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Leading American Medical Journal Continues To Omit Black Research, Reinforcing A Legacy Of Racism In Medical Knowledge

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Medical research is one of the keys in providing health care. SJ Objio for Unsplash, CC BY-SA

The leading U.S. medical journal, read regularly by doctors of all specialties, systematically ignores an equally reputable and rigorous body of medical research that focuses on Black Americans’ health.

The American Medical Association created a segregated “whites only” environment more than 100 years ago to prohibit Black physicians from joining their ranks. This exclusionary and racist policy prompted the creation in 1895 of the National Medical Association, a professional membership group that supported African American physicians and the patients they served. Today, the NMA represents more than 30,000 medical professionals.

In 2008, the AMA publicly apologized and pledged to right the wrongs that were done through decades of racism within its organization. Yet our research shows that despite that public reckoning 15 years ago, the opinion column of the AMA’s leading medical journal does not reflect the research and editorial contributions by NMA members.

Invisibility in the opinion column of one of the most prominent medical journals in the U.S. is another form of subtle racism that continues to lessen the importance of equitable medical care and health issues for Black and underserved communities.

As rhetoricians and researchers who study scientific communication, we look at the ways scientific writing perpetuates or addresses racial inequity. Our recent study traced how research is referenced by medical professionals and colleagues, known as citations, of flagship journals of the NMA and AMA: the Journal of the National American Association and the Journal of the American Medical Association.

Invisible research

Our research began with a question: Has the AMA’s 2008 apology had any effect on the frequency with which JAMA opinion writers draw on insights and research of JNMA scholars and authors?

We studied opinion columns, also referred to as editorials, precisely because they are useful indicators of current and future research as well as priorities and agendas. The purpose of editorials is to critically analyze and sift through various opinions and evidence. Effective editorials in scientific journals are especially rich forums for debate within the medical community.

Medical publications like JNMA and JAMA do not simply convey knowledge. They also establish professional community values through the topics that are studied and who is credited for ideas related to research. When writers choose to reference or cite another scholar, they are acknowledging and highlighting that expertise.

X-ray of a chest, several ribs, shoulder bone.
Influential medical journals serve to inform and shape health care.
Harlie Raethel for Unsplash

As such, citations play an important role in the visibility of research. Articles and authors with more citations are more likely to have a greater effect on the scientific community and patient care. Opinion pieces can shape the broader conversation among medical professionals, and citations can widen that circle of communication.

Invisible racism

We traced how frequently JAMA and JNMA opinion writers referenced one another from 2008 to 2021 by reviewing the 117 opinion pieces published in JNMA and 1,425 published in JAMA during this 13-year period. We found that JAMA opinion columns have continued to, in effect, uphold racial bias and segregation by ignoring JNMA findings.

A Black medical professional adjusts gloves in front of a mirror.
The work of Black medical proessionals is being overlooked in national medical journals.
Piron Guillaume for Unsplash, CC BY-ND

Even when focusing on race, racism and health disparities, topics that JNMA has explored in great detail, JAMA opinion columns did not reference JNMA colleagues or research. Only two JNMA articles were credited and referenced in the 1,425 JAMA opinion pieces that we reviewed.

Editors at JAMA did not respond to our requests for their comments on our analysis.

Racial equity in medicine

The story of the AMA and NMA is not only a reminder of the racist history of medicine. It demonstrates how the expertise of Black professionals and researchers continues to be ignored today. The lack of JNMA citations in JAMA research undercuts the AMA’s own work on racial equity and potentially compromises the quality of medical knowledge published in its journals.

For example, a recent study in the Proceedings of the National Academy of Sciences found that scientists from underrepresented groups innovate, or contribute novel scientific findings, at a higher rate than those from majority groups.

An article published in the weekly medical journal of the Public Library of Science noted that diverse research teams are often more successful in developing new knowledge to help treat women and underrepresented patients with greater precision.

Dissolving systemic bias

One way to intentionally tackle racial bias and segregation in medical knowledge is by deliberately referencing Black researchers and their work. To change this dynamic of racial bias, medical journals must pay attention to how much and how often the Black medical establishment is referenced. Health issues in underserved communities would likely become more visible and achieve greater quality of care in keeping with the AMA’s commitment to social justice.

Journal editors could tell writers and editorial staff to prioritize citation practices. Individual authors might conduct research and evaluate their reading habits to intentionally include research from the Black medical community.

