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HomeHealth LawCitational Racism: How Main Medical Journals Reproduce Segregation in American Medical Data

Citational Racism: How Main Medical Journals Reproduce Segregation in American Medical Data


By Gwendolynne Reid, Cherice Escobar Jones, and Mya Poe

Biases in scholarly citations towards students of coloration promote racial inequality, stifle mental evaluation, and might hurt sufferers and communities.

Whereas the dearth of citations to students of coloration in medical journals could also be as a consequence of carelessness, ignorance, or structural impediments, in some circumstances it is because of reckless neglect.

Our examine demonstrates that the American Medical Affiliation (AMA) has failed to advertise higher racial inclusion in its flagship publication, the Journal of the American Medical Affiliation (JAMA), regardless of an specific pledge to take action.

A “peculiar duplication”

The AMA’s pledge is greatest understood within the context of the group’s historical past of racism. And this historical past is intertwined with that of a lesser-known skilled medical affiliation, the Nationwide Medical Affiliation (NMA).

After its founding in 1847, the AMA notably sidestepped the difficulty of integration by making membership for Black physicians contingent on state medical society membership.

Like different compromises in American historical past which have elevated state rights to protect federal unity, this compromise allowed states that enforced racial segregation—primarily Southern states, the place most Black individuals lived on the time—to exclude Black physicians from the AMA.

After many years of exclusion, Black physicians based the Nationwide Medical Affiliation (NMA) in Atlanta, Georgia in 1895. The ensuing “peculiar duplication” {of professional} organizations created “unity via exclusion.”

Working inside this racially exclusionary system, the NMA devoted itself to the well being of Black People and the skilled wants of the Black physicians serving Black sufferers, a mission that continues in the present day. And for greater than 100 years, the peer-reviewed Journal of the Nationwide Medical Affiliation (JNMA), has devoted itself to analysis “tackle[ing] medical care disparities of individuals of African descent.”

A partial reckoning

In 2005, the AMA Institute for Ethics, in collaboration with each AMA and NMA leaders, convened a panel of consultants to look at the origins of the racial divide in American medication.

One end result of this work was the 2008 apology by Ronald Davis, the AMA’s fast previous president, for the AMA’s historical past of racial exclusion on the NMA’s annual assembly in Atlanta. In his tackle, Davis pledged the AMA to doing “every little thing in our energy to proper the wrongs that have been carried out by our group to African-American physicians and their households and their sufferers,” happening to precise hope “that we will proceed down a path towards stronger and stronger collaboration and partnership.”

The AMA apology and dedication to collaborate with the NMA, together with its latest progress on addressing racism in its publication course of, are promising steps in the direction of addressing the racial bias baked into medical analysis and the evidence-based requirements of care constructed on that analysis. So are the barely growing variety of analysis research printed in worldwide “gatekeeper” medical journals like JAMA that explicitly tackle the position of racism in well being. A spot to this point missed in these measures and analyses, nonetheless, is the position of quotation in together with or excluding medical information produced by Black physicians and researchers.

Research of quotation underscore that citations serve advanced functions in information manufacturing, together with reward, affiliation, proof, assist, and group constructing. Those that are not cited are remoted and their work can’t attain the standing of accepted scientific knowledge: they can not contribute to the collective work of the scientific group. Such citational racism is a type of epistemological racism that compromises the validity of the information produced by the scientific group and can hinder innovation.

Together with Black scientists on medical analysis groups and together with their work in worldwide gatekeeper medical journals, then, is about greater than skilled inclusivity. It is a crucial ingredient in the direction of decreasing bias in medical information and the racial inequities in well being care this bias helps produce.

What we did

As a primary step in the direction of addressing citational racism, we traced the citational relationships between the AMA’s and NMA’s flagship journals — JAMA and JNMA — specializing in their opinion items as helpful indicators of present and future analysis in addition to priorities and agendas. We chosen opinion items exactly as a result of these are agenda setting and since we anticipated that JAMA editors may draw on insights from JNMA editors subsequent to the AMA’s 2008 apology and because the just lately renewed racial justice motion.

We performed a literature search within the SCOPUS database for articles labeled “editorials” in JAMA and JNMA since January 1, 2008. The articles with the “editorial” label in SCOPUS included editorials, opinion items, and JAMA Viewpoints.

Earlier than conducting a quotation evaluation, we cleaned the ensuing two datasets exported from SCOPUS utilizing Microsoft Excel and two customized JavaScript scripts run by way of Node. Particularly, this course of corrected variant spellings of choose journals that may end in inaccurate counts of quotation.

We then used VOSViewer to research the 2 cleaned datasets, which collectively totaled 1,542 articles, for journal quotation frequency and reciprocity, which allowed us to establish which journals JAMA and JNMA opinion articles cite most ceaselessly, and the way usually the 2 journals’ opinion items cite one another. VOSViewer’s quotation counts by publication supply supplied the quotation frequency figures employed under.

As a closing step, we exported the listed key phrases for all of the opinion items from JNMA and JAMA from 2008 to 2021. We searched the key phrase index for the next phrases–race, racism, justice, and white supremacy–which replicate the presence of racial justice discourse in our pattern. This search allowed us to see how ceaselessly such matters have been addressed within the opinion items.

What we discovered

Between 2008 and 2021, JNMA printed 117 opinion items, and JAMA printed 1,425 opinion items. After we analyzed the highest citations from every journal, we discovered that self-citation was widespread in each journals, with 8% (JNMA) and 16% (JAMA) of self-citation respectively. As a result of opinion items usually tackle the content material of the present journal challenge, we weren’t stunned that self-citation was the commonest quotation in JNMA and JAMA (Determine 1).

