Medicating Race: Heart Disease and Durable Preoccupations with Difference

Medicating Race: Heart Disease and Durable Preoccupations with Difference

Massachusetts Institute of Technology
250 pages

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

Submitted to the Program in Science, Technology and Society In Partial Fulfillment of the Requirements of the Degree of Doctor of Philosophy in the History and Social Study of Science and Technology At the Massachusetts Institute of Technology

This dissertation is an examination of intersections of race, pharmaceuticals, and heart disease over the course of the 20th century and today. Each of these parts has had a dynamic history, and when they are invoked together they provide a terrain for arguments about interventions in health and in justice in the present.

An enduring aspect of discourses of heart disease over the past century has been articulating connections between characterizations of the modem American way of life and of heart disease. In that process, heart disease research and practice has participated in differentiating Americans, especially by race. This dissertation uses heart disease categories and the drugs prescribed for them as windows into racialized medicine.

The chapters are organized in a way that is roughly chronological, beginning with the emergence of cardiology as a specialty just before World War II and the landmark longitudinal Framingham Heart Study that began shortly thereafter. A central chapter tracks the emergence and mobilization of African American hypertension as a disease category since the 1960s. Two final chapters attend to current racial invocations of two pharmaceuticals: thiazide and BiDil. Using methods from critical historiography of race, anthropology, and science studies, this thesis provides an account of race in medicine with interdisciplinary relevance.

By attending to continuities and discontinuities over the period, this thesis illustrates that race in heart disease research and practice has been a durable preoccupation. Racialized medicine has used epistemologically eclectic notions of race, drawing variously on heterogeneous aspects that are both material and semiotic. This underlying ambiguity is central to the productivity of the recorded category of race. American practices of medicating race have also been mediating it, arbitrating and intervening on new and renewed articulations of inclusion and difference in democratic and racialized American ways of life.

Table of Contents

  • Abstract
  • Acknowledgements
  • Chapter 1: Introduction
  • Chapter 2: Preoccupations with Racialized Modernity in Early Cardiology
  • Chapter 3: Constructing and Supplementing Framingham’s Normal White Americans: The Framingham and Jackson Heart Studies
  • Chapter 4: The Durability of African American Hypertension as a Disease Category
  • Chapter 5: Thiazide and Racialization of a Generic Drug
  • Chapter 6: BiDil: Medi©ating the Intersection of Race and Heart Failure
  • Epilogue: Tracking Plural Noninnocent Discourses
  • Works Cited

…Early Framingham investigators did their research in an all-white population, but they participated in larger conversations about black/white differences, too. The Framingham investigators themselves participated in the simultaneous constructions of hypertension and African American hypertension in the 1960s, an era that saw the ascendance both of hypertension as a risk factor and of the Civil Rights Movement. Their own study’s lack of inclusion of African Americans did not preclude their participation in arguments about racial differences in hypertension. Addressing “Environmental Factors in Hypertension” in a 1967 publication, the investigators wrote:

The principal population groups among whom blood pressures have been reported to be lower than among Americans and Europeans are various primitive peoples. The sample size has usually been small, especially in the older ages, and conclusions about age trends are complicated both by this fact, and by the fact that it is often not possible to accurately determine the age of the subjects. Among those population groups studied adequately, the following may be said:

Blood pressure distributions are similar among such diverse groups as: Caucasians living in Europe, the United States, and the West Indies; among Chinese living in Taiwan, and among Japanese in Japan.

Negro populations have higher blood pressures than whites living in the same areas and studied by the same investigators, particularly among females and in the older age groups. Distributions of blood pressures among Negro populations living in the United States and in the West Indies, whether rural or urban, high or low salt eaters, are similar. Their blood pressures are higher than those of Negroes in Liberia, a principal source of Negro migration to the Western Hemisphere. Admixture of the Negro races in the Western Hemisphere makes the interpretation of this data difficult. It is in this general background of unencouraging experience that the study of particular environmental factors, which could conceivably affect the blood pressure level, must be approached.

I will return to the question of African American Hypertension as a disease category in Chapter 4, but for now attend to other aspects of this quote. Here, we can see the distance between direct evidence or argument and the invocation of a common sense of racialization of cardiovascular disease. Although their phrasing evokes neutral grammars of data, there are no citations or evidence for these assertions about “Negro populations,” suggesting that the authors conceive of these statements less as arguments than as reflecting the consensus of the field. Unable to grapple with the embodied admixture that is not merely biological but also historical and cultural, much history is paved over in word choices such as “migration” to describe the slave trade and “admixture” to describe oppressive sexual relations under slavery.

Paucity of data is not actually the problem. The investigators make an odd claim about the cause of the difficulty of research into environmental causes of racial disease disparities: that “admixture” gets in the way of interpretation. Logically, assimilation would be the kind of mixing that would pose a problem for separating out environmental causes of disease by race, but the investigators lacked a language for cultural, in addition to biological admixture. The peculiarity of the investigators’ framing should alert us both to the fact of racialized hypertension’s existence at the nexus of the biological and the environmental, and that Framingham is telling both a white story and a universal one…

Read the entire dissertation here.

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