Fofana Mariam O
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, , Baltimore, Maryland, USA.
Med Humanit. 2013 Dec 1;39(2):137-41. doi: 10.1136/medhum-2013-010374. Epub 2013 Aug 29.
Controversies and debates surrounding race have long been a fixture in American medicine. In the past, the biological concept of race-the idea that race is biologically determined and meaningful-has served to justify the institution of slavery and the conduct of unethical research trials. Although these days may seem far behind, contemporary debates over the race-specific approval of drugs and the significance of genetic differences are evidence that race still yields tremendous influence on medical research and clinical practice. In many ways, the use of race in medicine today reflects the internalisation of racial hierarchies borne out of the history of slavery and state-mandated segregation, and there is still much uncertainty over its benefits and harms. Although using race in research can help elucidate disparities, the reflexive use of race as a variable runs the risk of reifying the biological concept of race and blinding researchers to important underlying factors such as socioeconomic status. Similarly, in clinical practice, the use of race in assessing a patient's risk of certain conditions (eg, sickle cell) turns harmful when the heuristic becomes a rule. Through selected historical and contemporary examples, I aim to show how the biological concept of race that gave rise to past abuses remains alive and harmful, and propose changes in medical education as a potential solution. By learning from the past, today's physicians will be better armed to discern-and correct-the ways in which contemporary medicine perpetuates historical injustices.
围绕种族问题的争议和辩论长期以来一直是美国医学的一个固定话题。过去，种族的生物学概念——即种族是由生物学决定且具有意义的观点——曾被用来为奴隶制的制度和不道德的研究试验行为进行辩护。尽管那些日子似乎已远去，但如今关于特定种族药物审批以及基因差异意义的当代辩论表明，种族在医学研究和临床实践中仍然产生着巨大影响。在许多方面，当今医学中对种族的使用反映了奴隶制和国家强制隔离历史所产生的种族等级制度的内化，而且其利弊仍存在诸多不确定性。虽然在研究中使用种族有助于阐明差异，但不假思索地将种族作为一个变量使用，存在使种族的生物学概念具体化并使研究人员忽视诸如社会经济地位等重要潜在因素的风险。同样，在临床实践中，当将种族作为评估患者患某些疾病（如镰状细胞病）风险的启发式方法变成一种规则时，就会产生危害。通过选取历史和当代的例子，我旨在展示导致过去滥用行为的种族生物学概念是如何依然存在并有害的，并提出医学教育改革作为一种潜在的解决方案。通过吸取过去的教训，如今的医生将更有能力辨别并纠正当代医学延续历史不公正的方式。
