番茄社区

The American Medical Association (AMA) needs to work harder to help rid the medical profession of racism, several AMA members said at a special meeting of the AMA's House of Delegates.

"Numerous publications have demonstrated how racism affects housing, education, healthcare, criminal justice, and more," said Anna Heffron, a medical student from Wisconsin, speaking on behalf of the Medical Student Section at a meeting of the AMA's Reference Committee on Amendments to Constitution and Bylaws. "The Board of Trustees has noted that it's vital that medicine play a critical role in eliminating racism, but the AMA only has two policies using the word 'racism.'"

Heffron was speaking in support of a resolution authored by the Medical Student Section that calls for the AMA to "recognize racism, in its systemic, cultural, interpersonal, and other forms, as a serious threat to public health" and to "identify a set of current best practices for healthcare institutions, physician practices, and academic medical centers to recognize, address, and mitigate the effects of racism on patients, providers, and populations."

Support for the Resolution

"I support this wholeheartedly," said Alan Klitzke, MD, of Buffalo, New York, a delegate for the American College of Nuclear Medicine who was speaking for himself and the Section Council on Radiology. "I hear people say that the time for racism should be past, but racism and bias exist ... It is the duty of us as professionals and leaders in medicine to recognize this and create structural mechanisms to eliminate divisive and demoralizing practices. Racism is a public health threat that we must recognize and combat."

Stephen Taylor, MD, a delegate from the American Society of Addiction Medicine who was speaking for himself, also praised the resolution "as someone who has to think twice when a police officer stops me when I'm driving my car, and recognizes that I'm at a real risk any time I go anywhere because of the way I look," said Taylor, who is African American. "People in the community I serve suffer similar aggressions ... I strongly support this action."

While the vast majority of speakers at the reference committee were in favor of the resolution, there were a few critics. The Louisiana delegation recommended removal of the first two parts of the resolution -- which acknowledge that racist healthcare practices have harmed marginalized communities and that racism is a serious threat to public health -- "in order to focus the resolution on the action items" that would be left, said Jeff White, MD, of Shreveport, Louisiana, representing the delegation.

The remaining parts of the resolution recommending specific actions "can be approved and actualized without the debate that may be engendered by the first two resolves." The delegation also objected to the resolution's call for the AMA to "support the development of policy to combat racism and its effects," calling it "very expansive" and recommending its removal.

The Florida delegation initially objected to part of the resolution referring to "historic and racist medical practices." "I've been in practice or medical school for 35 years ... I don't know what a racist medical practice is," said Corey Howard, MD, speaking for the Florida delegation. But the delegation removed its objection once the language was changed to refer to "racism and unconscious bias within medical research and health care delivery."

James Hay, MD, a physician from Del Mar, California speaking for the PacWest delegation, said the resolution wasn't strong enough. The delegation called for part of the report to be referred back for further study "because it's so important and applies to so many things ... They can come back not only with things to educate ourselves and our patients but also with an action plan." Luis Seija, MD, from New York City, speaking on behalf of the Minority Affairs Section, panned that idea. "Calls for referral due to concern for unintended consequences or further study ring hollow," he said. "It's time for our AMA to recognize that Black lives matter."

Removing "Racial Essentialism"

Delegates were also very supportive of a resolution from the Minority Affairs Section calling for the elimination from medicine of "racial essentialism" -- the idea of a "genetic or biological essence that defines all members of a racial category." Brandi Ring, MD, of Denver, Colorado, a delegate for the American College of Obstetricians and Gynecologists (ACOG), called the resolution's language "fantastic."

"ACOG commits to promoting everything we do to incorporate anti-racism and to address institutional racism," she said. "We would love to work with the AMA on this issue and hope this passes and starts to change the tide against racism in this country."

Ronald Dunlap, MD, of Weymouth, Massachusetts, speaking for the New England delegation, noted that the COVID-19 pandemic "exposed healthcare disparities and therefore differences in outcomes, and created the impression that the disparity is due to race, rather than race driving the social determinants of health" that are the real causes of disparity. "These are not genetic differences, but socioeconomic and social differences," he said. I strongly support this resolution and efforts should be made so we can distinguish these differences going forward."

The Louisiana delegation was once again the outlier recommending that the first three parts of the resolution and leave in only the parts dealing with improving treatment algorithms that use race as a factor. Although the other parts of the resolution are of "significant concern," they are "not definitively proved," said White. "They do have some support in evidence but to base broad-based AMA on it at this point is not beneficial."

A third resolution in this area called for the "elimination of race as a proxy for ancestry, genetics, and biology in medical education, research, and clinical practice." Again, it received strong support. "In conflating biology with race, we continue to do demonstrable harm to patients," said Titus Hou, a medical student from Rockford, Illinois, speaking for the Medical Student Section. "Physicians need to be upgrading their language to be more precise in defining our patients' symptomatology."

Ricardo Correa, MD, a delegate for the international medical graduates section, noted that the United States Medical Licensing Examination has eliminated race from its case presentations: "They don't start with phrases such as 'a 37-year-old African-American person' ... This is the right time to do it."

Universal Immunization for Physicians

Delegates also discussed a report from the AMA's Committee on Ethical and Judicial Affairs regarding universal immunization of physicians. The report recommended changing language in current AMA policy -- which currently states that physicians should be immunized unless they have a medical, philosophical, or religious reason not to be -- to state that physicians should "accept immunization absent a recognized medical contraindication or when a specific vaccine would pose a significant risk to the physician's patients."

Michael Redinger, an alternate delegate from Kalamazoo, Michigan, speaking for himself, disagreed with the report's conclusions. "I'm well aware of the ways in which broad philosophical and religious exemptions have been abused by the anti-vaccine community based on pseudo-science to avoid compulsory immunization," he said. "It's a mistake, however, to assume there are no valid religious and philosophical exemptions to certain vaccinations; in fact, there are."

"As one example, those opposed to abortion have significant concerns regarding some vaccines because their development or manufacture utilized cell lines or tissues derived from aborted fetuses," he said. "The modifications proposed violate the religious and philosophical civil liberties of physicians when there are means other than compulsory vaccination which can prevent disease transmission to patients."

Melissa Garretson, MD, of Fort Worth, Texas, speaking for the American Academy of Pediatrics, supported the changes. "As a person who believes wholeheartedly in immunizations, I'm one of the first ones to sign up any time we get a new vaccine," she said. "I have fought anti-vaccination forces who use their platform to say they have religious exemptions, and they use those in ways that are not valid and not true. This is a time when public health has to take precedence over personal preferences and beliefs."

Comment