February 17, 2021

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s a Black woman, practicing physician and medical educator I can tell you unequivocally that the racism of my fellow doctors, researchers and other health professionals is killing Black people like me – and has been for a long time.

We Took an Oath

For those who are not in Medicine, you should know that when each physician graduation from medical school, before any of us can accept our Medical Degree (MD), we take an Oath. With our hands over our hearts, in front of our colleagues, mentors, faculty, friends and family, we swear to uphold a series of professional ethical standards. While the Hippocratic Oath has been written and rewritten over the centuries to suit the values of different cultures, most versions include the charge of primum non nocere – translated to mean “First do no harm”.

By failing to recognize and address the racism in our field and in ourselves, we as physicians and medical scientists are failing to uphold one of the foundational charges of our profession. We are contributing to the destruction of the very people we are charged to heal.

The Myth of Scientific Neutrality

While Medicine positions itself as an objective field above the messy fray of personal bias, the simple fact is that racism silently colors the vast majority of current medical thought, policy, and educational endeavors. The reason for this is as simple to understand as it is difficult to correct; especially when the myth of our own unerring objectivity is held up by us physicians and other health scientists as one of the defining characteristic of our profession.

As much as we love to (misguidedly) envision ourselves as benevolent and infallible healers, we physicians are in fact, human beings. The reality is that scientific “truth” is indelibly shaped by the biases of the people who are creating it. Since we as physicians and scientists do not routinely examine our own subconscious racist belief systems, it is inevitable that that racism will shape the problems we are able to perceive and the solutions we imagine.

Simply put, if you put bias in, you get bias out. If you put unexamined racism in, that’s what you’ll get out too. It follows then that if physicians and other medical professionals do not work to first accept that they hold racist beliefs – which we all do if we are not actively doing the work of challenging them – everything they do as a physician will be biased by racism. That includes the research they create, the medical students and trainees they teach, the patient care they deliver. That is exactly why it is incumbent on all of us who take our oath seriously to become antiracists.

As Professor of History, Ibram X. Kendi reminds us in his seminal work “How to Be an Antiracist“:

“[T]here is no neutrality in the racism struggle…One either allows racial inequities to persevere, as a racist, or confronts racial inequities, as an antiracist. There is not in between safe space of ‘not racist.’ The claim of ‘not racist’ neutrality is a mask for racism.” -Ibram X. Kendi, “How to Be an Antiracist” (2019)

Physicians must realize that there is no such thing as being “not racist”.

The belief that this is possible is just as much a myth as the myth of our own universal objectiveness.

Biological Racism as the Current Standard in Medicine

The belief in biological racial differences is a racist belief held by the overwhelming majority of the medical community today. This remains true despite the overwhelming evidence that there is no genetic or other biological basis of race. The Human Genome Project, a 13-year-long, collaborative, international research effort to sequence the entire human genome should have put this debate to rest. Started in 1984 and declared complete on April 14, 2003, this landmark project identified all of the approximately 20,500 genes in the human DNA. In June 2000, during the announcement of the working draft of the human genome, leading scientists on the project, Francis Collins and Craig Venter, declared in clear terms the lack of the scientific or genetic basis of race. Despite this proclamation, and similar ones by other leading scientists of the time, biological racist understanding of health and disease continues to be mainstream.

As Dorthy Roberts, an acclaimed scholar of race, gender and the law at the University of Pennsylvania, reminds us in “Fatal Invention” her pivotal book critiquing the “biopolitics of race:

“Every modern era has had a science of race…Science is the most effective tool for giving claims about human difference the stamp of legitimacy. And once scientists [are] committed to understanding human beings as divided into races, they believed that human biology could not be studied without attention to race”. Dorthy Robets, “Fatal Invention” (2011)

Even now, the most preeminent and well-respected medical institutions and scientific journals of our time espouse racist doctrine with alarming regularly. Widely accepted, yet fundamentally racist concepts, research, diagnostic tools and treatments are rampant.

Examples include:

1. JNC-8’s Hypertension guidelines

The Eighth Join National Committee (JNC-8)’s guidelines for diagnosis and treatment of hypertension differentiates treatments by race, The JNC-8 guidelines and much of the primarily literature on which it is based, is racist. The JNC-8 is the current standard by which physicians diagnosis and treat hypertension in the United States.

2. Measures of Lung Function (PFTs)

The automatic and ubiquitous race “correction” in spirometry , a tool Pulmonoglogists regularly utilize to quantify lung health is problematic. The unspoken assertion here is that races differ innately in the capacity and function of their lungs – which is, of course, deeply racist.

3. Measures of Kidney Function (GFR)

Estimated glomerular filtration rate (eGFR), a widely utilized measure of kidney function among physicians and researchers, is based on the flawed and racist assumption dating back to the formula’s creation that Black people have higher muscle mass on average, leading to higher kidney function. This calculation is central to the ordering of the kidney transplant waitlist in such a way that it makes it harder for Black people to get a new kidney when they need one.

Racism, Not “Race”

Physicians and other medical professionals are quick to suggest, both explicit and implicitly, that a person’s race puts them at elevated risk for disease. This stance implies a biological and genetic basis of racial difference that is not only innacurate, but dangerous. Indeed, this belief must be understood and addressed as the racist assertion that it is. The actual risk factor for worse disease outcomes is not race – it’s racism.

For example, Blackness is not a risk factor for hypertension or diabetes for example; racism is. Put another way, racism, which leads to sociopolitically manufactured food deserts, decreased access to healthcare and chronic stress as examples, is the leading force which creates racial disparities in health. Importantly, views of race that focus on biology can and do divert attention from the important sociopolitical origins of racial disparities in health.

The fact of the matter is that Medicine is not currently equipped with the tools to disrupt these disparities in a meaningful way. As long as our racism blinds us to the true etiology of the racial differences in health outcomes, the cure will continue to evade us.

A Call for a New Antiracist Standard in Medicine

As physicians, we think of ourselves as healers. However, the uncomfortable truth is that, because of our largely unexamined and unchecked racism, we are killing minorities through our action and inaction every single day. In doing so, we continue to break the sacred oath we took the day we became physicians.

We break our oath when we proclaim, without critical interrogation, that we are objective, rational and free of racist belief systems.

We break our oath when we gaslight our minority students and trainees regarding the racial trauma our medical education system inflicts on them.

We break our oath when we refuse to confront and seek to ameliorate our past and ongoing legacy of racial abuses in research and patient care.

We break our oath when we refuse to seek out the expertise of our colleagues from other disciplines including History, Sociology and Law to ground our education, research and patient care.

We physicians and other healthcare professionals must face the hard reality of our complicity, complacency and active participation in the ongoing racial violence being visited upon Black people, Indigenous people and People of Color (BIPOC). But it doesn’t have to be this way.

We can and must instead choose to become accountable, thoughtful and, most importantly antiracist in order to create meaningful change in our field. It is not enough to consider ourselves “not racist”. We must instead committee ourselves to the lifelong work of becoming healthcare antiracist. We must either do this, or continue to break our social contracts as physicians. We must do it because the lives of those under our charge hang in the balance of our choice whether or not to remain silent in the face of racism. We must do it because it is right.

After all – we took an oath that we would.

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