However, this work must go beyond individuals. Undoing decades of collective habits and embedded racism requires collaborations that work across systems, institutions and disciplines.

One hand holds a bottle of pills and the other hand holds three white pills.
Racial disparities in health care often result in lower-quality medical treatment and worse health care outcomes for Black Americans.
Towfiqu Barbhuiya for Unsplash, CC BY-ND

For example, libraries, databases, and search engines that help researchers find and evaluate medical publications might review today’s research tools. It is hard to contribute to a research conversation if your work is invisible or can’t be found.

Many tools, like impact factors, rank research according to how influential it is. If research begins in a category of less importance, it can be harder for the technology to rank it equitably. JNMA’s work was already marginalized when the tools that rank research were developed.

Thus, search results can hinder efforts of individual authors to work toward equitable citation practices. Black researchers and their research of Black health were excluded from the beginning, and existing systems of sharing knowledge and drawing attention to important studies incorporate that structural racism.

The AMA apology in 2008 and its recent progress on addressing racism in its publication process are promising steps. Influential medical journals serve to inform and shape health care. Who is referenced in these journals matters to the medical establishment, research funders and, ultimately, to the patients that are served by innovations in medicine.

Attention to citation can help reduce systemic bias in medical knowledge to achieve greater fairness in health care and, in the long run, help increase attention and resources that will help solve health issues in underserved communities.

The Conversation

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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TikTok Fears Point To Larger Problem: Poor Media Literacy In The Social Media Age

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Tiktok is not the only social media app to pose the threats it’s been accused of. picture alliance via Getty Images

The U.S. government moved closer to banning the video social media app TikTok after the House of Representatives attached the measure to an emergency spending bill on Apr. 17, 2024. The move could improve the bill’s chances in the Senate, and President Joe Biden has indicated that he will sign the bill if it reaches his desk.

The bill would force ByteDance, the Chinese company that owns TikTok, to either sell its American holdings to a U.S. company or face a ban in the country. The company has said it will fight any effort to force a sale.

The proposed legislation was motivated by a set of national security concerns. For one, ByteDance can be required to assist the Chinese Communist Party in gathering intelligence, according to the Chinese National Intelligence Law. In other words, the data TikTok collects can, in theory, be used by the Chinese government.

Furthermore, TikTok’s popularity in the United States, and the fact that many young people get their news from the platform – one-third of Americans under the age of 30 – turns it into a potent instrument for Chinese political influence.

Indeed, the U.S. Office of the Director of National Intelligence recently claimed that TikTok accounts run by a Chinese propaganda arm of the government targeted candidates from both political parties during the U.S. midterm election cycle in 2022, and the Chinese Communist Party might attempt to influence the U.S. elections in 2024 in order to sideline critics of China and magnify U.S. social divisions.

To these worries, proponents of the legislation have appended two more arguments: It’s only right to curtail TikTok because China bans most U.S.-based social media networks from operating there, and there would be nothing new in such a ban, since the U.S. already restricts the foreign ownership of important media networks.

Some of these arguments are stronger than others.

China doesn’t need TikTok to collect data about Americans. The Chinese government can buy all the data it wants from data brokers because the U.S. has no federal data privacy laws to speak of. The fact that China, a country that Americans criticize for its authoritarian practices, bans social media platforms is hardly a reason for the U.S. to do the same.

The debate about banning TikTok tends to miss the larger picture of social media literacy.

I believe the cumulative force of these claims is substantial and the legislation, on balance, is plausible. But banning the app is also a red herring.

In the past few years, my colleagues and I at UMass Boston’s Applied Ethics Center have been studying the impact of AI systems on how people understand themselves. Here’s why I think the recent move against TikTok misses the larger point: Americans’ sources of information have declined in quality and the problem goes beyond any one social media platform.

The deeper problem

Perhaps the most compelling argument for banning TikTok is that the app’s ubiquity and the fact that so many young Americans get their news from it turns it into an effective tool for political influence. But the proposed solution of switching to American ownership of the app ignores an even more fundamental threat.

The deeper problem is not that the Chinese government can easily manipulate content on the app. It is, rather, that people think it is OK to get their news from social media in the first place. In other words, the real national security vulnerability is that people have acquiesced to informing themselves through social media.

Social media is not made to inform people. It is designed to capture consumer attention for the sake of advertisers. With slight variations, that’s the business model of all platforms. That’s why a lot of the content people encounter on social media is violent, divisive and disturbing. Controversial posts that generate strong feelings literally capture users’ notice, hold their gaze for longer, and provide advertisers with improved opportunities to monetize engagement.