Wanting on the different most commonly-cited sources from 2008 to 2021, we discovered that each journals referenced high-impact scientific publications, equivalent to NEJM, the Lancet, and Most cancers. However after we appeared extra intently on the citational relationship between JNMA and JAMA, we found a sample of citational exclusion. Notably, whereas JNMA opinion items from 2008 to 2021 cited JAMA 21 occasions (2.8% of JNMA opinion items), JAMA opinion items cited JNMA solely twice throughout that very same time interval (.01% of JAMA opinion items). In different phrases, in additional than a decade because the AMA apology, JAMA opinion authors have solely cited two articles from JNMAone article on initiatives at U.S. medical faculties to recruit underrepresented minorities and a second article on the affect of direct-to-consumer commercials on African American sufferers.[1]

Figure 1: Most frequently cited sources in JNMA and JAMA, 2008-2021.

Figure 1: Most frequently cited sources in JNMA and JAMA, 2008-2021

Determine 1: Most ceaselessly cited sources in JNMA and JAMA, 2008-2021

After we examined using the important thing phrases race, racism, inequity, and white supremacy in JNMA and JAMA opinion items indexing, we discovered that, since 2008, each journals have printed opinion items that use many of those phrases as indexing key phrases (Determine 2), although JAMA authors wrote about race and racism at a considerably decrease charge than JNMA authors.

Figure 2: Focal Index Keywords, JNMA and JAMA, 2008-2021.

Determine 2: Focal Index Key phrases, JNMA and JAMA, 2008-2021

An unmet promise

Our outcomes are clear: regardless of the American Medical Affiliation’s promise of higher inclusion in its 2008 apology to the Nationwide Medical Affiliation and public declarations since, the AMA’s flagship journal has but to replicate that promise in its citational practices. For greater than 13 years because the 2008 apology, JAMA authors have continued to largely ignore contributions of JNMA researchers of their opinion items.

Our outcomes are usually not encouraging and underscore the necessity for extra intentional and specific consideration to quotation as a way to deal with racial bias in medical information.

Notably, our evaluation reveals that JAMA authors not often cite publications from JNMA, even when writing about problems with racial injustice in well being care, a topic well-suited for the flagship American medical journal on Black well being. Even when writing about problems with racism in well being care, a topic JNMA has explored extensively, JAMA authors not often cite publications from JNMA. This citational exclusion implies that over a century of analysis on the well being and well-being of African People, usually at intersections of care, disparities, and racism, are omitted from JAMA, one of many highest affect publications within the medical occupation (affect issue: 56.27). Because of this, this data turns into systemically segregated and ghettoized, decreasing its capacity to affect ongoing medical analysis and enhance care. In different phrases, epistemological racism has actual implications for the sufferers and communities that information serves.

A path ahead

As a result of citational practices are influenced by each people and programs, dismantling citational racism requires a multi-pronged method. As particular person authors, we might be intentional to keep away from perpetuating racist citational programs. And journals can put processes in place to assist editors in evaluating the sources authors draw upon to make their scientific claims. JAMA, specifically, as a consequence of its distinctive position within the segregation of medication in America and within the NMA’s genesis, ought to play a management position in mitigating the hurt it has created and in citing analysis printed in JNMA.

However citational inclusion isn’t merely referencing the work of Black researchers inside analysis research; “variety should exceed mere tokenism.” Addressing citational racism means addressing each the place and the way Black researchers are cited, in addition to understanding the circulate of data between journals like JAMA and JNMA.

And mitigating citational racism goes past particular person authors and editors, as particular person selections are constructed on technical programs researchers use to analysis and write. Technical programs like affect elements and algorithms, for instance, reify many years of epistemic erasure, making it straightforward to search out highly-cited sources from gatekeeper journals whereas burying sources from lesser identified journals like JNMA which were remoted over time.

Impression elements, for instance, render invisible the racism that has formed that affect. Penning this paper, we witnessed this erasure as we struggled to search out papers printed in JNMA amid the overwhelming search outcomes for gatekeeper journals. We additionally found that JNMA was not included in the usual Elsevier ScienceDirect bundle, proscribing our entry to full texts from points after the 2007 archive created by the Nationwide Library of Medication. Reshaping how well being science discourse values publications like JNMA would require deliberate, collaborative efforts throughout programs and establishments like libraries, databases, engines like google, scientific publishers, and different stakeholders.

JNMA has devoted itself to the well being and well-being of Black individuals for greater than a century. Contributions from journals like JNMA must be entrance and middle in scientific conversations about Black information contributions and Black well being. Whether or not oversights born of naive, unexamined habits or deliberate citational ostracism, exclusionary practices and the technical programs that assist and reinforce citational racism can do actual hurt to actual sufferers and communities.

Black Lives Matter, and Black information manufacturing issues, too.

[1] JAMA opinion items did cite the 2017 American Faculty of Cardiology/American Coronary heart Affiliation joint report on pointers concerning the prevention, detection, analysis, and administration of hypertension in adults on 5 events. That report was co-signed by 11 skilled organizations together with the AMA and the NMA.

Gwendolynne Reid is Director of the Writing Program and Assistant Professor of English at Oxford Faculty of Emory College.

Cherice Escobar Jones is a PhD pupil at Northeastern College learning rhetorics of race on the intersection of language, writing, and well being.

Mya Poe is an affiliate professor of English at Northeastern College.

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