Science reflects history as society influences science: brief history of “race,” “race correction,” and the spirometer

Abstract

Spirometers are used globally to diagnose respiratory diseases, and most commercially available spirometers “correct” for race. “Race correction” is built into the software of spirometers. To evaluate pulmonary function and to make recordings, the operator must enter the subject's race. In fact, the Joint Working Party of the American Thoracic Society/European Respiratory Society recommends the use of race- and ethnic-specific reference values. In the United States, spirometers apply correction factors of 10–15% for individuals labeled “Black” and 4–6% for people labeled “Asian.” Thus race is purported to be a biologically important and scientifically valid category. However, history suggests that race corrections may represent an implicit bias, discrimination, and racism. Furthermore, this practice masks economic and environmental factors. The flawed logic of innate, racial difference is also considered with disability estimates, preemployment physicals, and clinical diagnoses that rely on the spirometer. Thomas Jefferson’s Notes on the State of Virginia (1832) may have initiated this mistaken belief by noting deficiencies of the “pulmonary apparatus” of blacks. Plantation physicians used Jefferson’s statement to support slavery, believing that forced labor was a way to “vitalize the blood” of deficient black slaves. Samuel Cartwright, a Southern physician and slave holder, was the first to use spirometry to record deficiencies in pulmonary function of blacks. A massive study by Benjamin Apthorp Gould (1869) during the Civil War validated his results. The history of slavery created an environment where racial difference in lung capacity become so widely accepted that race correction became a scientifically valid procedure.