Breathing Race into the Machine

Fixing Health Medical historian Lundy Braun’s Breathing Race into the Machine offers a poignant illustration of the duplicity of fixity, wherein race is used simultaneously to help and harm Black workers. She examines how “cultural notions of race became embedded in the architecture of an apparently ordinary instrument,” the spirometer (a device built to assess lung function), and reviews the widespread implications of this process – from research to clinics to medical school training to insurance claims.31 In 1999 the world’s largest insulation manufacturer was busily trying to limit disability claims in a class- action lawsuit brought by 15,000 asbestos workers by drawing upon the long-standing belief among pulmonologists that racial groups differed in the capacity and the function of their lungs.

Drawing upon the widely accepted practice of “race correction … the idea of racial difference in lung capacity” – so normalized that there is a button for it on the spirometer that produces different measurements of normalcy by race – the company made it more difficult for Black workers to qualify for workers’ compensation. Black workers were required to demonstrate worse lung function and more severe clinical symptoms than White workers owing to this feature of the spirometer, whose developer, Dr. John Hutchinson, was employed by insurance companies in the mid-1800s to minimize payouts. Such discriminatory design normalizes environmental racism – not as an aberration from “business as usual,” but as a racial–economic imperative that is built in to the machine.

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In this way, such medical techniques demonstrate a type of “fixing”: they are health interventions that embrace a racialized conception of “problem people,” and thereby influence the direction of treatment by improper means. Drawing on Derrida’s notion of pharmakon as both cure and poison, STS scholar Anne Pollock explains that race-based drugs “have the capacity to be both beneficial and detrimental to the same person at the same time … Moreover, the poison that is part of the pharmakon is not separate from its efficacy, but immanent to it.