A doctor has been forced out of his position at the Journal of the American Medical Association (JAMA) after expressing a desire to ameliorate racial disparities and to better understand the concept of “structural racism,” but asking whether there might be a more productive term for it.
Edward H. Livingston resigned after being accused of hosting “a harmful podcast” that “minimized the effects of systemic racism in health care and questioned its profound impact on millions of people across the county.”
JAMA, the world’s most widely-circulated medical journal, is published by the American Medical Association (AMA) and also produces podcasts and video reports. The doctors’ group has no editorial control over JAMA’s content. Livingston was JAMA’s deputy editor for clinical reviews and education.
On Wednesday, AMA CEO Dr. James Madara released a statement announcing that Livingston had complied with a request to step down. He cited feedback “from many in our physician community” who “expressed anger, hurt, frustration and concern” about a February podcast titled “Structural Racism for Doctors – What Is It?”
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
“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,” Madara said. “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.”
Madara also condemned a Feb. 24 tweet by JAMA promoting the podcast, which read: “No physician is racist, so how can there be structural racism in health care?” Several Twitter users reacting to the post expressed outrage.
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
Dr. Aletha Maybank, the AMA’s chief health equity officer, wrote on a social media thread that “the podcast/tweet are/were wrong, absolutely appalling & at its very core is a demonstration of structural & institutional racism,” adding, “I am furious.”
The tweet and the podcast have since been deleted. However, The Daily Wire obtained a copy of the audio file after it was removed from the JAMA Network and the AMA’s online education portal.
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
The episode featured a conversation between Livingston, the host, and Dr. Mitchell Katz, an editor at JAMA Internal Medicine and CEO of NYC Health + Hospitals, the nation’s largest public health system. Both are white Jewish men.
Livingston led into the pre-recorded discussion by revealing that he did not understand the concept of structural racism “going into this interview.”
“The use of race for any sort of transactional activity was made patently illegal by the civil rights legislation passed in the 1960s,” Livingston said. “Given that racism is illegal, how can it be so embedded in society that it’s considered structural?”
“As a child of the 60s, I didn’t get it,” Livingston continued. “I asked about this concept, what it means, and what needs to be done about it. In today’s JAMA Clinical Reviews podcast, we discuss structural racism for skeptics.”
Livingston’s first question to Katz asked him to define structural racism. Katz spoke of the importance of acknowledging the concept.
“Structural racism is not about whether someone is a racist … it’s not about people’s personal opinions,” Katz explained. “Structural racism refers to a system in which policies, or practices, or how we look at people perpetuates racial inequality.”
Katz went on to provide specific examples of what he considered structural racism and provided ideas to make systems more equitable.
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
Livingston told Katz he had provided a “wonderful explanation” and said he thought “the term ‘racism’” might be preventing constructive dialogue because people often take the concept to apply to individual attitudes rather than oppressive structures.
Partial transcript as follows:
LIVINGSTON: 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?
KATZ: Yes… We’re going to end structural racism by changing policies that keep people down. Where it goes beyond socioeconomic but still stays as a societal issue is that because of the country’s past with slavery, because of the views that people held toward the Chinese coming to San Francisco or Mexicans coming to Los Angeles, there are biased views and that the goal should be that society should not reinforce them… The big thing that we can all do is move away from trying to interrogate each other’s opinions and move to a place where we are looking at the policies of our institutions and making sure that they promote equality.
LIVINGSTON: 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. Are there better terms we can use? Is there a better word than racism?
KATZ: There may well be. I don’t know it. 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.
LIVINGSTON: What do we do to end structural racism or try to address it the best way we can?
KATZ: We acknowledge that it exists. Acknowleging structural racism does not mean saying that I’m a racist. It means saying that our country’s policies need to be changed.
The interview concludes, then Livingston summarizes the conversation and provides more commentary on the subject:
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.
Following the public outcry, Katz released a statement that reportedly said, “Systemic racism exists in our country.”
“The disparate effects of the pandemic have made this painfully clear in New York City and across the country,” it continued. “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.”
JAMA Editor-in-Chief Howard Bauchner, who said he took “responsibility for these lapses” but still asked Livingston to resign, apologized for portions of the podcast and the language of the tweet promoting it.
“Comments made in the podcast were inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA,” Bauchner said. “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
JAMA executives held a town hall for employees to voice their concerns, said they would review the editorial process, and announced a new associate editor position to be filled by someone with “specific expertise in the topics of racism and structural racism in health care.”
“The AMA recognizes how our own decisions throughout history have contributed to the inequities that exist in health care, and we have taken a number of actions to address past wrongs,” wrote Dr. Madera. “But we must and will do more to help dismantle structural racism across health care, including within our own institution.”
Listen to the full podcast here.
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