Society was divided into races and such a division was observed so strictly that whites did not maintain social relations with blacks because that was undue, bad taste. In spite of that, I liked to go to Small’s Paradise in Harlem to see black people sing and dance, to admire the voices and bodies of women. There I listened to Sara Vaughan and Ella Fitzgerald. Such a separation between blacks and whites was natural, for I did not stop to think about it, I did not realize, that such classification, based on the color of the skin, contained an evil exploitation.
The division of humanity into “races” is already found in the Book of Gates of Ancient Egypt which identified Egyptians, Asians, Libyans and Nubians, based on skin color and tribal identity. In the Middle Ages, classifications from the Bible, the descendants of Noah: Sem (Asians), Cam (Africans) and Japheth (Europeans) were used, typifications that evolved towards segregation: the evil Spanish Inquisition persecuted Jews and Muslims. We also suffer the consequences of such discrimination because, to the natives of America, the Europeans did not consider us people. Bartolomé de Las Casas had to fight against this noxious idea that enclosed slavery, for profit, by the Spanish conquistadors.
Xenophobia, hatred abroad, became popular and in 1684, François Bernier wrote New division of the land by the different races that inhabit it. They were forms that justified the superiority of some social groups over others. In 1775, Johann Friedrich Blumebach, in his book The Natural Varieties of Humanity , classifies us into Caucasians, Mongols, Malays, Ethiopians and Americans. So now, I think, that when I wrote clinical history I followed the classification of that German anthropologist: “70-year-old Caucasian Caucasian man with difficulty urinating that …”
The twentieth century, after the discovery of Francis Crick and James Watson, about the code of life, DNA, allowed the advance of genetics and finally, in 2001, the deciphering of the human genome. This latter finding showed the intrinsic identity among men; so the concept of “human race” was discarded. By then there were already several researchers who thought about the unfairness of the concept “race”; but that was a more intuitive than scientific thinking: Franz Boas, who demonstrated the phenotypic plasticity due to environmental factors; Ashley Montagu, through observations on the inheritance; Edward Wilson, based on systematization theories; Claude Levi-Strauss who emphasized cultures.
These and other researchers rejected the old concept of “race” in the human and replaced it with that of population groups and that of geographic gradations “clines”. The distribution of melanin as a result of the sun, the haplotype of beta-S hemoglobin, was gradually understood in Africans as a result of malaria, and it was concluded that the concept of race was racist and a consequence of a discriminatory social construction. As a result of the above, and thanks to advances in genetics, the concept of “race” in the human has been replaced by that of ethnicity which refers to beliefs and customs, nationality and religion, language and history, shared.
This caused a controversy among conservative physicians and scientific researchers in the area of genetics. The former, were accustomed to interpret some diseases as Tay Sachss syndrome, sickle cell anemia and others, in relation to “race; the second, more scientific, are based on recent discoveries. The debate led the American Academy of Dermatology to review a colloquium on race / ethnicity / skin color, which was published in J. Acad. Dermat of June 2006, where dermatologists, researchers, academics, clinicians dedicated to private practice, Harvard University, Beth Israel Deaconess Medical Center and the Boston area, declare the inoperability of continuing to apply skin color, to the definition of race, in the study of dermatological diseases.(Bigby, M., Thaler, F. “Describing patients” race “in clinical presentations should be abandoned” J. Am Acad Dermatol, June 2006, Volume 54, number 6, pp. 1074-1075.)
The conclusions they reached are based on the fact that racial classification lacks genetic and anthropological credibility. In fact, studies of the human genome show the similarity between different human groups and, not just that, but between the man and the chimpanzee with whom we share 98.5% of our DNA. Further research in evolutionary anthropology shows the existence of a human ancestor common to all men that originated in Africa, first as homo sapiens 150,000 years ago and later as homo sapiens sapiens 50 thousand years ago. Which means that there are no races but a single human species. Genetic analyzes of the Y chromosome, as well as mitochondrial DNA, show that humans left East Africa 45,000 years ago, therefore we are all Africans. The first modern humans, who arrived in Europe, had black skin but the color of this one was modified because they required that the light of the sun penetrated it to effect a better synthesis of the vitamin D.
Secondly, the origin and practice of racial classification is inherently racist. As mankind grew, along with a desire to enrich a few, to attain economic fortune, they had to pass over the more, and thus, in 1853, Arthur Gobineau published an essay on the inequality of the human races in which it manifests the thesis of the inferiority of some of them for which they had to dedicate themselves to works subjected to the low wages and the ignominy. This reached the extremes of maintenance of slavery, in the United States of America and in South Africa, as well as in the case of the genocide between the Nazis promoted by Adolf Hitler.
The Americans, with the feeling of guilt that characterizes them in this respect, they pass by denouncing in novels, television series and cinematographic films, diverse anecdotes of the black enslavement. Such is the case of the writer Toni Morrison, Nobel Prize for Literature 1993 and author of Beloved (1987),book dealing with slavery, with its correlate of sexual abuse, violence and poverty. The novel won the Pulitzer Prize in 1988, was brought to the screen by Ophra Winfrey and in 2006, The New York Times Book Review named it the best American novel of the last twenty-five years. This means that the classification or definition of race is a social and political construction derived from the history of empires whose purpose has been the exploitation of minorities. To such ideology we obey when we write in a clinical history: “man of 45 years, black, that presents hematuria”.
In addition, classification by races is considered to be more of an obstacle than aid to diagnosis and treatment, since establishing such classification may lead to misdiagnosis. The diagnosis in dermatology should be based on the characteristics of the lesion, the differential diagnosis, the diagnostic tests, the experience of the clinician. With the above I do not want to affirm that there are certain conditions, more frequent in some ethnic groups in comparison with others, because there are differences in the incidence, severity, progression and response to the treatment of some affections. For example, in the United States it is observed that African-Americans have higher mortality than other population groups; Hispanics or Latinos, have higher mortality due to diabetes and liver disease; Europeans die more of heart disease and cancer than native Americans. The rejection of the term “race” in the human does not deny that there are affections that are more frequent in some skins than in others, but from there to identify a black as a “race” is an unfounded and undue conceptual leap.
Current epidemiological evidence asserts that “racial” or ethnic disparities are a consequence of the environment, discrimination, differences in treatment, poverty, lack of access to the health system, poor hygiene, poor diet, stress, racism, culture and other pathological etiologies of social root. This fact was noticed when it was noticed that infant mortality among African Americans was twice that among European Americans, but when the same army groups and similar medical care were compared, it was observed that infant mortality was same. A recent study of Mexican emigrants to the United States, showed that they had better health indicators than those who had been assimilated to American culture and that this was due to family solidarity. Thus, little by little, it was noticed that the socioeconomic and geographical, cultural and environmental conditions were the cause of unequal diseases.
In such a way that more emphasis is now placed on culture, socioeconomic structure, environment, education and other social aspects to understand the origin of the ailments. Racial classifications are now considered to be perverse, racist, and also because they have a profound effect on the lives of patients. On the other hand, the recognition of the ethnicity and the culture from which a patient comes, allows us a better knowledge of the disease and, therefore, to help the patient and establish empathy with him or her. The differences in the color of the skin, as a consequence of the environment, should be a reason for approach, not separation, as long as we come from the same ancestor. Alberto Einstein was right when he said: “Mankind has no choice but to be one or none.”