March 30, 2021 American Association for the History of Medicine
AAHM calls for properly archiving JAMA’s podcast on “Structural Racism for Doctors”
As scholars in the American Association for the History of Medicine, we support the sentiments expressed in the letter below by several AAHM members calling on the Journal of the American Medical Association to preserve and archive its recently aired, deeply disturbing podcast on “Structural Racism for Doctors.”
In the segment, Ed Livingston, the host and “full time editor of JAMA,” dismissed structural racism as “an unfortunate term,” insisting that people are “turned off by the whole structural racism phenomenon.” “Are there better terms we can use? Is there a better word than racism?” he asked, concluding that “personally, I think taking racism out of the conversation will help.” In light of the ignorance and dismissiveness expressed by Dr. Livingston (and following considerable public and professional outrage), the JAMA editor in chief apologized and JAMA deleted the podcast. JAMA’s editor in chief has been placed on administrative leave amid an independent investigation.
Expunging this important conversation from its website and archives, and thus erasing the full record of attitudes from the historical record, is a mistake by JAMA that should be remedied. A record of the podcast must be preserved by JAMA so that observers, scholars, and future historians looking back at 2021 will be able to analyze and learn from this unfortunate, roundly criticized, yet all-too-revealing controversy.
-Keith Wailoo, President, AAHM and the AAHM Council
Response to the JAMA Podcast on Structural Racism
As members of the American Association for the History of Medicine, we are acutely aware of the longstanding racist structures in American medicine that have explicitly and implicitly favored white healthcare providers and white patients. Racism in medicine and structural racism in the United States has produced a long history of health inequities that are still experienced today by Black, Latino/a, and Indigenous people. As historians of medicine we also recognize the need to preserve, document, archive, and make accessible the primary sources that are part of the historical record on racism in medicine.
A recent podcast on February 23, 2021 about structural racism, produced by the Journal of the American Medical Association (JAMA), has exposed the damaging ways that many doctors continue to ignore, downplay, perpetrate, and misunderstand racism in medicine and structural racism. We are pleased to see the pushback against the JAMA podcast by members of our organization in theBritish Medical Journal’s Medical Humanities. In response to that and more widespread criticism, the host of the podcast, JAMA Deputy Editor for Clinical Reviews and Education, Edward H. Livingstone, has resigned; JAMA Editor-in-Chief Howard Bauchner has issued a formal apology; and Bauchner hosted a hastily arranged a follow up event, a Conversation About #Racism and #StructuralRacism in Medicine & Health Care on the JAMA Network with three physicians who have extensive experience on racism and structural racism in medicine.
However, JAMA has withdrawn the original podcast and deleted it from all available platforms. JAMA has refused to either archive the episode or make it available publicly or privately upon request, which concerns us greatly.
Removing the podcast does not absolve JAMA or its parent organization, The American Medical Association, of the professional imperative to adequately address the errors in the podcast or rectify its damaging impact on ongoing efforts to dismantle structural racism in medicine. The podcast exemplifies how ignorance about structural racism and the history of the American health care system remain pervasive in the medical profession. It also revealed the consequences of privileging individual experiences and opinions about race over decades of historical knowledge, theory, and data. In its recent apology, the AMA stated that it would need to look inward. Removing the podcast risks erasing it from both the historical record and the AMA’s institutional memory, which impedes the process of self-examination, accountability, and transformation necessary to address the harms it caused. The ignorance displayed in this podcast must be archived and challenged by amplifying the history of racism in medicine. JAMA and the AMA must work collectively towards strategies for dismantling structural racism in medicine and advocate for an anti-racist pedagogy in universities, medical schools, and in the broader American health care system.
As members of the American Association for the History of Medicine, we believe that the JAMA podcast about structural racism must be preserved, archived, and made publicly accessible. Being transparent about errors and ignorance displayed in this podcast is the first step toward the accountability and education necessary for dismantling structural racism in medicine. Thus, we have provided a transcript of the podcast below. We call upon JAMA to archive the podcast episode about structural racism in their digital archive alongside the rest of their content and attach the formal apology given by Dr. Bauchner.
Jacob Steere-Williams, College of Charleston
Jaipreet Virdi, University of Delaware
Kylie M. Smith, Emory University
Elise A. Mitchell, New York University
Rana A. Hogarth, University of Illinois, at Urbana-Champaign
Ayah Nuriddin, Johns Hopkins University
Lauren MacIvor Thompson, Georgia State University
Christopher D. E. Willoughby, The Pennsylvania State University
Deirdre Cooper Owens, University of of Nebraska-Lincoln
Jacqueline D. Antonovich, Muhlenberg College
Graham Mooney, Johns Hopkins University
Antoine S. Johnson, University of California, San Francisco
Jim Downs, Gettysburg College
Stephen T Casper, Clarkson University
Mariola Espinosa, University of Iowa
Rebecca Kluchin, California State University, Sacramento
Janet Golden, Rutgers University
Cynthia Connolly, University of Pennsylvania
Susan Lederer, University of Wisconsin, Madison
Kavita Sivaramakrishnan, Columbia University
Podcast: Structural Racism for Doctors – What is it? JAMA clinical reviews 2/23/2021
Transcript by Rachel Buckle on 17th March 2021, using the verbatim format
Interviewer Ed Livingston – This is the third and final instalment of my recent interview with Dr Mitch Katz, the president and CEO of New York City Health and Hospitals. In the first two parts, that are linked to in the show-notes, we talked about COVID19 in New York and LA and racial and ethnic disparities in COVID19. In this final instalment we discuss structural racism. Going into this interview, I didn’t understand the concept. Racism is defined as the use of race to make decisions about what people can or can’t do or somehow influence their possibilities. The use of race for any sort of transactional activity was made patently illegal by the civil rights legislation passed in the 1960s. Given that racism is illegal, how can it be so embedded in society that it’s considered structural? As a child of the 60s I didn’t get it. I asked Dr Katz about this concept, what it means and what needs to be done about it. In today’s JAMA Clinical Reviews podcast we discuss structural racism for sceptics.
