AMA, JAMA Shakeup Highlights Divide in Medicine


A February podcast on structural racism — which led to the resignation of two top-level editors at the widely circulated Journal of the American Medical Association — has brought to light an ideological divide in medicine begetting two distinct camps: those who believe systemic racism permeates the field, and those who do not.

On June 1, Howard Bauchner, MD, stepped down as editor-in-chief of JAMA, saying he was “profoundly disappointed” with himself for not stopping the publication of a podcast in which then-deputy editor Ed Livingston, MD, said structural racism did not exist in medicine.

The fallout from the podcast and resignation of two well-respected figures was met with disappointment and outrage by many fellow doctors.

“I think it’s unfortunate that you can’t even say anymore that you don’t think there’s discrimination in medicine — it’s like the conversation isn’t allowed,” said Jonathan Savell, MD, a retired ophthalmologist living in California’s Bay Area, who entered medicine in 1973. “I’m against the resignation of the people involved. I think [Bauchner] was forced to resign because he expressed a view that we’re not allowed to have at this moment.”

Savell, who is White, said the idea of systemic racism has been amplified since the case of George Floyd, a 46-year-old Black man who was murdered by Minneapolis police officers during an arrest.

He added, “If you deny systemic racism, you’re treated like a climate denier. I think there is socioeconomic discrimination that may affect people of color more, but I don’t think it’s racism.”

Since the podcast aired, the AMA has released a strategic plan to address racism and health inequity. But that wasn’t received kindly by all members: five physicians penned a letter to the AMA — posted on Twitter by Boston Medical Center’s Carl Streed Jr, MD — criticizing the plan and calling the pressure for JAMA leaders to resign, “precipitous, possibly a blot on free speech and possibly also an example of reverse discrimination.”

Like Savell, there are many doctors who acknowledge socioeconomic biases in medicine that may lead to different treatment, but say this issue is distinctly separate from racism. However, the two issues are inextricably linked, said Stefan Richter, MD, PhD, a critical care specialist at Martin Luther King, Jr Community Hospital in Los Angeles.

If you look at discrimination based on socioeconomic status without acknowledging the legacy of the laws that got us here, that requires a unique ignorance of history,” said Richter, who graduated medical school in 2010 and is White. “Some White people in medicine don’t see systemic racism partially because they’re insulated and protected from it, and partially because they’re not looking for it. There are people who are not interested in seeing that it exists. They don’t view the world through that lens.”

Although the recent events served to jump-start conversation, many doctors have pointed to the AMA’s long history of racism: the founding editor of JAMA, Nathan Davis, MD, excluded both women and Black physicians from the association. In 2008, the AMA publicly apologized for historical discrimination.

Since then, there have been criticisms from some researchers and doctors that JAMA has published racist ideology, such as an article that claimed high death rates among Black COVID-19 patients can be attributed to their nasal gene expression.

Yet others believe the recent effort by the AMA to mitigate racism and inequity is only creating more of a racial divide.

Kevin Calongne, DDS, a Houston-area periodontist of 30 years, said both the American Dental Association (ADA) and the AMA have “delved too far into politics.”

“No matter what side of the aisle you’re on, it’s not a good thing,” he said. “The ADA is hosting seminars about coming to grips with your whiteness and other systemic racism issues. It does more to promote racism than to reduce it.”

And while he concedes there are examples of racism in medicine, he says “it’s not a systemic issue.” 

Meanwhile, many doctors of color are asking their White colleagues who doubt claims of systemic racism to listen to Black and brown people in the field.

“For those physicians who adamantly oppose the notion of systemic racism in medicine — despite the available objective data — please consider the subjective experiences of your underrepresented minority colleagues,” said Steven Bradley, MD, an anesthesiologist and fellow of the MacLean Center for Clinical Medical Ethics who hosts The Black Doctor Podcast . “We would never ignore our patient’s subjective concerns. Please do not ignore the subjective concerns of fellow physicians who are seeking to effect change. Listen. Try to understand.”

He added, “We have already diagnosed the condition of systemic racism. We must now learn the signs and symptoms and together work toward a cure.”

Sources:

American Medical Association

Journal of the American Medical Association

Dr. Carl Streed on Twitter





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