Four hundred years ago, Italian astronomer Galileo was persecuted for advancing Copernicus’s theory that the earth and other planets rotate around the sun. This heliocentric theory violated the prevailing belief dating back to Aristotle and engrained in Christian theology that the sun and planets rotate around a stationary earth. Galileo was tried for heresy and placed under house arrest for the remainder of his life. Science would eventually vindicate Galileo.
Today’s scientists and physicians face a different orthodoxy that explains all disparate health outcomes as the result of structural or systemic racism. Doubters and those who investigate genetic and scientific alternative explanations face their own latter-day inquisition. Just ask Howard Bauchner, editor in chief of JAMA — the Journal of the American Medical Association — who was recently forced to resign. While the remaining JAMA editors offered fulsome praise in a farewell editorial citing his accomplishments, including a commitment to Diversity, Equity, and Inclusion, make no mistake: He was purged for a thoughtcrime.
Dr. Bauchner’s offense was that he presided over JAMA when it aired a podcast titled “Structural Racism for Doctors — What Is It?” in late February. The podcast featured two white physicians — JAMA deputy editor Ed Livingston and Mitchell Katz, an editor at JAMA Internal Medicine, president and CEO of New York City’s public-hospital system NYC Health + Hospitals, and a member of the National Academy of Sciences. Dr. Katz described structural racism as societal policies or practices that perpetuate racial inequality, as opposed to individuals’ racist beliefs. Dr. Livingston wondered if “structural racism is an unfortunate term to describe a very real problem.” (emphasis added) He worried that people offended by being labeled racist would not address the societal barriers to equal opportunity. JAMA’s tweet promoting the podcast stated, “No physician is racist, so how can there be structural racism in health care? An explanation of the idea by doctors for doctors. . . .”
Criticism of the podcast and tweet was fierce. After clarifying that JAMA is editorially independent from the AMA, Dr. Aletha Maybank, the AMA’s chief health-equity officer, tweeted that the podcast was “absolutely appalling & at its very core is a demonstration of structural & institutional racism.” AMA CEO Dr. James Madara condemned the JAMA podcast and tweet as inconsistent with the policies and views of the AMA and declared, “Structural racism in health care and our society exists.”
While Bauchner did not author or approve the podcast or the clumsy, misleading tweet promoting it, he tweeted an apology for the harm caused by them and for his “lapses” and reaffirmed JAMA’s commitment to “call out and discuss the adverse effects of injustice, inequity, and racism in medicine and society.” He withdrew the podcast, replacing it with an apology for its allegedly inaccurate, offensive, and hurtful comments. Bauchner declared that “racism and structural racism exist in the U.S. and in health care.”
Livingston, the podcast host, resigned from JAMA at Bauchner’s request. Two weeks after, Bauchner himself would be placed on administrative leave by the AMA pending an investigation. Now, two months later, he is gone, too.
It isn’t as if Bauchner and the AMA previously ignored racism. The AMA acknowledged its own history of discriminatory practices in 2008 and this past November labeled racism as a public-health threat. JAMA and other associated AMA publications have published a plethora of articles discussing systemic racism in medicine and restorative justice for communities of color. Bauchner’s apology withdrawing the podcast transcript had links to 115 articles in the JAMA family of journals addressing racism and inequities in medicine. A more recent apology from 15 editors in the JAMA family of journals lists more than 650 “articles on race, racism, and racial and ethnic disparities and inequities” in their journals since 2015. An August 20, 2020, editorial in JAMA Network Open — the AMA’s monthly open-access medical journal — titled “Call for Papers on Prevention and the Effects of Systemic Racism in Health” stated there is “an emerging consensus” that systemic racism exists in society and medicine, referenced ten articles discussing racism and health disparities in AMA publications, and was accompanied by another editorial titled “Responsibility of Medical Journals in Addressing Racism in Health Care.”
Other medical organizations have been similarly confessional. An October 2020 policy statement on racism and health from the American College of Physicians indicts the organization for past discriminatory practices, calls for policies to address discrimination and racism in health care, medical education, law enforcement, and society, and commits the ACP “to being an antiracist organization.” The New England Journal of Medicine has published 70 articles on race and medicine in the past two years.
Official medicine, adopting the jargon of the day, now apparently believes if you are not an “antiracist,” you are a racist. Systemic racism in medicine is an established fact, and no contrary studies, opinions, or evidence will be allowed. Incoming AMA president Dr. Gerald Harmon rebuffed AMA delegates who challenged the association’s new plan to combat racism, claiming, “The existence of racism within medicine and society, both historically and present day, is not up for dispute.” Questioning this orthodoxy may end your career.
In the wake of Bauchner’s departure, the JAMA journals editors have committed to new editorial priorities that promote diversity, equity, and inclusion and advance antiracism. Needless to say, articles deviating from these priorities will not be welcomed.
Indeed, even speculating that there could be a nonracist cause for health disparities leads to condemnation. A September 2020 JAMA paper examined whether higher COVID-19 infection and death rates in blacks might be explained by the overexpression in blacks of a gene that makes a protein that facilitates the entry and spread of the SARS-CoV-2 virus into nasal cells. Overexpression of the gene was already associated with a higher incidence of prostate cancer in black men versus white men. The researchers found higher gene expression in blacks’ nasal cells compared with other races and reported that trials of inhibitors of the protein that might level the playing field for blacks were underway. Yet a founder of the Institute for Antiracism in Medicine labeled the study “biomedical racism.” A May 2020 Health Affairs paper that found higher risk of hospitalization from COVID-19 for African Americans wondered if there could be “unknown or unmeasured genetic or biological factors that increase the severity of this illness for African Americans” but was forced to revise the article and remove this language.
There is well-known evidence of biologic bases for disparate racial outcomes. Black women do worse than white women with breast cancer. Yet when black and white women with the same common, early form of breast cancer were treated with the same treatments, the black women still had higher rates of recurrences and death. Moreover, a particularly aggressive and lethal form of breast cancer called triple-negative disease is known to be more common in black than white women. These facts suggest that genetic factors, rather than structural factors such as poor access to medical care or systemic racism, are more important explanations for black women’s poorer breast-cancer outcomes. Similarly, prostate cancer is more common and perhaps more aggressive in black than in white men. Ignoring these biologic differences and the therapeutic approaches they suggest will harm black patients.
Dr. Bauchner was purged for allowing others to question the wisdom of applying a political construct, systemic racism, to medicine. Science and medicine thrive on independent inquiry that overturns accepted but erroneous ideas. Both will now be constrained by politically correct modes of thought. Hopefully, we will not sacrifice too many legitimate inquiries into racial differences surrounding the susceptibility to and optimal treatments for different diseases before science, once again, triumphs over authorized beliefs.