Sunday, July 18, 2021

AMA Publishes Report on Legacy of "White Men," Need for Racial Equity

Update 11/2021.  In the fall, AMA released "Guide to Language, Narrative, and Concepts."

Blog discusses here (n.b., takes contrary stance)

See also 10/2021:

And 10/2021, "How color-blind policies exacerbate black-white inequities," Ann. Intern. Med.

See a cluster of articles in JAMA in November 2021:

AHRQ: Racism methods report, Lin et al., here.  USPSTF racism overview report here.  (See also, social risk AHRQ report, Davidson, here.  AHRQ gender report here.)  Esslen, pharmacoequity here. Lyles, digital health equity here.  


This [July 2021] weekend, the Los Angeles Times carries feature articles on the "medical cartel," including a lead Sunday front page story here and a document archive to go with it, here.

Meanwhile, AMA releases an 86-page report as an "organization strategic plan" for Racial Justice.  Find the PDF report here.   Press release here.  See also op ed by AMA President Dr Harmon here.  Update - the August 17 issue of JAMA was dedicated entirely to racial equity issues (here).

The AMA report notes that both race and ethnicity have been categories based on "financial and self-interests of white men."  It notes that while these white-men driven categories have included "races," in contrast there is not "enough genetic variability among its populations to justify either the identification of geographically based races."  Rather, references to race in healthcare have been "used to legitimize the preferential treatment of whites over others"   Particularly, "definitions of race differ depending on context, but they always operate in the service and self-interests of social-dominance hierarchies, thus benefitting white individuals."  The system normalizes white, hetero, Christian people at the expense of others (p. 11).  Adding that the "direction forward requires us to gain the knowledge...[acknowledging structures] rooted in white patriarchy."  And adding by quotation, "Our nation’s investment in racism, capitalism, and white supremacy shredded our safety net."   

From page 25, the document turns to specific racist activities of the AMA from the 1800's forward through the 1960s and 1970s.  In the Native American section, the report notes that as recently as 1990, the AMA urged state medical associations to protect the "medical interests" of patients against harm by "inappropriate religious treatment,"  which could "undermine the legitimacy" of "native healers."  The AMA derided Asian health practices as "barbaric and cruel."  AMA insistence on Western medical practices "furthered the overall goal of eliminating indigenous cultures."  

Many of the themes echo those of Dr. Camara Jones in her 2018 essay describing issues arising as president of the American Public Health Association (2015-2016; article here; Jones is cited 22 times in the AMA review).


For an AMA review of a new book written "by physicians" about problems with care provided by nurse practitioners and physician assistants, here.


See also in precision medicine; Genomeweb article June 8, 2021, on "systemic rational inequities in lung cancer biomarker testing; here.  In addition to gene testing, clinical trial participation was 2X higher in the white population (though only reaching 4%).  

See also:  Goodman & Brett (2021) Race and Pharmacogenomics - personalized medicine or misguided practice?  JAMA 325:625-6.   Comment at Wolters-Kluwer by Streetman, here.