Aletha Maybank, a physician and activist for racial equality in medicine, joined the American Medical Association in 2019 as its first chief executive officer for health equity.
This work became more urgent as the Covid-19 pandemic revealed deadly inequalities in health care and George Floyd's death brought attention to the widespread nature of systemic racism. The statement by the AMA decried racism as a serious threat to public health. Maybank focused on the AMA's efforts to "dismantle racist, discriminatory practices and policies across all of healthcare." This included training medical workers in implicit bias and advocating for solutions for problems that have not been a priority for the organization such as police violence and housing inequities.
These equity initiatives faced growing opposition from think-tank researchers, doctors, and pundits. They were liberal as well as conservative. They claimed that the medical institution had outsold its mandate to support health care professionals, and instead was adopting a " awake" philosophy. This backlash was becoming increasingly vicious, especially for Maybank.
The AMA published a communication guide last Oct. It listed words and phrases doctors should avoid to not offend certain patient groups. However, threats to Maybank, a Black woman, escalated beyond trolling social media to violence. Maybank claimed that she found a New Yorker had spray-painted a death threat on her New York front door. In an effort to restore her privacy, the AMA employed a security team and scrubbed her internet presence.
Maybank, a doctor and AMA senior vice-president, stated that harassment can be "very scary" when it gets close to home. "But it's just really essential that people know about it -- I am not the only one," Maybank said.
According to Maybank, as well as a dozen academics and doctors who have been involved in this research, the medical establishment has put an unprecedented emphasis on removing barriers to medical care and improving the health outcomes of people of color. These advocates, medical professionals and researchers have faced unprecedented resistance, including lawsuits, attacks on cable news, harassment, and threats to their lives.
This latest criticism is part of the ongoing national furor about the teaching of racial history in America. Sometimes referred to as "critical race theory,", it has led to the expulsion of educators and flooded school boards with legal claims. This is also an extension to the harassment as well as the threats public health officials have dealt with over pandemic mitigation strategies.
Academics and doctors working on anti-racist projects say they are exhausted and anxious, especially after an extremist group demonstrated outside Brigham and Women's Hospital Boston in January. Protesters held signs claiming that the hospital "kills whites" and handed out flyers naming and identifying two doctors who developed a pilot program to improve the outcomes of cardiology for Latino and Black patients.
WGBH reported the protesters were connected to a neo Nazi group. Nearly 150 people took part in an emotional conversation on Twitter's Spaces platform moderated by Dr. Brittani, a Chicago primary care physician and antiracism activist. She opened the conversation by sharing her feelings about the Boston protest.
James stated, "It hit me hard because selfishly, as a Black women in this space, doing these work, how long before my face is on poster? James said, "How long before I'm hunted?"
Faced with this harassment, academics and doctors are asking for more support from their professional organizations and institutions. They are also strategizing how to deal with the trolling and backlash.
Monica McLemore, a University of California, San Francisco nurse and professor of reproductive health, stated that she fully anticipates that things will worsen before they get better. "There will continue harassment, there'll be more backlash and there will be even more unexpected situations. I believe we should be ready for this."
There is a flood of hate mail
For decades, the U.S. has been known to have significant racial and ethnic health disparities. Black, Hispanic and Native American people are more likely to have chronic and life-threatening health conditions, and they're more likely to lack of health insurance."
Researchers also found evidence of racial biases in the way that medical professionals treat patients. In a 2016 study , one fifth of the medical students surveyed thought that Blacks had a greater tolerance for pain than whites. More than half also believed that Blacks had thicker skin than those who were white. A 2019 analysis showed that software used in many hospitals was more likely than to direct healthier Black patients to specialized care programs.
However, there have been limited efforts to address these issues.
"Racism denial in our national landscape is like a dark hole: It's huge, powerful, and you can't even see it but it's one the great barriers," Dr. Camara Jones, an epidemiologist and physician who has long called for public-health scientists to face racism in their work.
Some doctors admit racial disparities in health, but blame larger societal forces such as housing problems or employment conditions. They say it is not the job of medical professionals to address areas where they aren't experts.
Dr. Sally Satel is a psychiatrist and fellow at American Enterprise Institute, an conservative think tank. She said, "To me it's kinda an exploitation of you position in society." "Because doctors have a certain degree of cultural authority. It shouldn't be misused. It shouldn't be used to advance personal politics."
The Covid-19 pandemic, Black Lives Matter protests and the Covid-19 pandemic boosted equity efforts in 2020. Institutions began to confront racial discrimination. With similar statements against racism in medicine, more than 200 cities and states and over 200 health agencies throughout the country have followed the AMA's lead.
Maybank stated that, "We were not only talking about inequities; we were also talking explicitly about racism structural racism and its effect -- words that were so difficult for many Americans even to say."
