Humanity in Medicine: Relic or Right?

Racism and sexism are alive and well in medicine.

It was about two weeks ago, February 12, 2019 to be exact, when Neurology (the official journal of the American Academy of Neurology) published an article that caused what some would call a stir. This also happened to be the week that Valentine's Day fell on. Like so many other holidays usurped by corporations, Valentine's Day is often forcibly thrust upon us, even in academic circles. So it is unsurprising that many among us may have expected our inboxes and notifications to be filled with lighthearted content to this end, for example an editorial filled to the brim with cardiology puns. Or maybe an article about the chemical and neurologic changes that occur when a person falls in love. Predictable and light-hearted, but appropriate. What none of us were expecting, save for the individuals who wrote, edited and published the piece, was the dizzying reminder of the racist history, misogynistic  leanings, and toxic superficiality, that still plagues many of our “trusted” institutions.

Dr. William W. Campbell is a neurologist who submitted and published the piece called “Lucky and the Root Doctor.” The article has since been redacted. If you were to click on the article link, you would be redirected to another page with a short explanation and apology. The apology from the journal Neurology states:

“Lucky and the Root Doctor,” a Reflections piece.  Articles within our Humanities section of  Neurology® seek to edify; this article did not achieve that goal, and should not have been published.  We sincerely apologize for our error. This story, a recollection by a doctor of a former patient, contains racist characterizations.  This has prompted a re-evaluation of our peer review process for humanities articles, and we are re-doubling our efforts to make sure such material is never published again.

While the retraction and apology are certainly pertinent, one has to wonder how something like that could be published in the first place. There is a tone deafness that seems to have afflicted the writer of the piece as well as all those who gave it approval for publishing...in an academic journal. Who exactly were these peer reviewers and editors? I ask this not for the purpose of making them targets, but rather to point to why and how something like this was allowed to happen.

Representation matters. Both when thinking about your content and your audience. Dr.Campbell, a white neurologist raised in the southern United States, made a statement in response to the retraction:

It is unfortunate that sensibilities in our society now create an inability to transcend cultural barriers by telling true stories.

The sensibilities he is referring to include his readers reaction to his use of the word 'roly-poly' to describe a large woman. It appears that he is equally baffled as why readers would be offended by the following description:  

His wife's abundant rolls of fat jiggled as she giggled.

 and this one:

I once shared a table at a fried chicken fast food establishment with a nice African American lady. Immensely enjoying her fries, she sat with the shaker in one chubby fist and liberally salted each individual fry.

It seems what Dr. Campbell and his editors could not grasp, others quickly recognized. One reader on social media commented:

I just read this, and am astounded by it. As someone raised in the South for the majority of his youth and early adulthood, I recognize the “sweet condescension” of a white male trying to “humorize” the sociocultural experience of poor African-Americans. The purpose of this article eludes me…

Another commented:

Cringe-inducing. It’s like they dusted their archives from the 1950s and thought it would be neat to publish it. Unfortunately this was written in 2019…

Despite this unfortunate event, I cannot say that all white male baby boomers are as insensitive in how they "transcend cultural barriers." In fact, I've spoken to a few that were also horrified by the piece and its subsequent publication. What I can say, however, is that this embarrassing event (and events like it) likely took place because of a lack of diversity in medicine generally, and on the  Neurology  humanities peer review board specifically.This diversity includes that of race and gender. You may have noticed that the apology issued by Neurology mentioned nothing about the editorials crass and sophomoric characterization of women.  

When the racist lens is so obvious, it is not surprising that people of color question the motivations of gestures like Black History Month. There are some that feel maligned that Valentine's Day shares a month with Black History Month (in the U.S. anyway). I do not. While love is not synonymous with respect and equality, between them there exists an important conceptual and practical overlap. Somewhere within the intersection of these concepts is the notion of working in the other person's best interest and preserving their dignity. Among other things, Black History Month endeavors to remind us that the history of the U.S. is deeply steeped in the unlawful and systematic disenfranchisement of persons of African descent. Therefore, acting very much against their interests. The U.S. is not unique in this regard. Respect and equality is not something that comes naturally to nor easily enforced within large institutions, be it governmental, commercial or academic settings.  

Combatting this type of inequity requires an ongoing and layered approach. One way we can encourage the representation and dignity of minorities, is by ensuring that minorities are in leadership and decision-making roles. One commenter shared this sentiment:

This is why we need diversity in medicine! I just gave a grand rounds in neurology in gender bias and focused on their specialty—neurology is one of the worst in terms of diversity—they have had ONE female president of AAN since 1948 and surely the majority if not all have been white.

The medical field is not immune to racism. I recall an incident earlier in the year where it surfaced that in 1984 medical school administrators at Eastern Virginia Medical School allowed students (among those students the current Virginia Governor Ralph Northam) to wear KKK garb and blackface in photographs published in the medical school yearbook. Many blamed the lack of diversity within the student body and medical school administration at the time. As is the case for many professional spaces, women and people of color are underrepresented.  The deficit is made even more apparent when we look at positions of authority. This criticism cannot be reserved solely for the medical field though, many U.S. institutions continue to have issues addressing sexism and racism. This likely comes as a surprise to few: I struggle to think of one nation that does not suffer from this social affliction. 

Currently, we find ourselves at a time when government officials, media outlets, and public figures shamelessly use race and gender to divide the masses. It is imperative that physicians and others in positions of authority make efforts to prevent events that play into this toxic narrative. While we are all unique, one universal truth is that our identities and our interactions with others are informed by the societies and spaces in which we live. 

Naturally, all of these spheres have a history and subtext of their own. Since the end of the 19th century, African Americans have matriculated and graduated from American medical schools. They were restricted to serving mainly in their own communities, and little was done by the white establishment to acknowledge their presence or accomplishments in the medical field. Women have endured a similar struggle. 

No one person can be expected to be cognizant of the intersections of all these variables, however, knowledge and awareness is not enough: it must be actionable, not merely symbolic.

 The piece offered by Neurology was plainly sexist and racist. As one commenter aptly noted, it is reminiscent of publications from the 1950s: reinforcing and rekindling the legacy of Jim Crow, ignoring the dignity of women and infantilizing of the ill and infirm. Although one misguided individual can be forgiven, precisely how an entire editorial board approved such a publication is worrying. It begs the question of who is on the board, and whether they are truly capable of providing nuanced oversight on the variety of content that comes before them. Is it possible that the editorial board lacks the diversity in race and gender necessary to do so in this ever-changing landscape?

It is perhaps unfair to expect perfection in anticipating every single misstep of this nature. Mistakes happen, after all. What is unforgivable is the persistent refusal and resistance to make the changes necessary to avoid these unnecessary and harmful blunders. Given the breadth of the audience, and the pieces subsequent notoriety, one can only hope that going forward, the journal Neurology does its part in assuring its content is reflective of its diverse audience.