There’s an important difference between actively consuming serious, well-vetted information and being manipulated to spend as much time as possible on a platform. The former is the lifeblood of democratic citizenship because being a citizen who participates in political decision-making requires having reliable information on the issues of the day. The latter amounts to letting your attention get hijacked for someone else’s financial gain.

If TikTok is banned, many of its users are likely to migrate to Instagram and YouTube. This would benefit Meta and Google, their parent companies, but it wouldn’t benefit national security. People would still be exposed to as much junk news as before, and experience shows that these social media platforms could be vulnerable to manipulation as well. After all, the Russians primarily used Facebook and Twitter to meddle in the 2016 election.

Media literacy is especially critical in the age of social media.

Media and technology literacy

That Americans have settled on getting their information from outlets that are uninterested in informing them undermines the very requirement of serious political participation, namely educated decision-making. This problem is not going to be solved by restricting access to foreign apps.

Research suggests that it will only be alleviated by inculcating media and technology literacy habits from an early age. This involves teaching young people how social media companies make money, how algorithms shape what they see on their phones, and how different types of content affect them psychologically.

My colleagues and I have just launched a pilot program to boost digital media literacy with the Boston Mayor’s Youth Council. We are talking to Boston’s youth leaders about how the technologies they use everyday undermine their privacy, about the role of algorithms in shaping everything from their taste in music to their political sympathies, and about how generative AI is going to influence their ability to think and write clearly and even who they count as friends.

We are planning to present them with evidence about the adverse effects of excessive social media use on their mental health. We are going to talk to them about taking time away from their phones and developing a healthy skepticism towards what they see on social media.

Protecting people’s capacity for critical thinking is a challenge that calls for bipartisan attention. Some of these measures to boost media and technology literacy might not be popular among tech users and tech companies. But I believe they are necessary for raising thoughtful citizens rather than passive social media consumers who have surrendered their attention to commercial and political actors who do not have their interests at heart.

The Conversation

The Applied Ethics Center at UMass Boston receives funding from the Institute for Ethics and Emerging Technologies. Nir Eisikovits serves as the data ethics advisor to Hour25AI, a startup dedicated to reducing digital distractions.

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How Trump Is Using Courtroom Machinations To His Political Advantage

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Former President Donald Trump sits in a New York courtroom as jury selection proceeds in one of his criminal cases. Jabin Botsford/Pool Photo via AP

The second week is wrapping up in former President Donald Trump’s first criminal trial on charges from the state of New York related to paying hush money to an adult film star. So far, the jury has been selected, but no other proceedings have begun.

The Conversation U.S. interviewed Tim Bakken, a former New York prosecutor and now a legal scholar teaching at West Point, and Karrin Vasby Anderson, a political communication expert at Colorado State University, to find out what overarching themes they have observed, both in the courtroom and outside it.

Is this trial proceeding normally?

Bakken: It seems like an ordinary trial, but it is an extraordinary trial underneath if we really look at some of the details. The first thing that struck me was on Day 1, when Judge Juan Merchan questioned 96 jurors. Fifty of them said they could not be fair to Trump. On Day 3, 48 of that day’s 96 said the same thing.

That does not bode well for a defendant in a jurisdiction where Democrats outnumber Republicans 9 to 1.

In addition, the judge did not make an accommodation to alleviate the possible difficulty that such antagonism represents. If 50 out of 96 people raised their hands and said they couldn’t be fair because of the color of the defendant’s skin, that would signal a problem. In a trial, that problem is addressed through allowing the defense to ask more questions of the jurors and to get more peremptory challenges, which allows them to dismiss a juror without having to explain why.

There are 10 already allotted because this is a low-level felony trial. In other cases in New York, you would have 20, such as a murder case. And the judge has the discretion to increase that number. He could have done that in this case, but he didn’t.

An artist's rendering of a courtroom scene.
A courtroom sketch depicts Judge Juan Merchan, Donald Trump, prospective jurors and other court and legal personnel.
Christine Cornell via AP Pool

How fast is the judge moving?

Bakken: Merchan has told Trump he may not be able to attend his child’s high school graduation, scheduled for May 17. That indicates that the judge is moving apace.

But in many cases in New York – on Fridays, for example, when a defendant or defense lawyer or prosecutor is Muslim or Jewish – some or all of the entire day will be taken off by the judge. There won’t be any trial.

