Anne Pollock’s new book, Medicating Race, is a meditation on the history and present state of racialized (specifically African American) forms of heart disease. As a history it is particularly interesting, documenting the emergence of the concept of ‘risk factor,’ the changing terrain of sampling procedures, and the social and economic forces that have shaped pharmaceutical enterprises. This book will be of particular interest to medical professionals and others less well acquainted with social theory. Anthropologists, however, may be left wishing that Pollock had engaged more deeply and critically with a few of the very salient theoretical issues toward which she gestures. Benjamin, Heidegger, Latour, and Marx, among others make brief appearances but are not given sufficient space to do serious interpretive work. Nonetheless, the strains Pollock does draw out are both provocative and important for the study of race and/in medicine. I would like to ruminate on these themes as a way of reviewing her book in more detail.
Pollock notes an “epistemological eclecticism” that has significant implications for modern biomedicine. In trying to address the question of race as an analytic, one’s epistemological field quickly becomes cluttered with an incommensurable variety of evidential and definitional material. How does one know race, and how does this knowing inform medical practice? Does one know race through genetic ancestry testing? Is race an apperceivable set of phenotypes? Is it a drop of blood or a narrative handed down through generations? Is it a circle one fills in on a government form?
“[D]octors more or less consciously look for a patient’s race, and they almost always find it,” Pollock writes (2012:105). So what does it mean when physicians mobilize race in diagnosis and treatment? Clearly it cannot be reliably reduced to genetics. Isosorbide dinitrate – an active component of the ‘race drug’ BiDil – interacts with calcium ions, not with ‘Ex Africa’ narratives. But if drugs are prescribed on the basis of self-ascription, it is just such ethnogenealogies that could inform medical decisions. For instance, the risk of hypertension is commonly said to be significantly higher in African Americans than in non-African Americans, and yet Nigerians have one of the lowest rates worldwide. Race as a criterion for diagnosis could thus become a source of misinformation rather than the boon it is often taken to be.
One of the major concerns expressed when the FDA approved BiDil, the first drug specified for a single race (African Americans), was that a sociopolitical category had been reframed as biological. Would this fuel racist practices in medicine by suggesting race was a natural and necessary division of the human species? Pollock presents two important insights regarding this question. One is that the specter of genetic reductionism, so dramatic in much social scientific literature, in reality looms less large. As Pollock notes, “the routine rehearsing of the Human Genome Project before analysis of any specific topic in race and medicine leads us astray” (2012:196). In fact, BiDil faced a large backlash from public soapboxes, decrying the genetic reality of race. Though in recent years genetics may certainly have become a major rhetorical device in lay logics of body and health, it is not the only one. Overemphasis on it can detract from our ability to explain and to critique.
Furthermore, race does have a biological reality, apart from genetics. The stress of living in a racist environment is one such effect of the sociopolitical on the biological. “[F]ew things are as consistently stressful as being black,” Pollock (2012:119) quotes Osagie Obasogie. This rings of Fanon’s (2008) sociogeny, the psychosomatic internalization of the Other’s imagined gaze. Pollock also cites Clarence Gravlee’s (2009:53-54) fascinating work on blood pressure, which can be correlated with the “cultural significance of skin color” (i.e., race) but not with biogenetic markers of skin pigmentation. It is certainly not enough to dismiss race as ‘just a social construct,’ but a serious engagement with the meaning of that very polysemous (and ‘epistemologically eclectic’) category seems imperative.
Speaking of polysemy, Pollock insightfully re-presents Derrida’s infamous pharmakon as a metaphor for racialized medicine like BiDil. It is simultaneously cure and poison. Taking the drug can treat illness and lessen the health gap, but it also interpellates the patient as a specific type (viz. race) of person. Race can thus become further institutionalized, creating yet another bureaucratic hurdle for projects of transcendence. One can admit race as a ‘best approximation’ – as does “the right-wing blowhard Sally Satel” (Pollock, 2012:195), who proudly proclaims herself “a racially profiling doctor” (Satel, 2002) – but it is always a double-edged sword.
Though Pollock raises many more issues upon which I will continue to meditate, I end this review where she does. She concludes with a warning about quandary ethics, suggesting that we should not leave our topic at such bald binaries as political life versus life as such. It’s in the shades of grey, the nuances of history and context, that the most valuable critical engagement lies. I certainly agree, and Pollock’s book serves well in highlighting the importance of considering the entirety of the social world (including the biomedical) with the same political and moral concerns borne by more traditional social theory.
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