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In the Blood: Sickle Cell Anemia and the Politics of Race

BMJ 1999; 319 doi: (Published 11 December 1999) Cite this as: BMJ 1999;319:1582
  1. Haroon Saloojee, community paediatrician
  1. University of the Witwatersrand, Johannesburg, South Africa

    Melbourne Tapper

    University of Pennsylvania Press, £21.50, pp 160

    ISBN 0 8122 34715

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    “Race” is a concept that has occupied a prominent place in the American culture for centuries. In spite of being conceptually vague, the use of “race” in health research has a long and sometimes disturbing history. Currently, thousands of publications exist on black-white differences in behaviour and disease patterns. Most anthropologists have rejected the traditional Western notion of race—as bounded, identifiable biological groups—both as a research tool and as a valid representation of biological diversity Nevertheless, the racialisation of disease continues to be a pervasive practice, risking the “ecological fallacy” of attributing group level behaviour to the individual and vice versa, and often providing researchers with simple and convenient explanations for complex socioeconomic determinants of ill health.

    Since its identification in 1910, sickle cell anaemia has been characterised as a “black” disease, despite its occurrence in people of Greek, Italian, Indian, and Latin American ancestry. In the Blood examines why this is. Tapper's critical analysis of anthropological, medical, genetic, and political discourses on sickle cell anaemia over the past century leads him to conclude that the scientific inquiry of the disorder was driven by such notions as racial difference and genetic purity and superiority. He argues convincingly that, by using the ostensibly value free science of genetics and laboratory medicine, these eugenic ideas were legitimised and normalised.

    Sickle cell anaemia has been used to question the racial identity of white patients afflicted by the disease; to support prevalent social concerns about the interbreeding of races and, more generally, the dangers inherent in “negro blood”; and even to uphold the notion that modern humans evolved from multiple origins. Tapper comprehensively examines these and other issues. He provides only sketchy details, however, on how the disorder was used to further the cause of the civil rights movement in the United States and omits discussion about the disastrous misinformation provided about the disease during the Black Panther campaigns.

    Sickle cell anaemia remains a controversial disorder even today While universal newborn screening for the disease has been implemented in most US states, many centres, including most in Britain, use targeted screening. High risk groups continue to be identified by racial and ethnic traits. The value of universal screening is supported by the results of California's newborn haemoglobinopathy screening programme It identified 7000 non-black carriers of the sickle cell trait or disease among two million infants screened.

    In the Blood has something to convey beyond what it says about sickle cell anaemia. Tapper bases his work on the notion espoused by French critical thinkers such as Foucault and Delaporte that disease does not exist outside of discourse and practice. It provides a fine example of an analytical framework which could be used to critically review current research linking conditions such as hypertension, low birth weight, and AIDS to race. I found this to be a stimulating read, once the turgid introductory chapter was negotiated, and a valuable contribution to the literature on the social construction of race and disease.

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