Alice B. Popejoy, Nature, August 24, 2021
Of the ten clinical genetics labs in the United States that share the most data with the research community, seven include ‘Caucasian’ as a multiple-choice category for patients’ racial or ethnic identity, despite the term having no scientific basis. Nearly 5,000 biomedical papers since 2010 have used ‘Caucasian’ to describe European populations. This suggests that too many scientists apply the term, either unbothered by or unaware of its roots in racist taxonomies used to justify slavery — or worse, adding to pseudoscientific claims of white biological superiority.
Erroneous ideas about genetic ‘races’ live on in the broad, ambiguous ‘continental ancestry’ groups such as ‘Black, African’ or ‘African American’, that are used in the US Census and are ubiquitous in biomedical research. These collapse incredible amounts of diversity and erase cultural and ancestral identities. Study participants deemed not to fit within such crude buckets are often excluded from analyses, despite the fact that fewer and fewer individuals identify with a single population of origin.
One practical way forwards is to move away from having people identify themselves using only checkboxes. I am not calling for an end to the study of genetic ancestry or socio-cultural categories such as self-identified race and ethnicity. These are useful for tracking and studying equity in justice, health care, education and more. The goal is to stop conflating the two, which leads scientists and clinicians to attribute differences in health to innate biology rather than to poverty and social inequality.
We need to acknowledge that systemic racism, not genetics, is dominant in creating health disparities. It shouldn’t have taken the inequitable ravages of a pandemic to highlight that. Furthermore, every researcher and physician should be aware of the racial bias that abounds in medical practice: some pulse oximeters give more accurate readings for light-skinned people than for those with dark skin; Black Americans are undertreated for pain; and historical biases in data used to train algorithms to make medical decisions can lead to worse outcomes for vulnerable groups. Hence the ongoing revisions to the subsection on race and ethnicity in the American Medical Association’s Manual of Style, and why medical schools are examining how their curricula reinforce harmful misconceptions about race.
Simply picking another word to replace ‘Caucasian’ won’t be enough to root out racism in research and medicine. But all should be aware of the harms the word represents.