has no biological reality. Biologists and anthropologists tell us
that none of the ways we have carved humankind into subgroups corresponds
to a stable set of biological features. Skin tone, hair texture,
and the shape of the face or eyes vary among humans, but these features
do not cluster in any way that would permit us to identify race
biologically. If race is not biologically real, should medicine
Insofar as medicine is a biological science, one might think so.
In P.C., M.D.: How Political Correctness is Corrupting Medicine
(Basic Books, 2000), Sally Satel argues that the attention public
health professionals give to race is a pernicious infiltration of
political values into scientific research. Political correctness,
she contends, is undermining methodological standards in the health
sciences, corrupting public health initiatives, and ultimately eroding
the health of individuals. In a recent essay in the Atlantic, she
calls for the federal government to cease funding into the
effects of powerlessness, classism, and
racism on health. Satels simple dichotomy,
however, between value-free scientific medicine and political correctness
was made problematic in the interdisciplinary Faculty Seminar on
Race and Medicine, hosted by the Program in Science and Society
in the spring of 2001. As a philosopher of science, I found these
discussions a bountiful resource for reflection on these issues.
One of the first puzzles is that, while race has no biological reality,
there are persistent correlations between race and disease. Satel
and others bristle at the notion that race could cause disease.
Particular pathogens cause diseases, not social constructs. To believe
that race is relevant to the study of disease, they argue, is to
confuse causes with mere correlations.
This conclusion is, however, an oversimplification. The correlation
between race and disease can be medically significant without thinking
that there is some kind of causal connection between an entity called
race and being sick. Race is a social construct in the
sense that we treat people as if similarity in skin tone or eye
shape were symptomatic of some deeper similarity. What matters for
medicine is not the physical similarity, but the similarity in treatment.
Racial classifications have far-reaching effects on opportunities
for jobs and housing, not to mention access to health care. Differential
treatment on the basis of race can mean that members of the group
are exposed to similar risk factors. Suppose that housing discrimination
forces disproportionate numbers of black Americans to live near
industrial sites. Blacks will then be differentially exposed to
health risks, and there will be a correlation between race and disease.
Each individual is indeed made sick by a particular pathogenand
there could be many different exposures involvedbut the similar
location means that blacks are more likely to be ill than whites.
Hence, there can be informative causal correlations between race
and disease, even if race is not a biological entity with causal
Even admitting this conclusion, one might argue, as Satel does,
that attention to race, class, and other social variables has pernicious
effects. Identifying race as a risk factor in disease has the effect
of blaming a persons race for his or her illness. The person
is not encouraged to take responsibility for her health. Emphasizing
personal responsibility is essential to good health, since only
individuals have control over their health. Emphasis on race (and
other social variables) serves only to distract from personal responsibility.
Satel concludes that PC science leads to bad medicine.
The irony of this argument is that it injects a political value
into medicine and public health. Satel complains that studying the
correlation between race and disease is motivated by a political
desire for social change. Her pc-free epidemiology would concentrate
on factors within the control of the individual. This is a quest
for health solutions that maximize individual autonomy, a motivation
that is no less political for being unselfconscious.
Satels substitution of one political value for another nicely
illustrates a point made by many philosophers of science. Scientific
inquiry is an attempt to answer questions concerning the world around
us. The questions we ask and the kind of answers we expect are not
forced upon us by nature itself. Rather, our study of nature reflects
extra-scientific motivations. She is insisting that public health
questions be answered by appeal to factors that are within the control
of individuals. Her opponents are answering questions about disease
by appeal to social factors that are not within the control of individuals.
This choice of scientific questions is fundamentally a political
one: should heath care interventions emphasize individual responsibility
or social action?
The issue is political, but as Satel recognizes, it is not entirely
political. Different emphases in public health can have measurably
different heath outcomes. Empirical evidence thus bears on the question
of what sort of questions we ought to pursue in public health. Satel
insists that public health purged of the politics of race is better
medicine. There is an important reason why this is not true: if
the concept of race were eliminated from medicine, physician diagnoses
would be less reliable. High prevalence of a disease in a population
increases the likelihood that a member of that population has the
disease. A physician must take account of this baseline probability
when she makes a diagnosis. It is therefore important for a physician
to know population-level generalizations about disease. Rates of
lung cancer are much higher among coal miners than among university
professors, so it is important to know the patients occupation.
Since race correlates with disease, knowledge of the patients
race is a crucial piece of information for the physician. Race is
therefore an important diagnostic variable, and failure to study
correlations between race and disease would lead to poor diagnosis.
The attempt to free medicine from social policy succeeds only in
interjecting different values into scientific inquiry. This should
be no surprise. Values and interests guide our scientific questions,
so a strictly value-free inquiry is impossible. Rather than pretending
that science could be purged of values, we need to deliberate on
the values that undergird particular scientific inquiries. We need
to reflect not only on the values themselves, but on the methodological
consequences of their adoption and the practical results of the
science so conducted. Race is a particularly important topic because
of the continuing ramifications of slavery, discrimination, and
colonization. As long as we feel these consequences in our lives,
the concept of race will remain important for medicine.