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The Alien Other: A Critique of Current Racial Disparity Research

by Cara Lewis

art by Raegan Boettcher



In July of 2023, I traveled with my cohort of Native American Research Internship students from the University of Utah to the 83rd American Diabetes Association Conference. My research was funded under a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, so I knew well that Native Americans have the highest prevalence of diabetes compared to other racial groups in the United States (1). Despite this fact and Janet Brown Friday(2)’s inspiring keynote address for more racially cognizant research (3) at the conference, I walked away from the research presentations feeling boxed, taped, and stacked into the anonymous abyss of the “other”.


Many of my fellow Native interns had the same experience of categorical exclusion. After a poster presentation of diabetes management racial disparities in teenagers, my friend commented wistfully that “she was a good presenter, and clearly proud of her work. It’s just sad that in her own research, she makes herself an ‘other’.” This problem of self-othering persists in many aspects of identity; we have unprecedented percentages of

women in positions of leadership in academic research, and yet many clinical trials are still limited to only including men, and cell culturing often only draws from male specimens. So many of us climb the rings of academia and health science with a hungry passion only to fall prey to the same cyclic and systematic “othering” of ourselves in our research. We allow the crushing demand of academia to eclipse our sense of identities beyond the institutional monolith of white men.


We use the concept of othering every day. We other by establishing names at birth and comparing our test scores against the class median and grabbing the tea we ordered from the pick-up counter instead of the drink of the person behind us. Lajos Brons, an analytical philosopher, concedes that “othering is common” and that it can be a necessity for self-identity(4). In order to construct a sense of self, one must create a boundary from the outside other. Othering is employed to prove points and make distinctions and form com-parisons. Yet this benign othering is different than malignant, “radically alien” othering. Brons defines the radically alien othering as establishing “a near impenetrable border between the self/in-groupand the inferior/out-group”(5). It is this hierarchical approach to othering that “justifies” damaging biases and subjugation. As the current Surgeon General, Vice Admiral Vivek H. Murthy, recently said at the Summit of Surgeon Generals at Dartmouth (6), “It’s much harder to hate someone close up.” Radically alien othering provides the illusion of distance sufficient for hate. He proceeded to add that “our connection to one another is the foundation for a healthy community." No wonder the converse, the reality of healthcare and research today riddled with senseless division and “others”, allows systemic health inequity. Radically alien othering allows hate to eclipse altruism, medical ethics, and basic principles of empirical research. When you deconstruct racism, sexism, homophobia, and other identity-based biases, radically alien othering is the foundation.


Brons warns that “history should teach us to be suspicious of such boundaries” (7). His advice draws upon the dividing lines of othering that propelled the many racially and sexually charged scientific crimes of World War II and the 20th century. A common theme of these atrocities was that they employed the radically alien other to dehumanize “research” participants (8). Janet Brown Friday reminded the ADA attendees that forgotten atrocities lead to repetition and that while the progression of diabetes research to include women in populations is a step forward, we need to make research teams and study participants a reflection of the community benefiting. At the very least, diversity of team members is proven to produce better outcomes (9) and diversity of participants is a matter of justice (10) in shouldering burdens.


If one were studying differences between frog species, surely they would analyze more than just two species before saying that they exhausted the comparisons (11). If one were to conduct a survey of who needed house insurance in a neighborhood, would you not want to include the block of houses that had all just burned down and not just the houses with expensive furnishings? Your data will be skewed if you choose to only include two frog species or only focus on houses with valuables due to inaccurate categorization and sample representation, and you will not achieve the point of your exploratory research in the first place. In order to have effectual research you must take into special consideration the categories outlined and how these groups relate to the purpose of the research.



There is a vital difference between categorizing and radically alien othering. Using inappropriate circumferencing language in conjunction with inaccurate categorization establishes the radically alien other even if the othering was unintentional. When the category of “other” is separated out in the face of supposedly encompassing racial disparity featuring two races (12), are those others inferior? If the racial category most affected by diabetes is not represented, what does that say about how the scientific world values members of that race? Ignoring a racial group most affected by a medical issue when conducting racial disparity research with a focus on that medical issue displays an implicit but strong message of “inferiority” in the socioeconomic hierarchy. These are the subversive and subliminal biases that arise from radically alien othering.


It is impossible to denote every race, ethnicity, and culture in biomedical research. Many people self-identify, have mixed cultural heritages that are unique, and overly tedious separation would create more division. For example, while Pan-Indian perspectives can cause controversy and over-simplification, its unrealistic to separate out all the federally recognized Native American tribes which number over 300 (13). Still, when a scientist claims to quantify the extent of racial disparity in a field while only listing two racial categories and sometimes the ambiguous “other”, there is clearly inaccurate representation, misleading data, and the metaphysical transgression of othering. We must find balance for a more accurate and more human system of categorization. We cannot begin to collect accurate data or disassemble racial disparity in health sciences if our reconnaissance research propagates alienation and erasure.



Notes


(1) Centers for Disease Control and Prevention. (n.d.). Native Americans with diabetes - vital signs - CDC. Centers for Disease Control and Prevention. https://

(2) Janet Brown-Friday, RN, MSN, MPH is the current American Diabetes Association President of Healthcare & Education and the American Diabetes Association Clinical Trials Manager.

(3) Brown-Friday, J. Written Testimony of Janet Brown-Friday, RN, MSN, MPH President of Health Care and Education, American Diabetes Association Clinical Trials Manager, Albert Einstein College of Medicine’s Diabetes Clinical Trials Unit. (July 27, 2023). American Diabetes Association. https://www.jec.

(4) Brons, Lajos. (2015). Othering, An Analysis. Transcience, a Journal of Global Studies. 6. 69-90.

(5) Brons, Lajos. (2015). Othering, An Analysis. Transcience, a Journal of Global Studies. 6. 69-90.

(6) Murthy, Vivek H. (2023, September 21st). Surgeons General Round Table. Dartmouth College.

(7) Brons, Lajos. (2015). Othering, An Analysis. Transcience, a Journal of Global Studies. 6. 69-90.

(8) The public tends to forget that it wasn’t just the Nazis from the Nuremberg Trial that violated consent, justice, and liberty in the name of research. The United States Government and many scientists were bad actors while simultaneously establishing international codes of ethics. Eugenics was popularized and propelled by the climate of United States politics and prejudice. Ko, L. (2023, September 6). Unwanted sterilization and eugenics programs in the United States. PBS. https://www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenics-programs-in-the-united-states/

(9) Rock, D., & Grant, H. (2016, November 4). Why diverse teams are smarter. Harvard Business Review. https://hbr.org/2016/11/why-diverse-teams-are-smarter

(10) National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

(11) There are in fact over 5000 species of frogs, so comparing only two species for a holistic review is completely ludicrous.

(12) Such limited representation appeared frequently, including as a talk titled “The Contribution of Risks to Racial Disparities in Type II Diabetes” that only collected data on White and African Americans.

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