AMA statement reckons with medicine's history of racism
The American Medical Association this week released a statement from CEO Dr. James L. Madara acknowledging the organization's history of racism, especially against Black physicians.
"Honest self-examination is a critically important step to better understanding ourselves, to heal old wounds, and to take corrective actions to address ongoing societal harms," said Madara, who also announced that the organization would be removing the bust and display of its commonly recognized founder, Dr. Nathan Davis, from public view at its headquarters in Chicago.
WHY IT MATTERS
Madara's comments followed remarks from past AMA president Dr. Patrice A. Harris this past week about the organization's renewed efforts to confront the root causes of health inequities and strive for a more just medical system.
Harris, the AMA's first Black woman president, pointed to the disparities exacerbated by the COVID-19 crisis, which has disproportionately harmed Black, Latinx and Native people in the United States.
"That is not a genetic issue ... as to the reason that Black and brown people, indigenous people are dying more, hospitalized more," she said. "It's the racism, it's not the race."
Harris, like Madara, noted the AMA's exclusionary history. She cited the group's renewed commitment to "embed health equity into the AMA."
In 2019, the AMA created its Center for Health Equity and hired Dr. Aletha Maybank as its first chief health equity officer, following the adoption of a policy and strategic framework for addressing health equity on a national scale the year before.
Still, "as we grapple with AMA’s 174-year history, we must acknowledge that decisions by AMA leaders contributed to a health care system plagued by inequities and injustices that harmed patients and systemically excluded many from our physician ranks," said Madara.
He specifically pointed to Davis, who served as the organization's president and the founding editor of the Journal of the American Medical Association – and who explicitly excluded Black physicians and women from representation in the AMA House of Delegates.
In addition, Davis blocked the National Medical Society of Washington, D.C., an integrated group of physicians from Howard University and Freedman's Hospital, from admission in 1870.
"This historical fact defines Dr. Davis’ role in blocking integration and promoting and embedding racism in the AMA. Dr. Davis’ role was highly active, not passive, and his choice for a racist direction was pursued with energy and force," wrote Madara.
"The above actions helped maintain the white, male-dominated power structure in American society. Sadly, this would remain AMA policy for nearly a century, until race- and gender-based discrimination was officially outlawed by the Civil Right Act of 1964," he continued.
THE LARGER TREND
Systemic racism in medicine continues to have lasting consequences for patients of color. But as former FCC Commissioner Mignon Clyburn pointed out earlier this week, addressing these inequities will take more than the latest devices or apps.
"We really have to ask ourselves right now – in the development stage, in the design stage, in the marketing stage, in the beta stage – we have to ask ourselves, have we really done all that we should and could to ensure that this [technology] is a game-changer to provide and change outcomes?" Clyburn said.
"Or is it hard-wiring the negative outcomes we've experienced?"
As just one example, experts have pointed to the unequal uptake of telehealth among the U.S. population. Far from being a "panacea," studies show that virtual care continues to both mirror and potentially worsen the digital divide.
ON THE RECORD
"'First, do no harm' is a guiding ethos in medical ethics, reminding us that at its core the art of care and caring for others seeks to reduce and eliminate harms that our patients and communities are experiencing," wrote Madara. "By continuing to examine our long history, our AMA is reaffirming medicine’s commitment to this ethos, and to creating a more just and perfect union for all."
Focus on Health Equity
This month we will be reporting on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.