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The Margin: JAMA editor in chief steps down over tweet that questioned racism in medicine

The editor in chief of the Journal of the American Medical Association (JAMA) has stepped down over a now-deleted tweet promoting a podcast that questioned whether structural racism exists in medicine.

Dr. Howard Bauchner, who has been on administrative leave since the controversy arose in March, will no longer helm the prestigious medical journal, the American Medical Association announced on Tuesday. 

“I remain profoundly disappointed in myself for the lapses that led to the publishing of the tweet and podcast,” Bauchner said in a statement. “Although I did not write or even see the tweet, or create the podcast, as editor in chief, I am ultimately responsible for them.” 

JAMA Executive Editor Phil Fontanarosa will serve as interim editor in chief until a new editor is appointed.

So what led to this JAMA shake-up? Here’s a refresher:

The March 4 tweet that set off the firestorm was promoting a Feb. 23 podcast hosted by JAMA and entitled “Structural Racism for Doctors—What Is It?” The episode featured host Dr. Ed Livingston, the deputy editor for clinical reviews and education at JAMA, and Dr. Mitchell Katz, president and chief executive officer of NYC Health + Hospitals, discussing structural racism. “Many physicians are skeptical of structural racism, the idea that economic, educational, and other social systems preferentially disadvantage Black Americans and other communities of color,” the episode description read.

And the now-deleted post from JAMA’s official Twitter account pushing the podcast doubled-down on that skepticism: “No physician is racist, so how can there be structural racism in healthcare?” it asked. And that sparked outrage among some followers, including many who identified themselves as doctors. 

As critics noted, many studies published in JAMA itself have provided evidence that such systemic inequalities are alive and well in the American health care system, which has only become more apparent during the COVID-19 pandemic. Black and Latino Americans bear a disproportionate share of COVID-19 illness and death. People of color are also getting vaccinated against the coronavirus at much lower rates compared with white Americans. And prior to the pandemic, this 2000 JAMA article notes that “socioeconomic and racial/ethnic disparities in health care quality have been extensively documented.”

A Word from the Experts: People of color shouldn’t be treated equally in COVID-19 vaccine trials, ER doctor says: They should be over-represented

Read more: How Black doctors are answering the call to reform medical education — and bringing COVID-19 vaccine trials to communities of color

Systemic racial inequality has been well documented in medicine. Almost one-third of African-American respondents in a 2017 NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll felt they had been “personally discriminated against” because of their race during a doctor or health clinic visit; one in five Latinos reported the same. Almost one-third of Muslims surveyed for a 2015 study in the Journal of Muslim Mental Health said they had perceived being discriminated against in a health-care setting.

Read more: Bias in health care isn’t limited to race, religion or gender — how to protect yourself against this common medical practice

Overall, Black Americans face lower life expectancies than their white counterparts and remain at greater risk for stroke, heart disease, HIV, cancer, mental illness and diabetes. Government research shows that racial minorities have not received the same quality of care as their white counterparts.

And people who listened to the controversial JAMA podcast expressed concern that Livingston suggested socioeconomic status was more responsible for inequalities in health care than racism. “Minorities…aren’t [in those neighborhoods] because they’re not allowed to buy houses or they can’t get a job because they’re Black or Hispanic. That would be illegal,” he said. “But disproportionality does exist.”

James Madara, the CEO of the American Medical Association, said he was “disturbed” and “angered” by the JAMA tweet and podcast.

The AMA’s House of Delegates passed policy stating that racism is structural, systemic, cultural, and interpersonal and we are deeply disturbed — and angered — by a recent JAMA podcast that questioned the existence of structural racism and the affiliated tweet that promoted the podcast and stated ‘no physician is racist, so how can there be structural racism in health care?’” he wrote in a statement published in March. “Structural racism in health care and our society exists and it is incumbent on all of us to fix it.”

The JAMA account deleted the controversial tweet at the time, and then proceeded to tweet out other articles that appeared to show its support for equality, such as one post that read, “5 actions to eliminate racial injustice in medicine, health disparities in the US.” Many followers weren’t buying this.

At the time, Bauchner, still acting as JAMA’s editor in chief, also tweeted a statement in which he said that “the language of the tweet, as well as portions of the podcast, do not reflect my commitment as editorial leader of JAMA and JAMA Network to call out and discuss the adverse effects injustice, inequity, and racism in medicine and society as JAMA has done for many years.”

He took responsibility for the incident, and apologized for the lapse and the harm it caused. The podcast has also been withdrawn from the JAMA website.

Upon stepping down permanently on Tuesday — which coincided with the 100th anniversary of the Tulsa Race Massacre — Bauchner wrote that, “I share and have always supported the AMA’s commitment to dismantling structural racism in the institutions of American medicine, as evident by numerous publications in JAMA on this issue and related subjects, and look forward to personally contributing to that work going forward.”

Katz (who was interviewed on that podcast) responded with a statement to the backlash in March, as well. He wrote: “I do not share the JAMA host’s belief of doing away with the word ‘racism’ will help us be more successful in ending inequities that exists across racial and ethnic lines. Further, I believe that we will only produce an equitable society when social and political structures do not continue to produce and perpetuate disparate results based on social race and ethnicity.”

Read his full statement here.

This article was originally published on March 4, and has been updated with the JAMA editor in chief stepping down.

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