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A Piece of My Mind
July 9, 2020

Eradicating Racial Injustice in Medicine—If Not Now, When?

Author Affiliations
  • 1Department of Urology, University of Michigan, Ann Arbor
JAMA. 2020;324(5):451-452. doi:10.1001/jama.2020.12432

As a child of the early 1980s, growing up in Baltimore, I would often stare at the speckled ceiling of the room my siblings and I shared and wondered why my family had to deal with basic struggles like obtaining food and keeping the heat on, at times warming the house with the oven. During my teenage years, I often questioned why people who grew up in urban America had similar problems, while these issues seemed nonexistent in more affluent areas. When I became an adult interested in pursuing medicine, I volunteered at several health fairs and realized quickly that many of the patients were from communities similar to mine; not infrequently, people I met had not received medical care in years, sometimes decades. These experiences, and others like them, revealed that the issues I would wonder about while staring at the ceiling were only a small portion of the concerns that communities like mine face daily.

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    3 Comments for this article
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    A Symptom Not a Disease
    Victor Cortes Mora, Associate professor | Pontificia Universidad Católica de Chile, School of Medicine
    Dr. Vince, thank you for your inspiring and well-documented reflection. I just want to raise the point that racism in medicine, as well as obesity, diabetes, hypertension, drug addiction, etc, is just a manifestation, a symptom, of a much broader and complex problem. As physicians, we can envision this problem as a disease, more properly, a social disease, that includes as other major symptoms the ecological depredation and uncontrolled materialism. And because this disease is global, we can consider it a pandemic disease. Expanding a little bit your reasoning, if we do fail to conceptualize this disease and make a proper diagnosis, we will necessarily mistake the treatment, and in the case of this lethal disease, the consequences would be catastrophic. The most important cognitive step is the transition from unconscious ignorance to conscious ignorance because it enables us to engage in the necessary research to make the proper diagnoses that this case requires.
    CONFLICT OF INTEREST: None Reported
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    A Solution Requires More Than a Few Good Doctors
    Anthony Morgan, MS, MD | Duke University Medical Center
    Thank you, Dr. Vince, for sharing your personal and professional experience and challenging our profession to address systemic injustice. I am a retired white hospitalist (from Duke and Parkland) who cared for many people in urban settings (Dallas, Durham, and Raleigh) and briefly in a rural setting in Texas. My patients were from many countries, spoke many languages, and had widely different backgrounds. I saw many people suffering from medical maladies related to their social and family resources. Though I honestly believe that all received the best care from me and my colleagues, regardless of their backgrounds, I saw how inequality continued to play out in our dysfunctional healthcare "system," as many were discharged from the hospital without access to adequate medical care in the community. Their chronic medical problems and their social and financial problems were heartbreaking. Almost all the patients and families I saw truly appreciated being treated compassionately and expertly, since many had experienced very different treatment from the healthcare system previously. Medical professionals can make a big difference in the disparities we see in our country, in part by acknowledging and challenging our own biases. But as you rightly point out, this problem is deeply systemic, and a real solution requires action on a national level to provide adequate healthcare to all of our people.
    CONFLICT OF INTEREST: None Reported
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    Safety
    Ben Park, MD | Physician
    In 2019 there were 348 homicides in Baltimore. Where race was known 92% of the homicide victims were Black. Baltimore ranked #2 in the nation with a homicide rate of 51/100,000. Baltimore and many other cities are not meeting the basic safety needs of their citizens.

    The fact that many blacks are the victims of systemic racism by the cities that owe them safety has consequence beyond the violent deaths. The failure to provide safety is hugely stressful on the population. As a physician I know how chronic stress increases stress hormones. Without safety the chronic activation of the
    “fight or flight” system causes hypertension, obesity, diabetes, chronic kidney disease and other related illnesses. These illness are responsible for countless lives lost that dwarf the lives lost to overt violence. These illnesses are more common in African Americans due to the chronic stress caused by a lack of safety. They are also the very illnesses that explain the increased COVID mortality in the black population.

    In Maslov's Hierarchy of Needs, right above food and shelter is safety. Citizens of our cities have a right to expect safety, yet cities are not meeting this basic need for our black citizens. This is a violation of their civil rights.

    The federal government does not have the constitutional authority to impose a solution on these cities. However, it does have the authority and I believe the obligation to hold the leaders accountable when they violate the civil rights of the citizens in their cities.

    We must demand that the Justice Department begin a civil rights investigation into policies that selectively hurt our black citizens. This systemic racism has gone on for too long. It is a public health problem as well as a humanity issue and it must end now.
    CONFLICT OF INTEREST: None Reported
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