Are American systems rotted out by racism?
Where medicine’s concerned, Edward H. Livingston recently made his own position clear.
As reported by The Daily Wire, the doctor hosted a February podcast entitled “Structural Racism for Doctors — What is It?”
The podcast was sponsored by the Journal of the American Medical Association — the world’s most widely circulated medical journal, for which Edward was deputy editor of clinical reviews and education.
JAMA’s published by the American Medical Association, which nonetheless has no editorial control.
During the webcast, Edward chatted up fellow white Jewish man and JAMA Internal Medicine Editor/NYC Health+ Hospitals CEO Dr. Mitchell Katz.
In his introduction to the pre-recorded conversation, Edward admitted that “going into this interview,” he’d not understood the idea of structural racism.
Here’s how it appeared to Ed:
“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?”
Amid the discussion, Mitchell defined the ailment:
“Structural racism is not about whether someone is a racist .… it’s not about people’s personal opinions. Structural racism refers to a system in which policies or practices — or how we look at people — perpetuates racial inequality.”
“I feel like I’m being told I’m a racist in the modern era because of this whole thing about structural racism, but what you’re talking about, it isn’t so much racism as much as that there are populations, it’s more of a socioeconomic 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 socioeconomic status. It’s where they are. Is that a fair assessment?
“I think using the term racism invokes feelings amongst people that are negative and that people do have this response which we’ve said repeatedly, ‘I’m not a racist, so why are you calling me a racist?’ And because they respond that way, they are turned off by the whole structural racism phenomenon.”
Mitchell returned, “When I describe it, I always try to get people to focus on the ‘structural’ part of it. … You can’t tell people how to think, but you can create a society that promotes equality.”
How can structural racism be erased? “We acknowledge that it exists,” Mitchell said. “Acknowledging structural racism does not mean saying that ‘I’m a racist.’ It means saying that our country’s policies need to be changed.”
At the end of the pre-recorded section, Edward summed things thusly:
“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 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 aren’t allowed to buy houses in better neighborhoods, or they can’t get a job because they’re 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 things better for those who live in structurally undesirable circumstances.”
As it turns out, some physician folks didn’t appreciate Edward’s antics:
Thread on @JAMA_current: (JAMA has complete editorial independence from AMA so this would not come to me or my team for review) The podcast/tweet are/were wrong, absolutely appalling & at its very core is a demonstration of structural & institutional racism. I am furious. 1/ pic.twitter.com/o82H8dgR5v
— Dr. Aletha Maybank (@DrAlethaMaybank) March 4, 2021
1) Yes, physicians can absolutely be racist.
2) Yes, physicians can be complicit in upholding the practices and policies of systemic racism.
— uché blackstock, md (@uche_blackstock) March 4, 2021
And the fact that they are out here WHITESPLAINING racism.
I can not.
The LEVELs to this nightmare!!#DNRJAMA
— Brittani James, MD (@DrBrittaniJ) March 4, 2021
JAMA Editor-in-Chief Howard Bauchner released a statement relaying the following:
“Comments made in the podcast were inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA. I once again apologize for the harms caused by this podcast and the tweet about the podcast. We are instituting changes that will address and prevent such failures from happening again.”
Statement from Howard Bauchner, MD, Editor in Chief JAMA and The JAMA Network pic.twitter.com/A1AJNnMWB4
— JAMA (@JAMA_current) March 4, 2021
AMA CEO Dr. James Madara issued a reaction as well, noting Edward had agreed to step down.
He lamented that the “harmful podcast” had “minimized the effects of systemic racism in healthcare and questioned its profound impact on millions of people across our country.”
And just so there’s no misunderstanding:
“To be clear, structural racism exists in the U.S. and in medicine, genuinely affecting the health of all people, especially people of color and others historically marginalized in society. This is not opinion or conjecture, it is proven in numerous studies, through the science and in the evidence.”
Doctors are obligated to speak out against injustice:
“As physicians, and as leaders in medicine, we have a responsibility to not only acknowledge and understand the impact of structural racism on the lives of our patients, but to speak out against racial injustices wherever they exist in health care and society.”
James also noted the AMA’s “anger and concern” at something so inconsistent “with AMA policy, published research and our understanding about systemic racism.”
Update: @CEO_AMA on important steps being taken in response to JAMA’s harmful podcast & tweet. Additionally, JAMA EIC Howard Bauchner, MD has asked for, received & accepted resignation of the editor who hosted the podcast. https://t.co/TlvHDl7eRw
— AMA (@AmerMedicalAssn) March 11, 2021
“We must,” James insisted, “and will do more to help dismantle structural racism across health care, including within our own institution.”
Mitchell also came around with a statement, emphasizing, “As clinicians, we must understand how these structures and policies have a direct impact on the health outcomes of the patients and communities we serve. It is woefully naïve to say that no physician is a racist just because the Civil Rights Act of 1964 forbade it, or that we should avoid the term ‘systemic racism’ because it makes people uncomfortable. We must and can do better.”
Yeah, so the podcast? It didn’t go so well.
Hear it in its entirety here.
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