June 1, 2021 -- Howard Bauchner, MD, will step down as editor-in-chief of JAMA, the journal of the American Medical Association -- one of the most widely circulated medical journals in the world -- after fallout from a February podcast and tweet about structural racism in medicine.
The announcement comes just days after a group of doctors wrote AMA leadership criticizing a racial equity and justice plan the AMA released last month.
“I remain profoundly disappointed in myself for the lapses that led to the publishing of the tweet and podcast. Although I did not write or even see the tweet, or create the podcast, as editor in chief, I am ultimately responsible for them,” Bauchner said in a statement. “I share and have always supported the AMA’s commitment to dismantling structural racism in the institutions of American medicine, as evident by numerous publications in JAMA on this issue and related subjects, and look forward to personally contributing to that work going forward. To advance equity in medicine, my contributions will be best accomplished in other venues.”
Bauchner had been on administrative leave for several weeks while the incident was under investigation by an independent panel, the AMA said.
The backlash began after a 16-minute JAMA podcast, published Feb. 23, that was billed as an attempt to discuss structural racism in the U.S. health care system.
“No physician is racist, so how can there be structural racism in health care? An explanation of the idea by doctors for doctors in this user-friendly podcast,” JAMA wrote in a now-deleted tweet to promote the episode.
The episode featured host Ed Livingston, MD, who was then the deputy editor for clinical reviews and education at JAMA, and guest Mitchell Katz, MD, the president and CEO for NYC Health + Hospitals, and deputy editor for JAMA Internal Medicine. In the podcast, Livingston, who said he “didn’t understand the concept” of structural racism, suggested that racism was made illegal in the 1960s and that the discussion of “structural racism” should shift away from the term “racism” and focus on socioeconomic status instead.
Critics of the podcast said it was harmful and tone-deaf, and pointed to several discriminatory articles that had been published in JAMA as recently as last summer.
Livingston resigned May 10 as deputy editor of the journal.
The aftermath reached new levels of contention last Friday, when a letter five doctors sent to AMA leadership made its way to Twitter. Carl G. Streed Jr., MD, a fellow in the Division of General Internal Medicine and Primary Care at Brigham and Women's Hospital in Boston, tweeted text of the letter, in which those who signed it called the censuring of Livingston and Bauchner “precipitous, possibly a blot on free speech and possibly also an example of reverse discrimination."
Streed has since deleted the post.
The authors of the letter also criticized the AMA’s strategic plan to address racism, saying “The language in the report uses terminology that is foreign to most of us. This use of unfamiliar multisyllabic terms often leads to misinterpretations and certainly slows reading the report. Rewriting of portions of the document would improve understanding as would the educational modules proposed above. Think Health Literacy!”
The letter goes on to say: “White males are repeatedly characterized [in the AMA plan] as repressive and to some degree, responsible for the inequities. This impressed many as an aggressively broad generalization and implies reverse discrimination against white males.”
Only one person who signed the letter, Claudette Dalton, MD, responded to a request for comment, saying she had “been instructed to refer you to media relations at the AMA.”
The AMA provided a statement that did not address the letter specifically or allegations of “reverse discrimination” from its authors.
“Response to this important plan runs the gamut -- some say it goes too far, and others say not far enough,” said the statement from AMA president Gerald Harmon, MD. “But social inequities and their consequences for families, health care, and our nation’s future are far too great for AMA to be a passive bystander when our mission is to improve the health of the nation. The existence of racism within medicine and society, both historically and present day, is not up for dispute. The only question is how we, as physicians, will lead in confronting the health implications of it.”
Raymond Givens, MD, one of several Black doctors who met with the AMA several weeks ago, called the letter “word salad” and said it illustrates the depth of the problem.
“These are physicians, I'm sure they're pretty bright people,” said Givens, an assistant professor of medicine at Columbia University Medical Center in New York City. “But something happens very often -- that ability to really reason and think in complicated ways seems to completely break down when we talk about issues like these.”
Givens called for more doctors of color to take part in the debate, specifically from the National Medical Association, which advocates for doctors and patients of African descent. They have not responded to his outreach, though, and did not return emails from WebMD.
But there was one point of agreement between those who signed the letter and Givens.
“Yes, I disagree with much of what I read, but I would welcome a chance to talk to these folks if there were the possibility to get beyond soundbites and prepacked ideas,” he says. “They talked about wanting to debate and discuss it in the [AMA] House of Delegates. That sounds like a great idea.”