Subject of racism in medicine prompts racist hot-takes from JAMA.

The Homo Scientificus blog looks at the ways Science and Culture intersect in everyday life.

Racism and inequality are obvious problems around the world. In 2020, race relations in the United States hit the lowest it’s been in decades. The murders of George Floyd and Brianna Taylor (to name two of many) galvanized millions. Concerned citizens took to the streets to express their displeasure with the state of relations between people of color and local police forces. As a result, there has been an increasing amount of analysis regarding racism in society. In particular, the notion of systemic racism has become a rallying cry for people concerned with racial injustice.

While discriminatory practices — intentional and unintentional — are damaging in all circumstances, there are varying levels of harm that may result. A recent review by Roberts et. al “Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis” highlights a particularly worrying manifestation of racism, this time by doctors in hospitals. They sought to determine whether people of color — particularly Black/African-Americans and Hispanic/Latino — were treated differently when seeking healthcare. They also factored in socio-economic status (SES) into their analysis. According to the authors, there are various ways discrimination is expressed:

Health care disparities occurring at the point of care with individual patients may be due to clinician bias (e.g. implicit or unconscious bias), and this may involve a lack of empathy. Examples include inadequate analgesia for Black/African American and Hispanic/Latino patients with painful conditions, inappropriately low use of cardiac catheterization for Black/African American patients with possible acute myocardial infarction, and clinicians’ false assumptions that Black/African American patients will have poor adherence to treatment recommendations, among many others.

Roberts et. al looked at eighteen studies that amounted to 9,708 patients in total. They compared SES between groups in higher and lower brackets.

We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance.

The authors go on to state that although they did not find statistically dignificant differences in empathy, their findings do highlight a trend that needs to be studied more. The scores were “consistently numerically lower” for people of color when compared to white patients. Moreover, none of the studies indicated that non-white patients reported higher empathy when compared to whites.

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The authors concluded, “We believe the results of this systematic review and meta-analysis are important preliminary data supporting that an empathy gap may exist for disadvantaged people in face-to-face health care encounters with clinicians.”

As if on cue, members of medical community power structure displayed how unaware they are of their own biases (if you want, you can call it racism…) by going on record to dispute that there could be any racism among medical professionals. No less than Ed Livingston, a deputy editor at the highly influential Journal of the American Medical Association, decided that rather than say nothing, he needed to express his displeasure with the notion. On Twitter, aka the graveyard of insufficiently thought out hot-takes, no less. It didn’t end there.

An article in The Scientist summed up the mind-blowingly stupid chain of events:

The tweet, since deleted, read in part, “No physician is racist, so how can there be structural racism in health care? An explanation of the idea by doctors for doctors . . .” In the February 24 podcast episode, also since taken down, host Ed Livingston, then JAMA’s deputy editor for clinical reviews and education, said, “Structural racism is an unfortunate term,” according to MedPage Today. “Personally, I think taking racism out of the conversation will help. Many of us are offended by the concept that we are racist.”

Needless to say, that did not go over well. Rightly so.

Dr. Aletha Maybank, the American Medical Association’s Chief Equity Officer, took Livingston to task.

Even the AMA went out of their way to denounce the tweet and podcast and distance themselves from the JAMA braintrust. Needless to say, Editor-in-Chief Howard Bauchner, probably sensing his own tenuous position, promptly did the customary Twitter-induced backpeddling. He even asked for and received Livingston’s resignation. He did what he could to stem the bleeding but to no avail.

On March 25, Bauchner was placed on administrative leave from JAMA.

Sometimes, when people don’t get it, they really don’t get it.

WORDS: Marc Landas

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