Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (review)

Disease as a commodity is a central focus of Wailoo's book on the history of sickle cell disease and health care in twentieth-century Memphis. As Wailoo says, "to call attention to disease as 'commodity' is merely to emphasize its place in a network of exchange relationships, where—much like any object—the disease concept and the illness experience acquired value and could leverage resources, money, or social concessions" (9). Drawing on concepts from anthropology and economics, Wailoo intertwines the stories of sickle cell disease and Memphis in an attempt not just to illuminate the history of one important disease but to show how it was used by various interests—politicians, hospitals, and medical researchers—to further their own goals.

Sickle cell disease first appeared in Western medical writing in 1910, although knowledge of the disease is much older among African folk traditions. From Wailoo's account, the ravages of sickle cell disease were not recognized routinely until the 1950s, although as many as 1 in 500 African-American children were born with it. He describes the confusion of its symptoms with other diseases (including malaria), as well as the lack of access to medical care and attitudes toward blacks as inherently diseased in explaining the disease's invisibility.

In 1949, Linus Pauling described the molecular mistake in hemoglobin S, elevating it to primacy as one of the first clearly delineated molecular diseases. In the 1950s, A.C. Allison demonstrated the connection between sickle cell disease and malaria, again showcasing the disease, this time as an illustration of evolutionary principles in humans. This prominence led to increased research dollars flowing into sickle cell research, some of it directed to laboratories in Memphis. The disease was beginning to be useful as a target for raising consciousness about black health, mobilizing resources, and building institutions.

In the 1970s, interest in sickle cell reached a zenith, as President Richard Nixon used sickle cell funding to demonstrate support for black causes, even as he withdrew funds from other government health research that had greater implications for African-American health. Celebrities raised money for sickle cell, and civil rights activists took up its cause. By the 1990s, this attention had faded; other diseases (notably, breast cancer and AIDS) moved into the spotlight.

Alongside this account of sickle cell disease is a running narrative about medicine in twentieth-century Memphis. Wailoo uses the local setting to emphasize how events on the national level played out in the acquisition of resources to build medical clinics, research laboratories, and hospital floors. Nonetheless, although the story of black health care in Memphis and the story of sickle cell disease are two threads that deserve attention, they are more often separate in this book than inter- woven. The debates about genetic counseling or certain experimental therapies, for example, are largely sketched on the national level, whereas the fate of Memphis hospitals during the managed care revolution of the 1990s is local, and largely unconnected with sickle cell disease. All in all, however, the author's ambitious goal of approaching a racial disease through an analysis of local social relations and political economy is admirable and pathbreaking.