Rejection used to be common for medical sociologist Thomas LaVeist when he tried to get his research published on the effects of racism on the health of black people. “Now,” said the 60-year-old dean of Tulane University’s School of Public Health and Tropical Medicine, “I have those same journals asking me to write articles for them.”
LaVeist’s experience illustrates the transformation in medical research. While few would dispute that black Americans are more prone to chronic health problems and have shorter life expectancies than whites, the medical community generally sought answers in biology, genetics, and lifestyle. Research, like LaVeist’s, that focused on racism was frowned upon as an amateurish detour from serious intellectual inquiry.
In recent years, and especially since Black Lives Matter protests erupted last year, systemic racism has been transformed from a fringe theory to a canonical truth. Medical researchers offer a sweeping socio-political explanation for racial health disparities by citing the hundreds of peer-reviewed articles authored by LaVeist and a host of others, thus conferring upon the study of systemic racism the imprimatur of scholarly authority.
This year, the National Institutes of Health issued an apology to all who have suffered from structural racism in biomedical research. The NIH is dedicating $90 million to the study of health disparities and structural racism, engaging in more than 60 diversity and inclusion initiatives, and committing “every tool at our disposal to remediate the chronic problem of structural racism.”
Deemed incontestable, systemic racism provides the political rationale for “dismantling”—in the words of no less an authority than the NIH—the institutions and cultural standards that, according to the framework’s advocates, are maintained to uphold white supremacy.
The consequences of ignoring this new prime directive for racially focused research were made clear this year when the top two editors of the Journal of the American Medical Association were pressured to resign after the organization ran a podcast that questioned whether systemic racism explains racial health disparities.
“This is the first time the NIH has issued a call for research on structural racism. This is the first time JAMA fires an editor who said something wrong about racism,” says Shervin Assari, an associate professor of family medicine and urban public health at Charles R. Drew University of Medicine and Science in Los Angeles, one of four historically black medical schools in the U.S. Assari has authored more than 350 papers on race, social determinants, and health equity
To institutionalize its new policy, JAMA is revising its peer review standards and diversifying its ranks to advance health care equity, a term that refers to narrowing or even eliminating racial health disparities in chronic conditions and life expectancies. Similar steps are being adopted throughout the medical profession. A lead editorial in JAMA’s August special issue dedicated to racial health disparities called systemic racism a scientific fact beyond dispute and said all medical journals are morally obligated to document it in their research.
Racial health disparities underlie the four-year gap in black-white life expectancy in the United States. Factors that contribute to this disparity include chronic conditions, unintentional injuries, and suicide and homicide, which is the leading cause of death for black males aged 44 and younger. Scholars committed to the systemic racism explanation blame the disproportionately high crime rates in poor black neighborhoods on discrimination, substandard schools, and other manifestations of systemic racism.
The rapid turn of events has blindsided traditional doctors.
“The spectacle of the gatekeepers of medical publications announcing a political blueprint that medical authors must follow – or else – is pretty breathtaking,” Thomas Huddle, who retired this year as professor at the University of Alabama–Birmingham’s medical school, said by email. “The medical gatekeepers are in the grip of a moral panic.”
Some find the systemic explanation to be leftist polemic, while others doubt that it explains everything it claims to explain. These skeptics worry about the career implications of publicly dissenting from the new orthodoxy – but it’s also possible that blaming an entire national culture for racial disparities could prompt independent scholars and conservative think tanks to produce opposing research that explores black-on-black murder, racial disparities in IQ testing, and other taboo subjects.
The transformation sweeping through the health-care profession is not happening in a vacuum. It mirrors social justice movements committed to exposing structural racism that allegedly pervades education, criminal justice, the arts, hard sciences, and other domains of U.S. society. Activists in those fields, as well as medicine, talk of dismantling white supremacy and other “structures“ that cause racial and gender power imbalances and harm non-white groups.
Skeptical physicians say that medical journal editors are essentially replacing the scientific method with a political ideology, namely critical race theory, and leaving little room for alternative explanations—such as personal agency or cultural differences.
“There’s a tremendous amount of groupthink,” said Stanley Goldfarb, a former dean for curriculum who taught about kidney disease at the University of Pennsylvania medical school before retiring this summer. “If you don’t agree with all that, you’re a bad person.”
This article was adapted from a RealClearInvestigations article published Nov. 11.
