Racism? CDC calls it a threat. Prominent doctors need a kick to recognize it.

bauchner-150x150dredlivingston-150x150While the federal Centers for Disease Control and Prevention has declared racism a serious threat to the nation’s health, establishment medicine finds itself mired in an angry scandal over doctors’ inability to recognize the term, much less its existence, or its considerable harms.

An uproar at a leading medical journal might seem a tempest in an ivy-covered tower. But patients will want to track even a little the professional furor falling on the leaders of the respected Journal of the American Medical Association.

Its website recently featured a podcast, for which doctors could get continuing professional education credit, in which host Ed Livingston (photo above left), JAMA’s deputy editor for clinical content and “a white editor and physician, questioned whether racism even exists in medicine,” Usha McFarling, a Pulitzer Prize-winning journalist reported for Stat, the medical-science news site.

No sooner than a Tweet went up to promote the program — the social media post contended counter-factually that “No physician is racist, so how can there be structural racism in health care?” — angry doctors began to barrage JAMA. Livingston was soon ousted. His boss, Howard Bauchner, JAMA’s editor-in-chief (photo, above right), apologized but was then put on administrative leave.

McFarling reported that the incident is more than an academic kerfuffle:

“[It is] surfacing complaints that JAMA and other elite medical journals have routinely excluded, minimized, and mishandled issues of race. Recent examples include research blaming higher death rates from Covid-19 in African Americans on a single gene in their nasal passages; a letter claiming structural racism does not play a role in pulse oximeters working less well on patients with dark skin because machines can’t exhibit bias; and an article claiming that students of programs designed to increase diversity in medicine won’t make good doctors. Critics say such ideas, published in powerful journals that doctors look to for leadership and education, are serving to perpetuate and entrench health inequities that have long harmed and shortened the lives of many people of color.”

Critics have surfaced other instances, McFarling reported, to support their contention that establishment medicine fails to grasp the gravity of racism in society and especially in health care:

“[P]roblems at JAMA and its network of medical journals include limiting publication of scholarship on how racism affects health and suggesting papers involving racism be submitted not as research articles, which have the most clinical impact, but as opinion pieces or ‘Perspectives,’ a series in JAMA Internal Medicine featuring ‘stories about the joys and challenges of practicing general medicine and truths discovered along the way’ … Problematic articles have appeared recently and steadily in JAMA and other prominent medical journals, even as discussions of racism in medicine have taken center stage during the pandemic and as journals and medical associations have publicly affirmed the Black Lives Matter movement and their own commitment to racial equality.”

McFarling also reported this disturbing matter:

“A number of researchers told STAT they have been explicitly told to remove the word racism from their work and replace it with less direct terms that white doctors won’t find offensive, such as socioeconomic status. A systematic review of more than 250 top-ranked journals in public health found that of all articles published between 2002 and 2015, only 25 named institutional racism or used related terms in their titles or abstract. Not a single article from either JAMA or the New England Journal [of Medicine] included articles that named racism in their title or abstract. ‘Scholars have been essentially told to whitewash race from their work,’ said Stella Safo, an HIV primary care physician and assistant professor at the Icahn School of Medicine at Mt. Sinai … ‘If you can’t call something by its name, how can you address it?’”

For medical researchers, of course, it is a harsh reality and not a myth that they must “publish or perish.” Getting studies done is one thing. But it can be mission critical to get them into elite journals where they not only attract professional attention, but they can also alter the practice of medicine. Publication can determine researchers’ study funding, as well as their career opportunities.

If top outfits like JAMA and NEJM — which both have insisted they are committed to diversity, equity, and greater inclusiveness in medicine — decline to put out quality work on racism and its effects, it can be crushing to those seeking to improve their profession.

It also runs contrary to the evidence-based position staked out, powerfully, by Dr. Rochelle Walensky, the CDC’s new chief, who said in a statement:

“The Covid-19 pandemic has resulted in the death of over 500,000 Americans. Tens of millions have been infected. And across this country people are suffering. Importantly, these painful experiences and the impact of Covid-19 are felt, most severely, in communities of color — communities that have experienced disproportionate case counts and deaths, and where the social impact of the pandemic has been most extreme. Yet, the disparities seen over the past year were not a result of Covid-19. Instead, the pandemic illuminated inequities that have existed for generations and revealed for all of America a known, but often unaddressed, epidemic impacting public health: racism.

“What we know is this: racism is a serious public health threat that directly affects the well-being of millions of Americans. As a result, it affects the health of our entire nation. Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects on the mental and physical health of individuals in communities of color. Over generations, these structural inequities have resulted in stark racial and ethnic health disparities that are severe, far-reaching and unacceptable.”

The agency’s web site points out these racism damages, besides what Walensky cited about the coronavirus:

“The data show that racial and ethnic minority groups, throughout the United States, experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to their white counterparts. Additionally, the life expectancy of non-Hispanic/black Americans is four years lower than that of white Americans.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

With all these challenges and obstacles that majority patients endure, it is a tragic and unacceptable truth that ill and injured African Americans and Latinos suffer relentless and unacceptable inequities in their medical treatment. There should be no place for discriminatory care in the U.S. health system, not for its mistreating women, nor for bias against those of Asian descent or of LGBTQ people.

We are slowly working our way out of a long and ghastly coronavirus pandemic and a year of nationwide protests against law enforcement excesses, particularly against communities of color. We have pledged to ourselves that we would emerge from a challenging period, not to our previous and imperfect normality but to something better. We have much work to do in so many areas to ensure that our country, and especially our health care system, is equitable, inclusive, and optimizing the opportunities presented by its diversity.

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