I think the judge will let Trump attend the high school graduation, because otherwise he might seem to treat Trump a little bit differently than other defendants.

What is most important for the public to understand so far?

Anderson: I think it’s important for the casual observer, who might wonder whether being on trial for a felony was hurting Trump’s presidential campaign, to understand that he’s strategically using the trial to his advantage.

Voters following the trial in the mainstream media are hearing from experts that the legal proceedings are progressing relatively normally and the system is standing up under the unprecedented circumstances of this case.

But in the conservative media sphere, Trump is using the trial as a campaign strategy pretty effectively, stoking his base’s fears and quoting pundits and hosts from Fox News, Newsmax and OAN who echo his framing of the trial.

Trump has said the requirement to be in the courtroom every day is harming his ability to campaign. The Guardian reported, however, that while he is in court, his “Truth Social page is putting up new posts minute by minute.”

If you look at those posts, you see a series of complaints about the case interspersed with pro-Trump campaign messaging and posts telling voters to be afraid of what he says is rampant crime under Joe Biden’s tenure as president.

Individually, the campaign posts are consistent with Trump’s usual messaging. But when Trump layers messages about crime with others about an allegedly corrupt justice system, the goal is to not only intensify voters’ fears but also tell voters they should be afraid because powerful people are coming for him and are going to come after regular people next.

Trump is also charging that the process of his trial is undermining democracy. He posted a video in which his close adviser Stephen Miller urged, “So when you hear them say that democracy is on trial, they’re right. Democracy is on trial. Freedom is on trial. The rule of law is on trial. … If Donald Trump is convicted then all of these principles are convicted and destroyed with him.”

This sets up a catch-22. If Trump is not convicted, he gets to say he was exonerated. If he is convicted, then he just pivots to this charge that a normally operating courtroom is what’s undermining justice and democracy – not his actions or the actions of his campaign.

If Trump was just posting on his social media account, it wouldn’t be nearly as powerful. But Fox News, OAN and Newsmax are really functioning as his campaign surrogates. Since much of the country is paying attention to that media space, that’s a really consequential campaign strategy. It’s savvy of him to use the court proceedings in this way.

A man walks out a door that is guarded by a police officer.
Donald Trump walks outside during a break in trial proceedings.
Mark Peterson/Pool Photo via AP

Is any of what Trump is saying a fair criticism or statement?

Bakken: The New York district attorney decided to prosecute Trump in this case. He didn’t have to. It seems unquestionable that Trump filed or made false business documents. That’s a misdemeanor. And in this instance, the misdemeanor statute of limitations had run out by the time the district attorney issued the charges. But the prosecutor chose to say the actions were related to another crime, which makes them felonies.

Anderson: The charges also have context. Maybe no other businessperson would be prosecuted for this filing of paperwork. But that’s only half of the problem. Donald Trump would not be in trouble for filing this paperwork if he hadn’t done it to allegedly illegally influence an election.

I think that’s actually why Trump is so aggressively pushing his narrative of “election interference.” He knows that the charges against him are really about breaking campaign finance laws and his conduct in an election more than a particular business filing.

Bakken: In the last week or so, it came out that Merchan had contributed to Democratic candidates, including President Biden, in the past. It was reportedly a total of US$35, which seems very minimal. But one of New York’s legal ethics leaders, Stephen Gillers, a professor at New York University, said it is a judicial ethics violation, though he said it would likely only merit a warning and not removal from the case.

What does the trial mean so far in terms of politics or the 2024 presidential election?

Anderson: I think the media has to report on the facts on all sides of this trial. But I worry that it may not actually be as consequential as maybe people who are following it think that it will be, because many undecided voters have opted out of political news altogether.

Bakken: The trial emphasizes an extraordinary level of political antagonism between the parties, and also an extraordinary reluctance of people who are not inclined toward party politics to tune out and protect themselves.

The people who are tuning out might not be strong advocates, politically, for one side or the other but the people who would be neutral if they collected all the information. They could be the moderators, the good-faith, middle-minded people who can help bridge the gap between the political combatants.

The Conversation

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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South Korean President Yoon Faces Foreign Policy Challenges After The National Assembly Election

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South Korea’s pesident faces political woes. Kim Hong-Ji/AFP via Getty Images

South Korea’s parliamentary election of April 10, 2024, was widely seen as a referendum on President Yoon Suk Yeol’s first two years in office.

