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What If Medicine Disappeared?

racial groups is far greater than diversity between socially recognized racial groups. He shows that the racial groupings commonly used in the medical profession are disturbingly imprecise and inaccurate (for example, the health status of African Americans is quite different from the health status of African immigrants) and that there is little research supporting racially driven medical decision-making. Barr offers health care providers a useful guide to determine when it makes sense to consider race in the medical decision-making process and when an emphasis on race obscures other more salient individual characteristics. In light of this nuanced approach, I find it somewhat surprising that Barr decided not to address gender in this book. He notes in the Preface that he chose to limit his discussion of health disparities to those that involve race, class and ethnicity because disparities based on gender (and age) “exist in a different context and stem from different causes, and they deserve their own examination and policy analysis” (p. xiii). Personally, I do not find this disclaimer persuasive. Gender disparities exist in exactly the same context as class, race and ethnic disparities—that context is what we call society. The pains and illnesses of racism and classism are always inscribed on gendered bodies—there are no other kinds of bodies in our social world. Barr cites a study that looks at gender and the impact of education on life expectancy in a North Carolina population. It turns out that white men with lower educational attainments lived 0.9 years longer than similarly educated black men. Regarding women, however, the authors found the opposite to be the case: Among women with lower educational attainments, whites lived 0.4 years fewer than blacks. The authors of this study (Gornick et al. 1996) conclude that “gender has a larger influence on life expectancy than race or education” (Barr, p. 148). By drawing attention to this particular study my intention is not to deflect attention from racial or economic disparities. They are real and they wreck havoc on the lives and health of millions of Americans. Rather, I hope to encourage exactly the kind of nuanced analysis that Barr advances in this book. Race, class, ethnicity and gender are intertwined moving targets that appear quite differently depending upon who is doing the looking. Good clinical practice, good medical research, and good policy-making rely on acknowledging these realities of our social landscape. To that end, Barr’s work makes a substantial contribution.