "race" and its place in the legal system and in legal scholarship,⁷ I have given a lot of thought as to Page 1549 how "race" impacts every significant facet of American society and how this society's history is inextricably tied to its legacy of slavery and the vestiges (for example, "separate but equal" comes to mind) of that awful chapter in American history. I have gone so far as to advocate, in two separate articles, the destabilization of racial categories as a vehicle to eliminate "race" and, ultimately, the effects of race (i.e., racism and racialism⁸) in American society.⁹

As a result, during the twenty-plus years I have been researching, writing, and thinking about race and race-related issues, I have always been puzzled by an event that happens regularly: the release of medical reports and studies that report differential results, findings, or outcomes based on the race of the test subjects. It is fairly common for some reporter to quote a statistic indicating that African-Americans have a higher rate of, say, hypertension than whites. ¹⁰ (As an aside, just the other day I discovered that I have one of the predictors for pancreatic cancer-I am black. ¹¹ This Page 1550 discovery was a result of the public announcement that Justice Ginsburg underwent surgery for pancreatic cancer. ¹²) Now, the fact that African-Americans or blacks have a higher rate of hypertension than whites does not necessarily surprise me. Given the demands, the so-called micro-aggressions that occur every day when you are a black person (no matter what your level of attainment in white society¹³), it is easy for me to intuit that a cost of being black in today's society is a higher rate of hypertension.¹⁴

So, even though I find plausible the claim that blacks have higher rates of illness than whites, I was puzzled by three meta-questions. First, just how do these studies define who is black?¹⁵ Related to this initial question is what Page 1551 are they using as a definition for racial classification?¹⁶ Is it self-referential? That is, do the test subjects themselves identify their race as part of the study? If so, how reliable are these data?¹⁷

Assuming the data are accurate and the racial identifications are reliable, a second, perhaps more important, question occurred to me: Am I correct that blacks have a higher rate of hypertension because of the impact of racism? In other words, why is it that blacks as a group would have a higher rate of a particular medical phenomenon given there is no identified biological connection that unites blacks-that is, no biological definition of race?¹⁸ Is it, as I alluded to above, a function of blacks' historically subordinated position in American society? I am not a medical doctor, but I think I understand why certain blacks, along with certain Jews¹⁹ and Page 1552 descendants of Mediterranean tribes, have a higher rate of sickle cell anemia. ²⁰ And notwithstanding my flippant observation earlier about hypertension,²¹ it is still puzzling and odd that one racial subgroup that has no identified biological or genetic "otherness" should have demonstrably different outcomes than another ill-defined or undefined group,²² that is, whites.²³ Perhaps differences in the incidence of hypertension may be explicable by the micro-aggressions that blacks experience, but how can a drug be developed and marketed to people of a specific race (for example, like BiDil)²⁴ when geneticists have not articulated a definition of race? On the other hand, given that there are other oppressed groups in American society, why don't these differential outcomes follow the identification of all Page 1553 oppressed groups if oppression or being subordinated (living on the bottom)²⁵ is the precipitating cause of the differential outcomes?²⁶

The third and final meta-question presented by this medical conundrum is central to the thesis of this article: what effect, if any, is the use of race or racial categories in medical research having on the social construction of race in American society? In other words, as race is becoming more fluid in our society, are the studies that report differential medical outcomes or recommend different treatments based on race having a positive or negative effect on the way race is viewed in American society? Assuming there is a benefit to the use of race or racially related categories in biomedical research, is there a cost associated with that use and, if so, does that cost outweigh any benefits gained?²⁷ Before a dispositive determination can be made regarding whether the use of race in medical research should be embraced or shunned, these questions must be addressed.

Consequently, whenever I came across a report concluding that blacks or African-Americans have a higher or lower incidence of a particular medical condition than their white peers I understood and believed the data to be credible from a common-sense point of view. ²⁸ I did not believe, nor Page 1554 am I alleging, that the various reporters, scientists, doctors, and others are or were being dishonest or disingenuous in their respective reports.²⁹

However, when I put aside common sense and began to think of this matter as an academic, I was and still remain puzzled-how could these "differences" exist when there are no fundamental racial differences biologically or genetically? Put more elegantly, the fact that there are demonstrable differences in outcomes based on what are perceived to be racial categories, when these racial categories probably do not exist, represents a conundrum. Collapsing and restating my three questions: How can there be demonstrable differences in medical outcomes (for example, the prevalence of high blood pressure and diabetes among blacks) when there is no biological definition of blacks? Or, how can a drug be targeted to one racial group? Again, how can there be differences when there are no differences?

This internal debate between my intuition (which accepts the fact that there are races and there may be perfectly good reasons why different medical outcomes are different for different racial groups) and, for want of a better term, my academic sense (which firmly believes that there is no stable biological definition of race and, further, that there are no meaningful, measurable differences between members of sub-groups that we classify as racial groups), lived harmoniously side-by-side. At least they did until I attended the aforementioned conference, which directly addressed the responsible use of racial categories in biomedical research.

I sat with bated breath as the debate over the proper use of racial and ethnic categories in biomedical research raged within the auditorium of the University of Minnesota Law School on that April day. I learned that researchers studying health disparities argue that using racial and ethnic categories are necessary to determine whether conditions can vary by race and ethnicity.³⁰ The epidemiologists also defended the continued use of race and ethnic categories in an attempt to better understand contributors to diseases, such as the stress of experiencing racial prejudice and reduced access to health care because of poverty and bias. ³¹

I began to see the benefits of using racial categories in medical research, yet I remained troubled about how such data is defined and accumulated. As I began to think about the larger implications of using race Page 1555 in medical research, I became very concerned about the societal impact that would result from its continued use in medical or-more accurately- biomedical research. When the medical profession advocates targeting drug treatments toward members of one race,³² it heightens my concern, especially considering the widely held scientific notions that there is no acceptable scientific definition of race and that no racial differences can be separated or characterized by genetic material. My thoughts were further stimulated by recent claims that there might (and I emphasize, might) be a genetic difference between blacks and whites that could further justify the development and use of a drug targeted toward one racial group but not another.³³

As one who has simultaneously advocated for the destabilization of racial...