Biology and RaceBiology and Race

At the end of the first paragraph of the aptly titled The Emperor's New Clothes, Joseph Graves, Jr, professor of evolutionary biology at Arizona State University, writes, "our society cannot progress toward true justice and equality until we exorcise racism from our collective consciousness." Graves firmly asserts that debunking the idea of race-as-biology is an essential first step to eliminating racism. His book helps set the path toward a "post-racial" human biology and, hopefully, a decline in racism in science and society.

The Emperor's New Clothes is a concise history of the origin and evolution of the idea of race, the development of the science of classification and ranking of human types/races, and the persistence of racial ideology and science. Graves concludes that race is a social construct that was given power by science. When the myth of biological races is smashed, biological differences cease to be an excuse for inequality, and racism is exposed.

Graves traces the ideological roots of the idea of race to the ancient Greek notions of ideal types and the great chain of being. Linnaeus and other natural historians accepted the idea of human races as fixed and hierarchically ranked. To Linnaeus and his fellow classifiers and natural historians, races were fixed and unchanging creations of God. With the late 19th-century Darwinian emphasis on change and gradualism, race did not die; rather, it changed its spots to fit in. Now races were viewed as adapted to different environmental and social conditions. So-called races, however, are not closed breeding groups, and there is far too much variation within them to think of them as having central tendencies. As Graves explains, sickle cell is not a disease of Africans but a genetic response to endemic malaria, which occurs in West Africa, the Mediterranean, and the Middle East. Natural selection does not recognize races.

One of the most engaging parts of The Emperor's New Clothes concerns the relationship between the US eugenics movement—specifically Charles Davenport and the Eugenics Records Office—Cold Spring Harbor Laboratories, and social policy in the United States and Germany. In the powerful chapter "Eugenics, Race, and Fascism: The Road to Auschwitz Went Through Cold Spring Harbor," Graves exposes how Nazi xenophobia and racism, and ultimately the planned extermination of a purported inferior race, were recast in eugenic terms as "natural" self-defense. Europe might have invented scientific racism and eugenics, but the US fined-tuned both pseudosciences.

At home, Graves describes how Davenport used family pedigrees ostensibly to demonstrate that pellagra was inherited, thus slowing the pace of discovery of the significance of diet. As we enter what has been declared the genetic century, it may be useful to reflect back to the 1920s, another period during which genetics became a common explanation for social ills: "Eugenics offered the middle-class white American a simple explanation for all this turmoil."

Since the first United Nations Educational, Scientific and Cultural Organization Declaration on Race (1950), an increasing majority of human biologists have believed that race has no biological reality. However, many scientists still practice racial science, many use race without understanding that race is not biologically based, and the public rarely gets an opportunity to learn why race is not biology. Like Davenport's missing the dietary causes of pellagra, an excessive focus on race-as-genetics still leads medical researchers to miss environmental causes of "race"-based variations in response to medical treatment and susceptibility to disease.

Graves makes clear that discrediting the idea that race is biological is necessary (but not sufficient) to eliminate racism. His book begins to provide the information to do so, particularly in its accessible history of the concept of race. Less well developed is a scientific critique of the race concept and examples of the abuse of the idea of race in practice. Graves' book is well suited for those who already know that race-as-biology is a myth, but as an expert in evolutionary biology, he could have provided more information for those who do not have access to a nonracial view of human biological diversity. Similarly, the last chapter, "The Race and Disease Fallacy," ought to be of great interest to readers of this journal. Graves focuses on summary statistics of racial variation in cancer rates and the illogic of considering race-as-biology to be the cause of different cancer rates among so-called races, after which he suggests that seeing race as biology hinders analyses of the social and economic causes of health inequalities.

Graves begins his book with Hans Christian Andersen's fable of the emperor's new clothes as a metaphor for the concept of biological race and ends with a comparison to Rachel Carson's Silent Spring (1962). Both comparisons are apt. Racial lenses must be thrown away so that, like the child in the fairy tale, all can see that race-as-biology is fictitious. Moreover, like the highlighting of environmental pollution in Carson's book, the biological idea of race creates a sort of silent violence, which requires exposure and action.

The book's historical analysis is better than its scientific analysis, and I wish that Graves had provided a sense of what a postracial biology, medicine, and public policy would be like. Yet, I enjoyed this book and appreciate the bold and exhaustive steps taken to write it. Reading and discussing The Emperor's New Clothes is a great way to begin to grasp what race is and what it is not.

The first edition of this wonderfully titled book, Imperial Medicine: Patrick Manson and the Conquest of Tropical Disease, has six chapters and an epilogue and includes endnotes, an index, 17 illustrations, and four tables, but no foreword, preface, bibliography or glossary. It is approximately 6×9×1 in and could easily fit into a standard briefcase. The dust jacket, printed in two colors on white semigloss paper, adds appropriate visual and historical impact. The jacket design is generally attractive, and the hard cover is functional and adds longevity to the text. The author states that he teaches history at the University of California at Irvine.

