Medical Racism

 In early March, the Journal of the American Medical Association (JAMA) published a podcast on its website that questioned the idea that racism existed in medicine. The blowback was immediate and warranted. Howard Bauchner, the JAMA editor-in-chief, was placed on administrative leave on 25 March and the medical community boycotted JAMA over this and prior examples of racism in its pages. 

The sad truth is that, as in America itself, racism is endemic in medicine and has been for hundreds of years. Perhaps the single best book on this subject is Harriet Washington’s award-winning Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. I pulled out my medical school yearbook from 1974 and it provided confirmation of exactly what I remembered. My class was overwhelmingly white and overwhelmingly male. The faculty composition was parallel; wonderful professors but almost all white males as well. 

In thinking about this now (after all, this blog is the thoughts of a retired physician), and parsing my life with reading and reflection on my career in medicine, the endemicity of racism in medicine is no surprise. I also think back to the years before I started medical school. Berks County, Pennsylvania when I was a child was also overwhelmingly white. Outside of Reading itself were lily-white suburbs, the “good” places. Better neighborhoods, better schools, ostensibly better people. The city was also divided into a heavily white northern area and a somewhat more mixed southern area. The proportion of children of color in my elementary school and junior high school was higher than my cousin’s experience on the north side. All of the schools funneled into one high school. In the end, however, there was very little mixing of the races in school or other activities. I never thought much of this as a child growing up in Reading but it seems to me this was truly white privilege at work. 

The demography of the U.S. is in flux. Over the next decade we will grow in numbers, in age, and see the racial composition change with a smaller proportion of whites. There will be increases in immigration and a growing number of people of color. Medically we must do much more to improve the health of all Americans. We never should have allowed the inequity we see today to occur and it must be reversed. Blacks and Latinx are still underrepresented in medical school classes but there has been much improvement since I cracked the door at Temple in September 1970. Women today comprise over 50% of medical school enrollment, a distinct difference from 50 years ago. I believe much of the current political polarization in the United States today represents fear among older whites that the world they grew up in (the 1950s and1960s) that they are being “replaced” by immigrants and people of color. This is the “white genocide conspiracy” and it has deep roots in white history. No matter how you dress this up, it represents white supremacy, the belief that having white skin makes a person inherently superior. 

This, of course, is complete bullshit. The idea is meant to stir up fear and hatred, an appeal to the limbic system instead of to the cerebral cortex. It is poison for our society. Medicine should never subscribe to such ideas but as Harriet Washington points out in Medical Apartheid, it has and as the JAMA podcast sadly illustrates, still does.

There is a good op-ed in the New York Times by Molly Worthen, a historian at the University of North Carolina-Chapel Hill. She points out how the Covid-19 pandemic will probably force a change in medical education to include more of the humanities. Too late in my life and career, I recognized this. About 30 years ago, I began reading more about the history of medicine and taught research and medical ethics before I retired. Probably better for me and my patients had I done so sooner. In order to stamp out the virus of racism, it has to be understood and confronted. I now realize that endemic racism was all around me while I was growing up and sadly, it seeps in even while you are striving not to be seen as a racist. Medicine was racist in the past. Medicine is racist today. We with white skin are responsible to see that medicine is not racist in the future.