乌鸦传媒

A episode billed as "structural racism for skeptics" hit all the wrong notes with Black physicians and people of color on Twitter.

"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," said podcast host Ed Livingston, JAMA's deputy editor for clinical reviews and education, in introducing the topic.

The rest of his discussion with Mitchell Katz, MD, an editor at JAMA Internal Medicine and president and CEO of NYC Health + Hospitals in New York City, didn't go much better.

Among the problematic features were Livingston's repeated protestation that the term racism is hurting the effort against structural racism.

"Structural racism is an unfortunate term," he said. "Personally, I think taking racism out of the conversation will help. Many of us are offended by the concept that we are racist."

A postgraduate year 3 internal medicine resident who goes by ShirlyWhirlMD on Twitter broke down several of the other issues with the podcast in a thread .

Then in promoting the podcast on Twitter, JAMA had "No physician is racist, so how can there be structural racism in health care?"

Altogether, the podcast and tweet were actually "a demonstration of structural & institutional racism. I am furious," Aletha Maybank, MD, MPH, chief health equity officer of the American Medical Association (AMA).

She pointed out that JAMA has complete editorial independence from her association, which does not review the podcasts, but acknowledged that the "absolutely appalling" podcast would .

AMA put out a Thursday noting that it just last month confessed to having made decisions that in the past.

CEO James L. Madara, MD, said in the statement that the organization was "deeply disturbed -- and angered" by the podcast and tweet that questioned the existence of structural racism. "Structural racism in health care and our society exists and it is incumbent on all of us to fix it," he said. He reiterated, however, that the JAMA journals are editorially independent from the AMA.

JAMA Editor in Chief Howard Bauchner, MD, put out a released Thursday afternoon on the journal's Twitter account saying:

"The language of the tweet, as well as portions of the podcast, do not reflect my commitment as an editorial leader of JAMA and JAMA Network to call out and discuss the adverse effects of injustice, inequity, and racism in medicine and society as JAMA has done for many years. I take responsibility for these lapses and sincerely apologize for both the lapses and the harm caused by both the tweet and some aspects of the podcast. JAMA will schedule a podcast(s) in the future to further discuss issues of structural racism and health, and to address concerns raised about the podcast."

Of course, not everyone was satisfied with that as a sufficient solution.

Among those calling for more accountability was Nancy Baxter, MD, PhD, of Australia's Melbourne School of Population and Global Health. "Think about how the make up and beliefs of your editorial board influences the manuscripts you publish. Your editorial board members are so unaware of structural racism and sexism that they actually thought this podcast was OK. Your editorial board needs a serious overhaul," she .

Ruth Carlos, MD, editor in chief of the Journal of the American College of Radiology, JAMA: "At @JACRJournal we take a different view that acknowledges our own intrinsic bias and work (our own and our institution's) to overcome this," linking to its article

Update March 11: Livingston, host of the podcast, has resigned at Bauchner's request. The AMA also announced that the JAMA Network removed the podcast and is doing an "end-to-end review of all editorial processes at JAMA Network, from creation to publication and dissemination of all content, including multimedia and social media engagement." It said JAMA would hire an associate editor with expertise in racism and specifically structural racism in healthcare.

Comment