Book Review: Fatal Invention by Dorothy Roberts
"Race is the product of racism; racism is not the product of race."
In the wake of the murder of George Floyd and the following protests against police brutality, many medical schools took it upon themselves to hold workshops or assign texts addressing racism in medicine. During orientation week at my school, two faculty delivered a presentation on the troubled history of medicine and the barring of women and Black people from the profession. They read excerpts from Medical Apartheid illustrating the ugly record of experimentation on and exploitation of Black Americans by academic medical centers and public health institutions. Finally, they concluded with the problematic usage of race correction in clinical algorithms. I found these presentations to be informative, and the inclusion of these topics in medical education long overdue.
Just days after orientation, I attended a lecture on how to interpret the CMP lab test, a blood panel that measures your electrolytes and glucose levels. A couple of slides in that lecture covered the normal ranges for two chemical waste products found in our blood, creatinine and BUN, in relation to an equation for estimated kidney function, eGFR. Curiously, one bullet point mentioned that variations of this formula are used to account for age, gender, and race. At the end of the lecture, a student asked for an explanation, and the professor replied: “Serum creatinine levels are higher in people with larger muscle mass…so there is, again, a generality that African-Americans are more muscular…so there is a slight alteration to the formula." After pressed on why such an assumption is even made, my professor could only state they had no part in writing the equation, that it is just a rule of thumb, and as a matter of fact, it is just an estimated equation, so minor differences are not that important anyway. *End lecture*
Fatal Invention by Dorothy Roberts is an incisive book that gives me a framework to help me make sense of the multiple instances of race being used unclearly or questionably, sometimes as a flat-out stand-in for a genetic category — not just in the past 6 months of school, but throughout all my channels of socialization since birth. I actually started reading this book as part of a discussion group last summer, but it fizzled out halfway through, so I re-read it over the long weekend starting from the beginning.
This is a book about the constant recreation and reification of biological race through (among other avenues) pharmacogenomics, genome sequencing technologies, and direct-to-consumer ancestry testing kits, under stamps of approval from biotech, pharmaceuticals, and academia. Roberts outlines in great detail the practices, assumptions, and overall aim behind redressing race as a biological category, sometimes portrayed as "genetic ancestry" or "geographical race" to escape controversy. The institutional backing from scientific authorities gives credence to a fiction that has otherwise been thoroughly debunked. These developments further codify race as a legal classification system, which is of course arbitrary and molded based on ideological goals of the state. And that is what makes essentialized notions of race so insidious: in the legal arena, the adjudication of race was historically inconsistent, ranging from “familiar observations and knowledge” to faux racial typologies.
Very early on, Roberts describes how woefully misconstrued the phrase "race is a social construct" is to the point where the common interpretation perverts the original meaning. The faulty line of reasoning goes something like this: there *are* inherent differences between so-called races…but that's Ok, Actually -- we just need to be mindful of these differences and treat everyone with respect. If you assume a priori that there must be some biological race, then it also okay to use race as a genetic category in research, as long as we employ the proper safeguards and filter out the bigots.
Yet, as Roberts shows throughout the book, these assumptions do not challenge race as a biological concept but only emboldens it further. Humans do not fit the zoological definition of race, "a population of organisms that can be distinguished from other populations in the same species based on differences in inherited traits." There is no racial essence. Rather, certain groups of people become racialized and, as a result, experience very real biological consequences such as disparities in life expectancy, infant & maternal mortality, chronic illnesses, mass incarceration, mortgage lending, etc. i.e. systemic racism.
On that note, try defining racism in your own words. Does it include more than interpersonal discrimination and hate crimes based on psychological in-group out-group bias? For the full picture, Roberts takes us back to the roots of European colonialism and explains how the production of difference as integral to the economic logic of capitalism. To give strategic cover for the Trans-Atlantic slave trade (and more broadly to justify their regime of pillaging and dispossession), English colonizers drew a wedge within the laboring class based on superficial physical attributes like skin color to prevent them from realizing their shared class interests. To enforce stability under capitalism, the ruling class needs ideologies that naturalize hierarchy. Disguising race as an intrinsic attribute is useful in convincing the general public that inequalities in status, wealth, and power across different groups are not only natural but inevitable.
