ABSTRACT

In this book I have attempted to show that there is much to think about with respect to SCD beyond important work in basic and clinical science. In the early chapters of the book, I tried to stress that sickle cell is first and foremost a genetic adaptation to malarial pressures and not an essential correlate of black skin. It is a complex as well as variable condition, and Chapter 1 discussed how the simplifications devised for community education do sickle cell a disservice in two crucial respects. First, the shape of the red blood cell that has given sickle cell its very name (in the Global North) has meant that not only were SCD and sickle cell trait inadequately distinguished (since both were associated with sickling in the sickle solubility test) but also that other key mechanisms, for example, the ongoing premature destruction of red blood cells then associated with anaemia, and with increased blood flow to the brain, with implications for strokes, are not considered. Second, the focus on sickled cells blocking narrow blood vessels ignores a host of interactive, generative and cumulative physiological processes, as much, if not more important than the mechanics of blocking. But the emblematic role of the sickle shape and the blocking mechanisms in community education permits the types of discourse that conflate SCD and sickle cell trait to flourish in popular media, journalism and everyday understanding of sickle cell. This has deleterious consequences. A more nuanced understanding would not permit the assertion of a relationship of sickle cell trait to sudden deaths, whether in state custody, military training or professional sports training, to pass unremarked.