Inclusion and Exclusion: The Politics of History, Difference, and Medical Research

The field of U.S. medical history has a "race problem" with black bodies. Despite rich and analytically varied scholarship, there is still much to do to theorize the link between medical and African American history.¹ There is always the danger, however, of creating what Barbara Fields labeled "Jim Crow" history in which "Afro-Americans [are relegated] to a space of their own. . .and set apart from the study of history properly so called."² To borrow Joan C. Scott's influential terms, like gender, race is a "useful category of analysis" that is too frequently shunted to the margins of medical history.³ When the social categories of race (as a category socially constructed in part by medicine and science) and racism (the structural, ideological, and systemic barriers set before African-Americans) are employed, they are often used interchangeably. Moreover, in many medical histories, race and racism are used as static social categories that lie outside of history, and thus change.⁴ Yet "the logic of difference," as Evelynn M. Hammonds has labeled the underlying reasoning in medicine and science about the black body and its links to clinical research, medical care, or public health, needs more consideration both analytically and factually.⁵

There is no easy way to write this history and make it relevant to the ever-changing forms of institutionalized racism in medical research and practice. Our tropes sometimes hide more than they reveal. When historians have attended to both medicine and race in their work, the result is often either narratives of abuse and suffering of African-Americans, and/or their triumph over adversity.⁶ I am concerned whether we have enough scholarship on suffering (quick answer no), and yet if we are also stuck in a limited analytic about what is "real" by focusing on "experiences to prove the abusiveness of power" (quick answer yes).⁷ I worry if we have sorted out enough how race and racism matters and changes over time as it both shapes and is shaped by the specificity of particular medical encounters, research projects, and disease frames.

Nor is any of this just academic, for the history lives on in claims that explain contemporary health disparities.⁸ These two new books by a journalist and a sociologist raise critical questions about African-Americans and medical research, while alerting us to the tropes and facts that inhabit our writing and the political use to which they may be put.

Writing the Race Card

The subjects of these books—inclusion and exclusion in medical research—are central to any analysis of medicine and "difference." The continued fascination with the history of too much inclusion of African-Americans in medical research before the 1970s appears to be a form of cultural schadenfreude that haunts both popular and scholarly writings. It is as if fears of medical uncertainty and research zealousness can be absorbed most easily when they are racialized in a national melodrama. When we name "the race card" as necessary, as cultural critic Linda Williams forcefully states, it "needs to be seen . . . as an integral process of the gaining of rights through the recognition of injury."⁹ What has been long ignored has to be almost shouted from the rooftops to be heard. The road to rights, as Williams argues, is paved then with the recognition first of the wrongs.

We appear to be stuck, however, in contradictory analytic viewpoints that reflect very different historiographic traditions. Histories of the misuse of black bodies do not often interrogate the context, as if they are telling a moral drama of black victims and white abusers where change does not happen and the over-arching use of the term "racism" or "medical arrogance" is supposed to tell us everything. However, when critics of such tropes then look at what appears to be the medical "facts," the "usual and customary practices" of doctors, or the uncertainty of the science, the cry of racism seems to some as over-wrought and anti-scientific.¹⁰ The dilemma of how to integrate our understanding...