Bioethics Perspective IV Difference and Biology

One goal of the TSS was to show that the course of syphilis was different in blacks, suggesting biological differences between blacks and whites. Similarly, an underlying motive behind the enactment of the aforementioned NIH Revitalization initiative was that minorities and women sometimes respond differently from white men to the same drug, again suggesting the possibility of biological difference among races.

Belief in biological difference has long been used to justify different treatment in social arrangements. Aristotle said that from their birth, some people were set out for subjection and others to rule. Slaves were to be ruled by their masters, women by their husbands, and children by their parents. Difference has been used to establish authority and hierarchies; dominance and subordination; superiority and inferiority; the rulers and the ruled; us and them; good and evil; the beautiful and the ugly; and the civilized and the savage. Concepts of difference have been used to oppress, exploit, maintain the status quo, strip people of their rights, and prevent them from making decisions regarding their own well-being. For the most part these hierarchies in the United States have separated whites from nonwhites.

The construction of difference or the other was used as a rationale so that one group—the group in power—could do as they wished with another group. The political uses of difference led to slavery, colonialism, racism, classism, and sexism, as well as other atrocities and racist brutalities like lynching, rape, medical neglect, and research abuse. The construction of the other worked well for those in power; if people were biologically different—not quite human—they did not have to be treated as moral agents. This of course was part of the implicit justification for the TSS. The men were different (they were black), so they could be treated differently.

Scientists have long been fascinated with the possibility of genetic differences between blacks and whites and they continue to search for black genes that explain disproportionate susceptibility to breast and lung cancers, heart disease, violent behavior and intelligence deficits, poverty, and the relation between race and detrimental health effects of environmental pollution.

In the March 20, 2003, issue of the New England Journal of Medicine, two articles highlight the controversy surrounding race and disease susceptibility. On the one hand, Esteban Gonzalez Burchard and his colleagues argue that there are racial and ethnic differences in the causes and expressions of various diseases. Richard Cooper and his colleagues, on the other hand, see race as a social category, not biological, and think that doctors have been too quick to suggest genetics as the reason for the greater susceptibility of African Americans to certain diseases. As with the TSS, race is again explicitly linked to ideas of biological differences between racial and ethnic groups (Cooper, Kaufman, and Ward).

As the debate about biology and disease susceptibility continues, the TSS is a reminder of the hazards of research on race-based differences. Genetic explanations often neglect or gloss over the interactions of genes and the environment. It is important to remember that when blacks receive comparable treatment for lung cancer or breast cancer, their survival rate is comparable to that of whites (Bach, Schrag, and Brawley) and that when black VA patients receive the same treatment as whites, they also receive a survival advantage (Jha et al.).

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