This year the American Medical Association (AMA) have stated that their next Guides to the Evaluation of Permanent Impairment will remove race equations from lung function testing. This has been a long time coming. It is a move that comes off the back of a 2025 article published by the New England Journal of Medicine (one of the oldest and most prestigious medical journals) which argued for implementing race-neutral PFT equations for disability compensation.
These welcome changes are the result of the efforts of myriad health professionals and campaigners, but they have been underlined by the work of historians who led the initial call to change policy around the use of race in occupational pulmonary assessments. It was work initiated by physician-turned historian Lundy Braun in her 2014 book Breathing Race into the Machine that first brought attention to the ways that data categorisation had obscured the environmental impacts on lung function by inflating the impact of racial difference. The idea that non-white people had naturally lower lung function had been enshrined in lung function testing in the 1970s, although the racist science that had established support for this idea was initiated in the nineteenth century. Braun’s work revealed the racist assumptions underlining the seemingly neutral practice of race corrections and her publications influenced the research of disability historian and Measurement Lab co-lead Coreen McGuire. McGuire investigated how US ideas about lung function were paralleled in British medical research, and how class intersected with race in the measurement and compensation of disability as the welfare state developed. Her focus on disability added to the growing evidence that pulmonary assessment reference values were founded on shaky ground. She identified that miners, for instance, were categorised in a reference class of their own — that is, normal was what was normal for miners. This obscured the disabling impact of mining on worker’s lung health and led to discrepancies in disability compensation.
The New England Journal of Medicine cited McGuire’s work extensively to call for a global end to the use of race based occupational pulmonary assessments and explain how spirometry came to play an outsized role in the measurement of respiratory impairment for the UK’s Medical Research Council.
This emphasises the point, recently made in Wellcome’s Report on Archives, Manuscripts, and Collections, that medical humanities work can generate transformational biomedical and cultural knowledge capable of effecting impacting on real-world clinical reform. More details on these changes can be found here: Mass General Brigham – Efforts Underway to End Race-Based Assessments of Lung Function.
