The Spectacle of the Races: Scientists, Institutions, and the Race Questions in Brazil, 1870-1930 (review)

Posted in Anthropology, Articles, Book/Video Reviews, Brazil, Caribbean/Latin America, Health/Medicine/Genetics, History, Media Archive, Social Science on 2015-10-29 22:10Z by Steven

The Spectacle of the Races: Scientists, Institutions, and the Race Questions in Brazil, 1870-1930 (review)

Bulletin of the History of Medicine
Volume 75, Number 1, Spring 2001
pages 152-153
DOI: 10.1353/bhm.2001.0014

J. D. Goodyear, Senior Lecturer and Associate Director, Public Health Studies Program
Johns Hopkins University, Baltimore, Maryland

Lilia Moritz Schwarcz. The Spectacle of the Races: Scientists, Institutions, and the Race Questions in Brazil, 1870-1930. Translated by Leland Guyer. Originally published as O espetáculo das raças: Cientistas, instituições e questão racial no Brasil, 1870-1930 (Brazil: Companhia das Letras, 1993). New York: Hill and Wang, 1999. ix + 355 pp. Ill. $35.00.

Brazil, like the United States, is an immigrant nation with an extensive history of slavery: in more than three hundred years of slave trading, Brazil received an estimated 3.5 million Africans. But unlike the United States, in Brazil slavery permeated all of the cities as well as the many distinctive regions. And with slavery came widespread miscegenation — a phenomenon that has shaped not only the demography of modern Brazil but also its intellectual history and cultural identity.

As the nineteenth century unfolded, Brazil shed its status as a Portuguese colony and educated elites sought to adopt notions of progress that were derived from ideas of the Enlightenment and the emerging power of science. Toward the end of the century, the thought of Darwin, Spencer, and the positivists lay at the core of debates about race and Brazil’s potential to achieve order and progress. Lilia Moritz Schwarcz takes up the challenge of examining the social history of racial ideas held by a range of Brazilian “shadowy men of science” (p. 16). In so doing she offers us a remarkable playbill of the extensive cast of characters and the plots that shaped the intellectual discourse among elites in Brazil for more than six decades.

Schwarcz focuses on the naturalists, historians, legal theorists, and physicians who sought to rationalize Brazilian social realities in light of nineteenth-century European thought. These are her “shadowy men” who engaged in defining the role of race in Brazilian identity. As a group, they were well educated and eager to participate in the debates begun in Europe and fueled by Darwinism and positivism. Other scholars who have visited this topic paint with much broader strokes. A great strength of this book is that Schwarcz teases apart the positions of the various players, examining the nuances that distinguish different lines of race thought. She has made a conscious effort to articulate the original contributions of Brazilians to the social construction of race that, by her estimate, occurred by the turn of the century. Another strength lies in her effort to take a comprehensive look at educated elites writing in different genres. Rather than isolating a single set of professionals, or concentrating on elites located in a single region of the country, she takes up the challenging task of reviewing extensive published materials across several disciplines. Through content analysis of journal articles, as well as close reading of editorials, theses, and treatises, she isolates the pivotal role of race in defining Brazil before and after emancipation (1888).

The materials used by Schwarcz are exceptionally rich. Whether analyzing natural history museums or institutes of history and geography, she can compare institutions founded in different cities to discern regional approaches to the meaning of miscegenation for Brazil. In her comparative profiles of the Goeldi Museum in Belém and the (new) National Museum in Rio, she reviews research efforts into physical anthropology as they relate to the perceived negative impact of Amerindians and Afro-Brazilians on the country’s ability to achieve sociocultural progress. She continues in the same style with her comparison of Brazil’s two law schools (at São Paulo and Recife) and two medical schools (at Bahia and Rio). She captures the individual approaches of different institutions through in-depth analyses of their respective journals and other publications that document the scholarly output each institution encouraged and found deserving. The jurists tended to view themselves as “masters in the process of civilization” (p. 233), and they repeatedly addressed issues of race and race-mixing as matters of penal law, criminal anthropology, and social policy. At the two medical schools, the physicians and medical students wrote regularly about race…

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Medicating Race: Heart Disease and Durable Preoccupations with Difference by Anne Pollock (review)

Posted in Articles, Book/Video Reviews, Health/Medicine/Genetics, History, Media Archive on 2014-07-11 06:52Z by Steven

Medicating Race: Heart Disease and Durable Preoccupations with Difference by Anne Pollock (review)

Bulletin of the History of Medicine
Volume 88, Number 2, Summer 2014
pages 393-395
DOI: 10.1353/bhm.2014.0025

Lundy Braun, Professor of Pathology and Laboratory Medicine; Africana Studies
Brown University, Providence, Rhode Island

Anne Pollock, Medicating Race: Heart Disease and Durable Preoccupations with Difference (Durham: Duke University Press, 2012).

