Digging into Literature: How to Read
Peer-Reviewed Literature with a Critical Eye

Unfortunately, articles are regularly published that build on racist frameworks or actively promote the codification of genetic differences between races. We are taught that peer-reviewed literature is the gold standard of science, which can sometimes predispose us to trust the conclusions put forth in peer-reviewed articles, even when the conclusions are based on faulty scientific principles and practices. Here are some questions you can ask to evaluate the legitimacy of articles that reference race.

In discussing the points here, we will use examples from a problematic article published by Gower and Fowler in the Journal of Internal Medicine, and a Letter to the Editor response by Tsai et al. All cited work can be found at the bottom of the page.

Questions to Critically Examine Race in Scientific Literature
1. How do the authors define race?
2. Do the authors connect race and genetic difference or race and physiology?
3. Do the authors include a discussion of social determinants of health?
4. Is the logic circular?
5. Do the authors use outdated or stigmatized terminology?
6. Do the authors reference racism or only race?
7. What to do next?

1) How do the authors define race?

Examine the paper’s definition of race or races. Are the definitions social in nature? Do the authors distinguish between race and ethnicity? Are they specific to one society or nation? If race is used as a category for grouping participants, do the authors specify how race was determined (self-report, survey, assignment)?

Gower and Fowler
The authors fail to define race, however they use words such as "inherent" when discussing insulin resistance in African American women: "These results suggest that AA are particularly sensitive to the influence of diet composition on body composition, perhaps due to their inherently high AIRg."

Tsai et al.
" 'Race' is a poor proxy for genetic differences, and 'phenotypic' features commonly referenced in discussions of race-- such as skin color or hair texture-- fail to correspond to discrete categories or underlying physiology… It is imperative to understand that socially constructed racial identities are poor representatives of geographic ancestry and do not warrant genetic inferences."

Takeaway: Be wary of genetic, “objective” definitions of race as well as extrapolations that one society’s racial categorization applies to another society.

2) Do the authors connect race and genetic difference or race and physiology?

Are the authors drawing connections (or implying connections) between race and genetics or physiology? How do they justify these connections?

Gower and Fowler
"We will present data in this review to support the hypothesis that the disproportionate burden of obesity seen in AA women reflects the combined effects and unique contributions of physiologic factors related to race and sex…Thus, physiologic factors that determine insulin sensitivity and AIRg may render many AA women uniquely prone to obesity." Problem: This discussion of physiology echoes eugenic reasoning.

Gower and Fowler

"We will present data in this review to support the hypothesis that the disproportionate burden of obesity seen in AA women reflects the combined effects and unique contributions of physiologic factors related to race and sex…Thus, physiologic factors that determine insulin sensitivity and AIRg may render many AA women uniquely prone to obesity."

Problem: This discussion of physiology echoes eugenic reasoning.

Tsai et al.
"The authors cite literature attributing racial differences in insulin sensitivity to atypical fat distribution, an assertion redolent of scientific racism. Similar observations about Black people’s skulls, facial features and lung capacity have been marshalled to assert inherent inferiority. The example of fat distribution is perhaps most tragically exemplified by Sara Baartman, a Khoisan woman who – because her breasts and buttockswere large relative to White women – was captured and exhibited throughout Europe as a model of the primitivity and fundamental difference of Black women."

Tsai et al.

"The authors cite literature attributing racial differences in insulin sensitivity to atypical fat distribution, an assertion redolent of scientific racism. Similar observations about Black people’s skulls, facial features and lung capacity have been marshalled to assert inherent inferiority. The example of fat distribution is perhaps most tragically exemplified by Sara Baartman, a Khoisan woman who – because her breasts and buttockswere large relative to White women – was captured and exhibited throughout Europe as a model of the primitivity and fundamental difference of Black women."

Takeaway: Examine implications of race as it pertains to genetic difference with particular scrutiny. Examine implications of race as it pertains to physiology with particular scrutiny.

3) Do the authors include a discussion of social determinants of health?

Is there an exploration into other, non-genetic factors that may contribute to the results? Do the authors consider impacts of housing or food insecurity, limited transportation options, poor access to healthcare, or other environmental factors that we know are connected with health?

Gower and Fowler
"Although the reason for this disparity is not clear, it has been observed that the AA participants in these trials also engage in less physical activity." Problem: This could easily be construed as passing judgement for lifestyle choices, without recognizing social/environmental factors that may drive this statistic.

Tsai et al.
"...In their discussion of obesity disparities, Gower and Fowler never mention racism, a known contributor to health inequity that operates on institutional and interpersonal levels… They disregard robust evidence that racist policies in Reconstruction-era and contemporary real estate practices reinforce neighborhood segregation, strand communities of colour in unsafe neighbourhoods with less green space and recreational facilities, and constitute major barriers to regular physical activity and attainment of ideal body weight."

Tsai et al.

"...In their discussion of obesity disparities, Gower and Fowler never mention racism, a known contributor to health inequity that operates on institutional and interpersonal levels… They disregard robust evidence that racist policies in Reconstruction-era and contemporary real estate practices reinforce neighborhood segregation, strand communities of colour in unsafe neighbourhoods with less green space and recreational facilities, and constitute major barriers to regular physical activity and attainment of ideal body weight."

Takeaway: Interrogate the exclusion of structural determinants of health in papers that focus on “biologic” differences between races.

4) Is the logic circular?

Follow the logic of the paper’s findings: Is it circular? Do the conclusions and their extrapolations sound eugenic in nature? Is it based on a presumption of racial essentialism?