The target audience appears to be primarily health professionals with an interest in the history and development of tropical medicine. It would also be useful to those who are studying the history of tropical medicine, especially colonial or imperial medicine. For health professionals who have undertaken undergraduate or postgraduate studies in tropical medicine, their historical horizons will be broadened by the experience of reading this book. The concise style is easy to read, and the book is well researched, consistent, and systematic in its presentation. Visual impact has been heightened by the incorporation of well-selected illustrations and tables.

Following the introduction, chapters include "The Making of an Imperial Doctor," "Transforming Colonial Knowledge into Imperial Knowledge: the Isolation of the Mosquito as Intermediary Host of the Filaria Worm," "The Rhetoric and Politics of Discovery," "Making Imperial Science British Science: the Discovery of the Transmission of Malaria," "Domesticating Tropical Medicine: the Formation of the London School of Tropical Medicine," and "The Tropical Diseases Research Fund and Specialist Science at the London School of Tropical Medicine." The epilogue is entitled "From White Man's Burden to White Man's Grave." The chapters are based on major transitions in the development of tropical medicine during the colonial years, with an exploration of major issues in the development of tropical medicine as a discipline.

Imperial Medicine takes the reader on a voyage of discovery, which is very much focused on the life work of Patrick Manson and, to a certain extent, the politics of tropical medicine. A sense of competition and excitement is conveyed by selected dialogue of Patrick Manson, Ronald Ross, and others involved in the imperial medical conquest. This sense is also evident in the description of various achievements of these individuals, whether the application of a new surgical technique for treatment of scrotal elephantiasis or the confirmation of the mode of transmission of malaria in humans. One of Patrick Manson's major political achievements was his influence in helping to establish and maintain the status of the London School of Tropical Medicine, which is also discussed. Seemingly distant were his earlier years as a port surgeon for the Imperial Chinese Maritime Customs Service, but this period of service was of vital importance for both the "British imperial project" and for Manson's career development. His place in the history of tropical medicine has been well recognized, whether through the establishment of awards, such as the Manson Memorial Medal of the Royal Society of Tropical Medicine and Hygiene in 1922, or through the naming of a genus (Mansonia) and species (Schistosoma mansoni). It would have been nice to summarize more about Manson's scientific recognition somewhere in the book.

The production of Imperial Medicine is a creditable effort. Coming long after Patrick Manson, by Sir Philip Manson-Bahr, published in 1962, the present book breathes new life into what was the romantic period of tropical medicine research and development, while giving some insight into the "father of tropical medicine." The book will appeal to students of the development of tropical medicine. Health professionals who are working in tropical medicine will find it interesting reading, particularly those who may be relatively new to the area. Graduates of schools of tropical medicine around the world may also wish to gain a better understanding of the origins and development of their discipline. The cost of the book is not prohibitive for health professionals or students. Imperial Medicine is a worthy addition to other books describing historical influences on tropical medicine, and its currency is likely to transcend many editions of standard textbooks of tropical medicine, such as Manson's Tropical Diseases.

Dr Lazar Greenfield's most recent edition of Surgery: Scientific Principles and Practice is the third version of this work in only 8 years. This incredible turnaround time explains the popularity of Greenfield among general surgery program directors nationwide, who require a textbook with the most current perspectives for their residents, medical students, and teaching staff.

This writer was privileged to review the second edition of Greenfield¹ and can confirm that the standard of excellence established by the editor-in-chief and his colleagues at the time the book was first published has been maintained despite the short interval between editions. The editors have made very few changes in the chapter topics and, most remarkable, have replaced almost half of the 200 contributors, thus ensuring that the reader receives fresh viewpoints and an abundance of new information.

Although individual chapter lengths have remained the same, the content in each has been enriched, and the bibliography extended. The chapter on trauma, for example, adds 200 references to its previous 444 yet remains at exactly the same number of pages. The currency of the material throughout the book is reflected in the chapter bibliographies, which cite numerous journal articles published between 1997 and 1999.

Readers familiar with Greenfield's textbook will recognize that it is still the most current, comprehensive single-volume textbook of surgery ever published, and, if its present revision cycle continues, it will remain so for years to come. This edition, like its predecessors, supports the original determination of the editors to successfully integrate sophisticated basic science principles into the discussion of clinical management of surgical disorders. Other texts purportedly have the same idea in mind, but none are as successful in accomplishing this.

For example, part 1, "Scientific Principles," contains the chapters on trauma, burns, and transplantation, entitites for which outcome very much depends on basic concepts of anatomy, biomechanics, pathophysiology, toxicology, and immunology. Part 1 also includes chapters on nutrition and metabolism, wound healing, hemostasis, and shock, areas in which a clear understanding of applicable basic science is crucial.

Part 2, "Surgical Practice," comprises two thirds of the volume and is lavishly illustrated with photographs (including color), radiographs, imaging studies, and Holly Fischer's superb drawings. Her artwork is liberally distributed throughout the 2300-page volume and consistently enhances interpretation of the text. It is this reviewer's opinion that Greenfield is better illustrated than any other general surgery textbooks published during the last two decades.

