Chest
Volume 159, Issue 4, April 2021, Pages 1670-1675
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Humanities: CHEST Reviews
Race Correction and Spirometry: Why History Matters

https://doi.org/10.1016/j.chest.2020.10.046Get rights and content

In recent months, medical institutions across the United States redoubled their efforts to examine the history of race and racism in medicine, in classrooms, in research, and in clinical practice. In this essay, I explore the history of racialization of the spirometer, a widely used instrument in pulmonary medicine to diagnose respiratory diseases and to assess eligibility for compensation. Beginning with Thomas Jefferson, who first noted racial difference in what he referred to as “pulmonary dysfunction,” to the current moment in clinical medicine, I interrogate the history of the idea of “correcting” for race and how researchers explained difference. To explore how race correction became normative, initially just for people labeled “black,” I examine visible and invisible racialized processes in scientific practice. Over more than two centuries, as ideas of innate difference hardened, few questioned the conceptual underpinnings of race correction in medicine. At a moment when “race norming” is under investigation throughout medicine, it is essential to rethink race correction of spirometric measurements, whether enacted through the use of a correction factor or through the use of population-specific standards. Historical analysis is central to these efforts.

Section snippets

Race and Pulmonary Function Tests in the 19th Century

Most spirometers “correct” or “adjust” for “race” or “ethnicity,” either through a correction factor or through the use of population-specific standards, a practice recognized by prominent professional societies.8,9 By setting white standards as the norm of lung health and programming them into the software and hardware of the medical device, both methods of correction build on and reproduce hierarchic notions of race, and both are rooted in a history of simplistic explanations for observed

The Scientific Literature in the 20th Century

One might argue that innovations in measurement technologies and statistical analytic tools over the course of the 20th century would move us beyond such offensive 19th century ideas of race and racial difference and that, with more refined concepts of “population” or “race,” observed differences would now be capable of capturing objective variation in lung function. And yet, it was during the 1920s and even more expansively in the 1960s that ideas of innate difference hardened. As scientists

Acknowledgments

Financial/nonfinancial disclosures: None declared.

Other contributions: My sincere thanks go to John Trimbur, PhD, and Rahul Vanjani, MD, for their careful reading of this manuscript.

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