Recently, Huff Post published an article entitled, “The BMI Is Racist And Useless. Here’s How To Measure Health Instead.” The author, Christine Byrne wrote, “If a research group today conducted a study on a single gender or ethnic group, critics would be quick to point out that its findings couldn’t reasonably be applied to anyone outside of that gender or group. It seems like basic logic, right?” Yet, despite this obvious concern, the majority of medical research, including body mass index (BMI), has historically been primarily conducted on a single gender in one ethnic group…Caucasian males. An added concern in the widespread use of BMI is that its inventor, the mathematician Adolphe Quetelet, created it as a metric to study large groups of people, and did not intend it to be used on individuals. However, when Ancel Keys, an American physiologist, reintroduced it and coined the term “BMI” in 1972, it gained traction for measuring personal health, because it was easy to use.

In discussing the widespread promotion of BMI by the medical community, and despite the fact that its use can be a disservice to many people, especially those in underserved ethnic groups, we need to look at the history of modern medicine in America. The National Institutes of Health (NIH), our primary government agency for biomedical and public health research, began as the Public Health and Marine Hospital Service in the late 1700s, to care for sick and disabled seamen, and then expanded its services to all officers and enlisted men shortly after. It was renamed the Public Health Service in 1912, and its research program was expanded beyond communicable diseases, including the study of venereal diseases. This, in turn, led to one of the earliest atrocities committed by this institution, the study most commonly known as the “Tuskegee study.” The actual title of the study was “US Public Health Service Syphilis study at Tuskegee”, however the study is most often referenced with the abbreviated title, deflecting attention from the fact that it was conducted by the US government. This so-called research study was on the progression of untreated syphilis, the details of which were already well known. Almost 400 African American sharecroppers with syphilis were diagnosed with the disease, but were not informed of their condition, nor given treatments. A significant number of the spouses of these farmers became infected during the course of the study, as well as a number of their children. This cruelty, lasting from 1932 until 1972, when whistleblowers finally brought it to an end, was unfortunately only an early example of abuse by medical institutions in the U.S. of people not of European descent.

Simultaneous with the development of the Public Health Service was the establishment of a national laboratory, which was re-designated the National Institute of Health by the Ransdell Act in 1930, and the National Cancer Institute Act was signed into law seven years later.

This set the stage for a second, well-known case of unethical practices involving African Americans; in this case, a woman by the name of Henrietta Lacks. Many people know her story now, as the result of a recent book “The Immortal Life of Henrietta Lacks” and subsequent movie based on her life. Cells taken from a tumor in her body, without her knowledge or consent, were used, and continue to be used, in a long and extensive series of medical research studies. Additionally, these “HeLa” cells (named using the first two letters from Henrietta’s first and last name) were injected, over the course of a decade and without consent, to patients at Memorial Sloan Kettering, the Jewish Chronic Disease Hospital, and to prisoners in the Ohio State Penitentiary by Dr. Chester Southam. These studies served no benefit to the participants, but were intended to determine if Henrietta Lacks’ tumor cells could multiply in another person. In some instances, they did. Southam stated that the justification for not informing patients they were being injected with living cancer cells, was that it might be “psychologically harmful”. When doctors at the Jewish Chronic Disease Hospital discovered that patients were not being informed, they stopped the studies, comparing Southam’s ethical practices to those of Nazi studies on concentration camp prisoners.

These are, unfortunately, only two examples in a long history of unethical research practices conducted by government, military, state, academic, and law enforcement institutions, and are the tip of the iceberg of institutionalized racism in the medical field. This systematic misuse of power has been termed “medical apartheid.” The impact of this history can still be seen today in the form of racial health disparities, driven in part by the general lack of trust in medical institutions by African Americans. The next blog in this series will look at the adoption of BMI, particularly in the infertility space, as well as some additional events in US medical history, and how these have contributed to the racial inequality we see in healthcare today.

Dr. Bradford Wilson, Ph.D. is a geneticist with expertise in next-generation sequencing (NGS) technology with peer-reviewed publications in the areas of cancer genetics and pharmacogenetics.

Bradford received his Ph.D. from Howard University in Washington, DC. where he also served as an Adjunct Lecturer.

He has also received bio informatics and statistical genetics training from the National Institutes of Health and the University of Colorado, Boulder's Institute for Behavioral Genetics respectively.

Bradford served as the Chief of Research and Development for his previous company in the 7th cycle of the Illumina Accelerator Program where he developed a prognostic NGS-based expression assay for post-traumatic stress disorder and laid the groundwork for the development of a multi-omic prognostic PTSD assay.

He is the father of a 12 year-old son and is a recent transplant to the state of North Carolina.