Race, the new genomics, and lung function measurements

The spirometer is an instrument used routinely in many clinical and public health settings to measure the capacity of the lungs. An important feature of the device is that numerical values produced with the device are routinely “corrected” for race and sometimes ethnicity. “Correction” factors for race and/or ethnicity, most commonly for people labeled “black,” or “population-specific” standards are embedded seamlessly in the software and hardware of the spirometer such that operators are often unaware that they are “correcting” for race/ethnicity. “Adjusted” lung function measurements are widely used in research investigations for clinical diagnosis of pulmonary diseases, such as chronic obstructive pulmonary disease; medical surveillance of industrial workers; pre-employment physical examinations; and disability assessments in compensation cases. This paper uses historical methodology to explore the following questions: how did the idea that the lungs of blacks were different than the lungs of whites first develop? What are the consequences in present-day practice for the naturalization of difference? What is the relationship between the racialized history of lung function testing and new genomics? I will show that race became a key organizing principle in spirometry beginning in the mid-19th century US -- in dialogue with other categories of difference, including occupation, social class, gender, and disability. It quickly became a transnational project, becoming more deeply and invisibly incorporated into the machinery over time. With complex new genomic technologies and renewed cultural enthusiasm for race-based medicine, another era in the use of race in spirometry--centered mostly on African Americans--looms.