Intro – From the JAMA Network, this is JAMA Clinical Reviews, interviews and ideas about innovations in medicine, science and clinical practice. Here’s your host: Ed Livingston
Ed Livingston – Dr Katz, can you start by defining what structural racism is for us?
Dr Katz – Yeah, I think it’s a great question Ed. I think actually acknowledging structural racism can be helpful to us, because structural racism is not about whether someone is a racist, or whether some individual person loves other people of a different ethnicity, or doesn’t like it, it’s not about peoples personal opinions. Structural racism refers to a system in which policies or practices or how we look at people perpetuates racial inequality. So it gets people off the question of “Well, what are people talking about, I’m not racist. My neighbor’s African American, he and I go golfing every weekend, we love each other, you know I’m not racist” This is not about racism of meaning someone’s individual views. This is about how as a society we perpetuate inequality. And. You know, you raised the issue of your own background and I, you were insightful enough to mention to me that your family changed its name. We are of a similar age. I remember, you know, my own father making reservations in the name of Mr K instead of Mr Katz because of his fear that if he made a reservation in the name of Mr Katz, his name would never come up on the list. I remember him explaining that he didn’t go to law school because the feeling was that at that time they wouldn’t hire a Jewish lawyer. So, I mean the idea of bias prejudice is not a new one. It has existed in our society, ah I worked for many years in San Francisco and was horrified to learn that the history of the creation of Chinese hospital, was that the public sector in San Francisco which is now an incredibly progressive place, in the 1880s wouldn’t see Chinese Americans and viewed them as a source for disease. So, this is not a new phenomenon but what we are talking about are, how does policy prevent people from rising. So a common example outside of the health, but I think that people can understand, in almost every big city when you’re building a truck route, it isn’t through the middle-class neighborhoods, the truck route always goes through the lower income neighborhoods. And that truck route, those trucks, spew their diesel fumes and the surrounding population is more likely to be exposed to that pollution, more likely to develop asthma, more likely to then miss school because they developed asthma. In that poor section because there are our society despite the civil rights movement in many cities remains segregated, and so in certain neighborhoods the schools are not as good, the hospitals have fewer resources, so the children don’t get educated in the same way. The hospitals are not able to provide the same level of care, not cause they don’t want to, um not because the doctors aren’t every bit if not more committed to that population, since they’re choosing to work in safety net hospitals, but because the resources are not there. So, you know, I think what’s important is to that we ask ourselves we, we know that there are disparities, we recognize that the racial disparities in the US are connected to income, so what are the set of interventions? What are the sets of changes in policy that we can do? Income grants if you want people to be out of poverty, you can provide them economic assistance that enables them to not live at the level of poverty. As you and I were talking, housing can be important not just for people who are homeless, but for people who are living in sub-standard housing, we can improve those conditions to the extent, you improve the conditions then you are participating in a set of practices that decreases racial inequality instead of perpetuating it.
Ed Livingston – So the way you explain it, which is by the is a wonderful explanation, I think the term racism might be hurting us, because as I articulated my response to it is just what you and your explanation of my response is: I don’t feel I’m a racist, I grew up in a family where racism was reviled and my parents taught me never to hate based on what people’s colors are or their religion because they had suffered the most extreme violence because they were Jews, and they said ‘that’s wrong’, ‘its fundamentally wrong, you can’t do that’, so I grew up kinda anti-racist that just never ever even think about a person’s race or ethnicity when you’re when you’re evaluating them. Yet I feel like I’m being told I’m a racist in the modern era cause of this whole thing about structural racism, but what you’re talking about isn’t racism as much as that there are populations that its more of a socio-economic phenomenon that have a hard time getting out of their place because of their environment, and it isn’t their race, it isn’t their color, it’s their socio-economic status, it’s where they are. Is that a fair assessment?
