Twisting Lung Function Measurements Based on Race

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"Breathing Race into the Machine" by Lundy Braun explores the use of the spirometer to naturalize racial and ethnic differences in lung function.
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Pulmonologists had a long-standing belief that lung function measurements differed among racial and ethnic groups.

In Breathing Race Into the Machine(University of Minnesota Press, 2014), science studies scholar Lundy Braun traces the little-known history of the spirometer to reveal the social and scientific processes by which medical instruments have worked to naturalize racial and ethnic differences. In this excerpt from the introduction, “Measuring Vital Capacity,” Braun introduces us to the case of a company’s attempts to limit disability claims by using “race-corrected” lung function measurement data.

“Precision carries immense weight in the twentieth century . . . It connotes trustworthiness and elegance in the actions or products of humans and machines. Precision is everything that ambiguity, uncertainty, messiness, and unreliability are not. It is responsible, nonemotional, objective, and scientific. It shows quality . . . These values of precision have become part of our heritage.”

— M. Norton Wise, The Values of Precision

On March 25, 1999, the front page of the Baltimore Sun featured a startling headline, “Racial Basis for Asbestos Lawsuits?Owens Corning Seeks More Stringent Standards for Blacks.” Accordingto the article, the American insulation manufacturer OwensCorning was engaged in another legal maneuver to limit disabilityclaims. This time it would be more difficult for African Americans in Baltimore to qualify for compensation.

Home to former shipyards and Bethlehem Steel’s plant at Sparrow’s Point, Baltimore had been the site of endless legal wrangling in a massive lawsuit against asbestos manufacturers for decades. Over the years, lawyers for Owens Corning made numerous attempts to delay proceedings and many verdicts went against the defendants. But, invoking a racial basis for disability assessment represented a troubling twist in the legal landscape. How, at the dawn of the twenty-first century, could there be a racial basis for legal redress in the United States?

Plaintiffs would soon learn that Owens Corning’s motion rested on a long-standing belief among pulmonologists that racial groups–particularly “blacks” and “whites”–differed in the capacity and the function of their lungs. In fact, the idea of difference is so widely accepted that manufacturers program race and ethnic “correction” into the spirometer, the instrument that measures lung function.

The company’s motion to apply the practice of “race correction” in this contentious case surprised workers. The effects of asbestos exposure were among the most heavily debated health issues in U.S. courts during the twentieth century. Many former asbestos workers in Baltimore were on the inactive docket, suffering at home from asbestosis, mesothelioma, and lung cancer, their physical condition– and lung function–deteriorating steadily. At the time Owens Corning presented its motion, approximately fifteen thousand cases were waiting to be heard in Baltimore. In making race the central issue with which to limit disability claims, this deeply divisive case suddenly became even more contentious. The authority of science was at stake.

In a letter to the Sun, Jim Fite, an asbestos activist with the White Lung Association, angrily wrote that the “idea that blacks (once the court has decided what that is) should require a higher level of disability rating to qualify for compensation is vulgar and discriminatory. To maintain that there is any scientific justification to this nonsense is more ‘science’ by corporate donations.” Anthony Bradford, a former worker for Bethlehem Steel, vehemently decried the practice: “I would say this is a low point in the system that you’re going to make a rule based on race, of an African-American’s lungs not being equal to a white person’s lungs. . . . But it doesn’t surprise me. When you have a racist viewpoint I guess you can get a doctor to say anything.”

Owens Corning’s tactic to limit disability claims was not only legally clever; it was also scientifically grounded. Race-specific criteria for impairment were consistent with the guidelines of the American Thoracic Society (ATS), one of the most authoritative associations in pulmonary medicine. Had the company’s motion been successful, black workers would have had to demonstrate lower lung function and worse clinical symptoms than white workers before receiving compensation for asbestos-induced disease. To the surprise of courtroom observers, Maryland Circuit Court Judge Joseph H. H. Kaplan denied the motion by Owens Corning in an oral ruling. Race correction would not be allowed in this particular case, at least for the time being.

Beyond the fractious medicolegal issues related to compensation, this case made public a long-standing–but rarely examined–history of racial assumptions informing the theories and practices of lung function research. In this case, cultural notions of race became embedded in the architecture of an apparently ordinary instrument that purports to measure lung function. Had lawyers for Owens Corning researched this history (which they probably did), they would have uncovered a large scientific literature detailing racial difference in lung function, with white norms higher than almost all other racial and ethnic groups. They might also have located occasional attempts to contest this idea. Not surprisingly, company lawyers based their legal argument on the consensus view, as articulated by the ATS and the American Medical Association, that blacks have lower lung function than whites. In a legal deposition, a leading pulmonary specialist defended the mainstream view that average values differ in blacks and whites.

Breathing Race Into the Machine explores the central historical question behind these debates: how did the idea that the lungs of blacks were different from the lungs of whites develop? The belief in racially distinctive lungs was a “racial project,” enmeshed in an industrial capitalist system that emerged concurrently with enthusiasm for precision instruments, measurement, and statistical analysis–increasingly reductive frameworks for understanding respiratory physiology–and problematic notions of race. These dynamics enhanced the epistemic authority of comparative scientific analyses of racial “traits,” while the spirometer and the social and scientific beliefs embedded in it traveled across time and space.

The idea of racial difference in lung capacity cannot be dismissed as “pseudo-,” “junk,” or “bad” science, or as the work of scientists with explicitly racist intent. On the contrary, the practice of “race correction” or “ethnic adjustment” is a historical product of mainstream, prominent, and mostly well-intentioned scientists. Elite professional societies and consensus panels have long sanctioned–and promoted–race correction, though official statements often cautioned that the “causes of differences were unclear.” Science produced with the spirometer was thus “normal.” Only rarely in the history of spirometric measurement were the racial meanings ascribed to lung capacity questioned. For the last century, debate has centered on technical issues, such as operator error, subject compliance, procedure, cutoffs for normal, and standardization of the hardware and software that control the spirometer’s operation without critically examining the underlying meanings of racial difference.

Reprinted with permission fromBreathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Geneticsby Lundy Braun and published by University of Minnesota Press, 2014.

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