ANCESTRAL GENOMICS

A Black evolutionary historian and mother makes the case for systematizing the ways in which ethnic origins influence modern genomic medicine.

While Hilliard was a visiting professor in Japan, joint pain led her to consult a local physician for relief. The doctor correctly diagnosed her with arthritis, but incorrectly diagnosed her with kidney failure. When she returned to the U.S., the author received a clean bill of health from a laboratory that used her race to assess her kidney function. The doctor “handed me a lab report and directed my attention to the left-hand corner of the sheet,” she writes. “A tiny box that read ‘Race—African Amer­ican’ had been checked.” The distinction puzzled Hilliard, who understood race as a social—not biological—construct. Her research into modern genetics and the Black community convinced her that the accepted “colorblind approach” to race in medicine was faulty. Specifically, the author discovered that although African-origin genes are more diverse than European genes, the Human Genome Project’s emphasis on sequencing European genes has led diagnosticians to use European genes as a universal reference point. Consequently, modern medicine bases diagnoses on European models that ignore African origin adaptations, rendering current medical practices at best ineffective and at worst harmful. For instance, Hilliard discovered how adaptations that allowed her African ancestors to survive in salt-deprived regions now render Black people vulnerable to hypertension and how unnecessary calcium supplementation in lactose-intolerant Black women can lead to increased rates of breast cancer. The author’s arguments are well argued and deeply researched, and her use of memoir is poignant and effective. At times, the prose will be too dense for general readers, but Hilliard presents a thought-provoking take on the influence of race on modern medicine.

A scholarly book about damaging Eurocentric approaches to genetics that will reward dedicated readers.