That being the case, the nation collectively expressed its strong disapproval.

With a relatively high turnout of 67%, voters handed Yoon’s conservative People’s Power Party defeat, with its share of the 300-seat National Assembly dropping from 114 to 108.

The opposition Democratic Party retained its large majority in the National Assembly, winning 175 seats and maintaining control in the populous metropolitan areas of Seoul, Incheon and Gyeonggi provinces. Voters also delivered a disappointing outcome for most third-party candidates, the exceptions being the Rebuilding Korea Party, which campaigned as more combative opposition to the DP, and the New Reform Party, which broke away from the ruling PPP earlier this year.

As a political scientist with a focus on East Asia and international affairs, I believe the election results will have ramifications on Yoon’s foreign and domestic agenda during the remainder of his term.

Growing domestic pressure

Yoon had hoped the election would end the political gridlock that has stymied his first two years as president.

Throughout that time, the opposition has held a legislative majority. Subsequently, Yoon’s government has seen key parts of its agenda for education, labor and pension reforms blocked. Yoon has also vetoed multiple bills passed by the opposition-controlled legislature.

But the election saw the DP and other opposition parties amass 192 seats, just short of a veto-proof, two-thirds majority. As such, President Yoon again faces a divided government for the remainder of his term. In fact, he will be the only South Korean president whose party has failed to control the National Assembly at any time during the five-year presidential term.

A better parliamentary outcome for Yoon’s party would have bolstered the chances for the government’s legislative agenda on pressing domestic issues, such as addressing the country’s declining birthrate, high inflation and expanding medical student enrollment, as well as relaxing business regulations.

Instead, the Yoon government is more likely to be on the defensive after the election. Opposition parties have vowed to investigate alleged stock manipulation involving first lady Kim Keon Hee and probe former Defense Minister Lee Jong-sup over claims that he influenced an earlier report into the drowning death of a Korean marine.

Though Yoon retains veto power, there is now growing uncertainty over whether ruling PPP assembly members will continue defending the president’s actions if and when the two probes move forward.

Meanwhile, President Yoon’s prime minister, Han Duck-soo, announced his resignation after the assembly election. The National Assembly can vote against the president’s nominee to replace him, which may compel Yoon to pick a candidate acceptable to the opposition parties.

A trickier foreign policy climate

Under South Korea’s political system, the presidency has greater leeway in national security and foreign affairs than in domestic policy.

As such, the Yoon government will likely continue its foreign policy of expanding trilateral partnerships with the U.S. and Japan, building ties with NATO and striving to be a “global pivotal” state in the Asia-Pacific region.

During his first two years in power, Yoon has generally aligned South Korea closer to the West, though he has also been careful to avoid direct confrontation with China and Russia – both of which are geographic neighbors and trade partners.

While the opposition-controlled National Assembly has, to date, been generally supportive of the Yoon government’s attempts to strengthen ties with the U.S. – a policy that remains popular among the South Korean public – the same cannot be said about its attempts to bolster relations with Japan.

In particular, the Democratic Party and the Rebuilding Korea Party have criticized the prospect of a closer partnership with Japan – whether through military exercises or intelligence sharing – mainly due to Korea’s experiences under Japanese colonial rule.

And despite being generally welcoming of ties with the West, the two opposition parties are more cautious than the Yoon government when it comes to engaging in geopolitical rivalry. Specifically, Democratic Party leader Lee Jae-myung warned during the recent election campaign that South Korea should not become involved in the Russia-Ukraine war or China-Taiwan tensions.

The opposition might not directly stop Yoon from pursuing his foreign policy, but they are likely to pressure the president to pay attention to domestic political issues.

Moreover, opposition parties will be pushing the Yoon government to demonstrate what diplomatic “wins” the country has secured through its partnership with Japan and the United States. Notably, if the point of strategic partnership with the United States and Japan is to ensure security in East Asia, some voters may legitimately ask why it has failed to deter North Korea’s continued military provocations.

If the Yoon government cannot demonstrate diplomatic successes, opposition parties are likely to frame his foreign policy as one-sided “subservient diplomacy.”

Yoon has three years to show that his foreign policy has paid dividends; South Korea’s next presidential election is in the spring of 2027.

How successfully the president can navigate the domestic and international constraints exacerbated by the results of the parliamentary election could determine whether he exceeds the political expectations of a president facing a divided government or encounter, as some predict, an early “lame-duck presidency.”

The Conversation

Jong Eun Lee does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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