June 5, 2021 by Fred Gardner     Dr. Howard Bauchner the longtime editor-in-chief of the Journal of the American Medical Association, has agreed to resign after a JAMA podcast and the tweet publicizing it denied the reality of structural and individual racism within the profession. Changes in the journal and in the field itself are coming, according to an account by Apoorva Mandavilli in the New York Times June 2, but whether they amount to more than superficial amelioration remains to be seen. 

In the Feb. 24 podcast that touched off the long-delayed reckoning, JAMA’s deputy editor Dr. Edward Livingston, who is white, said “‘Structural racism’ is an unfortunate term. Personally, I think taking racism out of the conversation will help. Many people like myself are offended by the implication that we are somehow racist.”

A Twitter message from JAMA publicizing the podcast had posed a moronic question based on an obviously false premise: “No physician is racist, so how can there be structural racism in healthcare?”

Both the promotional tweet and the podcast itself drew immediate complaints, but it took a week for Bauchner to retract, apologize, and promise in a statement that “We are instituting changes that will address and prevent such failures from happening again.” On March 25 the editor-in-chief went on administrative leave; his retirement will take effect June 30. 

AMA leaders have proposed “a three-year plan to ‘dismantle structural racism'” that is being hailed by many physicians as “a step in the right direction.” According to the Times, some 9,000 members have signed a petition “calling on JAMA to restructure it staff and hold a series of town hall conversations about racism in Medicine.”   

Dr. Raymond Givens NYT photo by Nathan Bajar

These vague demands don’t impress Dr. Raymond Givens, a Columbia University cardiologist who is Black. Givens had written Bauchner last fall to point out that “editors at the JAMA journals were overwhelmingly white and male.” Also, that “in the entire history of all the JAMA network journals, there’s only been one non-white editor.” The editor-in-chief never responded, Givens told the Times. But his resignation, “is not a cause to celebrate.

“Looking for a just a person of color misses the point,” Givens added. “I am more interested in a bold voice. I want somebody who’s willing to take a stand, push to move things forward.” 

In other words, better a melatonin-deficient reformer who means business than an opportunist of color. 

Chairing the search committee for Bauchner’s successor will be Dr. Otis Brawley, an African- American professor of oncology and epidemiology at Johns Hopkins. Brawley has previously headed search committees for the editor-in-chief of Cancer. 

The SCC’s Interaction With JAMA

New members of the Society of Cannabis Clinicians probably don’t know, and old members might not recall, that the experience of having a letter published in JAMA left us —SCC Board President Steve Robinson, MD, past President Jeffrey Hergenrather, MD, and yours truly— surprised by the journal’s shoddy editorial standards. We had caught a powerful medical bureaucrat in a lie and JAMA let him defend himself in print with another lie. 

In its December 13  2016 issue, JAMA published our letter exposing duplicity on the part of Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards. Unfortunately, the editors had chosen to show our letter to Chaudhry  —a special courtesy— and published his deceitful reply in the same issue. 

Our letter had been written in response to a “Viewpoint” op-ed by Chaudhry entitled “Medical Board Expectations for Physicians Recommending Marijuana.” In it he laid out “model guidelines” that the Federation was urging its members to adopt. In our letter we objected to the FSMB proposing that state med boards should:

•  Trigger investigations of cannabis clinicians based on how many patients they approve, how many plants they authorize patients to grow, and the percentage of patients under age 30 for whom they issue approvals.

• Constrain cannabis clinicians from using cannabis as medicine themselves.

• Prevent cannabis clinicians from conducting research in concert with dispensaries.

Replying in JAMA, Dr. Chaudhry addressed only that third point. He wrote:

“The FSMB model guidelines do not prohibit and are not meant to impede physician association with dispensaries for research purposes. The policy states: ‘A physician who recommends marijuana should not have a professional office located at a dispensary or cultivation center or receive financial compensation from or hold a financial interest in a dispensary or cultivation center. Nor should the physician be a director, officer, member, incorporator, agent, employee, or retailer of a dispensary or cultivation center.’”

Which sounds very reasonable— because Chaudhry simply omitted his own concluding sentence:  “The physician should not be associated in any way with a dispensary or cultivation center.” 

If the editors at JAMA had checked Chaudhry’s original “Viewpoint” piece,  they would have caught the very significant and very obvious lie of omission in his letter. Instead, they let him get away with another one.

No Structural Racism in US Medicine?

While JAMA was making plans for a three-year conversation on the subject, two blatant examples of systemic racism in Medicine were making headlines. In Example A, the National Football League took the hit —“NFL says it will end controversial ‘race norming’ in concussion settlement with players,”  is how the headline in the Washington Post framed the story— but it was a tenet of Neurophysiology that enabled the team owners to chisel the Black athletes who suffered impairment while in their employ.

According to the Post story by Will Hobson, “The use of race norms in the NFL’s concussion settlement payouts first came to light last August, when two former players accused the league in a lawsuit of discriminating against hundreds — and potentially thousands — of Black former players. Najeh Davenport and Kevin Henry alleged that race-norming prevented them from getting settlement payouts. In Davenport’s case, he claimed that a doctor initially diagnosed him with dementia, but the NFL appealed and demanded his test scores get curved using race-normed data, which resulted in a reversal of the diagnosis.” (NFL means the billionaire team owners)

The NFL is now in damage-control mode. Their flack, Brian McCarthy, says “Everyone agrees race-based norms should be replaced.” The owners are waiting on medical “experts” to come up with “replacement norms” that will be applied “prospectively and retrospectively.” 

Some 70% of retired NFL players are African American… More than 2,000 retirees have filed brain-damage claims, but fewer than 600 have received awards… And of course there’s a cannabis angle to the story.

Example B warranted a headline on the front page of the New York Times: “How a Genetic Trait in Black People Can Give the Police Cover.”  Research by Michael LaForgia and Jennifer Valentino-DeVries uncovered some 47 “instances over the past 25 years in which medical examiners, law enforcement officials or defenders of accused officers pointed to the trait as a cause or major factor in deaths of Black people in custody. Fifteen such deaths have occurred since 2015…

“As recently as August, lawyers for Derek Chauvin, the Minneapolis police officer convicted last month of murdering George Floyd, invoked sickle cell trait in an unsuccessful motion to dismiss the case against him, saying that the condition, along with other health problems and drug use, was the reason Mr. Floyd had died.”

The reporters seemed shocked by “How willing some American pathologists have been to rule in-custody deaths of Black people accidents or natural occurrences caused by sickle cell trait, which is carried by one in 13 Black Americans and is almost always benign.” They added helpfully, “Those with the trait have only one of the two genes required for full-blown sickle cell disease, a painful and sometimes life-threatening condition that can deform red blood cells into crescent shapes that stick together and block blood flow.”

For years drug companies have claimed that effective treatments for sickle cell disease are imminent; but they have yet to reach the market. Some six years ago Donald Abrams, MD, was involved in a clinical trial of cannabis, but—as reported here— he had trouble recruiting patients because so many African Americans in the Bay Area already knew that the herb was effective and didn’t want to risk being given a placebo in their time of crisis. The trial eventually did get conducted with 23 patients. Last summer  “Effect of Inhaled Cannabis for Pain in Adults With Sickle Cell Disease” was published on JAMA Open Network.