Science and technology studies (STS) scholar Anne Pollock’s Medicating Race uses the lens of “durable preoccupations” to explore the racialization of different categories of heart disease from the early twentieth century when cardiology emerged as a medical specialty. The book is a useful reminder that the intense and sometimes vitriolic debate over BiDil, a medication for heart failure and the first race-based drug, is but one moment—though a very public one—in a long history of the mobilization of race in cardiology. Drawing on rich and varied sources, including archival materials, scientific articles, interviews, and professional conferences, Pollock extends prior analyses of BiDil to examine the intersection of race with the numerous epistemological debates that characterize the history of heart disease. Why, Pollock asks, has race proved so resilient in the history of heart disease, despite relentless critique?

This deeply theorized account tracks “epistemologically eclectical” racial preoccupations as they travel among the social worlds of science, the clinic, and the pharmaceutical industry. Weaving together three main themes—the role of heart disease research in constituting Americanness, the persistence of racial categorization throughout this history, and the social and political dimensions of health disparities activism—Pollock argues that the durability of race in theories of heart disease is a dynamic biosocial process enmeshed in ambiguous and changing classifications of both disease and race and the persistence of unequal access to power, resources, and treatment. As Pollock writes, “Preoccupations with racial differences always exceed the data itself” (p. 19).

Beginning with early twentieth-century beliefs about infectious etiologies of heart disease, racial discourses shaped the emergence and professionalization of cardiology in complex ways. So deeply entrenched were ideas of syphilitic heart disease in blacks, for example, that Booker T. Washington’s death from arteriosclerosis in 1915 remained a matter of dispute until the 2000s. For African American physicians committed to providing medical care to their neglected communities, engagement with black heart disease also provided them with access to the modern technologies of scientific medicine, albeit limited. As others have shown with diseases such as tuberculosis and cancer, discourses of modernity, stress, and civilization were central to the whitening of coronary heart disease by midcentury.

Particularly fascinating is Pollock’s detailed examination of the complicated relationship between the famed Framingham Heart Study organized in 1948 and the Jackson Heart Study organized in 2000. Framingham researchers constructed their population as both white and normal through changing coding practices, categorizations, computerization, and data analysis, all of which cohered to produce hypertension as a distinct disease category. Modeled on Framingham, the Jackson Heart Study recruited only self-identified blacks, constructing a population that was simultaneously representative and different. Unlike the Framingham investigators, the Jackson investigators incorporated the social dimensions of health disparities, in addition to lifestyle and genetics, into the study design. In chapter 3, Pollock traces the complexity of social processes that produced African American hypertension as a distinctive disease category—and the consequent emergence of the category of African American itself as a risk factor for heart disease. Moving to “durable preoccupations” in contemporary race science in later chapters, Medicating Race analyzes the debates about the salt-slavery hypothesis of hypertension, thiazide diuretics, and BiDil.

While arguing throughout the book for careful attention to biology in any constructivist analysis, for this reader Pollock underestimates the consequences of genetic essentialism and market imperatives in medicine. Yet, in making explicit the tensions in democracy embedded in the historical debates over black heart disease, this book provides fresh insight into a key aspect of the dilemma of difference: when and how to use race in contemporary research. Despite at least a decade of careful social and scientific scrutiny, the academic and public debate about race and race science is not, nor can it be, settled as long as race remains such a salient marker of inequality in U.S. society.

