By Cory Franklin
The Journal of the American Medical Association is one of the most prestigious medical journals in the world, and in a special summer edition several authors announced that systemic racism is a scientific fact beyond dispute. Moreover, disagreeing on this point is “wrong,” “misguided” and “uninformed”.
To make sure physicians know the Journal means business, two top editors were pressured to resign after the AMA ran a podcast that questioned whether systemic racism is a complete explanation for the health disparities between Blacks and other Americans.
“There’s a tremendous amount of groupthink,” said Stanley Goldfarb, a former dean for curriculum at the University of Pennsylvania medical school who, perhaps not coincidentally, retired this summer. “If you don’t agree with all that, you’re a bad person.”
“This is an argument that you’re not allowed to have — that’s the problem here,” said Goldfarb, a former editor-in-chief of a top nephrology journal.
Whatever the role of racism in modern medicine, the stance the Journal has adopted basically removes any effort at scientific inquiry and scientific rigor – a position completely at odds with traditional medical thinking and scientific rigor.
When I read this, my mind drifted back more than 40 years to an unusual little man. He was holed up in a tiny cubbyhole office in Cleveland. When I was a medical research fellow and he was the Professor of Biometry at Case Western Reserve Medical School, he taught me an important lesson (If you don’t know what biometry is, don’t feel bad, neither did I. Biometry was the old-school term for medical statistics.)
His name was Dr. Judah Rosenblatt, medical statistician and prominent researcher and author in his field in the 1960s and 1970s. When I met him in 1980, he must have been about 50. Yet he seemed much older to me.
I had just completed a study and written an abstract showing Black patients in the Case medical clinic were less likely to have private attending physicians compared with white patients. I was really proud of myself, too proud in retrospect, that I had conclusively demonstrated racism in the medical system. My supervisor said, “Well done, but run it by our biometry professor before you submit it to a medical journal.”
When I finally figured out what biometry was, I found his small, dimly lit office in a remote building of the medical complex. He sat there alone, no secretary, flanked by dusty file cabinets. He seemed lonely and looked glad someone stopped in. I got the sense people didn’t visit him very much
I handed him my abstract, expecting him to marvel at my brilliance, but things didn’t go as I planned. Dr. Rosenblatt eyeballed it, then peered over his glasses. And in a high-pitched but matter-of-fact voice said, “Did you control for socioeconomic status?”
I was almost offended. I wasn’t sure exactly what he meant – and how could he question such obvious findings. What he was asking was whether I had looked for another possible explanation for my findings – like whether the patients were rich or poor. I challenged him by asking: What did it matter? Not a smart move on my part.
He was unfazed by the cheekiness of the little snot in front of him. He peered over his glasses again, “Well, we have a lot of upper middle class Black families in the clinic from Shaker Heights. We also have poor ethnic whites from the West Side of Cleveland. Can you say through your findings that Shaker Heights Blacks are less likely to have a private attending than the Parma whites? That would support your theory. But if the Shaker Heights Blacks did have private attendings more often than the whites from Parma, your theory doesn’t hold up.”
I had no answer forthcoming, nothing more than a clueless look on my face. Seeing that he had completely disarmed me, he took an understanding approach and explained,
“Racism may look obvious to a lay observer, and it’s true you cannot completely separate race from socioeconomic status. It’s complicated. I have no doubt that race has something to do with your finding. But it is a common error not to consider socioeconomic status in any analysis of racial effects in medicine, and science demands scientific rigor. I’m very sorry, but tell your supervisor, I can’t approve this abstract until you demonstrate you have taken socioeconomic status into consideration.”
He put special emphasis on the phrase “science demands scientific rigor.”
Duly chastened, I thanked him and walked out with my now useless abstract. There was no time to collect more data, so I just crumpled it up and threw it away before I left the building. When I told my supervisor what happened, he smiled and said, “Yes, Dr. Rosenblatt is a stickler for scientific rigor. That’s why I made you see him.”
Returning to the JAMA special issue, one of those who commented on it was Dr. Thomas Laveist, dean of Tulane University’s School of Public Health & Tropical Medicine, who said:
“We cannot make direct causal inferences. The best we can do is look at plausible causality… what we have is a case where once you’ve ruled out all of the plausible explanations, the only thing left is systemic racism…when the weight of the evidence becomes so overwhelming that we reach consensus, we no longer continue to question whether or not [it is true]. We don’t question gravity anymore because the consensus is that gravity is a thing.”
Yes, we take gravity for granted; everyone knows about Sir Isaac Newton and his apple. But the point is scientists do question gravity -through scientific rigor.
More than 100 years ago, Albert Einstein developed a whole new theory concerning gravity – general relativity. Today our greatest scientists, like the late Stephen Hawking, continue to question the nature of gravity. And the truth is, there is no consensus about exactly what kind of thing gravity is.
Dr. Laveist may not have realized it, but he unwittingly undercut his own argument by using the example of gravity.
I never did publish that work from the Case clinic, but I have no regrets. Throughout my later medical career, I would often notice how medical studies attributed things like emergency room use or surgical complications to racism, while completely ignoring socioeconomic status (and other salient variables).
Occasionally, if it was a presentation at a meeting, I would point out that the author did not consider socioeconomic status. I was usually met with the same kind of clueless look I gave that day in that little office in Cleveland. Today, I think I might encounter a different, more withering look, because to question–as science demands–is now considered wrong, misguided and uninformed.
I never saw Dr. Rosenblatt again. He has been dead for many years. Yet he lives on in my memory – vividly, I might add.
And I am sorry I never really got to thank him for teaching a great lesson scientific rigor, something the medical profession is on the verge of willingly abandoning, if it hasn’t abandoned it already.
Cory Franklin is a doctor who was director of medical intensive care at Cook County Hospital in Chicago for over 25 years. An editorial board contributor to the Chicago Tribune op-ed page, he writes freelance medical and non-medical articles. His work has also appeared in the New York Times, Jerusalem Post, Chicago Sun-Times, New York Post, Guardian, Washington Post and has been excerpted in the New York Review of Books. Cory was also Harrison Ford’s technical adviser and one of the role models for the character Ford played in the 1993 movie, “The Fugitive.” His YouTube podcast Rememberingthepassed has received 900,000 hits to date. He published Chicago Flashbulbs in 2013, Cook County ICU: 30 Years Of Unforgettable Patients And Odd Cases in 2015, and most recently coauthored, A Guide to Writing College Admission Essays: Practical Advice for Students and Parents in 2021.