Dr Katz – Yes, I mean I think I mean I the so you are not a racist, and also we are not going to end structural racism by focusing on individual people’s attitudes. We’re going to end structural racism by changing policies that keep people down, that’s how we’re going to do it. I think where it goes beyond socio-economic but still stays as a as a societal issue is that because of the countries past with slavery, because of views that people held toward the Chinese coming to San Francisco, or Mexicans coming to Los Angeles, there are biased views and that the goal should be that society should not re-inforce them. One of my co-authors tells a really funny story, Dr Louis Hart, he’s a pediatrician with us, brown skinned African American, he grew up in Canada until he was a young teenager. When he came to the US, the question that people asked him the most was what’s your ethnicity? and he answered Canadian. Because he wasn’t aware, you know, that in the US race was considered such a major part of your identity. And I, I do believe, and I think there’s good data to suggest that whatever people’s belief they cannot necessarily prevent the idea that they may react differently to a person who looks different than they do. That it happens and again JAMA has, you know, done a good job, I think of revealing ways that it happens between physicians, again I point out not just along racial grounds, it can happen every time a woman doctor is assumed to be a nurse, or called ‘honey’ or told to get a doctor into the room, but there are ways that that people see other people and if you grow up African American and the number of people see you as dangerous or in someway less-than or less likely to succeed, maybe they wish you the best, but they feel oh you won’t succeed because, you know, they’ve never met an African American doctor or they’ve never seen an African American as president until Obama, so they assume you can’t be. But all of those things have an impact on that minority person, but the big thing that we can all do is move away from trying to interrogate each other’s opinions and move to a place where we are looking at the policies of our institutions, making sure that they promote equality.
Ed Livingston – So you’re an editor at JAMA Internal medicine. I’m a full time editor at JAMA so we spend a lot of time thinking about words and what those words mean. I think using the term racism invokes uh feelings amongst people, as I just said my own feelings earlier on. That make it, that are negative and that people do have this response that we said repeatedly ‘I’m not a racist, so why are you calling me a racist’ that’s how because they respond that way, they’re turned off by the whole structural racism phenomenon. Are there better terms we can use? Is there a better word than racism?
Dr Katz – There may well be, I I don’t know it, again when I when I describe it I always try to get people to focus on the structural part of it. And to help people see that the issue is not trying to tell people how to think, which I think will always fail. And I think that one of the mistakes that good people make is thinking that we need to tell people how to think, that is not going to succeed. You cannot tell people how to think, but you can create a society that promotes equality.
Ed Livingston– So, asking you a hard question. What do we do to end structural racism? Or try to address it the best that we can
Dr Katz – We acknowledge that it exists, so, and again that’s why I make the distinction, acknowledging structural racism does not mean saying that I’m a racist. It means saying that our countries policies need to be changed. And then I think that you’re your next part would be to say ‘Ok well what would the US look like if we didn’t have structural racism. What it would look like is that we we might still have people living in poverty but they wouldn’t be disproportionally minority. We would still have people in jail, but they wouldn’t be disproportionally minority. We would still have people who lived in sub-standard housing, but they wouldn’t be disproportionally from the minority. We would at every level you would see all of the country in a equitable way. So that the proportion of doctors, an lawyers, an senators, an supreme court justices would reflect the percentages in the population because we don’t believe that it’s genetic differences. Right, we don’t believe that the disproportionate harm that’s come to African Americans and Latinos for their health is because of genetic differences. We are physicians and we know there are a few diseases, you know, whether that’s Sickle Cell or Tay-Sachs that have a genetic basis, but that is not why we believe that black and brown people have higher mortality uh in this country due to COVID and a number of other illnesses. So the world that doesn’t have structural racism is a world where everyone doesn’t grow up to be president but anyone could grow up to be president.
Ed Livingston – Structural racism is an unfortunate term to describe a very real problem. There are structural problems in our society, as Dr Katz pointed out. There are neighborhoods that are impoverished; the quality of life is poor in those areas, because we may put factories in them or have major thoroughfares that travel through them. But we strive to have a society that’s more equal. Where, everybody has the same opportunities, so that hard working people can improve those neighborhoods and make them better for the people who live there. The racism part means that in those poor areas there tends to be a disproportionate share of certain kinds of races such as blacks or Hispanics. They aren’t there because they are not allowed to buy houses in better neighborhoods, or they can’t get a job because they are black or Hispanic, that would be illegal. But, disproportionality does exist and we as a society need to figure out why that occurs and how to make conditions better for people who live in structurally undesirable circumstances. Personally I think taking racism out of the conversation would help. Many people like myself, are offended by the implication that we are somehow racist, when many of us grew up in an era when there had been racism and much progress had been made in ameliorating racism via dramatic legislation that was passed in the 1960s. I think the population at large would be more accepting of this general concept if we concentrate on the structural part of it, and ensured that all people who lived in these disadvantaged circumstances have equal opportunities to become successful and have better qualities of life. The focus must be on equal opportunity and making sure that that exists. Others at the JAMA Network have discussed this and related topics and we have linked those podcasts in the show-notes. I’d like to thank Dr Mitch Katz for talking with us today on JAMA Clinical Reviews about structural racism. This episode was produced by Daniel Morrow. Our audio team here at the JAMA Network includes Jesse McQuarters, Shelly Stephens, Maylyn Martinez from the University of Chicago, Lisa Hardin and Mike Berkwits, the deputy editor for electronic media here at the JAMA Network. I’m Ed Livingston, deputy editor for clinical reviews and education at JAMA. Thanks for listening.