This theoretically sophisticated book does an excellent job of making many familiar STS concepts relevant to medical history. Placing current arguments over race and heart disease in a broad historical context, Pollock adds valuable nuance to the historiography of race and heart disease and their material-semiotic natures. For all its semiotic ambiguity, heart…

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Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age by Jonathan Kahn (review)

Posted in Articles, Book/Video Reviews, Health/Medicine/Genetics, Media Archive, United States on 2013-12-23 17:34Z by Steven

Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age by Jonathan Kahn (review)

Bulletin of the History of Medicine
Volume 87, Number 4, Winter 2013
pages 708-709
DOI: 10.1353/bhm.2013.0067

Anne Pollock, Assistant Professor of Science, Technology and Culture
Georgia Institute of Technology, Atlanta, Georgia

Jonatha Kahn, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age. New York: Columbia University Press, 2013. xi + 311 pp. Ill. (978-0-231-16298-2).

When BiDil was approved by the U.S. Food and Drug Administration in 2005 for heart failure in black patients, it became the first ever drug to receive a racial indication. Race in a Bottle is likely to be the most in-depth book that will ever be written about BiDil’s controversial regulatory approval. Its author, Jonathan Kahn, has followed the case of BiDil’s approval at least as closely as anyone else, probably including those most directly involved (the clinicians, the pharmaceutical company, the FDA). Ever since he first heard about BiDil in 2002 (p. 4), Kahn has pursued the story doggedly. He became part of BiDil’s story through the articles he wrote about it, starting with a 2003 piece in Perspectives in Biology and Medicine, which debunked the statistic that blacks were twice as likely as whites to die of heart failure. These articles were read by regulators, among others, and in 2005 Kahn testified against BiDil’s race-specific indication at the FDA hearings on the drug (p. 94). Kahn notes that material in this book has previously been published in sixteen different journal articles and book chapters (pp. ix–x); Race in a Bottle is the definitive compilation of that body of work.

Regulatory processes are at the center of Kahn’s account. According to Kahn, “Race enters biomedicine through many pathways. Foremost among these are federal initiatives that shape the production and use of racial categories in biomedical research” (p. 25). Kahn carefully traces the ways in which the terrain of BiDil was laid by mandates at the FDA and NIH to use OMB categories and, especially, by patent law. This regulatory focus is not inevitable as a way to approach how race enters biomedicine: we might start with lived experience in a structurally racist society, or with clinical encounters, or with social movements mobilized against health disparities, or elsewhere. But Kahn’s passion is for regulation, and this is where his expertise is on display.

Race in a Bottle is at its most effective in debunking two things: BiDil’s racialized indication and racialized medicine as a path toward pharmacogenomics. As Kahn fastidiously shows, the vasodilating drug combination that would become BiDil (isosorbide dinitrate and hydralazine) was originally conceived of as a treatment for anyone with heart failure, not just blacks, and it was commercial imperatives—specifically circumventing the fact that the patent on the drug without the racial indication was about to expire—rather than persuasive scientific evidence that led the pharmaceutical company to seek approval for it as a drug for blacks. Kahn also persuasively debunks the notion that racialized medicine is a step toward pharmacogenomics. Although many BiDil proponents argued that race was a “crude surrogate” but nevertheless useful “in the meantime” until more was known about the genetics of drug response (p. 157), Kahn shows that even when there are genetic tests available to indicate drug response (as in warfarin, the “poster child for pharmacogenomics” [p. 165]), “far from withering away, race is persisting and even proliferating as genetic information increases” (p. 168).

Race in a Bottle is less convincing as a window into “racialized medicine in a post-genomic age.” Situating BiDil in a “post-genomic age” is misleading. In Kahn’s own account, BiDil emerged from statistical signals in clinical trial data, not from genetic research. Related claims of racial differences in heart failure foregrounded pathophysiology, not genetics. BiDil’s FDA indication is for “self-identified black patients,” an explicitly social category rather than a genetic one. Yet the book opens by describing the White House ceremony on the occasion of the completion of the Human Genome Project (p. 1). This narrative choice is emblematic of a preoccupation with genetics in the account as a whole, and shows the intractable appeal of analyzing race in terms of genetics, even for those explicitly critiquing genetic understandings of race. Even if some (but not all) BiDil proponents simply slide the drug into a genetic frame, why should critique of BiDil do so?

Finally, because of the explicitness of its racialization, BiDil has become an obvious icon of racialized medicine, but it is actually not clear that BiDil is…

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