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Examining the American Medical Association’s racist history and its overdue reckoning

The national calls to action over racial justice have brought new awareness of past injustices in many parts of our society, including the fields of science and medicine. Yamiche Alcindor speaks to Dr. Aletha Maybank, the American Medical Association's chief health equity officer, about the organization's racist history, how it plans to reckon with it, and the intersection of race and medicine.

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  • Amna Nawaz:

    The national calls to action and protests over racial justice have brought new awareness of past injustices in many parts of our society.

    That's true in the fields of science and medicine, which are starting to look more carefully at their own history.

    Yamiche Alcindor focuses tonight on some of these developments, part of our continuing series on Race Matters.

  • Yamiche Alcindor:

    The American Medical Association is one of the country's oldest, largest and best known associations of doctors. Its voice has long been influential.

    But now the AMA is finally beginning to come to terms with racism in its own past. It recently issued an 83-page report that found that the organization is — quote — "rooted in white patriarchy and affluent supremacy." The report outlines a number of examples, including the group's past support of excluding physicians of color.

    And it notes that, in the 19th century, a president of the group once practiced vaginal surgeries on enslaved Black women without anesthesia. The AMA is vowing to take action on racial justice and health equity.

    Dr. Aletha Maybank is the AMA's chief health equity officer. She started work on the report two years ago.

    Thank you so much for joining us, Dr. Maybank.

    I want to start by saying ,you did work on this report. Tell me a little bit about what was most troubling to you when you look at what was uncovered and what the report says?

  • Dr. Aletha Maybank:

    You know, when you start to dig into the history, you're not sure what you're going to find.

    And most of the history and some of the points you have already mentioned, many of us knew, or at least those who are connected to this work had an understanding of the exclusion of Black physicians, and the consequences of shutting down five of the seven Black med schools and all the women med schools, which has a direct connection on the lack of diversity today.

    So, to uncover that — and I don't feel we actually have done it to its fullness yet. This was just really more so kind of a more of a taste for us to get to that point and start demonstrating the importance of naming the harms and being an example to start doing that.

  • Yamiche Alcindor:

    And, Dr. Maybank, there's J. Marion Sims, he practiced surgery on enslaved Black women.

    Talk to me about the harm that was done then, but also the continuing harm, the consequences of that in present day.

  • Aletha Maybank:

    As you mentioned, he did slaves — without anesthesia on enslaved women.

    And so it's a representation of how bodies literally were used, were experimented upon, were not valued, without any consent, and how that still even translates to some level until today.

    And so the reality is, is that women's bodies, Black women's bodies, bodies of other people of color and those who have been historically marginalized are still not fully valued. And that's really what our data and evidence is really showing up.

    If we look at the COVID-19 pandemic, the data is really telling us that we're not valuing all lives the same way. Everybody doesn't have the power or the resources or the conditions in order to achieve optimal health. And that still is pervasive through our health care and our medical system.

    And so we really wanted to make sure that we were very explicit about that in this report, that we didn't tiptoe around the edges, as I kind of say, sometimes do soft equity work. But we really named the root causes of oppression in this country, and really even speaking to and starting to name the impacts of colonization, as well as capitalism, as just an introduction.

    And, as you can imagine, many of these terms are not — are new to the people in the health care profession and make people very uncomfortable. And so we're trying to find ways to bring folks along, while, at the same time, being very direct and instructive that this is where we really need to go if we really, really are committed to advancing equity and really committed to racial justice work in health care.

  • Yamiche Alcindor:

    There's also this idea that there were physicians of color that were excluded. There was also the closing of those medical schools catering specifically to Black people and women.

    How is that showing up in present-day diversity issues in medicine?

  • Aletha Maybank:

    There's just a tremendous still lack of diversity, of having Black physicians and Latinx physicians, as well as Native American physicians, who have been completely excluded still from the medical profession.

    We're the ones, as AMA, who commissioned Abraham Flexner. We valued this model of significant scientific rigor and really evaluated schools across the country in the early 1900s and said, if you didn't have that, if you didn't have those types of resources, we didn't think you were a good enough school to stay open, basically.

    And so that impacted, as you can imagine, many Black med schools that aren't going to be resourced. And so five were recommended to shut down. And, in addition, the part that really — I think really speaks to the impact at that time, AMA was also excluding Black physicians.

    And so, back then, in order to get licensed to hospitals, you actually had to be a member of the®MD-IN¯ medical society within your local community, which was an AMA, or American Medical Association, affiliate. So, if you couldn't gain membership to an AMA medical affiliate, you couldn't gain a license to work at the local hospital.

    So, now you have Black physicians who also can't find hospitals to work at, which impacts in our communities. We have to take a look at that entirety of the history and its impacts.

  • Yamiche Alcindor:

    There are some who look at this report and say it lacks teeth, timelines and targets.

    What, concretely, does the AMA plan to do, given now the history that is known?

  • Aletha Maybank:

    When people say it lacks teeth and targets — and, clearly, I'm very close to it. And we have spent a lot of time. We have spent over a year-and-a-half working together to pull this report together.

    And when you look at health care and how far they have not gone as it relates to talking about equity and injustice and using terms such as racism and white supremacy and capitalism, you don't see that in health care.

    And so we really, again, wanted to make sure that this report did go far enough, but we're going to need to have many types of partners in order to help propel this forward. And then, more importantly, I think most importantly is the accountability piece.

    And I think that's the part where I do accept definitely criticism or just push at any institution, especially an institution that is historically known to embody discrimination and racism and perpetuate institutional structural racism, hold us accountable.

    So, I absolutely call upon others in the health care community to do that, but not only the health care community, all the folks who are impacted by the decisions that we make and contribute to and influence at the policy and advocacy level, but also at the system level of health care.

  • Yamiche Alcindor:

    Well, a critical conversation about equity and health care.

    Thank you so much for joining us, Dr. Aletha Maybank.

  • Aletha Maybank:

    Thank you.

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