Podcast on Race Reveals Deep Divides in the Medical Community on Racial/Ethnic Disparities
Several weeks ago, a podcast published on the Journal of the American Medical Association's website featured a statement that questioned whether racism exists in medicine, a statement that spurred a barrage of complaints from concerned readers, scientists and even public opinion leaders. The journal is still under fire for these comments, given the large disparities between racial and ethnic groups regarding care access and clinical outcomes.
During the podcast, JAMA’s deputy editor for clinical content, Ed Livingston, and editor at JAMA Internal Medicine and CEO of NYC Health + Hospitals, Mitchell Katz, stated racism was “illegal,” therefore suggesting it couldn’t be explicitly embedded in society. Livingston noted he did not see himself as racist because of his Jewish background and him being taught to never hate, and instead questioned the whether the term “racism” could “be hurting us.” Instead, he wondered if there could be a better word as “the term racism invokes feelings amongst people.”
In contrast, Katz stated he believed that structural racism exists but was criticized after the podcast for not pushing back harder on Livingston’s statements. Since the podcast aired, Katz condemned the show’s content and reaffirmed his belief that structural racism exists in the field of medicine.
Livingston, however, has not made a public comment on the matter. The journal asked Livingston to resign due to the backlash it received on the show. While JAMA’s editor-in-chief Howard Bauchner apologized, it didn’t stop the organization from placing him on administrative leave. Bauchner and other JAMA editors have refused comment, perhaps due to an ongoing investigation conducted by an outside counsel.
Complaints made to JAMA are not just centered on the podcast, nor are they geared only to the one journal. Medical journals have also minimized issues of race in medicine, including a JAMA article blaming higher mortality rates related to coronavirus disease 2019 (COVID-19) in African Americans on a gene in nasal passages and excluding issues surrounding structural racism. This is despite the fact that there exist questions regarding the clinical relevance of the gene’s expression and that Hispanic people, who also have higher death rates from COVID-19, do not exhibit an increased expression rate of the gene.
Also, one letter claimed structural racism isn’t implicated in pulse oximeters not working as well in dark skin because the devices can’t demonstrate bias, despite an FDA warning letter stating pulse oximeters have issues with darker skin types.
Some critics believe that ideas within the medical community that pushed back on structural racism perpetuate health inequities, further worsening the quality of life and survival of people of color.
Upon hearing the JAMA podcast, Brittani James, assistant professor of clinical family medicine at the University of Illinois College of Medicine and co-founder of the Institute for Antiracism in Medicine, launched a petition that calls for initiating change at JAMA. Since it was announced, the petition has already garnered almost 8,000 signatures.
Critics of the organization suggest JAMA and its medical journals limit the publication of content related to racism and its effects on health. These critics also claim that papers discussing racism are not often published as research pieces, which can offer the most impact from a clinical perspective, but instead as “Perspectives” or opinion pieces.
In addition, some allege that editors ask authors to remove the term “racism” from their manuscripts. One systematic review that included 250 top-ranked public health journals found that only 25 articles published between 2002 and 2015 either named institutional racism or featured related terms in the titles or abstracts.