And while critics like to invoke historical examples of natural races as evidence for the “innateness” of racism, it is important to draw a distinction. The social construction of race by English colonizers for the extraction of labor from stolen Black bodies fundamentally differed from, say, ancient civilizations indiscriminately subjugating portions of their populations to slavery or Egyptians’ paintings contrasting skin tones of the Syrians and Nubians they conquered. The former explicitly imposed an ascriptive hierarchy based on perceived immutable differences, while the latter was rooted in immaterial, non-systemic ethnocentrism. Race depends on historically-defined power relations.
Indeed, racial categories vary across temporospatial landscapes. Look at how quickly and fluidly the checkboxes for race on US censuses change: more than twenty times since 1790. Which race you belong to for bookkeeping purposes largely depends on invented rules and where you were born.
Who qualifies as white, black, and Indian has been the matter of countless rule changes and judicial decisions. These racial reclassifications did not occur in response to scientific advances in human biology, but in response to sociopolitical imperatives.
But if there is nothing inherent or biological about race, why do we instantly sort a room of 100 people into based on appearance? Roberts describes the recurrent tendency to taxonomize as foundational to Western science. The famous botanist Carolus Linnaeus actually subdivided H. sapiens into 4 groups in Systema Naturae, and he took the liberty to assign "H. asiaticus" and “H. afer" disparaging descriptors that undergird racist tropes we see today. Throughout this exercise, Linnaeus drew significant inspiration from the "Great Chain of Being" in Christianity that divides all things in the universe into a hierarchy; the seemingly objective practice of science was in this case rested on divine justifications. This was not an instance of "scientific racism" or "pseudoscience," just science. It is not hard to see, then, how race has become a go-to shorthand in the social sphere.
After laying the groundwork for critical discussions and offers numerous points of reflection, Roberts devotes the bulk of Fatal Invention to expanding on the subtitle’s thesis, demonstrating show science and capitalism continue to uphold racism by disguising a sociopolitical system as an innate marker and obscuring our common humanity. For example, the use of gene cluster analysis software to group variances in polymorphic gene sequences (SNPs and microsatellites) sampled across different geographic regions is necessarily contingent on a preconceived notion of race — because researchers indicate beforehand the number of genomic clusters into which the data should be grouped! In other words, garbage in —> garbage out. And that is all to say nothing of (1) which populations researchers select to sample, (2) the researchers’ sampling methods, and (3) the vast inconsistencies and ambiguities in attempting to turn a social category into a biological one.
I particularly enjoyed chapter 5 “The Allure of Race in Biomedical Research,” in which Roberts challenges the misdirected efforts by minority- and women-led campaigns to include more “diverse” groups in certain research pools.
Claims about justice in scientific research has shifted from protecting socially disadvantaged subjects from unethical practices toward promoting access to clinical trials and biomedical products.
She comes from a place of empathy, citing her own loss of connection to her home country of Jamaica. But ultimately, she holds that calling for the inclusion of haplotypes from diverse racial groups in reference databases of genealogy companies can further a paradigm of difference and contribute to racial essentialism. Solidarity, she argues, arises not from a probabilistic result from a genetic test, but a common political struggle against racial oppression.
I noticed many instances in which Roberts would meet personally with scientists and researchers to understand how they were using race in their studies and their motivations for doing so. Often, the well-intentioned person she was interviewing would state that they are not letting racial prejudice influence their research; rather, they are using race the proper way as an objective category. She would then go on to expand on their reasoning, showing that she cared enough to consider each argument carefully before she would proceed to pour kerosene on their false premises with her characteristically polemical tone.
Nearing 10 years old, Fatal Invention was both highly pertinent to its time and prescient of a bleak future yet to come (see Part 4 “The New Biopolitics of Race”). But it does not have to be this way. If we heed its calls to affirm our shared humanity and reject the obsession with solely using technoscience breakthroughs to address gaping structural problems, we can make a real dent in social inequality.
The one line that made it all click for me was “Race is the product of racism; racism is not the product of race." If you do not fully grasp what she means by this, or if there was ever a point in your life where you have thought race as a biological concept (me until late teen years at the earliest), then I wholeheartedly recommend this book.
5/5
Related books
Racecraft: The Soul of Inequality in American Life
Race, Monogamy, and Other Lies They Told You: Busting Myths about Human Nature
Not in Our Genes: Biology, Ideology and Human Nature
The Protest Psychosis: How Schizophrenia Became a Black Disease
When the Body Says No: The Cost of Hidden Stress
For people in medicine, also see
https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/
https://www.instituteforhealingandjustice.org/section-3-race-based-medicine-in-diagnosis-and-treatment (IHJ has working groups that meet monthly, centering around removing race from eGFR and ASCVD calculations.)