First African-American woman to lead JAMA | More work to end medical racism

Last June, the editor-in-chief of the Journal of the American Medical Association (JAMA), Howard Bauchner, had to resign due to podcasts and talks challenging structural racism in medicine. Nearly a year later, the influential medical publication has just announced the appointment of its first African-American editor-in-chief, Kirsten Bibbins-Domingo.

Mathieu Perreault
The Press

“I think what happened in JAMA last year is part of the general reassessment of the concept of race in medicine,” says Dr.^D Bibbins-Domingo in interview with The Press. “Yes, we must take into account the obstacles to maintaining health and the difficulties of access to care for racialized groups and other disadvantaged groups. But race must be taken out of screening and treatment decisions. »

Aren’t there genetic traits that are more prevalent in certain racialized groups? “Yes, for example, there are certain blood metabolism problems that are more common among African Americans,” says Dr.^D Bibbins-Domingo. But above all, it must not be used to legitimize the idea that race is a biological category. It is a social categorization. »

These particular genetic traits tend to diminish with the progressive mixing of society, argues Joseph Wright, lead author of a statement from the American Psychological Association published this week calling for the “end of race-based medicine”.

“There may be a few cases where there is still a rationale for using a person’s appearance to determine clinical decisions, but in the vast majority of cases current race-based practices should be abandoned,” said the D^r Wright, who is the vice president of equity for the University of Maryland Medical System.

As examples of improper practices, the D^r Wright cites the idea that African American women are less likely to have a vaginal birth after a C-section, or that African American babies are less likely to have UTIs.

Racialized groups and COVID-19

Since the start of the COVID-19 pandemic, parts of the United States have included racialized groups among patients at increased risk for severe COVID-19 who had priority access to vaccines and drugs like Paxlovid. Should this practice be encouraged?

“Yes, because racialized groups are more often victims of inequalities in treatment and in living conditions”, answers the D^D Bibbins-Domingo, who is an epidemiologist specializing in health inequalities. “That said, there have also been public health decisions that have been unfavorable to racialized groups. »

Some right-wing analysts have argued that lengthy school closures in some cities, attributed to unreasonable union demands, have disadvantaged African Americans and other disadvantaged groups. Is this an example of unfavorable public health policies? “It’s very delicate, says the D^D Bibbins-Domingo. Yes, children who have missed school for a long time have suffered. But the situation in these schools also reflected more difficult access to masks and rapid tests, and the living conditions of teachers in these schools. »

End of a controversy

No African American had ever led the JAMA. Only one woman was editor-in-chief, from 2000 to 2011.

The D^r Bauchner, who had been on the job since 2011, gave two white doctors a podcast in February 2021 questioning the existence of systemic racism in medicine. The podcast was announced on Twitter with a slogan echoing a famous question from Socrates: “No doctor is racist, so how could there be systemic racism in health?” »

In front of the outcry, the D^r Bauchner apologized and participated in an exchange with three African-American specialists on inequalities in medicine. On this occasion, the D.^r Bauchner had aggravated his case with one of his interventions: “Do you realize how heavy the word ‘racism’ is for white people like me? »