The Association of American Medical Colleges asked its members "dismantle unconscious bias" and work with local governments and community organizations to "dismantle structure racism and end police brutality". The report by the AMA documents the group's history of discrimination. It includes supporting segregation as well as the Chinese Exclusion Act and taking steps to prevent women and Jewish students from medical schools.
In September 2020, Trump's administration issued a directive banning federal agencies from using diversity training that discusses "white privilege" and critical race theory. This order sparked a culture war. It was often described as being against critical-race theory, an academic concept that suggests that laws and policies imposed on governments and institutions perpetuate racial discrimination.
Jones was about to lead a 13-week training for Centers for Disease Control and Prevention staff on the effects of systemic racism on public and community health. Conservative activists accused the CDC in violation of President Donald Trump's directive after excerpts from Jones' course were leaked . The White House directed that her course be canceled on the following day .
In her inbox, a flood of hate mail arrived. It also targeted a public-health organization that was supposed to honor her later in the week.
Jones stated, "That scared me." Jones said, "That terrified me." Jones continued, "I hid for 2 weeks."
She said, "They don't understand that when they fight for justice we are not anti-white." That is why there is so much confusion. Anti-racism does not discriminate against white people. It is for the good of all.
Others who advocate anti-racism policies have said that trolls commented on photos of their children online and that they received death threats. This forced them to miss work while they worked out safety plans. Due to the constant trolling, some people said that they don't even check their social media anymore.
"It feels as if when we take one step forward, the racists take five," Dr. Stella Safo, a primary HIV care physician and professor at Mount Sinai Hospital's Icahn Medical School in New York, said.
Critical race theory
Contrary to K-12 school administrators who have mostly resisted claims that they are teaching critical race theory in schools, many doctors and researchers explicitly draw on the concept when designing new race-conscious policies. They believe can correct long-standing disparities in health outcomes.
Wispelwey and Morose then created a pilot program at Brigham and Women's Hospital in order to encourage providers to automatically refer Black and Latino patients with heart failure to cardiologists specialists. After a year, they will check to see if the improved equity has resulted to better health outcomes. The program, Healing ARC was inspired by critical race theory.
Wispelwey stated that racism is the root problem.
After the program was made public by Fox News in March 2021, there was immediate backlash from conservative media outlets and Fox News . Wispelwey claimed they were subject to hate mail and threats. This culminated in the neoNazi demonstration that took place outside the hospital in January, during which protesters called the doctors "antiwhite."
Health equity efforts have been criticized by the courts. To address the fact that research showed that Black, American Indian, and Alaskan Native people were hospitalized and later died from Covid-19 at high rates while received monoclonal antibody rates at lower rates, many states recommended to providers that they consider race when deciding who should be given coronavirus treatment.
A political group, founded by Stephen Miller , sued New York State on behalf of a law prof who runs an anticritical race theory website. They claimed that the state's Covid treatment guidelines amounted to racial disparagement. New York has opposed Miller's lawsuit by arguing in court filings it was only providing guidance and that hospitals could not ignore it. Miller also threatened to sue Minnesota, and Utah for similar guidance. However, those states changed their policies to remove race from the equation.
J.P. Leider is a University of Minnesota researcher in health policy who oversaw the state’s tool to determine if Covid patients are eligible for treatment. He said that while political groups might succeed in stopping race-conscious policies, that does not mean they don't exist.
He said that health inequalities are "very real" and "very measurable".
Some doctors have been critical of the use of race-conscious policies in healthcare, claiming that they could interfere with doctor-patient relationships.
"I would like to teach the trainees that each patient is an individual, and what their unique identity and situation are," Dr. Carrie Mendoza, a Chicago-based doctor, said. She leads the medicine chapter of the Foundation Against Intolerance and Racism. "Not lumping them together into a group -- this's kinda dehumanizing."
"This work is more difficult than ever"
McLemore, a UC San Francisco professor, stated that she received at least one death threat per week since writing an op-ed on famous biologists who she criticized for having problematic ideas which contributed to "scientific racist." She said someone contacted her chancellor to get her fired.
She stated that "as long as we are busy responding to all the absurdity, then we're not doing what we're actually paid to do." "And it's a defensive, reactive stance that isn't powerful."
McLemore, along with other doctors and academics working on equity in healthcare, stated that they need to create a digital safety toolkit and call upon their universities and professional organizations to assist with the development of rapid response teams for harassment.
McLemore stated that she started keeping track of hate mail and threats she received to help the campus police. McLemore also took other steps to protect her identity, including setting up public mailboxes and forwarding calls to her phone using Google numbers.
These safety tips are currently being spread through word-of-mouth, leaving many people unprepared.
Morse, a Harvard Medical School instructor and chief medical officer for New York City, stated that "this work is more difficult than ever in some ways." "But, we still have a responsibility to improve, since we've been aware of these racial inequalities for so many years and have not been able to make any progress."