Dangerous Quackery | City Journal

Radical activists are so determined to enshrine the idea that race is a social construct with no biological relevance that they are willing to endanger patient care to make their case. If they get their way, the next battleground for the assault on science and common sense could be obstetrics.

Historically, black race has been considered a risk factor for preeclampsia (marked by persistent high blood pressure), a dangerous and sometimes life-threatening pregnancy complication. Black women exhibit a higher incidence of preeclampsia, and the discrepancy is not fully explained by potential confounding factors such as obesity and hypertension. According to newly published commentary in The New England Journal of Medicine, the culprit is racism—the apparent causative agent of every health disparity these days.

The idea that racism is to blame for higher preeclampsia risk relies on the idea that race is a social construct. On this premise, biological factors cannot explain the higher rates of black-female preeclampsia; thus, social forces must be at work. This argument makes sense only if one accepts the plainly fictional assertion that race doesn’t convey any biologically useful information. Race certainly does have socially constructed aspects, but it also contains genetic data.  

When it comes to preeclampsia specifically, about 55 percent of risk is estimated to be genetic. Recent research shows that West African ancestry is linked to risk variants in a gene called alipoprotein L1 (APOL1) that dramatically increase the likelihood of developing preeclampsia or kidney disease. Variants in APOL1 are widely theorized to have persisted in African-descended populations because they confer resistance to the parasite that causes African Sleeping Sickness, a dangerous disease endemic in sub-Saharan Africa. The evidence in favor of a biological basis for differences in preeclampsia by race is clear.

The newly published commentary in favor of the racism hypothesis, however, cites a 2021 study in the Journal of the American Medical Association, which observes that native-born American black women have a higher incidence of preeclampsia than foreign-born black women. Moreover, among foreign-born black women, those who have lived in the United States for ten years or more have a higher incidence of preeclampsia than those who have lived in the United States for less than ten years. The researchers opine that the differences reflect “prolonged exposure to systemic racism, neighborhood poverty, and residential segregation throughout their life course that negatively affects their health.” Among white and Hispanic women, nativity and length of residency are not associated with differences in risk of preeclampsia. 

In reality, the outcomes are almost certainly explained by a combination of the two forces that woke activists reflexively reject when it comes to explaining health disparities: genetics and behavior. One half to two thirds of African American ancestry can be traced to West Africa, the region which was most heavily exploited by the American slave trade. However, recent African migration to the United States is more geographically diverse and features a comparatively lower proportion of the West African population with the highest risk of preeclampsia, hence the greater incidence among native-born blacks. Moreover, obesity rates are low in sub-Saharan Africa but high in the United States. This pattern almost certainly contributes to the phenomenon that preeclampsia is rarer in foreign-born individuals with African ancestry than native individuals with African ancestry. It also plausibly explains the higher incidence of preeclampsia among African immigrants who have lived in the United States for ten years or more. A 2022 study notes that in the United States, “weight gain tends to increase significantly after 10 years of migration” and that the effect is particularly acute among African women, 65 percent of whom experience an “unhealthy BMI change” after migration.

Ultimately, the findings say more about the acceptance of post hoc rationalization and contempt for the United States in contemporary medical literature than the supposed effects of racism. Consider: another study also published in JAMA in 2021 asserts that “exclusionary state-level immigration policies” contribute to a higher incidence of preterm birth among black immigrant women. These women are supposedly vulnerable to these effects because “Most Black immigrants come from Caribbean or African countries where they are the racial majority, and thus they may be facing this racialization for the first time.” On the other hand, there are “no significant associations for Latina women across nativity status. One hypothesis for this finding is that most of the anti-immigrant rhetoric has focused over time on Latinos, with periodic anti-Muslim and anti-Chinese rhetoric, resulting in high levels of exposure to xenophobia and discrimination that may not vary significantly across states.”

Apparently, when it comes to preeclampsia, the impact of racism is most acute in native-born black women. When it comes to preterm birth, however, the effects of “systemic” racism suddenly and magically flip, and it is foreign-born black women who feel the effects most acutely.

Such quackery in obstetrics is emblematic of changes in medicine more broadly. Nephrology is removing race indicators from kidney algorithms, even though doing so makes them less accurate. Meantime, journals including JAMA recently announced new guidance proclaiming that “Population descriptors such as race, ethnicity, and geographic origin should no longer be used as proxies for genetic ancestry groups in genomic science.”

Someday, scientific advancement might allow doctors to collect extensive genetic information on each patient easily and efficiently, negating the need to consider race. Until that happens, the unscientific purging of race from medical practice threatens patients everywhere.

Photo: SDI Productions/E+ via Getty Images