Top medical journals, ob-gyns, and NFL all face tough reckoning with racism

bauchner-150x150Racial inequities roiled an array of health-related situations in recent days, showing how far the nation still must go to deal with pervasive injustices in medical systems nationwide.

The reported matters include:

  • The editor-in-chief departed a leading medical journal after one of his chief deputies, in a purported “education” session for which practitioners could earn professional credit, sought to deny the existence of racism in modern U.S. medicine and baldly asserted that no doctors are racist. The deputy already was forced out. The top editor, who served for a decade in his post, said he was sorry that the incident occurred on his watch, and his defenders praised his accomplishments at the Journal of the American Medical Association.
  • But critics laced into JAMA, its associated publications, and other top medical journals. Black researchers assailed these important information sources for doctors, saying they continue to be dominated at the top by older, white males. Those editors too often red-penciled the very word racism out of studies by researchers of color. They also set difficult hurdles for black researchers to get published careful examinations of medical situations showing race-based problems. Critics, in fact, cited evidence showing that prestigious medical publications publish a dearth of rigorous research about systemic racism in the field, preferring, instead, to deflect problems by tying them to economic or social factors, rather than race. This not only blocks racial progress in medicine. It can stunt the careers and slash the funding for researchers of color and their investigations of vital areas of huge concern. JAMA has promised changes and offered a new plan for them.
  • The National Football League, as part of its running, billion-dollar program to compensate and assist athletes for serious head and brain injuries that occurred during their professional careers, decided to eliminate a controversial “race-norming” aspect of its damage settlements. The league, denying it discriminated against black players, had settled an undetermined number of cases with an assumption that African-American athletes “started out with lower cognitive functioning. The practice had made it harder for black players to show [an injury-related cognitive] deficit and qualify for an award. The standards were designed in medicine in the 1990s in hopes of offering more appropriate treatment to dementia patients,” the Associated Press reported. Two players contested the league’s medical standards, losing a lawsuit over the issue. The judge in the case, however, ordered a mediator to examine the issue, leading to the NFL reverse. Players’ wives, on learning of the issue, were infuriated and played a major role in petitioning the league to reconsider its approach.
  • Some leading obstetrician-gynecologists reported that they have revamped an online tool, used widely by practitioners, to eliminate race and ethnicity as factors in counseling patients about their likelihood of having successful vaginal births after they underwent a cesarean. The change in the so-called VBAC calculator took “years of work by researchers, advocates, and clinicians [working to] that racialized calculator has been replaced by a newly validated versionthat is the same in almost every way — except for eliminating race and ethnicity as a risk factor. The VBAC calculator is just one of several clinical algorithms that have recently been challenged over their use of race adjustment. Providers across specialties have questioned the inclusion of race and ethnicity — which are social, not biological factors — in their decision-making tools, pointing to the risk of perpetuating existing health inequities,” Stat, the science and medicine news site reported. The site’s article noted that researchers have pointed out other problematic algorithms and urged they be revised, adding, “In March of this year, for example, the American Society of Nephrology and the National Kidney Foundation officially recommended ending the practice of race-adjusting the estimated glomerular filtration rate, a measure of kidney function that can play a critical role in whether a patient receives a kidney transplant.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the struggles of patients of color and women to receive equitable care. Women long have suffered too many and various kinds of mistreatment in traditional medicine, and the coronavirus pandemic exposed the urgent need for the medical establishment to deal with injustices in the treatment of blacks, especially, but also Latinos and other minorities in this country.

Rooting out inequities will take concerted efforts at all levels, whether in the research studies that shape our care, the publications that share key information on advancements in the field, or in the front-line tools, assessments, and practices that can produce life changing and saving outcomes. These are not small nor esoteric matters but rather concerns that sincere, engaged leaders and practitioners must tackle — for the good of their craft, themselves, and, most important, their patients.

The American Medical Association has been slow to own up to its racist history, though the prominent group, with declining membership now representing a slice of the nation’s doctors, dove into its past and issued a formal apology for its past wrongs in 2008. The group in May said it would rededicate itself to more equitable medical care for all patients in this country, issuing a high-minded plan that leaders said would seek to root out systemic racism in health care.

In the richest, most high-minded nation in the world, health care must be a right, not a privilege. It cannot be separate and unequal, with patients getting lesser or worse care based solely on their race, gender, sexual orientation, or economic status. Checking our biases can be challenging but productive. It needs to happen often and steadily. We have much work to do to ensure the fairness of our health care.

 

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