Sunday, September 6, 2015

On Skin Color, Epidemiology and Bias

My father is a cardiologist in a small town in Wisconsin. Heart disease is as much a pillar of our community as are beer and the Packers, so he sees a lot of patients. My father, awkward socially, likes to challenge himself to make personal connections with his patients. Sometimes he uses the word "good" instead of "well", or "ticker" instead of "heart". I know it makes his brain twitch to do this. My father is the sort of person who enjoys reading Kant and taking notes (in unusual-for-a-doctor perfect cursive, with a fountain pen). He also enjoys listening to Mozart piano concertos. In short, he is an insufferable intellectual, thoughtful and mostly introspective, using Tolstoy when he wants to make a point.

When I was a child, my father had a patient come to see him. The patient entered the room, saw my father, hesitated, then turned around to the nurse who had led him there and asked: "Does he speak English?"

As an Indian man growing up as a minority in several different countries, my father's intellectualism was a form of rebellion. He knew that because of his name and skin color, he'd be expected to be a certain way. He was as smart as he could be, to prove everyone wrong. (In other teenaged attempts to culturally assimilate, he ate McDonald's and watched wrestling.) This plan could've worked: our race is one of those races that (at least now, though not then) is seen as a group of smart, hard workers, and the effect of my father's skin color on his children was diluted by my mother's Germanic blond hair and blue eyes. We learned to politely explain "what" we were to countless people who didn't know us too well. And for a long time I didn't think about race, my race, anyone else's race. I knew I didn't belong, but I didn't think about why. I just didn't.

When I was in high school, terrorism became a national security threat, and brown people with AK-47s were on the news a lot. Kids say offensive shit to each other all the time in high school, just testing boundaries. For me, it took on an interesting color after the 9/11 attacks. (Terrorist. Towelhead. Sand nigger.) I wasn't angry; I knew they were joking. I just wished I could be white so I wouldn't remind people of what happened.

It wasn't until about halfway through college that I realized I would never, ever be white. Yes, I understand how melanin and genetics work. But I'd thought, as my father did, that if I did things a certain way, people wouldn't notice my skin color as much. Ten years after I started college, I still sometimes hear the "war whoop" when I explain I am half Indian. Just a few days ago, a (drunk) friend told me that if immigrants received citizenship based on beauty, no Indian people would ever become American. (Instead of walking away, I laughed and showed him a picture of my beautiful brother. His response: "Yeah, but he's only half.")

I am not upset that I will never be white. I like my chameleon skin color, a hue that my friend Jason refers to as "cinnamon sexy". I'm upset that I know others will see my non-whiteness before they know about my love of bluegrass music or Japanese food or my scientific ability. And my skin color will tell them things about me that I haven't said out loud (I do yoga! I drive a Toyota! I have a temper!). And most of those things my skin color said will be wrong (I don't know how to wear a sari. I hate lentils. I think chakras are bullshit). This is the problem of bias, a problem I know well as an epidemiologist.

Bias is the insidious notion we have as humans that any information is good information. It's even more pernicious among scientists. If the information is available, we use it. If the information is used, we draw a conclusion based on our results. Once we draw that conclusion, we rarely go back to the information to see whether it's really valid. It isn't. Thinking a doctor licensed to practice medicine in the US doesn't speak English hurts that doctor who is trying to connect with you. Thinking a Black person is dangerous because of their skin color hurts them in a much more serious way (Trayvon Martin. Mike Brown. Eric Garner).

You might think this isn't about race, but let my story above prove to you that it is. If a young, published, straight-A student with a cardiologist dad is put in the position of defending their own existence, imagine how much worse it could be.

I'm lucky that my skin color says things like "smart" and the mildly annoying "not beautiful" to others. I am fortunate that my skin color doesn't say "dangerous", "violent", "thug", "criminal", or thousands of other equally untrue and revolting words. My father is fortunate to be in the position of actively helping those that might fear or dislike him based on his skin color. He can change their minds through his actions. Many don't have the opportunity to do so. (To be fair, none should have to.)