Gower and Fowler
"When the acute insulin response to glucose (AIRg) is plotted against insulin sensitivity, AIRg is higher in AA vs EA at any given level of insulin sensitivity. Even when pair-matched for insulin sensitivity, AIRg remains higher in AA compared to EA. Thus, higher insulin amongst AA is not simply a compensatory response for insulin resistance, and it results in higher tonic level of insulin action."

Gower and Fowler

"When the acute insulin response to glucose (AIRg) is plotted against insulin sensitivity, AIRg is higher in AA vs EA at any given level of insulin sensitivity. Even when pair-matched for insulin sensitivity, AIRg remains higher in AA compared to EA. Thus, higher insulin amongst AA is not simply a compensatory response for insulin resistance, and it results in higher tonic level of insulin action."

Tsai et al.
"They do not even define race, their major operative variable, and make genetic inferences, absent any genetic data. And because the authors do not allow any other explanation-- beyond intrinsic racial difference-- the only conclusion they can reach is the premise they began with: physiologic differences rooted in unspecified and unmeasured genetic differences between races exist and account for racial obesity disparities. The circular logic reveals a prior commitment to genetic explanation that even their own evidence cannot penetrate."

Tsai et al.

"They do not even define race, their major operative variable, and make genetic inferences, absent any genetic data. And because the authors do not allow any other explanation-- beyond intrinsic racial difference-- the only conclusion they can reach is the premise they began with: physiologic differences rooted in unspecified and unmeasured genetic differences between races exist and account for racial obesity disparities. The circular logic reveals a prior commitment to genetic explanation that even their own evidence cannot penetrate."

Takeaway: If the conclusions of the article are, themselves, based on assumptions, do not trust the conclusions.

5) Do the authors use outdated or stigmatized terminology?

Do the authors use outdated terms, rooted in structures of colonialism and racism? Does the language convey inferiority or abnormality when describing characteristics observed in non-white study participants?

Gower and Fowler
"According to recent data from the Centers for Disease Control and Prevention, obesity (BMI > 30 kg m2) is more widespread in African Americans (AA) relative to Caucasians or European Americans (EA)."

Tsai et al.
"The authors engage in racially inflammatory rhetoric. For instance, they use the term 'Caucasian' to refer to White populations, which is based on archaic colonial-era racial categories, and expressly prohibited by the Council of Science Editors. In addition, the authors cite literature attributing racial differences in insulin sensitivity to atypical fat distribution, an assertion redolent of scientific racism. Similar observations about Blck people's skulls, facial features and lung capacity have been marshaled to assert inherent inferiority."

Tsai et al.

"The authors engage in racially inflammatory rhetoric. For instance, they use the term 'Caucasian' to refer to White populations, which is based on archaic colonial-era racial categories, and expressly prohibited by the Council of Science Editors. In addition, the authors cite literature attributing racial differences in insulin sensitivity to atypical fat distribution, an assertion redolent of scientific racism. Similar observations about Blck people's skulls, facial features and lung capacity have been marshaled to assert inherent inferiority."

Takeaway: Be wary of articles that use stigmatized language, as it indicates-- at best-- a lack of awareness around appropriately presenting issues of race.

6) Do the authors reference racism or only race?

If there is a reference to race, but no reference to racism, the authors are not fully investigating the implications of their study categories. At times, race has its place as a marker in research when investigating where inequities lie; however, this should be done in the context of structural barriers to care, which often invokes a discussion of racism. Race is not a biomarker and varies tremendously between societies.

Gower and Fowler
They never mention racism, so there is nothing to quote.

Tsai et al.
"...In their discussion of obesity disparities, Gower and Fowler never mention racism, a known contributor to health inequity that operates on institutional and interpersonal levels… They disregard robust evidence that racist policies in Reconstruction-era and contemporary real estate practices reinforce neighborhood segregation, strand communities of colour in unsafe neighbourhoods with less green space and recreational facilities, and constitute major barriers to regular physical activity and attainment of ideal body weight." "The authors similarly ignore the direct, physiological effects of interpersonal racism."

Tsai et al.

"...In their discussion of obesity disparities, Gower and Fowler never mention racism, a known contributor to health inequity that operates on institutional and interpersonal levels… They disregard robust evidence that racist policies in Reconstruction-era and contemporary real estate practices reinforce neighborhood segregation, strand communities of colour in unsafe neighbourhoods with less green space and recreational facilities, and constitute major barriers to regular physical activity and attainment of ideal body weight."

"The authors similarly ignore the direct, physiological effects of interpersonal racism."

Takeaway: If the authors reference race, but not racism, be wary of their race-based conclusions.

7) What to do next?

So, you found an article that doesn't pass the test. What do you do now?

Team up with colleagues and write a publishable letter to the editor.
Write a behind-the-scenes letter to the journal that published the article.
Encourage journal editors to interrogate the criteria necessary to publish research that uses race as a variable.

Takeaway: Don't stop at reading. Act. Write. Engage.

Digging into Literature: How to Read Peer-Reviewed Literature with a Critical Eye

1) How do the authors define race?

2) Do the authors connect race and genetic difference or race and physiology?

3) Do the authors include a discussion of social determinants of health?

4) Is the logic circular?

5) Do the authors use outdated or stigmatized terminology?

6) Do the authors reference racism or only race?

7) What to do next?

Works Cited

Digging into Literature: How to Read
Peer-Reviewed Literature with a Critical Eye