JAMA Podcast on Racism in Medicine Faces Backlash

March 4, 2021 – A 16-minute podcast of JAMA: TheJournal of the American Medical Association that attempts to discuss structural racism in the U.S. healthcare system sparked discussions on social media about the management and promotion of the episode.

Posted on February 23, the episode is hosted on JAMAthe learning platform for physicians and is available for continuing medical education credits.

“No doctor is racist, so how can there be structural racism in health care? An explanation of the idea of ​​physicians for physicians in this user-friendly podcast, ” JAMA wrote in a Twitter post to promote the episode. This tweet has since been deleted.

The episode features host Ed Livingston, MD, associate editor of clinical journals and education at JAMA, and guest Mitchell Katz, MD, president and CEO of NYC Health + Hospitals and associate editor of JAMA Internal Medicine. Livingston approaches the episode as “structural racism for skeptics,” and Katz attempts to explain how structural racism exacerbates health disparities and what health systems can do about it.

“Many physicians are skeptical of structural racism, the idea that economic, educational, and other societal systems preferentially disadvantage black Americans and other communities of color,” the description of the episode reads.

In the podcast, Livingston and Katz discuss health care disparities and racial inequalities. Livingston, who says he “didn’t get the concept” going into the episode, suggests that racism was made illegal in the 1960s and that the discussion of “structural racism” should move away from the term. “Racism” and focus on socioeconomic status instead.

“What you’re talking about isn’t so much racism … it’s not their race, it’s not their color, it’s their socio-economic status,” says Livingston. “Is that a fair statement?”

But Katz says that “recognizing structural racism can help us. Structural racism refers to a system in which policies or practices or the way we look at people perpetuate racial inequality. “

Katz points to the creation of a hospital in San Francisco in the 1880s to separately treat patients of Chinese descent. Outside of health care, he talks about environmental racism between neighborhoods with inequalities in hospitals, schools and social services.

“All of these things have an impact on this minority person,” Katz says. “The great thing we can all do is stop trying to question each other’s opinions and move to a place where we look at the policies of our institutions and make sure they promote equality. “

Livingston concludes the episode by re-insisting that “racism” should be taken out of the conversation and instead focus on the “structural” aspect of socio-economics.

“Minorities … are not [in those neighborhoods] because they are not allowed to buy houses or because they cannot find a job because they are black or Hispanic. It would be illegal, ”says Livingston. “But the disproportion exists.”

On Twitter, doctors and health professionals commented on the podcast, often dismayed that the episode was allowed to unfold and presented an inadequate approach to discussing structural racism in medicine, especially from leading medical journal editors.

“Why name your episode structural racism if you don’t get it right or believe it, despite the evidence?” Tamara Saint-Surin, MD, assistant professor at the University of North Carolina at Chapel Hill, written on twitter Wednesday.

Social media users have pointed to other researchers and experts who may provide a nuanced and complex view of the ways structural racism affects American patients. Thursday morning, Saint-Surin clarified that the podcast episode was still available.

“I’m confused,” she wrote. “Why did @JAMA_current re-share 3 articles from last year regarding health inequalities and racial injustice in the last HOUR… but they haven’t addressed their ridiculous podcast episode yet?” “

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