Every major subject in general surgery and its subspecialties is given comprehensive review. Each section follows the same well-organized format as seen, for example, in the excellent 120-page section "Colon, Rectum, and Anus." A discussion of colonic embryology, anatomy, and physiology introduces a superb presentation of ulcerative colitis, polyps and polyposis syndromes, cancer, diverticular disease, and benign anorectal disorders. The more than 300 pages devoted to surgery of the arterial system, Greenfield's subspecialty, is by far the best vascular surgery discussion published to date in a general surgery textbook. Particularly noteworthy are the 200 or so illustrations and the remarkable currency of the material, which includes the very recent information on endovascular management of aortic aneurysms, a concept still in its infancy in US surgery.

The publisher informs me that this edition of Greenfield has an accompanying review and study guide, similar to that included with the second edition, which now includes both an informal self-assessment with references and a formal examination, timed and graded. This will be an invaluable tool in preparing for the American Board of Surgery qualifying and recertification examinations. The guide for the present edition was not yet off the press at this writing but should now be available, along with a compact disk with links to surgical journals and home pages of surgical societies.

Greenfield's textbook is a spectacular and ambitious academic work. This reviewer remains hopeful, as with the second edition, that the next version perhaps will include more information on surgical history to enhance young surgeons' understanding of the exciting concepts and technical procedures so well presented in the text. We probably won't have that long to wait and see.

Earlier, I had the pleasure of reviewing the two-volume hardcover edition of this classic textbook.¹ I said then that the frequent revision of the book and the rotation of new authors to write standard chapters, with the addition of new chapters on emerging concepts, make this set a formidable and up-to-date resource.

For those of us who did not grow up with computers, the heavy tomes are welcome, sitting on our shelves until we need to look something up, then propped up on the reading stand to reassure us that we are in the presence of authority. But now, the CD-ROM of the book has arrived, and it speaks the language of our fellows and residents in a format they find comfortable.

A single disk contains the entire contents of the books, and the illustrations are better delineated and more useful, augmented by new color illustrations that better convey their message. In addition, a superb lecture on the pathogenesis of rheumatoid arthritis by Edward D. Harris, Jr, MD, lavishly illustrated, which many of us have heard in another context, is now added, so that those not previously so privileged can hear it and play it again and again. Another lecture, on the differential diagnosis of rheumatoid arthritis, should instruct many clinicians who struggle with it in their practices.

Unlike the books, this CD-ROM can go anywhere and be accessed anywhere. As I previously wrote, "the Kelley" is a masterpiece, although it has rivals that have met the challenge to be at the forefront and to remain as contemporaneous as the journals. I recommend this version for its accessibility and completeness.

Clinics in Family Practice succeeds in accomplishing its stated goal of providing family practitioners with the unique attitudes, skills, and knowledge that they need "to provide continuing and comprehensive medical care, health care maintenance, and preventive services to a broad range of patients." Barbara S. Apgar, MD, MS, a leader in family medicine, is the consulting editor for the series. She selects both the topic for each issue and a guest editor with special expertise in that subject area. The guest editor then selects that issue's contributing authors, who prepare articles discussing the various aspects of the chosen topic. This is an effective means of integrating points of view from both family practice and specialist perspectives.

The topics covered in the reviewed issues, "Sports Medicine," "Office Management of Trauma," and "Preventive Services," are highly relevant to a typical family practitioner's patient population. Other issues published to date cover hepatobiliary diseases, adolescent health, behavioral medicine in family practice, maternity care, long-term care of geriatrics, and cardiovascular disease. The individual articles are timely, comprehensive, well organized, and thoroughly referenced, including the most recent advances. Particularly helpful are the bulleted and highlighted main points with each article, which make the articles easy to scan for the busy practitioner.

The inaugural issue on sports medicine is highly appropriate to lead off the series, presenting timely articles on the exercising patient, whether child, athlete, or "weekend warrior." The emphasis is on diagnosis, prevention, health maintenance, and the treatment of specific orthopedic conditions. In all three issues reviewed, the articles present the research basis of practice in such a way that they give the clinician only the necessary nuts and bolts for rapid clinical application. This information is highly synthesized and critically analyzed, aided by understandable and well-chosen tables.

The format is similar in clinical context and presentation to the American Family Physician (AFP) journal, although AFP is issued monthly, while the Clinics are issued quarterly as shelf-ready bound volumes. AFP offers continuing medical education questions in each issue, for which clinicians can obtain credits recognized by the American Academy of Family Practice; Clinics in Family Practice does not offer this service. The Journal of the American Board of Family Practice, Journal of Family Practice, and Family Medicine differ from Clinics in Family Practice in being more research oriented and not as immediately useful for the practitioner. Journal of Family Practice includes color photographs that can sometimes yield more information than the Clinics' black-and-white ones.

Overall, these reviewers are excited about the value of this journal for both seasoned clinicians and medical students and residents—some of whom, incidentally, routinely borrowed the first three issues while this review was being written. Today's family practitioners will most likely consider Clinics in Family Practice a "must read" journal.