Science: The New England Journal of Medicine kicks off a historical series looking at its troubled past

Articles by doctors and historians will wrestle with the journal’s involvement in perpetuating racism and bias in medicine

In an editorial announcing the series, NEJM editors write that they “recognize that the Journal and other medical institutions have in the past justified and advocated the mistreatment of groups on the basis of their race, ethnicity, religion, sex or gender, and physical or mental conditions.” The editors commissioned independent historians to review the journal’s content and produce a series of articles highlighting biases and injustices that NEJM helped perpetuate. “We hope that in learning from our mistakes, we can prevent new ones,” the editors write.

https://www.science.org/content/art...s-historical-series-looking-its-troubled-past

 

(Great, now do The Lancet)

 

I can see the interest in historical aspects of racial discrimination and their effects health but I also see serious problems with this initiative.

The article has a dialogue with the series editor that ends with these statements

"That’s when we began to see a major focus on the problems with this very notion that Black and white bodies were innately different, and NEJM authors then begin to respond to these serious and increasing critiques of these ideas."

" I am working on another article on racial differences [for the series]. I expect that this work will inform what gets published going forward, and therefore ultimately change medical theory and practice."

It is well established medical science that there are major 'innate differences between Black and white bodies'. It is also telling that the editor capitalises Black but not White. Why should a journalist change medical theory and practice on the basis of a preconception of this sort? Medical theory should be based on fact.

To illustrate what I mean, black Africans have an innate risk of hypertension, certain Indian racial groups have a very high incidence of diabetes and frozen shoulder, Maori men have a very high risk of gout, certain Jewish racial subgroups carry genes for Gaucher's disease and other rare conditions. Just as women are innately differently from men and get breast cancer and more autoimmunity.

Denying all this medical science helps nobody.

In fact the alternative to understanding the innate physical differences between racial groups lands you fair and square in a biopsychosocial mind set, where illness is all due to leading a bad life - whether through bad luck or feebleness.

 

It's just standard usage in the US, I think. It seems a long time since I read a formal publication that didn't use it. To a US audience it might look odd or disrespectful if Black weren't capitalised, which would be a distraction from whatever they're trying to say.

 

I think you’re misunderstanding where they’re coming from. The innate difference they refer to and reject is the scientific racism and eugenics of the 19th and early 20th centuries. It is true that since the demise of scientific racism and eugenics post 1945, some medical differences have been found between racial groups, but these differences are minuscule compared to the vast innate differences proposed by scientific racism.

 

Just to add on - the scientific racism of the early 20th century had huge societal implications. It is obviously very different to propose that some ethnicities are more prone to certain disease than others, rather than to argue that black people must never be given the rights of other groups because their genetics prevent full intelligence and predispose them to criminality. The alternative to scientific racism is acknowledging that racial inequalities in society are neither the product of nor can be justified by genetic inferiority, but are instead borne of history - of societal racism. The scientific differences that have been found between racial groups over the past 70 years thus have completely different implications to scientific racism. They exist in a framework that sees society as the primary force that creates racial inequalities rather than inherent inferiority or difference.

 

Yes, this is standard. Many or most publications capitalize Black when it refers to racial/ethnic issues. White is not capitalized.

 

In the US, "innate differences" was part of the justification for slavery. How many of these were manufactured and not really innate is the subject of Medical Bondage, which tells the early history of gynecology in the US. It's an ugly history and much of it is about controlling enslaved women's fertility, especially after banning the importation of more slaves from abroad.

https://news.berkeley.edu/2020/02/1...odern gynecology,“fix” diseases and disorders.

Or consider the use of different GFR calculations for Black and white Americans with kidney disease. Previously, there were adjusted GFR calculations that downgraded the severity of kidney dysfunction in Black people. Current recommendations are to use the same for everyone, because using a different one for Black Americans means missing diagnoses of early kidney disease and delayed transplant options. You can see how delaying a diagnosis of kidney disease would be a problem for someone with hypertension.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495470/

I'm betting that sort of thing is what the article refers to.

 

The UK Kidney people say something similar about not using race in calculating GFR.

https://ukkidney.org/sites/renal.or...or_implementation_NICE CKD Guideline 2021.pdf

 

I was never aware of any racial correction for GFR throughout my career as a physician. Maybe there has been in the US but sweeping statements from journalists are not helpful in this area in my view.

 

https://www.kidney.org/atoz/content/race-and-egfr-what-controversy

Blacks in the US make up 35% of dialysis patients (13% of general US population) but trail far behind in kidney transplantation rates (referral problem due to racial prejudice in large part, in my experience as a dialysis RN back twenty years ago).

ETA: a more sophisticated analysis:
https://health.ucdavis.edu/blog/lab...disparities-in-chronic-kidney-disease/2021/04