Let’s move on from ‘Caucasian’

Clinical trial reports are still referring to white people as ‘Caucasian’, a rather outdated and inappropriate term. This blog post discusses why we have to stop using this descriptor and some alternatives. 

When reading clinical trial papers, I frequently stumble across sentences like this: “Of the 500 randomised patients 60% were Caucasian (…).” Each time I wonder: Why are we still using the term ‘Caucasian’?

Race reporting in clinical trials
Race is an essential characteristic in clinical trials. Some evidence suggests that the response to medicines varies across people of different racial backgrounds. Thus, a study cohort should reflect the racial diversity of the population the trialled drug is ultimately meant for. So, including information on race in trial reports is correct and follows regulatory guidelines. However, ‘Caucasian’ appears to be quite outdated.

The origin
In the late 18th century, anthropologist Friedrich Blumenbach established the term ‘Caucasian’ in his description of the ‘five main varieties’ of humans, which he primarily based on differences in skull shape. Blumenbach’s ‘Caucasians’ included people from the Caucasus region, Europe, Northern India, and parts of North Africa. The other four types of humans in Blumenbach’s theory were Mongolians, Ethiopians, (Native) Americans, and Malays. 

(The descriptors of the non-Caucasian variants are outrageously racist, and I won’t repeat them here. However, if you enjoy staring into the abyss of human arrogance, I recommend looking up how Blumenbach and his predecessor Carl Linnaeus categorised people.)

A sticky term
Humankind has long since moved on from Blumenbach’s races. These days, nobody would label people from Japan or South Korean as ‘of Mongolian race’. However, ‘Caucasian’ has proven weirdly persistent. Long used in official documents and (medical) reporting, it has an undeserved aura of scientific accuracy, that simply doesn’t hold up to critical inspection. It is outdated, based on false assumptions about the origins of humankind, and unpractically broad: In its original form, ‘Caucasian’ groups together people from such distant regions as Bangladesh and Norway.

There is also no legal reason to use this term. Indeed, the FDA guidance for collecting race data in clinical trials lists the minimum choices for race self-reporting as American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White!

‘White’ – not an ideal substitute
Overall, it seems that the accurate racial descriptor of white participants in clinical trials is ‘White’. Indeed, the American Medical Association Manual of Style, ‘The’ authority in the field of medical writing, recommends this term. However, it is not great either: Like ‘Caucasian’, ‘White’ has the problem of describing a highly heterogeneous population and is unrelated to ethnicity and largely uncoupled from geographic links. Also, it may feel ideologically loaded and perpetuates the idea of classifying people by skin colour. So, while ‘White’ is undoubtedly preferable to ‘Caucasian’, it is not ideal, either.

A possible alternative?
Most race designations refer to geographic status or origin, e.g., Asian and Pacific Islander. ‘White’ diverts from this trend. Why don’t we adjust this? Recently, clinical trial reports have started featuring the term ‘of African ancestry’ instead of ‘Black’. With the same logic, we could substitute ‘White’ with ‘of European ancestry’.

No matter which term we eventually land on, it is clear that we have to move on from the inappropriate designator ‘Caucasian’. The scientific community is great at revising outdated concepts – it’s way past time that we finally shelf the leftovers of Blumenbach’s idea of humankind.

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