Chest
Humanities: CHEST ReviewsRace Correction and Spirometry: Why History Matters
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.
References (49)
- et al.
Socioeconomic status and lung function
Chest
(2007) “Manners,” selections from notes on the state of Virginia
- Hutchinson B, Ghebremedhin. Jacob Blake paralyzed by police shootings, father says. AbcNews, August 25, 2020....
- et al.
Structural racism and supporting black lives: the role of health professionals
N Engl J Med
(2016) - et al.
Toward a historically informed analysis of racial health disparities
American J Public Health
(2019) The myth of innate racial differences between white and black people’s bodies: lessons from the 1793 yellow fever epidemic in Pennsylvania
American J Public Health
(2019)The performance of “antiracism” curricula
N Engl J Med
(2020)- Mervis J. Senior U.S. lawmaker wants National Academies to scrutinize racism in science. Science August 11 2020....
- et al.
Interpretative strategies for lung function tests
Eur Respir J
(2005) Defining race/ethnicity and explaining difference in research studies on lung function
Eur Respir J
(2015)
Spirometry, measurement, and race in the nineteenth century
J Hist Med Allied Sciences
Breathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics
Report on the diseases and physical peculiarities of the Negro race
N Orleans Med Surgical J
Investigations in the Military and Anthropological Statistics of American Soldiers
“Race correction” in pulmonary function testing
N Engl J Med
Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century
Diagnostic value of determining vital capacity of lungs of children
JAMA
Infectious Fear: Politics, Disease, and the Health Effects of Segregation
The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South
How Cancer Crossed the Color Line
The History of White People
Vital Capacity of the Lungs: A Handbook for Clinicians and Others Interested in the Examination of Hearts and Lungs Both in Health and Disease
The Assessment of Physical Fitness by Correlation of the Vital Capacity and Certain Measurements of the Body
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Racial Disparities in Pulmonary Fibrosis and the Impact on the Black Population
2022, Archivos de BronconeumologiaElevating Health Disparities Education Among Trainees and Physicians
2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Most training in ethics only draws on known examples such as the Tuskegee Syphilis Trials.29 Systemic racism also shows up in diagnostic tools used in A/I that should be recognized such as the history of race correction with spirometers30 and bias in pulse oximetry. Black patients were 3 times more likely than White patients to have low oxygen levels that were missed by pulse oximeters31 due to biased devices that were not tested on diverse patients to consider the impact of sources of error, like skin tone, that might impact readings.
Deconstructing the Way We Use Pulmonary Function Test Race-Based Adjustments
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